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Immigrant Child Health Toolkit
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Immunizations: catch-up per CDC schedule if no records

Latent TB screening: TST if age < 5yo, IGRA if age = 5yo and history of BCG vaccine

CBC with differential

Lead testing: for all patients age 6mo - 16yo

Intestinal parasitic infection: screening (stool O&P x 2-3 samples and Strongyloides serology) or presumptive treatment per CDC guidelines with Albendazole x 1 for soil-transmitted helminths and Ivermectin x 1 for Strongyloides infection. Be aware of contraindications to treatment.

Schistosomiasis treatment: consider presumptive treatment with Praziquantel for all immigrants from Sub-Saharan Africa per CDC guidelines. Be aware of contraindications to treatment.

Hepatitis B infection testing: if history unknown or from area with > 2% prevalence

HIV screening: for all with unknown history, or any high risk. CDC recommends 4th generation testing with antigen/antibody to not miss acute infection window before seroconversion

Syphilis screening: RPR for all with unknown history, or any high risks

Gonorrhea/Chlamydia screening: Urine PCR for all with unknown history, or any high risks

Urine HCG: for all adolescent girls for whom consensual or non-consensual sexual activity is suspected/confirmed

Malaria: presumptive treatment per CDC guidelines for all Sub-Saharan African immigrants, screening only for symptomatic patients

Newborn Metabolic screen:

  • MD and VA - can send up to age 6mo
  • DC - no maximum age but need to interpret in context of age

Refer to these resources for more information:

  • If written and credible-appearing documentation present, can accept as given
  • If not, vaccination or re-vaccination is standard of care (checking serologic titers is an alternative, but not generally recommended for most patients)
  • Risks associated with giving possible extra doses of vaccines are minimal and the risks of being under- immunized is far more dangerous

Pay attention to the following:

  • White blood cell count for infection
  • Hemoglobin/Hematocrit for anemia
  • RBC indices for potential hemoglobinopathies (ie. Thalassemia or Sickle Cell Trait)
  • Eosinophilia (absolute eosinophil count >400 warrants further investigation - possible parasitic infection)

Causes of Eosinophilia

SOURCE: from CDC domestic guidelines for refugee health

  • For all children 6mo - 16 years
    • Consider repeating in 6 months for children age 6mo - 6 years
  • All patients should be either screened or empirically treated for common parasitic infection (soil-transmitted Helminths, Strongyloides stercoralis, Schistosomiasis - depending on region of world)
    • May omit for refugees if received pre-departure treatment per CDC guidelines - should have documentation of this
  • Costs and benefits of empiric treatment vs. testing must be weighed
    • Empiric treatment is simple and generally safe, with few contraindications - many of these patients have received such treatment routinely in their home countries
  • General resource for more detailed information: CDC Domestic Guidelines for Intestinal Parasites

Hepatitis B Surface Ag (infection, not immunity)

  • Recommend checking for infection (Hepatitis B Surface Antigen) if coming from a part of the world where prevalence of Hepatitis B is > 2 %
    Prevalence of Chronic Hepatitis B Virus Infection Among Adults
  • CDC guidelines for Hepatitis in care of Refugees and Immigrant: CDC Hepatitis Screening guidelines
  • Recommended for all patients with unknown history or any high risk (ie. travelling unaccompanied to US, teenager, history of sexual activity)
  • Per CDC HIV screening guidelines, recommend 4th generation HIV testing (Antigen/Antibody) since fewer false negatives in serologic conversion window period
  • RPR recommended for all recent refugee/immigrants unless maternal status clearly known and child has had no high risk activity (ie. did not travel unnacommpanied US and no possible sexual abuse)
  • Consider in all patients, especially in those that immigrated as unaccompanied minor and may have been sexually abused

Refer to state-specific guidelines

Nothing in this section constitutes legal advice; consult an attorney for legal advice.

  • Every child in D.C. and Maryland has the right to attend his or her in-boundary public school, regardless of immigration status.
  • You can find a child's DC in-boundary school online
  • Flyers on topics including "Who Should Apply" and "What Do I Need to Apply" can be found at:

This Spanish/English resource has a step-by-step guide of the special education process: www.parentcenterhub.org/repository/steps/

All states and the District of Columbia must identify, locate, and evaluate all children suspected of having a disability from birth to age 22 regardless of whether they attend a traditional public school.

