Increased immigration enforcement and anti-immigrant policies and rhetoric negatively impact immigrant health by increasing stress, stigma, and decreasing use of needed healthcare services. Amid changing immigration policies, Federally Qualified Health Centers (FQHCs) are implementing innovative interventions to address heightened anxieties and to empower immigrant patients. FQHCs are particularly suited for these efforts as they are the primary source of medical care for low-income individuals, including uninsured immigrants. We describe the implementation of “Know-Your-Rights” (KYR) presentations conducted by community health workers (CHWs) in clinic waiting rooms of Clínica Msr. Oscar A. Romero, an FQHC in Los Angeles. The goals of these presentations are to: (1) empower immigrant patients, equipping them with knowledge of legal rights in potential immigration enforcement and (2) integrate legal education and services into medical care.
Data collection and analysis took place May-July 2018 using a descriptive qualitative case study approach, incorporating key informant interviews, direct field observations, and document review. Four field visits were followed by an interview of the KYR facilitator, with an additional interview with the Community Organizing team lead (total interviews=5). Observations, field notes, and interview notes were taken on site and typed within 24 hours, including reflective journaling. Descriptive and content analyses were conducted iteratively, and a synthesis of the findings was developed. This study was approved by the UCLA IRB.
Intervention: A member of the clinic’s Community Organizing Department and members of a clinic youth program lead 5-10 minute KYR presentations 3-6 times a week. The presentations discuss individual’s legal rights if facing immigration or law enforcement and include distribution of written materials, review of sample warrants, and a legal resource guide developed in partnership with local immigrant-serving legal organizations. The facilitator remains in the room to answer questions at the completion of the presentation, connecting patients to lawyers from the legal resource guide as needed. The team is currently integrating a structured method of collecting patient feedback; the primary limitation being lack of formal evaluation.
Challenges: Decreasing waiting room times can impede patients from listening to the entire KYR presentation. The noisiness of the waiting room may distract patients or overcome the facilitator’s voice. There also remain challenges with maintaining funding and incorporating needs of African and Asian immigrants as they become clinic patients.
This case study describes an innovative CHW-led, waiting room KYR intervention. To our knowledge, this is the first such intervention of its kind and reflects a larger national trend of healthcare facilities addressing legal needs of immigrant patients.