MONTGOMERY COUNTY’S RESPONSE TO THE HEALTH CARE NEEDS OF

THE IMMIGRANT COMMUNITY

 

INTRODUCTION

From its earliest beginnings Maryland has welcomed new arrivals.  The state, in fact, was founded by refugees seeking freedom from English religious intolerance.  Montgomery, now the most diverse county in the state, has continued the tradition of openness and multiculturalism, accommodating new Americans who strive to work and raise their families here and add a rich culture to the community.

 

According to the 2000 census, there were 232,996 foreign-born residents in Montgomery County - 26.7% of the population.  Between 2000 and 2004 an additional 33,868 international immigrants moved to the county.  El Salvador, India, China, Korea and Vietnam were the top five countries of origin for the foreign born.

 

As the county seeks to assimilate the newcomers, it faces the reality of providing services to many who, because of the high cost of living, are unable to pay for them.  In the past, most public health agencies focused on public safety and control of communicable diseases, primary prevention, maternal and child welfare and education of the public. Changing demographics brought new challenges and new responsibilities for the public health system.  In its Strategic Plan, published in 2005, the Montgomery County Department of Health & Human Services (DHHS) listed as its number one goal to “increase access to quality health care.”  Improving the health of individuals and the community as a whole continues as a core function with the “elimination of racial and ethnic disparities..." as an important objective.[1]

 

For this study, we focused on the following categories of immigrants who may be eligible to use public health services:

1. Documented immigrants - those who are legal permanent residents or “green card” holders. Some of these have health insurance.   Many others are uninsured.  2. Undocumented immigrants - those who entered the country illegally or remained beyond the expiration date of a temporary visa. 

 

Although these distinctions are important for legal reasons, persons seeking public health care in Montgomery County are not required to prove immigration status, except when applying for federal- or state-funded insurance programs. Many low-income, linguistically isolated individuals are unaware of the health care programs available and do not seek out services for which they are eligible.  The undocumented foreign born are especially reluctant to seek help for fear of being reported to authorities, with the possibility of deportation.

 

As the cost of health care soars, and the number of uninsured increases, we focused on how the county is meeting the health needs of the low-income immigrant community, many of whom are part of the estimated 80,000 uninsured adults in the county.  Many new arrivals work at several jobs with combined salaries that exceed the Federal Poverty Level (FPL) ($15,260 for a family of three) but are well below the Self-Sufficiency Standard ($51,086) for the county.

 

ELIGIBILITY FOR GOVERNMENT-SUPPORTED HEALTH SERVICES

Three Service Eligibility Units (SEUs) provide assistance to families in determining eligibility for county- and some state-provided services.

 

At the federal level, insurance under the Medicare program is open to US citizens and legal permanent residents.  Comprehensive coverage is available to those over age 65 who qualify without regard to income, people under 65 with certain disabilities and people of any age with end-stage renal disease.

 

Medical Assistance or Medicaid is a state and federally funded insurance program that provides comprehensive coverage to those with very low incomes, including legal immigrants.  To qualify, individuals must meet the Federal Poverty Level (FPL), which for a family of three (one adult, one pre-school child and one school-aged child) is $15,260.

 

 

Maryland Children’s Health Insurance Program (M-CHIP) uses state and federal funds to provide full health benefits, including hospitalization, to US citizens and permanent legal residents.  To qualify, family income must be at or below 200% of the FPL.  For a family of four the income level would be $37,700. Approximately 35,000 Montgomery County children are enrolled.

 

Care for Kids, funded by Montgomery County, provides medical and dental services to 2,500 children in low-income families who do not qualify for Medical Assistance or M-CHIP.  The average cost per child per year for medical care is $325 and $125 for dental care.  Children who are county residents are eligible for this program if their families’ incomes are below 250% of the FPL - $48,375 for a family of four.  They do not have to be citizens or legal residents to qualify.

