1. PA REFUGEE RESETTLEMENT PROGRAM CONSULTATION CONFERENCE JUNE 13 - 14, 2012 PA REFUGEE HEALTH PROGRAM Asresu Misikir, Dr.Ph., MPH Epidemiologist & Refugee Health Program Coo. Bureau of Epidemiology Division of Infectious Disease Epidemiology, Refugee Health Program Section

2. PRESENTATION POINTS : I.PA REFUGEE HEALTH PROGRAM (PA RHP) OVERVIEW II. STATISTICAL INFORMATION III. ACCOMPLISHMENTS IV. FUTURE PLAN PA RHP_AM 2012

3. Program Objectives :  To assess the current health status of all newly arriving refugees and identify health problems not identified during or developing after overseas medical exam  To ensure follow-up of refugees with conditions identified during the overseas medical exam or subsequently and provide treatment and referral PA RHP_AM, 2012

4. Program Tasks :  Coordination of care  Training and Health Education  Develop Electronic Reporting System and Provide Technical Supports  Collaborations  Increase Public Awareness  Site Monitoring  Identify of Potential health risks  Documentations & Produce Reports PA RHP_AM 2012

5. Refugee Health Assessment (RHA) Primary Components :  Medical history and physical exam  Immunization (children and adult)  Tuberculosis (TB) Screening  Sexually Transmitted Infection (STI)/HIV Screening  Hepatitis B Screening  Intestinal Parasite & Malaria Screening  Mental Health Screening  Childhood Blood lead Test  Referral of Chronic diseases PA RHP_AM 2011PA RHP_AM 2012

6. Refugee Population Served by RHP PA RHP_AM 2012  Refugees  Asylees  Parolee/Cuban/Haitian Entrants  Amerasians  Victims of Human Trafficking  Unaccompanied Alien Children  Survivors of Torture

7. Health Care Providers By Region Erie Elk Forest Crawford McKean Warren Mercer Venango Lawrence Butler Clarion Beaver Allegheny Armstrong PotterTiogaBradford Cameron Lycoming Jefferson Clearfield Clinton Centre Indiana Westmoreland Washington Cambria Blair Union Snyder Susquehanna Wyoming Sullivan Luzerne Wayne Lackawanna Northumberland Montour Columbia Carbon Monroe Pike Schuylkill Northampton Lehigh Mifflin Juniata DauphinPerryBerks Bucks Montgomery Chester Lebanon Lancaster Huntingdon Bedford FranklinAdams Cumberland York Fulton Delaware Somerset Greene Fayette Health CARE Providers (20) Philadelphia PA RHP_AM 2011PA RHP_AM 2012 Active Health Care Providers

8. II. STATISTICAL INFORMATION  Notifications of Arrival  Health Screening Status PA RHP_AM 2011PA RHP_AM 2012

9. Figure 1 Total Newly Arriving Refugees by States in 2011 PA RHP_AM 2012 Source: ORR annual refugee arrivals report, 2011. These data excludes secondary migrants N=56,419

10. Figure 2 Trends of Newly Arriving Refugees in PA from 2009 - 2011 Sources: Sources: CDC EDN Data (2008-2011) http://www.acf.hhs.gov/program/orr/data/state_profiles.htm. Date includes secondary migrantshttp://www.acf.hhs.gov/program/orr/data/state_profiles.htm PA RHP_AM 2012

11. Figure 3 Newly Arriving Refugees in PA by Country of Origin, 2011 Note: Refugees came from 59 different countries; Source – CDC EDN, 2011 PA_RHP_AM, 2012 N=3303

12. Figure 4 Percent of Newly Arriving Refugees in PA by Country of Origin(Region) in PA 2011 PA_RHP_AM, 2012 Note: Among refugees who came from East-South Asia Region, 46% came from Bhutan, 24% from Nepal, and 7% from Myanmar.

