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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics

This policy is a revision of the policy in

  • 131(6):e2028
From the American Academy of PediatricsPolicy Statement

Providing Care for Children in Immigrant Families

Julie M. Linton, Andrea Green and COUNCIL ON COMMUNITY PEDIATRICS
Pediatrics September 2019, 144 (3) e20192077; DOI: https://doi.org/10.1542/peds.2019-2077
Julie M. Linton
aDepartments of Pediatrics and Public Health, School of Medicine Greenville, University of South Carolina, Greenville, South Carolina;
bDepartment of Pediatrics, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; and
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Andrea Green
cLarner College of Medicine, The University of Vermont, Burlington, Vermont
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Abstract

Children in immigrant families (CIF), who represent 1 in 4 children in the United States, represent a growing and ever more diverse US demographic that pediatric medical providers nationwide will increasingly encounter in clinical care. Immigrant children are those born outside the United States to non–US citizen parents, and CIF are defined as those who are either foreign born or have at least 1 parent who is foreign born. Some families immigrate for economic or educational reasons, and others come fleeing persecution and seeking safe haven. Some US-born children with a foreign-born parent may share vulnerabilities with children who themselves are foreign born, particularly regarding access to care and other social determinants of health. Therefore, the larger umbrella term of CIF is used in this statement. CIF, like all children, have diverse experiences that interact with their biopsychosocial development. CIF may face inequities that can threaten their health and well-being, and CIF also offer strengths and embody resilience that can surpass challenges experienced before and during integration. This policy statement describes the evolving population of CIF in the United States, briefly introduces core competencies to enhance care within a framework of cultural humility and safety, and discusses barriers and opportunities at the practice and systems levels. Practice-level recommendations describe how pediatricians can promote health equity for CIF through careful attention to core competencies in clinical care, thoughtful community engagement, and system-level support. Advocacy and policy recommendations offer ways pediatricians can advocate for policies that promote health equity for CIF.

  • Abbreviations:
    AAP —
    American Academy of Pediatrics
    CIF —
    children in immigrant families
    DACA —
    Deferred Action for Childhood Arrivals
    FGC/M —
    female genital cutting or mutilation
    LEP —
    limited English proficiency
    LPR —
    lawful permanent resident
    PTSD —
    posttraumatic stress disorder
    TPS —
    temporary protected status
  • Demographics

    Health care of children in immigrant families (CIF) in the United States has received increasing attention over the past decade, in part because of increasing migration of children caused by conflicts globally, greater diversity among migrant populations, and divisive sociopolitical discussion regarding immigration policy. Definitions regarding immigrant children vary, but for the purposes of this policy statement, immigrant children are those born outside the United States to non–US citizen parents. The term CIF includes both those who are foreign born and those who are born in the United States and have at least 1 parent who was foreign born. In 2015, 43 million people, representing 13% of the US population, were immigrants, approaching the historic high of 14.8% in 1890.1,2 Currently, 3% of US children are foreign born, and 25% of US children live in immigrant families.3,4 It is projected that by 2065, 18% of the US population will be foreign born and an additional 18% will be US-born children of immigrants.2 Immigrant children and CIF reside in all 50 states (Figs 1 and 2).

    FIGURE 1
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    FIGURE 1

    Population of immigrant children in the United States, 2017. Reprinted with permission from The Annie E. Casey Foundation, KIDS COUNT Data Center, https://datacenter.kidscount.org.

    FIGURE 2
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    FIGURE 2

    CIF, 2016. Reprinted with permission from The Annie E. Casey Foundation, KIDS COUNT Data Center, https://datacenter.kidscount.org.

    Children immigrate to the United States with or without their parents for diverse and complex reasons, including, but not limited to, economic needs, educational pursuits, international adoption, human trafficking, or escape from threatening conditions in pursuit of safe haven. Immigrants may arrive with temporary visas (eg, work visa, student visa, tourist visa, J-1 classification), have or obtain permanent permission to remain in the United States (eg, lawful permanent residents [LPRs] or “green card” holders), come with refugee status, seek legal protection on arrival to the United States, or remain without legal status (Table 1). Refugees, who obtain legal status before arrival, and asylees, who can obtain legal status after arrival in the United States, must have a well-founded fear of persecution based on race, religion, nationality, sexual/gender orientation, political opinion, or membership in a particular social group.5 LPRs and refugees can apply for citizenship after 5 years of living in the United States.6 In addition to asylum, other forms of protection (eg, special immigrant juvenile status, T nonimmigrant status, and U nonimmigrant status) may also be available to particular children and families seeking safe haven in the United States.7 If parents or children do not qualify for a legal form of protection, they may choose to remain in the United States without legal status. Specifically, approximately 11.1 million individuals in the United States lack current legal status,8 and 5.1 million US children live with at least 1 immigrant parent without legal status.9

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    TABLE 1

    Definitions

    In 2016, half of the 22.5 million refugees worldwide were 18 years or younger, and less than 1% are resettled annually.10 Ongoing humanitarian needs are acutely exacerbated by global migration crises, exemplified by the displacement of nearly 12 million Syrians by the end of 2015.10 The number of refugees entering the United States is set annually by Congress and the president and historically has fluctuated on the basis of sociopolitical events. All 50 states, with the exception of Wyoming, have refugee resettlement programs.11

    Migration to the United States varies on the basis of global poverty, armed conflict, and exceedingly complex sociopolitical circumstances. Despite these complexities, the United Nations Convention on the Rights of the Child, endorsed by the American Academy of Pediatrics (AAP) but not ratified by the US government, is an internationally recognized legal framework for the protection of children’s basic rights, regardless of the reasons children migrate.12,13 The AAP policy statement “The Effects of Armed Conflict on Children” delineates the impact of armed conflict on children and the role of child health professionals in a global response.14

    Responses to migration, and especially migration of children, are equally varied and complicated.15 For instance, increasing arrivals of unaccompanied children and family units from Guatemala, Honduras, El Salvador, and Mexico at the southern US border beginning in 2014 triggered a series of governmental responses, including escalating detention of immigrant children, described in detail in the AAP policy statement “Detention of Immigrant Children.”7,16 Additionally, the Deferred Action for Childhood Arrivals (DACA) program was developed to allow young adults who had arrived in the United States as children without legal status but had grown up in the United States to apply for deportation relief and work permits.15 A related program, Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA), would have offered similar protections for parents without legal status who have US-born children, but it was halted in federal courts and was subsequently rescinded by presidential executive order before it could be implemented.15,17 In 2017, the president signed new executive orders focused on heightened immigration enforcement, increased border security, and limits to the US refugee program. Furthermore, changes to temporary protected status (TPS), granted to individuals physically present in the United States who are from countries designated by the secretary of the US Department of Homeland Security as unsafe to accept their return, have created uncertainty for the nearly 320 000 TPS beneficiaries and their families.18

    In addition to changes in the numbers and demographics of immigrants and the legal protections afforded them, family immigration status represents an important and often-neglected social determinant of health. The immigration status of children and their parents relates directly to their subsequent access to and use of health care, perceived health status, and health outcomes.7,19–26 Family immigration status is intertwined with other social determinants of health, including poverty,27 food insecurity,28,29 housing instability,30,31 discrimination,32,33 and health literacy.34–37

    Resilience and Integration

    Despite the challenges that immigrant children and families often face, many offer tremendous assets and demonstrate remarkable resilience. On first arrival in the United States, immigrant children may be healthier than native-born peers, a phenomenon often described as “the immigrant paradox” or “the healthy immigrant effect.”27,33 A strengths-based approach to immigrant child health celebrates assets of immigrant families and populations, buffers marginalization, and supports integration. Understanding cultural assets, such as ethnic-racial identity and cultural values, may offer opportunities to build resilience among immigrant children.38–40 Furthermore, recognizing assets facilitates productive dialogue that supports immigrant families not as threats but as valuable resources to our society.40

    Cultural Humility and Safety

    When caring for CIF, health care providers must recognize the role culture plays in understanding illness without reflexively assuming that challenges are always attributable to cultural differences.41–45 Because culture is dynamic, cultural competency is never fully realized,46 but rather serves as a developmental process.47 Providers bring personal cultural biases, as well as biases of biomedicine, that can implicitly or explicitly affect the provision of care.48,49 Cultural humility is the concept of openness and respect for differences.50–52 Cultural safety reflects the recognition of the power differences and inequities in health and the clinical encounter that result from social, historical, economic, and political circumstances.53–55 By recognizing ourselves and others as cultural beings, by building trust through respect and awareness of power differentials and cultural beliefs, and by developing and implementing communication skills that facilitate mutual understanding, health care providers work to minimize disparities and promote equity in a health encounter.

    Culturally sensitive systems of health care, ones that value cultural humility and safety, emerge when patients and families are engaged with 3 core values: curiosity, empathy, and respect.56 Some immigrants bring with them a system of healing that, like biomedicine practiced in the United States, claims to be curative, includes interventions that can be applied by an expert practitioner, and offers a body of theory regarding disease causation, classification, and treatment.57 With acculturation, these individuals may or may not modify their healing system to incorporate biomedical concepts. Culturally sensitive care systems have the flexibility to support health literacy, to recognize values of community and family that may supersede individual rights, to engage spirituality and respect traditions, and to include diverse perspectives in implementation and evaluation. The reciprocity of culturally sensitive health care offers us a wider lens that reduces health inequities and strengthens the practice of healing through multicultural medicine and medical practice that acknowledges nonallopathic traditions.58,59

    Care of CIF: Core Competencies

    Immigrant children benefit from increased access and communication offered in a patient- and family-centered medical home with an identified primary care provider in which care “is respectful of and responsive to individual patient preferences, needs, and values.”60–64 The medical home, infused with cultural humility and safety, supports continuous, comprehensive, and compassionate care and increases collaboration with community supports, including schools, places of worship, legal agencies, and extracurricular activities. Interpreters are an essential part of the medical team to support health literacy, improve access, and ensure quality medical care.65,66 However, disparities in access to care for CIF, and especially for those with special health care needs, have persisted.24,25,67–72 Immigrant families, particularly those with children with special health care needs, often benefit from intensive supports in negotiating a complex medical system, special education system, and network of community resources. Pediatric providers can play a lead role for the medical home team in implementing and educating on core competencies that are meant to build health equity for CIF. Core resources for the provision of care for CIF include, but are not limited to, the AAP Immigrant Child Health Toolkit44 and the Centers for Disease Control and Prevention Refugee Health Guidelines.73

    Cross-cultural Approach

    Rather than learning generalities of a given culture, a practical framework can guide the clinical approach.74,75 A classic patient-based model recommends assessing for core cross-cultural issues, exploring the meaning of the illness, determining the social context, and engaging in negotiation around treatment plans.76 Core cross-cultural issues include styles of communication, trust, family dynamics, traditions and spirituality, and sexual and gender considerations.75 Kleinman and Benson’s45 7 questions for cultural assessment are helpful to explore patient’s perspectives; most crucially, this includes what matters most to the patient and family within the context of illness and treatment (Table 2). The efficacy of treatment may need to be understood “within the scope of cultural beliefs and not that of the scientific evidence.”77,78 Therefore, there may be need for cross-cultural negotiation facilitated through tools like “LEARN” (listen, explain, acknowledge, recommend, negotiate).57,79

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    TABLE 2

    Questions to Elicit the Patient Explanatory Model

    Knowledge and skills can be developed regarding cross-cultural patient care, migration health issues, and unique vulnerabilities and strengths of immigrant families. Although all children and families are unique, origin-country profiles may be helpful to provide generalized information about immigrant groups.80–82

    Migration Health Issues

    Care of immigrant children requires knowledge of unique health issues in the child’s country of origin and country or countries of refuge before arrival as well as an understanding of the challenges of resettlement and acculturation once within the United States. When taking a medical history, it is therefore necessary to elicit details of migration73 as well as the child’s birth; medical, immunization, developmental, social, and family history; and exposure to trauma and violence.73,83 Past medical and immunization records may require translation as well as awareness and management of different global immunization schedules.84,85 CIF often return to their families’ countries of origin to visit relatives, and providers need to be familiar with travel risks, prophylactic medications, and unique vaccine needs.86

    Communicable Disease

    When screening for and treating infectious diseases, a public health approach is advantageous.44,87 For refugees, some screenings may have been performed in another country, and presumptive treatments may have been provided through the International Organization for Migration.88 Depending on the migration history, immigrant children may need screening on arrival in the United States for infectious diseases (eg, tuberculosis; malaria; Chagas disease; intestinal parasites such as helminths, schistosomiasis, and strongyloides; chronic hepatitis B; HIV; syphilis; and other vertically and horizontally transmitted sexual infections).44,87–94 Comprehensive reproductive and mental health services are warranted for immigrant children with a history of sexual activity, trafficking, exploitation, or victimization.

