The American Immigrant Policy Portal

Cultural and Linguistic Competency

Care for America’s Elderly And Disabled People Relies on Immigrant Labor, Health Affairs, 38:6 (2019), 8 pp. Authors:  Leah Zallman et al As the elderly population in the United States is expected to double in size by 2050, health care workforce shortages are expected to increase. Three-and-a-half million additional workers will be needed in the next decade alone. Although several studies have examined the role that immigrants play in the formal health care sector, “Care for America’s Elderly and Disabled People Relies on Immigrant Labor” focuses on the immigrant role in nonformal settings such as private housing and nonmedical facilities.  The study used the Annual Social and Economic Supplement of the 2018 Current Population Survey (CPS), a nationally representative survey conducted by the Census Bureau and the Bureau of Labor Statistics, which collected data on 180,084 people in March 2017.  The researchers found that immigrants constituted 18.2 percent of health care workers, 27.5 percent of direct care workers, and 30.3 percent of nursing home housekeeping and maintenance workers. The category of direct care workers includes home health and personal care aides. The authors observe that these workers allow hundreds of thousands of Americans to live at home or in other nonmedical settings such as senior housing-- thereby reducing the need for expensive institutional care. “Curtailing immigration,” the authors conclude, “will almost certainly move us in the wrong direction…” in ensuring quality health care for all Americans

The Worst of Health: Law and Policy at the Intersection of Health and Immigration, Symposium Paper, Indiana Health Law Review, 16: 2 (2019), 22 pp. Author: Wendy E. Parmet Due to the influence of nativist forces, the United States has had a long history of misguided health policy and law. This essay reflects on past and present immigration, healthcare and public health policies and shows how they are connected to and impact each other. Parmet cites various cases of immigration policy that had a harmful effect on public health, from the quarantine of Chinese-Americans in San Francisco during a 1900 epidemic to the recent Trump administration family separation policies. Parmet utilizes these historical case examples to illustrate the damaging conflation of immigration and health policy and the extent to which these federal policies are fueled by anti-immigrant and racist sentiment. She stresses that these policies are not only exclusionist, they are ineffective, costly and dangerous to public health. The author also strongly opposes the Trump administration’s regulation to expand the meaning of “public charge,” which, she points out, was used to turn away Jewish refugees during the Holocaust. The article recommends that policymakers rethink the ethical foundations at the intersection of immigration and public health law. (Olivia Pickard for The Immigrant Learning Center’s Public Education Institute)

Approaches to Protect Children’s Access to Health and Human Services in an Era of Harsh Immigration Policy, Institute of Human Development and Social Change, New York University, March 18, 2019, 26 pp. Authors:  Hirokazu Yoshikawa et al This report examines the barriers low-income immigrant children and their families encounter when trying to access social services in a climate of heightened immigration enforcement and hostility towards immigrants. The paper also outlines a wide range of strategies that can partly overcome these barriers. In the U.S., one in four children lives with at least one immigrant parent, and more than one-quarter of children of immigrants have an undocumented parent or are undocumented themselves. Recent policy changes and proposals have severely disrupted the lives and well-being of many immigrant families. Citing examples of best practices from across the country, the authors make 12 recommendations to mitigate the adverse affects that these policies have on the nearly 18 million at-risk immigrant children. Among the solutions are ensuring the confidentiality of public benefit records, expanding program eligibility through state action, easing enrollment challenges, increasing access to immigrant legal services, expanding family educational programming, providing identity documents and allowing child-only applications. In order to benefit from any of these recommendations, the authors suggest improved collaboration between community stakeholders, policymakers and immigrant individuals, as well as more robust government infrastructure, such as offices of immigrant affairs, to coordinate policy responses. (Patrick Bloniasz for the Immigrant Learning Center's Public Education Institute)

Health Justice for Immigrants, Journal of Law and Public Policy (University of Pennsylvania), 4:2 (January 2019), 78 pp. Author:Medha D. Makhlouf Should universal health coverage include immigrants in the definition of “universal?” Should federal taxpayers subsidize health insurance coverage for immigrants, even those who are undocumented? Should all immigrants be required to purchase health insurance? The author of this paper answers all these questions in the affirmative and in so doing, challenges both the cost-savings and “deservedness” arguments of restrictionists. She cites, for example, a number of studies that suggest that cost increases, such as spikes in the cost of uncompensated emergency room care, may partly or completely offset any gains to the system through the denial of benefits. She also fears that the ethos of deservedness reinforces the individualistic notion that some people, whether immigrant or not, are entitled to health care and others are not. This ethos also imposes a seemingly gratuitous punishment for lack of immigration status, above and beyond removal from the country.  The author then goes on to explicate a “health justice” framework for understanding coverage priorities -- a philosophical orientation quite different from the “individualistic” focus that seemed to dominate until the passage of the Affordable Care Act. Under this new framework, the starting point is not the health needs of the individual, however important in final outcome, but the needs of the community as a whole. “The Health Justice approach highlights evidence that disparities in access to health care do not merely affect the individuals or populations with restricted access; they can also have negative spillover effects in the general community,” such as increasing the threat of infectious disease, building antibiotic resistance, reducing worker productivity, and increasing wasteful spending and transaction costs for the entire healthcare system.

Immigrants and Public Benefits: What Does the Research Say Bipartisan Policy Center, November 2018, 18 pp. Authors: Tim O’Shea & Cristobal Ramón This review of studies on the use of public benefits by immigrants takes a look at research that has been done to examine whether immigrants use public benefits at greater rates than other groups; which groups of immigrants use public benefits; immigrants’ fiscal impacts on public benefits programs; the impact of federal and state benefits legislation on immigrants’ use of public benefits; and the impact of immigration enforcement and the complexity of benefits laws on the use of public benefits. The report concludes that whether or not immigrants are found to have a negative or positive fiscal impact often depends on who has conducted the research. For example, most studies find that individual immigrants use public benefits at lower rates and at lower levels that native-born Americans. However, other studies show that immigrant-headed households — which may include U.S.-citizen children — use public benefits at a higher rate than households headed by the native-born. The household method tends to be favored by immigrant restrictionist groups. In another example, studies come to different conclusions about the costs and benefits of immigrants depending on whether they measure costs and benefits in a moment in time or over the course of many years. An immigrant household with children in local schools might be viewed as a net cost on the one hand, but if the higher productivity, earnings, and tax payments of that educated child are factored in over the long term, there is a net benefit to the system. The report also points out some areas where additional research would be useful — including whether extending Medicaid and state health benefits to undocumented immigrants would save local governments money by lowering costs associated with the provision of emergency medical care by hospitals. (Maurice Belanger, Maurice Belanger Consulting)

Immigration as a Social Determinant of Health: Proceedings of a Workshop, National Academies of Sciences, Engineering and Medicine, 2018, 64 pp. Rapporteurs:  Steve Olson & Karen M. Anderson These proceedings summarize discussions held at a workshop on “Immigration and the Social Determinants of Health” held by the Roundtable on the Promotion of Health Equity of the National Academies in October of 2017.  The National Academies does not expect this type of workshop to reach a consensus, or to produce a set of recommendations, but rather to engage in a preliminary exploration of the issue.  Citing a meta-analysis on immigration and health that was published in 2015, one conference participant noted that research on immigrant health has largely focused on cultural practices and individual behaviors, rather than “on glaring patterns of inequality and pathogenic conditions produced by structures of poverty, immigration policy, and heavy-handed enforcement tactics.” Another participant suggested that pursuing comprehensive immigration reform should be considered a public health strategy because of the high rates of depression and post-traumatic stress caused by lack of legal status and intensified deportations. The workshop included a “world café” session featuring the work of six California organizations active in reducing health inequities:  The Alameda Health Consortium, Asian Pacific Islander Legal Outreach, the Center for Empowering Immigrants and Refugees, Centro Legal de la Raza, Culturally Responsible Care groups at Kaiser Permanente, and Filipino Advocates for Justice.

Proposed Public Charge Rule Would Significantly Reduce Legal Admissions and Adjustment to Lawful Permanent Resident Status of Working Class Persons, Center for Migration Studies, November 2018, 11 pp. Authors: Donald Kerwin et al A proposed rule issued by the Department of Homeland Security in October 2018 would broaden the ability of U.S. Citizenship and Immigration Services officers to determine that a beneficiary is inadmissible to be granted a visa, adjust status or apply for Lawful Permanent Residence (LPR) based upon the perceived risk that the individual could become a “public charge,” i.e. financially dependent upon the federal or state government for assistance. This report analyzes the implications this proposed rule could have on the immigration system and discusses the impact on two populations of immigrants that would be most affected by the change in adjudication procedure: undocumented immigrants and otherwise LPR-eligible nonimmigrants. Under the proposed guidelines, the government would consider “all the factors bearing on the intending immigrant’s ability or potential ability to be self-sufficient” -- a much broader standard than the one currently in use. The new factors would include lack of current employment or history of unemployment, lack of access to private health care, and receipt of one or more public benefits. The authors argue that the proposed DHS rule would place an undue burden on lower-income immigrants, restrict the entry of individuals within family-based categories, and have negative ripple effects on millions of other people both in the U.S. and in sending countries. The article concludes by estimating the number of individuals who could be affected by the proposed rule and providing educational, economic and employment profiles of those individuals. (Mia Fasano for The Immigrant Learning Center's Public Education Institute)

Estimated Impacts of the Proposed Public Charge Rule on Immigrants and Medicaid, Henry K Kaiser Family Foundation, October 2018, 15 pp. Authors: Samantha Artiga et al This brief provides an analysis of the potential impact of the Trump Administration’s proposed rule changes regarding what types of support can be included in determinations of how likely it is for someone applying for Legal Permanent Residency (LPR) to become a public charge at some point. Previously, housing, nutrition and health programs (including Medicaid) had been excluded from the analysis of the applicant’s economic vulnerability. Including those programs under the proposed rule would mean that 94 percent of non-citizens looking for LPR status would have at least one characteristic that could lead to their application being denied. The authors suggest that in order to maintain eligibility for LPR, non-citizen immigrants will avoid getting any support from fear of being considered a public charge. For example, they estimate that between 2.1 to 4.9 million Medicaid enrollees would disenroll, even when there may be US born children in the household that are eligible for services. This massive loss of healthcare will lead to worse health outcomes not only for those who are disenrolling, but also for their families and communities. The authors also stress that this will in turn affect housing security, educational attainment and economic productivity. In this way, perceptions of the new regulations will be just as consequential as the rule changes themselves, and the negative impacts will not be limited to members of the immigrant community that are the target of the law (Erik Jacobson, Montclair State University).