13. Figure 5 Percent of Newly Arriving Refugees by Sex and Age Group in PA, 2010 and 2011 Sex PA RHP_AM 2012

14. Figure 6 Newly Arriving Refugees by County in PA 2011 Erie Elk Forest Crawford McKean Warren Mercer Venango Lawrence Butler Clarion Beaver Allegheny Armstrong PotterTiogaBradford Cameron Lycoming Jefferson Clearfield Clinton Centre Indiana Westmoreland Washington Cambria Blair Union Snyder Susquehanna Wyoming Sullivan Luzerne Wayne Lackawanna Northumberland Montour Columbia Carbon Monroe Pike Schuylkill Northampton Lehigh Mifflin Juniata DauphinPerryBerks Bucks Montgomery Chester Lebanon Lancaster Huntingdon Bedford FranklinAdams Cumberland York Fulton Delaware Somerset Greene Fayette Philadelphia Legend: 51 - 100 Refugees >101 Refugees Note: Refugees and Eligible Immigrants reside in 36 counties in PA, 2011

15. Figure 7 Refugees Who were Diagnosed with TB Conditions Overseas and Resettled in PA from 2009 - 2011 PA RHP_AM 2012

16. Figure 8 Refugees Who Completed Health Screening in PA, 2010 and 2011 PA RHP_AM 2012 Note: Refugees who reside in Philadelphia are excluded since reports were not received.

17. Figure. 9 Percent of Refugees Who Completed Health Screening by Type of Services in PA 201 1 PA RHP_AM 2012 N= 1,733

18. Figure 10 Refugees Who Received Referral & Interpretation Services in PA, 2011 PA RHP_AM 2012

19. Figure 11 Refugees who were Referred for Other Health Conditions in 2011 PA RHP_AM 2012

20. Figure 12 Type of Languages Used during Health Screening PA RHP_AM 2012 Type of language# of Refugees Arabic27 Bhutan (Druk Yul)91 Burma29 China1 Karen23 Nepali635 Russian2 Somali7 Spanish33 Swahili5

21. III. Accomplishments in 2011  Coordination of Health Care:  Increased number of HCP from 5 to 10  Increased health screening rate by 32%  Integrated mental health screening  Deployed two Refugee Case Mangers  Obtained Refugee Preventive Health Grant PA RHP_AM 2011 PA RHP_AM 2012

22. Cont.:  Electronic Reporting System of PA RH eSHARE development process continues  Training and Public Awareness  300 Educational materials on refugee health distributed  4 conference calls with HCP were conducted  Produced Annual report 2011 made available at  ARHC website to the Public at the national level  Site monitoring Protocol Developed.  One site monitoring was done PA RHP_AM 2012

23. Cont.:  Participated in 4 Regional Refugee Resettlement Collaborative meetings  Developed good communication and working Relationship with HCP and Local VOLAGS PA RHP_AM 2012

24. IV. Future Plans  Enhance Coordination of Health Care  Epidemiological Refugees Tracking system development and make it access to all concerns  Provide Technical support and Immigration Legal Update  Training and Health Promotion PA RHP_AM 2012

25.  Develop link with academic Institutes  Identify and study potential health risk among refugees  Continue active collaborative work with Key Partners  Conduct Site Monitoring  Documentation and Producing Reports Cont., Future Plans PA RHP_AM 2012

26.  PA, Department of Public Welfare, Refugee Resettlement Program (RRP) http://www.state.pa.us  PA, Department of Health Bureau of Epidemiology, Division of Infectious Disease Epidemiology, Refugee Health Program Section. http://www.dpw.state.pa.us/  CDC, Division of Global Migration and Quarantine : http://www.cdc.gov/ncidod/dg/refugee/fag/fag.htm  Department of State Human Health service, Office of Refugee Resettlement : http://www.acf.hhs.gov/program/orr  United States Citizenship and Immigration Services (USCIS) http://www.uscis.gov  Public Health Services Act: http://www.os.dhhs.gov/about/opdivs/phs.html and http://www.usphs.gov/AboutUs/mission.aspx).) PA RHP_AM 2012 Reference:

27. Q & A THNAKS