    Oral Health

    The global burden of oral diseases is high.95 Caries risk varies depending on previous country of residence.96,97 Differences in oral health may reflect cultural practices and norms related to weaning and brushing, dietary changes, and limited oral health literacy.98–101 Access to dental services and education on oral health is essential for immigrant children.102

    Noncommunicable Disease

    The incidence of noncommunicable diseases globally has grown.103–105 Rates of asthma, obesity, autism,106–110 depression, anxiety, and posttraumatic stress disorder (PTSD) may be similar or disproportionately increased in immigrant children.71,111–114 In addition, newly arrived immigrant children may present with diseases not yet diagnosed or further progressed. Examples include genetic conditions related to consanguinity. Furthermore, newborn screening for hearing loss, hypothyroidism, metabolic diseases, or hemoglobinopathies may not have been performed.94,115 Vision problems and elevated blood lead concentrations are also common and must be considered.94,116–120

    Nutrition and Growth

    During assessment of nutrition and growth on entry into medical care, immigrant children may be recognized as wasted, having underweight, having overweight, or stunted.97,121–124 Health care providers will need to be familiar with global diets, dietary restrictions, and vitamin and nutrient sources.124–126 Anemia, thalassemia, glucose-6-phosphate dehydrogenase deficiency, and micronutrient deficiencies (including iron, vitamin D, and vitamin B12) may exist.97,127–129 Families can be screened for food insecurity and connected to relevant resources.126,130,131

    Developmental and Educational Considerations

    Age-appropriate developmental and behavioral screening is possible with the use of validated multilingual screening tools, such as the Ages and Stages Questionnaire132 and the Survey of Well-being of Young Children,133 and with historical assessment of milestones.134,135 Care must be taken to recognize cultural bias and experiential differences in skill development.136–139 Screening needs to be sensitive to cultural differences in parenting140,141 and disparities in reading or sharing books with children,142 but referral should not be delayed if screening results are concerning.143 Age-appropriate vision and hearing screening is essential.144 Providers’ encouragement of a language-rich environment in the parent’s primary language recognizes the strengths of bilingualism.145–150

    One in 10 students from kindergarten to 12th grade in the United States is an English-language learner.151 Dual-language learners, defined as children younger than 8 years with at least 1 parent who speaks another language in the home other than English, make up one-third of young children in the United States currently. Dual-language learners are less likely to be enrolled in high-quality early child care and preschools compared with peers, potentially limiting kindergarten readiness.152,153

    All children are entitled to free public education and specialized educational services regardless of immigration status.154 Immigrant children may face particular academic challenges.155,156 Before arrival to the United States, some children may have had no opportunity for formal schooling or may have faced protracted educational interruptions. Students with interrupted or no schooling may lack strong literacy skills, age-appropriate content knowledge, and socioemotional skills; in addition, they may need to learn the English language.157 Learning may also be affected by traumatic brain injury, cerebral malaria, malnutrition, personal trauma, in utero exposures (eg, alcohol),94 and toxic exposures (eg, lead).116–120 Testing for developmental and learning challenges in the school setting may result in overrepresentation of students with limited English proficiency (LEP) in special education.158–161 Through collaboration with parents and schools, pediatricians can facilitate thoughtful consideration of learning difficulties in the setting of LEP. Supplemental anticipatory guidance may include recognition of family strengths and differences in parent-child relationships, child-rearing practices and discipline, dietary preferences, safety risks and use of car restraints and safe sleep practices, and acculturation.162–168

    Mental Health

    Many immigrant children and youth may have had disruptions to the basic experiences that allow for healthy development.169 Immigrant children and their families may experience trauma before migration, during their journey, on arrival at our borders, and while integrating into American communities170–176 and, as a result of their increased risk, require “health and related services of a type or amount beyond that required by children generally.”177 Trauma may include personal history of physical or sexual abuse, witnessing interpersonal violence, human trafficking, actual or threatened separation from parents, or exposure to armed conflict.173,174,176,178 Traumatized children with traumatized parents (or, in some cases, without their parents) may be at risk for toxic stress or prolonged serious stress in the absence of buffering relationships.179 In addition to intergenerational transfer of mental health problems, core stressors include trauma, acculturation, isolation, and resettlement.172 In particular, acculturation includes stressors that families experience as they navigate between the culture of their country of origin and the culture in their new country.172

    On arrival, many refugee and unaccompanied children have high levels of anxiety, depression, and PTSD.174,180–186 Compared with US- origin youth, refugee youth have higher rates of community violence exposure, dissociative symptoms, traumatic grief, somatization, and phobic disorder.187 Unaccompanied minors have even higher levels of PTSD compared with accompanied immigrants,188 which may be further heightened if they are seeking asylum.189 Immigration-related trauma history may be shared over time as a trusting relationship develops with the physician.190 Some CIF who were born in the United States may face difficulty with emotional and behavioral problems relating to identity formation.191 Initial and ongoing screening for mental and behavioral health problems with multiple cross-culturally validated tools (eg, the Ages and Stages Questionnaire-Social Emotional, the Survey of Well-being of Young Children, the Strengths and Difficulty Questionnaire, the Refugee Health Screener 15, and the Child Behavior Checklist) facilitates recognition of distress and concerns.44,132,133,192–195

    By understanding the interplay of biological, social, environmental, and psychological risk and protective factors, emotional disorders can be modulated on population, community, and individual levels.196 Protective factors and sources of resilience observed in immigrants include having a positive outlook, having strong coping skills, having positive parental coping strategies, connection to prosocial organizations such as places of worship and athletics, and cultural pride reinforcement.32,197–200 Resilience is fostered through strong family relationships and community support.201 Bicultural identity, a strong attachment to one’s culture of origin in addition to a sense of belonging within the culture of residence, promotes resilience.140,202

    Because of the shame and stigma associated with mental health problems, families may be reluctant to seek treatment.203 Providers can increase access and minimize stigma by integrating culturally tailored mental health services into the medical home, in the school setting, and through engagement with community mental health resources,78,175,204 including home visitation.205 Community-wide strategies that foster belonging, reduce discrimination, and provide social supports can facilitate healing and reduce stigma.

    Traditional Health Care and Cultural Practices

    Traditional healing and cultural practices, common among some immigrant populations, warrant awareness by health care providers.206 Patients may not disclose use of herbal and traditional treatments unless directly asked.42,207 Some immigrant families use traditional forms of protection for vulnerable infants, such as prayer, amulets, kohl, or myrrh. Other immigrant families use traditional practices to treat illness (eg, cupping, coining, and uvulectomy), and stigmata of these traditional treatments may be observed on examination and may be misinterpreted as abuse.208,209

    Female genital cutting or mutilation (FGC/M) is still practiced in some communities in Africa, in the Middle East, and in parts of Asia despite increased efforts to educate on risks.210,211 Performing FGC/M is against the law in the United States and has been defined as torture by the United Nations, but foreign-born girls may have experienced this before entry into the United States.210,212 Resources exist regarding the types of FGC/M, complications that can result, recommended documentation in the medical record, and strategies to sensitively discuss this with families.213,214 In 2013, the United States passed the Transport for Female Genital Mutilation Act, which prohibits knowingly transporting a girl out of the United States for the purpose of “vacation cutting.”215 The need to screen for FGC/M further underscores the importance of examining the external genitalia of children at all preventive visits in addition to sensitively counseling families regarding the laws and other concerns regarding FGM/C.

    Practice-Level Barriers and Potential Opportunities

    Communication challenges between families with LEP and health care providers must be addressed to provide high-quality care. Fifty-four percent of CIF have resident parents who have difficulty speaking English.3 Parental LEP is associated with worse health care access and quality for children.216–220 National Standards for Culturally and Linguistically Appropriate Services in Health Care were issued by the US Department of Health and Human Services, in accordance with Title VI of the Civil Rights Act. Culturally and Linguistically Appropriate Services in Health Care Standards describe the federal expectation that health care organizations receiving federal funding must provide meaningful access to verbal and written-language services for patients with LEP.221,222 Interpreters are an integral part of the medical home team for CIF and hold the same confidentiality standards as the physician.67,68 Most state insurance programs and private insurers do not offer reimbursement for language services. Although teaching health care providers when and how to work with interpreters can improve care, few providers receive such training.223,224 For these and other reasons, some providers inappropriately use family members as ad hoc interpreters.225 However, family members, friends, and especially children are not acceptable substitutes for trained interpreters.226,227 Trained medical interpreters, via phone or tablet or in-person, facilitate mutual understanding and a high quality of communication.228,229 Use of trained interpreters maintains confidentiality, reduces errors and cost, and increases the quality of health care delivery.227,228,230–232 Interpretation requires that extra time be allotted to health care encounters. Qualified bicultural and bilingual staff can receive medical interpreter training if expected to perform as interpreters, and bilingual providers can ideally demonstrate dual-language proficiency before engaging with families in their preferred language without an interpreter.233–235 Access can be further improved by the use of multilingual signage, screening tools, handouts, and other key documents (eg, consent forms and hospital discharge summaries) that are prepared by qualified translators.

    Although some immigrant families integrate without hardship, many CIF face inequities resulting from complex determinants, including poverty, immigration status, insurance status, education, and discrimination on the basis of race and/or ethnicity.32,33 For some, fear regarding family immigration status threatens children’s health, development, and access to care.22,32,236–238 For others, growing up in 2-parent families and having environmental stimulation at home, particularly for those with low socioeconomic status, may be protective.33,239 Screening for social determinants of health can trigger referrals to community-based supports.240 The hallmarks of the medical home, comprehensive care and enhanced care coordination, are important supports for immigrant families. Integrated mental health, nutrition, social work, and patient navigation services allow for ease of access and for reduction in stigma and barriers. Community health workers who are members of immigrant communities have been effective in reducing disparity and improving health outcomes.241–246 Interagency partnerships with the local health department, home-visiting programs, community mental health providers, schools, and immigrant service organizations facilitate access to medical homes and cross-sector communication. “Warm hand-offs,” or in-person transfer of care between health care team members with patients and families present, can help to ensure linkage between providers and relevant resources.247

    Systems-Level Barriers and Potential Opportunities

    Health literacy challenges experienced by CIF include not only language comprehension but also the myriad of system barriers in the health care network. Limited health literacy can complicate enrollment in public benefits for CIF. Immigrant children are specifically less likely to have a medical home67,68 and health insurance, resulting in delayed or foregone care.248 Most immigrant children with legal status are eligible for health coverage. A majority of states have opted to allow lawfully residing immigrant children to receive Medicaid and/or Children’s Health Insurance Program coverage using federal Medicaid and Children’s Health Insurance Program funds without a 5-year waiting period, an option given to states by the Children’s Health Insurance Program Reauthorization Act of 2009; however, 17 states have not taken the Children’s Health Insurance Program Reauthorization Act of 2009 option.249–253 Only a minority of states offer health coverage to children regardless of immigration status.252,253 Additionally, immigrant children without legal status, including DACA youth, are excluded from eligibility for most federal programs, including health insurance, although some states have included and/or are considering inclusion of DACA youth (or, more broadly, other noncitizen children) as eligible for programs such as in-state tuition or professional licensing.254,255 Opportunities to mitigate these literacy, access, and health insurance enrollment challenges include system-wide use and funding of interpreters and multilingual tools and use of community health workers and patient navigators to reduce barriers through facilitation, education, and advocacy.43,58,59,256,257 For CIF without health coverage, federally qualified health centers, public health departments, free clinics, and charity care systems may offer access to consistent care. Home-visiting programs can support immigrant parents and parents with LEP who may be isolated and unable to access public services152,258; attention to cultural safety is particularly critical when engaging in home-based services. Quality after-school programming, with support of school social work, can also facilitate integration and build resilience for CIF.259,260

    Immigration and Related Legal Issues

    Federal immigration policies can adversely affect immigrant health coverage, access, and outcomes. Immigration status of children and/or their parents continues to affect access to services and public benefits, despite some improvement.33,261,262 Increased fears about the use of public programs and immigration status has deterred immigrants from accessing programs regardless of eligibility.263–265 In addition, immigration enforcement activities that occur at or near sensitive locations, such as hospitals, may prevent families from accessing needed medical care.264 Sensitive locations include medical treatment and health care facilities, places of worship, and schools, and US Immigration and Customs Enforcement actions, including apprehension, interviews, searches, or surveillance, should not occur at these locations.266,267 Fear of immigration enforcement or discrimination may exacerbate transportation barriers and worsen perceived access to care.23,237,268–271 Discrimination relating to immigration may intersect with religion (eg, Muslim immigrants) and race in complex ways.264,272–274 Discrimination and immigration enforcement policies may also create fear and uncertainty, which threaten the mental health of immigrant children275 and their families.19,236,264,276 Families living on the US-Mexico border face particular risk of mistreatment and victimization.277 Policies that offer protection from deportation, such as DACA, may confer large mental health benefits for youth and for the children of parenting youth.278,279

    Immigrant children who have been detained and are in immigration proceedings face almost universal traumatic histories and ongoing stress, including actual or threatened separation from their parents at the border.7 Immigrant children, including unaccompanied children, are not guaranteed a right to legal counsel, and as such, roughly 50% of children arriving in the United States have no one to represent them in immigration court.280 Lack of guaranteed legal representation for immigrant children and families at risk for deportation is further complicated by funding restrictions; specifically, medical-legal partnerships receiving federal funding that operate under Legal Services Corporation guidelines cannot accept most cases related to immigration.281 Many nongovernmental efforts have sought to address lack of legal representation for children, but opportunities remain to better provide immigration-specific legal support for immigrant families,282,283 including novel medical-legal partnerships with different funding streams that do not exclude people without legal status and offer representation in immigration court. In addition, traumatized immigrant children can benefit from system-level supports for integration of mental health and social work supports into schools, the medical home, and protected community settings.284

    Evidence-based programs can systematically build resilience among CIF by supporting integration into US culture while preserving home cultural heritage. Although specific evidence regarding CIF is limited, home-visiting programs offer opportunities to celebrate unique strengths and mitigate stress in a natural environment.258,285 Programs that support literacy and encourage play, such as Reach Out and Read, can reinforce parent-child relationships, build parenting skills, support development, and prepare children for academic success.150,286,287 For children experiencing parental reunification after prolonged separation, mental health services and educational support are particularly critical.238 Given the strong role of communities in many cultures, community-based interventions may be particularly effective for immigrant families.

    Opportunities to investigate strategies, mitigate barriers, and optimize health and well-being for CIF include research, medical education, and community engagement, including community-based participatory research and health education. Research used to examine acculturative stress and resilience of immigrant children over time is limited. Among CIF, diversity within and between racial and ethnic groups (eg, Hispanic, Asian, African, and Caribbean) and between CIF of varying socioeconomic statuses is also understudied and underappreciated.288 Medical education has become increasingly responsive to health disparities for immigrants and to the opportunities for experiential broadening of global health. By implementing core competencies in the care of immigrant populations, trainees can learn to support a culture of health equity for CIF. Pediatricians can support families within and beyond the medical home through efforts supported by cross-sector community collaboration, including fields such as education and law, innovative research, and thoughtful advocacy, to inspire progressive policy.171,180,289 Grants that are focused on minority and underserved pediatric populations have the potential to mitigate inequities for immigrant children.171

    Summary and Recommendations

    With ever-increasing levels of migration worldwide, the population of CIF residing in the United States grows. The following practice- and policy-level recommendations offer guidance for pediatricians caring for CIF. Although it is aspirational to fully implement all recommendations in all situations, most are achievable by intentionally enacting practice- and systems-based changes over time.

    Practice-Level Recommendations

    1. All pediatricians are encouraged to recognize their inherent biases and work to improve their skills in cultural humility and effective communication through professional development.

    2. CIF benefit from comprehensive, coordinated, continuous, and culturally and linguistically effective care in a quality medical home with an identified primary care provider.

    3. Co-located or integrated mental health, social work, patient navigation, and legal services are recommended to improve access and minimize barriers.