Detained and Denied: Healthcare Access in Immigration Detention, New York Lawyers for the Public Interest, 2017, 20 pp. Authors: Sola Stamm et al As the Trump administration threatens to deport an increasing number of immigrants, immigration advocates have expressed concern over the state of health care treatment within detention centers. The New York Lawyers for Public Interest (NYLPI) provides legal representation and advocacy work for undocumented immigrants in ICE custody. NYPLI reports in Detained and Denied: Healthcare Access in Immigration Detention that immigrant detention facilities often provide sub-par health care to detained individuals and fail to provide timely and adequate medical care to accommodate the medical needs of the incarcerated population. Under the 14th Amendment of the U.S. constitution, detained immigrants have a right to adequate healthcare. ICE itself also has issued official "performance-based standards" for medical care.  NYPLI collected information on the state of medical care at detention facilities through a review of complaint records and interviews with 47 individuals with serious medical conditions who were held in immigration detention in the New York metropolitan area. The researchers found recurring deficiencies in medical care, including incomplete intake assessments, lack of interpreters for patient-doctor communication, denied or severely delayed medical care, and inadequate departure planning for continuing medical care. These deficiencies, the authors argue, have endangered the lives of detainees and undermined their basic human dignity. The report concludes with a recommendation that ICE detention facilities be mandated to comply with performance standards regarding comprehensive health care and be held legally accountable for the care of detained individuals.   (Mia Fasano for The Immigrant Learning Center) Living in an Immigrant Family in America: How Fear and Toxic Stress are affecting Daily Life, Well-Being, & Health The Henry J. Kaiser Family Foundation, December, 2017, 24 pp. Authors: Samantha Artiga & Petry Ubri According to this report, immigrant families from various backgrounds are living with increased fear and uncertainty due to the current political climate. The election of Donald Trump has led to policies that increase immigration enforcement and restrict the entry of immigrants from selected countries. These policies can potentially impact 23 million non-citizens who live in the United States, as well as 12 million children who are predominantly U.S.-born. This Kaiser Family Foundation brief uses focus groups with 100 immigrant parents from 15 countries as well as 13 telephone interviews with pediatricians who serve immigrant families to understand how the political climate and enforcement policies since the 2016 presidential election impact the daily lives and health of immigrant families.  The report finds that the heightened stress many immigrant families are experiencing can have broad effects on the life and daily routine of these families. Many immigrant parents report difficulty in finding employment. Adults also feel insecure about their ability to stay in the U.S., and they limit their time outside the home to reduce risk of deportation or interaction with law enforcement. Said one Latino parent, "Before, there were many kids in the parks... but now... the kids spend more time inside these days because we are afraid of being deported." In addition, children appear to be exposed to elevated levels of toxic stress. Parents report that their children are experiencing more bullying at school, causing physiological, behavioral and mental health changes in children that can lead to compromised development and poorer mental and physical health outcomes. In response to witnessing increased racism and bullying since the 2016 election as well as changes in health care use, some pediatricians have taken steps to help immigrant families feel safe including increasing communication to reassure confidentiality, having bilingual staff welcome families, and writing letters to assist families facing deportation. (The Immigrant Learning Center's Public Education Institute) Facilitating Health Communication with Immigrant, Refugee, and Migrant Populations Through the Use of Health Literacy and Community Engagement Strategies: Proceedings of a Workshop The National Academies of Sciences, Engineering, and Medicine, 2017, unpaginated Rapporteur:  Joe Alper The goal of this workshop was to identify approaches that will enable health care organizations to serve immigrant and refugee populations "in a manner that allows all members of these communities to obtain, process, and understand basic health information and the services needed to make appropriate health and personal decisions." This publication summarizes the workshop's presentations and discussions, and highlights important lessons, practical strategies, and opportunities for using the principles of health literacy to facilitate communication with newcomer populations. In accordance with the policies of the National Academies, the workshop did not attempt to reach any conclusions or make any recommendations about needs and future directions. Rather, it simply highlights the issues identified by speakers and workshop participants and calls attention to programs and initiatives that show some promise of success.  One important concern of participants was to earn the trust of immigrant communities by responding to the climate of fear that surrounds immigrants today and to ensure that personal information, if collected at all, is safeguarded. One model program is the "You are safe here" campaign of the San Francisco Department of Public Health. Another approach is to probe more deeply into the experience of migrants, many of whom have been tortured or have suffered other forms of trauma. As one participant said, "perhaps the most important thing a clinician can do is to be curious and ask people about their experiences." The workshop gave examples of efforts to address the social determinants of health, such as the work of the California Healthy Nail Salon Collaborative.  Workshop participants also learned about efforts on the part of health care organizations to partner with community-based organizations, such as the Casa de Salud in the St. Louis metropolitan area. Finally, innovative programs to improve communication with newcomer populations, such as the Let's Talk About Medicines project of Wisconsin Health Literacy, were described. Pre-Migration Trauma Exposure and Mental Health Functioning among Central American Migrants Arriving at the US Border, PLoS One 12(1), January 10, 2017, 8 pp. Authors:  Allen Keller, Amy Joscelyne, Megan Granski, Barry Rosenfeld In recent years, the influx of families and children from Central America arriving at the U.S. border has been deemed an "urgent humanitarian situation." Examining how the experiences of migrants correspond with the requirements for asylum status can powerfully inform public discourse and policy.  This report focuses on migrants from the Northern Triangle region, formed by El Salvador, Guatemala and Honduras, and considers their pre-migration trauma, current mental health functioning, reasons for leaving the region, and rate at which they appeared to satisfy the legal criteria for asylum. Researchers interviewed 234 adults seeking assistance at the Church of the Sacred Heart in McAllen, Texas and found that 83 percent of participants cited violence as a reason for fleeing their country, 69 percent did not report violent events to the police for fear of police corruption and gang-related retribution, and 90 percent are afraid to return to their native country. Based on self-report symptom checklists, 32 percent of participants met the criteria for post-traumatic stress disorder, 24 percent for depression, and 17 percent for both disorders. When considering the data against the criteria for asylum in the U.S., researchers found that 70 percent of the overall sample met the criteria for asylum. The findings indicate that with the high degrees of trauma and psychological distress present in the population, the use of detention for these asylum-seekers may be cruel and retraumatizing. (Grace Chen for The ILC Public Education Institute) Organisational systems' approaches to improving cultural competence in healthcare: a systematic scoping review of the literature, International Journal for Equity in Health, 16:78 (2017), 19 pp. Authors: Janya McCalman, Crystal Jongen, & Roxanne Bainbridge Noting that the scope of cultural competence has expanded beyond the interpersonal domain to address system-level factors, the authors of this study set about to determine the evidence base for a systems approach to eliminating inequities in health care. A systems approach "requires an amalgamation of attitudes, practices, policies and structures to enable healthcare organizations and professionals to work effectively in culturally diverse situations." A review of the literature from 2002 to 2015, examining health care interventions in Australia, Canada, New Zealand, and the United States, produced nearly 3,000 studies touching on cultural competence in healthcare settings. However, only 141 studies appeared to focus on systems-level approaches, and of those studies, only 15 studies included evaluation measures and were deemed worthy of inclusion in the study.  Three approaches that seemed particularly efficacious were: user engagement in the development or implementation of strategies, organizational readiness, and delivery across multiple sites. However, there is a clear need for additional studies in order to bolster the case for systemic approaches to cultural competence. "...There is little guidance for healthcare organisations about how to identify what mix of cultural competence strategies works in practice, when and how to implement them properly, or whether their investment in cultural competence interventions will have the intended effects on client experiences or health outcomes." Building an Organizational Response to Health Disparities: A Practical Guide to Implementing the National CLAS Standards, National Committee for Quality Assurance, December, 2016, 59 pp. In 2013, the federal Office of Minority Health (OMH) issued the "enhanced" National CLAS Standards  (Culturally and Linguistically Appropriate Services) to guide health and health care organizations in their efforts to ensure health equity. This Toolkit, produced under OMH contract with the National Center for Quality Assurance (NCQA), provides examples of resources available to support organizations committed to the implementation of the CLAS standards. The toolkit is divided into four chapters that follow the organization of the National CLAS Standards:  Principal Standard; Governance, Leadership and Workforce; Communication and Language Assistance; Engagement, Continuous Improvement and Accountability.  Resources are categorized by the five groups that are likely to experience disparities in care:  people with disabilities, people with limited English proficiency, people with low health literacy, racial/ethnic minorities, sexual and gender minorities. The LEP section of the Toolkit provides descriptions and links to a variety of resources, including training materials and assessment tools. A panel of experts reviewed the content of the Toolkit to ensure the quality and relevance of all materials. Practicing Cultural Humility American Counseling Association, Counseling Today, December 27, 2016, 6 pp. Author: Sidney Shaw This paper endorses a revision to the Multicultural Counseling Competencies (MCCs) model, which has been a foundational document in the counseling profession for several decades. The chief flaw in the model, according to Shaw, is the "self-assessment bias" of the counselor, who typically overrates his/her abilities in relating to clients from diverse cultural backgrounds. Although the insights of MCC remain valid, they need to be supplemented with what the author calls Multicultural Orientation (MCO). This approach "privilege(s) the voice of clients and make(s) the counselor's own invisible privilege a little more visible."  It requires the counselor to practice "cultural humility," which involves "engag(ing) in collaborative, open exploration with clients regarding their cultural identity as a salient factor in treatment." It also enables counselors to practice "dynamic sizing," i.e. knowing under what circumstances to generalize cultural knowledge to specific individuals. In addition, the approach helps to reduce the number of "microagressions" (reported by more than 50 percent of racial and ethnic minority clients). The paper concludes with a number of in-session recommendations for counselors interested in embracing this new approach. Ethnic Attrition and the Observed Health of Later-Generation Mexican Americans, Institute for the Discussion of Labor, Discussion Paper No. 10062, August 8, 2016, 13 pp. Authors: Francisca Antman, Brian Duncan, & Stephen J. Trejo This study suggests that there is a bias built into many studies of the health condition of second and later generations of Mexican immigrants. These studies often show a pattern of worsening health outcomes with each successive generation. The authors point out that there is a major flaw in these studies, in that they rely on the reported ethnic self-identification of survey respondents. "Ethnic attrition" occurs whenever a U.S.-born descendent of a Mexican immigrant fails to self-identify as Mexican.  Such individuals "are generally more likely to display health outcomes closer to those of non-Hispanic whites compared with individuals who identify as Mexican Americans."  The data used in this study came from the 2000-2014 waves of the National Health Interview Survey, the major source of detailed data on a broad range of health outcomes and related characteristics of the U.S. population.  Ethnic attrition rates are greatest for children of intermarried parents. Pursuing Health Equity through Welcoming Work Welcoming America, 2016, 10 pp. Authors: M. Mayor & Jennifer Drive Pursuing Health Equity through Welcoming Work describes replicable strategies to promote health equity as part of efforts to integrate immigrants into community life. The report draws on key points from a Welcoming America panel discussion and uses data from governmental agencies and scholarly research to highlight promising practices in Georgia, Pennsylvania, Virginia and New Hampshire. The authors emphasize three key requirements for achieving health equity: involving immigrants in planning and research, overcoming social and cultural barriers, and examining the effects of social and economic policies on health outcomes. Attention to these requirements has led to successful initiatives at both local and state levels. In Atlanta, for instance, a health center worked with immigrant community leaders to implement the "promotores de salud" model. Used in Latin America to raise awareness among Latinas about reproductive health, this model has reached 11,000 community members in Atlanta. As an example of the "Health in All Policies" approach from the American Public Health Association, New Hampshire's health equity plan promotes broader agency partnerships to address the social determinants of health and provides periodic report cards to help identify issues that require follow-up action. The authors advise that immigrant and refugee voices should be at the center of local and national discussions on community health. (Jasmina Popaja for The Immigrant Learning Center Public Education Institute) Racial and Ethnic Disparities in Mental Health Care for Children and Young Adults: A National Study International Journal of Health Services, August 12, 2016, 15 pp. Authors: Lyndonna Marrast, David U. Himmelstein, & Steffie Woolhandler This study finds that black and Latino children and young adults receive substantially less outpatient mental health and substance abuse care than their non-minority counterparts, even when controlling for income and health insurance status. About 5.7 percent of white children and young adults saw a mental health specialist in a single year, compared with about 2.3 percent for black or Hispanic young people. The authors note that the prevalence of most psychiatric conditions is similar for all three groups. Among reasons suggested by the authors for these treatment disparities are:  the stigmas associated with mental illness in some groups and the shortage of behavioral health specialists in minority communities. The authors also suggest that the disparities in mental health treatment for blacks and Latinos lead to high rates of school discipline, such as suspensions and expulsions, and higher incarceration rates. For example, blacks and Hispanics account for 63 percent of children detained in juvenile facilities. "Prisons and jails," the authors argue, "have become de facto mental institutions," and the consequences for families and communities have been devastating. Integrating Health Literacy, Cultural Competence, and Language Access Services: Workshop Summary National Academies, Health and Medicine Division, July 18, 2016, 96 pp. Rapporteur:  Joe Alper This "roundtable" discussion focused on important lessons, practical strategies, and opportunities for creating greater integration of health literacy, cultural competence, and language access services in the healthcare system. Held on October 19, 2015, the workshop brought together a select group of leaders in these three fields, including academics, health care administrators, and advocates. Sponsors of the event included various agencies with the U.S. Department of Health and Human Services, as well as non-governmental organizations such as the Aetna Foundation and Eli Lilly and Company. In accordance with the policies of the National Academies of Sciences, Engineering, and Medicine, the workshop did not attempt to reach conclusions or make recommendations, but instead focused on the issues identified by the speakers and workshop participants. An initial presentation by Dennis Andrulis, senior research scientist at the Texas Health Institute, was followed by a panel discussion addressing two key questions:  what are the key concepts in this area, and what three things have changed over time to facilitate integration? Another panel featured presentations from four organizations that have made progress in achieving this kind of integration:  the National Committee for Quality Assurance, the California Pan-Ethnic Health Network, the Robert Wood Johnson Foundation, and Hofstra North Shore - LIJ School of Medicine. Upon conclusion of these sessions, three breakout groups in the areas of research, policy, and services/care were formed to discuss developments and needs in these areas. Improving Cultural Competence to Reduce Health Disparities Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services, March, 2016, 91 pp + appendices Prepared by: Minnesota Evidence-based Practice Center In furthering its mission to improve the quality, safety, efficiency and effectiveness of health care in the U.S., AHRQ conducts systematic reviews of health care research to determine its strengths, limitations, and usefulness to practitioners.  This review analyzed over 37,000 English-language citations dealing with the provision of "culturally appropriate health care" for racial/ethnic minority populations, people with disabilities, and LGBT populations. Fewer than 100 studies met the rigorous standards for inclusion in the final report. However, none of the included studies measured the effect of cultural competence interventions on health care disparities. Most of the training interventions measured changes in professional attitudes toward the population of interest but did not measure the downstream effect of changing provider beliefs on the care delivered to patients." The report concludes by suggesting a new model for research that substitutes a "relational" for an "attributional" model, i.e. instead of focusing on the internal characteristics of groups (or "culture"), which may not apply to all members of a particular group, practitioners are urged to examine "the devaluation and exclusion of these groups within the broader society." Another possible term for this approach, according to the authors, might be "diversity competence." A ‘Healthy Immigrant Effect' or a ‘Sick Immigrant Effect'? Selection and Policies Matter, Institute for the Study of Labor, September 22, 2015, 25 pp. Authors:  Amelie F. Constant et al The "healthy immigrant effect" refers to research showing that immigrants to the U.S. and other countries tend to be healthier than comparable native-born populations. In this study, the researchers attempt to tease out the reasons for this phenomenon.  Using data from the Survey of Health Aging and Retirement Europe (SHARE), the researchers compare the health status of immigrants in 16 European countries with that of immigrants in Israel. Israel provides an intriguing and "unique" case study, as it is the only country that does not screen Jewish immigrants by education level or health status. The study shows that immigrants to Israel have only a "fair" health status, compared to their counterparts in Europe who are rated as "good."  Compared to native Israelis, immigrants to Israel "have also been diagnosed with major diseases, have more medical symptoms and more mobility limitations, use more prescriptions drugs, have a higher number of hospitalizations, have lower cognitive skills, and suffer more from eyesight problems."  The researchers provide evidence that "self-selection alone does not explain the healthy immigrant effect."  Rather, the migration policy of the immigrant-receiving country may have a powerful impact on the health status of arriving immigrants. Creating Conditions to Support Healthy People: State Policies that Affect the Health of Undocumented Immigrants and their Families, UC Global Health Institute, UCLA Blum center on Poverty and Health in Latin America, UCLA Center for Health Policy Research, 2015, 22 pp. Authors: Michael A. Rodríguez, Maria-Elena Young, & Steven P. Wallace This study attempts to rank states according to their record in promoting the health of undocumented immigrants. The authors consider five areas to be important "social determinants of health," which they define as "the circumstances in which people are born, grow up, live, work, and age - and that impact immigrants' ability to live healthy lives. " The five policy areas are:  the availability of public health and welfare benefits, such as children's health insurance, prenatal care, and eligibility for SNAP; access to higher education; labor and employment practices, such as the inclusion of undocumented workers in workers' compensation laws; the availability of driver's licenses; and state legislation limiting participation in the federal Secure Communities enforcement program. The states with the highest scores were California (9), Illinois (7), Washington (4), Colorado (2), and Texas (2). The states with the lowest scores were Ohio (-7), West Virginia (-6), Mississippi (-6), Indiana (-6), Arizona, (-6) and Alabama (-6). Improving Cultural Competence: A Treatment Improvement Protocol Substance Abuse and Mental Health Services Administration (SAMHSA), 2014, 329 pp. With a mission to reduce the impact of substance abuse and mental illness, SAMSHA produces Treatment Improvement Protocols (TIPs) to provide evidence-based and best practice guidance to clinicians, program administrators, and payers. A panel of non-federal clinical researchers, clinicians, program administrators, and patient advocates debates their particular area of expertise until they reach a consensus on best practices. This particular TIP explores the importance of cultural competency in treating substance abuse and mental illness. The first chapter defines cultural competence and the rationale for pursuing it. The second chapter covers behaviors and skills for cultivating cultural competence as well as attitudes conducive to working effectively with diverse client populations. The third chapter discusses interviewing skills, assessment practices, and treatment planning. The fourth chapter discusses "top-down" organizational strategies for achieving cultural competency. The fifth chapter reviews cultural knowledge specific to individual racial and ethnic groups; and the final chapter explores the concept of "drug culture." Implementing CLAS Standards and Improving Cultural Competency and Language Access: A Practical Toolkit, Arizona Health Disparities Center, 2014, 15 pp. This publication is designed to promote use of the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS Standards) developed by the Office of Minority Health. Originally published in 2000, the CLAS standards were revised in 2013. The Toolkit includes a short history of the CLAS standards movement, the rationale for their use, as well as a side-by-side comparison of the original and revised versions of the standards. The publication also provides links to resources useful in implementing each of the 15 standards. Responding to Culture: Beyond Cultural Competence Training, Robert Wood Johnson Foundation, March, 2014, 14 pp. While cultural competence training for health care professionals may increase awareness of cultural differences and of the need to address disparities in health outcomes, it is not enough to produce real results. This is one conclusion of a national program of the Robert Wood Johnson Foundation that funded 33 organizations to examine intervention to reduce health disparities with particular focus on diabetes, cardiovascular disease, and depression.  Entitled "finding Answers: Disparities Research for Change," the program evaluated strategies used in a variety of health care settings to determine what works - and what does not - to improve prevention and care.  This report summarizes the main conclusions of this research and urges four broad "strategies for considering culture" as an integral aspect of quality improvement in health care. First, gather as much information about patients' culture through patient and community input; second, build interventions based on patients' culturally-based values, preferences, and perceptions; third, create patient educational materials  with images and language that resonate with the target population; and fourth, ensure sustainability of the overall effort especially during periods of staff turnover or changes in the patient population.  The report includes many practical examples of these strategies in action.  The website of Finding Answers has descriptions of the funded projects, as well as summaries of the published research produced by them. Hispanic Community Health Study Data Book: A Report to the Communities U.S. Dept. of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute, September, 2013, 58 pp. Described as "the largest health study of Hispanic/Latino populations in the United States,"  this publication presents data from 16,415 Hispanic adults recruited from a random sample of households in the Bronx, Chicago, Miami, and San Diego between 2008 and 2011. Participants were given the opportunity to self-identify as Cuban, Dominican, Puerto Rican, Mexican, Central American, or South American and health measures were reported accordingly. Participants were selected to be representative of the local population rather than the broader U.S. population.  Although almost 80 percent of participants were born in other countries or Puerto Rico, the data does not differentiate between native-born and foreign-born Hispanics. The primary purpose of the study was to identify the factors "that may have a protective or harmful role in the development of cardiovascular disease..." The study found that prediabetes, diabetes, and obesity were "very common" among Hispanics, with one out of three participants with diabetes unaware of having the disease.  The study also examined the prevalence of hypertension, smoking, depression and anxiety, sleep problems, and hearing problems.  Lifestyle factors such as diet and physical activity were also examined. The Affordable Care Act & Mixed-Status Families: Frequently Asked Questions (FAQs), National Immigration Law Center (NILC), October, 2013, 7 pp NILC answers sixteen FAQs about how the Affordable Care Act (ACA) affects mixed-status families in the U.S. The report defines a mixed-status family as "a household made up of individuals with different citizenship or immigration statuses."  Many of these families are unsure if and/or how they can access health insurance through the ACA without putting their undocumented family members at risk. Under the ACA "only U.S. citizens and people who are ‘lawfully present'" are eligible for health insurance. However, ineligible (i.e. undocumented) family members may complete an application on behalf of an eligible family member without being required to reveal their immigration status and risk apprehension. "The ACA codifies longstanding federal guidance, known as the Tri-Agency Guidance, which...ensure[s] that applications do not require unnecessary information from nonapplicants, because these inquiries deter eligible people from securing benefits for which they may be eligible." Therefore, any information provided on ACA applications, NILC advises,  "will not be used by U.S. Immigration and Customs Enforcement (ICE)." NILC also encourages family members to apply for Medicaid or CHIP on behalf of eligible family members.(Jade Flora-Holmquist) Is the United States Bad for Children's Health? Risk and Resilience among Young Children of Immigrants, Migration Policy Institute (MPI), July, 2013, 28 pp. Authors: Jennifer Van Hook, Nancy Landale, & Marianne Hillemeier The authors wrote this paper for a health policy symposium convened by MPI in January of 2013. The goal of the symposium was to "frame the major policy and practice issues affecting children (birth through age 10) with immigrant parents." As childhood health disparities are associated with delays in cognitive development and poor integration outcomes later in life, an examination of the health status of these children may have important public policy implications. This paper reviews the available research on health outcomes for immigrant children, with particular focus on the children of Mexican immigrants, who experience greater health risks than most other children.  Although the so-called "epidemiological paradox," i.e. the lower prevalence of several health conditions, such as allergies, asthma and learning disabilities, among the children of immigrants, is well-documented, new data is "paint(ing) a considerably more nuanced picture," especially when you dig down to the level of national origin groups. Like other children with immigrant parents, children of Mexican parents, particularly those from lower socio-economic backgrounds, show a lower incidence of asthma; however, Mexican children with the disease are "highly disadvantaged in access to high-quality care for chronic health conditions." Mexican children also have the highest prevalence of obesity among all racial/ethnic groups in the U.S. The authors review four factors that help to explain the poor health outcomes of children of Mexican immigrants: limited English proficiency of many parents, low socioeconomic status of many families, parental legal status, and the dispersion of Mexican immigrants to new destinations where they may be viewed with resentment and suspicion. The authors conclude that the fate of these children may "stand at a crossroads." As children of immigrants now make up almost one-quarter of all children, "promoting the health of children in immigrant families will maximize the long-term well-being and productivity of tomorrow's adults." Health Care for Immigrant Families: Current Policies and Issues Migration Policy Institute, June, 2013, 19 pp. Authors:  Leighton Ku & Mariellen Jewers This report assesses how the current health care system in the U.S. addresses the health care needs of immigrants. Debunking the myth that immigrants abuse health care services, the report finds that immigrants, even when covered by public or private insurance, see doctors less frequently and use emergency rooms at a lower rate than the native-born. Low-income, immigrant children with private insurance, for instance, were significantly less likely to visit a doctor's office in 2010 than low-income, native-born children at 44 percent versus 69 percent. Similarly, only 17 percent of publicly insured (Medicaid or Medicare), low-income, immigrant adults overall visited an emergency room versus 25 percent of low-income, native-born adults. Among uninsured adults, the rate was six percent for immigrants and 14 percent of the native-born. Although low levels of insurance coverage (both public and private) does in part account for low utilization of health care by immigrants, there are other reasons as well, including language barriers, cultural differences, and worries over whether utilization will lead to deportation or revocation of legal status. The authors recommend that federal and state governments expand Medicaid access to legal permanent residents; support non-profit, community health centers; and increase access to interpreters. (Denzil Mohammed) Cultural Competency and Health Literacy Primer, Maryland Office of Minority Health and Health Disparities & University of Maryland School of Public Health, March, 2013, 237 pp. Authors: Monica McCann, Olivia Carter-Pokras, Bonnie Braun, & Carlessia A. Hussein In 2012, Maryland enacted a law requiring attention to cultural competency and health literacy in the curricula of health profession degree programs.  This primer is intended to help health educators, students, and practicing health professionals learn how to reduce health disparities and improve health outcomes through culturally-sensitive and effective communication with patients across the various health disciplines. The primer is unique in merging the fields of health literacy and cultural competence, which are usually treated separately and often compete for time in already tight curricula. The primer consists of six modules of instruction: health disparities, community strategies, bias and stereotyping, effective communication skills, use of interpreters, and self-reflection and culture of health professions. Within each module, learning objectives are listed by type of competency (K = knowledge; S = skill; and A = attitude), as well as by learning stage (novice, intermediate, and advanced). The primer is a work in progress. Revisions will be made as new resources are identified for specific learning objectives and as existing resources undergo standardized review. National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care: A Blueprint for Advancing and Sustaining CLAS Policy and Practice, Office of Minority Health (OMH), U.S. Department of Health and Human Services, April, 2013, 191 pp. First developed by OMH in 2000, the national CLAS Standards have been widely circulated and implemented. In 2010, OMH launched a project to update the Standards to reflect growth in the field of cultural competency and increasing diversity in the nation.  The new Standards emerged out of an extensive consultation process with stakeholders and experts, many of whom recommended clarification as to the Standards' intention, terminology, and implementation strategies. The Standards now reflect a broader and more inclusive definition of culture, encompassing racial/ethnic, linguistic, religious/spiritual, sociological, and biological markers of difference. The Standards are also directed toward a broader audience than the original Standards, including policy makers and legislators, accrediting and credentialing agencies, educators, and community-based organizations. The 15 standards are grouped into three categories:  (1) Governance, Leadership, and Workforce; (2) Communication and Language Assistance; and (3) Engagement, Continuous Quality Improvement, and Accountability.  This publication contains both the standards and a "blueprint" for the implementation of each standard.  The Blueprint explains the purpose and components of each standard, along with model implementation practices and useful resources. The Standards themselves are also available in a separate file. Information on Small Populations with Significant Health Disparities: A Report on Data Collected on the Health of Asian Americans in Massachusetts, Institute for Asian American Studies, University of Massachusetts (Boston), November, 2012, 48 pp. Authors: Carolyn Wong, Hannah Hosotani, & John Her How can data collection procedures be improved to capture information on Asian populations with significant health disparities? Hoping that the State of Massachusetts might become a model for the country, the authors offer a number of recommendations to public authorities and private health care organizations. One is to conduct health surveys in local communities where many Asian Americans live. Another is to use categories that reflect "sensitivity to ordinary people's understandings" of their primary identity, which may not be "Asian." Another is to use interviewers speaking the languages of Asian populations, so that findings are not biased towards fluent English-speakers. And finally, academic researchers should partner with community-based organizations, especially those working in low-wage Asian communities, to gain access to hard-to-reach populations. Maximizing Health Care Reform for New York's Immigrants, New York Immigration Coalition, Empire Justice Center, & NYS Health Foundation, February, 2013, 41 pp. This paper contains a set of recommendations on how New York can maximize the inclusion of immigrants in health care reform. The authors also devote special attention to immigrants left out of federal reform. The paper is divided into five major sections: eligibility of non-citizens to participate in New York's Health Benefit Exchange; documentation and verification requirements; marketing and outreach to immigrant communities; community input and monitoring; and maintaining safety net services for the residual uninsured population. In developing these recommendations, researchers undertook a review of the literature; conducted in-depth interviews with stakeholders and experts; and analyzed the experience of three early-adopter states: Massachusetts, California, and Maryland. The authors hope that the report will serve as a "blueprint" for advocates in working with state and local government partners on health care reform, and that "New York can pave the way nationally as a model of immigrant inclusion." Promoting appropriate use of physicians' non-English language skills in clinical care: Recommendations for policymakers, organizations and clinicians, American Medical Association, 2013, 18 pp. Authors:  Marsha Regenstein, Ellie Andres, & Matthew Wynia Produced by the Commission to End Health Care Disparities, an umbrella group consisting of more than 70 state and specialty medical societies, this report seeks to improve the quality of communication and care given by bilingual physicians, who may have varying levels of ability in one or more non-English languages.  While nearly nine out of ten hospitals report using bilingual providers to treat limited English proficient (LEP) patients, very few evaluate their competence in non-English languages in any careful and systematic way.  As there are a number of groups in the process of development assessment tools for this purpose, the Commission seeks to encourage these efforts and to capture the consensus of stakeholders on effective strategies for reducing disparities in treatment and health outcome due to language barriers. The report provides separate recommendations for clinicians, healthcare organizations, and policy makers.  Among the recommendations for policy makers are: creating tools to assess and improve use of clinicians' non-English language skills, developing payment models to cover the cost of interpreter services, and collecting and recording patients' language needs at initial point of service.  Health care organizations are urged to provide training to staff on how to work with interpreters and to bring interpreters into clinical care teams.  Finally, the Commission encourages physicians to use their bilingual skills with patients "whenever doing so is safe and effective."  In order to make this determination, physicians may wish to ask a trained interpreter "to audit a handful of patient encounters and provide feedback on the quality of the communication." Finally, the Commission proposes a research agenda to clarify outstanding issues, including developing and testing "affordable and accessible (language) assessment tools for bilingual physicians and other health professionals providing care to patients with LEP." (Lorin Mordecai) Discharge, Deportation, and Dangerous Journeys: A Study on the Practice of Medical Repatriation, Center for Social Justice (Seton Hall Law School) & New York Lawyers for the Public Interest, December, 2012, 55 pp. Authors:  Pyo lee, Erica Sibley, Todd Tolin, & Sarah Vader Woud This study reviews almost 1,000 cases of forced or coerced medical repatriation, defined as the decision of a hospital to return a critically injured or ill immigrant patient back to his/her native country without consent.  Often the quality of care available to these patients is inferior, family members and support networks are missing, and patients suffer and die. According to the authors, the frequency of such cases will likely increase under the Affordable Care Act by reducing the pool of Medicaid Disproportionate Share Hospital (DSH) payments and by excluding an estimated 4.3 million undocumented immigrants from coverage. By tolerating coerced repatriation, the United States is violating its obligations under international human rights agreements. Moreover, hospitals are, in effect, preempting the authority of the federal government to deport individuals and denying them due process. In addition, hospitals often fail to inform immigrant patients of the immigration consequences of repatriation, which may include a 10-year bar on reentry to the United States. The report includes many case histories and provides a series of recommendations to the U.S. Congress, HHS, the Department of State, hospitals, states, state courts, and community groups and advocates, designed to prevent the proliferation of this practice. Black and Immigrant: Exploring the Effects of Ethnicity and Foreign-Born Status on Infant Health, Migration Policy Institute, September, 2012, 21 pp. This study challenges earlier research suggesting "superior" birth outcomes among immigrant mothers when compared to their native born counterparts. Most immigrant birth-outcome studies were based on data derived primarily from Mexican immigrant mothers.  