 

Montgomery Cares is the county-sponsored program for uninsured adults comprising a number of clinics under the administrative umbrella of the Primary Care Coalition.  Residency, income requirements and fees are established by the individual clinics.  Patients are not required to provide immigration status.

 

MONTGOMERY’S COMMITMENT TO HEALTH CARE FOR THE UNINSURED

For many years health professionals and community activists in Montgomery County have been dedicated to improving health care for the growing numbers of people without, or with inadequate, public or private health insurance.  For many years, the most underserved were African Americans; now, immigrants are most in need.

 

The county’s five hospitals have always provided services in their emergency rooms (ERs) to people unable to pay for them.  While that care can be life-saving and of great value, there is no system for follow up.  In addition, use of the ER as a substitute for primary care is inappropriate and expensive.

 

It was this recognition that inspired concerned citizens in the late sixties to search for low-cost ways to organize systems of health care for the growing numbers of county residents who were without primary medical care.  This was the beginning of a system of safety net clinics in Montgomery County.

 

Mobile Medical Care, Inc., opened its first clinic in the basement of the KenGar Baptist Church some 30 years ago, closely followed by Community Clinics, Inc. (CCI) and later, the Spanish Catholic Center.

 

In 1993, private physicians, with support from the Medical Society, joined these independently operating safety net clinics and created the Primary Care Coalition (PCC) and through its "Project Access" physicians agreed to take some “part” or “no pay” patients into their practices.  These efforts received active support from the Montgomery County DHHS.

 

In 1995, under a Robert Wood Johnson Foundation grant, PCC expanded its mission to increase access to health care for the underserved.  In subsequent years, Proyecto Salud, Mercy Clinic and a number of clinics dedicated to serve specific ethnic groups were added to the network.

 

DHHS, which had been providing funds to the individual safety net clinics, contracted with PCC to administer the funding and provide for accountability of the various clinics and programs.  DHHS partially funds and PCC administers a number of programs to assist low-income residents, including Care for Kids.

 

In 2000, the county received a federal grant to build an infrastructure of systems of health care for the underserved.  PCC and a network of not-for-profit health care service providers (organized as Community Health Link) developed a plan to provide primary care to 40,000 of the 80,000 uninsured county residents.  In 2005 the county government appropriated $15 million to be disbursed over a period of five years for a new initiative, Montgomery Cares, which will provide primary care, some specialty care and medications.  Currently, DHHS contracts with PCC to manage this program.

 

Montgomery Cares will soon inaugurate an advisory board of 15 members that will include strong representation from the minority community.  It is expected that this board will ensure that decisions on growth and operation are transparent and that decision-makers are held accountable to the public for outcomes.

Steve Galen, PCC’s Executive Director, hopes to continue to collaborate with hospitals and other county organizations. While the goal is to make health care available to all, he hopes that in five years 40,000 individuals will get health care, that uniform standards of care will have been established, that a data base that makes inter/agency and clinic communication possible will be operational and that medications and specialty care will be available.

 

THE SAFETY NET CLINICS

Because they receive some funding from the county, safety net clinics are open to all ethnicities and faiths.  All ask patients for a modest fee, based on ability to pay, but much of the care is free.  The following clinics represent the network of health care resources available to low-income uninsured residents:

 

Mobile Medical Care, Inc., provides primary health care, some medications and, when necessary, specialty care to some 5,000 low-income county residents, many of whom are immigrants.  Its patients come from more than 50 countries and speak as many languages and dialects.

 

The organization has a multi-cultural full-time and part-time staff of 27.  It also has 200 volunteers, half of whom are physicians or registered nurses.  Mobile Med has 19 clinic sites around the county.  Half of its patients are cared for at community sites, and half are seen on one of its three fully equipped mobile medical vans, each staffed by a physician’s assistant or a nurse practitioner.  In recent years several clinics have been developed to meet the cultural and language needs of specific ethnic groups.  Mobile Med partners with three of them:

 

The Pan Asian Volunteer Health Clinic (PAVHC) in Silver Spring is a collaborative program with the Chinese Culture and Community Service Center.  The majority of its patients are elderly and speak little or no English.  Finding providers competent in the variety of Asian languages and dialects is a problem.  Another is that the clinic is open only four hours a week.  Mobile Med provides a bilingual nurse, who also keeps the clinic’s medical records.  Local area hospitals provide laboratory work, Xray and inpatient care.