    4. Trained medical interpreters, via phone or tablet or in-person, are recommended to facilitate mutual understanding and a high quality of communication. Family members, friends, and especially children are not recommended for interpretation. Materials may be translated into the patient’s preferred language by qualified translators whenever possible. Consideration should be given for the extended time needed for interpretation during medical encounters.

    5. It is recommended that pediatricians and staff receive training on working effectively with language services and that bilingual providers and staff demonstrate dual-language competency before interacting with patients and families without medical interpreters.

    6. Pediatricians and pediatric trainees are encouraged to engage in professional development activities that include specific competencies (including immigrant health; global health, including the global burden of disease; integrative medicine; and travel medicine) and to incorporate these competencies into the evaluation and care of CIF.

    7. Pediatricians caring for CIF are urged to apply a trauma-informed lens, with sensitivity to and screening for multigenerational trauma. Mental health professionals adept at treating immigrants can be integrated into the medical home or identified in the community.

    8. Screening for social determinants of health, including risks and protective factors, is recommended.

    9. Assessment of development, learning, and behavior is warranted for all immigrant children, regardless of age. Pediatricians can support dual language as an asset and as part of cultural pride reinforcement.

    Advocacy and Policy Recommendations

    1. The AAP endorses the United Nations Convention on the Rights of the Child and the principles included in this document as a legal framework for the protection of children’s basic rights.

    2. All US federal government, private, and community-based organizations involved with immigrant children should adopt policies that protect and prioritize their health, well-being, and safety and should consider children’s best interests in all decisions by government and private actors.

    3. Interagency collaboration is recommended between service providers (eg, medical, mental health, public health, legal, education, social work, and ethnic-community based) to enhance care, prevent marginalization of immigrant families, and build resilience among immigrant communities.

    4. Health coverage should be provided for all children regardless of immigration status. Neither immigrant children with legal status nor their parents should be subject to a 5-year waiting period for health coverage or other federal benefits.

    5. Private and public insurance payers should pay for qualified medical interpretation and translation services. Given the increased cost-effectiveness and quality of care provided with medical interpretation, payers should recognize and reimburse for the increased time needed during a medical encounter when using an interpreter.

    6. Both the separation of children from their parents and the detention of children with parents as a tool of law enforcement are inhumane, counterproductive, and threatening to short- and long-term health. Immigration authorities should not separate children from their parents nor place children in detention.

    7. Immigration enforcement activities should not occur at or near sensitive locations such as hospitals, health care facilities, schools (including child care and Head Start), places of worship, and other sensitive locations. Pediatricians have the right to report and protest any such enforcement. Medical records should be protected from immigration enforcement actions. Health systems can develop protocols to minimize fear and enhance trust for those seeking health care.

    8. Children in immigration proceedings should have access to legal representation at no cost to the child. Medical-legal partnerships that include immigration representation (eg, Terra Firma290) and efforts to increase legal representation (eg, KIND,291 the Young Center for Immigrant Children's Rights,292 RAICES293) should be supported practically and financially at local, state, and federal levels.

    9. Immigration policy that prioritizes children and families by ensuring access to health care and educational and economic supports, by keeping families together, and by protecting vulnerable unaccompanied children is of fundamental importance for comprehensive immigration reform. Humanitarian protection (eg, refugee resettlement and protection for victims of trafficking and asylum seekers) supports trauma-informed care of children and is an essential component of immigration policy.

    10. All children with LEP merit early, intensive, and longitudinal educational support with culturally responsive teaching. Literacy skills are necessary for health literacy, an essential health need.

    11. Enhanced funding is recommended to support research regarding immigrant child health, including, but not limited to, health outcomes; screening tools for development, mental health, and social determinants of health that are culturally and linguistically sensitive; developmental and/or learning difficulties in children whose home language is not English; and reduction of barriers to health access and equity.

    12. Medical education can facilitate education of trainees and health care professionals through implementation of core competencies in the care of immigrant populations and through advocacy curricula that incorporate special populations, including CIF.

    13. AAP chapters can work with state governments to adopt policies that protect and prioritize immigrant children’s health, well-being, and safety.

    Conclusions

    CIF represent a growing, diverse demographic in the United States. Pediatricians play an essential role in addressing vulnerabilities, minimizing barriers to care, and supporting optimal short- and long-term health and well-being of CIF within the medical home and in communities across the nation. With compassionate, respectful, and progressive policy, CIF can achieve their full potential for health and well-being.

    Lead Authors

    Julie M. Linton, MD, FAAP

    Andrea Green, MD, FAAP

    Council on Community Pediatrics Executive Committee, 2017–2018

    Lance A. Chilton, MD, FAAP, Chairperson

    James H. Duffee, MD, MPH, FAAP, Vice-Chairperson

    Kimberley J. Dilley, MD, MPH, FAAP

    Andrea Green, MD, FAAP

    J. Raul Gutierrez, MD, MPH, FAAP

    Virginia A. Keane, MD, FAAP

    Scott D. Krugman, MD, MS, FAAP

    Julie M. Linton, MD, FAAP

    Carla D. McKelvey, MD, MPH, FAAP

    Jacqueline L. Nelson, MD, FAAP

    Liaisons

    Gerri L. Mattson, MD, MPH, FAAP – Chairperson, Public Health Special Interest Group

    Kathleen Rooney-Otero, MD, MPH – Section on Pediatric Trainees

    Donene Feist – Family Voices North Dakota

    Staff

    Dana Bennett-Tejes, MA, MNM

    Jean Davis, MPP

    Tamar Magarik Haro

    Acknowledgment

    We thank Jennifer Nagda, JD (Young Center for Immigrant Children’s Rights).

    Footnotes

    • Address correspondence to Julie M. Linton, MD, FAAP. E-mail: Julie.linton@prismahealth.org
    • This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

    • Policy statements from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. However, policy statements from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent.

    • The guidance in this statement does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

    • All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

    • FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

    • FUNDING: No external funding.

    • POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

    References

    1. ↵
      1. Migration Policy Institute
      . Immigrant profiles and demographics. US data. Available at: https://www.migrationpolicy.org/topics/us-data. Accessed July 26, 2019
    2. ↵
      1. Pew Research Center
      . Modern immigration wave brings 59 million to US, driving population growth and change through 2065: views of immigration’s impact on US society mixed. 2015. Available at: www.pewhispanic.org/2015/09/28/modern-immigration-wave-brings-59-million-to-u-s-driving-population-growth-and-change-through-2065/. Accessed August 30, 2018
    3. ↵
      1. The Annie E. Casey Foundation; Kids Count Data Center
      . Children in immigrant families in the United States. Available at: https://datacenter.kidscount.org/data/tables/115-children-in-immigrant-families?loc=1&loct=1#detailed/1/any/false/871,870,573,869,36,868,867,133,38,35/any/445,446. Accessed July 26, 2019
    4. ↵
      1. Urban Institute
      . Children of immigrants data tool. Available at: http://webapp.urban.org/charts/datatool/pages.cfm. Accessed August 30, 2018
    5. ↵
      1. United Nations Office of the High Commissioner for Refugees
      . Convention and protocol relating to the status of refugees. 2010. Available at: www.unhcr.org/en-us/protection/basic/3b66c2aa10/convention-protocol-relating-status-refugees.html. Accessed August 30, 2018
    6. ↵
      1. The National Child Traumatic Stress Network
      . Bridging refugee youth and children’s services. Refugee 101. Available at: https://www.nctsn.org/resources/bridging-refugee-youth-and-childrens-services-refugee-101. Accessed August 30, 2018
    7. ↵
      1. Linton JM,
      2. Griffin M,
      3. Shapiro AJ; Council on Community Pediatrics
      . Detention of immigrant children. Pediatrics. 2017;139(5):e20170483pmid:28289140
      OpenUrlAbstract/FREE Full Text
    8. ↵
      1. Passel JS,
      2. Cohn D
      . Overall number of US unauthorized immigrants holds steady since 2009. 2016. Available at: www.pewhispanic.org/2016/09/20/overall-number-of-u-s-unauthorized-immigrants-holds-steady-since-2009/. Accessed December 27, 2017
    9. ↵
      1. Capps R,
      2. Fix M,
      3. Zong J
      . A profile of U.S. children with unauthorized immigrant parents. Available at: https://www.migrationpolicy.org/research/profile-us-children-unauthorized-immigrant-parents. Accessed December 27, 2017
    10. ↵
      1. United Nations Office of the High Commissioner for Refugees
      . Global Trends: Forced Displacement in 2015. Geneva, Switzerland: United Nations Office of the High Commissioner for Refugees; 2016
    11. ↵
      1. Administration for Children and Families
      . Office of refugee resettlement. 2017. Available at: https://www.acf.hhs.gov/orr. Accessed June 12, 2017
    12. ↵
      1. Haggerty RJ
      . The convention on the rights of the child: it’s time for the United States to ratify. Pediatrics. 1994;94(5):746–747pmid:7936910
      OpenUrlAbstract/FREE Full Text
    13. ↵
      1. United Nations General Assembly
      . Convention on the rights of the child. 1989. Available at: www.ohchr.org/Documents/ProfessionalInterest/crc.pdf. Accessed April 8, 2016
    14. ↵
      1. Shenoda S,
      2. Kadir A,
      3. Pitterman S,
      4. Goldhagen J; Section on International Child Health
      . The effects of armed conflict on children. Pediatrics. 2018;142(6):e20182585pmid:30397166
      OpenUrlAbstract/FREE Full Text
    15. ↵
      1. Cohn D
      . How U.S. Immigration Laws and Rules Have Changed through History. Washington, DC: Pew Research Center; 2015. Available at: www.pewresearch.org/fact-tank/2015/09/30/how-u-s-immigration-laws-and-rules-have-changed-through-history/. Accessed June 16, 2017
    16. ↵
      1. US Customs and Border Protection
      . United States border patrol southwest family unit subject and unaccompanied alien children apprehensions fiscal year 2016. Available at: https://www.cbp.gov/newsroom/stats/southwest-border-unaccompanied-children/fy-2016. Accessed December 26, 2016
    17. ↵
      1. US Department of Homeland Security
      . Frequently asked questions: rescission of memorandum providing for Deferred Action for Parents of Americans and Lawful Permanent Residents (“DAPA”). 2017. Available at: https://www.dhs.gov/news/2017/06/15/frequently-asked-questions-rescission-memorandum-providing-deferred-action-parents. Accessed June 15, 2017
    18. ↵
      1. Cohn D,
      2. Passel JS,
      3. Bialik K
      . Many Immigrants With Temporary Protected Status Face Uncertain Future in U.S. 2017. Available at: www.pewresearch.org/fact-tank/2017/11/08/more-than-100000-haitian-and-central-american-immigrants-face-decision-on-their-status-in-the-u-s/. Accessed December 27, 2017
    19. ↵
      1. Martinez O,
      2. Wu E,
      3. Sandfort T, et al
      . Evaluating the impact of immigration policies on health status among undocumented immigrants: a systematic review [published correction appears in J Immigr Minor Health. 2016;18(1):288]. J Immigr Minor Health. 2015;17(3):947–970pmid:24375382
      OpenUrlCrossRefPubMed
      1. Novak NL,
      2. Geronimus AT,
      3. Martinez-Cardoso AM
      . Change in birth outcomes among infants born to Latina mothers after a major immigration raid. Int J Epidemiol. 2017;46(3):839–849pmid:28115577
      OpenUrlPubMed
      1. Hardy LJ,
      2. Getrich CM,
      3. Quezada JC,
      4. Guay A,
      5. Michalowski RJ,
      6. Henley E
      . A call for further research on the impact of state-level immigration policies on public health. Am J Public Health. 2012;102(7):1250–1254pmid:22594736
      OpenUrlCrossRefPubMed
    20. ↵
      1. Vargas ED,
      2. Ybarra VD
      . U.S. citizen children of undocumented parents: the link between state immigration policy and the health of Latino children. J Immigr Minor Health. 2017;19(4):913–920pmid:27435476
      OpenUrlPubMed
    21. ↵
      1. Lopez WD,
      2. Kruger DJ,
      3. Delva J, et al
      . Health implications of an immigration raid: findings from a Latino community in the midwestern United States. J Immigr Minor Health. 2017;19(3):702–708pmid:27041120
      OpenUrlPubMed
    22. ↵
      1. Yun K,
      2. Fuentes-Afflick E,
      3. Curry LA,
      4. Krumholz HM,
      5. Desai MM
      . Parental immigration status is associated with children’s health care utilization: findings from the 2003 new immigrant survey of US legal permanent residents. Matern Child Health J. 2013;17(10):1913–1921pmid:23329165
      OpenUrlCrossRefPubMed
    23. ↵
      1. Javier JR,
      2. Huffman LC,
      3. Mendoza FS,
      4. Wise PH
      . Children with special health care needs: how immigrant status is related to health care access, health care utilization, and health status. Matern Child Health J. 2010;14(4):567–579pmid:19554437
      OpenUrlCrossRefPubMed
    24. ↵
      1. Siddiqi A,
      2. Zuberi D,
      3. Nguyen QC
      . The role of health insurance in explaining immigrant versus non-immigrant disparities in access to health care: comparing the United States to Canada. Soc Sci Med. 2009;69(10):1452–1459pmid:19767135
      OpenUrlCrossRefPubMed
    25. ↵
      1. Child Trends
      . Immigrant children. 2017. Available at: https://www.childtrends.org/indicators/immigrant-children. Accessed August 27, 2018
    26. ↵
      1. Chilton M,
      2. Black MM,
      3. Berkowitz C, et al
      . Food insecurity and risk of poor health among US-born children of immigrants. Am J Public Health. 2009;99(3):556–562pmid:19106417
      OpenUrlCrossRefPubMed
    27. ↵
      1. Walsemann KM,
      2. Ro A,
      3. Gee GC
      . Trends in food insecurity among California residents from 2001 to 2011: inequities at the intersection of immigration status and ethnicity. Prev Med. 2017;105(1):142–148pmid:28911952
      OpenUrlCrossRefPubMed
    28. ↵
      1. Koball H,
      2. Capps R,
      3. Perrera K, et al
      . Health and Social Service Needs of US-Citizen Children With Detained or Deported Immigrant Parents. Washington, DC: Urban Institute, Migration Policy Institute; 2015, Available at: https://www.urban.org/research/publication/health-and-social-service-needs-us-citizen-children-detained-or-deported-immigrant-parents/view/full_report. Accessed December 27, 2017
    29. ↵
      1. Hooper K,
      2. Zong J,
      3. Capps R,
      4. Fix M
      . Young Children of Refugees in the United States: Integration Successes and Challenges. Washington, DC: Migration Policy Institute; 2016, Available at: https://www.migrationpolicy.org/research/young-children-refugees-united-states-integration-successes-and-challenges. Accessed August 27, 2018
    30. ↵
      1. Brown CS
      . The Educational, Psychological, and Social Impact of Discrimination on the Immigrant Child. Washington, DC: Migration Policy Institute; 2015, Available at: https://www.migrationpolicy.org/research/educational-psychological-and-social-impact-discrimination-immigrant-child. Accessed August 27, 2018
    31. ↵
      1. Singh GK,
      2. Rodriguez-Lainz A,
      3. Kogan MD
      . Immigrant health inequalities in the United States: use of eight major national data systems. ScientificWorldJournal. 2013;2013:512313pmid:24288488
      OpenUrlPubMed
    32. ↵
      1. Braveman P,
      2. Barclay C
      . Health disparities beginning in childhood: a life-course perspective. Pediatrics. 2009;124(suppl 3):S163–S175pmid:19861467
      OpenUrlAbstract/FREE Full Text
      1. Braveman P,
      2. Egerter S,
      3. Williams DR
      . The social determinants of health: coming of age. Annu Rev Public Health. 2011;32:381–398pmid:21091195
      OpenUrlCrossRefPubMed
      1. Simich L
      . Health literacy and immigrant populations. Public Health Agency of Canada and Metropolis Canada, Ottawa, Canada. 2009. Available at: http://www.metropolis.net/pdfs/health_literacy_policy_brief_jun15_e.pdf. Accessed August 27, 2018
    33. ↵
      1. Lee HY,
      2. Rhee TG,
      3. Kim NK,
      4. Ahluwalia JS
      . Health literacy as a social determinant of health in Asian American immigrants: findings from a population-based survey in California. J Gen Intern Med. 2015;30(8):1118–1124pmid:25715993
      OpenUrlPubMed
    34. ↵
      1. Rivas-Drake D,
      2. Stein GL
      . Multicultural developmental experiences: implications for resilience in transitional age youth. Child Adolesc Psychiatr Clin N Am. 2017;26(2):271–281pmid:28314455
      OpenUrlPubMed
      1. US Department of Health and Human Services, Office of Minority Health
      . National Standards for Culturally and Linguistically Appropriate Services in Health Care. Washington, DC: US Department of Health and Human Services; 2001
    35. ↵
      1. Baran M,
      2. Kendall-Taylor N,
      3. Lindland E,
      4. O’Neil M,
      5. Haydon A
      . Getting to “we”: mapping the gaps between expert and public understandings of immigration and immigration reform. Available at: www.frameworksinstitute.org/assets/files/Immigration/immigration_mtg.pdf. Accessed December 28, 2017
    36. ↵
      1. Kodjo C
      . Cultural competence in clinician communication. Pediatr Rev. 2009;30(2):57–63; quiz 64pmid:19188301
      OpenUrlFREE Full Text
    37. ↵
      1. Brach C,
      2. Fraser I
      . Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Med Care Res Rev. 2000;57(suppl 1):181–217pmid:11092163
      OpenUrlCrossRefPubMed
    38. ↵
      1. Committee on Pediatric Workforce
      . Enhancing pediatric workforce diversity and providing culturally effective pediatric care: implications for practice, education, and policy making. Pediatrics. 2013;132(4). Available at: www.pediatrics.org/cgi/content/full/132/4/e1105pmid:24081998
      OpenUrlAbstract/FREE Full Text
    39. ↵
      1. American Academy of Pediatrics
      . Immigrant Child Health Toolkit. 2015. Available at: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Immigrant-Child-Health-Toolkit/Pages/Immigrant-Child-Health-Toolkit.aspx. Accessed October 29, 2018
    40. ↵
      1. Kleinman A,
      2. Benson P
      . Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoS Med. 2006;3(10):e294pmid:17076546
      OpenUrlCrossRefPubMed
    41. ↵
      1. Kirmayer LJ
      . Rethinking cultural competence. Transcult Psychiatry. 2012;49(2):149–164pmid:22508634
      OpenUrlCrossRefPubMed
    42. ↵
      1. Cross T,
      2. Bazron BJ,
      3. Dennis KW,
      4. Isaacs MR
      . Towards a Culturally Competent System of Care: A Monograph on Effective Services for Minority Children Who Are Severely Emotionally Disturbed. Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center; 1989
    43. ↵
      1. Project Implicit
      . About us. Available at: https://implicit.harvard.edu/implicit/aboutus.html. Accessed September 17, 2018
    44. ↵
      1. Blair IV,
      2. Steiner JF,
      3. Fairclough DL, et al
      . Clinicians’ implicit ethnic/racial bias and perceptions of care among Black and Latino patients. Ann Fam Med. 2013;11(1):43–52pmid:23319505
      OpenUrlAbstract/FREE Full Text
    45. ↵
      1. Tervalon M,
      2. Murray-García J
      . Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998;9(2):117–125pmid:10073197
      OpenUrlCrossRefPubMed
      1. Hook JN,
      2. Davis DE,
      3. Owen J,
      4. Worthington EL,
      5. Utsey SO
      . Cultural humility: measuring openness to culturally diverse clients. J Couns Psychol. 2013;60(3):353–366pmid:23647387
      OpenUrlCrossRefPubMed
    46. ↵
      1. Yeager KA,
      2. Bauer-Wu S
      . Cultural humility: essential foundation for clinical researchers. Appl Nurs Res. 2013;26(4):251–256pmid:23938129
      OpenUrlCrossRefPubMed
    47. ↵
      1. Papps E,
      2. Ramsden I
      . Cultural safety in nursing: the New Zealand experience. Int J Qual Health Care. 1996;8(5):491–497pmid:9117203
      OpenUrlCrossRefPubMed
      1. Darroch F,
      2. Giles A,
      3. Sanderson P, et al
      . The United States does CAIR about cultural safety: examining cultural safety within indigenous health contexts in Canada and the United States. J Transcult Nurs. 2017;28(3):269–277pmid:26920574
      OpenUrlPubMed
    48. ↵
      1. Bozorgzad P,
      2. Negarandeh R,
      3. Raiesifar A,
      4. Poortaghi S
      . Cultural safety: an evolutionary concept analysis. Holist Nurs Pract. 2016;30(1):33–38pmid:26633724
      OpenUrlPubMed
    49. ↵
      1. Green AR,
      2. Betancourt JR,
      3. Carillo JE
      . Cultural competence: a patient-based approach to caring for immigrants. In: Walker PF, Barnett ED, eds. Immigrant Medicine. 1st ed. Philadelphia, PA: Elsevier Health Sciences; 2007:83–97
    50. ↵
      1. Culhane-Pera KA,
      2. Borkan JM
      . Multicultural medicine. In: Walker PF, Barnett ED, eds. Immigrant Medicine. 1st ed. Philadelphia, PA: Elsevier Health Sciences; 2007:69–82
    51. ↵
      1. McPhail-Bell K,
      2. Bond C,
      3. Brough M,
      4. Fredericks B