Bullying is an increasingly prevalent problem at all levels of schooling. Immigrant children, in particular the newly arrived, are more vulnerable to bullying. "Immigrant bullying" has been defined as "bullying that targets another's immigrant status or family history of immigration in the form of taunts and slurs, derogatory references to the immigration process, physical aggression, social manipulation, or exclusion because of immigration status."

1. Source: Scherr, T. G., & Larson, J. (2010). Bullying dynamics associated with race, ethnicity, and immigration status. In S. R. Jimerson, S. M. Swearer, & D. L. Espelage (Eds.).The Handbook of Bullying in Schools: An International Perspective. New York: Routledge.

To address bullying within school, parents should contact:

Please see Language Service / Interpretation Section of the toolkit

Parents with concerns or complaints about their child's treatment in school or ability to obtain needed services can contact the following offices.

For a comprehensive listing of referral resources, please access the Child & Adolescent Mental Health Resource Guide, a product of the DC Collaborative for Mental Health in Pediatric Primary Care.

For any unaccompanied minor (age <18yo when entered country without legal guardian present, and apprehended at border): Office of Refugee Resettlement Call Center
ORR National Call Center Info (Eng & Esp.)

Search Engines:

For Additional Resources See "Mental Health"
Last updated on 2/7/2017
American University, Washington College of Law
4300 Nebraska Ave, Suite Y265, Washington, DC 20016
Phone: 202-274-4147
Takes cases based on referrals from service providers. Works on four broad substantive areas: immigrant deportation defense and immigration detention; workers' rights; civil rights for immigrants; and immigration, gender and sexual orientation.

https://www.wcl.american.edu/clinical/ijc/areasoffocus.cfm
AYUDA
6925 B Willow Street NW, Washington, DC 20012
Phone: 202-387-4848
Immigration consultations: Thursday mornings, 9:00 to 11:00am, by appointment only. Call (202) 387-4848 to make an appointment.

Immigration Consultations cost $100, cash only.

Domestic Violence consultations: Monday through Friday, 9:00 am to 5:00 pm. Free of charge.

http://ayuda.com/wp/get-help/legal-services/immigration-law/
CAIR Coalition (Capital Area Immigrant Rights Coalition)
1612 K Street NW, Suite 204, Washington, DC 20006
Phone: 202-331-3320
Provides advice and representation to detained immigrants.

https://www.caircoalition.org/need-help
CARECEN
1460 Columbia Rd. NW, Suite C-1, Washington, D.C. 20009
Phone: 202-328-9799
Serves low and moderate income Latinos in any part of the Washington metro area (including nearby MD and VA).

Immigration Consultations: Mondays, 9:00 to 11:00am and Tuesdays, 1:00 to 3:00pm Consultations cost $60. The first ten people are seen in order of arrival. Phone interpreters are available for people who do not speak Spanish or English.

Citizenship Consultations: Wednesdays, 9:00 to 11:00am and 1:00 to 3:00pm. Call to verify times and prices.

http://www.carecendc.org/direct-services/immigration-legal-services/
Catholic Charities

DC: 924 G St. NW,
Washington, DC 20004
Phone: 202-350-4305 or 202-772-4325 (Spanish)

DC: 1618 Monroe Street, NW
Washington, DC
Phone: 202-939-2420

Maryland: Esperanza Center, 430 S. Broadway, Baltimore, MD 21201
Phone: 410-534-8015
DC: Call during intake hours - Monday, Tuesday, Friday: 9:30am to 12:00pm, and 2:00pm to 4:30pm; Wednesday, Thursday: 9:30am to 12pm, and 2:00pm to 7:30pm

Maryland: Walk-in intakes Tuesdays must arrive before 9:00 AM (but best to arrive at least 30-60 minutes prior), $100 money order. General immigration services. No detention cases.