Using 2000-2003 data from the National Center for Health Statistics, this study compares the prenatal behaviors and birth outcomes (preterm birth, low birth weight, and small for gestational age) of non-Hispanic Black immigrant mothers to those of non-Black immigrants and both Black and non-Black US-born mothers. The findings indicate that Black foreign-born mothers show a slight health advantage over Black US-born mothers, and the author suggests that lifestyle choices among Black immigrant mothers, such as lower rates of smoking, may play a role in better birth outcomes when compared to their US-born counterparts. However, the author notes a lower likelihood among foreign-born Black mothers of beginning prenatal care during the first trimester when compared across all groups.  The study also finds that the health advantages of Black immigrant mothers disappear when compared to most non-black foreign-born mothers, mirroring the "infant-health gap observed among US-born Black and non-Hispanic white mothers." The author suggests that these disparities have a wider implication for the health of the overall Black population residing within the US, and calls for further research to investigate the "socioeconomic mechanisms" behind these inequities. (Dan McNulty)   Enhancing the Delivery of Health Care: Eliminating Health Disparities through a Culturally & Linguistically Centered Integrated Health Care Approach: Consensus Statements and Recommendations, Office of Minority Health (OMH) & Hogg Foundation for Mental health, June, 2012, 28 pp. This is the fourth in a series of OMH-sponsored reports addressing the mental health needs of underserved populations.  This report grew out of a two-day expert panel meeting in 2011 looking at "the integration of behavioral health and primary care services for racial and ethnic minority populations and those with limited English proficiency."  A companion technical report reviewing the literature on integrated approaches was also prepared.  Among the key elements of such an integrated approach are: the deployment of an integrated care team, consisting of multi-disciplinary and cross-trained practitioners in both physical health and behavioral health; use of a single patient health and behavioral health history; and development of unified treatment plan. The report recommends specific strategies to enhance cultural and linguistic competence at the individual, community, practice, system, and workforce levels.These strategies are illustrated with examples of how specific organizations have utilized these strategies in real world settings. Community-Defined Solutions for Latino Mental Health Care Disparities, UC Davis Center for Reducing Health Disparities, 2012, 79 pp. In order to reduce mental health disparities in minority populations, the California Department of Mental Health (Office of Multicultural Services) launched the California Reducing Disparities Project, which established five Strategic Planning Workgroups (SPWs) to study the following populations: African Americans, Asian/Pacific Islanders, Latinos, LGBTQ, and Native Americans. Funding for the project was provided by Proposition 63, better known as the Mental Health Services Act, passed by the California voters in 2004. With staff support provided by the UC Davis Center, the 15-member Latino SPW got off the ground in 2009, quickly followed by the creation of a stakeholder group called the California Latino Mental Health Concilio. The goal of the project was to identify "community-defined, strength-based promising practices, models, resources, and approaches that may be used as strategies to reduce disparities in mental health."  The report's conclusions were shaped by input from more than 550 Latinos who participated in community forums conducted in 13 cities and two high schools throughout the state. According to the authors, this study is "the first of its kind to use a community-based, grassroots approach to identify barriers and seek solutions to mental health care needs in historically unserved or underserved Latino communities."  Stressors associated with immigration, undocumented status, and poverty receive considerable attention in the study. Based on evidence gathered from community informants and a literature review, the study recommends six "core strategies" and seven "strategic directions" for adoption by stakeholders. The study concludes with capsule summaries of 16 programs in California that satisfy its seven-point criteria for being listed as promising in nature. Health Care and the Illegal Immigrant, Georgetown University Law Center, March, 2012, 60 pp. Seeking to "steer a middle course between the rhetorical extremes of the health care and immigration debates," the author of this article, Patrick J. Glen,  examines two questions in depth: first, whether unauthorized immigrants have a legal  or constitutional claim to health benefits when they lack status in a country; and second, whether there are compelling economic and public health reasons for providing such benefits. The first section of the article discusses constitutional precedents relevant to the legal question both in the Canadian and U.S. contexts, including a lengthy discussion of the 2010 Toussaintdecision by the Canadian Federal Court barring an unauthorized immigrant from accessing the Canadian health care system. The author concludes that deference to the authority of legislatures to set limits on alien access to benefits is a precedent that will be hard to overturn. However, "under the U.S. Constitution and Canadian Charter no provision mandates that public coverage be extended to illegal immigrants, but nothing forbids that choice as a matter of policy."  And here the author feels there are persuasive arguments for providing coverage, including the counterintuitive idea that such coverage would actually lower costs to the overall healthcare system. Unauthorized immigrants, who are relatively healthier and younger than the general population, would increase the risk pool for insurance, thereby helping to subsidize the sick. Moreover, by using more preventive services, unauthorized immigrants would drive down the cost of more expensive emergency room and acute care services. Finally, the author suggests that extending health care benefits to this population would contribute to public health generally by allowing all people to have access to primary care, thereby reducing the threat of infection and contagious disease. Language Proficiency and Health Status: Are Bilingual Immigrants Healthier? (Article available by subscription only), Stanford University and Rice University, March, 2012, 36 pp. Increases in English fluency are often associated with progress in acculturation and improved health for immigrant populations in the United States.  However, as English fluency increases, native language fluency may decrease, producing possible negative effects on both physical and mental health.  This article seeks to examine the effect of both English and native language fluency, or simultaneously maintaining native language fluency while increasing English language fluency, on self-rated physical and mental health for immigrant populations.  The authors examine the effect of language proficiency while controlling for mediating variables such as socioeconomic status, family and social supports, stress, discrimination, age at migration, and country of origin.  Findings indicate that those who are bilingual, or proficient in both their native and English languages, report better health on both physical and mental health self-rated scales, as compared to those who are native language dominant or English language dominant.  These findings are consistent with other studies on biculturalism, that indicate that those who simultaneously maintain strong ethnic identities while also acculturating into their host society show improved psychosocial well-being. (Patricia Lundgren)  A Pastoral Education Guide: Responding to the Mental Health Needs of Multicultural Faith Communities, NY State Office of Mental Health, The Nathan Kline Institute for Psychiatric Research, Center of Excellence in Culturally Competent Mental Health, October 12, 2011, 24 pp. This guide and accompanying workbook describe several paths that faith leaders can follow to assist multicultural congregants in addressing mental health needs. The guide briefly discusses the impact of culture on mental health which, the authors suggest, influences how the symptoms of mental illness are experienced and how various coping strategies and help-seeking behaviors are likely to be perceived. Other barriers, such as fear of being stigmatized, lack of knowledge of community resources, and limited English proficiency can all present challenges to receiving care. Additionally, the authors note, mainstream providers are often unaware of culture's relationship to mental health, which can result in poor treatment outcomes. Through case studies, the guide introduces four pathways that faith leaders can take to identify and address concerns within their diverse faith communities, including: giving comfort and counsel to affected individuals;  recognizing and referring mental health problems; serving as a "religion and cultural liaison" to mental health providers; and supporting care and promoting recovery through a welcoming congregation.  In the guide's accompanying workbook, the authors provide several training tools to help leaders recognize mental distress; elicit information on cultural, religious, and spiritual beliefs; and develop a community action plan for addressing mental health treatment and recovery. (Dan McNulty) Implementation Guidance on Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status, U.S. Department of Health and Human Services (HHS), Office of Minority Health, October, 2011, 10 pp. After a careful review, with more than 400 public comments on draft standards, HHS adopted final data standards for race, ethnicity, sex, primary language and disability status. The new standards permit the collection and analysis of data about ethnic groups within the broader Hispanic, Asian, and Pacific Islander populations. The standards are designed to reveal disparities in health status among people in specific groups, whose conditions are often masked in current data collection practices, and to facilitate the development of targeted interventions to reduce these disparities.  The new standards were required under Section 4302 of the Affordable Care Act. Addressing Health Disparities and Health Literacy Challenges in the South Asian Community: Conference (October 9, 2010) Summary Report and Recommendations South Asian Total Health Initiative, UMDNJ, and other sponsors, June, 2011, 28 pp. This report provides detailed summaries of all conference plenary and workshop sessions. The conference drew 126 participants, including 28 faculty members.  Plenary sessions dealt with the meaning and significance of health literacy in multicultural communities, the state of current research on the subject of health disparities in South Asian communities, and innovative models for reaching these communities. Three workshops focused on health disparities in diabetes, cancer, and tuberculosis. Another three workshops discussed innovative strategies to address health disparities, including complementary and alternative medicine, chronic disease management, and the development of multimedia solutions for health promotion. The report concludes with a series of recommendations relating to policy planning and resource development, data collection and research, community education and professional training, and networking and partnerships. Assuring Health Equity for Minority Persons with Disabilities: A Statement of Principles and Recommendations, U.S. Dept. of Health and Human Services Advisory Committee on Minority Health (ACMH), July, 2011, 17 pp This is the third in a series of reports by ACMH designed to ensure that health care reform responds to the needs of vulnerable populations.  While people with disabilities experience worse health outcomes than the general population, the report finds that "minorities with disabilities are doubly burdened by their minority status." The report makes five recommendations: first, raise awareness about the health inequities experiences by persons with disabilities, especially minorities;  second, improve care and treatment by devoting attention  to "the culturally specific differences among people with disabilities, and among subgroups of that population;"  third, require cultural competency for all health care providers and professionals; fourth,  improve research and practice on disabilities in minority populations; and fifth, strengthen the health care workforce to ensure high quality care for people with disabilities.   Educating Clinicians About Cultural Competence and Disparities in Health and Health Care (Abstract Only), Journal of Continuing Education in the Health Professions, 2011, 12 pp. Authored by Robert C. Like, Professor and Director of the Center for Healthy Families and Cultural Diversity, UMDNJ, this paper outlines the role that the continuing medical education (CME) profession can play in reducing disparities in service access and health outcomes. The paper reviews CME initiatives in cultural competency around the country, discusses the reaction of medical professionals to them, and makes a series of thoughtful recommendations to improve their effectiveness. Among these recommendations are the development of "a new type of ‘participatory CME' through active engagement and collaboration with patients, consumers, and advocates as the ‘faculty experts'..." and greater use of social media to facilitate on-going communication on cultural competency among medical professionals. National Standards for Healthcare Interpreter Training Programs, National Council on Interpreting in Health Care, April, 2011, 38 pp. The publication of these standards culminates a two-year process, involving a review of existing training curricula, consultation with an expert advisory committee, the convening of ten focus groups, and online surveys seeking feedback on draft standards.  The standards are intended to apply to all preparatory training programs regardless of their duration or sponsorship. They cover core content to be mastered before an aspiring interpreter begins professional work in the field.  More demanding areas of healthcare interpreting, such as proficiency in simultaneous interpreting, are omitted from the standards because they may be addressed in advanced training.  In addition to content standards in such areas as modes of interpreting, message conversation, and interpreting ethics, the document also outlines a set of recommended instructional strategies, as well  as guidelines for program design and operation.  The Council recommends some flexibility in implementing the standards for speakers of "languages of lesser diffusion." National Immigration Policy and Access to Health Care: A Position Paper, American College of Physicians (ACP), 2011, 18 pp. Honoring medical ethics and mindful of legal requirements under EMTALA (Emergency Treatment and Active Labor Act), the ACP -- the nation's largest medical specialty society representing 130,000 internists -- developed this position paper to voice concerns over "unsustainable" policies limiting immigrant access to health care. The College, for example, opposes provisions of the Affordable Care Act barring undocumented immigrants from paying out-of-pocket for health insurance coverage. The College also opposes any effort to require physicians to report on the legal status of their patients. The College also laments the low levels of insurance coverage for the U.S. born children of immigrants, many of whose parents refrain from seeking coverage for their children out of fear of possible deportation. Another issue of concern to ACP is the absence of testing for communicable diseases, and low levels of vaccinations, among undocumented immigrants - gaps in the health care system that threaten the health status of all Americans.  Finally, ACP urges the federal government to strengthen the network of safety-net health care facilities around the country that provide primary care for the poor and uninsured. The Health of the Newest New Jerseyans:  A Resource Guide, Center for Health Statistics, Office of Policy & Strategic Planning, NJ Dept. of Health and Senior Services, February, 2011, 72 pp. This report provides detailed information on the health status of foreign-born residents of New Jersey. With the exception of infectious disease and HIV/AIDS, where nativity data is lacking, the report covers a wide array of illnesses, such as heart disease, stroke, diabetes, and cancer, and provides incidence data both by race/ethnicity and by nativity.  Most comparisons are between native-born and foreign-born in broad racial/ethnic categories, i.e. Black, White, Hispanic, and Asian. Health outcomes for specific national groups are not given, even though the report notes that "each foreign-born group comes to the U.S. with its own health advantages and health disadvantages." In general, "overall health outcomes for the foreign-born for many leading causes of mortality and morbidity are quite favorable."  However, the longer the period of residence in the United States, the more the foreign-born appear to resemble the native-born. "As time spent in the United States increases, nativity differences in health diminish." Culturally Effective Care Toolkit American Academy of Pediatrics, 2011, 22 pp. The Academy describes this publication as a "practical, hands-on resource to help practicing pediatricians and their office staff provide culturally effective care to their patients and families."  The toolkit provides short summaries of key issues, such as health beliefs and practices, nutritional questions, child development and mental health norms, interpretive services, and health literacy. The toolkit includes a selected listing of supplemental tools and resources in each area. Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals, The Joint Commission, August, 2010, 93 pp This report culminates a multi-year project of The Joint Commission to develop new accreditation standards for hospitals for addressing the language and communication needs of diverse patient populations. This publication provides guidance to hospitals in complying with the new standards. Each of six chapters covers a separate component on the continuum of care:  admission, assessment, treatment, end-of-life care, discharge and transfer, and organizational readiness. The report urges hospitals to "embed effective communication, cultural competence, and patient- and family-centered care practices into (their) core activities," rather than viewing them as stand-alone initiatives. Copies of the old and new standards are included in the appendices to the publication, along with explanations as to why particular standards were revised. The new standards were approved in December 2009 and released to the field in January 2010. They will be published in the 2011 hospital accreditation manual, initiating a pilot implementation phase. Full implementation is expected to occur in 2012. DiversityRx has produced an informative webinar about the new standards. A System of Care Team Guide to Implementing Cultural and Linguistic Competence(CLC), Technical Assistance Partnership for Child and Family Mental Health, July, 2010, 14 pp. This Guide offers practical suggestions as to how local communities can organize to deliver culturally and linguistically competent mental health care.  It discusses the role and compensation of the CLC Coordinator;  budgeting suggestions for CLC; the role of the CLC committee;  the importance of the CLC plan; and examples of how all staff members and community partners can contribute to the goal of CLC. The Guide provides links to many tools and templates, including  a sample CLC coordinator position description, suggested hiring tips, and a CLC budget spreadsheet. The Partnership operates under contract with the federal Child, Adolescent and Family Branch, Center for Mental Health Services (SAMHSA),  U.S. Dept. of Health and Human Services. The High Costs of Language Barriers in Medical Malpractice, National Health Law Program & School of Public Health, University of California, Berkeley, 2010, 21 pp. This study analyzed 35 closed claims of medical malpractice based on inadequate language assistance. The claims were against a single insurer operating in four states in the West.  All claims were adjudicated between 2005 and 2009. Major themes in the cases included the following: "failure to provide competent oral interpretation; failure to provide written translations of important documents, e.g. informed consent forms and discharge instructions; inadequate documentation; and allegations of discrimination."  The insurance carrier paid out over $5 million in damages, settlements, and legal fees on the 35 cases. What's in a Word? A Guide to Understanding Interpreting and Translation in Health Care, National Health Law Program in cooperation with NCIHC and ATA, April, 2010, 27 pp. This guide is designed to clarify the differences and commonalities between interpreting and translation, to identify the skill sets required for each, to identify standards of practice, to review progress towards national certification, to define the role and functions of the interpreter and translator, and to summarize the modes and methods of interpreting and translation. A final section of the guide discusses procedures for hiring interpreters and translators. Confronting Inequities in Latino Health Care, Special Issue of the Journal of General Internal Medicine, Abstracts and links to in-depth news releases on each article, October, 2009, 4 pp. An important theme of this series of articles is that the country of birth and immigration status of Latinos affect the quality of health care they receive in the U.S. The nine studies examine topics such as rates of hypertension, diabetes, health insurance coverage, discrimination, quality of care, and spiritual beliefs. Predictably, lack of insurance and undocumented status are associated with poor health outcomes. The authors argue for attention to the needs of the Latino population in the current health care reform debate. Moving to the Land of Milk and Cookies:  Obesity among the Children of Immigrants, Migration Policy Institute, Sept., 2009, 8 pp Based on a federal longitudinal study of 21,000 children from kindergarten to 8th grade, 25% of whom were children of immigrants, this study concludes that children of immigrants are a high-risk group for obesity, and that poverty doesn’t fully explain their vulnerability. Obesity cuts across all socio-economic levels, but tends to be higher among boys, Hispanics, and non-Hispanic whites. By 8th grade, 49% of immigrant boys were obese or overweight, compared to 33% of native-born. The authors speculate as to causes, e.g. "many immigrants originate from countries in which food insecurity and stunting pose significant health risks to children, so they may be unaccustomed to protecting children from the opposite problem that comes from overeating." The Health and Cognitive Growth of Latino Toddlers:  At Risk or Immigrant Paradox? Bruce Fuller et al, Maternal and Child Health Journal, June 25, 2009, 14 pp. Looking primarily at Mexican immigrant mothers, most living in households earning $25,000 or less annually and with limited educational backgrounds, the authors of this study explore the causes and consequences of "the immigrant paradox," i.e. the fact that Mexican and other Latino immigrant newborns display robust birth weight and low mortality compared to whites and African-Americans.  The study finds that these early advantages do not persist over time. Instead, these children at 24 months of age display higher rates of obesity and asthma and lagging cognitive development.  These results have important implications for federal policy makers interested in designing effective intervention strategies.     State Practices in Health Coverage for Immigrants: A Report for New Jersey, Rutgers Center for State Health Policy, June, 2009, 29 pp. This report surveys the landscape of health coverage for immigrants in New Jersey. Although New Jersey provides more public coverage and safety net programs for immigrants than most other states, New Jersey appears to lag behind other states with large immigrant populations in its outreach and enrollment success. The report contains descriptions of outreach strategies employed in California, Illinois, Massachusetts, and New York, and concludes that "culturally-attuned outreach efforts and improved enrollment processes" will be "critical factors in the success of any public program to cover immigrants and their children." An earlier CSHP reportprovided esimates of children and parents without health insurance in New Jersey, including non-citizens. NJ FamilyCare Outreach, Enrollment and Retention Report, Submitted by the Outreach, Enrollment and Retention Working Group in Response to the New Jersey Health Care Reform Act of 2008, NJ Office of the Child Advocate, May, 2009, 32 pp + appendices Created under a provision of the NJ Health Care Reform Act of 2008, this Working Group was charged with developing a plan to improve outreach to low and moderate income families eligible to participate in NJ FamilyCare. One of the subcommittees of the Working Group examined the challenge of  "Overcoming Barriers to Immigrant and Minority Access" (OBIMA).  The report contains numerous recommendations, either building on existing initiatives or employing new approaches based on successful outreach strategies used in other states. The report also emphasizes collaboration among various departments of state government, such as the Department of Education which tracks the location of limited English proficient students in local school districts, and urges expanded use of incentives to community-based organizations to enroll uninsured individuals. Improving Access to Language Services in Health Care: A Look at National and State Efforts, Policy Brief, Mathematica Policy Research, Inc., April, 2009, 10 pp. This policy brief focuses on the three states that have been most active in legislating access to language services in health care:  California, Minnesota, and New York. The authors discuss the history and scope of various legislative initiatives in those states. They also identify key challenges facing states and stakeholders seeking to develop language services, including setting up information technology systems to support the collection and management of data on primary language, promoting appropriate use of language services by clinical staff, ensuring the quality of language services, and developing payment mechanisms for language services. The State of Asian American, Native Hawaiian and Pacific Islander Health in California Report, A report from the California Asian Pacific Islander Joint Legislative Caucus, Prepared by the University of California Asian American Pacific Islander Policy Multi-Campus Research Program, Health Work Group, April, 2009, 67 pp. By disaggregating California's Asian American Pacific Islander group, comprising over 14% of the state's population, into some of its many ethnic sub-groups, and investigating the health characteristics of each group, this report sheds important light on the health needs of particular communities and appropriate policy responses to those needs. Koreans and Vietnamese, for example, have uninsured rates higher than the state average. Filipinos have high obesity and smoking rates. Childhood asthma rates are highest among South Asians. Vietnamese experience mental distress at higher rates than other groups. The authors urge further efforts to disaggregate other communities, particularly the South Asian category, into Indian, Pakistani, Bangladeshi and Sri Lankan sub-groups.   More than Words Toolkit Series, Hablamos Juntos, April 2009 This series of 7 short publications outline the requirements for effective document translation, a process often approached haphazardly and without full understanding of its complexity. Tool One (Getting Started with Translations in Health Care) lays out the basic steps in the process, cautions against use of unqualified bilingual staff as translators, and emphasizes the importance of document meaning, context and purpose, as opposed to "word-for-word replacement operations." Tool Three (Developing the Translation Brief: Why and How) describes how to provide formal instructions for the translator, based in part on an analysis of potential "source culture bias" in the original document. Tool Six (Assessing Translation - A Manual for Requesters) outlines a tested procedure for evaluating the quality of translations. A Comprehensive Framework and Preferred Practices for Measuring and Reporting Cultural Competency, National Quality Forum, April, 2009, Public Version, 11 pp. In an attempt to "bring the cultural competency movement to the next level," the National Quality Forum (NQF), a broad-based coalition of stakeholders in the healthcare industry dedicated to the definition and measurement of quality care, has produced this "comprehensive framework – a road map – for measuring and reporting cultural competency." The framework consists of four guiding principles, and 45 endorsed practices within seven domains: leadership, integration into management systems and operations, patient-provider communication, care delivery and supporting mechanisms, workforce diversity and training, community engagement, and data collection. The framework is intended for all healthcare organizations, but has applicability to the broader human service field. The significance of this document is that NQF standards become the primary standards used to measure the quality of healthcare in the United States. Full report is available by purchase only. Webinars on Language Access in Health Care, Polyglot Systems, 2008-2009. A for-profit language technology provider for health care organizations, Polyglot Systems has produced a series of five free webinars on the subject of language access for hospital patients. Each webinar features national experts in the field. Among the topics covered are:  language and cultural barriers in health care: a growing crisis (September 18, 2008), leveraging data to improve the quality and availability of language services (November 18, 2008), using technology to improve language access (December 9, 2008), the Prolingua platform for hospital admissions and patient instructions (January 9, 2009), and funding sources for language services (April 1, 2009). Undocumented Immigrants in New Jersey's State and County Psychiatric Hospitals, New Jersey Department of the Public Advocate, February, 2009, 11 pp. This report examines the plight of 55 undocumented immigrants in state psychiatric hospitals, deemed medically ready for release into less costly residential health care facilities but who cannot be placed into such facilities because of their lack of eligibility for federal benefits. In some instances, patients were in (or eligible for) legal status at one time, but lacked the capacity to file the necessary legal papers. Among the recommendation in this report are the assignment of staff to work exclusively with this population and the possible establishment of a state-funded community placement option for such patients, which might prove more cost effective than prolonged hospital stays. Robert Like, MD, et al,  "Educating Physicians to Provide Culturally Competent, Patient-Centered Care," Perspectives (New Jersey Association of Family Physicians), Summer, 2008, 11 pp. In 2005, the New Jersey legislature passed a law requiring all physicians to complete cultural competency training as a condition of re-licensure and mandating the inclusion of such training in the curriculum of New Jersey medical schools. This article reviews the requirements of the law, as well as related legislation elsewhere in the United States One of the six required New Jersey training areas deals with techniques for overcoming language barriers, including best practices in working with interpreters.  The article features a extensive listing of web-based continuing education and professional development courses in cultural competence in health care.  Cultural and Linguistic Competence Implementation Guide, Technical Assistance Partnership for Child and Family Mental Health, January, 2008, 116 pp. In sponsoring this Guide, the Child, Adolescent and Family Branch of the Center for Mental Health Services (SAMHSA) noted that the mental health field "has changed little" since the 1989 release of Towards a Culturally Competent System of Care, and that "there is still only limited understanding of how to operationalize cultural competence." The Guide is organized around six domains:  governance and organizational structure; services and supports; planning and continuous quality improvements; collaboration; communication; and workforce development. Within each domain, the Guide provides specific implementation strategies and related performance indicators, along with examples of best practices in the field. The major premise of this Guide is that Cultural and Linguistic Competence (CLC) must be infused through every aspect of the mental health system of care. "This requires transformation at the policy, administrative, practice, and consumer levels of service."   Summary of State Law Requirements Addressing Language Needs in Health Care, National Health Law Program, January, 2008, 137 pp. This report summarizes legislation on language access in all 50 states. It updates earlier reports done in 2003 and 2005. A short introduction identifies major trends and noteworthy initiatives (Currently available for purchase only)   One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations, The Joint Commission and The California Endowment, 2008, 60 pp. Based on research conducted at 60 hospitals in the United States, this report recommends a common planning framework to address the growing linguistic and cultural diversity of hospital patients. The report argues that planning must be on-going and that solutions must be tailored to the needs and circumstances of individual hospitals.   Serving Patients with Limited English Proficiency:  Results of a Community Health Center Survey, National Association of Community Health Centers (NACHC), June 16, 2008, 19 pp. Representing over 1,150 community health centers in the United States, NACHC undertook a survey of its membership to determine the extent to which limited English proficient patients are served by local centers and the range of techniques used to bridge the language gap. Among other things, the report found that one in every three patients seen in local centers is LEP, and that 74% of centers use bilingual nonclinical staff, 59% use bilingual clinical staff, 47% use staff interpreters, 27% use telephonic and/or video services, and 15% use external language agencies. Hospitals, Language, and Culture: A Snapshot of the Nation, The Joint Commission, 2007, 107 pp. This report analyzes how 60 selected hospitals around the country are providing health care to culturally and linguistically diverse patients and offers recommendations for improving hospital responsiveness to this patient population. Language Services Resource Guide for Health Care Providers, National Health Law Program, October, 2006, 186 pp. This useful guide contains state-by-state listings of language service associations, providers, and trainers. It also includes a directory of web-based health information resources in foreign languages. Other sections cover assessment tools and signage.  Certification of Health Care Interpreters in the United States: A Primer, a Status Report and Considerations for National Certification, The California Endowment, September, 2006, 95 pp. Author Cynthia E. Road compares and contrasts nine different existing certification programs for health care interpreters, as well as the eight state certification programs that were in various stages of development at the time of publication. She also explains the various strategies for providing quality assurance in interpreting, of which certification (assessment) is only one part. These strategies include appropriate recruiting, language screening, training, monitoring, and continuing education. Globalization, Migration Health, and Educational Preparation for Transnational Medical Encounters, Peter H. Koehn, Global Health 2006 2:2 This article argues for a new paradigm in medical training called “transnational competence (TC).”  Noting that more than 700 million people cross international borders every year, whether as visitors, businesspersons, or immigrants, the author argues that the quality of health care, as well as the success of disease prevention efforts, hinge on the ability to identify “ the special circumstances that surround and define each individual’s health.”   According to the author, TC as a model is preferable to traditional culture-competence education, which tends to reify cultural characteristics within particular groups, ignoring intra-group variations,  as well as differences of class, generation, experience, and education. The author proposes a far-reaching set of reforms in medical school education designed to prepare a new generation of medical students for “ethnically and socially discordant clinical encounters.” Straight Talk: Model Hospital Policies and Procedures on Language Access, California Health Care Safety Net Institute, 2005, 61 pp. Drawing on the expertise of "best practices" hospitals around the country, the California Health Care Safety Net Institute, the educational and research affiliate of the California Association of Public Hospitals and Health Systems, issued this set of model policies and procedures on language access to guide its membership. The Interpreter's World Tour:  An Environmental Scan of Standards of Practice for Interpreters,  Publication of The California Endowment for the National Council on Interpreting in Health Care, March, 2005, 44 pp. As part of an effort to draft a national code of ethics for interpreters in health care, this project reviewed 145 standards documents in 11 languages from 25 countries, including 36 U.S. states. The scan was inclusive of all fields of interpreting. The scan uncovered both similarities and contradictions in these documents. Bridging the Cultural Divide in Health Care Settings:  The Essential Role of Cultural Broker Programs, National Center for Cultural Competence, Georgetown University Center for Child and Human Development, Spring/Summer 2004, 39 pp. Defining cultural brokering as "the act of bridging, linking, or mediating between groups or persons of different cultural backgrounds for the purpose of reducing conflict or producing change," this report spells out the four primary functions of cultural brokers (liaisons, cultural guides, mediators, and catalysts for change) and the many contexts in which they work. Most cultural brokers assume multiple roles and may not work exclusively as cultural brokers. Cultural brokers, for example, may be health care professionals, social workers, or community members. They may work at community health centers, hospitals, government offices, community-based organizations, or religious institutions. The report features numerous case examples of successful cultural brokering initiatives. The authors also see cultural brokering as an "essential" to the reduction of health disparities for racial and ethnic populations. Language Access: Helping Non-English Speakers Navigate Health and Human Services, National Conference of State Legislatures, January, 2003, 24 pp. As the U.S. population has become more diverse, language has emerged as a critical factor in health care access and quality. This report indicates that the language gap can lead to delays in or denial of service, unnecessary tests, more costly or invasive treatment of disease, racial or ethnic disparities in insurance, and other problems. The report surveys the demographic landscape and current governmental efforts to address language access, focusing on four states that are using federal matching payments from Medicaid and SCHIP to pay for language interpretation. The report also outlines "next step" options for states and the federal government. Health Care Access for Immigrants and Refugees: A Guide to Understanding Eligibility for Health Care in New Jersey, New Jersey Immigration Policy Network, 2001, 62 pp. This guide was designed to help health outreach workers and immigrant advocates in New Jersey to understand the sometimes intricate rules surrounding immigrant eligibility for health benefits, especially in the aftermath of the 1996 welfare reform legislation. National Standards for Culturally and Linguistically Appropriate Services in Health Care, Final Report, Office of Minority Health, U.S. Dept. of Health and Human Services, March, 2001, 132 pp. In 1997, the Office of Minority Health (OMH) began a study and consultation process leading to the publication of this standard-setting document four years later. A prime motivation for this project was widespread dissatisfaction with the earlier patchwork of standards that often left health care providers without clear guidance as to what constitutes culturally and linguistically appropriate services (CLAS). OMH consulted with numerous stakeholders in the field, and after publication of draft standards in the Federal Register, received comments from 413 individuals and organizations. The standards were published in final form in 2000. The 14 standards are organized by themes:  Culturally Competent Care (1-3), Language Access Services (4-7), and Organizational Support for Cultural Competence (8-14). Part II of the Report discusses each standard in detail, covering intent, supportive research, and implementation issues.