      . ‘We don’t tell people what to do’: ethical practice and Indigenous health promotion. Health Promot J Austr. 2015;26(3):195–199pmid:26599355
      OpenUrlPubMed
    52. ↵
      1. Swota AH,
      2. Hester DM
      . Ethics for the pediatrician: providing culturally effective health care. Pediatr Rev. 2011;32(3):e39–e43pmid:21364011
      OpenUrlFREE Full Text
    53. ↵
      1. American Academy of Pediatrics
      . National center for patient/family-centered medical home. Available at: https://medicalhomeinfo.aap.org/Pages/default.aspx. Accessed October 29, 2018
      1. Medical Home Initiatives for Children With Special Needs Project Advisory Committee
      2. American Academy of Pediatrics
      . The medical home. Pediatrics. 2002;110(1, pt 1):184–186pmid:12093969
      OpenUrlAbstract/FREE Full Text
      1. Barry MJ,
      2. Edgman-Levitan S
      . Shared decision making–pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780–781pmid:22375967
      OpenUrlCrossRefPubMed
      1. Bennett AC,
      2. Rankin KM,
      3. Rosenberg D
      . Does a medical home mediate racial disparities in unmet healthcare needs among children with special healthcare needs? Matern Child Health J. 2012;16(suppl 2):330–338pmid:22976880
      OpenUrlCrossRefPubMed
    54. ↵
      1. Okumura MJ,
      2. Van Cleave J,
      3. Gnanasekaran S,
      4. Houtrow A
      . Understanding factors associated with work loss for families caring for CSHCN. Pediatrics. 2009;124(suppl 4):S392–S398pmid:19948604
      OpenUrlAbstract/FREE Full Text
    55. ↵
      1. Hsieh E,
      2. Ju H,
      3. Kong H
      . Dimensions of trust: the tensions and challenges in provider–interpreter trust. Qual Health Res. 2010;20(2):170–181pmid:19826078
      OpenUrlCrossRefPubMed
    56. ↵
      1. Hsieh E,
      2. Kramer EM
      . Medical interpreters as tools: dangers and challenges in the utilitarian approach to interpreters’ roles and functions. Patient Educ Couns. 2012;89(1):158–162pmid:22857777
      OpenUrlCrossRefPubMed
    57. ↵
      1. Raphael JL,
      2. Guadagnolo BA,
      3. Beal AC,
      4. Giardino AP
      . Racial and ethnic disparities in indicators of a primary care medical home for children. Acad Pediatr. 2009;9(4):221–227pmid:19487171
      OpenUrlCrossRefPubMed
    58. ↵
      1. Kan K,
      2. Choi H,
      3. Davis M
      . Immigrant families, children with special health care needs, and the medical home. Pediatrics. 2016;137(1):e20153221pmid:26702031
      OpenUrlAbstract/FREE Full Text
      1. Mendoza FS
      . Health disparities and children in immigrant families: a research agenda. Pediatrics. 2009;124(suppl 3):S187–S195pmid:19861469
      OpenUrlAbstract/FREE Full Text
      1. Yu SM,
      2. Huang ZJ,
      3. Kogan MD
      . State-level health care access and use among children in US immigrant families. Am J Public Health. 2008;98(11):1996–2003pmid:18799781
      OpenUrlCrossRefPubMed
    59. ↵
      1. Javier JR,
      2. Wise PH,
      3. Mendoza FS
      . The relationship of immigrant status with access, utilization, and health status for children with asthma. Ambul Pediatr. 2007;7(6):421–430pmid:17996835
      OpenUrlCrossRefPubMed
    60. ↵
      1. Health Resources and Services Administration Maternal and Child Health
      . Children with special health care needs. Available at: https://mchb.hrsa.gov/maternal-child-health-topics/children-and-youth-special-health-needs. Accessed January 9, 2018
    61. ↵
      1. Centers for Disease Control and Prevention
      . Domestic examination for newly arrived refugees: guidelines and discussion of the history and physical examination. Available at: https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/guidelines-history-physical.html. Accessed August 14, 2018
    62. ↵
      1. Betancourt JR
      . Cultural competence and medical education: many names, many perspectives, one goal. Acad Med. 2006;81(6):499–501pmid:16728795
      OpenUrlCrossRefPubMed
    63. ↵
      1. Epner DE,
      2. Baile WF
      . Patient-centered care: the key to cultural competence. Ann Oncol. 2012;23(suppl 3):33–42pmid:22628414
      OpenUrlCrossRefPubMed
    64. ↵
      1. Carrillo JE,
      2. Green AR,
      3. Betancourt JR
      . Cross-cultural primary care: a patient-based approach. Ann Intern Med. 1999;130(10):829–834pmid:10366373
      OpenUrlCrossRefPubMed
    65. ↵
      1. Kleinman A,
      2. Eisenberg L,
      3. Good B
      . Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978;88(2):251–258pmid:626456
      OpenUrlCrossRefPubMed
    66. ↵
      1. Roldán-Chicano MT,
      2. Fernández-Rufete J,
      3. Hueso-Montoro C,
      4. García-López MDM,
      5. Rodríguez-Tello J,
      6. Flores-Bienert MD
      . Culture-bound syndromes in migratory contexts: the case of Bolivian immigrants. Rev Lat Am Enfermagem. 2017;25:e2915pmid:28699998
      OpenUrlPubMed
    67. ↵
      1. Berlin EA,
      2. Fowkes WC Jr
      . A teaching framework for cross-cultural health care. Application in family practice. West J Med. 1983;139(6):934–938pmid:6666112
      OpenUrlPubMed
    68. ↵
      1. Centers for Disease Control and Prevention
      . Refugee health profiles. Available at: https://www.cdc.gov/immigrantrefugeehealth/profiles/index.html. Accessed August 14, 2018
      1. Cultural Orientation Resource Center
      . Refugee backgrounders. Available at: www.culturalorientation.net/learning/backgrounders. Accessed August 14, 2018
    69. ↵
      1. EthnoMed
      . Clinical topics. Available at: https://ethnomed.org/clinical. Accessed August 14, 2018
    70. ↵
      1. Centers for Disease Control and Prevention
      . Immigrant and refugee health. Available at: https://www.cdc.gov/immigrantrefugeehealth/index.html. Accessed August 14, 2018
    71. ↵
      1. Centers for Disease Control and Prevention
      . Catch-up immunization schedule for persons aged 4 months-18 years who start late or who are more than 1 month behind—United States. 2019. Available at: https://www.cdc.gov/vaccines/schedules/hcp/imz/catchup.html. Accessed July 26, 2019
    72. ↵
      1. World Health Organization
      . WHO Vaccine-preventable diseases monitoring system. 2019 Global Summary. Available at: https://apps.who.int/immunization_monitoring/globalsummary. Accessed July 29, 2019
    73. ↵
      1. Centers for Disease Control and Prevention
      . Travelers’ health. Available at: https://wwwnc.cdc.gov/travel/destinations/list/. Accessed August 24, 2018
    74. ↵
      1. Centers for Disease Control and Prevention
      . Refugee health guidelines: guidelines for pre-departure and post-arrival medical screening and treatment of U.S.-bound refugees. Available at: https://www.cdc.gov/immigrantrefugeehealth/guidelines/refugee-guidelines.html. Accessed July 26, 2019
    75. ↵
      1. Centers for Disease Control and Prevention
      . Guidelines for overseas presumptive treatment of strongyloidiasis, schistosomiasis, and soil-transmitted helminth infections. 2018. Available at: https://www.cdc.gov/immigrantrefugeehealth/guidelines/overseas/intestinal-parasites-overseas.html. Accessed August 14, 2018
      1. Seery T,
      2. Boswell H,
      3. Lara A
      . Caring for refugee children. Pediatr Rev. 2015;36(8):323–338
      OpenUrlFREE Full Text
      1. Haber BA,
      2. Block JM,
      3. Jonas MM, et al; Hepatitis B Foundation
      . Recommendations for screening, monitoring, and referral of pediatric chronic hepatitis B. Pediatrics. 2009;124(5). Available at: www.pediatrics.org/cgi/content/full/124/5/e1007pmid:19805457
      OpenUrlAbstract/FREE Full Text
      1. Ciaccia KA,
      2. John RM
      . Unaccompanied immigrant minors: where to begin. J Pediatr Health Care. 2016;30(3):231–240pmid:26858232
      OpenUrlPubMed
      1. Muennig P,
      2. Pallin D,
      3. Sell RL,
      4. Chan MS
      . The cost effectiveness of strategies for the treatment of intestinal parasites in immigrants. N Engl J Med. 1999;340(10):773–779pmid:10072413
      OpenUrlCrossRefPubMed
      1. Centers for Disease Control and Prevention
      . Domestic intestinal parasite guidelines. Available at: https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/intestinal-parasites-domestic.html. Accessed July 17, 2017
    76. ↵
      1. Jones VF,
      2. Schulte EE; Council on Foster Care, Adoption, and Kinship Care
      . Comprehensive health evaluation of the newly adopted child. Pediatrics. 2019;143(5):e20190657
      OpenUrlAbstract/FREE Full Text
    77. ↵
      1. Petersen PE,
      2. Bourgeois D,
      3. Ogawa H,
      4. Estupinan-Day S,
      5. Ndiaye C
      . The global burden of oral diseases and risks to oral health. Bull World Health Organ. 2005;83(9):661–669pmid:16211157
      OpenUrlPubMed
    78. ↵
      1. Cote S,
      2. Geltman P,
      3. Nunn M,
      4. Lituri K,
      5. Henshaw M,
      6. Garcia RI
      . Dental caries of refugee children compared with US children. Pediatrics. 2004;114(6). Available at: www.pediatrics.org/cgi/content/full/114/6/e733pmid:15574605
      OpenUrlAbstract/FREE Full Text
    79. ↵
      1. Shah AY,
      2. Suchdev PS,
      3. Mitchell T, et al
      . Nutritional status of refugee children entering DeKalb County, Georgia. J Immigr Minor Health. 2014;16(5):959–967pmid:23828627
      OpenUrlPubMed
    80. ↵
      1. Finnegan DA,
      2. Rainchuso L,
      3. Jenkins S,
      4. Kierce E,
      5. Rothman A
      . Immigrant caregivers of young children: oral health beliefs, attitudes, and early childhood caries knowledge. J Community Health. 2016;41(2):250–257pmid:26370378
      OpenUrlPubMed
      1. Davidson N,
      2. Skull S,
      3. Calache H,
      4. Murray SS,
      5. Chalmers J
      . Holes a plenty: oral health status a major issue for newly arrived refugees in Australia. Aust Dent J. 2006;51(4):306–311pmid:17256304
      OpenUrlCrossRefPubMed
      1. Butani Y,
      2. Weintraub JA,
      3. Barker JC
      . Oral health-related cultural beliefs for four racial/ethnic groups: assessment of the literature. BMC Oral Health. 2008;8:26pmid:18793438
      OpenUrlCrossRefPubMed
    81. ↵
      1. Riggs E,
      2. Gibbs L,
      3. Kilpatrick N, et al
      . Breaking down the barriers: a qualitative study to understand child oral health in refugee and migrant communities in Australia. Ethn Health. 2015;20(3):241–257pmid:24739019
      OpenUrlPubMed
    82. ↵
      1. Nicol P,
      2. Al-Hanbali A,
      3. King N,
      4. Slack-Smith L,
      5. Cherian S
      . Informing a culturally appropriate approach to oral health and dental care for pre-school refugee children: a community participatory study. BMC Oral Health. 2014;14:69pmid:24923308
      OpenUrlPubMed
    83. ↵
      1. Beaglehole R,
      2. Horton R
      . Chronic diseases: global action must match global evidence. Lancet. 2010;376(9753):1619–1621pmid:21074261
      OpenUrlCrossRefPubMed
      1. United Nations General Assembly
      . Political declaration of the high-level meeting of the General Assembly on the prevention and control of non-communicable diseases. Available at: www.who.int/nmh/events/un_ncd_summit2011/political_declaration_en.pdf. Accessed August 14, 2018
    84. ↵
      1. World Health Organization
      . Noncommunicable diseases and mental health. Global status report on noncommunicable diseases 2014. 2014. Available at: www.who.int/nmh/publications/ncd-status-report-2014/en/. Accessed August 14, 2018
    85. ↵
      1. Pondé MP,
      2. Rousseau C
      . Immigrant children with autism spectrum disorder: the relationship between the perspective of the professionals and the parents’ point of view. J Can Acad Child Adolesc Psychiatry. 2013;22(2):131–138pmid:23667359
      OpenUrlPubMed
      1. Lin SC,
      2. Yu SM,
      3. Harwood RL
      . Autism spectrum disorders and developmental disabilities in children from immigrant families in the United States. Pediatrics. 2012;130(suppl 2):S191–S197pmid:23118251
      OpenUrlAbstract/FREE Full Text
      1. Becerra TA,
      2. von Ehrenstein OS,
      3. Heck JE, et al
      . Autism spectrum disorders and race, ethnicity, and nativity: a population-based study. Pediatrics. 2014;134(1). Available at: www.pediatrics.org/cgi/content/full/134/1/e63pmid:24958588
      OpenUrlAbstract/FREE Full Text
      1. Croen LA,
      2. Grether JK,
      3. Selvin S
      . Descriptive epidemiology of autism in a California population: who is at risk? J Autism Dev Disord. 2002;32(3):217–224pmid:12108623
      OpenUrlCrossRefPubMed
    86. ↵
      1. Schieve LA,
      2. Boulet SL,
      3. Blumberg SJ, et al
      . Association between parental nativity and autism spectrum disorder among US-born non-Hispanic white and Hispanic children, 2007 National Survey of Children’s Health. Disabil Health J. 2012;5(1):18–25pmid:22226294
      OpenUrlCrossRefPubMed
    87. ↵
      1. Akbulut-Yuksel M,
      2. Kugler AD
      . Intergenerational persistence of health: do immigrants get healthier as they remain in the U.S. for more generations? Econ Hum Biol. 2016;23:136–148pmid:27644070
      OpenUrlPubMed
      1. Bischoff A,
      2. Schneider M,
      3. Denhaerynck K,
      4. Battegay E
      . Health and ill health of asylum seekers in Switzerland: an epidemiological study. Eur J Public Health. 2009;19(1):59–64pmid:19158102
      OpenUrlCrossRefPubMed
      1. Perreira KM,
      2. Ornelas IJ
      . The physical and psychological well-being of immigrant children. Future Child. 2011;21(1):195–218pmid:21465861
      OpenUrlCrossRefPubMed
    88. ↵
      1. Centers for Disease Control and Prevention
      . Non-communicable diseases (NCDs). Central American refugee health profile. Available at: https://www.cdc.gov/immigrantrefugeehealth/profiles/central-american/health-information/chronic-disease/index.html. Accessed August 14, 2018
    89. ↵
      1. Hamdoun E,
      2. Karachunski P,
      3. Nathan B, et al
      . Case report: the specter of untreated congenital hypothyroidism in immigrant families. Pediatrics. 2016;137(5):e20153418pmid:27244801
      OpenUrlAbstract/FREE Full Text
    90. ↵
      1. Minnesota Department of Health
      . Lead poisoning prevention programs biennial report to the Minnesota legislature 2019. Available at: https://www.health.state.mn.us/communities/environment/lead/docs/reports/bienniallegrept.pdf. Accessed July 29, 2019
      1. Centers for Disease Control and Prevention
      . Managing elevated blood lead levels among children: recommendations from the Advisory Committee on Childhood Lead Poisoning Prevention. Available at: https://www.cdc.gov/nceh/lead/casemanagement/casemanage_main.htm. Accessed August 30, 2018
      1. Centers for Disease Control and Prevention (CDC)
      . Elevated blood lead levels in refugee children–New Hampshire, 2003-2004 [published correction appears in MMWR Morb Mortal Wkly Rep. 2005;54(3):76]. MMWR Morb Mortal Wkly Rep. 2005;54(2):42–46pmid:15660019
      OpenUrlPubMed
      1. Geltman PL,
      2. Brown MJ,
      3. Cochran J
      . Lead poisoning among refugee children resettled in Massachusetts, 1995 to 1999. Pediatrics. 2001;108(1):158–162pmid:11433069
