Challenges to Addressing Mental Health Repercussions of Large-Scale Immigration Worksite Raids in the Rural United States.

Immigration worksite raids-in which dozens to hundreds of individuals are detained-often target food processing plants or other warehouse-based operations, primary sources of employment for immigrants in rural communities. Drawing on interviews with 77 adults who provided support following six worksite raids, we describe three challenges to identifying resultant mental health impacts: 1) amid poverty and family disappearance, mental health is not the priority; 2) untrained practitioners misidentify signs of declining mental health; and 3) mental health care is linguistically limited, expensive, and inaccessible to working families. We end by discussing how practitioners and advocates can address these challenges.

Immigration and Immigrant Policies, Health, and Health Equity in the United States.

Policy Points There is growing attention to the role of immigration and immigrant policies in shaping the health and well-being of immigrants of color. The early 21st century in the United States has seen several important achievements in inclusionary policies, practices, and ideologies toward immigrants, largely at subnational levels (e.g., states, counties, cities/towns). National policies or practices that are inclusionary toward immigrants are often at the discretion of the political parties in power. Early in the 21st century, the United States has implemented several exclusionary immigration and immigrant policies, contributing to record deportations and detentions and worsening inequities in the social drivers of health.

Police Violence: Reducing the Harms of Policing Through Public Health-Informed Alternative Response Programs.

Police violence is a public health issue in need of public health solutions. Reducing police contact through public health-informed alternative response programs separate from law enforcement agencies is one strategy to reduce police perpetration of physical, emotional, and sexual violence. Such programs may improve health outcomes, especially for communities that are disproportionately harmed by the police, such as Black, Latino/a, Native American, and transgender communities; nonbinary residents; people who are drug users, sex workers, or houseless; and people who experience mental health challenges. The use of alternative response teams is increasing across the United States. This article provides a public health rationale and framework for developing and implementing alternative response programs informed by public health principles of care, equity, and prevention. We conclude with recommendations for public health researchers and practitioners to guide inquiries into policing as a public health problem and expand the use of public health-informed alternative response programs. (Am J Public Health. 2023;113(S1):S37-S42. https://doi.org/10.2105/AJPH.2022.307107).

The mixed-status community as analytic framework to understand the impacts of immigration enforcement on health.

Social scientists are increasingly interested in the detrimental health impacts of immigration enforcement, including surveillance, arrest, detention, and deportation. In most empirical research-as well as the legal process itself-the family or household serves as the social unit for understanding ripple effects of immigration enforcement beyond the individual. While the mixed-status family analytic framework foregrounds the experiences of millions of individuals and valuably extended immigration scholarship to move beyond its heavy focus on individual behavioral choices, we argue that a continued reliance on the family as an analytic framework reproduces normative conceptualizations of kinship and care, obscures how the process of illegality is mediated by empire, racism, and (hetero)sexism, and risks reproducing narratives about the "deserving" immigrant. We propose the mixed-status community as an analytic framework to better understand the detrimental health impacts of immigration enforcement by accounting for the synergistic influence of 1) a fuller range of social and intimate relationships; 2) spatial arrangements of risk; 3) presumptions of immigration status; and 4) racialization of immigration law and enforcement practices. We draw on a case study of an immigration raid as well as contemporary examples to illustrate the added value of this analytic framework.

Large-Scale Immigration Worksite Raids and Mixed-Status Families: Separation, Financial Crisis, and Family Role Rearrangement.

Mixed-status families-whose members have multiple immigration statuses-are common in US immigrant communities. Large-scale worksite raids, an immigration enforcement tactic used throughout US history, returned during the Trump administration. Yet, little research characterizes the impacts of these raids, especially as related to mixed-status families. The current study (1) describes a working definition of a large-scale worksite raid and (2) considers impacts of these raids on mixed-status families. We conducted semistructured interviews in Spanish and English at 6 communities that experienced the largest worksite raids in 2018. Participants were 77 adults who provided material, emotional, or professional support following raids. Qualitative analysis methods were used to develop a codebook and code all interviews. The unpredictability of worksite raids resulted in chaos and confusion, often stemming from potential family separation. Financial crises followed because of the removal of primary financial providers. In response, families rearranged roles to generate income. Large-scale worksite raids result in similar harms to mixed-status families as other enforcement tactics but on a much larger scale. They also uniquely drain community resources, with long-term impacts. Advocacy and policy efforts are needed to mitigate damage and end this practice.

Trauma and Police Violence: Issues and Implications for Mental Health Professionals.