There is No Safety Here:  The Dangers for People with Mental Illness and Other Disabilities in Immigration Detention at GEO Group’s Adelanto ICE Processing Center, Disability Rights California, March 2019, 58 pp. Authors: Aaron J. Fischer et al One of the largest immigrant detention facilities in the country (and the largest in the State of California) is the Adelanto detention facility in the City of Adelanto in San Bernandino County. Operated by the GEO Group, a private contractor, the facility houses an average detainee population of almost 2,000.  Since the Trump administration ended prosecutorial discretion and ramped-up immigration enforcement, the number of detainees with disabilities or mental illness in federal detention facilities has risen, raising questions as to whether these facilities are following federal guidelines in treating this population. Media reports and the government’s own internal investigative reports suggest widespread abuse of detainees with disabilities. This situation prompted Disability Rights California (DRC), the state designated protection and advocacy organization for people with disabilities, to undertake an investigation of conditions at the Adelanto facility. DRC conducted four site visits to Adelanto and interviewed over 100 detainees as part of its investigation. They concluded that people held at Adelanto are subject to punitive, prison-like conditions that harm people with disabilities. Moreover, Adelanto has an inadequate mental health care medical health care system, made worse by the facility’s harsh and counter-therapeutic practices. The investigators also found that the GEO group significantly underreported data on the number of suicide attempts at the facility. The investigators found that Adelanto’s system fails to comply with disability antidiscrimination laws, as well as with ICE’s own detention standards regarding the treatment of people with disabilities.