      OpenUrlAbstract/FREE Full Text
    91. ↵
      1. Centers for Disease Control and Prevention
      . Screening for lead during the domestic medical examination for newly arrived refugees. 2013. Available at: www.cdc.gov/immigrantrefugeehealth/guidelines/lead-guidelines.html. Accessed July 16, 2017
    92. ↵
      1. Yun K,
      2. Matheson J,
      3. Payton C, et al
      . Health profiles of newly arrived refugee children in the United States, 2006-2012. Am J Public Health. 2016;106(1):128–135pmid:26562126
      OpenUrlPubMed
      1. Dawson-Hahn EE,
      2. Pak-Gorstein S,
      3. Hoopes AJ,
      4. Matheson J
      . Comparison of the nutritional status of overseas refugee children with low income children in Washington state. PLoS One. 2016;11(1):e0147854pmid:26808275
      OpenUrlPubMed
      1. Dawson-Hahn E,
      2. Pak-Gorstein S,
      3. Matheson J, et al
      . Growth trajectories of refugee and nonrefugee children in the United States. Pediatrics. 2016;138(6):e20160953pmid:27940678
      OpenUrlAbstract/FREE Full Text
    93. ↵
      1. Centers for Disease Control and Prevention
      . Guidelines for evaluation of the nutritional status and growth in refugee children during the domestic medical screening examination. 2012. Available at: https://www.cdc.gov/immigrantrefugeehealth/pdf/nutrition-growth.pdf. Accessed August 14, 2018
      1. Oldways
      . Inspiring good health through cultural food traditions. Available at: https://oldwayspt.org. Accessed July 6, 2017
    94. ↵
      1. Centers for Disease Control and Prevention
      . Guidelines for evaluation of the nutritional status and growth in refugee children during the domestic medical screening examination. 2013. Available at: www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/nutrition-growth.html. Accessed July 6, 2017
    95. ↵
      1. Centers for Disease Control and Prevention (CDC)
      . Vitamin B12 deficiency in resettled Bhutanese refugees–United States, 2008-2011. MMWR Morb Mortal Wkly Rep. 2011;60(11):343–346pmid:21430638
      OpenUrlPubMed
      1. Hintzpeter B,
      2. Scheidt-Nave C,
      3. Müller MJ,
      4. Schenk L,
      5. Mensink GB
      . Higher prevalence of vitamin D deficiency is associated with immigrant background among children and adolescents in Germany. J Nutr. 2008;138(8):1482–1490pmid:18641195
      OpenUrlAbstract/FREE Full Text
    96. ↵
      1. Penrose K,
      2. Hunter Adams J,
      3. Nguyen T,
      4. Cochran J,
      5. Geltman PL
      . Vitamin D deficiency among newly resettled refugees in Massachusetts. J Immigr Minor Health. 2012;14(6):941–948pmid:22411495
      OpenUrlPubMed
    97. ↵
      1. Council on Community Pediatrics
      2. Committee on Nutrition
      . Promoting food security for all children. Pediatrics. 2015;136(5). Available at: www.pediatrics.org/cgi/content/full/136/5/e1431pmid:26498462
      OpenUrlAbstract/FREE Full Text
    98. ↵
      1. Food Research and Action Center
      . Addressing food insecurity: a toolkit for pediatricians. Available at: http://frac.org/aaptoolkit. Accessed August 14, 2018
    99. ↵
      1. Ages and Stages Questionnaires
      . Social-emotional health: look to ASQ:SE-2 for truly accurate screening. 2018. Available at: http://agesandstages.com/products-services/asqse-2/. Accessed August 14, 2018
    100. ↵
      1. Floating Hospital for Children at Tufts Medical Center
      . The survey of well-being of young children. Available at: https://www.floatinghospital.org/The-Survey-of-Wellbeing-of-Young-Children/Overview.aspx. Accessed August 14, 2018
    101. ↵
      1. Kroening AL,
      2. Moore JA,
      3. Welch TR,
      4. Halterman JS,
      5. Hyman SL
      . Developmental screening of refugees: a qualitative study. Pediatrics. 2016;138(3):e20160234pmid:27527798
      OpenUrlAbstract/FREE Full Text
    102. ↵
      1. Martin-Herz SP,
      2. Kemper T,
      3. Brownstein M,
      4. McLaughlin JF
      . Developmental screening with recent immigrant and refugee children: a preliminary report. 2012. Available at: http://ethnomed.org/clinical/pediatrics/developmental-screening-with-recent-immigrant-and-refugee-children. Accessed August 14, 2018
    103. ↵
      1. Rogoff B
      . The Cultural Nature of Human Development. New York, NY: Oxford University Press; 2003
      1. Cowden JD,
      2. Kreisler K
      . Development in children of immigrant families. Pediatr Clin North Am. 2016;63(5):775–793pmid:27565358
      OpenUrlPubMed
      1. Pachter LM,
      2. Dworkin PH
      . Maternal expectations about normal child development in 4 cultural groups. Arch Pediatr Adolesc Med. 1997;151(11):1144–1150pmid:9369877
      OpenUrlCrossRefPubMed
    104. ↵
      1. Stein MT,
      2. Flores G,
      3. Graham EA,
      4. Magana L,
      5. Willies-Jacobo L,
      6. Gulbronson M
      . Cultural and linguistic determinants in the diagnosis and management of developmental delay in a 4-year-old. Pediatrics. 2004;114(suppl 6):1442–1447
      OpenUrl
    105. ↵
      1. Johnson L,
      2. Radesky J,
      3. Zuckerman B
      . Cross-cultural parenting: reflections on autonomy and interdependence. Pediatrics. 2013;131(4):631–633pmid:23509169
      OpenUrlFREE Full Text
    106. ↵
      1. deVries MW,
      2. deVries MR
      . Cultural relativity of toilet training readiness: a perspective from East Africa. Pediatrics. 1977;60(2):170–177pmid:887331
      OpenUrlAbstract/FREE Full Text
    107. ↵
      1. Festa N,
      2. Loftus PD,
      3. Cullen MR,
      4. Mendoza FS
      . Disparities in early exposure to book sharing within immigrant families. Pediatrics. 2014;134(1). Available at: www.pediatrics.org/cgi/content/full/134/1/e162pmid:24918215
      OpenUrlAbstract/FREE Full Text
    108. ↵
      1. Toppelberg CO,
      2. Collins BA
      . Language, culture, and adaptation in immigrant children. Child Adolesc Psychiatr Clin N Am. 2010;19(4):697–717pmid:21056342
      OpenUrlCrossRefPubMed
    109. ↵
      1. Hagan JF Jr,
      2. Shaw JS,
      3. Duncan PM
      , eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017
    110. ↵
      1. Adesope OO,
      2. Lavin T,
      3. Thompson T,
      4. Ungerleider C
      . A systematic review and meta-analysis on the cognitive correlates of bilingualism. Rev Educ Res. 2010;80(2):207–245
      OpenUrl
      1. Feliciano C
      . The benefits of biculturalism: exposure to immigrant culture and dropping out of school among Asian and Latino youths. Soc Sci Q. 2001;82(4):865–879
      OpenUrlCrossRef
      1. Zhou M
      . Growing up American: the challenge confronting immigrant children and children of immigrants. Annu Rev Sociol. 1997;23(1):63–95
      OpenUrlCrossRef
      1. Engel de Abreu PM,
      2. Cruz-Santos A,
      3. Tourinho CJ,
      4. Martin R,
      5. Bialystok E
      . Bilingualism enriches the poor: enhanced cognitive control in low-income minority children. Psychol Sci. 2012;23(11):1364–1371pmid:23044796
      OpenUrlCrossRefPubMed
      1. Bialystok E
      . Reshaping the mind: the benefits of bilingualism. Can J Exp Psychol. 2011;65(4):229–235pmid:21910523
      OpenUrlCrossRefPubMed
    111. ↵
      1. High PC,
      2. Klass P; Council on Early Childhood
      . Literacy promotion: an essential component of primary care pediatric practice. Pediatrics. 2014;134(2):404–409pmid:24962987
      OpenUrlAbstract/FREE Full Text
    112. ↵
      1. Education Commission of the States
      . English language learners. The progress of education reform. 2013. Available at: https://www.rwjf.org/en/library/research/2011/11/caring-across-communities--.html. Accessed July 26, 2019
    113. ↵
      1. Park M,
      2. O’Toole A,
      3. Katsiaficas C
      . Dual Language Learners: A National Demographic and Policy Profile. Washington, DC: Migration Policy Institute; 2017
    114. ↵
      1. Morland L,
      2. Ives N,
      3. McNeely C,
      4. Allen C
      . Providing a head start: improving access to early childhood education for refugees. Migration Policy Institute. 2016. Available at: https://www.migrationpolicy.org/research/providing-head-start-improving-access-early-childhood-education-refugees. Accessed August 30, 2018
    115. ↵
      Plyler v Doe, 457 US 202 (1982)
    116. ↵
      1. Graham HR,
      2. Minhas RS,
      3. Paxton G
      . Learning problems in children of refugee background: a systematic review. Pediatrics. 2016;137(6):e20153994pmid:27194628
      OpenUrlAbstract/FREE Full Text
    117. ↵
      1. Walker SP,
      2. Wachs TD,
      3. Gardner JM, et al; International Child Development Steering Group
      . Child development: risk factors for adverse outcomes in developing countries. Lancet. 2007;369(9556):145–157pmid:17223478
      OpenUrlCrossRefPubMed
    118. ↵
      1. DeCapua A
      . Reaching students with limited or interrupted formal education through culturally responsive teaching. Lang Linguist Compass. 2016;10(5):225–237
      OpenUrl
    119. ↵
      1. Macswan J,
      2. Rolstad K
      . How language proficiency tests mislead us about ability: implications for English language learner placement in special education. Teach Coll Rec (1970). 2006;108(11):2304–2328
      OpenUrl
      1. Wagner RK,
      2. Francis DJ,
      3. Morris RD
      . Identifying English language learners with learning disabilities: key challenges and possible approaches. Learn Disabil Res Pract. 2005;20(1):6–15
      OpenUrl
      1. McCardle P,
      2. Mele-McCarthy J,
      3. Cutting L,
      4. Leos K,
      5. D’Emilio T
      . Learning disabilities in English language learners: identifying the issues. Learn Disabil Res Pract. 2005;20(1):1–5
      OpenUrl
    120. ↵
      1. Figueroa RA,
      2. Newsome P
      . The diagnosis of LD in English learners: is it nondiscriminatory? J Learn Disabil. 2006;39(3):206–214pmid:16724793
      OpenUrlPubMed
    121. ↵
      1. Lara M,
      2. Gamboa C,
      3. Kahramanian MI,
      4. Morales LS,
      5. Bautista DE
      . Acculturation and Latino health in the United States: a review of the literature and its sociopolitical context. Annu Rev Public Health. 2005;26:367–397pmid:15760294
      OpenUrlCrossRefPubMed
      1. Bornstein MH,
      2. Cote LR
      , eds. Acculturation and Parent–Child Relationships: Measurement and Development. Mahwah, NJ: Lawrence Erlbaum Associates, Inc; 2006
      1. Antecol H,
      2. Bedard K
      . Unhealthy assimilation: why do immigrants converge to American health status levels? Demography. 2006;43(2):337–360pmid:16889132
      OpenUrlCrossRefPubMed
      1. Zamboanga BL,
      2. Schwartz SJ,
      3. Jarvis LH,
      4. Van Tyne K
      . Acculturation and substance use among Hispanic early adolescents: investigating the mediating roles of acculturative stress and self-esteem. J Prim Prev. 2009;30(3–4):315–333pmid:19408121
      OpenUrlPubMed
      1. Myers R,
      2. Chou CP,
      3. Sussman S,
      4. Baezconde-Garbanati L,
      5. Pachon H,
      6. Valente TW
      . Acculturation and substance use: social influence as a mediator among Hispanic alternative high school youth. J Health Soc Behav. 2009;50(2):164–179pmid:19537458
      OpenUrlCrossRefPubMed
      1. Ho J,
      2. Birman D
      . Acculturation gaps in Vietnamese immigrant families: impact on family relationships. Int J Intercult Relat. 2010;34(1):22–23pmid:20161537
      OpenUrlPubMed
    122. ↵
      1. Birman D,
      2. Taylor-Ritzler T
      . Acculturation and psychological distress among adolescent immigrants from the former Soviet Union: exploring the mediating effect of family relationships. Cultur Divers Ethnic Minor Psychol. 2007;13(4):337–346pmid:17967102
      OpenUrlPubMed
    123. ↵
      1. Refugee Health Technical Assistance Center
      . Youth and mental health. Available at: http://refugeehealthta.org/physical-mental-health/mental-health/youth-and-mental-health/. Accessed August 30, 2018
    124. ↵
      1. The National Child Traumatic Stress Network
      . Learning center for child and adolescent trauma. Refugee Services Toolkit (RST). 2012. Available at: https://www.nctsn.org/resources/refugee-services-core-stressor-assessment-tool. Accessed July 26, 2019
    125. ↵
      1. Sawyer CB,
      2. Márquez J
      . Senseless violence against Central American unaccompanied minors: historical background and call for help. J Psychol. 2017;151(1):69–75pmid:27660898
      OpenUrlCrossRefPubMed
    126. ↵
      1. The National Child Traumatic Stress Network
      . Refugee trauma. 2017. Available at: http://nctsn.org/trauma-types/refugee-trauma/learn-about-refugee-core-stressors. Accessed August 14, 2017
    127. ↵
      1. United Nations Office of the High Commissioner for Refugees
      . Children on the run. Available at: www.unhcr.org/en-us/about-us/background/56fc266f4/children-on-the-run-full-report.html. Accessed August 30, 2018
    128. ↵
      1. Cleary SD,
      2. Snead R,
      3. Dietz-Chavez D,
      4. Rivera I,
      5. Edberg MC
      . Immigrant trauma and mental health outcomes among Latino youth. J Immigr Minor Health. 2018;20(5):1053–1059pmid:29139024
      OpenUrlPubMed
    129. ↵
      1. Isakson BL,
      2. Legerski JP,
      3. Layne CM
      . Adapting and implementing evidence-based interventions for trauma-exposed refugee youth and families. J Contemp Psychother. 2015;45(4):245–253
      OpenUrl
    130. ↵
      1. Greenbaum J,
      2. Bodrick N; Committee on Child Abuse and Neglect; Section on International Child Health
      . Global human trafficking and child victimization. Pediatrics. 2017;140(6):e20173138pmid:29180462
      OpenUrlAbstract/FREE Full Text
    131. ↵
      1. McPherson M,
      2. Arango P,
      3. Fox H, et al
      . A new definition of children with special health care needs. Pediatrics. 1998;102(1, pt 1):137–140pmid:9714637
      OpenUrlFREE Full Text
    132. ↵
      1. Dreby J
      . U.S. immigration policy and family separation: the consequences for children’s well-being. Soc Sci Med. 2015;132:245–251pmid:25228438
      OpenUrlCrossRefPubMed
    133. ↵
      1. Garner AS,
      2. Shonkoff JP; Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics
      . Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics. 2012;129(1). Available at: www.pediatrics.org/cgi/content/full/129/1/e224pmid:22201148
      OpenUrlPubMed
    134. ↵
      1. Lustig SL,
      2. Kia-Keating M,
      3. Knight WG, et al
      . Review of child and adolescent refugee mental health. J Am Acad Child Adolesc Psychiatry. 2004;43(1):24–36pmid:14691358
      OpenUrlCrossRefPubMed
      1. Savin D,
      2. Seymour DJ,
      3. Littleford LN,
      4. Bettridge J,
      5. Giese A
      . Findings from mental health screening of newly arrived refugees in Colorado. Public Health Rep. 2005;120(3):224–229pmid:16134561
      OpenUrlCrossRefPubMed
      1. Allwood MA,
      2. Bell-Dolan D,
      3. Husain SA
      . Children’s trauma and adjustment reactions to violent and nonviolent war experiences. J Am Acad Child Adolesc Psychiatry. 2002;41(4):450–457pmid:11931602
