One in five children living in San Francisco was born outside the United States. Although many of their families were admitted into the country legally, they were met with few resources when they set foot in the United States. They know little about the US health care system, and the system knows very little about them. This puts them at a severe disadvantage in obtaining health care.

The Child Health Initiative for Immigrant/Refugee Newcomers (CHIRN) reasoned that school registration provided a golden opportunity to begin bridging this gap. With the collaboration of the school district and the health department, the initiative placed bilingual, bicultural field workers in the registration centers to offer health screening and community resources as part of the registration process. This strategy achieved multiple objectives: It found children with immediate health needs, linked families with primary care, and documented the health needs of the population.

Who is served?

This initiative serves low-income, foreign-born children of elementary school age who have lived in the United States for two years or less and who have unresolved health or medical problems and/or are having difficulty in obtaining the health care services they need.

How does the project work?

The initiative's bilingual and bicultural health workers make initial contact with families when they enroll their elementary-age children at the school district's central registration office. Locating at the registration center has enabled the initiative to reach immigrants within two or three months of their arrival. A public health nurse/health worker team provides an overall health screening, with an emphasis on immunizations and preventive care. They also make referrals for follow-up health care. The initiative developed tools for health screening, including an immunization record and health history, a nutrition screening questionnaire, a family service plan and referral forms. The initiative also created a training program with bilingual materials for health workers.

Children identified as high-risk receive case management through the initiative. This case management includes home visits by a public health nurse or health worker, screenings for health and social service needs, and referrals to connect families with the needed services.

How is the project financed?

The initiative received funding from a state Medicaid grant (through the preventive health services program) and a local foundation grant.

Quotes About the Project

Our greatest achievement in the area of service integration was assisting newly arrived immigrants in establishing their preventive health care and transitioning them into a new psycho-social environment."
Rosemary Lee, Coordinator, CHIRN Program

…We have learned that despite many difficulties immigrants and refugees experience in leaving their own country and settling in our community, newcomer children and youth arrive here in relatively good health and that, although they bring with them certain unique health problems, they can be corrected relatively quickly if timely interventions are provided."
Newcomer Children in San Francisco: Their Health and Well-Being — A Report by the Child Health Initiative for Immigrant & Refugee Newcomers, 1995