https://www.catholiccharitiesdc.org/ILS
http://www.catholiccharities-md.org/immigrants/
DC Affordable Law Firm
1717 K St. NW
Washington, DC 20006
Phone: 202-844-5430
info@dcaffordablelaw.org
Intake & Eligibility Questionnaire
Low-cost option for D.C. residents whose incomes fall between 200% and 400% of the federal poverty level. Initial consultations: $75; Hourly rate of $75 or flat fee for certain legal services

http://www.dcaffordablelaw.org/practice-areas/immigration/
DC Bar Pro Bono Program - Immigration Legal Advice and Referral Clinic Holds regular immigration clinics to provide advice and possible representation for D.C. residents. See website for updated schedule.

http://www.dcbar.org/pro-bono/volunteer/immigration-clinic.cfm
George Washington Immigration Legal Clinic
2000 G Street NW, Ste B-04, Washington, D.C. 20052
Phone: 202-994-7463
Accepts removal cases scheduled in the Arlington Immigration Court and affirmative asylum cases. Asylum cases (filed in removal proceedings or with USCIS for Asylum Office Interviews).

Interviews potential clients through phone intake.

Potential clients should call 202.994.7463 and ask for the Immigration Clinic.

https://www.law.gwu.edu/immigration-clinic
Human Rights First, Asylum Legal Representation Program
805 15th Street NW, Suite 900, Washington, DC 20005
Phone: 202-547 5692
Helps people living in the greater Washington, DC area who do not already have legal representation, cannot afford an attorney, and need help with a claim for asylum or other protection-based form of immigration status.

http://www.humanrightsfirst.org/asylum
Justice for Our Neighbors
Emory United Methodist Church
6100 Georgia Avenue NW, Washington, DC 20011
Phone: 202-722-7077
Services for non-minors in MD and DC and sometimes VA. Four monthly intake clinics. Must call first to schedule an appointment at (301) 920-0507. Cannot serve minors (under 21 in MD or under 18 in DC).

http://njfon.org/our-services/legal-clinics/
Kids in Need of Defense (KIND)
1300 L St. NW, Suite 1100, Washington, DC 20005
Phone: 202-824-8680
Email: info@supportKIND.org
Serves children in immigration proceedings.

https://supportkind.org/contact/
Tahiri Justice Center Greater DC
201 North Charles Street, Suite 920, Baltimore MD 21201
Phone: 571-282-6161
Gender-based violence cases, anywhere in US, any sex, any age. Can take on many kinds of cases: asylum, T and U visas, VAWA, Batters spouse, SIJ cases.

Call Tuesdays 10-2 for intake.

http://www.tahirih.org
University of D.C. Immigration and Human Rights Clinic
David A. Clarke School of Law, Bdg 52, Rm 303
4340 Connecticut Avenue NW, Washington, DC 20008
Tel: 202-274-6428
Represents immigrant clients in a wide variety of immigration and other civil legal matters (ie. employment issues).

http://www.law.udc.edu/?page=ImmigrationClinic
University of Maryland School of Law Immigration Clinic
500 W. Baltimore Street, Baltimore, MD 21201
Phone: 410-706-3295
Represents individuals in immigration proceedings before the Immigration Court and the United States Citizenship and Immigration Service (USCIS) in Baltimore.

https://goo.gl/BPBjRa
U.S. Committee for Refugees and Immigrants (USCRI)
2231 Crystal Drive, Suite 350
Arlington, VA 22202
Phone: 703-310-1130
Provides legal family- and humanitarian-based immigration services to low-income refugees and immigrants in a low-cost scale-based fee-for-services model.

Immigration consultations: Wednesdays, by appointment. Call 703-310-1130 to make an appointment.