      OpenUrlCrossRefPubMed
      1. Jaycox LH,
      2. Stein BD,
      3. Kataoka SH, et al
      . Violence exposure, posttraumatic stress disorder, and depressive symptoms among recent immigrant schoolchildren. J Am Acad Child Adolesc Psychiatry. 2002;41(9):1104–1110pmid:12218432
      OpenUrlCrossRefPubMed
      1. Fazel M,
      2. Wheeler J,
      3. Danesh J
      . Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet. 2005;365(9467):1309–1314pmid:15823380
      OpenUrlCrossRefPubMed
      1. Weine SM,
      2. Vojvoda D,
      3. Becker DF, et al
      . PTSD symptoms in Bosnian refugees 1 year after resettlement in the United States. Am J Psychiatry. 1998;155(4):562–564pmid:9546008
      OpenUrlCrossRefPubMed
    135. ↵
      1. Sack WH,
      2. Clarke GN,
      3. Seeley J
      . Multiple forms of stress in Cambodian adolescent refugees. Child Dev. 1996;67(1):107–116pmid:8605822
      OpenUrlCrossRefPubMed
    136. ↵
      1. Betancourt TS,
      2. Newnham EA,
      3. Birman D,
      4. Lee R,
      5. Ellis BH,
      6. Layne CM
      . Comparing trauma exposure, mental health needs, and service utilization across clinical samples of refugee, immigrant, and U.S.-origin children. J Trauma Stress. 2017;30(3):209–218pmid:28585740
      OpenUrlPubMed
    137. ↵
      1. Hodes M,
      2. Jagdev D,
      3. Chandra N,
      4. Cunniff A
      . Risk and resilience for psychological distress amongst unaccompanied asylum seeking adolescents. J Child Psychol Psychiatry. 2008;49(7):723–732pmid:18492037
      OpenUrlCrossRefPubMed
    138. ↵
      1. Jakobsen M,
      2. Meyer DeMott MA,
      3. Wentzel-Larsen T,
      4. Heir T
      . The impact of the asylum process on mental health: a longitudinal study of unaccompanied refugee minors in Norway. BMJ Open. 2017;7(6):e015157pmid:28637731
      OpenUrlAbstract/FREE Full Text
    139. ↵
      1. Majumder P,
      2. O’Reilly M,
      3. Karim K,
      4. Vostanis P
      . ‘This doctor, I not trust him, I’m not safe’: the perceptions of mental health and services by unaccompanied refugee adolescents. Int J Soc Psychiatry. 2015;61(2):129–136pmid:24898523
      OpenUrlCrossRefPubMed
    140. ↵
      1. Belhadj Kouider E,
      2. Koglin U,
      3. Petermann F
      . Emotional and behavioral problems in migrant children and adolescents in American countries: a systematic review. J Immigr Minor Health. 2015;17(4):1240–1258pmid:24851820
      OpenUrlCrossRefPubMed
    141. ↵
      Youthinmind. SDQ: Information for researchers and professionals about the Strengths & Difficulties Questionnaires. Available at: www.sdqinfo.com. Accessed September 17, 2018
      1. Refugee Health Technical Assistance Center
      . Refugee Health Screener-15 (RHS-15) packet. Available at: http://refugeehealthta.org/2012/07/31/refugee-health-screener-15-rhs-15-packet/. Accessed August 30, 2018
      1. Achenbach System of Empirically Based Assessment
      . Multicultural applications. Available at: https://aseba.org/multicultural-applications/. Accessed July 29, 2019
    142. ↵
      1. Fazel M,
      2. Betancourt TS
      . Preventive mental health interventions for refugee children and adolescents in high-income settings. Lancet Child Adolesc Health. 2018;2(2):121–132pmid:30169234
      OpenUrlPubMed
    143. ↵
      1. Institute of Medicine
      . Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Washington, DC: The National Academies Press; 2009
    144. ↵
      1. Carlson BE,
      2. Cacciatore J,
      3. Klimek B
      . A risk and resilience perspective on unaccompanied refugee minors. Soc Work. 2012;57(3):259–269pmid:23252317
      OpenUrlCrossRefPubMed
      1. Eide K,
      2. Hjern A
      . Unaccompanied refugee children–vulnerability and agency. Acta Paediatr. 2013;102(7):666–668pmid:23560773
      OpenUrlCrossRefPubMed
      1. Timshel I,
      2. Montgomery E,
      3. Dalgaard NT
      . A systematic review of risk and protective factors associated with family related violence in refugee families. Child Abuse Negl. 2017;70:315–330pmid:28683372
      OpenUrlPubMed
    145. ↵
      1. Anderson AT,
      2. Jackson A,
      3. Jones L,
      4. Kennedy DP,
      5. Wells K,
      6. Chung PJ
      . Minority parents’ perspectives on racial socialization and school readiness in the early childhood period. Acad Pediatr. 2015;15(4):405–411pmid:25534762
      OpenUrlPubMed
    146. ↵
      1. Ellis BH,
      2. Hulland EN,
      3. Miller AB,
      4. Bixby CB,
      5. Cardozo BL,
      6. Betancourt TS
      . Mental health risks and resilience among Somali and Bhutanese refugee parents. 2016. Available at: https://www.migrationpolicy.org/research/mental-health-risks-and-resilience-among-somali-and-bhutanese-refugee-parents. Accessed August 30, 2018
    147. ↵
      1. Rothe EM,
      2. Tzuang D,
      3. Pumariega AJ
      . Acculturation, development, and adaptation. Child Adolesc Psychiatr Clin N Am. 2010;19(4):681–696pmid:21056341
      OpenUrlCrossRefPubMed
    148. ↵
      1. Geltman PL,
      2. Augustyn M,
      3. Barnett ED,
      4. Klass PE,
      5. Groves BM
      . War trauma experience and behavioral screening of Bosnian refugee children resettled in Massachusetts. J Dev Behav Pediatr. 2000;21(4):255–261pmid:10972248
      OpenUrlPubMed
    149. ↵
      1. Caballero TM,
      2. DeCamp LR,
      3. Platt RE, et al
      . Addressing the mental health needs of Latino children in immigrant families. Clin Pediatr (Phila). 2017;56(7):648–658pmid:27879297
      OpenUrlPubMed
    150. ↵
      1. De Milto L
      . National program executive summary report—caring across communities: addressing mental health needs of diverse children and youth. Available at: https://www.rwjf.org/en/library/research/2011/11/caring-across-communities--.html. Accessed July 26, 2019
    151. ↵
      1. Al-Rawi SN,
      2. Fetters MD
      . Traditional Arabic & Islamic medicine: a conceptual model for clinicians and researchers. Glob J Health Sci. 2012;4(3):164–169pmid:22980243
      OpenUrlPubMed
    152. ↵
      1. Pachter LM
      . Culture and clinical care. Folk illness beliefs and behaviors and their implications for health care delivery. JAMA. 1994;271(9):690–694pmid:8309032
      OpenUrlCrossRefPubMed
    153. ↵
      1. Risser AL,
      2. Mazur LJ
      . Use of folk remedies in a Hispanic population. Arch Pediatr Adolesc Med. 1995;149(9):978–981pmid:7655602
      OpenUrlCrossRefPubMed
    154. ↵
      1. EthnoMed
      . Ethnic medicine information from Harborview Medical Center. Available at: https://depts.washington.edu/ethnomed/HMCproject/hmcproject_talk_0302/F_EthnoMed%20Home%20Page.htm. Accessed August 30, 2018
    155. ↵
      1. World Health Organization
      . Eliminating Female Genital Mutilation. An Interagency Statement. Geneva, Switzerland: World Health Organization; 2008. Available at: www.un.org/womenwatch/daw/csw/csw52/statements_missions/Interagency_Statement_on_Eliminating_FGM.pdf. Accessed August 30, 2018
    156. ↵
      1. United Nations Children’s Fund
      . Female genital mutilation/cutting: a statistical overview and exploration of the dynamics of change. 2013. Available at: https://www.unicef.org/publications/index_69875.html. Accessed August 30, 2018
    157. ↵
      1. Refugee Legal Aid Information for Lawyers Representing Refugees Globally Rights in Exile Programme
      . United States. Available at: www.refugeelegalaidinformation.org/united-states-america-fgm. Accessed August 30, 2018
    158. ↵
      1. Hearst AA,
      2. Molnar AM
      . Female genital cutting: an evidence-based approach to clinical management for the primary care physician. Mayo Clin Proc. 2013;88(6):618–629pmid:23726401
      OpenUrlPubMed
    159. ↵
      1. Vissandjée B,
      2. Denetto S,
      3. Migliardi P,
      4. Proctor J
      . Female genital cutting (FGC) and the ethics of care: community engagement and cultural sensitivity at the interface of migration experiences. BMC Int Health Hum Rights. 2014;14:13pmid:24758156
      OpenUrlPubMed
    160. ↵
      National Defense Authorization Act for Fiscal Year 2013, HR 4310, 112th Cong, 2nd Sess (2012). Available at: https://www.gpo.gov/fdsys/pkg/BILLS-112hr4310enr/pdf/BILLS-112hr4310enr.pdf. Accessed August 30, 2018
    161. ↵
      1. Eneriz-Wiemer M,
      2. Sanders LM,
      3. Barr DA,
      4. Mendoza FS
      . Parental limited English proficiency and health outcomes for children with special health care needs: a systematic review. Acad Pediatr. 2014;14(2):128–136pmid:24602575
      OpenUrlCrossRefPubMed
      1. Arthur KC,
      2. Mangione-Smith R,
      3. Meischke H, et al
      . Impact of English proficiency on care experiences in a pediatric emergency department. Acad Pediatr. 2015;15(2):218–224pmid:25201156
      OpenUrlCrossRefPubMed
      1. Jimenez N,
      2. Jackson DL,
      3. Zhou C,
      4. Ayala NC,
      5. Ebel BE
      . Postoperative pain management in children, parental English proficiency, and access to interpretation. Hosp Pediatr. 2014;4(1):23–30pmid:24435597
      OpenUrlAbstract/FREE Full Text
      1. Levas MN,
      2. Cowden JD,
      3. Dowd MD
      . Effects of the limited English proficiency of parents on hospital length of stay and home health care referral for their home health care-eligible children with infections. Arch Pediatr Adolesc Med. 2011;165(9):831–836pmid:21536949
      OpenUrlCrossRefPubMed
    162. ↵
      1. Gallagher RA,
      2. Porter S,
      3. Monuteaux MC,
      4. Stack AM
      . Unscheduled return visits to the emergency department: the impact of language. Pediatr Emerg Care. 2013;29(5):579–583pmid:23603647
      OpenUrlCrossRefPubMed
    163. ↵
      Title VI of the Civil Rights Act of 1964, 42 USC §2000d-1–2000d-7 (2009). Available at: http://uscode.house.gov/view.xhtml?path=%2Fprelim%40title42%2Fchapter21&req=granuleid%3AUSC-prelim-title42-chapter21&f=&fq=&num=0&hl=false&edition=prelim. Accessed November 15, 2018
    164. ↵
      1. Office of the Surgeon General
      2. Center for Mental Health Services
      3. National Institute of Mental Health
      . Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2001. Available at: https://www.ncbi.nlm.nih.gov/books/NBK44243/. Accessed August 30, 2018
    165. ↵
      1. Flores G,
      2. Torres S,
      3. Holmes LJ,
      4. Salas-Lopez D,
      5. Youdelman MK,
      6. Tomany-Korman SC
      . Access to hospital interpreter services for limited English proficient patients in New Jersey: a statewide evaluation. J Health Care Poor Underserved. 2008;19(2):391–415pmid:18469412
      OpenUrlCrossRefPubMed
    166. ↵
      1. Jacobs EA,
      2. Diamond LC,
      3. Stevak L
      . The importance of teaching clinicians when and how to work with interpreters. Patient Educ Couns. 2010;78(2):149–153pmid:20036480
      OpenUrlCrossRefPubMed
    167. ↵
      1. DeCamp LR,
      2. Kuo DZ,
      3. Flores G,
      4. O’Connor K,
      5. Minkovitz CS
      . Changes in language services use by US pediatricians. Pediatrics. 2013;132(2). Available at: www.pediatrics.org/cgi/content/full/132/2/e396pmid:23837185
      OpenUrlAbstract/FREE Full Text
    168. ↵
      1. Flores G,
      2. Laws MB,
      3. Mayo SJ, et al
      . Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics. 2003;111(1):6–14pmid:12509547
      OpenUrlAbstract/FREE Full Text
    169. ↵
      1. Flores G,
      2. Abreu M,
      3. Barone CP,
      4. Bachur R,
      5. Lin H
      . Errors of medical interpretation and their potential clinical consequences: a comparison of professional versus ad hoc versus no interpreters. Ann Emerg Med. 2012;60(5):545–553pmid:22424655
      OpenUrlCrossRefPubMed
    170. ↵
      1. Juckett G,
      2. Unger K
      . Appropriate use of medical interpreters. Am Fam Physician. 2014;90(7):476–480pmid:25369625
      OpenUrlPubMed
    171. ↵
      1. Hsieh E
      . Not just “getting by”: factors influencing providers’ choice of interpreters. J Gen Intern Med. 2015;30(1):75–82pmid:25338731
      OpenUrlCrossRefPubMed
    172. ↵
      1. Jacobs EA,
      2. Shepard DS,
      3. Suaya JA,
      4. Stone EL
      . Overcoming language barriers in health care: costs and benefits of interpreter services. Am J Public Health. 2004;94(5):866–869pmid:15117713
      OpenUrlCrossRefPubMed
      1. Johnstone MJ,
      2. Kanitsaki O
      . Culture, language, and patient safety: making the link. Int J Qual Health Care. 2006;18(5):383–388pmid:16956931
      OpenUrlCrossRefPubMed
    173. ↵
      1. Flores G
      . The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev. 2005;62(3):255–299pmid:15894705
      OpenUrlCrossRefPubMed
    174. ↵
      1. Moreno MR,
      2. Otero-Sabogal R,
      3. Newman J
      . Assessing dual-role staff-interpreter linguistic competency in an integrated healthcare system. J Gen Intern Med. 2007;22(suppl 2):331–335pmid:17957420
      OpenUrlCrossRefPubMed
      1. Tang G,
      2. Lanza O,
      3. Rodriguez FM,
      4. Chang A
      . The Kaiser Permanente Clinician Cultural and Linguistic Assessment Initiative: research and development in patient-provider language concordance. Am J Public Health. 2011;101(2):205–208pmid:21228282
      OpenUrlCrossRefPubMed
    175. ↵
      1. Lion KC,
      2. Thompson DA,
      3. Cowden JD, et al
      . Impact of language proficiency testing on provider use of Spanish for clinical care. Pediatrics. 2012;130(1). Available at: www.pediatrics.org/cgi/content/full/130/1/e80pmid:22689864
      OpenUrlAbstract/FREE Full Text
    176. ↵
      1. Dreby J
      . The burden of deportation on children in Mexican immigrant families. J Marriage Fam. 2012;74(4):829–845
      OpenUrl
    177. ↵
      1. Rhodes SD,
      2. Mann L,
      3. Simán FM, et al
      . The impact of local immigration enforcement policies on the health of immigrant Hispanics/Latinos in the United States. Am J Public Health. 2015;105(2):329–337pmid:25521886
      OpenUrlCrossRefPubMed
    178. ↵
      1. Suârez-Orozco C,
      2. Todorova IL,
      3. Louie J
      . Making up for lost time: the experience of separation and reunification among immigrant families. Fam Process. 2002;41(4):625–643pmid:12613121
      OpenUrlCrossRefPubMed
    179. ↵
      1. Crosnoe R,
      2. Leventhal T,
      3. Wirth RJ,
      4. Pierce KM,
      5. Pianta RC; NICHD Early Child Care Research Network
      . Family socioeconomic status and consistent environmental stimulation in early childhood. Child Dev. 2010;81(3):972–987pmid:20573117
      OpenUrlCrossRefPubMed
    180. ↵
      1. Council on Community Pediatrics
      . Poverty and child health in the United States. Pediatrics. 2016;137(4):e20160339pmid:26962238
      OpenUrlAbstract/FREE Full Text
    181. ↵
      1. Singh P,
      2. Chokshi DA
      . Community health workers–a local solution to a global problem. N Engl J Med. 2013;369(10):894–896pmid:24004115
      OpenUrlCrossRefPubMed
      1. Postma J,
      2. Karr C,
      3. Kieckhefer G