 

The L’A.M.I. Family Health Clinic, located at St. Camillus Parish in Silver Spring, initially opened its doors to primarily French-speaking African and Caribbean immigrants but now serves patients from all over the world.  Mobile Med’s van is there half a day on a weekly basis.

 

County Association of Spanish Americans (CASA) of Maryland, partnering with Washington Adventist Hospital and Mobile Med, has opened a clinic in Silver Spring in response to the special needs of Hispanic day laborers.  One of Mobile Med’s vans provides a full day of services at the site weekly.

 

Mobile Med is funded by federal, state, county and city governments; private foundations; and individual gifts-with Montgomery Cares funding approximately 15%.  Its medical vans have been funded by foundations, the county and one by a match from Washington Adventist Hospital.

 

Community Clinics, Inc. (CCI), a pioneer in the delivery of primary health care to the medically indigent, was founded 33 years ago.  It serves some 3,000 uninsured children and adults in its primary care clinics in Gaithersburg, Silver Spring and Takoma Park.  In addition, CCI’s Women, Infants, and Children (WIC) nutrition program enrolls more than 18,000 pregnant and nursing women and children under the age of five.  CCI’s Wheaton, Aspen Hill and Germantown clinics provide WIC services only.

 

CCI’s staff is comprised of 70 full- and part-time licensed physicians, nurse practitioners, medical assistants, nutritionists, managers and administrators.  Bilingual staff and licensed medical volunteers contribute to service delivery.  CCI partners with both Washington Adventist Hospital and Holy Cross Hospital.

 

CCI’s financial support comes from the U.S. Department of Agriculture and the state of Maryland WIC, Montgomery Cares, the City of Gaithersburg (for city residents), Care for Kids and a number of foundations and organizations, businesses and private donors.

 

The Spanish Catholic Center was founded in 1967 by the Archdiocese of Washington to provide health care, education, and social services to low-income and limited-English-speaking immigrants.

 

The center operates an adult and pediatric health care clinic in Langley Park that provides more than 10,000 services each year.  Primary health care services include: immunizations for infants, children and adults; pregnancy testing with referrals to prenatal programs; treatment and maintenance of chronic illness; yearly physicals; and full dental services. The center also provides health education and counseling for groups and individuals on pregnancy, infant and child care, nutrition, cancer, diabetes and general health issues.

 

Proyecto Salud, (the Montgomery County Language Minority Health Project, Inc.) was created and organized in 1998 specifically to meet the health needs of Montgomery County’s low-income language-minority population in a culturally sensitive and linguistically appropriate way.  Located in Wheaton, its name suggests a Latino focus, but patients from countries as diverse as Ethiopia, Gambia and Pakistan are also served.

 

The clinic provides comprehensive primary, family-centered health care for uninsured adults, 18 and up.  It has 3,000 registered patients, with 436 diabetics under regular care.  A psychiatric consultant from DHHS visits twice a month - an important service because there is a large psychiatric component in many of the patients’ conditions.

 

Patients are asked for proof of residency and income when they register.  Major funding comes from Montgomery County DHHS and some from Catholic Charities.  Suburban Hospital makes an important contribution by supplying some lab work.

The Peoples Community Wellness Center (TPCWC) located at 3300 Briggs Chaney Rd, Silver Spring in the Eastern Montgomery Community Services Center, provides ambulatory health care to adults in Montgomery County – particularly those residents of eastern Montgomery County. Clinical services are available to uninsured adults who are ineligible for government assisted health care and who have insufficient personal resources to support their own medical care. Many of those seeking care are foreign born.