Consultations cost $100.
Whitman Walker
1701 14th St., NW
Washington, DC 20009
Phone: 202-939-7627
Email: contact-legal@whitman-walker.org
Immigration services include direct representation and pro bono placement of immigration claims related to sexual orientation, gender identity, and HIV status. Cases for representation or pro bono placement include adjustment of status, affirmative and defensive asylum applications, Deferred Action for Childhood Arrivals (DACA), employment authorization, family petitions and waivers, naturalization, Temporary Protected Status (TPS), protection under VAWA, Special Immigrant Juvenile Status, and U/T visas. Immigration legal services are limited to Whitman-Walker Health medical patients and are provided free of charge.

https://www.whitman-walker.org/legal/legal-services/
World Relief Baltimore Immigration Legal Clinic
7 E Baltimore St., Baltimore, MD 21202
Phone: 410-244-0002
Advises and represents immigrants and their family members in immigration matters such as: applying for permanent residence and work permits, petitioning for family members to remain or reunite in the U.S., and applying for naturalization. Residents of Maryland, or individuals who have cases with the Immigration Court in Maryland. In addition, the Clinic participates in a joint program with the University of Maryland School of Law ("UM") to provide free consultations to individuals in deportation proceedings on a biweekly basis with the collaboration of volunteer pro bono attorneys.

Consultations Wednesdays, arrive before 9:30 AM. $70.

https://www.peoples-law.org/world-relief-baltimore-immigration-legal-clinic
Before enrolling in any local or federal public benefits programs, individuals who are uncertain about the impact enrollment will have on their ability to become Legal Permanent Residents (LPR/Green Card holders) or Naturalized Citizens should consult with an immigration attorney before proceeding.

Two types of government-funded public benefits programs: D.C.-specific programs and federal programs. Few immigrants qualify for federal public benefits, though there are exceptions which are outlined below. All immigrants are eligible for emergency Medicaid.

Entry into the U.S.

  • Did you come to the U.S. by illegally crossing the border at some place other than a U.S. checkpoint?

Visa

  • Did you come to the U.S. on some type of visa?
  • What kind of visa (i.e. student, tourist, employment)
  • Is your visa still current or is it expired?
  • Are you getting a U-visa because you were a crime victim? Is someone assisting you?

Legal Permanent Resident/Greencard

  • Are you a legal permanent resident? Do you have a greencard ? (same thing)
  • If not, have you or any of your relatives ever filed family visa petitions for you to get a greencard?
  • If so, when were they filed?
  • Who filed these petitions? (I.e. parent? spouse?)
  • Are the papers still in process with the immigration authorities?

Work Permit

(A work permit will say "Employment Authorization" on it.) There are many different types of status that let you apply for a work permit. If you can make a legible copy of the card, the "(c)-code" information on it can pinpoint the type of status or application it is linked to. WDAIP can help with that.

  • Were you given a work permit?
  • Do you know why it was granted?

Marriage

Marriage per se does not confer any lawful immigration status on a noncitizen spouse. Where the noncitizen marries a US citizen or LPR, this entitles the noncitizen to begin the process of applying for lawful status based upon a valid marriage.

  • Are you married to a U.S. citizen or lawful permanent resident?

Refugee or Asylee

  • Did you come to the U.S. after having been given refugee status/visa? (Refugee visas are granted outside the US and people then enter legally; a refugee visa is often stamped or noted on an "I-94" entry document.)
  • Have you ever applied for asylum since you arrived in the U.S.? (Political asylum is granted to people who are inside the US when they apply.)
  • Was your application granted?
  • If so, when?
  • If so, are you still in asylee or refugee status or did you apply for your greencard? (Refugees must, and asylees can apply for a greencard, after one year.)
  • If not granted, is your application still pending?
  • If your application was denied, have you had a hearing with an immigration judge?

DACA (Deferred Action for Childhood Arrivals)

DACA is a type of non-statutory, temporary administrative status created in 2012, after the Dream Act and immigration reform law failed. It gives temporary status and work authorization to some undocumented people who entered the US before age 16, before 6-15-2007, and who were born on or after 6-15-1981. DACA does not lead to LPR status or give any other immigration status. Felony and some misdemeanor convictions are a bar.

  • Did you apply for the program for Dreamers/people who came before they were 16?
  • Did you apply for work authorization?
  • How old were you when you came to the US? When did you come?

