TABLE 1

Potential Strategies To Address Challenges Due to COVID-19 for CIF

Strategies
For pediatricians
 Health care access and deliveryHighlight opportunities to celebrate the strengths of immigrant families despite fear and uncertainty, including cultural pride reinforcement6 and reading multilingual books7 together.
Share multilingual information8 with families regarding COVID-19, including social distancing,9 wearing masks in public,10 and testing for COVID-19. 
Provide information on free health clinics11 and/or local health resources for mixed-status families. 
Offer resources for families to cope with emotional distress associated with COVID-19, such as strategies to manage stress and anxiety,12 talking with children about COVID-19,13 and disaster support.14
Encourage employers to implement telemedicine15 systems that support the needs of immigrant families, including dissemination of information in preferred language and availability of interpretation.
 Socioeconomic impactsEmphasize comprehensive screening for social determinants of health.16
Encourage participation in public programs (eg, Medicaid, WIC, SNAP) for which children and families are eligible.17 
Provide resources to mitigate food insecurity, including school-based nutrition programs18 and food banks.19
Refer families to community-organized, culturally and linguistically relevant, updated SDH resource links (eg, Hispanic Alliance, Greenville, SC20; Informed Immigrant Resources21; Immigrants Rising22; Aunt Bertha23).
 Immigration enforcement and policyAcknowledge fear and uncertainty that families are facing and offer resources, including Know Your Rights materials.24
Familiarize yourself with legal resources for immigrant families25 who face particular risks for lack of access to public services or immigration enforcement.
For hospitals and health care systems
 Health care access and deliveryEnsure that free testing for COVID-19 is accessible and advertised to immigrant families.
Develop and implement free walk-up and drive-through testing and treatment (eg, New York City, NY26; Trenton, NJ27) sites within trusted venues in immigrant communities, such as schools, community centers, or places of worship.
Increase capacity for access to interpreters and patient navigators to facilitate telehealth.
Rapidly employ and train bicultural, bilingual professionals and paraprofessionals (eg, community health workers28) to assist with COVID-19 testing and information dissemination in densely populated immigrant communities.
 Socioeconomic impactsImplement and/or expand systems-wide screening for social determinants of health in the setting of COVID-19.29
Ensure continued access to social workers, community health workers, and other team members dedicated to connecting families to resources such as unemployment, nutrition, housing, and other public and community-based programs.
 Immigration enforcement and policyPost welcoming signage30 that offers families a sense of safety while seeking health care services.
Ensure that any security presence during visitor and patient screening protocols is trained to offer culturally relevant, sensitive screening that recognizes disparate impact of law enforcement on communities of color, including immigrant families. 
Develop protocols that ensure the rights of immigrant families are maintained31 while seeking health care.
For policymakers and public health entities
 Health care access and deliveryDevelop and disseminate smartphone-accessible resources32 and materials in multiple languages.
Clarify access to free testing and treatment regardless of immigration status (eg, New York City33). 
Encourage states to provide Medicaid to all individuals regardless of immigration status, including those with DACA, TPS holders, green card holders, and undocumented individuals, to ensure that they have access to testing and treatment. 
Ensure access to data stratified by race, ethnicity,34 and language preference to better implement interventions that meet the needs of communities who are most impacted.
Suspend public charge enforcement.
 Socioeconomic impactsEnsure that resources on public websites about COVID-19 include accessible, multilingual information regarding access to housing, food, and other critical services (eg, Chicago, IL35; Boston, MA36).
Include all immigrants, regardless of legal status, in any federal or state financial relief package (Chicago, IL37).
Expand unemployment eligibility to people with DACA and TPS and to others who have work eligibility.
Automatically extend work permits for individuals with DACA, TPS, and nonimmigrant visas for the same time period as the individual’s status or work authorization.
Place a moratorium on housing evictions and foreclosures,38 utilities termination,39 and suspended telephone or Internet services.40
 Immigration enforcement and policyDevelop timely and well-communicated protocols for immigrants in ICE custody who fall ill, and immediately close the 3 family detention facilities, ensuring monitoring for symptoms with community-based case management.
Resume access to humanitarian protection at the US–Mexico border for unaccompanied children and family units. 
Stop interior ICE enforcement unless someone has a criminal background that threatens public safety.
Continue DACA renewals, including work authorization, and resume acceptance of new applications.
  • Recommendations within each category are listed in order of increasing expected time commitment or complexity. SNAP, Supplemental Nutrition Assistance Program.