Guiding Principles for Writing About Immigrants and Immigrant Health.

This perspective identifies harmful phrasing and frames in current clinician and researcher work relating to immigrant health and provides equity-centered alternatives. Recommendations are organized within two broad categories, one focused on shifting terminology toward more humanizing language and the second focused on changing frames around immigration discourse. With regards to shifting terminology, this includes: 1) avoiding language that conflates immigrants with criminality (i.e., "illegal"); 2) using person-first language (i.e., "person applying for asylum" or "detained person" rather than "asylum-seeker" or "detainee"); 3) avoiding comparisons to "native" populations to mean non-foreign-born populations, as this contributes to the erasure of Native Americans and indigenous people; 4) avoiding hyperbolic and stigmatizing "crisis" language about immigrants; and 5) understanding inherent limitations of terms like "refugee," "asylum seeker," "undocumented" that are legal not clinical terms. With regards to challenging dominant frames, recommendations include: 6) avoiding problematization of certain borders compared to others (i.e., U.S.-Mexico versus U.S.- Canada border) that contributes to selectively subjecting people to heightened surveillance; 7) recognizing the heterogeneity among immigrants, such as varying reasons for migration along a continuum of agency, ranging from voluntary to involuntary; 8) avoiding setting up a refugee vs. migrant dichotomy, such that only the former is worthy of sympathy; and 9) representing mistrust among immigrants as justified, instead shifting focus to clinicians, researchers, and healthcare systems who must build or rebuild trustworthiness. Ensuring inclusive and humanizing language use and frames is one critical dimension of striving for immigrant health equity.

Immigration-related Legal Collaboration in Primary Care: Evaluating Impact on Knowledge and Well-being.

OBJECTIVES: To evaluate the impact of embedding an immigration attorney in a primary care clinic to address immigration-related legal needs. METHODS: We conducted a mixed-methods study of 42 legal clinic participants from May 2019-February 2020. Measures included psychological distress, understanding of legal options, and self-rated general health collected prior to, following, and 60-90 days after consultation. RESULTS: There was significant improvement in participants' understanding of their legal immigration options pre- (4.9, SD 2.9) and post-consult (8.6, SD 2.1), and 60 days later (7.0, SD 2.8) (F=11.0, p<.05), but self-rated health scores and distress did not significantly improve, although there was a high loss-to-follow up rate at 60 days (42.8%). Qualitative results underscored the interconnectedness of immigration status and health. DISCUSSION: Embedding immigration legal services in primary care improved patients' understanding of immigration-related legal options, although successfully mitigating the health impacts of vulnerable immigration status may take broader societal interventions.

Consideration of racism experiences in the implementation of trauma-focused therapy in primary care.

OBJECTIVE: To understand providers' perceptions of how a patient's experience of racism may impact the successful implementation of a brief posttraumatic stress disorder (PTSD) treatment in the safety net integrated primary care setting. To conduct a developmental formative evaluation prior to a hybrid type I effectiveness-implementation trial. DATA SOURCES AND STUDY SETTING: From October 2020 to January 2021, in-depth qualitative interviews were conducted with integrated primary care stakeholders (N = 27) at the largest safety net hospital in New England, where 82% of patients identify as racial or ethnic minorities. STUDY DESIGN: Interviews with clinical stakeholders were used to (a) contextualize current patient and provider experiences and responses to racism, (b) consider how racism may impact PTSD treatment implementation, (c) gather recommendations for potential augmentation to the proposed PTSD treatment (e.g., culturally responsive delivery, cultural adaptation), and (d) gather recommendations for how to shift the integrated primary care practice to an antiracist framework. DATA COLLECTION/EXTRACTION METHODS: Interview data were gathered using remote data collection methods (video conferencing). Participants were hospital employees, including psychologists, social workers, primary care physicians, community health workers, administrators, and operations managers. We used conventional content analysis. PRINCIPAL FINDINGS: Clinical stakeholders acknowledged the impact of racism, including racial stress and trauma, on patient engagement and noted the potential need to adapt PTSD treatments to enhance engagement. Clinical stakeholders also characterized the harms of racism on patients and providers and provided recommendations such as changes to staff training and hiring practices, examination of racist policies, and increases in support for providers of color. CONCLUSIONS: This study contextualizes providers' perceptions of racism in the integrated primary care practice and provides some suggestions for shifting to an antiracist framework. Our findings also highlight how racism in health care may be a PTSD treatment implementation barrier.

Is it best to add native shrubs to a coastal sage scrub restoration project as seeds or as seedlings?

Ecological restoration frequently involves the addition of native plants, but the effectiveness (in terms of plant growth, plant survival, and cost) of using seeds versus container plants has not been studied in many plant communities. It is also not known if plant success would vary by species or based on functional traits. To answer these questions, we added several shrub species to a coastal sage scrub restoration site as seeds or as seedlings in a randomized block design. We measured percent cover, density, species richness, size, survival, and costs. Over the two years of the study, shrubs added to the site as seeds grew more and continued to have greater density than plants added from containers. Seeded plots also had greater native species richness than planted plots. However, shrubs from containers had higher survival rates, and percent cover was comparable between the planted and seeded treatments. Responses varied by species depending on functional traits, with deep-rooted evergreen species establishing better from container plants. Our cost analysis showed that it is more expensive to use container plants than seed, with most of the costs attributed to labor and supplies needed to grow plants. Our measurements of shrub density, survival, species richness, and growth in two years in our experimental plots lead us to conclude that coastal sage scrub restoration with seeds is optimal for increasing density and species richness with limited funds, yet the addition of some species from container plants may be necessary if key species are desired as part of the project objectives.

A Logic Model Framework for Planning an International Refugee Health Research, Evaluation, and Ethics Committee.

Collaborative approaches to supporting the health of refugees and other newcomer populations in their resettlement country are needed to address the complex medical and social challenges they may experience after arrival. Refugee health professionals within the Society of Refugee Healthcare Providers (SRHP)-the largest medical society dedicated to refugee health in North America-have expressed interest in greater research collaborations across SRHP membership and a need for guidance in conducting ethical research on refugee health. This article describes a logic model framework for planning the SRHP Research, Evaluation, and Ethics Committee. A logic model was developed to outline the priorities, inputs, outputs, outcomes, assumptions, external factors, and evaluation plan for the committee. The short-term outcomes include (1) establish professional standards in refugee health research, (2) support evaluation of existing refugee health structures and programs, and (3) establish and disseminate an ethical framework for refugee health research. The SRHP Research, Evaluation, and Ethics Committee found the logic model to be an effective planning tool. The model presented here could support the planning of other research committees aimed at helping to achieve health equity for resettled refugee populations.