The Aging Apple: Older Immigrants a Rising Share of New York's Seniors, Center for an Urban Future, May, 2017, 10 pp. Author: Christian González-Rivera This data brief updates an earlier (2013) report on New York's immigrant senior population. Immigrant seniors now represent an even larger share of the total senior population in the city, reaching almost 50 percent of the total (up from 46 percent in 2010).  The data brief reports trends in the senior population by nativity for the five boroughs, for particular neighborhoods, and for selected countries of origin. As a group, immigrant seniors are 1.5 times as likely as native-born seniors to be poor, and almost two out of three speak English less than very well, creating challenges for organizations trying to serve them effectively. The median income of immigrant seniors citywide is $10,800, roughly half that of native-born seniors, which is $20,800. One reason for the gap is the fact that 33 percent of older immigrants do not qualify to receive Social Security benefits, compared to 17 percent of native-born seniors. The New Face of New York's Seniors, Center for an Urban Future, July, 2013, 36 pp. Author: Christian Gonzalez-Rivera  The New Face of New York's Seniors by the Center for an Urban Future shows that, in the nation's most populous and diverse city, immigrant seniors are a surprisingly large share of the aging population. Census data shows that one in 10 older immigrants in the country calls New York City home. Immigrants comprise nearly half a million, or 46 percent, of the city's senior population. Indeed, the median age of the city's immigrant population (43) is 14 years higher than that of the native-born population (29). Informed by interviews with over 50 people active in the field of senior services, the report argues that the city is not devoting sufficient attention to the health and well-being of its immigrant population. Immigrant seniors have lower incomes, less in retirement savings, and receive fewer benefits from Social Security and Medicare. Their limited English proficiency prevents them from accessing adequate healthcare, housing and even meals appropriate to their religious beliefs or medical conditions. The authors recommend that the city prioritize outreach and service to immigrant seniors in its already commendable senior services programs. Such an initiative would include strategies for increasing the level of, and access to, government benefits; improving access to translators; taking advantage of technology to help older adults access services; updating city housing regulations to allow extended families to live together; funding library-based English language courses especially designed for the senior population; and funding capacity-building for, and service delivery by, promising immigrant community-based organizations.  (Denzil Mohammed)  Senior Immigrants in the United States, Migration Policy Institute, May 30, 2012, 10 pp. After declining from 1960 to 1990, the number of older immigrants nearly doubled from 1990 to 2010.  The immigrant share of the elderly population in the U.S. is now 12 percent. This report provides a statistical portrait of the senior immigrant population, mostly drawn from national data sets. More than half of older immigrants were limited English proficient. Forty-two percent had less than a high school education, and 40 percent resided in low-income families, i.e. below 200 percent of the poverty line. Immigrants were also three times more likely to receive Supplemental Security Income (SSI) (12 percent vs. 4 percent for the native-born). Systems Change for Greater Cultural Competence in the Pennsylvania Disability Service and Support Sector, Diversity Dynamics, LLC, for the Pennsylvania Developmental Disabilities Council, 2011, 91 pp. This report concludes a two-year study of the responsiveness of the Pennsylvania disability service system to the needs and potential of immigrants and other culturally diverse individuals with disabilities. Through the use of surveys, focus groups, structured interviews, and a literature review, this report focuses on systems-level issues, traces the evolution of cultural competence as a concept, creates a framework of core principles to guide system reform, identifies model practices both in Pennsylvania and elsewhere in the country, and offers a series of recommendations for consideration by public and private entities in the Commonwealth. The report devotes special attention to the newer cultural and linguistic groups that have settled in Pennsylvania over the last 25 years. Do Cultural Competency Interventions Work?  A Systematic Review on Improving Rehabilitation Outcomes for Ethnically and Linguistically Diverse Individuals with Disabilities, National Center for the Dissemination of Disability Research, Technical Brief No. 31, 2011, 12 pp. This brief reports on a systematic review of disability-related empirical research bearing upon the efficacy of "cultural competency interventions." The team of nine researchers identified a total of 3,022 titles and abstracts of potentially relevant studies published between 1980 and the present. Only 22 studies, however, met the rigorous criteria for inclusion in the analysis, one of which was the use of control groups. Based on the analysis of these 22 studies, the researchers conclude that "culturally adapted interventions do improve rehabilitation outcomes for minority and immigrant individuals..." Disability and Displacement,  Special Issue of Forced Migration Review, July, 2010, 44 pp This issue is intended to address the neglect of disability among the world's 42 million displaced people. Twenty-six articles examine conditions for people with disabilities in countries of origin or first asylum, such as Sierra Leone, Sri Lanka, and Yemen, as well as their experiences and opportunities in countries of resettlement, including the United Kingdom, New Zealand, and the United States. In part, the articles are designed to debunk the myth that there are few people with disabilities among displaced populations and to challenge the notion that accommodations are too costly or difficult to implement in crisis situations. The final article calls for the development of a "conclusion" (or consensus statement) on disability to provide operational guidance to staff of the UN High Commissioner on Refugees The Use of Culturally Adapted Competency Interventions to Improve Rehabilitation Service Outcomes for Culturally Diverse Individuals with Disabilities, National Center for the Dissemination of Disability Research, November 2, 2009, 80 pp. This review of 3,022 research studies published between 1980 and 2009 seeks to understand whether "the cultural competency training of rehabilitation providers translates into better outcomes for the clients or consumers of these services?"  There is ample evidence that such training improves the knowledge, attitudes, and skills of service providers, but few studies have attempted to assess the actual impact of culturally competent interventions on individuals with disabilities. In fact, only 22 studies met the rigorous criteria, including use of randomized control trials, set by the authors of this report.  These studies, however, pointed to statistically significant outcomes in four of five outcome measures. The authors conclude with a recommendation for additional evidence-based studies to test the efficacy of "specific training approaches and conceptual models..." The Rehabilitation Provider's Guide to Cultures of the Foreign-Born,  Center for International Rehabilitation Research Information and Exchange (CIRRIE), University of Buffalo, 2001-2008 The thirteen monographs in this series contain specific information about the cultural backgrounds of recent immigrants in the U.S., with special attention given to how disability and rehabilitation are viewed in each culture. The monographs cover the top ten countries of origin of the foreign-born population: Mexico, China, Philippines, India, Vietnam, Dominican Republic, Korea, El Salvador, Jamaica, and Cuba. There are additional monographs on the culture of Haiti and the Muslim perspective. Resource Guide for Serving Refugees with Disabilities,  United Sates Committee for Refugees and Immigrants, 2007, 139 pp. This publication is intended primarily for resettlement workers needing to understand the disability service system in order to make appropriate referrals for recently arrived refugees. Content was developed based on input from focus groups and surveys. Sections include: a description of the disability legal and service framework in the U.S., services for adults with disabilities, services for children with disabilities, housing, assistive technology and other topics. Latinos with Disabilities in the United States,  The World Institute on Disability, 2006, 51 pp. Perhaps the first national overview of the situation of Latinos with disabilities in the U.S., the report paints a bleak picture, finding "a strong reluctance to seek services" among Latinos, coupled with "slowness" on the part of service organizations to use culturally competent practices. Focusing primarily on vocational rehabilitation services, the authors discuss the cultural factors that impede access to services. The report includes profiles of successful programs that are bridging the disability service system and the Latino community. The report concludes with 13 "priorities for change," including "encourag(ing) diverse interpretations of independent living....adopt(ing) effective outreach methods...integrating culturally appealing messages...and educat(ing) Latino community leaders about disability issues." Culturally Competent Disability Support: Putting It into Practice, A Review of the International and  Australian Literature on Cultural Competence,  Multicultural Disability Advocacy Association of New South Wales, 2004, 99 pp. This international literature review focuses on individual practice and skills, as opposed to system and organizational change. The author discusses the relationship between critical thinking, "scientific mindedness," ethnographic approaches and cultural competence, and calls attention to the theme of "empowerment" which underpins much of the literature. A section of the report discusses strategies for engaging families and ethnic communities in supporting individuals with disabilities. Finally, the author cites examples of effective outreach efforts to ethnic communities, including messaging strategies and media selection. The Rehabilitation Service provider as Culture Broker:  Providing Culturally Competent Services to Foreign Born Persons, Center for International Rehabilitation Research Information and Exchange, University of Buffalo, 2001, 50 pp. This monograph is offered as "a starting point to understanding and providing culturally sensitive care to foreign-born consumers" in the rehabilitation service system. The authors identify and describe the range of skills involved in functioning as an effective culture broker, present a three-stage intervention model, and recommend an assessment tool designed to elicit cultural information. The authors assume that cultural brokers will work as members of the rehabilitation service systems, rather than as outside advocates. Disability and Access to Health and Support Services Among California's Immigrant Population,  UCLA Center for Health Policy Research, January, 2000, 49 pp. This report examines rates of disability and disability service utilization among California's immigrant population. Utilizing data from three supplements of the National Health Interview Survey of 1994, the researchers find that adult immigrants "are less likely than U.S. natives to report any activity limitation, difficulties in any activities of daily living (ADL's), difficulties in any instrumental activities of daily living (IADL's), and any days in bed..." Taking note of the lower socioeconomic status and educational levels of immigrants, the authors conclude that the so-called "epidemiological paradox" in health status, i.e. lower mortality rates despite higher known risks for poor health, also applies to disabilities. Lift Every Voice: Modernizing Disability Policies and Programs to Serve a Diverse Nation, National Council on Disability (NCD), 1999, 137 pp Noting that a "shameful wall of exclusion" continues to exist for people with disabilities from diverse communities, the authors of this report update an earlier 1993 NCD study on the plight of minority group members with disabilities. Informed by a public hearing in English, Spanish, and Cantonese held in San Francisco, and other community forums in Atlanta and New Orleans, the report uses the testimony of participants to highlight the multiple barriers faced by diverse people with disabilities. Among the problems noted in the report is the tendency of some employers to practice "double discrimination" - not only showing reluctance to hire persons with disabilities, but also being especially dismissive of disabled applicants with foreign accents. The report also laments the small numbers of employees from diverse ethnic and racial backgrounds employed in state and private disability service organizations, and urges partnerships with organizations, such as religious organizations and community-based organizations, that form part of the "internal social structure" of ethnic and minority communities. The report places great emphasis on the importance of "culturally appropriate outreach" and urges federal agencies with responsibility for services to people with disabilities to convene an interagency team to mount a "large-scale outreach and training program" to inform community members of available supports and services.

