Addressing Health and Social Needs of Immigrant Families: Lessons from Local Communities
Since taking office, the Trump Administration has implemented a range of policies to curb immigration and enhanced immigration enforcement efforts. Amid this policy and political climate, immigrant families are reporting growing fears and challenges which are affecting their and their children’s health and well-being and have implications for organizations serving immigrant families and their broader local communities. This brief presents findings from discussions with service providers across sectors (including health, legal, and education), local officials, and parents in immigrant families in the San Francisco Bay Area and San Diego about issues facing immigrant families and providers in the current environment, how the local communities have responded to growing needs, and key priorities and opportunities identified for serving immigrant communities. It is based on roundtable discussions and interviews with service providers and local officials (referred to as providers throughout this brief) and focus groups with parents in immigrant families that were conducted by the Kaiser Family Foundation in Summer 2019. It finds:
Providers and families reported that the shifting policy and political environment has substantially increased fear and uncertainty among immigrant families, leading to negative effects on families and growing pressures on local organizations and communities. They noted that families, including children, have increased mental health needs, such as anxiety and depression, and are facing growing economic pressures that are compounded by fears of accessing public programs and services. Providers expressed concerns about the long-term negative consequences of the current environment for families and the potential implications of worsened health conditions and unrealized potential among the youth for the broader community. They also pointed to growing pressures on service providers and local communities, including stress and secondary trauma among staff serving families and increased challenges providing services, particularly legal support, to families in light of ongoing and uncertain policy changes. Providers and families noted that organizations and communities have shifted some resources and efforts away from longstanding immigrant populations to address needs of new migrants, who are often in crisis and need immediate support.
“I don’t understand how they get by day-by-day. Being traumatized and re-traumatized over and over….I mean these kids are always fearful, always thinking their parents are going to be deported, constantly in trauma.” Legal Services Provider, San Diego
“The crisis today—we’re going to see the effects from it ten years from now, five years from now.” Health Provider, San Francisco Bay Area
“It’s a lot of just having to be in crisis mode and reactionary mode that is really not sustainable. Unhealthy for the people affected, unhealthy for the staff…” Community-based Organization, San Diego
Families are decreasing use of programs and services due to fears. Families and providers pointed to a range of concerns among families about using programs and services, including increased risk of deportation, potential negative impacts on ability to adjust status and/or sponsor relatives, and being required to pay back benefits. Providers indicated that the administration’s changes to public charge and housing assistance policies have amplified fears. Providers and families reported that families are disenrolling themselves and their children from Medi-Cal (the Medicaid program in California) and other programs, and declining to renew or enroll themselves or their children in programs despite being eligible.
“…they’re scared to apply for certain much needed funding whether it’s Calfresh [food assistance] or it’s Medi-Cal, to get them the health insurance.” Family Services Provider, San Francisco San Francisco Bay Area
“…what we’re seeing is a lot of women are very hesitant to now enroll in medical services…They’re getting care here in the very last stages of their pregnancy and…the health of the mom and the child are impacted.” Health Provider, San Diego
Providers described how the San Francisco Bay Area and San Diego communities have responded to growing needs among immigrant families by strengthening cross-sector relationships and enhancing services and supports. They highlighted a range of strategies including strengthening existing or developing new cross-sector relationships, expanding capacity in other sectors to provide mental health screenings and services, increasing services and supports in schools, identifying trusted individuals and organizations to communicate with and assist families, and providing support for staff in service organizations. Providers and families indicated that actions by state and local leaders and certain state and local policies have underpinned the community response.
“I do think that if it wasn’t for building this cross-sector, multi-disciplinary, multi-agency network…we wouldn’t have been able to do some of the good things that we’ve been able to do.” Legal Services Provider, San Diego
“The other component that we are working with…is really building out mental health services and supports to our schools. …how do we provide trainings to teachers to identify depression, identify anxiety and how do we react and what resources do we have in place?” Educator, San Diego
“I live in California. I can go wherever here, and I feel protected because, thank God, we have people who support us and we are a sanctuary city, and that comforts me.” Parent, San Francisco Bay Area
Looking ahead, providers identified a range of priorities, including continuing to integrate and coordinate services and filling gaps in mental health care and legal support. They suggested continuing to strengthen cross-sector partnerships so they are sustainable over time; addressing gaps in mental health and legal services by facilitating connections to existing services and increasing the supply of providers over the long-term; and providing resources to meet the increased demands on non-profit organizations and local governments. Other key priorities they identified included maintaining access to health care as people disenroll from Medi-Cal; addressing shifting demographics and growing needs in underserved areas; educating and informing families, service providers, and legislators about ongoing policy changes; increasing access to data; and developing philanthropic approaches that respond to evolving needs. Providers also pointed to the role state leaders can play in framing public discussion of immigration issues and supporting efforts to address family needs and fill service gaps moving forward.
“…the model of intervention has to be a wraparound model. It has to be a comprehensive set of services that wraps around rather than siloed service…” Family Services Provider, San Francisco Bay Area
“…funding for legal services is critical. Building up the…army of immigration attorneys. …it’s a most complex area of the law, and it’s changing by the minute.” Legal Services Provider, San Diego
“We have seen a great number of people disenrolled in programs for which they are eligible… This does translate to greater burdens on our nonprofit community and our CBOs [community-based organizations], but also on local government to cover all the gaps.” Local Official, San Francisco Bay Area
In sum, families and providers report that the shifting policy and political environment is leading to increased fears and uncertainty among immigrant families that have wide-ranging negative effects on families’ daily lives and health. The growing fears and challenges among families also are increasing pressures on service providers and local communities. The San Francisco Bay Area and San Diego communities have responded to growing family needs in many ways that center on strengthening cross-sector partnerships and relationships and enhancing services and supports for families and service providers. Looking ahead, providers view continuing to support cross-sector collaborations and addressing gaps in services, particularly mental health and legal services, as key priorities. Providers also highlighted an ongoing need for trusted information and education about policy changes for families and service providers. Providers pointed to varied ways state and local leaders and philanthropy can support efforts to address families and service organizations moving forward, and stressed that addressing these needs is key for preventing erosion of California’s progress advancing health.