Child and Adolescent Refugee Outreach Clinic

Sanaa Abo Aisha, Navneet Binepal, Kristen Godin, Alessandra Rossi-Ricci

Children and Adolescent Refugee (CARE) Outreach Project

As paediatricians, we have a major role in promoting health care for children, particularly for those at high risk. Our scope of service not only encompasses providing compassionate and high standard care to the children we see every day, but it should also extend to include vulnerable children who struggle to access health care services due to a variety of barriers. We identified the refugee population in Ottawa as a particularly vulnerable group and wanted to learn more about their immediate and long term medical needs in order to offer them better services.

Refugees can be divided into two large subgroups: Government assisted refugees (GAR) and refugee claimants. GARs, as the name implies, receive support from the Government of Canada or the Government of Quebec that supports their initial resettlement in Canada. In 2011, there were 27,872 protected persons admitted to Canada, of which 6,977 (24%) under 15 years old. In the same year, there were 428 government assisted refugees (GAR) in Ottawa, of which 180 (42%) under 18 years old.

“Refugee children are children first and foremost, and as children, they need special attention. As refugees, they are particularly at risk with the uncertainty and unprecedented upheavals which are increasingly marking the post-Cold War era.”  Guidelines on Protection and Care, UNHCR, 2001.

In a 2011 study done by Citizenship and Immigration Canada, client support service staff reported access to healthcare as the main issue for government assisted refugees in their first year in Canada. Furthermore, the Canadian Collaboration for Immigrant and Refugee Health published evidence-based clinical guidelines for immigrants and refugees in September 2011. They identified that immigrants and refugees frequently face barriers to local health services, with women and children most at risk. Pottie, K. et al. Evidence Based Guidelines for Immigrants and Refugees. CMAJ. 2011.

We therefore decided to create a project that would better assess these issues. Our goals were to perform a needs assessment, to broaden community partnerships with key organizations involved in refugee health, to enhance paediatric resident education regarding refugee health, and finally to develop a working model for a paediatric refugee outreach clinic, if necessary.

The needs assessment was achieved through retrospective and prospective data collection. The retrospective surveys were submitted to the Community Health Centers and the Wellness Center, since they provide most of the primary care to refugee children and youth in Ottawa. As well, data is being collected prospectively at the Wellness Center, giving us a better picture of the current needs of Government Assisted Refugee children and youth. With this data, we wanted to assess what are the main health needs of this population, what are the barriers to accessing the current services  and if there is a need for a specific paediatric refugee clinic.

We therefore administered our Retrospective Survey to Community Health Centres (CHCs) Dec 2012 - Feb 2013. Descriptive data about refugee children < 18 years seen over last 6 months was collected. Demographic information was collected and we assessed common paediatric medical problems, their frequency and  need for referrals. We found that most refugees were originally from Africa (54%) and  South East Asia (22%). The main reported medical concerns were of infectious origin (70% of cases), dental issues (70%) and failure to thrive (60%), followed closely by behavioural problems (45%). These patients are commonly referred to subspecialty paediatrics, but rarely to general paediatrics.

A second part of our needs assessment is still ongoing at the Wellness Center, where all Government Assisted Refugees receive their screening medical examination upon arrival to Canada. We are collecting anonymous medical information on all paediatric patients seen at the center.  The group is evenly divided in younger (50%) and older (50%) than 10 years of age. An interim data analysis was performed in April of 2013. It showed that the regions of origin were distributed as follows: African countries (50%), Afghanistan (33.3%), Syria (16.7%). Failure to thrive, vision loss, hearing loss and developmental delay (all 33%) are the major health issues. The secondary issues were: behavioural problems, mental health concerns and physical disability. Referrals were considered to dentistry (50% of cases), family physicians (33%) and mental health providers (16%). 33% of patients would be referred to general paediatrics, including a paediatric refugee clinic, if there was one available. It was anticipated that 50% of these patients will require long-term follow-up.

Hence, the data we have collected so far demonstrates that refugees have unique medical needs, often present with comorbidities and many will require long-term follow-up. They are frequently referred to allied health professionals and subspecialty paediatrics, occasionally to general paediatrics. The number of patients and the lack of referral to general paediatrics currently do not support the need for a paediatric refugee clinic that would require a significant amount of resources. Therefore, despite the fact that this was one of our goals, we have not pursued any further work towards the creation of such a clinic.

As part of our project, we also organized formal lectures that were added to the current curriculum for paediatric residents at the University of Ottawa and the Grand Rounds lectures held at CHEO. We created a network of professionals involved in caring for refugees that includes staff form the Catholic Center for Immigrants and the Wellness Center, and physicians from CHEO and the University of Ottawa. We hope that the collaboration between these key players will continue, in order to better serve refugee children and youth.

In the long term, we aim to continue to promote resident interest in refugee and global health through refugee health specific education, while emphasizing the importance of health advocacy in one’s community. We would like to present our initiatives and findings at local, regional and national level. And finally, if it ever becomes necessary, we would aim to develop and implement a working model for a paediatric refugee outreach clinic and to find sources of funding for our activities.

Kristen Godin, Sanaa Abo Aisha, Alessandra Rossi Ricci and Navneet Binepal
Paediatrics, University of Ottawa