      . Community health workers and environmental interventions for children with asthma: a systematic review. J Asthma. 2009;46(6):564–576pmid:19657896
      OpenUrlCrossRefPubMed
      1. Coker TR,
      2. Chacon S,
      3. Elliott MN, et al
      . A parent coach model for well-child care among low-income children: a randomized controlled trial. Pediatrics. 2016;137(3):e20153013pmid:26908675
      OpenUrlAbstract/FREE Full Text
      1. Enard KR,
      2. Ganelin DM
      . Reducing preventable emergency department utilization and costs by using community health workers as patient navigators. J Healthc Manag. 2013;58(6):412–427; discussion 428pmid:24400457
      OpenUrlPubMed
      1. Pati S,
      2. Ladowski KL,
      3. Wong AT,
      4. Huang J,
      5. Yang J
      . An enriched medical home intervention using community health workers improves adherence to immunization schedules. Vaccine. 2015;33(46):6257–6263pmid:26435190
      OpenUrlPubMed
    182. ↵
      1. Anugu M,
      2. Braksmajer A,
      3. Huang J,
      4. Yang J,
      5. Ladowski KL,
      6. Pati S
      . Enriched medical home intervention using community health worker home visitation and ED use. Pediatrics. 2017;139(5):e20161849pmid:28557721
      OpenUrlAbstract/FREE Full Text
    183. ↵
      1. Agency for Healthcare Research and Quality
      . Design guide for implementing warm handoffs. 2017. Available at: https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/warmhandoff-designguide.pdf. Accessed August 30, 2018
    184. ↵
      1. Blewett LA,
      2. Johnson PJ,
      3. Mach AL
      . Immigrant children’s access to health care: differences by global region of birth. J Health Care Poor Underserved. 2010;21(suppl 2):13–31pmid:20453374
      OpenUrlPubMed
    185. ↵
      1. National Immigration Law Center
      . Overview of immigrant eligibility for federal programs. 2015. Available at: https://www.nilc.org/issues/economic-support/overview-immeligfedprograms/. Accessed August 30, 2018
      1. National Immigration Law Center
      . Table: medical assistance programs for immigrants in various states. 2018. Available at: https://www.nilc.org/wp-content/uploads/2015/11/med-services-for-imms-in-states.pdf. Accessed November 14, 2018
      1. Georgetown University Health Policy Institute Center for Children and Families
      . Health coverage for lawfully residing children. 2018. Available at: https://ccf.georgetown.edu/wp-content/uploads/2018/05/ichia_fact_sheet.pdf. Accessed August 30, 2018
    186. ↵
      1. Brooks T,
      2. Wagnerman K,
      3. Artiga S,
      4. Cornachione E,
      5. Ubri P
      . Medicaid and CHIP eligibility, enrollment, renewal, and cost sharing policies as of January 2017: findings from a 50-state survey. 2017. Available at: https://www.kff.org/medicaid/report/medicaid-and-chip-eligibility-enrollment-renewal-and-cost-sharing-policies-as-of-january-2017-findings-from-a-50-state-survey/. Accessed August 30, 2018
    187. ↵
      1. National Immigration Law Center
      . Health care coverage maps. 2018. Available at: https://www.nilc.org/issues/health-care/healthcoveragemaps/. Accessed July 26, 2019
    188. ↵
      1. Flores SM
      . State dream acts: the effect of in-state resident tuition polices and undocumented Latino students. Rev High Ed. 2010;33(2):239–283
      OpenUrl
    189. ↵
      1. New American Economy
      . Removing barriers: expanding in-state tuition for Dreamers in South Carolina. 2019. Available at: https://www.newamericaneconomy.org/wp-content/uploads/2019/04/SC_InState_Tuition.pdf. Accessed April 4, 2019
    190. ↵
      1. Mirza M,
      2. Luna R,
      3. Mathews B, et al
      . Barriers to healthcare access among refugees with disabilities and chronic health conditions resettled in the US Midwest. J Immigr Minor Health. 2014;16(4):733–742pmid:24052476
      OpenUrlCrossRefPubMed
    191. ↵
      1. National Immigration Law Center
      . Know your rights: Is it safe to apply for health insurance or seek health care? Available at: https://www.nilc.org/issues/health-care/health-insurance-and-care-rights/. Accessed July 26, 2019
    192. ↵
      1. Duffee JH,
      2. Mendelsohn AL,
      3. Kuo AA,
      4. Legano LA,
      5. Earls MF; Council on Community Pediatrics; Council on Early Childhood; Committee on Child Abuse and Neglect
      . Early childhood home visiting. Pediatrics. 2017;140(3):e20172150pmid:28847981
      OpenUrlAbstract/FREE Full Text
    193. ↵
      1. Greenberg JP
      . Determinants of after-school programming for school-age immigrant children. Child Sch. 2013;35(2):101–111
      OpenUrl
    194. ↵
      1. Greenberg JP
      . Significance of after-school programming for immigrant children during middle childhood: opportunities for school social work. Soc Work. 2014;59(3):243–251pmid:25076648
      OpenUrlCrossRefPubMed
    195. ↵
      1. Jarlenski M,
      2. Baller J,
      3. Borrero S,
      4. Bennett WL
      . Trends in disparities in low-income children’s health insurance coverage and access to care by family immigration status. Acad Pediatr. 2016;16(2):208–215pmid:26329016
      OpenUrlPubMed
    196. ↵
      1. Avila RM,
      2. Bramlett MD
      . Language and immigrant status effects on disparities in Hispanic children’s health status and access to health care. Matern Child Health J. 2013;17(3):415–423pmid:22466718
      OpenUrlCrossRefPubMed
    197. ↵
      1. Artiga S
      . Immigration reform and access to health coverage: key issues to consider. 2013. Available at: https://www.kff.org/uninsured/issue-brief/immigration-reform-and-access-to-health-coverage-key-issues-to-consider/. Accessed July 29, 2019
    198. ↵
      1. Artiga S,
      2. Ubri P
      . Living in an immigrant family in America: How fear and toxic stress are affecting daily life, well-being, and health. 2017. Available at: https://www.kff.org/disparities-policy/issue-brief/living-in-an-immigrant-family-in-america-how-fear-and-toxic-stress-are-affecting-daily-life-well-being-health. Accessed August 30, 2018
    199. ↵
      1. Artiga S,
      2. Garfield R,
      3. Damico A
      . Estimated impacts of the proposed public charge rule on immigrants and Medicaid. 2018. Available at: https://www.cmhnetwork.org/wp-content/uploads/2018/10/Issue-Brief-Estimated-Impacts-of-the-Proposed-Public-Charge-Rule-on-Immigrants-and-Medicaid.pdf. Accessed July 30, 2019
    200. ↵
      1. US Immigration and Customs Enforcement
      . FAQ on sensitive locations and courthouse arrests. 2018. Available at: https://www.ice.gov/ero/enforcement/sensitive-loc. Accessed April 3, 2019
    201. ↵
      1. National Immigration Law Center
      . Health care providers and immigration enforcement: know your rights, know your patients’ rights. Available at: https://www.nilc.org/issues/immigration-enforcement/healthcare-provider-and-patients-rights-imm-enf/. Accessed April 5, 2019
    202. ↵
      1. Mann L,
      2. Simán FM,
      3. Downs M, et al
      . Reducing the impact of immigration enforcement policies to ensure the health of North Carolinians: statewide community-level recommendations. N C Med J. 2016;77(4):240–246pmid:27422942
      OpenUrlAbstract/FREE Full Text
      1. Hacker K,
      2. Chu J,
      3. Leung C, et al
      . The impact of Immigration and Customs Enforcement on immigrant health: perceptions of immigrants in Everett, Massachusetts, USA. Soc Sci Med. 2011;73(4):586–594pmid:21778008
      OpenUrlCrossRefPubMed
      1. Montealegre JR,
      2. Selwyn BJ
      . Healthcare coverage and use among undocumented Central American immigrant women in Houston, Texas. J Immigr Minor Health. 2014;16(2):204–210pmid:23224739
      OpenUrlPubMed
    203. ↵
      1. Raymond-Flesch M,
      2. Siemons R,
      3. Pourat N,
      4. Jacobs K,
      5. Brindis CD
      . “There is no help out there and if there is, it’s really hard to find”: a qualitative study of the health concerns and health care access of Latino “DREAMers”. J Adolesc Health. 2014;55(3):323–328pmid:25151054
      OpenUrlCrossRefPubMed
    204. ↵
      1. Giuliani C,
      2. Tagliabue S,
      3. Regalia C
      . Psychological well-being, multiple identities, and discrimination among first and second generation immigrant Muslims. Eur J Psychol. 2018;14(1):66–87pmid:29899799
      OpenUrlPubMed
      1. Suleman S,
      2. Garber J,
      3. Rutkow L
      . Xenophobia as a determinant of health: an integrative review. J Public Health Policy. 2018;39(4):407–423
      OpenUrl
    205. ↵
      1. Budhwani H,
      2. Hearld KR,
      3. Chavez-Yenter D
      . Depression in racial and ethnic minorities: the impact of nativity and discrimination. J Racial Ethn Health Disparities. 2015;2(1):34–42pmid:26863239
      OpenUrlPubMed
    206. ↵
      1. Davis AN,
      2. Carlo G,
      3. Schwartz SJ, et al
      . The longitudinal associations between discrimination, depressive symptoms, and prosocial behaviors in U.S. Latino/a recent immigrant adolescents. J Youth Adolesc. 2016;45(3):457–470pmid:26597783
      OpenUrlPubMed
    207. ↵
      1. Gulbas LE,
      2. Zayas LH,
      3. Yoon H,
      4. Szlyk H,
      5. Aguilar-Gaxiola S,
      6. Natera G
      . Deportation experiences and depression among U.S. citizen-children with undocumented Mexican parents. Child Care Health Dev. 2016;42(2):220–230pmid:26648588
      OpenUrlCrossRefPubMed
    208. ↵
      1. Sabo S,
      2. Shaw S,
      3. Ingram M, et al
      . Everyday violence, structural racism and mistreatment at the US-Mexico border. Soc Sci Med. 2014;109:66–74pmid:24705336
      OpenUrlCrossRefPubMed
    209. ↵
      1. Venkataramani AS,
      2. Shah SJ,
      3. O’Brien R,
      4. Kawachi I,
      5. Tsai AC
      . Health consequences of the US Deferred Action for Childhood Arrivals (DACA) immigration programme: a quasi-experimental study [published correction appears in Lancet Public Health. 2017;2(5):e213]. Lancet Public Health. 2017;2(4):e175–e181pmid:29253449
      OpenUrlPubMed
    210. ↵
      1. Hainmueller J,
      2. Lawrence D,
      3. Martén L, et al
      . Protecting unauthorized immigrant mothers improves their children’s mental health. Science. 2017;357(6355):1041–1044pmid:28860206
      OpenUrlAbstract/FREE Full Text
    211. ↵
      1. Kids in Need of Defense
      . No Child Should Appear in Immigration Court Alone. Washington, DC: Kids in Need of Defense; 2018. Available at: https://supportkind.org/wp-content/uploads/2018/01/General-KIND-Fact-Sheet_January-2018.pdf. Accessed August 30, 2018
    212. ↵
      1. Houseman AW
      . Civil legal aid in the United States: an update for 2013. 2013. www.clasp.org/resources-and-publications/publication-1/CIVIL-LEGAL-AID-IN-THE-UNITED-STATES-3.pdf. Accessed August 30, 2018
    213. ↵
      1. Kids in Need of Defense
      . Improving the Protection and Fair Treatment of Unaccompanied Children. Washington, DC: Kids in Need of Defense; 2016. Available at: https://supportkind.org/wp-content/uploads/2016/09/KIND-Protection-and-Fair-Treatment-Report_September-2016-FINAL.pdf. Accessed August 30, 2018
    214. ↵
      1. National Immigrant Justice Center
      . Justice for Unaccompanied Immigrant Children: An Advocacy Best Practices Manual for Legal Service Providers. Chicago, IL: National Immigrant Justice Center; 2016. Available at: https://www.americanbar.org/content/dam/aba/administrative/probono_public_service/ls_pb_uac_doc_uic_best_practices_4_27_16.pdf. Accessed August 30, 2018
    215. ↵
      1. Portes A,
      2. Rivas A
      . The adaptation of migrant children. Future Child. 2011;21(1):219–246pmid:21465862
      OpenUrlCrossRefPubMed
    216. ↵
      1. Avellar S,
      2. Paulsell D,
      3. Sama-Miller E,
      4. Del Grosso P,
      5. Akers L,
      6. Kleinman R
      . Home Visiting Evidence of Effectiveness Review: Executive Summary. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, US Department of Health and Human Services; 2016, Available at: https://homvee.acf.hhs.gov/HomVEE-Executive-Summary-2016_Compliant.pdf. Accessed August 30, 2018
    217. ↵
      1. Yogman M,
      2. Garner A,
      3. Hutchinson J,
      4. Hirsh-Pasek K,
      5. Golinkoff RM; Committee on Psychosocial Aspects of Child and Family Health; Council on Communications and Media
      . The power of play: a pediatric role in enhancing development in young children. Pediatrics. 2018;142(3):e20182058pmid:30126932
      OpenUrlAbstract/FREE Full Text
    218. ↵
      1. Weisleder A,
      2. Cates CB,
      3. Dreyer BP, et al
      . Promotion of positive parenting and prevention of socioemotional disparities. Pediatrics. 2016;137(2):e20153239pmid:26817934
      OpenUrlAbstract/FREE Full Text
    219. ↵
      1. Katigbak C,
      2. Foley M,
      3. Robert L,
      4. Hutchinson MK
      . Experiences and lessons learned in using community-based participatory research to recruit Asian American immigrant research participants. J Nurs Scholarsh. 2016;48(2):210–218pmid:26836035
      OpenUrlPubMed
    220. ↵
      1. Huemer J,
      2. Karnik NS,
      3. Voelkl-Kernstock S, et al
      . Mental health issues in unaccompanied refugee minors. Child Adolesc Psychiatry Ment Health. 2009;3(1):13pmid:19341468
      OpenUrlCrossRefPubMed
    221. ↵
      1. Terra Firma
      . Supporting Resilience for Immigrant Children. Available at: http://www.terrafirma.nyc. Accessed July 30, 2019
    222. ↵
      1. Kids in Need of Defense
      . Legal services. Available at: https://supportkind.org/our-work/legal-services-2/. Accessed July 30, 2019
    223. ↵
      1. Young Center for Immigrant Children’s Rights
      . The Goal. Available at: https://www.theyoungcenter.org/big-picture. Accessed July 30, 2019
    224. ↵
      1. RAICES
      . Services. Available at: https://www.raicestexas.org/services/. Accessed July 30, 2019
    • Copyright © 2019 by the American Academy of Pediatrics
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    Vol. 144, Issue 3
    1 Sep 2019
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    Providing Care for Children in Immigrant Families
    Julie M. Linton, Andrea Green, COUNCIL ON COMMUNITY PEDIATRICS
    Pediatrics Sep 2019, 144 (3) e20192077; DOI: 10.1542/peds.2019-2077

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    Providing Care for Children in Immigrant Families
    Julie M. Linton, Andrea Green, COUNCIL ON COMMUNITY PEDIATRICS
    Pediatrics Sep 2019, 144 (3) e20192077; DOI: 10.1542/peds.2019-2077
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      • Demographics
      • Resilience and Integration
      • Cultural Humility and Safety
      • Care of CIF: Core Competencies
      • Practice-Level Barriers and Potential Opportunities
      • Systems-Level Barriers and Potential Opportunities
      • Immigration and Related Legal Issues
      • Summary and Recommendations
      • Conclusions
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      • Council on Community Pediatrics Executive Committee, 2017–2018
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