The Impact of Changes to the Public Charge Rule on Undocumented Immigrants in the U.S., UC San Diego, US Immigration Policy Center, August 13, 2019, 13 pp. Authors: Tom K. Wong et al While many commentators have examined the impact of changes to the public charge rule on legal immigrants, few have explored the impact on the undocumented population. The authors of this paper aim to fill this gap. Through a survey methodology involving 516 undocumented respondents in San Diego County, the authors show that substantial numbers of undocumented immigrants would refrain from accessing health services, including emergency medical care, preventive healthcare services, and free immunization services, both for themselves and their children.  Many would withdraw their children from free or reduced-price school meals. The authors also suggest that undocumented immigrants may want to qualify for a future legalization program and are fearful that use of such non-cash benefits may disqualify them from such a program. The authors also note that the observed effects would be even greater if the final rule becomes official policy, as the survey instrument referred to a “proposed policy,” rather than an actual change.

Safety Net Access in the Context of the Public Charge Rule, Urban Institute, August 2019, 13 pp. Authors: Hamutal Bernstein et al The Trump administration’s proposed changes to the “public charge” rule in 2018 have caused fear and confusion in immigrant communities that are now avoiding participating in social welfare programs. “Safety Net Access in the Context of the Public Charge Rule” by the Urban Institute examines this chilling effect and other impacts of the proposed changes. Previously, public charge referred to individuals deemed likely to receive cash benefits or long-term medical institutionalization.” In 2018, the report notes, the Trump administration expanded the criteria for which both temporary visa and green card holders can be designated a “public charge.” By accepting non-cash support, such as food stamps or Medicaid, an immigrant can be deemed “inadmissible” to the United States and have their permanent residency applications denied. Owing to the lack of meaningful analysis on behalf of the government, it is unclear exactly which programs qualify as a public charge. Through a qualitative analysis of survey data collected through the Well-Being and Basic Needs Survey of nearly 2,000 adults in immigrant homes, including 25 in-depth telephone interviews, the report finds that this lack of clarity has led to widespread fear and anxiety around accepting necessary benefits due to the perceived effect such acceptance will have on their immigration status. These benefits include food assistance and Medicaid. The report captures the toll that the proposed public charge rule has taken upon immigrants by including excerpts from one-on-one interviews. The report argues that this shift in policy causes individuals to be afraid to sign up for programs that are vital to their financial, psychological and physical wellbeing. (Mia Fasano for The Immigrant Learning Center’s Public Education Institute)

One in Seven Adults in Immigrant Families Reported Avoiding Public Benefit Programs in 2018, Urban Institute, May 2019, 19 pp. Authors: Hamutal Bernstein et al This paper presents the results of an internet-based survey that attempted to measure the potential effects of changes in the Public Charge rule that would make it harder for immigrants to obtain permanent residency. Survey respondents self-reported the degree to which the rule change produced a “chilling effect” that discouraged them or their family members from utilizing certain public benefits for which they were otherwise eligible. The authors provide a short history of the Public Charge rule and detail the legal implications of the changes before reporting on the results of the survey. They found that twice as many adults living with children reported a chilling effect compared to those living without children (17.4 percent to 8.9 percent respectively), suggesting that although the rule change is focused on adults it will have a multigenerational effect. Additionally, a larger percentage of Hispanic adults reported this chilling effect (20.6 percent) than non-Hispanic white (8.5 percent) and non-Hispanic nonwhite immigrants (6.0 percent). There was also an association between income level and the chilling effect, as immigrants with lower incomes felt the effect more drastically. Taken together, the authors are concerned that those who are most vulnerable will be more likely to refrain from accessing services and supports so as not to jeopardize their ability to receive permanent residency in the future.  They suggest that the proposed rule will lead to negative long-term effects for these immigrant adults, their children and the community as a whole. (Erik Jacobson, Montclair State University)

Adults in Immigrant Families Report Avoiding Routine Activities Because of Immigration Concerns, Urban Institute, July 2019, 17 pp. Authors: Hamutal Bernstein et al One in three adults in the U.S. with a vulnerable immigration status (those without citizenship or permanent residency) reported that they or a family member avoided routine activities to minimize the risk of deportation or other negative immigration consequence. This report chronicles the way immigrants have changed their behaviors to guard against any risk to their legal status arising from the Trump administration’s emphasis on immigration enforcement. Researchers from the Urban Institute analyzed data from the Well-Being and Basic Needs Survey to see how often adult members of immigrant families forgo enrollment in assistance and educational programs, refuse medical care and avoid interactions with public employees such as school teachers or police officers. The survey found that one common fear, even among those here legally, is that they or a loved one may be denied a green card on the grounds of being labeled a “public charge,” i.e. a person primarily dependent on government assistance for their survival. This fear has been exacerbated by the Trump administration’s effort to expand the definition of “public charge” to include many forms of noncash assistance. The authors found that one in seven adults from immigrant families reported that they or a family member did not participate in noncash government assistance programs in 2018 due to uncertainties over how such participation would affect their ability to gain residency. The article emphasizes that uncertain immigration status and Hispanic ethnicity are the strongest factors that influence immigrants’ decisions to lead a more insular life. As patterns of avoidance are demonstrably linked to serious psychological distress, the authors suggest further research into community-based strategies to assuage immigrant fear and promote health and well-being.  (Clare Maxwell for The Immigrant Learning Center’s Public Education Institute)

Demographic Data Highlight Potential Harm of New Trump Proposal to Restrict Housing Assistance Center on Budget and Policy Priorities, July 1, 2019, 10 pp. Author: Alicia Mazzara This paper assesses the impact of the Trump administration’s proposed rule that would bar families with undocumented members from receiving any form of federal housing assistance. At present, the assistance for mixed status families is prorated based on the number of eligible family members. Under the proposed rule, families would have to split up to retain assistance or give it up entirely and risk homelessness. Among the more than 100,000 people in 25,000 households that would be affected by the rule, 95 percent are people of color (predominantly Latino), 56 percent are female, and 53 percent are children. The authors also point out that the proposed rule would impose new documentation requirements on U.S. citizens and eligible immigrants who receive assistance. Housing officials would be expected to refuse applicants who cannot prove that they are U.S. citizens through the presentation of passports or birth certificates. Such requirements would serve to exclude large numbers of poor people who cannot produce such documentation. The report includes a chart estimating the number of people who would be negatively impacted by the proposed rule in each state.

Immigrant Families and Child Welfare Systems: Emerging Needs and Promising Policies, Migration Policy Institute, April 2019. 68 pp. Authors: Mark Greenberg et al Drastic changes in demographics and immigration policy and enforcement, particularly under the Trump administration, have important implications for child welfare programs. This report by the Migration Policy Institute, with research assistance provided by the American Public Human Services Association, reviews the policies and practices of state and local child welfare systems in working with immigrant families. The authors interviewed officials in 21 jurisdictions (14 states, 6 counties and the City of New York), and developed recommendations in nine key issue areas: organizational structure; training on immigration-related issues; language access; licensing; placement of a child with a caregiver outside the United States; memoranda of understanding with foreign consulates; screening for immigration benefits; confidentiality and information sharing; and policies when parents are in immigration detention. They found, for instance, that some agencies have developed training materials on immigration issues, sometimes in collaboration with state offices for immigrant affairs. A few jurisdictions explicitly provide that immigration status does not affect the licensing of a relative caregiver. Despite these positive developments, the authors found inconsistent awareness of many immigration-related issues as they relate to “care arrangements.” This knowledge gap limits access to crucial programming for immigrants. Among their recommendations, the authors suggest that agencies develop pre-service and ongoing training for frontline workers on immigration issues, review whether language access policies adequately reflect the characteristics and needs of the target population, and address barriers that may prevent noncitizen caregivers from becoming licensed providers. (Patrick Bloniasz for The Immigrant Learning Center Public Education Institute)

Gauging the Impact of DHS’ Proposed Public-Charge Rule on U.S. Immigration, Migration Policy Institute, November 2018, 34 pp. Authors: Randy Capps et al On October 10, 2018, the U.S. Department of Homeland Security (DHS) proposed a new “public-charge” rule that could transform the current landscape of legal immigration by preventing many immigrants from obtaining lawful permanent residence (green card) or renewing temporary visas. The rule broadens the range of public benefits that officials need to consider when applying the “totality of circumstances” test to determine if an applicant is likely to use those benefits in the future. In this report, the Migration Policy Institute utilizes U.S. Census data and “conservative” modeling techniques to estimate the number of recent green card recipients who may have been at risk of denial had the proposed rule been in effect. Their analysis shows that women, children, older adults and low-skilled workers would be at greatest risk of denial. For example, 43 percent of recent green card recipients were neither employed nor in school, thus “at risk” of becoming a public charge, and 70 percent of those recipients were women. The report indicates the proposed rule would significantly reduce the number of immigrants sponsored by relatives, and favor immigrants originating in Europe over those from Mexico and Central America leading to a break from the current pro-family and diversity-focused policies. (Jasmina Popaja for The Immigrant Learning Center Public Education Institute)

Applying Behavioral Insights to Support Immigrant Integration and Social Cohesion, Migration Policy Institute (MPI) (Europe), October 2018, 36 pp. Authors: Meghan Benton et al The research for this publication was commissioned for presentation at a March, 2018, meeting of the Integration Futures Working Group, an initiative of MPI Europe that brings together senior policymakers, experts, civil society officials, and private sector leaders to stimulate new thinking on immigrant integration policy.  Written largely for a European audience, the report looks at the applicability of “behavioral insights,” described by the authors as “an interdisciplinary, evidence-based approach that draws on findings and methods from behavioral economic, psychology, anthropology, and other fields,” to the challenge of immigrant integration. While behavioral insights have been adopted in a wide range of policy areas, such as health, tax, and education, there has been no systematic exploration of the potential benefits of such an approach for immigrant integration.  The authors focus on three areas where behavioral insights might prove helpful:  first, community cohesion, understood as fostering the “character skills” necessary for life in a diverse society and promoting social interaction between natives and newcomers; second, narrowing inequalities between immigrant groups and the broader population; and third, access to public services, citizenship, and voting. Although behavioral insights are not designed to achieve structural change, they can, according to the authors, lead to major improvements in existing programs especially if rigorously evaluated. The report concludes with a series of recommendations for policy makers interested in implementing this approach.

Chilling Effects: The Expected Public Charge Rule and Its Impact on Legal Immigrant Families’ Public Benefits Use, Migration Policy Institute, June 2018, 41 pp. Authors: Jeanne Batalova et al The Trump Administration is currently writing a regulation that will completely change the way the government determines whether an immigrant (or an immigrant’s sponsor) is “likely to become a public charge” by greatly expanding the list of public benefits, the use of which will make immigrants inadmissible (and possibly deportable). In “Chilling Effects,” the Migration Policy Institute reviews a leaked draft of the proposed rule, and provides data on the number of immigrants who use the four major means-tested public benefits for which data is available in the American Community Survey—Temporary Assistance for Needy Families (TANF), Supplemental Security Income (SSI), the Supplemental Nutritional Assistance Program (SNAP, formerly Food Stamps), and Medicaid, the Child Health Insurance Program (CHIP) or other public health insurance programs. According to MPI’s analysis, more than 6.8 million noncitizens used at least one of these programs, but a larger number—10.3 million—lived in households where at least one person—including U.S. citizen children—used one or more of these programs. The effect will be to raise the share of noncitizens for whom benefits use could be considered in a public charge determination from 3 percent today to 47 percent under the new rule. Most immigrants in benefits-receiving families are employed; they use benefits as work supports. In the estimation of the authors, the use of this new rule, once implemented, will allow the administration to drastically cut back on legal immigration—particularly family-based immigration—without having to go through Congress to change the law. Looking back at the experience of restrictions on the receipt of benefits imposed by the 1996 welfare reform law, MPI estimates that in total, between 20 and 60 percent of immigrants will disenroll from public benefits programs—even if they are entitled to them. While this study focused on benefits use, a future report will estimate the impact of the new rule on the future flow of immigrants (Maurice Belanger, Maurice Belanger Consulting)

Regulatory Rights: Civil Rights Agencies, Courts, and the Entrenchment of Language Rights, University of Colorado Law Legal Studies Research Paper, May 20, 2018, 29 pp. Author:  Ming Hsu Chen The “rights revolution” in the United States consisted of both sweeping changes in constitutional doctrines and landmark legislative reform, followed by decades of innovative implementation in every branch of the federal government -- Congress, agencies, and the courts. This paper  -- a chapter in a recently released book on the rights revolution and based on the author’s research for her doctoral dissertation– tells the story of how “policy entrepreneurs” within various federal agencies worked to extend civil rights protections to language minorities after the passage of the Civil Rights Act of 1964 and the Hart-Cellar Act of 1965. Of particular importance were the actions of officials within the Office of Civil Rights (OCR) of the Department of Health, Education, and Welfare (HEW) and officials within the Equal Employment Opportunity Commission (EEOC). Their interpretations of the law, treated with some deference by the courts because of their superior expertise, were either upheld or constrained by the courts. Paradoxically, the courts seemed to grant greater leeway to the OCR, even though there was some lack of consensus as to appropriate educational remedies in the aftermath of the Lau v. Nichols decision of 1974. The EEOC, on the other hand, found their interpretations of the law repeatedly challenged by the courts. The author reviews the “regulatory roller coaster” of the last 50 years and concludes that “regulatory rights rest on shifting ground” although they are “sufficiently rooted to remain,” because the complexity and ever-changing nature of modern life make regulation an indispensable tool of government.