Services at TPCWC include care for acute illness and chronic medical conditions; routine physical exams; preventive care/wellness; laboratory tests; medications, when available; counseling on nutrition and lifestyle management. Referrals are provided for clinical services not provided on site.

Financial contributions are welcome but patients are seen regardless of their ability to pay. Office visits are by appointment only. TPWCW is co-sponsored by the Montgomery County government and the Peoples Community Baptist Church of Silver Spring.

 

Mercy Health Clinic was founded in 2000 and is supported partially by parishioners from Our Lady of Mercy Catholic Church in Potomac.  Montgomery County provides clinic space in its Upcounty Regional Services Center in Germantown.

 

About 400 patients are seen each month for primary and specialty care; 62% are Hispanic, 9% Asian, 14% African American and 15% Caucasian.  The staff are bilingual in English/Spanish, and use trained volunteer interpreters from CASA of Maryland when needed.

 

The major problem in serving this population is that most patients have untreated chronic disease and serious health problems when they first come to the clinic.  Medications are provided by the clinic, and referrals to specialists are made through Project Access and the Archdiocesan Healthcare Network.

 

The clinic is linked to the Primary Care Coalition and Montgomery Cares, which provides part of its funding.  It also receives support from grants, donations and fund-raisers.  There are two salaried full-time and two part-time staff members, but the remaining 150 are volunteers.  Half have been at Mercy for more than five years.

 

Muslim Community Center Health Clinic in Silver Spring is run by Muslim physicians, who provide free health care to the uninsured.  Although the clinic is open to people of all faiths, most patients are adult Muslim immigrants from all over the world, but especially from South Asia and Africa.  The clinic’s doctors provide care that is sensitive to the special needs of newcomers in a very different culture.  A woman doctor is always available to care for female patients - a need in conservative Muslim culture.

 

Members of the community center, all of whom are Sunni Muslims, contribute a percentage of their incomes to a “zakat” fund, a portion of which is used to pay for the clinic’s medicine and equipment.  Members of the staff donate their time to the center, and labs and specialists in the region provide services at steep discounts.

 

HEALTH SERVICES FOR CHILDREN

While many health services for the adult immigrant community have been fragmented, children, overall, have fared better.  Those children from the very poorest families may be eligible for Medical Assistance.  A major problem arose in FY’06 when the governor eliminated funds for health care to legal immigrants who had been in the country for less than five years.  The county has stepped in to enroll these children in the Care for Kids program at considerable cost and enrollment overruns.  This program and the M-CHIP program are described in the section on Eligibility.

 

The School Health Services program is an important provider of health services to children and particularly those enrolled in the Care for Kids program and attending one of the three schools with a Linkages to Learning/ School Based Health Center (LTL /SBHC).  These centers, administered by Montgomery County DHHS, School Health Services under the LTL program, grew out of the need for a safety net provider for a number of uninsured children in specific school communities where health risks were high.  In 1997 the first two LTL/SBHCs opened at Broad Acres and Harmony Hills Elementary Schools.  A third center opened at Gaithersburg Elementary School in September 2005.  The county estimates that 10,000-20,000 children remain uninsured or underinsured.

 

The school-based centers are staffed by culturally competent health and mental health staff who work as a team with other members of the school community to provide primary health care, behavioral health and support services for children and their families.  The clinics are staffed by community health nurses, school health room aides, part-time nurse practitioners and part-time physicians.  A full range of primary health services are provided to uninsured children and those in the Care for Kids program.  Children covered under M-CHIP or by private health insurance are eligible for sick care and treatment and are referred back to their private providers for follow up.

 

SBHCs provide immediate access to sick and well care and other services.  With no wait lists, students who are sick can be evaluated and treated by a physician or nurse practitioner in the school building, reducing the burden on emergency rooms and the parents' need to take off from work.  Based on the success of the current LTL/SBHCs, plans are in place to expand the program to open four new centers by 2011 with the first one opening in 2008.

