Integrating Refugee Services and Primary Health Care to Improve Disease Treatment and Prevention

With a total of over 36,000 refugees, asylees and victims of trafficking residing within Colorado, there is an urgent need to improve the quality of medical care this vulnerable population receives. Additionally, the total numbers of these individuals are steadily increasing; projected numbers for 2009-10 are 2800 new residents in Colorado, approximately 20% greater than the previous year. The refugees' resettlement funding ceases after 90 days, with the presumption that they are capable of navigating the medical infrastructure and accessing health care services by that time. This is a far cry from reality. There is a promising trend among some clinics in Colorado to offer not only the service of refugee screenings but also to provide a medical home for those same populations. Once the refugee has been screened, the wealth of data regarding his or her medical, social, and mental health history is retained within the medical record and made an active part of his or her subsequent health care. Primary care providers have comprehensive documentation of pre-arrival conditions and can provide enhanced continuing care. Additionally, these populations suffer from stressors and illnesses unique to displaced person surviving in often dire circumstances. These clinics already have well-established networks of community representatives and translators to improve quality of care. We will present a successful program that has integrated physical and mental health services, utilizes culturally competent providers and navigators, while emphasizing a socio-ecological framework for addressing social determinants.