COFA (Compact of Free Association) Resident

Three Pacific island nations have Compacts of Free Association with the United States. COFA citizens may come into, reside in, and work indefinitely in the US, but like permanent residents, they can be deported or excluded for crimes. They are not US nationals. Origin in a COFA country is usually the tip- off to this status, although such a person could have become an LPR or US citizen through normal channels. These countries are:

  • Federated States of Micronesia (FSM) (Chuuk, Yap, Pohnpei, Kosrae)
  • Republic of Palau
  • Republic of the Marshall Islands (RMI)

Temporary Protected Status (TPS)

TPS is a type of temporary status well short of asylum. Eligibility is established by designation by the Secretary of Homeland Security and must be renewed, usually every 18 months. TPS allows work authorization but does not lead to LPR or any other immigration status. The group is designated by country and date of arrival. Countries with groups currently designated for TPS are listed here

Currently (August, 2014) there are TPS designated groups from El Salvador, Haiti, Honduras, Nicaragua, Somalia, Sudan, South Sudan and Syria. Any felony or two misdemeanors are bars to TPS.

  • Do you have TPS? (Most people know if they have it.)
  • When did you arrive in the US?

Removal Proceedings or Previously Deported and Came Back

  • Have you ever seen an immigration judge or been detained by immigration?
  • Do you have another hearing that you have to go to?
  • Have you ever been deported?

ICE Order of Supervision (Final Order of Removal/Deportation)

People with final orders of removal (deportation) sometimes cannot be deported because the country of origin will not cooperate or because a travel document cannot be obtained. In such cases ICE will release the person with an Order of Supervision. They usually have to report to ICE, and can apply for work authorization. Some people stay in this status for years or permanently.

  • Did you ever see the immigration judge? W ere you ordered deported?
  • Were you told you can't be deported because your country won't take you back?
  • Do you have to report to ICE (Immigration and Customs Enforcement)?

To apply or recertify for one or more of the assistance programs, must fill out combined application and either mail or submit application to service center. Interviews required for all programs except Medicaid.

Documentation recommended for Interview:

Proof of: Examples
Income Recent paystubs; statement showing retirement income, disability income, or Workers Compensation; pension statement; etc.
Assets Recent bank and checking account statements, etc.
DC Residency DC driver's license, lease, rent receipt, written statement from your landlord, utility or telephone bill, etc.
Social Security Number Social Security card; tax or payroll documents with your SSN on it; DC driver's license with your SSN on it; etc. (Not required for Food Stamp-only applicants.)
Medical Exam Report / Disability Recent medical report (or Form 856) and any supporting materials from your doctor.
Immigration Information Employment Authorization card, I-94, visa, passport, or other documents from the INS.
Rent / Mortgage (SNAP Only) Lease, rent receipt, cancelled check, mortgage statement, etc.
Utility Bills (SNAP Only) Recent bills for electric, gas, fuel, phone, water, telephone, etc. (if you pay these separately from your rent).
Relationship (TANF Only) Birth certificate (full copy) for your child(ren) or official records from a school, court, hospital, etc.
"Living With" (TANF Only) Statements from two non-relatives or school records.

Note: Also bring your Medicare card or other health insurance card, if you have one.

IN DC, TRANSLATION VIA LANGUAGE LINE MUST BE PROVIDED FOR INTERVEW. PLEASE REFER TO LANGUAGE ACCESS RIGHTS SECTION OF HANDBOOK FOR ADDITIONAL DETAILS.

Economic Security Administration (ESA) Service Centers

Taylor Street
1207 Taylor Street NW
Phone: (202) 576-8000
Fax: (202) 576-8740
Hours: 7:30 am - 4:45 pm on Monday, Tuesday, Thursday and Friday; 7:30 am - 8:00 pm on Wednesday

H Street
609 H Street NE
Phone: (202) 698-4350
Fax: (202) 724-8964
Hours: 7:30 am - 4:45 pm on Monday, Tuesday, Thursday and Friday; 7:30 am - 8:00 pm on Wednesday

Fort Davis
3851 Alabama Avenue SE
Phone: (202) 645-4500
Fax: (202) 645-6205
Hours: 7:30 am - 4:45 pm on Monday, Tuesday, Thursday and Friday; 7:30 am - 8:00 pm on Wednesday

Anacostia
2100 Martin Luther King Jr Avenue SE
Phone: (202) 645-4614
Fax: (202) 727-3527
Hours: 7:30 am - 4:45 pm on Monday, Tuesday, Thursday and Friday; 7:30 am - 8:00 pm on Wednesday