Gender-Based Violence against Women: Both Cause for Migration and Risk along the Journey Migration Policy Institute, September 7, 2017, 7 pp. Author: Anja Parish  This brief addresses gender-based violence that may cause women to migrate, as well as the prevalence of such violence along the journey and the vulnerable position female migrants are in when arriving in a country of first asylum.  The author notes that increasingly rape and sexual violence have become military strategies, often used within a single country when there are multiple factions fighting for control.  Evidence is presented from all over the world, including data from conflicts in Central American, Europe and Africa.  This initial gender-based violence causes women to flee their countries, and along their route they continue to face the danger of sexual violence.  For example, a UNICEF study found that half of the female Libyan migrants interviewed reported experiencing sexual violence. Once in refugee camps, women are likely to confront sexual violence again, often perpetrated by those in uniform.  Additionally, the report notes that although the United States considers gender-based violence allowable grounds for asylum, the burden of proof is high and the process may be difficult for the applicant. Protections for the victims of gender-based violence do exist outside of the asylum system, but the report’s author notes that these protections require the involvement of law enforcement, which undocumented victims may be wary of contacting.  Statistics suggest that increased fears of deportation have led to a reduction in the reporting of gender-based violence among the Hispanic community in the United States. The author concludes that current policy directives are placing more female migrants at risk of gender-based violence and hampering the recovery efforts of survivors (Erik Jacobson, Montclair State University).  Keeping Families Together: Why All Americans Should Care About What Happens to Unauthorized Immigrants Center for American Progress, March 16, 2017, 7 pp. Author: Silva Mathema  More than eight million U.S. citizens have at least one undocumented family member in their household. This report examines the effects of policies targeting undocumented immigrants on millions of American citizens. This study uses the 2010-2014 American Community Survey to estimate the number of family members of unauthorized immigrants. The analysis finds 16.7 million people in the United States have at least one unauthorized family member living with them. Almost half of these people are U.S.-born or naturalized citizens, and 72 percent of these citizens are children. Immigration policies focused on enforcement and mass deportation separate the families of American citizens, leading to parentless children who are often sent into the foster system causing psychological trauma. Deportations can also result in a rise in single-parent families that experience greater economic stress. Additionally, the report notes that removing seven million unauthorized workers will result in a loss of $4.7 trillion in gross domestic product over a decade to the detriment to the U.S. economy and its citizens. The report recommends that U.S. immigration policies should prioritize keeping families together "rather than a relentless focus on ramping up enforcement."(Christy Box for The ILC Public Education Institute). Not Lost in Translation: The Growing Importance of Foreign Language Skills in the U.S. Job Market New American Economy, March 2017, 33 pp.  The demand for bilingual workers in the U.S. increased dramatically from 2010 to 2015: online bilingual job postings increased from around 240,000 in 2010 to roughly 630,000 in 2015. This report from New American Economy investigates the growing demand for bilingual workers and what can be done to help both U.S.- and foreign-born workers access these high-demand jobs. The report finds that the need for bilingual workers is widespread across many industries and skill levels, but especially strong in healthcare and finance. Individual employers like Bank of America, Wells Fargo, and the health insurer Humana had an exceptionally high number of postings. Strong demand existed for speakers of Arabic, Chinese, and Spanish. The authors applaud policy initiatives such as the "Seal of Biliteracy," which recognizes advanced language skills among high school graduates, as well as efforts to aid bilingual immigrants get relicensed for careers that they pursued in their home countries The authors recommend enhanced foreign language instruction in high schools and universities for non-native speakers and more workforce preparation programs so bilingual immigrants can better connect with employers. (Samantha Jones for The ILC Public Education Institute)  Family Stability and Instability among Low-Income Hispanic Mothers with Young Children, National Research Center on Hispanic Children & Families, February, 2017, 12 pp. Authors: Elizabeth Karberg et al Early experiences of young children in Latino families vary greatly from the experiences of children in white and black families. Family Stability and Instability Among Low-Income Hispanic Mothers with Young Children compares the experiences of low-income Latina mothers, both US and foreign-born, to their white and black counterparts using four rounds of quantitative data from the national "Fragile Families and Child Well-Being" survey. Key findings include evidence that low-income, foreign-born Hispanic mothers report more stable family life and lower levels of depression in the first five years after their child's birth than black, white or U.S.-born Latina mothers. However, levels of economic stress remain the same for all groups. Both foreign- and U.S.-born Latina mothers are also less likely to move in with a new romantic partner in the first five years of their child's life than white or black women. The authors conclude that, because foreign-born Latina mothers are more likely to be in a stable relationship at the time of their child's birth, efforts made on their behalf to increase family stability should account for those long-term relationships and focus on strategies to improve economic mobility. (The ILC Public Education Institute) A Portrait of Latino Fathers: Strengths and Challenges, National Research Center on Hispanic Children & Families. February 23, 2017, 12 pp. Authors: Elizabeth Karberg et al Using data from the National Survey of Family Growth, this study examines a sample of Latino fathers ages 18 to 44 with biological children ages zero to 18.  The researchers find that Hispanic fathers possess many characteristics that are associated with higher levels of father involvement and child well-being. Specifically, Latino fathers have high levels of co-residence with their children, high levels of marriage and cohabitation with their female partners, and relatively low levels of multiple-partner fertility. Although these patters were found for both immigrant and U.S.-born Hispanic fathers, they are especially pronounced for immigrant fathers. Indeed, "the family experiences of Latino immigrant fathers and their U.S.-born counterparts diverge to such a degree than in order to understand Latino fathers, it is important to know their nativity status." The researchers also note that, as Latino fathers are predominantly low income and have high labor force participation rates -- often working long hours or multiple jobs -- they were less likely than their resident black or white counterparts to engage in daily caretaking chores. Language Diversity and English Proficiency in the United States, Migration Policy Institute, November 11, 2016, 13 pp. Authors: Jeanne Batalova & Jie Zong A new study shows that the 25.9 million individuals with Limited English Proficiency (LEP) in the United States in 2015 were more likely to have less education and live in poverty than the English-proficient population. In Language Diversity and English Proficiency in the United States, the Migration Policy Institute presents a profile of LEP individuals ages 5 and older citing data from the United States Census Bureau's American Community Survey and Decennial Census from 1980-2015. This study offers insight into the distribution of LEP individuals by state and city, country of birth, languages spoken, race and ethnicity, education and employment, poverty and age. For example, the years 1980-2015 saw a 4 percent increase (from 56 percent to 60 percent) in English proficiency, despite a significant rise in immigration levels. While the majority of LEP individuals in 2015 were foreign-born, 18 percent were native-born. In 2015, nearly half (49 percent) of the foreign-born population were LEP. Additional analysis reveals that LEP men and women are more likely to work in industries such as maintenance and service, respectively, than their English-proficient counterparts. This analysis points to the need for further research on the impact of English language skills on the educational performance and career options of both native- and foreign-born individuals in the United States. (Sarah Purdy for The ILC Public Education Institute) Domestic Violence, Asylum and the Perpetuation of the Victimization Narrative, Southern Methodist University Dedman School of Law, Legal Studies Research Paper No. 242, February 3, 2016, 45 pp. Author: Natalie Nanasi The author of this study contends that the prevalence of the "battered women's syndrome," the notion that victims of domestic violence are passive, submissive, and helpless, has made it exceedingly difficult for women who don't conform to this stereotype to obtain asylum under U.S. law. Under the law, a woman must prove persecution on the basis of "membership in a particular social group." Reviewing the case law governing this phrase, the author suggests that being locked into a male-dominant abusive relationship seems to offer the best chance for a successful asylum claim. She argues that "the effective inability of a survivor of domestic violence to tell her authentic story, one that may involve a combination of power and powerlessness, is a profound violation perpetrated by the legal system." One solution would be for the Department of Justice to finalize a proposed rule governing domestic violence asylum claims. In the absence of such a rule, the author proposes ways to reinterpret the concept of "particular social group" to allow for agency and assertiveness on the part of victims. Women who come from countries where the state is complicit in enforcing male dominance and where perpetrators of domestic violence are not punished should see battered women as "not so different from the revolutionaries, freedom fighters, and political activists who came before them." Raising the Future: Parenting Practices among Immigrant Mothers Urban Institute, June, 2015, 48 pp. Authors: Julia Gelatt et al Prior research has shown that parenting practices have an impact on children's social and cognitive development. Specifically, "displays of warmth and affection, monitoring of children's activities, and consistent but not harsh discipline are tied to improved academic performance and fewer behavioral problems." This study attempts to understand how parenting practices vary among immigrants from various ethnic backgrounds while at the same time, controlling for socio-economic and educational factors.  Using data from the Early Childhood Longitudinal study (Birth Cohort), the authors examine five groups of immigrants: Mexicans, immigrants from the rest of Latin America, Chinese, immigrants from other Asian countries, and all other immigrants. The researchers find "strong differences" in "supportive parenting" by place of birth, with lower supportive parenting among Mexican and other Latin American-born immigrants than among U.S.-born white mothers or U.S.-born Hispanic mothers. However, there was also less use of physical punishment among all foreign-born mothers than among U.S.-born mothers. In future research, the authors "plan to analyze how changes in family circumstances - such as education, employment characteristics, material hardship, and social support - are correlated with changes in parenting."   Race inequity Fifty Years Later: Language Rights Under the Civil Rights Act of 1964, University of Pittsburgh School of Law, Legal Studies Research Paper, July, 2015, 45 pp Author:  Jasmine B. Gonzales Rose Noting that provisions of the Civil Rights Act of 1964, designed to address the discrimination and indignities experienced by African-Americans - the largest racial minority at the time -- may be insufficient to prevent discrimination against Latinos and other minorities, the author argues that English-only requirements in employment, education, public accommodations, and civic participation (jury service) may serve as a "method of subordinating Latinos." She observes that  "expressions of racism have become more subtle and sophisticated" over the last 50 years. While the Civil Rights Act clearly bans restaurant signs such as "No Mexicans or dogs allowed," common in the Southwest during the Jim Crow era, the Act does not bar the ‘racialized code" term "English-only." Not only are Spanish-dominant customers poorly served by such policies, but even bilingual employees who "inadvertently revert back to their native language" in speaking with customers from the same ethnic background could be harmed by such policies. "Penalizing an employee for - or preventing an employee from - expressing this essential element of his or her national origin when there is no genuine business necessity is inherently discriminatory."  The author gives a number of examples of the "inconsistent and incomplete language protection under the Act," including the failure of almost half states to require interpreters in civil proceedings. She observes that "the lack of explicit mention of language in the text of the statute or its legislative history has made language protections under the Act uncertain and subject to attack, criticism, and inconsistent treatment." On the other hand, the existence of the Act, under the "doctrine of constitutional avoidance," has been used as a reason not to extend constitutional protection to language minorities under the 14th Amendment. Welcoming the Outsider:  The Practices of Public Libraries towards Immigrants, Social Science Research Network, Research supported by the National Science Foundation, March 23, 2015, 40 pp. Author:  Linda M. Williams  Research increasingly shows that local administrative agencies, staffed by what the author of this report calls "street-level bureaucrats," such as librarians, teachers, police, and social workers, play an important role in the integration of immigrants into the community. Perhaps on a continuum from welcoming to hostile, these local officials have some discretion in how they approach immigrants. Public libraries stand out in this regard, having provided important information and services to immigrants throughout their history.  Moreover, unlike the police or social workers, librarians do not pose any kind of serious threat to immigrants. This report analyzes the results of a nationwide survey of public library systems (responses were received from 461 libraries), measuring their degree of "welcomeness," defined as the capacity to offer specific programs and services for immigrants. In designing the survey, the researcher identified seven dimensions of welcomeness: in-language resources for non-English speakers; classes or other programs specifically for immigrants, such as language or citizenship classes; in-language website resources; immigrant community outreach programs; collaboration with other immigrant-serving agencies; staff training on immigration or cultural-awareness skills; and eligibility for library services without immigration status verification. The report describes the range of library practices for each dimension, differentiating between welcoming and unwelcoming libraries. Findings show that many of the surveyed public libraries intentionally developed welcoming practices to build positive relationships between the library and immigrant patrons and to support immigrant integration. According to the author, "libraries are safe spaces that pose little risk to immigrants...and can serve a unique role in helping immigrants integrate into the community." (Chiara Magini, The ILC Public Education Institute) Unauthorized Welfare: The Origins of Immigrant Status Restrictions in American Social Policy, Paper presented at the University of California (Santa Barbara), May 8, 2015, Forthcoming in the Journal of American History, 42 pp. Author: Cybelle Fox This paper challenges popular and sometimes scholarly assumptions that restrictions on undocumented immigrant access to social welfare benefits can be traced back to the New Deal period. Indeed, "when the modern welfare state was established in 1935, there were no federal laws barring non-citizens, even unauthorized immigrants, from social assistance."  States,  however, were free to enact their own restrictions on immigrant access to benefits, but as late as 1970, only Texas required welfare and Medicaid recipients to be U.S. citizens. Nine other states barred non-citizens from some of their other welfare programs, "but the vast majority of states did not ask applicants about their legal status." The author suggests that state policy reflected the legacy of 19th century state poor laws which restricted aid only to "transients," not to people who had resided in the community for a specified period of time, whether foreign-born or native-born. The "restrictive turn" in federal policy started in 1972 under the Nixon administration when Congress created the Supplemental Security Income (SSI) program. Between that year and 1977, unauthorized immigrants were barred from receiving Medicaid and AFDC, Food Stamps, and Unemployment Insurance. The Social Security Administration also stopped issuing Social Security numbers for unauthorized immigrants. The author suggests that these "dramatic" changes in federal policy had their roots in the sixties, when the Bracero program was eliminated and quota limits were placed on immigration from Latin America, thus leading to a growth in the unauthorized immigrant population. Although there is little evidence that unauthorized immigrants were abusing the system, and even less evidence that restrictions would deter people from migrating, "the symbolic value of restriction was good enough" for most policy makers.     What Kind of Welcome?  Integration of Central American Unaccompanied Children into Local Communities, Institute for the Study of International Migration, Georgetown University, February, 2015, 29 pp. Author: Elżbieta M. Goźdiak  The arrival of young migrants at U.S. borders is not a new phenomenon, according to the author of this study. Countless unaccompanied children have entered the country since Annie Moore, a 15-year-old Irish girl and her two younger brothers became the first immigrants to enter Ellis Island when it opened in 1892. After reviewing the several waves of unaccompanied children to have entered the United States since that time, Goźdiak focuses on the 2014 migration. Citing data from U.S. Customs and Border Protection (CBP), the Pew Research Center and the United Nations High Commissioner for Refugees (UNHCR), the first part of the study examines the demographic characteristics of this population, emphasizing the growing number of females and the surge in the number of Central Americans. The second part, drawing on interviews with school officials, policy leaders, attorneys, and community leaders, focuses on how these children have been received and integrated at the community level. The author identifies strategies to overcome some of the challenges they face, highlighting the central role that community programs have played in creating welcoming and cohesive communities. The author also provides details on programs that have proven most successful in addressing the emotional needs of this population. (Ariella Katz-Suchov for The ILC Public Education Institute)   Examining the Hidden Ideologies within Cultural Competence Discourses Among Library and Information Science (LIS) Students:  Implications for School Library Pedagogy, School Libraries Worldwide, 19:1 January, 2013, 13 pp. Authors:  Kafi D. Kumasi & Renee f. Hill The goal of this research is to elucidate the "dominant and competing discourses around cultural competence" in the field of library and information science (LIS).  The authors begin by reviewing the literature on cultural competency within the LIS field. They point out that some scholars have exposed "the conceptual blind spots and false ideologies" that exist within the profession, which tend to obscure the role of race and class in American society.  One researcher (Pawley, 2006) identifies four dominant paradigms that tend to guide LIS teaching and practice, including the business/management model, which sees library and information users as consumers or customers, or the mission/service model, which depicts them as clients or patrons. In this paper, the authors administered an electronic survey to LIS students at two accredited institutions. The survey responses tended to show the strength of the dominant service-oriented ideology in which "the library user is depicted as a somewhat powerless consumer of the goods or services that an all-knowing librarian has procured for their benefit." An alternate view of cultural competency, reflected in some of the survey responses, values "authentic interactions with people and engaging with the cultural context of their daily lives."  Immigrant Access to Health and Human Services: Final Report Urban Institute, October, 2014, 25 pp. Editors:  Julia Gelatt & Heather Koball This report contains information drawn from seven briefs and one policy report produced by the Immigrant Access to Health and Human Services Project of the Urban Institute - an initiative that analyzed policies and practices that govern immigrant access to health and human services in the U.S. The research found that "complicated eligibility criteria combined with existing data systems and eligibility screening forms and processes made enrollment difficult for both agency staff and immigrant families." Other barriers included the lack of availability of in-person translation services, inaccessible service locations, and misperceptions regarding  the consequences of enrollment on undocumented family members. As a result, eligible low-income immigrant families have lower utilization rates for programs like SNAP, TANF, Medicaid, and CHIP than other low-income families. However, research in the states of California, Maryland, Massachusetts, North Carolina, and Texas revealed a number of promising practices to close this gap. The most commonly mentioned one was collaboration with immigrant-serving, community-based organizations. "Community-based organizations can provide linguistically and culturally appropriate outreach, build trust between immigrant communities and programs, bring enrollment services to places immigrants already visit, overcome cultural barriers, and communicate important program and eligibility information." The report also spells out a number of techniques that might prove useful with mixed status families. How can a metro embrace and build on the strengths of its immigrant communities? Brookings, The Avenue, September 30, 2014, 23 pp. Author: Jennifer Bradley The article is adapted from a book entitled The Metropolitan Revolution published by Brookings. When outsiders look at a high-poverty neighborhood, they often focus on what's wrong with the neighborhood instead of what's right. "How can a metro embrace and build on the strengths of its immigrant communities?" focuses on the Houston-based nonprofit group Neighborhood Centers, Inc. and its use of the Appreciative Inquiry model, a management style that challenges people to examine the positive aspects of a community or organization rather than to "fix" it. Neighborhood Centers has implemented this model in Gulfton and Pasadena, high-poverty communities in the Greater Houston area with large immigrant populations. Interwoven with graphics, pictures and video interviews, the article describes how neighborhood residents were asked to contribute their skills and abilities to make the neighborhood better. It also discusses the demographic history and evolution of Gulfton and Pasadena, and how the "wish list" of the community became the blueprint for the services of a new community center that opened in 2010 and served 23,000 people during its first year and a half.  Neighborhood Centers has now grown to become one of the largest nonprofit organizations in the U.S., with a budget of $275 million and a presence in 58 other locations in the Houston region. The organization is adept at "tak(ing) rigid, compartmentalized, regulation-encrusted funding streams and braid(ing) them together to provide the services that new and low-income Houstonians need if they are to flourish." This article examines current services provided to Houston community members through partnerships, including statistics on the effectiveness of Neighborhood Centers' Head Start program, charter school, and adult education program. (Ariella Katz Suchow for The Immigrant Learning Center, Inc.'s Public Education Institute) Immigration and the Changing Landscape for Local Service Delivery:  Demographic Shifts in Cities and Neighborhoods, Urban Institute, March, 2014, 8 pp. Authors: Julia Gelatt, Gina Adams, William Monson  Rising immigration has varied impacts on the size, dispersion, and diversity of immigrant populations in local communities. According to this report, corresponding services and policies must be differentiated and context-specific. Overall, the growth in U.S. immigrants and their children rose from 14 million in 1980 to 41 million in 2012-from 6 percent to 13 percent of the total population. While traditional areas like New York and California reflect these trends, the fastest growth has been in the Southeast. At the same time, European immigration decreased, while immigration from Mexico/Central America, South America, Asia, and the Caribbean increased; such a shift in immigrant demographics impacts agencies providing services. The report contains sample maps to illustrate the importance of place-based planning. The rise of Mexican/Central American immigrants in Raleigh (NC) occurred as academic and research institutions attracted highly skilled immigrants. By contrast, Houston showed steady growth in the Mexican population, but also increasing numbers from China, Vietnam, and India. Meanwhile, Minneapolis-St. Paul showed a pattern of balanced growth in its Mexican, Asian, and East African populations. The report emphasizes the importance of neighborhood-level shifts, which impact service delivery provision. Chicago's Archer Heights, for example,  changed from a predominantly Polish community comprising 49 percent of the total local immigrant population in 2000 to being 75 percent Mexican in 2011. Meanwhile, the Near South Side saw growth in its Southeast Asian populations. Here, the same city has differing neighborhoods requiring contextualized responses and skill sets from agencies. Related challenges include: communication, different beliefs, legal status, and establishing relationships with community leaders. Knowledge of trends and data, flexible approaches, and diversifying a range of resources are crucial in service delivery. (Colin Liebtag, Rutgers Graduate School of Social Work) Ten Years of Language Access in Washington, DC, Urban Institute, April 15, 2014, 39 pp. Authors: Hamutel Bernstein, Julia Gelatt, Devlin Hanson, William Monson Written with support from the District of Columbia Office of Human Rights, this paper analyzes the achievements and shortcomings of the DC Language Access Act of 2004. One of only a few cities in the U.S. to have passed such legislation, the District has seen a significant inflow of immigrants since 1980. Roughly 1 in 20 District residents are either limited or non-English proficient. The report summarizes the provisions of the Act and discusses steps taken to implement it.  The report also provides a detailed demographic analysis of the limited English proficient (LEP) population, so that agencies with a more specific mandate, e.g. poverty-reduction, senior services, might understand how the LEP population intersects with their populations of interest. The report concludes with a number of recommendations to improve the Act's effectiveness, including improved data collection and analysis, greater attention to recognizing and strengthening the District's multilingual personnel, improved coordination between agencies, and possible new investments to ensure greater access to language access services. Governing by Guidance: Civil Rights Agencies and the Emergence of Language Rights, Harvard Civil Rights -  Civil Liberties Law Review, April 17, 2014, 52 pp. Author: Ming Hsu Chen This article traces the emergence of language rights for non-English speakers out of the "national origins" provisions of Titles VI and VII of the Civil Rights Act of 1964 - a development that occurred without any explicit reference to such rights in the legislation. The author credits the initiative of "policy entrepreneurs" within the federal government for this expansion of rights, rather than any pressure from activists within immigrant communities. Working within regulatory agencies, these individuals "used nonbinding guidances to interpret the undefined statutory term ‘national origin discrimination'" and in so doing, provided "meaningful legal protection for a neglected group," whose numbers were growing sharply thanks to the passage of landmark immigration reform in 1965. The author contends that social scientists tend to overlook regulatory agencies as "institutional change actors and regulatory practice as a mechanism of change. To the extent that they do consider agencies, they paint agencies as weak institutions subject to significant political or organizational constraints." The author provides two case studies to buttress her argument: the efforts of the Office of Civil Rights to combat linguistic isolation and lack of educational opportunity in the schools, and the work of the EEOC to define national origin discrimination in the workplace. Although Congress and the courts acted to constrain the efforts of bureaucrats, particularly in the case of the EEOC, their work "enable(d) the law to keep pace with changing circumstances and assist(ed) the ongoing quest for equal opportunity." Race for Results: Building a Path to Opportunity for all Children, The Annie E. Casey Foundation, 2014, 33 pp.  The Annie E. Casey Foundation developed the Race for Results Index "to better measure the impact of a child's race on his or her opportunity for success in adulthood." The index is made up of 12 measures, including normal birth weight, pre-school enrollment, reading scores at the 4th grade level, math scores at the 8th grade level, high school students graduating on time, teenagers delaying childbearing until adulthood, and children living in two-parent families. Results are reported by race and ethnicity, singly and in composite form, and by state.  Asian and Pacific Islander children have the highest composite score at 776, followed by white children at 704, Latinos at 404, American Indians at 387 and African-Americans at 345. In interpreting the results, the authors give two caveats: first, that the scores sometimes mask significant intragroup differences; and second, that "a family's immigrant status often is a determining factor in the well-being of children." In each of the separate racial and ethnic sections of the report, there are sidebars pertaining to the immigrant cohort within each group.  The report concludes with four broad recommendations designed to improve outcomes for "children of color - especially African-Americans, American Indians, and Latinos - (who) are in serious trouble in numerous issue areas and in nearly every region of the country." "Are We There Yet?" Immigration Reform for Children Left Behind, Regent Journal of International Law, 2013, 31 pp. Authors: Keila E. Molina & Lynne Marie Kohm This article calls attention to the plight of millions of citizen children left behind in the U.S. after their parents were deported; more than 5,000 of these children are now in foster care.  The authors trace the root of the problem to the failure of federal immigration law to take into consideration the "best interest of the child" doctrine, which is considered "central to American family law."  Nor does the federal government consider the impact of its actions on state actors. "State governments are expected to handle the fallout and devastation from the separation of these families without receiving recognition or assistance from the federal government."  According to the authors, there are at least 22 states where parental rights have been terminated by family court judges on the grounds that parents who entered the country illegally engaged in criminal behavior and were therefore unfit to raise their children. The authors make ten recommendations to address these problems, including allowing federal immigration judges to consider the best interest of the U.S. citizen child when his or her parent is in deportation proceedings; using methods such as house arrest or angle bracelet detention, rather than detention, to allow parents to care for their children during their hearing process; and federal reimbursement to states for child welfare costs associated with immigration enforcement. The Immigrant "Other": Racialized Identity and the Devaluation of Immigrant Family Relations, Northern Illinois University College of Law, February 3, 2014, 60 pp. Author: Anita Ortiz Maddali  When undocumented parents are detained or deported their children, often U.S. citizens, become involved with state child welfare systems, which determine appropriate temporary or permanent custody. The author draws upon historical and current practices and legislation, as well as case examples to show how ideas of identity and culture serve to bias officials against the parental rights of immigrants without status.  According to a qualitative study done by the Applied Research Center, at least 5,100 children are in the foster care system as a result of immigration detention and deportation. The article suggests that children of undocumented parents are more likely to be placed in foster care as a result of the anti-immigrant bias of child welfare officials, who keep children from being placed with other family members or returning to their parents' country of origin if deported. When the parental rights of undocumented parents are terminated, "these decisions may have more to do with tensions around identity than the protection and welfare of children."   As boundaries between the immigration and criminal justice systems have dissolved, there is a growing tendency for the public to believe that a parent's undocumented status equates to abuse or neglect of their children. The author draws a parallel between current anti-immigrant biases in the legal and child welfare system and the removal of  immigrant children on the "orphan trains" of the late 19thcentury to be raised by Anglo-American families in the West, and the use of boarding schools to "civilize" Native-American children. The author urges passage of the Humane Enforcement and Legal Protections for Separated Children Act introduced in the Senate and a companion bill in the House. Finally, she takes issue with legal scholar Marcia Yablon-Zug who has argued that the State has an interest in keeping U.S.-citizen children in America. (Jade Flora-Holmquist) Immigrant Legal-Aid Organizations in the United States, Urban Institute, October, 2013, 8 pp. Authors:  Erwin de Leon & Robert Roach  Knowing that the application process for legal status will be "long, arduous, and costly," the authors of this study weigh the capacity of nonprofit legal service providers in the United States to respond to the anticipated surge in demand for legal services from the estimated 8 million individuals who will be eligible to apply for legal status under various immigration reform proposals. Using a variety of methods, the authors estimate that there are at least 684 such organizations around the country. A map shows the location and relative budget size of these organizations.  The authors are then able to determine the ratio of projected new clients to each existing organization. For example, nonprofits offering legal aid services in Texas would be confronted with a 1 to 41,250 client ratio, whereas New York nonprofits would have a 1 to 7,911 ratio. In order to prepare effectively for the influx of immigrant clients needing legal assistance, Roach and de Leon propose a more in-depth analysis of the nonprofit legal services sector.  "Adding thousands of new cases to existing caseloads without substantial infusion of resources - funding and staffing and volunteers - is not a realistic scenario." (Jade Flora-Holmquist) Rainbow Welcome - A Field Manual for LGBT Refugee Resettlement, Heartland Alliance for Human Needs & Human Rights, 2012, 65 pp. This publication is intended to support resettlement service providers as they adapt their services to meet the specific needs of lesbian, gay, bisexual, and transgender (LGBT) refugees and asylees.  According to the authors, "the housing, employment, health, and safety concerns shared by LGBT refugees upon their arrival are unique and require specialized interventions."  The manual describes LGBT refugees as being "doubly marginalized," as they are often shunned and discriminated against by members of their own ethnic groups. The first chapter of the manual offers a primer on sexual orientation and gender identity as influenced by the myriad of cultures from which refugees and asylees spring. The next chapter discusses how to make resettlement agencies a "safe space" for LGBT refugees. Additional chapters examine the specific services, including employment, vocational, housing, health, legal, mental health and substance abuse, that are vital to the successful resettlement of LGBT refugees. The manual is the product of the feedback and insights gained from a series of regional training workshops conducted by Heartland Alliance around the country. Heartland Alliance developed the manual with the financial support of the Administration for Children and Families, Office of Refugee Resettlement. Building a Wall around the Welfare State, Instead of the Country Cato Institute, July 25, 2013, 22 pp. Authors: Alex Nowrasteh & Sophie Cole In order to build stronger public support for, and maximize the fiscal benefits from, immigration reform, the authors of this policy analysis argue for a major narrowing of immigrant eligibility for means-tested programs, including Temporary Aid to Needy Families (TANF), food stamps, SSI, Medicaid, unemployment benefits, and other programs. As a conservative think tank promoting immigration reform, the leaders of the Cato Institute (publishers of the report) believe that immigration benefits the American economy in a myriad of ways, but that these benefits can be broadened "by building a wall around the Welfare State."  The authors project that "preventing noncitizens from accessing means-tested welfare programs will immediately save taxpayers more than $29 billion for the five programs under discussion." Moreover, the "high cost of naturalization would likely dampen, although not eliminate, any rush to naturalize that would occur if the strict welfare restrictions were enacted." The Cato writers are sanguine about the impact of their proposal on the immigrant population. "The success of second generation immigrants in the United States in terms of education, income, home ownership rates, civic assimilation, and poverty rate convergence with natives is evidence that welfare is not needed to promote intergenerational mobility or immigrant assimilation. By reducing the small amount of immigrant welfare dependency that exists, the pace of intergenerational mobility could actually increase." Race, Legality, and the Social Policy Consequences of Anti-Immigrant Mobilization, American Sociological Review, 2013, 25 pp. Author: Hana E. Brown This article explores how racial depictions of Hispanics influence welfare policy.  Previous research has shown that Black racial stereotypes have long emboldened get-tough welfare campaigns. Is similar imagery for Hispanics fueling roll-backs of benefits? Through case studies of California and Arizona in the 1990s, the author finds that two different "racial frames" seem to produce diverging results. The first frame, predominant in California, demonizes illegal Hispanic immigrants but contrasts them with virtuous and hard-working legal Hispanic immigrants. The second frame, common in Arizona and more explicitly racist, attributes moral worth to White citizens and derides all Hispanics as undeserving. By conducting a content analysis of 500 randomly sampled news stories about welfare reform in each state, along with follow-up interviews with key leaders of welfare reform efforts, the author found that the "cultural discourse" in California shifted welfare policy in a more "lenient" direction, whereas in Arizona, it led to the "passage of harsh reforms."   Thus, the "legality frame" seems to more productive of progressive social policy "because it incorporates multiple groups (including native-born and foreign-born, in-status Hispanics) under the umbrella of legal immigrants" A Local Official's Guide to Language Access Laws, Hastings College of the Law, University of California, 2013, 37 pp. Authors: David Jung, Noemi Gallardo & Ryan Harris Although written primarily for a California audience, this publication also offers useful information for general readers. The report reviews federal laws and regulations requiring language access services, and includes a description of the "four factor test" to determine whether such services must be provided, and the "safe harbor provision" to determine whether vital documents must be translated into foreign languages. California-specific sections of the report discuss the provision in the state constitution declaring English to be the official language and whether this provision places limitations on the use of non-English languages in local governance. The report also reviews two California laws requiring local agencies to provide language accommodations: the California Civil Right Act and the Dymally-Alatorre Bilingual Services Act. Finally, the report concludes with a description of how cities in California and around the country (Oakland, San Francisco, Monterey Park, Philadelphia, Minneapolis, New York, and Seattle) are proactively addressing language access issues. Taking Action against Violence and Discrimination Affecting Migrant Women and Girls, International Organization for Migration (IOM), 2013, 7 pp.  