"Pretty much all the honest truth telling there is in the w - - PowerPoint PPT Presentation

▶
pretty much all the honest truth telling there is in the
SMART_READER_LITE
LIVE PREVIEW

"Pretty much all the honest truth telling there is in the w - - PowerPoint PPT Presentation

Apr 17, 2023 50 likes •721 views

"Pretty much all the honest truth telling there is in the w orld is done by children." Oliver Wendell Holmes, author and poet Health Care for Internationally Adopted Children and Immigrants Miriam Toporowicz MD MPH Professor

slide-1
SLIDE 1
slide-2
SLIDE 2

"Pretty much all the honest truth telling there is in the w orld is done by children."

— Oliver Wendell Holmes, author and poet

slide-3
SLIDE 3

Health Care for Internationally Adopted Children and Immigrants

Miriam Toporowicz MD MPH Professor Department of Pediatrics Georgetown University MGUH

slide-4
SLIDE 4
slide-5
SLIDE 5
slide-6
SLIDE 6

Scope

  • 2014: over 42 million immigrants in USA
  • 13% of the total population.
  • 19.7 million naturalized citizens
  • 9.9 million lawfully present immigrants
  • 12.5 million undocumented immigrants.
  • >250,000 children in last 15 years have come

to join their adoptive families

slide-7
SLIDE 7
slide-8
SLIDE 8

Child migration and displacement

  • In 2015, there were 244 million people

worldwide living outside their country of birth; 31 million of them were children.

Among the world’s migrants are more than 21 million refugees – some 10 million of whom are children – who have been forcibly displaced from their own countries. An additional 41 million people in 2015 were internally displaced due to conflict and violence, and estimated 17 million of those were children.

slide-9
SLIDE 9
slide-10
SLIDE 10

U.S. Population by Immigration Status, 2014 316 Million Total U.S. Population

U.S. Born Citizens 87% All Immigrants 13% (42.2 million) 6%, 3%, 4% Immigrants as a Share of the Total Naturalized citizens (19.7 million) Lawfully Present Immigrants (9.9 million) Undocumented Immigrants (12.5 million) SOURCE: Kaiser Family Foundation analysis of March 2015

Current Population Survey, Annual Social and Economic Supplement

slide-11
SLIDE 11

87 6 3 4

Share of US Population, 2014

US born Naturalized Lawful undocumented

slide-12
SLIDE 12

Terminology

  • Adoption
  • Migrant
  • Immigrant
  • Naturalized
  • Lawfully present
  • Undocumented
  • Refugee
slide-13
SLIDE 13

Medical examination for immigrants and refugees

  • Under the authority of the Immigration and Nationality Act (INA)

and the Public Health Service Act, the Secretary of Health and Human Services promulgates regulations outlining the requirements for the medical examination of aliens seeking admission into the United States. The Division of Global Migration and Quarantine provides the Department of State (DOS) and the U.S. Citizenship and Immigration Services (USCIS) with medical screening guidelines for all examining physicians, which outline in detail the scope of the medical examination. The purpose of

the medical examination is to identify, for the DOS and USCIS, applicants with inadmissible health- related conditions.

slide-14
SLIDE 14
slide-15
SLIDE 15

IN USA

  • The immigration medical exam must be

conducted by a physician designated by USCIS (also known as a "civil surgeon").

slide-16
SLIDE 16

ABROAD

  • The immigration medical exam must be

conducted by a physician designated by the U.S. Department of State (also known as a "panel physician").

slide-17
SLIDE 17

Civil Surgeons

  • These are the Technical Instructions for Medical Examination of

Aliens used by the Civil Surgeons in the medical examinations conducted in the United States.

  • Introduction and Background
  • Medical History and Physical Examination
  • Tuberculosis
  • Syphilis
  • Gonorrhea
  • Hansen’s Disease
  • Physical or Mental Disorders with Associated Harmful Behaviors and

Substance-related Disorders

  • Other Physical or Mental Abnormality, Disease or Disability
  • Vaccinations
  • On October 6, 2008, HHS/CDC post
slide-18
SLIDE 18
  • Medical examinations in the United States are

typically required for adjustment of status cases (Form I-485), and may also be required for requests for “V” nonimmigrant status (Form I-539).

slide-19
SLIDE 19

Domestic medical screening for refugees

  • Currently 12 guidelines are available.
  • General Guidelines
  • Guidelines for the History and Physical
  • Hepatitis Screening Guidelines
  • HIV Infection Screening Guidelines
  • Immunizations Guidelines
  • Intestinal Parasite Guidelines
  • Lead Screening Guidelines
  • Mental Health Screening Guidelines
  • Malaria Guidelines
  • Nutrition and Growth Guidelines
  • Sexually Transmitted Diseases Guidelines
  • Tuberculosis Guidelines
slide-20
SLIDE 20

Panel Physicians

  • These are the Technical Instructions for Medical Examination of

Aliens used by the Panel Physicians in the medical examinations conducted outside of the United States.