Congress Heights
4001 South Capitol Street SW
Phone: (202) 645-4546
Fax: (202) 654-4524
Hours: 7:30 am - 4:45 pm on Monday, Tuesday, Thursday and Friday; 7:30 am - 8:00 pm on Wednesday

Legal Aid Society of the District of Columbia

First come, first serve at the intake locations during hours listed. Call (202) 628-1161 with any questions. Fax: 202-727-2132

  • NW Site/Main Office: 1331 H St. NW, Suite 350, Washington, DC 20005
    Site Hours: Monday 12:30pm-6pm, Thursday 12:30pm-4pm
  • SE Site: 2041 MLK Jr. Ave. SE, Suite 201, Washington, DC 20020
    Site Hours: Monday & Thursday 10:00am-1:30pm

Neighborhood Legal Services Program (NLSP) of the District of Columbia

Go in person to any intake location below or call during intake hours at (202) 832-6577 on Monday, Wednesday, and Friday from 10:00 am to 3:00 pm.

  • NW Site: 680 Rhode Island Ave. NW, Washington, DC 20002
  • NE Site: 4609 Polk St. NE, Washington, DC 20019
  • SE Site: 2811 Pennsylvania Ave. SE, Washington, DC 20020

Bread for the City

Please Note: Bread for the City is currently not accepting SSI cases for representation; however, Bread for the City can provide general advice for people who want to know more about the process from 1:00 to 3:00 on Monday at one of the locations below:

  • SE Site: 1640 Good Hope Rd. SE
    Washington, DC 20020
    Phone: 202-561-8587
    Fax: 202-574-1536
  • NW Site: 1525 7th St. NW
    Washington, DC 20001
    Phone: 202-265-2400
    Fax: 202-745-1081

Catholic Charities

924 G St. NW, Washington, DC 20004
Phone: (202) 350-4305 or (202) 772-4325 (Spanish)

Intake hours:
Monday, Tuesday, and Friday: 9:30am-12pm, 2pm-4:30pm
Wednesday and Thursday: 9:30am-12pm, 2pm-7:30pm

Washington Legal Clinic for the Homeless

1200 U Street NW, Washington, DC 20009
Phone: (202) 328-5500

Call to find out about frequently changing intake schedule.

Quality Trust for Individuals with Disabilities

5335 Wisconsin Ave. NW, Washington, DC 20015

Represents persons with intellectual disabilities. Call (202) 448-1450 to talk with staff about legal issues.

DC Bar Pro Bono Advice and Referral Clinic

This is a free legal advice clinic on the second Saturday of every month from 10am-12pm. There are lawyers who can give you advice on your case, but they probably will not be able to represent you. To register, call: 202-737-4700, ext. 3292. For more information, see: www.dcbar.org/for-the-public/help-for-individuals/advice.cfm. The clinic is held at two locations:

  • Bread for the City - Northwest Center: 1525 7th Street NW
    To arrive by Metro take the Green Line to Shaw-Howard University Metro Station.
  • Bread for the City - Southeast Center: 1640 Good Hope Road SE
    To arrive by Metro take the Green Line to the Anacostia Metro Station.

Legal Counsel for the Elderly (**Clients must be age 60 or over**)

601 E St. NW, Washington, DC 20049

Call their legal hotline at (202) 434-2170, Monday through Friday, between 9:30 a.m. and 3:30 p.m. The regular office number is (202) 434-2120. Staff speak Spanish.

APPLYING FOR MEDICAID:

DC Medicaid provides health care coverage to adults, children and families who have a low income or a disability. To be eligible, you must be a resident of D.C. and meet certain eligibility requirements. Apply online at www.DCHealthLink.com or call 1-855-532-5465.

For problems with your health insurance, contact:

Office of Health Care Ombudsman and Bill of Rights
One Judiciary Square
441 4th Street, N.W. 900 South - 9th Floor
Washington, DC 20001

Phone: 202-724-7491
Toll-Free: 1-877-685-6391
Confidential Fax: 202-535-1216
Office E-Mail: healthcareombudsman@dc.gov
Website: www.healthcareombudsman.dc.gov