P0684 - Legal Relief for Children in Immigrant Families

Background: Immigration status is a known social determinant of health that can negatively impact the physical and emotional well-being, stability and self-actualization of families. Research shows that securing legal representation increases the likelihood of being released from detention, appearing in court, winning removal cases, and seeking relief from deportation. However, there is little research on how to address immigration status in a clinical setting given funding restrictions of medical-legal partnerships. The goal of this study was to better understand how a clinical-community partnership can effectively address immigration concerns through referral for legal services.

Acknowledgments: Funding for legal consultations was generously provided by FaithHealth.

Methods: We introduced a novel immigration legal needs screening tool and referral to a local immigration law firm in January 2018. Grant funding was obtained to provide a free immigration legal consultation. We conducted a retrospective study of children from families who screened positive for immigration legal concerns between March 2018 to January 2020. We extracted data from the electronic medical record for pediatric visits to a primary care clinic serving 13,450 patients primarily with Medicaid (>90%). We reviewed and compared records for patients who were screened and referred to immigration legal services. We conducted semi-structured interviews of 19 families who were referred for legal services, which are ongoing.

Results: Nineteen families screened positive for immigration legal concerns and were referred to legal services. The majority of patients were male (74%) with a mean age of 8 years, while the parents were mothers (84%), with a mean age of 37 years, and Hispanic (95%) (Table 1). The most common legal concerns were persecution/mistreatment (58%) and fear of returning to their home country (58%) (Table 2). Of the 19 families referred to legal services, 12 underwent the free immigration legal consultation. Semi-structured interviews are ongoing (complete results will be available by October 2020). Sample quotes from the screening process indicate fear and persecution: “I was arrested for protesting against the Cuban government, and my son suffered maltreatment for [his medical condition];” “We witnessed gangs kill neighbors for not meeting monthly quotas, and then they threatened my family;” and, “I was raped in Mexico during my journey to the United States.”

Discussion: We found that the majority of immigrant families reported persecution and fear of returning to their own country. Immigrant families face many barriers in accessing legal services, including lack of access or knowledge. This pilot intervention demonstrates the need for immigration-related services in primary care settings that serve immigrant patients and the feasibility of implementing a novel screening tool and community-based medical-legal partnership with an immigration law firm.