This report suggests that violence against women is rampant throughout the migration process.   Risk factors include legal status, age, class, culture, ethnicity, religion, sexual orientation, gender identity, and disability.  Domestic violence may occur in migrant families as male partners physically and sexually abuse women or children in order to maintain traditional gender roles in the new country.  Women may also encounter physical abuse from law enforcement, employers, or local civilians during migration.  Sexual exploitation is common in exchange for transportation, food, or accommodation.  "Systematic disempowerment" occurs as women experience difficulties accessing the labor market and public services. Moreover, migrant women are more likely to be employed in domestic, factory, agriculture, or entertainment which may lead to poor working conditions, low wages, and/or sexual exploitation.  Victims are unlikely to report incidents of violence or workplace abuses for fear of losing their legal status or facing repercussions.  IOM recommends ratifying, implementing, and enforcing existing human rights policies through coordinated multi-sectoral approaches in order to effectively address violence against migrant women and girls.  (Lorin Mordecai) Poor Immigrants Use Public Benefits at a Lower Rate than Poor Native-Born Citizens, Cato Institute, March 4, 2013, 8 pp.  Contrary to the myth that immigrants in the U.S. are a drain on the social welfare system, this report suggests that low-income immigrants actually access public benefits at a lower rate than their native-born counterparts. When immigrant children and adults do receive assistance, the average benefits value per recipient is almost always lower for immigrants than for the native-born. Using data from the 2012 Current Population Survey and available medical records, the study found lower utilization rates and lower average benefits for non-citizens in four programs:  Medicaid, the Supplemental Nutrition Assistance Program, cash assistance and Supplemental Security Income. In the Medicaid program, for example, "if there are 100 native-born adults, the annual cost of benefits would be about $98,400, while for the same number of non-citizen adults the annual cost would be approximately $57,200. The benefits cost of non-citizens is 42 percent below the cost of the native-born adults." The findings are consistent with other recent reports, e.g. the Center on Budget and Policy Priorities (2013), which found that Latinos use less than their fair share of government benefits, and the Russell Sage Foundation, whose research "provides little indication of welfare abuse or dependency among new immigrants." The report also attempts to correct methodological flaws in a study (2011) of immigrant benefit utilization by the Center for Immigrant Studies.(Denzil Mohammed) Protecting Migrants During Times of Crisis: Immediate Responses and Sustainable Strategies, International Organization for Migration (IOM), 2012, 30 pp. Aware of the serious dilemma facing many immigrants during Libya's 2011 civil war and revolution, the IOM decided to devote the 2012 International Dialogue on Migration to the plight of migrant people during natural and man-made disasters --  a problem it calls largely "invisible and underreported."  Held in Geneva, Switzerland, in September of 2012, the conference drew 300 participants from government, international and non-governmental organizations, research institutions and others.  The publication opens with a chair's summary, followed by a more detailed report on conference deliberations and recommendations.  A seven-page paper prepared for conference attendees is included in the appendices.   The report suggests that the intersection of migration and humanitarian assistance will gain greater importance in the years to come. In addition to their exposure to the same risks as native-born populations, migrants have "specific vulnerabilities" related to legal status; difficulties in accessing supports, such as language barriers and lack of information about available services; employer restrictions on migrants' freedom of movement; and in some cases a climate of discrimination and xenophobia.  Attention to migrant concerns needs to be woven into emergency planning both "before" , "during" and "after" a crisis. In addition, different actors have different responsibilities in addressing these issues, including countries of origin, transit and destination, as well as recruiters and employers. Falling Through the Cracks, The Impact of Immigration Enforcement on Children Caught Up in the Child Welfare System, Immigration Policy Center and First Focus, December, 2012, 10 pp. This paper reviews recent research on the effects of immigration enforcement on children. Between July 1, 2010, and September 30, 2012, 204,810 parents of U.S.-citizen children were removed from the U.S. The precise number and circumstances of children left behind are not known. However, according to the authors, the risks to these children are great, including: disruption to the family unit, social and economic stress, poor educational outcomes, and weakened economic security caused by the loss of income from the deported parent. In 2011, the Applied Research Center estimated that ca. 5,100 children with a detained or deported parent were in the public child welfare system; these numbers are expected to grow in future years if the current pace of deportations continues. The authors point out that local immigration and child welfare agencies rarely collaborate, and policies are not in place to promote family reunification. Immigration may transfer parents to detention centers outside their home communities; parents may not be able to participate meaningfully in family court proceedings; and federal guidelines mandate termination of parental rights when a child has been in foster care for 15 of the previous 22 months.  The paper proposes a number of solutions to ameliorate this situation, including the passage of laws similar to those passed in California in October, 2012 (the Call for Kids Act and the Reuniting Immigrant Families Act). Caught in the Housing Bubble:  Immigrants' housing outcomes in traditional gateways and newly emerging destinations, Center for the Study of Immigrant Integration, Univ. of Southern California, November, 2012, 26 pp.  This report looks at housing trends for immigrants and the native-born population since the onset of the great recession.  Using data from the American Community Survey, researchers studied homeownership, household formations (captured through a study of "headships," i.e. the ratio of household heads to adults), and residential mobility (moves within the previous year).  Housing outcomes were looked at across three types of metropolitan areas: established immigrant gateways, emerging gateways, and small metros. In general, immigrants fared better than their native-born counterparts.  While native-born homeownership, for example, decreased nationally from 67.3 percent in 2000 to 66 percent in 2009, immigrant homeownership increased from 45.2 percent to 49.1 percent.  During this period, native-born families showed declines in headship, while immigrant families showed slight increases. Immigrant mobility also declined in established gateway from 39 percent to 32 percent and in emerging gateways from 49 percent to 40 percent.  In the future, researchers hope to look at the impact of specific changes in the job market on location choices and housing outcomes among immigrants. (Loren Mordecai) Unintended and Unavoidable: The Failure to Protect Rule and its Consequences for Undocumented Parents and Their Children, Albany Law School, August 13, 2012, 24 pp. Exploring the intersection of child-welfare systems and immigration policy, this paper examines how allegations of child abuse and neglect can negatively influence judicial outcomes in immigration proceeding and, conversely, how immigration status often unduly influences the outcome of child-custody determinations. Drawing on several case examples, the author Sarah Hill Rogerson shows how the shortsighted application of state Failure to Protect Laws are often used to level neglect charges against immigrant mothers, many of whom are victims of intimate partner violence. Such actions fail to take into account the precarious situation created by immigration law and policies that make it difficult for the undocumented to report abuse. Immigration enforcement campaigns, such as "Secure Communities," that give local police the authority to enforce federal immigration law, create disincentives for victims to work with officials. This situation can often result in the elevation of an accusation, or minor infraction, into a deportable offense. The author discusses several cases in which immigrant women were persuaded to plead "no contest" to Failure to Protect, unaware that doing so would have negative consequences for both immigration and custody proceedings. The paper concludes with several policy recommendations aimed at aligning immigration law with family law concepts of parental rights and the best interest of the child. The author also offers suggestions for practitioners advising the undocumented, including the need to develop a safety plan for child custody in the event of parental detention or deportation. She also calls attention to the knowledge gaps in child welfare caseworkers and immigration officials and calls for more comprehensive and holistic training for both groups. (Dan McNulty) Access Denied: The Unfulfilled Promise of the D.C. Language Access Act, American University & DC Language Access Coalition, April, 2012, 44 pp. This report examines the effectiveness of the District of Columbia Language Access Act of 2004, a comprehensive law that requires "covered entities" (those with substantial public contact) to provide oral language interpretation services for limited English proficient individuals and to translate "vital documents"  into high demand languages. Despite robust internal monitoring mechanisms built into the Act, the evaluation found "substantial deficiencies" in agency compliance with the Act. Researchers used a variety of methods to test compliance, including "18 in-person tests at government agencies, 27 tests of agency websites to assess language accessibility and the availability of vital documents, and 40 tests of agency interactions by telephone." Researchers also surveyed 258 limited or non-English speaking individuals and filed 15 Freedom of Information Act requests to gain insight into agency compliance, training and outreach procedures. Through these various means, the investigators  distill 10 recommendations relating to internal agency operations, 5 recommendations relating to agency oversight and accountability, and 4 recommendations relating to enforcement. Promising Practices for language Access in Federal Administrative Hearings and Proceedings, U.S. Dept. of Justice and Administrative Conference of the United States, February 3, 2012, 25 pp. This is a report from a conference held in Washington, DC, on September 22, 2011. Representatives of the Social Security Administration and the Executive Office of Immigration Review (Dept. of Justice) discussed language access efforts within their respective agencies.  Another speaker reviewed services available through the National Virtual Translation Center, an interagency office established in 2003 for the purpose of providing quality translations for the intelligence community and other federal agencies. Finally, the manager of GobiernoUSA.gov, the official Spanish language web portal of the U.S. government, discussed the "top 10 best practices for multilingual websites." The Flow of Unaccompanied Children Through the Immigration System: A Resource for Practitioners, Policy Makers, and Researchers, Vera Institute of Justice, March, 2012, 35 pp. This report provides an in-depth exploration of the "complex web of policies and practices" that unaccompanied children face in navigating the U.S. immigration system. The report traces the sequence of steps from initial apprehension to case closure, which can result in removal to home country, voluntary return, or placement with a sponsor and possible relief from deportation. Beginning with a brief overview of the rights and responsibilities of custodial bodies, legal classification schemes, and the evolution of federal policy and legislation, the report goes on to detail the agencies and facilities children encounter in their journey across the "disjointed and labyrinthine" immigration and justice systems. Additionally, the report provides a description of the rights and recourse available to unaccompanied minors, along with the legal services and advocacy options available through the federal Office of Refugee Resettlement (ORR).  Concluding with a look at case outcomes, the authors note the need for empirical research in order to improve the experiences children undergo as they are processed through, and after they exit, the system.  Since 2005, the Vera Institute of Justice has administered the Unaccompanied Children Program funded by ORR, which seeks to improve access to legal services for unaccompanied children. In 2010, there were 8,207 children admitted to ORR custody after referral by the Department of Homeland Security, an increase of 35 percent over the previous year. (Daniel McNulty) The Impact of Migration on Family Left Behind,  Institute for the Study of Labor, February, 2012, 33 pp. Written by Francisca Antman of the University of Colorado, this paper discusses the impact of migration on family members, i.e. non-migrant children, spouses, and parents, left behind in sending countries. The author reviews the limited research available on this topic and discusses some of the methodological problems encountered in doing research in this area.  In her review of non-migrating children's educational outcomes, she finds both positive and negative effects, sometimes correlated with the gender of the migrating parent.  She also notes a "detrimental impact of migration on time contributions and health outcomes for elderly parents," suggesting that governments and local institutions in sending countries should be sensitive to the possible weakening of traditional support structures for the elderly. N.B. Institute discussion papers often represent preliminary work and are circulated to encourage discussion of particular issues. Language Access Laws and Legal Issues: A Local Official's Guide, Institute for Local Government, 2011, 35 pp. Although developed primarily for a California audience, this guide may prove useful for public officials in other parts of the country. The guide summarizes federal laws requiring language access services, with particular attention to the Justice Department's "Four Factor" analysis. The document also discusses the extent to which official language or English-only laws passed by state or local jurisdictions might weaken or undermine federal requirements for language access. The guide also reviews California's separate and robust requirements for language access under the California Civil Rights Act and the Bilingual Services Act. Finally, the guide summarizes notable features of local language policies in the following cities: Oakland, San Francisco, Philadelphia, Minneapolis, Monterey Park, New York, and Seattle, and provides links to useful resources in a concluding section.  Limited English Proficient Individuals in the United States: Number, Share, Growth, and Linguistic Diversity, Migration Policy Institute, December, 2011, 12 pp. This Data Brief analyzes the 25.2 million individuals in the United States over the age of 5 who are limited English proficient (LEP).  Representing 8.7 % of the total U.S. population, these individuals are concentrated in 13 states. The four states with the highest percentages are: California (19.8 percent), Texas (14.4 percent), New York (13.5 percent), and New Jersey (12.5 percent).  While Spanish-speakers accounted for 65.8% of the total US LEP population in 2010, the proportion of Spanish-speakers varies by region, state, and locality. Texas at 87.4 percent had the highest percentage while Montana and North Dakota at 20.8 percent had the lowest.  Other top languages nationally in 2010 were: Chinese, Vietnamese, Korean, and Tagalog.  Links to detailed companion charts may be found in endnote 5 of the brief. Shattered Families: the Perilous Intersection of Immigration Enforcement and the Child Welfare System,  Applied Research Center, November, 2011, 65 pp. Increasingly, measures to detain and deport undocumented immigrants in the U.S.  have resulted in  the  forced separation of families, despite child welfare policies that make family preservation a priority. There are at least 5,100 children in foster care today due to parental detention or deportation. This study examines the impact of immigration enforcement on the child welfare system, using interviews, focus groups and analysis of qualitative data. The study suggests several factors that have contributed to family separation and sometimes permanent termination of parental rights: once children are taken into custody, ICE procedures, which lack due process, make it virtually impossible for parents to comply with Child Protective Service guidelines for reunification; prejudice, poverty, lack of social services, "unverifiable employment," inability to obtain driver's licenses, barriers faced by undocumented relatives in assuming kin-care, and limited knowledge of immigration law on the part of officials and social service workers,  contribute to obstructing parent-child reunification. Findings also suggest that that the Secure Communities program enables local law enforcement to subjectively and erroneously enforce federal immigration policy, despite policy directives to focus enforcement efforts solely on criminal threats. The study concludes with a number of policy recommendations for state and federal lawmakers. (Dan McNulty)   Media and Immigration: An International Dialogue Organized by the French-American Foundation - United States,  June, 2011, 25 pp. In November 2009 and in May 2010, the French-American Foundation convened two international symposia as part of its Media Coverage of Immigration (MCI) program. Held in Paris and Miami, the two symposia attracted media professionals and immigration experts from 18 countries and focused on improvements to the quality and depth of immigration reporting.  As a "highly complex and emotional issue, defined by important economic, social and political forces," immigration poses both a challenge and an opportunity to reporters.  There were four general  recommendations developed at the symposia: first, continue efforts to diversify the newsroom; second, find ways to give a voice to the ordinary immigrant, as opposed to "the most vocal and visible ones;"  third, reimagine the audience for immigration-related news stories; and fourth, "think outside the box" by recognizing that "immigration forces society to reflect upon its ideals, freedoms and institutions, and journalists too, should reflect on these larger questions as part of their work."   Housing the City of Immigrants, Community Service Society, March, 2011, 19 pp One of the major conclusions of this report is that housing conditions vary widely among immigrant groups, even when one controls for household income.  The researchers examined the degree of "housing stress" among specific immigrant communities using data from the 2008 New York City Housing and Vacancy survey. Housing stress is a composite of three factors: unaffordable rent burdens, poor apartment conditions, and crowding. Different immigrant communities experience these stressors in different ways. For example, immigrants from the former Soviet Union have the highest rent burdens, Mexicans are the most overcrowded, and Dominicans occupy the highest percentage of apartments with violations. These patterns, according to the authors, lead to an important conclusion:  "that housing stressors don't just affect individual households; they affect communities" and that advocacy groups must adjust their housing-related agendas to fit the particular circumstances of these communities.   Guidance for Integrating Culturally Diverse Communities into Planning for and Responding to Emergencies: A Toolkit, National Consensus Panel on Emergency Preparedness and Cultural Diversity, Office of Minority Health, U.S. Department of Health and Human Services, February, 2011, 40 pp. The Toolkit is a "user-friendly reference guide, with succinct summaries of key principles, practices, and strategies for appropriately working with diverse communities," including those consisting of immigrants and other limited English proficient individuals. The Toolkit is divided into two main sections.  Section I presents the National Consensus Statement on Emergency Preparedness and Cultural Diversity originally released on June 11, 2008 - "a historic moment in the life of the nation's emergency preparedness efforts."  The preamble to the statement notes "that racial and ethnic minorities experience higher rates of injury, disease, traumatic stress, death and loss due to public health emergencies as compared with non-minority populations." Section II identifies eight guiding principles that agencies, organizations, and providers should consider to improve their effectiveness in reaching diverse communities, along with suggested strategies and practices consistent with each principle. An "underlying tenet" of the Toolkit is that "effective preparedness and response requires the ongoing and active engagement of diverse communities."  The Toolkit also features links to useful resources. Communication More for Less:  Using Translation and Interpretation Technology to Serve Limited English Proficient Individuals,  Migration Policy Institute (MPI), January, 2011, 25 pp. This manual describes new forms of technology that are lowering the cost of providing interpreting and translating services and expanding the range of language options available to government agencies and human service organizations.  Beyond Language Line, or telephone-based interpreting, the author covers more recent innovations, such as video interpreting, interpreter network technology, and multiple listener technology. The manual also reviews the pros and cons of technologies that dispense with third-parties altogether, including automated interpreting and machine translation. Finally, the report discusses specialized software designed to manage interpretation and translation projects within organizations.  As the field is evolving quickly, MPI intends to update this "catalogue of possibilities" on a regular basis.   Entering the Mainstream: Making Children Matter in Immigration Law,  Fordham Urban Law Journal, 2010, 23 pp. Author: David B. Thronson This article proposes "three simple reforms" to American immigration law to bring it into line with "mainstream values" on the treatment of children: first, broaden the construct of family beyond the traditional nuclear family (recognizing, for example, the important role that Latino grandparents play in children's  lives); exclude children from grounds of inadmissibility or bars against adjustment of status; and  allow children to become "generators of immigrant rights" for their parents by at least reverting to pre-1996 "extreme hardship" standard to avoid deportation, rather than the current standard of "exceptional and extremely unusual hardship." The author concludes that "the misalignment of U.S. immigration law with underlying legal and societal values related to children and families has contributed to the growth of the unauthorized population in the United States," and that this misalignment must be addressed in any broad reform of the nation's immigration laws. Caught Between Systems:  The Intersection of Immigration and Child Welfare Policies,  First Focus and the Migration and Child Welfare National Network, 2010 More than 5 million children living in the United States today have at least one parent who is an undocumented immigrant. This publication is a collection of three policy briefs examining the plight of these children as they come into contact with the child welfare system. Each brief offers recommendations for policy changes and system reforms.  The Impact of Immigration Enforcement on Child Welfare (12 pp) provides an overview of immigrant enforcement activities and the “unintended consequences for children and families.” Public Benefits and Child Welfare Financing (9 pp) highlights the difficulties that immigrant parents, caretakers, and relatives face when their immigration status prevents them from accessing critical public resources, court-mandated reunification services, or permanency options. Language, Culture and Immigrant Relief Options (10 pp) observes that child welfare policies and practices often do not reflect the current demographics of the child population, creating risks for children of immigrants within the system.  Incorporating a "Best Interest of the Child" Approach into Immigration Law and Procedure Yale Human Rights and Development Law Journal, Spring, 2009, 57 pp. Author: Bridgette A. Carr This article examines how the U.S. fails to protect both foreign-born and U.S. citizen children who are directly affected by immigration proceedings. The absence of a "best interest of the child" approach disregards a standard method of protecting children that is common in both domestic and international law.  The author discusses the nature and evolution of this approach in U.S. child welfare case law. She also points out that this approach is enshrined in the U.N. Convention on the Rights of the Child, the most universally adopted of all human rights charters ratified by all but two countries in the world. The article gives detailed examples of how the "invisibility" of children in immigration proceedings can lead to outcomes injurious to their welfare and safety.  The author then contrasts the U.S. practice with that of Canada, which requires the designation of a representative for children in immigration proceedings, and argues for the adoption of the Canadian model in the U.S.  She also addresses the most common objections to this approach, i.e. the additional resources required to implement the plan, and the fear that such an approach would "open... the floodgates to immigrants by allowing children to be a source of immigration relief for parents." With regard to the latter argument, the author states that many "best interest of the child" determinations may result in the child voluntarily departing with the parent or legal guardian. New Americans Initiative: 6-year Report,  State of Illinois, Department of Human Services, 2009, 65 pp. In 2003, the Department of Human Services (DHS) of the State of Illinois, the largest agency providing and funding human services in Illinois, with a budget of over $5 billion, launched a coordinated and systematic effort to make its services accessible to limited English proficient individuals.  In 2005, DHS contracted with a team of consultants from the Shriver National Center on Poverty Law to interview executives and managers in each of DHS' six program divisions, examine current agency practices, evaluating them against national "best practice" standards, and produce a report and set of recommendations that became the basis of the agency's subsequent efforts to improve service accessibility.  When the governor of Illinois in 2005 decided to expand this work to other departments and agencies of state government, DHS became the model for the rest of state government. This report summarizes the work that was accomplished by DHS over the course of the six years. The report includes a number of useful appendices, including copies of departmental policy memoranda governing the provision of interpreting services and the payment of a 5% salary differential for bilingual state employees, as well as a sample customer service plan for limited English proficient persons.    Language Use in the United States: 2007, U.S. Census Bureau, April, 2010, 16 pp. Twenty percent of the American people speak a language other than English at home. Based on data from the 2007 American Community Survey, this report examines the preponderance of various languages, patterns of language change since 1980, the English-speaking ability of various language communities, and language concentrations in the 50 states. A particularly useful table estimates the number of limited English proficient people in each state.  Eliminating Language Barriers for LEP Individuals:  Promising Practices from the Public Sector,  Grantmakers Concerned with Immigrants and Refugees, Summer, 2009, 37 pp. Authored by Ted Wang, this report draws on input from the Language Access Practitioners Network, a group of state and municipal officials managing or overseeing language access programs. The Network was created by the Annie E. Case Foundation in 2006. The report analyzes language access legislation passed in the states of California, Minnesota, Maryland, Hawaii and Illinois, as well as local ordinances in seven U.S. cities. The report features a helpful discussion of some of the institutional barriers and political forces working against the introduction of effective language access policies and procedures. Wang also provides guidance in determining which governmental entities should be assigned responsibility for language assistance oversight and technical assistance. A Social Worker's Tool Kit for Working with Immigrant Families: A Child Welfare Flowchart, Migration and Child Welfare National Network (MCWNN), August, 2009, 10 pp. This resource was developed in response to the growing recognition that the child welfare field faces many new issues of practice, policy and research arising from the rapid growth in the population of children in immigrant families. Established in 2006 and consisting of some 16 organizations around the country, MCWNN has sponsored several national conferences and produced a series of publications related to the challenge of working with vulnerable immigrant children. A full listing of these resources may be found on the website of the Network.  Is This Working?  Assessment and Evaluation Methods Used to Build and Assess Language Access Services in Social Service Agencies,  Migration Policy Institute, July, 2009, 28 pp. This publication contains a tool kit of solutions for public and private agencies interested in establishing and maintaining high quality language access programs, and features descriptions of effective LEP data collection systems and program self-assessment tools.  The report is particularly useful in cataloguing the range of methods used to evaluate the language skills of new and current employees. Detailed descriptions of innovative and promising practices in the states of California, Hawaii, Iowa, Minneosta, Washington, and Wisconsin are highlighted.  The "secret shopper" program in New York City is also profiled.  Language Access Webinars,  Migration Policy Institute, 2008-2009 Growing out of an Annie E. Casey Foundation initiative to promote sharing and dialogue among public sector officials involved in developing and managing language access services, MPI's National Center on Immigrant Integration Policy launched a series of one-hour webinars on language access in October of 2008. Each webinar features several presenters who discuss innovative practices in various parts of the country. Among practices highlighted in the first three webinars are: Washington State's process for certifying and compensating bilingual employees; New York City's 2008 Citywide Executive Order on language access; the Washington, DC, Community Interpreter Bank; the Alaska Language Interpreter Center; the Office of Multi-Cultural Services (Hennepin County, MN); and the Translation and Interpretation Unit of the New York City Dept. of Education.   Intimate Partner Violence in Immigrant and Refugee Communities:  Challenges, Promising Practices and Recommendations,  A Report by the Family Violence Prevention Fund for the Robert Wood Johnson Foundation, March, 2009, 64 pp. This report provides recommendations for funders interested in addressing the special challenges and complexities associated with preventing and responding to intimate partner violence in newcomer communities. The report discusses the tension that often exists between service provision and prevention efforts, as well as the optimal framework for service provision, i.e. whether specialized in nature or housed within a larger community-based organization offering a variety of services unrelated to domestic violence. The report features a 30-page literature review by Mieko Yoshihama of the University of Michigan School of Social Work, as well as case studies of 7 organizations doing exemplary work in the field, including the Arab-American Family Support Center in Brooklyn, NY, Manavi in New Jersey, and Casa de Esperanza in St. Paul, MN. Language Access Advocacy,  Management Information Exchange: An Exchange of Information for Legal Services, Winter, 2008, 7 pp This article discusses recent successful language access advocacy campaigns organized by legal service entities, in partnership with immigrant community-based organizations in Arizona, California, New York, and Pennsylvania. The article is divided into two sections: the first focusing on language access in public benefits and health care, and the second, on language access in courts and law enforcement. The authors highlight and explain effective advocacy strategies. Top Tips from Responses to the Survey of Language Access Strategies Used by Federal Government Agencies,  Federal Interagency Working Group on Limited English Proficiency, September 3, 2008, 4 pp. Updated periodically, this document contains 25 recommendations in 10 categories, including strong language access coordination and accountability, meangingful access to web-based information, and consistent enforcement of quality control standards.   Integrating Immigrant Families in Emergency Response, Relief and Rebuilding Efforts,  The Annie E. Casey Foundation and Grantmakers Concerned with Immigrants and Refugees, 2008, 22 pp. This report provides a framework for local planning to ensure that vulnerable limited English proficient families are not neglected and placed at risk before, during, and after disasters. More like a manual, the report contains step-by-step suggestions for emergency responders and examples of effective immigrant outreach practices from communities around the country. The report also features a listing of funding sources that could be tapped to support emergency outreach work to immigrant families. Addressing the Needs of Immigrants and Limited English Communities in Disaster Planning and Relief,  National Immigration Law Center, October 28, 2008, 11 pp. Drawing on evidence of serious deficiencies in managing emergencies in localities with large numbers of immigrants, this report makes a number of recommendations, including the formation of partnerships between government agencies, disaster relief organizations, and immigrant-serving organizations; the avoidance of inquiries into immigrant status; the cessation of immigrant enforcement activities for the duration of the emergency; the relaxation of documentation requirements in areas where a disaster has caused the widespread destruction of documents; ensuring that disaster victims do not lose their preexisting immigration status due to the death of a spouse or loved one; and greater attention to meaningful language assistance in the delivery of disaster-related services.    The Intersection of Immigration and Child Welfare:  Emerging Issues and Implications,  Conference Proceedings, Second National Forum, Migration and Child Welfare National Network, April 1-3, 2008,  34 pp. Bringing together researchers and practitioners interested in the impact of migration on child welfare policy and practice, this conference reviewed the status of key issues identified in an earlier 2006 conference on the same subject. The 2008 proceedings include a report from the "Promising Practices Committee," discussions of several case histories, a summary of the work of the Immigrant Children's Advocacy Project in Chicago, and abstracts of research projects underway in various parts of the country. In a presentation entitled "Beyond Cultural Competence," Jorge Cabrera of Casey Family Programs argues that practitioners working with immigrant children must pay attention to "issues such as acculturation, the family's ‘story' of migration, the social, economic and political circumstances that led to the migration experience, the struggles and hardships experienced by the family in their journey and the levels of isolation and connection that they may be experiencing in their present community setting."  Library Services for Immigrants: A Report on Current Practices, U.S. Citizenship and Immigration Services (USCIS) and Institute of Museum and Library Services, 2007, 7 pp. This report describes promising approaches, along with recommendations, to strengthen library services to immigrants. Areas covered include:  community partnerships, development of collections, information services, special programming and events, outreach, and planning. The report grew out of a working group of library and community representatives convened by the Office of Citizenship (USCIS). School Year Filled with Missed Communication,  Equity Monitoring Project for Immigrant and Refugee Education (EMPIRE), June 27, 2007, 25 pp. In 2006, the Chancellor of the New York City Department of Education adopted Regulation A-663 for the purpose of providing translation and interpretation services to hundreds of thousands of parents with limited English skills. This report, based on parent surveys, focus groups, and on-site visits, documents widespread noncompliance with the regulation and contains recommendations, such as the establishment of an accountability system, professional development for administrative staff, and parent education efforts, to improve the effectiveness of the regulation. Achieving Language and Cultural Competence in Serving People with Limited English Proficiency in Illinois Department of Human Services Programs: Findings and Recommendations Report,  January 30, 2006, 24 pp. (Report no longer in the public domain) With support from several local foundations, the Illinois Dept. of Human Services undertook a comprehensive review of its track record in enabling limited English proficient individuals to access its programs.  An outside research team interviewed division staff members and analyzed documents and reports related to issues of language and cultural competence. The team then produced a series of nine recommendations, constituting a "strategic plan" for increasing the departments' effectiveness in serving LEP individuals.  Ethnocultural Issues in Disasters: A Overview of Research, Issues, and Directions  Psychiatric Clinics of North America, 27(2004), 18 pp. (article no longer in the public domain), Authors: Anthony J. Marsella & Michael A. Christopher The authors argue that disasters often involve "a complex cultural encounter," and that responders need to be aware of the communication patterns and cultural resources of impacted communities so as to provide effective assistance and promote "post-traumatic growth," not depression. The authors outline the scope of cultural competence training for disaster workers and offer a series of recommendations designed to improve culturally sensitive service delivery during disasters. Finally, they propose a research agenda, including the development of a "cultural disaster research archives" and the study of cultural variations in loss, grief, and bereavement.  Mobility Information Needs of Limited English Proficiency Travelers in New Jersey,  New Jersey Institute of Technology, September, 2004, Produced under contract with the New Jersey Department of Transportation, this comprehensive study explores the public transit needs of limited English proficient (LEP) persons in New Jersey. Noting the high correlation between public transit use and LEP status, the study reviews pertinent literature on language access, identifies best practices in LEP transit access both nationally and internationally, reports on the results of a survey to 575 LEP people on transit issues, discusses findings from 10 focus groups with LEP individuals, and outlines a series of cost-effective recommendations for improving access.   Denied at the Door: Language Barriers Block Immigrant Parents from School Involvement,  Advocates for Children of New York and the New York Immigration Coalition, February 19, 2004, 55 pp. Based on a survey of immigrant parents and students in the New York City School System, this report documents widespread failure to communicate in native language with immigrant parents. Without parental involvement in the education process, students will be deprived of parental support and schools will not have the full cooperation of parents. Language Access in State Departments,  Bilingual Services Program, California State Personnel Board, April, 2001, 36 pp. In compliance with California legislation mandating that state agencies employ a sufficient number of qualified bilingual staff in public-contact positions and translate key documents into languages spoken by their clients, the Bilingual Services Program (BSP) was established in June, 2000, with six staff positions.  Perhaps the first comprehensive assessment of multi-lingual communication capacity within state government, this report represents the initial findings and recommendations of the BSP based on interviews with 119 state agencies, three public hearings, and input from two advisory task forces.  The report points out major areas of deficiency, as well as promising practices in particular departments/agencies. The advantages of a coordinated approach to language accessibility are stressed throughout the report.