 

As part of the Linkages to Learning program, the School Health Services Center (SHSC/LTL) works closely with the International Student Admissions Office (ISAO) of the Montgomery County Public Schools (MCPS) to provide tuberculosis screening and necessary immunizations for all newly enrolling MCPS international students and to students returning to the US after living abroad for one year or more.  The clinic is staffed with school community health nurses and school health room aides who work collaboratively with school-based nurses to monitor students’ health needs, counsel students and families and refer to appropriate agencies for follow-up.  Uninsured children are referred to MCHIP or the Care for Kids program.

 

The clinic has some staff members who are bilingual in Spanish and French; staff also has access to counselors from the English for Speakers of Other Languages (ESOL) program located in the same building.  Written information describing the vaccines that the child receives is provided to the parents in 31 languages from Arabic to Vietnamese.  SHSC received 2,740 referrals for tuberculosis screening and immunizations in FY’05.  This group of students represented 134 countries and 87 languages.  In year-to-date ‘06, 38% of new students came from Spanish-speaking countries, 19% came from Asian countries and 15% from African countries.  In addition to the new international students, the clinic also provided services to eligible MCPS students, with a total of 11,896 visits in FY’05.

 

PROGRAMS AND CLINICS THAT MEET SPECIAL NEEDS

HIV/AIDS

Through June of 2004, 2,176 people were living with HIV/AIDS in Montgomery County, of whom 47% were HIV-positive and 53% had AIDS.  AIDS is the seventh leading cause of death in the county.  In 2005, 105 clients were served in the county's clinic, of whom  38% were Sub-Saharan African, 24% Hispanic, 19% African American, 13% white, 4% Haitian and 1% each Asian and Native American.

 

The Dennis Avenue Clinic for HIV/AIDS, supported by  a combination of federal (64%) and state (36%) funds, provides a single point of entry for newly diagnosed HIV-infected people to receive a comprehensive multi-discipline assessment and a plan of care.  To receive further services clients must be county residents with income below 250% of the federal poverty level.  Those who do not qualify for public services are referred to private providers.

 

The clinic, which is open five days a week, performs testing, counseling and education of patients and provides some primary care, dental care and medications.  A staff of 35 medical and nursing personnel, social workers, mental health and oral health and administrative personnel serve at this clinic.  Several staff members are bilingual.

 

Oral Health Services

DHHS provides basic dental health services to children, pregnant women, seniors and those with HIV.  The Montgomery Volunteer Dental Clinic (MVDC), Inc. was providing dental care to an additional 1,000 low-income, uninsured adults at the Colesville Health Center.  However, due to the loss of a major funding source, MVDC will discontinue its operation on June 30, 2006.

 

A transition plan was developed to ensure a smooth “hand-off” of patients, charts, equipment and supplies from MVDC to DHHS.  By July 1, 2006, about 250 individuals will have been absorbed into the Oral Health pilot sites of Montgomery Cares.  The remaining patients will receive services from the new DHHS Oral Health Program for adults at the Colesville site.  This clinic will be open five days a week and may provide evening hours and additional support for volunteer dentists and hygienists.

 

Maternity Partnership Program

Currently Holy Cross Hospital provides prenatal care for about 1, 800 pregnant women annually under a contract with Montgomery County.  Eligibility for the program is determined on the basis of documentation of pregnancy, residency and income at the county’s Service Eligibility Unit.  The hospital has an excellent record of maternity outcomes, with percentages of low birth-weight babies below county and state averages.

 

Prenatal services may be provided at the hospital or at the county’s Piccard Drive Health Center. At the time of delivery, women and their newborns are covered under the county Project Deliver Program, in which physicians are reimbursed at a set fee of $720 per delivery and are provided medical liability insurance coverage.  They are registered as county employees while delivering a county-enrolled patient.  At the time of delivery, these women become eligible for Medicaid. The county bills Medicaid for reimbursement of the delivery fee.