In this piece, the authors present the case of a young Black American man who experienced symptoms of post-traumatic stress disorder after an episode of police violence. Through engagement with this case, the authors consider whether trauma-focused psychotherapies, particularly trauma-focused cognitive behavioral therapies (TF-CBT), are equipped to attend to contextual factors relevant to traumatic experiences of police violence. The authors suggest further research to determine for whom and in what contexts standard forms of psychotherapy as well as alternatives to TF-CBT are effective, and augmenting provider education to include advocacy strategies aimed at reducing police violence-advocacy that is relevant in the context of nationwide protests occurring after the officer-perpetrated killings of George Floyd, Breonna Taylor, and others.

Immigration law enforcement, social support, and health for Latino immigrant families in Southeastern Michigan.

RATIONALE: Social support is a key determinant of physical and mental health outcomes. Implementation of restrictive immigration policies in the U.S. under the Trump administration impacted the way mixed-status Latino families (i.e., those with varying legal statuses, including undocumented) maintained social relationships and provided social support. OBJECTIVE: This paper examines how federal immigration policies introduced after the 2016 U.S. presidential election impacted social networks and support related to health for undocumented and mixed-status Latino families. METHODS: We interviewed 23 clients and 28 service providers at two Federally Qualified Health Centers and one non-profit organization in Southeast Michigan. The interviews were audio-recorded, transcribed, and analyzed thematically. RESULTS: Policies introduced during the Trump administration increased opportunities for deportation and contributed to the isolation of mixed-status Latino families by transforming safe spaces of social interaction into prime locations for immigration enforcement activity. Despite the limitations created by these restrictive policies, mixed-status families employed alternative mechanisms to maintain access to vital informal and formal support systems while simultaneously navigating emerging immigration-related threats. CONCLUSIONS: Elections have health consequences and immigration policies are needed that promote the health and well-being of Latino immigrant communities.

Policing Is a Public Health Issue: The Important Role of Health Educators.

For decades, marginalized communities have been naming the harms of policing-and the systemic racism that undergirds it-for health and well-being. Only recently have policing practices and racism within policing gained more widespread attention in public health. Building on social justice and emancipatory traditions in health education, we argue that health educators are uniquely prepared to use the evidence base to reframe narratives that drive aggressive policing and their disproportionate impacts on communities of color, promote disinvestment in militarized policing, and build relationships with community-based organizations and community organizers developing community-centered approaches to safety. Using public health institutions and institutions of higher education as examples, we suggest specific strategic actions that health educators can take to address policing as a public health issue. Health educators are uniquely poised to work with diverse community and institutional partners to support social movements that create community-centered, equitable approaches to public safety and health.

Preventing the Spread of COVID-19 in Immigration Detention Centers Requires the Release of Detainees.

Immigration detention centers are densely populated facilities in which restrictive conditions limit detainees' abilities to engage in social distancing or hygiene practices designed to prevent the spread of COVID-19. With tens of thousands of adults and children in more than 200 immigration detention centers across the United States, immigration detention centers are likely to experience COVID-19 outbreaks and add substantially to the population of those infected.Despite compelling evidence indicating a heightened risk of infection among detainees, state and federal governments have done little to protect the health of detained im-migrants. An evidence-based public health framework must guide the COVID-19 response in immigration detention centers.We draw on the hierarchy of controls framework to demonstrate how immigration detention centers are failing to implement even the least effective control strategies. Drawing on this framework and recent legal and medical advocacy efforts, we argue that safely releasing detainees from immigration detention centers into their communities is the most effective way to prevent COVID-19 outbreaks in immigration detention settings. Failure to do so will result in infection and death among those detained and deepen existing health and social inequities.

Work in Progress: Immigrant Health Care from the Vantage of Cancer Testing and Screening.

This letter offers a perspective from cancer testing and screening on the improvements in immigrant insurance coverage and care charted in Bustamante et al.'s April 2019 article in JOIH on "Health Care Access and Utilization Among U.S. Immigrants Before and After the Affordable Care Act." Supportive evidence for their data may be found in complementary literature drawing from both the National Health Interview Survey the authors use and the Medical Expenditure Panel Survey, while post-ACA surveys and state level information suggest disparities remain for lawfully present and undocumented immigrants ineligible for Medicaid and unable to secure insurance to pay medical costs. Existent options for cancer services are discussed. Further relevant reform depends on voter awareness and collaborative efforts between consumer advocates and legislators.

Application of the Minority Stress Theory: Understanding the Mental Health of Undocumented Latinx Immigrants.

