Norton Sarah, Esmaili Emily, Williams Weston, Labrador Amy, Crowder Carolyn, Cholera Rushina
Duke Global Health Institute, Duke University, Durham, NC, USA.
Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
J Racial Ethn Health Disparities. 2024 Sep 30. doi: 10.1007/s40615-024-02182-y.
We developed a telephonic outreach and care coordination program for children in immigrant and refugee families (CIRF) at a federally qualified health center (FQHC) in North Carolina to address unmet health-related social needs (HRSN).
Participants were recruited between December 2020 and October 2021. Eligible children were ages 0-5, non-English speaking, and were seen at the FQHC in the 2 years prior. A bicultural/bilingual case manager completed telephonic outreach to caregivers of participants with HRSN screening. Bilingual patient navigators made follow-up calls to assess connection to resources and to develop strategies for addressing unmet needs.
Three hundred forty-two families received outreach; 212 (62.0%) completed the baseline questionnaire. The majority (N = 160, 75.5%) completed at least one follow-up. The majority (N = 186, 88.1%) were Spanish-speaking, and over two-thirds (N = 149, 70.3%) were uninsured. Most participants had between 3-5 HRSNs identified (N = 121, 57.1%); "employment" (n = 158, 74.5%) and "food" (n = 138, 65.1%) were the most common. Despite repeated assistance, the majority of participants struggled to link to a community resource for their highest priority need (N = 123, 78.3%).
Proactive phone-based HRSN screening may be a feasible and effective intervention to facilitate the identification of social needs for CIRF. The delivery of the intervention in languages other than English may have further contributed to program acceptability. Despite program feasibility and acceptability, community-level barriers to the resolution of HRSNs persist. While similar care coordination models can be considered to identify the high burden of unmet HRSN among CIRF, addressing the limited capacity of community-based resources for this population will be a critical component to ensuring the sustainability of such programs.
我们在北卡罗来纳州一家联邦合格健康中心（FQHC）为移民和难民家庭中的儿童（CIRF）制定了一项电话外展和护理协调计划，以满足未得到满足的与健康相关的社会需求（HRSN）。
2020年12月至2021年10月招募参与者。符合条件的儿童年龄在0至5岁之间，非英语使用者，且在之前两年内在FQHC就诊过。一名双文化/双语个案经理通过电话外展对有HRSN筛查需求的参与者的照顾者进行联系。双语患者导航员进行跟进电话，以评估与资源的联系，并制定解决未满足需求的策略。
342个家庭接受了外展服务；212个家庭（62.0%）完成了基线调查问卷。大多数家庭（N = 160，75.5%）完成了至少一次随访。大多数家庭（N = 186，88.1%）说西班牙语，超过三分之二（N = 149，70.3%）没有保险。大多数参与者被确定有3至5项HRSN；“就业”（n = 158，74.5%）和“食物”（n = 138，65.1%）是最常见的。尽管多次提供帮助，但大多数参与者仍难以将其最优先需求与社区资源联系起来（N = 123，78.3%）。
基于电话的主动HRSN筛查可能是一种可行且有效的干预措施，有助于识别CIRF的社会需求。以英语以外的语言提供干预措施可能进一步提高了项目的可接受性。尽管项目具有可行性和可接受性，但解决HRSN的社区层面障碍仍然存在。虽然可以考虑采用类似的护理协调模式来识别CIRF中未满足的HRSN的高负担情况，但解决该人群基于社区的资源有限的问题将是确保此类项目可持续性的关键组成部分。