 

An open solicitation was issued by the county to give other county hospitals with obstetrical services an opportunity to provide prenatal care to pregnant, uninsured women in the future - both to broaden geographical access to women and to reduce the burden on Holy Cross.  At this time, both Adventist hospitals expect to make these services available this summer or fall.

 

Latino Health Initiative

The Latino Health Initiative (LHI) was organized by the DHHS in 2000 to improve the quality of life of Latinos (the largest and fastest growing ethnic group in the county).  It attempts to implement, integrate and coordinate a culturally and linguistically competent health wellness system that supports and respects the values of Latino families and communities.  Its functions are to identify and promote reliable sources of data on Latino health; advise individuals and people in decision-making positions on policies and practices needed to reach and serve Latinos; enhance the coordination among existing programs and provide technical assistance to other programs and services targeting Latinos; develop and support culturally competent model programs and services to adequately reach Latinos; and to promote training and licensing of Latino health care professionals.

 

A pilot program for achieving licensure of foreign trained nursing professionals is a collaboration of LHI, Montgomery College, Holy Cross Hospital and the Workforce Investment Board.  All are working to overcome the barriers Latino nurses meet when trying to obtain nursing licensure in Maryland.

 

Mental Health

Although, in general, mental health services in the county have improved over the past few years, the same cannot be said for services for the language minority community.

 

For Latinos, the largest of the immigrant groups, some of the following barriers to care have been identified:  scarcity of mental health resources; lack of knowledge of available resources; shortage of bilingual/bicultural mental health providers; lack of health insurance; lack of bilingual residential treatment facilities; lack of sensitivity regarding mental health issues by emergency room staff and fragmentation of available resources.[2]  Many of these same barriers apply to other language minority groups as well.

 

Two new county initiatives offer some hope for improvement in mental health services in the future.  Beginning in 2006, Montgomery Cares will begin a pilot program offering mental health services at Proyecto Salud and Holy Cross Hospital Health Center.  The clinics will be staffed with bilingual therapists, a nurse case manager, family support workers and a part-time psychiatrist.  It is estimated that the clinics will see 300 patients a year.

 

 

 

The Mental Health Association (MHA) of Montgomery County has developed a new program that will focus on the need for improved mental health services.  The Multicultural Mental Health Initiative consists of three main components:  1) multicultural apprenticeship training, which will provide opportunities for internship experiences at MHA and other partner agencies, thus increasing the core of linguistically competent mental health professionals in the county,  2) professional training, offering continuing education to mental health professionals on multicultural and diversity issues and  3) clinical services for families unable to afford treatment.  The program will provide therapeutic services in Spanish for children and families to address family issues, acculturation and traumatic losses that may be associated with immigration.

 

THE HOSPITALS’ ROLES

Emergency rooms in Montgomery County hospitals have always been open to anyone in need of care regardless of insurance or immigration status.  In recent years, several have reached out to the county’s immigrant population.  What follows is a summary of some of the services hospitals are offering to this group:

 

Holy Cross Hospital

Cognizant of the growing number of immigrants among its patients, Holy Cross trains its intake staff to be aware of and sensitive to immigrants’ legitimate fears.  Patients are asked for their residence, country of birth, primary language and whether they will need an interpreter.  The hospital's manager of multicultural affairs helps hospital personnel work with language and cultural differences and educates them on diverse cultural expectations.  Forms for patients are printed in English, Spanish and several other languages.

 

In the 1990s, Holy Cross became the first center for obstetric care for low-income women, many of whom were immigrants from Hispanic countries.  Through its Maternity Partnership with the county, the hospital presently contributes approximately $2 million annually in unreimbursed expenses for prenatal care for 1,800 low-income women - most of whom are immigrants.  The hospital has recently opened a health center on the Takoma Park campus of Montgomery College that provides free or reduced price primary care for the uninsured.  The center will provide for about 5,000 health care visits this fiscal year.

