Medical-Legal Strategies to Improve Immigrant Child Health

1. Medical-Legal Strategies to Improve Immigrant Child Health June 2012 • Welcome from Gonzalo Paz-SoldanMD • AAP Immigrant Health Special Interest Group • Today’s Webinar

2. Webinar Presenters • Valerie Zolezzi-Wyndham, Esq. Community Legal Aid, Worcester MA • David Keller, MD UMass Medical School, Worcester MA

3. Information contained in this presentation is for educational purposes only and does not constitute legal advice.

4. Current Conceptual Framework Guiding Early Childhood Policy and Practice Significant Adversity Healthy Developmental Trajectory Impaired Health and Development Supportive Relationships, Stimulating Experiences, and Health-Promoting Environments From J Shonkoff, Center on the Developing Child, Harvard University

5. Building an Enhanced Theory of Change that Balances Enrichment and Protection New Protective Interventions Significant Adversity Healthy Developmental Trajectory Supportive Relationships, Stimulating Experiences, and Health-Promoting Environments From J Shonkoff, Center on the Developing Child, Harvard University

6. Origins of Medical-Legal Partnership “The social determinants of health are the conditions in which people are born, grow, live, work and age…These circumstances are shaped by the distribution of money, power and resources… The social determinants of health are mostly responsible for health inequities.” World Health Organization

7. Family Advocates of Central Massachusetts • A partnership of Community Legal Aid with UMass Memorial Children’s Medical Center, Tri-River Family Health Center, and Edward M. Kennedy Community Health Center. • Mission: to improve family health through strong, coordinated, collaborative advocacy by medical providers and lawyers.

8. Why Immigration Status matters? Dignity If status can be obtained – there is no need to hide Children face less stress without fearing parents will be arrested and/or deported Security Ability to work legally to provide for children Access to benefits, such as health insurance

9. Why medical providers should understand immigration issues: • Immigration Status impacts families’ medical decisions • Immigration Status impacts families’ access to public benefits • Misinformation in the immigrant community is a major problem

10. How do medical providers fit in to the immigration equation? Doctors are often the first people to know about domestic violence, child abuse and other crime-related injuries Knowing how to recognize potential immigration issues will make you a better “whole patient” advocate Medical professionals are instrumental in helping document abuse

11. Screening for Immigration Concerns • Listen: • Fear around Immigration status • Violence in the house • Fear of accessing benefits and health care despite having citizen children • Protective Services involvement

12. Lets talk about Mary • Mary is a 10 y/o, presenting for a school PE in September • Mom seems distant, nervous. • Hx domestic violence • Mom is undocumented.

13. Federal Immigration Agencies DHS (Department of Homeland Security) USCIS (U.S. Citizenship and Immigration Services) • f/k/a BCIS (Bureau of Citizenship and Imm. Services) • f/k/a INS (Immigration and Naturalization Service) ICE (Immigration and Customs Enforcement) U.S. Department of Justice (DOJ) • Executive Office of Immigration Review (EOIR) • (BIA) Board of Immigration Appeals • Immigration Court

14. Types of Immigration Status U.S. Citizen (born or naturalized) Legal Permanent Resident - “green card” (LPR) Asylee/ Refugee Parolee Temporary Protected Status Student Visa Visitor Visa Undocumented PRUCOL (Definition relevant to public benefits)

15. What does it mean to be“undocumented”? Overstay • Entered with a visa, but stayed longer than permitted time • Verify by date on I-94 Entered Without Inspection • Crossed border • Not inspected by customs • No lawful permission to be in the U.S. • Very few options for lawful status

16. How can a person obtain Legal Permanent Resident Status in the U.S.? • Option 1: • Family/Spousal Sponsorship • Employer Sponsorship • Asylum / Refugee status • Diversity Visa Lottery • Domestic Violence-based remedies