This paper applies the Minority Stress framework to data collected from an ongoing community-based participatory research project with health and social service agencies in Southeast Michigan. We examine the stressors and coping strategies employed by undocumented Latinx immigrants and their families to manage immigration-related stress. We conducted in-depth interviews with 23 immigrant clients at Federally Qualified Health Care Centers (FQHC) in Southeast Michigan and 28 in-depth interviews with staff at two FQHC's and a non-profit agency serving immigrants. Findings suggest that immigrants face heightened anxiety and adverse mental health outcomes because of unique minority identity-related stressors created by a growing anti-immigrant social environment. Chronic stress experienced stems from restrictive immigration policies, anti-immigrant rhetoric in the media and by political leaders, fear of deportation, discriminatory events, concealment, and internalized anti-immigrant sentiment. Though identity can be an important effect modifier in the stress process, social isolation in the immigrant community has heightened the impact of stress and impeded coping strategies. These stressors have resulted in distrust in community resources, uncertainty about future health benefits, delayed medical care, and adverse mental health outcomes. Findings provide a framework for understanding the unique stressors experienced by immigrants and strategies for interventions by social service agencies.

Barriers & facilitators to healthcare and social services among undocumented Latino(a)/Latinx immigrant clients: Perspectives from frontline service providers in Southeast Michigan.

Immigration- and enforcement-related policies and laws have significantly and negatively impacted the health and well-being of undocumented immigrants. We examine barriers and facilitators to healthcare and social services among undocumented Latino(a)/Latinx immigrants specifically in the post 2016 US presidential election socio-political climate. By grounding our study on the perspectives of frontline providers, we explore their challenges in meeting the needs of their undocumented clients. These include client access to healthcare and social services, the barriers providers face in providing timely and effective services, and avenues to reduce or overcome factors that impede service provision to improve quality of care for this population. Data are from 28 in-depth interviews with frontline healthcare and social service providers. Based on data analysis, we found that the domains of the Three Delays Model used in obstetric care provided a good framework for organizing and framing the responses. Our findings suggest that these undocumented clients encounter three phases of delay: delay in the decision to seek care, delay in identifying and traveling to healthcare facilities, and delay in receiving adequate and appropriate care at healthcare facilities. Given the current socio-political climate for immigrants, healthcare and social services organizations that serve undocumented clients should adapt existing services or introduce new services, including those that are not site-based.

The Washtenaw ID Project: A Government-Issued ID Coalition Working Toward Social, Economic, and Racial Justice and Health Equity.

Introduction. The policing of identities through policies that restrict access to IDs issued by U.S. governmental entities disparately affects communities of color; communities who identify as low-income, immigrant, older, and/or transgender; and community members who experience chronic mental illness, housing instability, or incarceration. Yet government-issued IDs are increasingly needed to access health-promoting resources such as housing, banking, social services, and health care, and in interactions with law enforcement. Methods. Since 2012, the Washtenaw ID Project's coalition-building process has involved communities affected by restrictive ID policies, advocates, and institutional stakeholders to enact community and systems change regarding inequities in government-issued IDs. We discuss the coalition-building process that culminated in the implementation of a photo ID issued by Washtenaw County government as a policy change strategy. We also highlight the community-academic research partnership evaluating the effectiveness of the Washtenaw ID in order to ensure equity in Washtenaw ID access and acceptance. Results. In 2015, 77% of Washtenaw ID holders reported having no other locally accepted ID. At follow-up, Washtenaw ID holders reported favorable Washtenaw ID acceptance rates in several domains (e.g., health care, school), but not when accessing banking services and housing. Additionally, community discussions suggested racial inequities in carding and ID acceptance. We discuss next steps for policy improvement to ensure equitable impact of the ID. Conclusions. Without national policy reform instating access to government-issued IDs for all, the social movement to establish local IDs may improve access to health-related resources contingent on having an ID. Careful attention must be paid to community organizing processes, policy implementation, and evaluation to ensure equity.

A qualitative study on the impact of the 2016 US election on the health of immigrant families in Southeast Michigan.