 

Adventist Health Care

Both Shady Grove and Washington Adventist Hospitals have active programs of community outreach and provide important services to the immigrant community.  In 2005, their Early Cancer Detection program served mostly Hispanic patients - 600 to 700 were seen at Shady Grove and 700 to 800 at Washington Adventist. Shady Grove provided lab services for Mercy Clinic which amounted to $167,000 last year.

 

Within two years, Adventist Health Care expects to open a primary care clinic in Long Branch (East Silver Spring), where there is a large immigrant population.  As part of its expanded vision, it plans to create a Center on Health Disparities to address the needs of the undeserved.  A first step was the announcement of a Blue Ribbon panel made up of a diverse cross-section of experts to provide guidance in the development of the center.

 

Suburban Hospital

Suburban Hospital provides services to minorities and indigent communities in programs that are conducted without regard to immigration or insurance status.  In 2004, in partnership with the Montgomery County Cancer Crusade, Suburban conducted 38 health education screenings for colorectal cancer, reaching more than 1,600 minority individuals. They have also partnered with Proyecto Salud on a Latino Diabetes Education program for more than 1,500 enrollees.

 

Suburban has worked with Mobile Medical Care, Inc., since 1995, providing free radiology, laboratory, cardiovascular diagnostics and certain in-patient services.  In FY’05 Suburban contributed $600,000 to Mobile Med and free services to other community clinics totaling nearly $2 million.

 

 

 

 

 

 

Montgomery General

Montgomery General Hospital serves many recent uninsured immigrants in its emergency room.  No questions are asked about immigration status, and efforts are made to make patients feel welcome.  Some of the hospital’s staff are bilingual and able to translate to meet every patient’s language needs.  Lessons in basic Spanish are available to staff.

 

CONCLUSION

 

Having spent the past year reviewing a variety of health care initiatives in the county, we have identified several of the notable achievements in addressing the needs of the new arrivals.  While many of the cited programs do not exclusively serve immigrants, but are open to all uninsured residents who meet the income guidelines, they have addressed the health needs of many in the immigrant communities.  The establishment of Montgomery Cares to provide primary and preventive care for the working poor and the uninsured was based on the principle that early diagnosis and treatment can prevent long-term, chronic conditions at a reduced cost to the patient and the community.

 

While great strides have been made, there continue to be barriers that challenge providers and planners as they attempt to meet the needs of this rapidly growing community.  The following approaches are recommended:

• Increase awareness of available programs
• Recruit more culturally and linguistically competent providers
• Engage in active outreach to the ethnic communities
• Increase the number of mental health providers
• Improve data collection
• Standardize eligibility and fee schedules
• Develop outcome measures

 

It is important to point out the major contributions of volunteers who, in some of the clinic settings, provide the backbone of health care delivery.  Anyone familiar with the health care system in hospitals and nursing homes today is very aware of the large proportion of staff, both professional and non-professional, who come from the ranks of the ethnic minorities.  A recent article in the Washington Post pointed out the importance of the current wave of immigrants, many in their prime working years, who serve as caregivers for our increasingly aging population.  In nursing homes today they are our front-line providers of care.[3]

 

Montgomery County has offered vigorous leadership in addressing the needs of the underserved, including many immigrants, through its focus on correcting health care disparities and providing services for the uninsured.  The County Executive, County Council and leaders in the DHHS have supported the public/private partnerships that offer care to members of the immigrant community.

 

As we complete this Fact Sheet, our country is experiencing deep and troubling divides regarding immigration policy.  We hope that the gains made in Montgomery County, particularly in relation to health care, will not be eroded in this acrimonious climate.

 

 

 

 

We would like to acknowledge the many administrators, directors and providers from DHHS, School Health Services, PCC, LHI, the safety net clinics and the hospitals who assisted us in developing this Fact Sheet.

 

Members of the Health Committee who participated in this study are:  Myrna Bernstein, Pat Dougherty, Eva Feder, Dorothy Millon, Laura Ryan, Ruth Shvedoff and Mary Jane Zusy.