17. How can a person obtain LPR status in the U.S.? • Option 2: Violence against Women Act • VAWA Self-Petition Abused spouse or child of citizen or LPR can apply for LPR status • Good-faith marriage • Battered or subjected to extreme cruelty • Joint Residence with abuser (here or abroad) • Residence in U.S. • Good moral character (last 3 years) • VAWA cancellation – for people in immigration court proceedings

18. How do people get legal status? Option 3: “U” Visa Available immigrant victims of certain crimes who are helpful to law enforcement in either investigation or prosecution of the crime assault, kidnapping, rape, domestic violence, incest Or “ any similar activity in violation of federal, state or local criminal law” Good option for abuse victim who is ineligible for VAWA because is unmarried, or because abuser is not a citizen or LPR

19. Letsreturn to Mary Referred to Medical-Legal Partnership Attorney met with family Screened for VAWA immigration relief for battered spouses of US citizen or LPR. Screened for family law assistance - custody and divorce Case moving forward so that mom can work and provide for Mary.

20. Why legal partners need your help? Documenting Substantial Physical or Mental Abuse Nature of injury inflicted Severity of perpetrator’s conduct Severity/ duration of harm Pattern of abuse by perpetrator against victim Existence of permanent or serious harm (physical or mental)

21. Public Charge • Lets talk about Juan. • Juan does not have insurance or Supplemental Nutritional Assistance Plan (food stamps). You ask why? He responds that he is worried about what might happen later if he accepts benefits now. • You know your patient is not getting enough to eat and could benefit from SNAP.

22. Your patient’s parent is worried about being a “public charge” • USCIS Explanation of Public Charge • For purposes of determining inadmissibility, “public charge” means an individual who is likely to become primarily dependent on the government for subsistence, as demonstrated by either the receipt of public cash assistance for income maintenance or institutionalization for long-term care at government expense.

23. Cash Benefits*USCIS can consider receipt of these benefits in making determination TAFDC/welfare SSI long-term institutional care Non-Cash Benefits *USCIS cannot consider receipt of these benefits in making determination Food Stamps Housing Subsidies Health Coverage (Medicaid, CHIP, etc.) WIC School Lunch/Breakfast Child care subsidies LIHEAP / energy assistance Head Start benefits Job training Fear of accessing programs comes from fear of “Public Charge”

24. Lets return to Juan • Juan has reported that he does not have enough money to feed his children. He has concerns about being a public charge. • What can you tell him?

25. Reporting Obligations for Medical Providers • Unless your state has specific reporting obligation, individuals, hospitals, and schools do not generally have an obligation to report individuals who do not have lawful status in the U.S. • Police have some obligations to report individuals • State agencies have some reporting obligations but they are limited. Note: Please contact local legal aid providers to learn about your local obligations.

26. Advice you can give patients Patient’s safety comes first; Seek help from a domestic violence provider/shelter Don’t be afraid to report crimes, domestic violence, or child abuse to police because of undocumented status Keep copies of all vital records, medical records, police reports or court records relating to domestic violence or other crime of which they were a victim

27. Advice you can give patients • Keep copies of all documents sent to and received from USCIS and other agencies • Send all correspondence by certified mail • Remember to submit Change of Address forms • If you are unsure of your immigration status or the progress of a particular application, do not go to your local USCIS office before consulting with an experienced advocate or lawyer; also consider a FOIA (Freedom of Information Act) request

28. Thanks! Questions?

29. For more information • National Immigration Law Center www.nilc.org • U.S. Citizenship and Immigration Services www.uscis.gov • Link to Immigration Legal Services Directory www.nilc.org/links.html The information in this presentation does not constitute legal advice.

30. MLP in 2010 225 hospitals & health centers http://www.medical-legalpartnership.org/ Number of Healthcare Sites with an MLP ___________________________ 0 1 2-4 5-9 10+

31. Contact Us AAP Immigrant Health Special Interest Group cocp@aap.org