Group Processing and Client Centered Approach

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Group Processing and Client Centered Approach

• Joy Baldwin
• Manager Interim Federal Health
• Medical Services Branch
• Citizenship and Immigration Canada
• Vancouver, February 23,2007

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The Karen Movement 2006

• Enhanced client-centered approach to group
  processing for protracted groups of refugees
  coming from high risk environments

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Saskatoon, August 18, 2006

• Amongst the first Karen refugees welcomed to
  Canada

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Rationale for an enhanced immigration health
management

• International trend
• Other major immigration receiving countries such
  as U.S. and Australia are enhancing their
  immigration medical screening for high-risk
  populations.
• Epidemiological evidence
• Certain populations are at higher risk of
  developing conditions of public health concern.
• CIC resettlement process refugee group
  processing
• Large movements of people over a short period of
  time
• All coming from high health risk environment
• Significant number of individuals to resettle in
  limited number of cities
• Better integration of high risk populations for
  mutual benefits of Canadians and immigrants

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Overview of a high risk population the Karen
Refugees

• Canada has agreed to resettle 810 Karen Refugees
  in 2006-2007.
• All lived in a crowded, remote camp in northern
  Thailand for over a decade.
• Described as the poorest of the poor.
• Very limited health services available in the
  camp.
• Vaccination status not known.
• Frequent outbreaks of malaria, dengue hemorrhagic
  fever, cholera, influenza-like illness over the
  past few years.
• High Tuberculosis (TB) and MDR-TB
  incidence/prevalence amongst refugees in
  Thailand.

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Tuberculosis statistics amongst refugees in
Thailand

• TB prevalence in Thailand refugee camps over the
  past two years 2,674/100,000
• MDR-TB
• 76/100,000 for the Burmese refugees - 10 of all
  positive cultures
• 126/100,000 for the Hmong refugees - 30 of all
  positive cultures.
• Active TB diagnosed amongst the 805 Karen
  refugees coming in Canada
• 9 ? cases/805 refugees 621/100,000

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Enhanced Immigration Health Management

• To ensure optimal immigration medical screening
  of high risk populations
• For the protection of public health of Canadians
• For the benefits of individuals at high risk
• Interventions to happen
• Pre-departure
• Post-arrival
• Limitations and challenges
• Demographic constraints
• Time constraints
• Technical constraints
• Communication challenges.

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Enhanced immigration health management of Karen
Refugees

• Pre-departure and post-arrival initiatives
• Enhanced TB management
• Shorter validity date of the immigration medical
  examination (IME)
• All children 10 years referred to Public Health
  (PH) authority
• All cases of Pulmonary TB-inactive (PTI) referred
  to PH authority for an urgent assessment
• Fitness to fly assessment within 72 hours
  pre-departure
• Strengthened communication with provincial health
  authorities and timely sharing of information
• Enhanced coordinator role for CIC
• Comprehensive medical examination covered by the
  Interim Federal Health (IFH) program

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Implementation and coordination

• Establish contact with high level Public Health
  officials in each province
• Establish communication network of local CIC,
  Public Health and SPO reception center personnel
• Establish and maintain contact with IOM personnel
  conducting Fit to Fly assessments
• Prepare/distribute
• PHAC recommendations to public health
• PHAC recommendations to primary care physicians
• Interim Federal Health billing instructions
• Letters to clients

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Implementation and coordination

• Prepare sealed medical files on each client and
  with instructions to primary care physicians to
  be sent to local CIC offices and distributed to
  each client prior to their comprehensive medical
  examination
• Provide local Public Health with lists of
  children prior to their arrival
• Copy and send files and films on all PTI cases to
  local Public Health as soon as destination is
  confirmed
• Ensure post evaluation information is collected
  from local CIC, Public Health and primary care
  practitioners where possible

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Enhanced immigration health management success

• Timely support and advice by stakeholders (such
  as the Public Health Agency of Canada (PHAC) and
  the Canadian Tuberculosis Committee (CTC))
• Great opportunity to strengthen our network with
  partners
• Within the PHAC
• CCMOH
• Provincial and municipal public health
  authorities
• Internationally (US/CDC, IOM)
• Close collaboration amongst CIC Branches involved
  in the Karen refugee resettlement process
• Timely sharing of information, facilitating the
  health assessment by PH authorities
• More efficient interface with primary care for
  high risk population

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Enhanced immigration health management of Karen
Refugees challenges

• The need to refine criteria defining non fitness
  to fly
• Process challenged by a recent outbreak of acute
  hemorrhagic conjunctivitis
• Operational challenges due to the fitness to fly
  assessment location
• Facilitation of the process if done within the
  refugee camp
• Late involvement/awareness of Medical Services
  Branch, CIC in the Karen Refugee resettlement
  process
• MSB to work in early and close collaboration with
  other CIC Branches for future refugee group
  processing
• Communication challenges
• Wide audience international, national,
  provincial, municipal and non-governmental
  organizations
• Need to develop network of contacts at multiple
  levels
• Timely communications with all stakeholders

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Evaluation of the enhanced immigration health
management of Karen Refugees

• Is there any benefit to continuing the enhanced
  immigration health management for high risk
  populations?
• What is the impact on public health?
• Tuberculosis
• Immunization
• What are the benefits of doing a comprehensive
  medical examination soon after arrival?
• What is the impact of this enhanced approach on
  integration and access to care of high risk
  populations newly arrived in Canada?

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Evaluation of the enhanced immigration health
management of Karen Refugees (contd)

• Standardized tools amongst provinces receiving
  refugees
• Karen Refugee - TB control form
• Karen Refugee - Comprehensive Medical Assessment
  form
• CIC analysis of the IFH database for the Karen
  refugee group
• Key elements of success
• Participation of provincial/municipal public
  health authorities
• Participation of involved health care providers
• Successful integration into the Canadian health
  care system and optimal health outcomes for
  clients

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Next steps

• Analyse the impact/benefits of the enhanced
  immigration health management of high risk
  populations
• Review and refine the medical content of the
  protocol
• Pre-departure initiatives
• Post-arrival initiatives
• Develop criteria defining high risk populations
• Not limited to refugees

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Welcome to Canada Saskatoon, August 18, 2006
an integrated client-centered success story