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

Latent TB screening: Tuberculin Skin Test (PPD) if age < 2yo, either PPD or Interferon Gamma Release Assay (IGRA) can be used for age = 2yo (IGRA preferred if history of BCG vaccine).

CBC with differential

Lead testing: for all patients age 6 months to 16 years. Repeat within 3-6 months of permanent residence for children 6mo-6yo, regardless of initial result.

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 >13 years old; for 12 years and younger if any risk factors. Consider retesting in 3 months for recent high-risk behaviors. CDC recommends 4th generation testing with antigen/antibody.

Syphilis screening: RPR for all >15yo and for any <15yo unless maternal status clearly known and child has no risks (possible risks: unaccompanied minor, sexually active, history of sexual abuse or assault, or uncertain prior living conditions and risks).

Gonorrhea/Chlamydia screening: test all children at risk (unknown history, unaccompanied minor, history of sexual abuse or assault, or uncertain prior living conditions and risks), including all young adults >15 years old. Testing: GC/chlamydia NAAT from urine or from self-collected male urethral, vaginal or endocervical swabs.

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

Malaria: all Sub-Saharan African immigrants within 3 months of arrival must be tested OR presumptively treatment per CDC guidelines. Screen patients from all other regions only if symptomatic.

Newborn Metabolic screen: no evidence supports universal screening. If newborn screen wanted:

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

  • 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

ADDITIONAL RESOURCES:

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)
  • For all children 6mo - 16 years
  • Repeat in 6 months for children age 6mo - 6 years
    • This is highest risk age group
    • Disproportionate number of immigrant children live in poor housing conditions that may be contaminated with lead
    • At risk for increased lead absorption with malnutrition and micronutrient deficiencies (iron, calcium, zinc)
  • 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 13-64 years of age.
  • Children <13 years old should be screened unless HIV negative status of mother confirmed and child at low risk
    • Unique risk factors for this population may include: travelling unaccompanied, history of previous known or suspected sexual activity or abuse, unstable or unsafe living condition in home country
    • Medical risk factors include history of blood transfusion.
  • Consider repeat screening in 3-6 months for any individual with recent exposure or high-risk activity, due to possible 'window period' (early infection prior to seroconversion).
  • Per CDC HIV screening guidelines, recommend 4th generation HIV testing (Antigen/Antibody) since may identify infection up to 14 days after infection (instead of longer window period before serologic conversion with previous testing methods).

RPR recommended for all recent refugee/immigrants according to following approach:

  • All refugees >15 years of age, if no overseas results are available
  • Children <15 years of age:
    • who are sexually active
    • who are at risk: unaccompanied, history of sexual abuse or assault, or uncertain prior living conditions and risks
    • whose mother tested positive for syphilis
  • Neonates <30 days can be evaluated according to the Congenital Syphilis section of the CDC Sexually Transmitted Diseases Treatment Guidelines, 2015
    1. highly probably congenital infection: abnormal exam OR serum quantitative non-tremponemal serologic titer that is 4-fold higher than the mother's titer OR a positive darkfield test or PCR of lesions/body fluids
    2. possible congenital syphilis: normal exam and titer < 4-fold mother's titer and: mother was not treated, inadequately treated, or has no documentation of having received treatment; OR mother was treated with erythromycin or a regimen other than those recommended in these guidelines (i.e., a nonpenicillin G regimen); OR mother received recommended treatment <4 weeks before delivery.
    3. congenital infection less likely or unlikely: normal exam, and mom adequately treated before or during pregnancy.
  • Consider in patients at risk, including all young adults >15 yo regardless of unique risk factors.
  • Unique risk factors to consider for immigrant populations: travelling unaccompanied by guardian, uncertain or unsafe prior living conditions, history of any suspected sexual abuse.
  • Consider testing in children with symptoms for STI.
  • Consider in patients with urinalysis is + for leucocyte esterase.

Test to send is GC/chlamydia NAAT from urine or from self-collected male urethral, vaginal or endocervical swabs.

Refer to state-specific guidelines

www.dccovidconnect.org
Community resource and reliable up-to-date information about COVID-19 in DC, Maryland and Virginia.
Maintained and updated by medical students at The George Washington University School of Medicine & Health Sciences.

Specific information for the undocumented community here.

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.

Last updated on 8/18/2020

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"

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.

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