  • Introduction and Background
  • Medical History and Physical Examination
  • Tuberculosis Screening and Treatment
  • Syphilis
  • Gonorrhea
  • Hansen’s Disease
  • Physical or Mental Disorders with Associated Harmful Behaviors and

Substance-related Disorders

  • Other Physical or Mental Abnormality, Disease, or Disability
  • Communicable Diseases of Public Health Concern
  • Vaccinations
slide-21
SLIDE 21

Done overseas

  • The visa medical exam includes:
  • a physical exam
  • a series of vaccines*
  • a screening for tuberculosis/TB (skin test/chest x-ray

examination)

  • a blood test for syphilis (not routinely done for children

under 15 unless there is reason to suspect infection)

  • *Some adopted children can receive a waiver to have

their vaccinations delayed until after they arrive in the United States. Children who receive a waiver must receive the required vaccines once they arrive in the United States.

slide-22
SLIDE 22

CDC

slide-23
SLIDE 23
slide-24
SLIDE 24

Laws governing adoption process

U.S. Federal Law Laws of child’s country of birth Laws of State or Territory

  • f residence
slide-25
SLIDE 25

International adoption in USA

  • 2004

23000

  • 2015

5648

  • 88 countries
  • 42% China
slide-26
SLIDE 26

International Adoptions

  • Year

<5 years of age <1 year of age 2003 87% 56 % 2015 54% 0.6%

slide-27
SLIDE 27

Geography

  • Countries
  • States
slide-28
SLIDE 28

Adoptions from all countries by year

slide-29
SLIDE 29

Top 5 Adopting Countries and States

slide-30
SLIDE 30

2015

slide-31
SLIDE 31
slide-32
SLIDE 32
slide-33
SLIDE 33
slide-34
SLIDE 34
slide-35
SLIDE 35
slide-36
SLIDE 36
slide-37
SLIDE 37
slide-38
SLIDE 38
slide-39
SLIDE 39

Delaware adoptions

slide-40
SLIDE 40

Preadoption

Travel for parents Medical exam at origin point Communication during travel Review of documents Counseling

slide-41
SLIDE 41

Post Placement Evaluation

Office contact Initial Visit Evaluation components Nutrition/ feeding Behavior Immunizations Laboratory Referrals Follow up

slide-42
SLIDE 42

MEDICAL EVALUATION

slide-43
SLIDE 43

Preadoption Parent(s)/ Family travel and preparation Post placement and adoption evaluation

slide-44
SLIDE 44

Pre adoption

  • Counseling. No child assigned
  • Planning stage. Child assigned
  • Documentation review
slide-45
SLIDE 45

Parent- Family

Travel advice Immunizations Contact with Agency Contact with Pediatrician

slide-46
SLIDE 46

Post Placement/Adoption Evaluation

  • System Contact
  • Office contact
  • Initial Visit
  • Comprehensive evaluation
  • Evaluation components
  • Immunizations
  • Referrals
slide-47
SLIDE 47

Comprehensive Evaluation

  • Review records
  • Physical exam
  • Measurements
  • Nutrition
  • Behavior
  • Screening
  • Immunizations
slide-48
SLIDE 48

Comprehensive Evaluation

  • Review records
  • Physical exam
  • Measurements
  • Nutrition
  • Behavior
  • Screening
  • Immunizations
slide-49
SLIDE 49
slide-50
SLIDE 50
slide-51
SLIDE 51
slide-52
SLIDE 52

Records

  • Language
  • Translation
  • Official records
  • ??
slide-53
SLIDE 53
slide-54
SLIDE 54

Screening

  • CBC
  • Hepatitis
  • HIV
  • Syphilis
  • Thyroid
  • Lead
  • Urinalysis
  • Stool
slide-55
SLIDE 55
  • Newborn Metabolic screen
  • Vit D
  • PPD
  • Others

– G6PD – Hemoglobin electrophoresis – Tailor to patient and epidemiology of country

slide-56
SLIDE 56

…and /or Referrals

  • Audiology
  • Ophthalmology
  • Dental
  • Developmental evaluation
  • Others
slide-57
SLIDE 57

WORK UP check list

1 2 3 4 5 6 7 8

slide-58
SLIDE 58
slide-59
SLIDE 59
slide-60
SLIDE 60

Immunizations

  • Review records
  • Determine acceptable from record
  • Formulate plan
  • Immunize
  • Catch up
slide-61
SLIDE 61
slide-62
SLIDE 62
slide-63
SLIDE 63

Follow up

  • Review laboratories and results
  • Growth and Development
  • Feeding
  • Behavior
  • Long term issues
  • Routine care
  • Work up Sheet
slide-64
SLIDE 64

GOALGOAL

  • Incorporate to regular care
  • Follow up as needed
  • Relationship
  • Healthy and Happy
slide-65
SLIDE 65

SOURCES

  • U.S Department of State
  • Bureau of Consular Affairs
  • UNICEF
  • UNICEF Global Database
  • CDC
  • AAP
  • Department of Homeland Security ( US

Citizenship and Immigration Services)

  • Medical Literature
slide-66
SLIDE 66
slide-67
SLIDE 67