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.

Embedding Chaplaincy Services in Primary Care for Immigrants, Refugees and Asylum Seekers: A Boston Pilot Intervention.

This Boston-based pilot research was an exploratory study that integrated outpatient chaplaincy into a refugee and immigrant health primary care clinic. Patients were screened for spiritual distress and offered a meeting with chaplaincy interns. Forty-eight patients were seen in clinic, 28 were screened, and 9 met with a chaplain. Most frequent domains of spiritual distress were grief (n = 8), feelings of abandonment (n = 5), guilt (n = 4), betrayal (n = 4), fear of death (n = 3), shame (n = 3), and trust (n = 3). Faith was relevant to treatment decision-making for 6 patients. It was found that outpatient chaplaincy services are a feasible intervention to address spiritual distress in immigrant and refugee patients.

Long-Term Trends in Psychiatric Emergency Services Delivered by the Boston Emergency Services Team.

Rising psychiatric emergency department (ED) presentations pose significant financial and administrative burdens to hospitals. Alternative psychiatric emergency services programs have the potential to alleviate this strain by diverting non-emergent mental health issues from EDs. This study explores one such program, the Boston Emergency Services Team (BEST), a multi-channel psychiatric emergency services provider intended for the publicly insured and uninsured population. BEST provides evaluation and treatment for psychiatric crises through specialized psychiatric EDs, a 24/7 hotline, psychiatric urgent care centers, and mobile crisis units. This retrospective review examines the sociodemographic and clinical characteristics of 225,198 BEST encounters (2005-2016). Of note, the proportion of encounters taking place in ED settings decreased significantly from 70 to 58% across the study period. Findings suggest that multi-focal, psychiatric emergency programs like BEST have the potential to reduce the burden of emergency mental health presentations and improve patient diversion to appropriate psychiatric care.