Approximately 3,000–5,000 refugees per year have resettled in New York State, the majority in the upstate region. Although refugees come from different parts of the world, many experience similar challenges as they seek adequate medical care in their new communities. These challenges are often exacerbated by their exposure to torture, terrorism, poverty, and lengthy stays in refugee camps, as well as cultural shock and language barriers. In the last decade, upstate New York has been home to health care clinics that have either shut their doors to new refugee patients or have closed down altogether because of the financial burden of treating these patients.

Mr. Sutton’s and Ms. Kefi’s organizations have both found ways to overcome these challenges: Rochester General Hospital (RGH) devised a financially sustainable refugee health care model, and JFS developed the Western New York Center for Survivors of Torture, the first of its kind in upstate New York, to provide rehabilitative treatment for refugee torture victims.

Ms. Kefi explained the intensive process necessary for refugees and asylum seekers to enter the United States, along with the challenges they face adjusting to life in a new country. She described the serious physical and mental health issues faced by refugees, many of whom have languished in refugee camps under difficult circumstances for years while awaiting resettlement. In response, JFS’ refugee resettlement program has moved toward a care coordination model that provides comprehensive services for newly arrived refugees during and after the resettlement period. Services include parenting support, senior programs, refugee disability programs, and referrals to primary care and mental health providers. With NYHealth support, JFS also opened the Western New York Center for Survivors of Torture to address the complex medical, psychological, immigration, legal, and social service needs of refugee torture survivors.

Mr. Sutton gave an overview of the refugee health care crisis upstate New York faced in the last decade, as health care clinics could no longer cope with the growing number of newly arrived refugees. He outlined RGH’s efforts, with NYHealth support, to assess the problem and find a solution, culminating with RGH’s development of a sustainable model to provide primary care services to refugees. The model shifts the health assessments mandated for refugees in the first 90 days of arrival to agencies that already deliver primary care or that are partnered with providers that can link refugees to preventive care. These providers are then able to retain the federal reimbursement funds provided for these assessments, which helps to support the ongoing provision of primary care for refugees. The model also streamlines the Medicaid recertification process for refugees, allowing for continuous coverage of all eligible refugees and for primary care clinics to receive full reimbursement for services provided.

Along with the successes, Ms. Kefi and Mr. Sutton described the challenges in developing their programs. Ms. Kefi noted a lack of mental health providers and issues of health literacy for refugees. Mr. Sutton expressed that many clinics are not as receptive to collaboration or alternative models of care delivery for refugees until a financial crisis hits. “In order to adopt this model, you have to be in a place where you’re ready to try to make this work,” said Mr. Sutton. Some communities have difficulties with changing demographics, so JFS holds community consultations with schools, community members, and providers to educate residents and receive feedback on how they perceive the community’s capacity to absorb refugees.

With these challenges in mind, both speakers emphasized the need for cultural competency within the field. “I look for individuals who feel comfortable working within other cultures,” said Mr. Sutton. Curriculum for cultural competency training and events like the North American Refugee Health Conference, developed by RGH, help providers learn best practices and develop better skills for treating refugee patients. “Cultural competency is a lifelong goal,” said Ms. Kefi.

Both speakers ended the panel on an optimistic note, highlighting the progress that has been made over the years on refugee health issues. “Ten years ago, there were no mental health counselors or bilingual providers—we’ve come so far and are really in a better place,” said Ms. Kefi. “There’s a lot more dialogue taking place.” As more communities open up to newly arrived refugees, RGH and JFS are setting examples for future models of quality health care delivery for refugees.

Learn more about the refugee resettlement process in the United States. View a chart on how refugees get to the United States.


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