Both service providers and health care providers have the best interests of clients’ health and well-being in mind. However, demanding caseloads and potential ambiguities around roles can hinder collaboration between them. This post will share insights from clinicians and resettlement providers to facilitate coordinated care for refugee and newcomer clients.
Effective communication and collaboration between health care and service providers is one of the best ways to support refugee and newcomer health needs. However, there can be obstacles to doing so, especially given the busy schedules and competing priorities of clinicians and providers. Through understanding each position’s roles, strengths, and limitations in providing care—and taking steps to improve collaboration—providers and clinicians can provide the best care to refugees. Below is a basic list of roles for providers and clinicians, and eight tips on improving collaboration.
Understanding the service provider’s role in health care
Service providers, such as resettlement agencies and community-based organization (CBO) staff, help to address challenges that newcomers may face in accessing health care services. Service providers:
- Support clients in achieving self-sufficiency;
- Leverage their knowledge of available resources and programs;
- Understand cultural and linguistic needs;
- Help facilitate coordination of care; and
- Build trust and relationships with refugees and their communities.
While some service provider organizations have health teams or medical case management programs, most service providers are not health care providers. They therefore do not have the training or licensing to, and should not, diagnose or treat medical conditions. Their assistance in helping clients keep appointments and arrive on time remains highly beneficial, allowing clinicians to focus their appointment time solely on addressing health concerns.
For more details about service providers’ roles and boundaries, read our blog post: “What is Health Case Management?”
Understanding the health care provider’s role
Health care providers (also referred to as clinicians) are professionals with specific health care system knowledge who are licensed and trained to:
- Diagnose medical conditions;
- Prescribe medications or treatments;
- Assess signs and symptoms; and
- Determine the urgency of medical issues.
Depending on the state or region, health care providers serving refugees and newcomers may provide:
- Only medical screenings;
- Only primary care services, after the medical screening is completed elsewhere; or
- Both medical screenings and primary care.
Clinicians often work in a clinic or hospital system with specified expectations—from their employers and insurance companies—around how much time they spend with patients and how many patients they see, alongside other administrative obligations (charting, refilling prescriptions, completing paperwork, and more).
Tips for Collaboration
- Identify champions: Since health care providers and case managers/CBO staff are often busy, identifying a champion or point person at each site helps with communication between partners. For example, the resettlement agency or CBO may have a health team member, a specified case manager, or another designated person. At a clinic, this can be a medical assistant, nurse, social worker, care coordinator, or community health worker. This often works best when the champion of the site is passionate about refugee health care, has health care experience, and has allotted sufficient time to carry out this role (rather than having to make time as an “extra” on top of their existing workload).
- Share resources: Explore ways to share and leverage resources between the service provider organization and medical clinic. These resources may include staffing, interpretation, educational materials, support groups and services, spaces, and publicity or logistical collaborations around health initiatives such as vaccine clinics.
- Schedule meetings: It is important to meet regularly to determine goals, successes, and challenges to existing processes, improving efficiency for all parties involved. Identify goals of the clinic-service provider partnership, find an ideal frequency for meeting (i.e., monthly, quarterly, etc.), and specify who needs to be involved (i.e., which agencies, clinics, staff, etc.).
- Develop a communication chain of command: At both the primary care clinic and resettlement agency/CBO, ask: what is the process for routine scheduling versus urgent medical needs? For example, clients who arrive with urgent medical needs, as indicated on pre-arrival IOM documents, may need an appointment within 48 hours of arrival. How can the resettlement agency and medical clinic work to accommodate these cases (within reason and when possible)? What are the after-hours communications options and contacts, if available and necessary, within your collaboration team? The communication chain should be bi-directional so that, if a client brings up a non-medical concern to the health care provider, the provider knows they can communicate with the champion at the resettlement agency/CBO and ensure the client’s case manager is able to follow up.
- Plan for emergencies: If there is a client in crisis, how will you manage it? Thinking this through and having a written protocol is essential. Clients often will go first to their trusted case manager with a medical issue, rather than a health care provider. However, service providers should be mindful that health issues are not solely their responsibility. These medical issues may involve calling 911. Or, for non-life-threatening crises, they could require a more urgent phone call to the clinic to speak with the health care provider.
- Clearly identify responsibilities: Identify who is responsible for each aspect of care coordination. For example: does the resettlement agency/CBO have a program that assists with transportation to the appointment? Or does the medical clinic have a community health worker who can assist with transportation as part of their job? Who helps coordinate follow-up and specialty appointments? Who assists the client with obtaining required medical devices? Health care providers may not be aware of what is and is not within a service provider’s scope, and the type of health care assistance provided to clients may depend on their enrollment in specific programs.
- Respect privacy around health information: When dealing with health care information and records, it is important to respect and follow privacy and confidentiality guidelines and laws. Some options to consider include: drafting a memorandum of understanding (MOU) between the resettlement agency/CBO and health care clinic outlining roles and information sharing; having clients sign release of information forms between partners; and encrypting emails. Both sides should limit the amount of health information they share, both by communicating only the most necessary information and limiting the number of people who receive that information. Providers should be mindful of their surroundings when discussing health information to ensure that other clients, family members, or staff members cannot overhear their conversations.
- Include all staff in training: While not everyone needs an in-depth training about the care coordination process, all staff should receive training on topics such as cultural humility, trauma-informed care, refugee health 101 (i.e., an introduction to who refugees are and their unique health considerations), confidentiality and personally identifying information, and interpretation and translation requirements. This training is not just essential for service providers and health care providers who work with newcomers; it is also for front office staff, medical assistants, and other personnel.
