O3213: Dallas Immigrant Health Collaborative: Laying the Foundation for a Regional Collaborative to Improve Access to Subspecialty Care for Immigrant Children and Families

Background: In Dallas County, Texas, one in seven children are uninsured. For children in immigrant families (CIF) who are uninsured, the existing infrastructure to access outpatient pediatric subspecialty care is limited and inequitable. This results in delays in care that are detrimental and can lead to adverse health outcomes for CIF.

Project Description: Supported by an AAP CATCH grant, the goal of this advocacy project was to obtain qualitative data and establish partnerships with regional stakeholders to inform the development of the Dallas Immigrant Child Health Collaborative, a network of pediatricians, subspecialists, and community leaders working together to improve access to pediatric subspecialty care for underinsured/uninsured CIF through clinical care, education, and advocacy.

With a team that included six trainees, we conducted 17 semi-structured interviews with pediatric healthcare professionals and 8 focus groups (4 with community members, 5 with community leaders/organizations who serve immigrant families). Participants were recruited through collaboration with trusted community organizations. All focus group participants were Spanish-speaking; thus, sessions were moderated in Spanish. Qualitative data were analyzed to elucidate the experiences of caregivers of immigrant children when accessing pediatric subspecialty care (Figure 1) and lay the foundation for potential community-level interventions for the Collaborative to pursue (Figure 2).

Discussion: Barriers to pediatric subspecialty care for CIF due to lack of insurance are similar to those described in the literature for other uninsured populations. These include cost, navigating the healthcare system, social determinants of health (e.g. transportation), and distrust of the healthcare system. Barriers that may be unique to CIF include vulnerability to scams, fear/distrust due to anti-immigrant policies, and health literacy (in spoken, written, and technological form). Existing support systems include free/low-cost clinics, immigrant-focused community organizations, home remedies, and social support.

Potential interventions should focus on financial assistance, flexible scheduling, health navigation support, improved information sharing, accessible health information, language and cultural concordance, academic-community partnerships, and legislative health policies. Trainee-led advocacy projects that have already stemmed from this work include a patient navigator program and community health education sessions on navigating the healthcare system – both of which will be focused on children in immigrant families.

Next steps include:

1. Development of a white paper combining the findings from the qualitative data from pediatric professionals, immigrant community members, and leaders/advocates in immigrant-serving community organizations

2. Planning the logistics to launch the first DFW Immigrant Child Health Collaborative meeting.

Conclusion: Academic-community partnership with members and leaders of the immigrant community is crucial to the development of a collaborative focused on improving access to pediatric subspecialty care for uninsured CIF. The long-term goal of the collaborative will be to advocate for a sustainable and robust infrastructure via local health policies to ensure equitable access to pediatric subspecialty services for uninsured/underinsured CIF in Dallas County.