BACKGROUND: Given the anti-immigrant rhetoric and policy proposals by President Donald Trump during the 2016 presidential campaign and afterwards, his election to president in November 2016 and subsequent policy changes has affected immigrant families. In this study, we aim to better understand how post-election policy change may have impacted the health and well-being, including health and social service utilization, of Latino immigrants in Southeastern Michigan. METHODS: We conducted 28 in-depth interviews with frontline staff at two Federally Qualified Health Centers and a non-profit agency. These staff had intimate knowledge of and insights into the lived experiences of the mixed-status immigrant families they serve. The interviews were audio recorded, transcribed, and analyzed thematically. RESULTS: Our findings show three major themes: (1) An increased and pervasive fear of deportation and family separation among mixed-status immigrant clients, (2) The fear of deportation and family separation has resulted in fractures in community cohesion, and (3) Fear of deportation and family separation has had an impact on the healthcare utilization and health-related behaviors of mixed-status families. Staff members report that these three factors have had an impact on physical and mental health of these immigrant clients. CONCLUSIONS: These results add to previous literature on the effect of immigration policies on the health and provide key insights for interventions to improve the health of immigrants within this socio-political environment.

'I'm going to look for you and take your kids': Reproductive justice in the context of immigration enforcement.

Prior research has shown that immigration law enforcement contributes to poor health outcomes-including reproductive health outcomes-among Latinos. Yet no prior research has examined how immigration enforcement might inhibit reproductive justice and limit individual's reproductive autonomy. We utilized data from an existing study that consisted of a partnership with a Latino community in Michigan in which an immigration raid resulted in multiple arrests and deportations midway through data collection. Using cross-sectional survey data (n = 192) where no one was re-interviewed, we used ordinal logistic regression to compare desired pregnancy timing of individuals surveyed prior to and after the raid to determine the impact of an immigration raid on desired timing of next pregnancy. We then used qualitative data-including 21 in-depth interviews and participant observation-collected in the community after the raid to contextualize our findings. Controlling for socio-demographic characteristics, we found that Latinos surveyed in the aftermath of the raid were more likely to report a greater desire to delay childbearing than Latinos surveyed before the raid occurred. Our qualitative data showed that an immigration raid has financial and psychological effects on immigrant families and that a raid may impact reproductive autonomy because people are fearful of these impacts. These finding suggest that current immigration enforcement efforts may influence reproductive decision-making, impede Latinos reproductive autonomy, and that family-friendly immigration policy reform is needed.

It Works, But For Whom? Examining Racial Bias in Carding Experiences and Acceptance of a County Identification Card.

Purpose: Policies that restrict access to U.S. government-issued photo identification (ID) cards adversely affect multiple marginalized communities. This context impedes access to health-promoting resources that increasingly require government-issued IDs and exacerbates health inequities. In 2015, Washtenaw County, Michigan, implemented the Washtenaw ID to improve access to resources contingent upon having an ID. We employed an audit study to examine whether Washtenaw ID users experienced racially biased treatment in carding experiences and acceptance of the Washtenaw ID. Methods: Seven 25- to 32-year-old mystery shoppers (two Latina, three black, and two white women) attempted to purchase a standardized basket of goods, including an age-restricted item in Washtenaw County stores (n=130 shopping experiences). We examined whether experiences of being asked for ID and acceptance of the Washtenaw ID varied by race/ethnicity. Results: Each shopper visited 9-22 stores. Shoppers were asked for ID in 63.1% of shopping experiences. Of these, the Washtenaw ID was accepted 91.5% of the time. Among those who were asked for ID, a higher percentage of Latina (16.0%) shoppers had their Washtenaw IDs rejected than black (6.3%) and white (4.0%) shoppers, although differences were not statistically significant (p=0.27). Latina shoppers had 2.9 times the odds of receiving a comment about their Washtenaw ID relative to white shoppers (OR=2.92, p=0.08), comments that were nonpositive. Conclusion: Local IDs may improve access to resources contingent upon having an ID. However, racialization processes, including anti-immigrant sentiments, may inhibit the mitigating goal of local IDs. Continued attention to the health equity impacts of equity-driven interventions is warranted.

Health Implications of an Immigration Raid: Findings from a Latino Community in the Midwestern United States.

Immigration raids exemplify the reach of immigration law enforcement into the lives of Latino community members, yet little research characterizes the health effects of these raids. We examined the health implications of an immigration raid that resulted in multiple arrests and deportations and occurred midway through a community survey of a Latino population. We used linear regression following principal axis factoring to examine the influence of raid timing on immigration enforcement stress and self-rated health. We controlled for age, sex, relationship status, years in the county in which the raid occurred, children in the home, and nativity. 325 participants completed the survey before the raid and 151 after. Completing the survey after the raid was associated with higher levels of immigration enforcement stress and lower self-rated health scores. Findings indicate the negative impact of immigration raids on Latino communities. Immigration discussions should include holistic assessments of health.