Every day, organizations worldwide are engaged in a collective two steps forward, one step back march toward improved immigration services and policies. What hard-earned lessons are these nonprofits, and the foundations that support them, learning from their persistent efforts? This collection of evaluations, case studies, and lessons learned exposes and explores the nuances of effective collaboration, the value of coordinated messaging, the bedrock of ongoing advocacy efforts, and the vital importance of long-term and flexible funding.

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Asian Immigrant Experiences with Racism, Immigration-Related Fears, and the COVID-19 Pandemic

June 18, 2021

Asian immigrants have faced multiple challenges in the past year. There has been a rise in anti-Asian hate crimes, driven, in part, by inflammatory rhetoric related to the coronavirus pandemic, which has spurred the federal government to make a recent statement condemning and denouncing acts of racism, xenophobia, and intolerance against Asian American communities and to enact the COVID-19 Hate Crimes Act. At the same time, immigrants living in the U.S. have experienced a range of increased health and financial risks associated with COVID-19. These risks and barriers may have been compounded by immigration policy changes made by the Trump administration that increased fears among immigrant families and made some more reluctant to access programs and services, including health coverage and health care. Although the Biden administration has since reversed many of these policies, they may continue to have lingering effects among families.Limited data are available to understand how immigrants have been affected by the pandemic, and there are particularly little data available to understand the experiences of Asian immigrants even though they are one of the fastest growing immigrant groups in the U.S. and are projected to become the nation's largest immigrant group over the next 35 years. To help fill these gaps in information, this analysis provides insight into recent experiences with racism and discrimination, immigration-related fears, and impacts of the COVID-19 pandemic among Asian immigrant patients at four community health centers.The findings are based on a KFF survey with a convenience sample of 1,086 Asian American patients at four community health centers. Respondents were largely low-income and 80% were born outside the United States. The survey was conducted between February 15 and April 12, 2021. 

The Impact of COVID-19 on Noncitizens and Across the U.S. Immigration System

September 30, 2020

The COVID-19 (the novel coronavirus) pandemic, and the related federal response, disrupted virtually every aspect of the U.S. immigration system. Visa processing overseas by the Department of State, as well as the processing of some immigration benefits within the country by U.S. Citizenship and Immigration Services (USCIS), have come to a near standstill. Entry into the United States along the Mexican and Canadian borders—including by asylum seekers and unaccompanied children—has been severely restricted. Immigration enforcement actions in the interior of the country have been curtailed, although they have not stopped entirely. Tens of thousands of people remain in immigration detention despite the high risk of COVID-19 transmission in crowded jails, prisons, and detention centers that U.S. Immigration and Customs Enforcement (ICE) uses to hold noncitizens. The pandemic led to the suspension of many immigration court hearings and limited the functioning of the few courts which remain open or were reopened. Meanwhile, Congress left millions of immigrants and their families out of legislative relief, leaving many people struggling to stay afloat in a time of economic uncertainty.This report seeks to provide a comprehensive overview of the impact of COVID-19 across the immigration system in the United States. Given that the landscape of immigration policy is changing rapidly in the face of the pandemic, this report will be updated as needed.


Foreign-Trained Doctors are Critical to Serving Many U.S. Communities

January 1, 2018

Foreign-trained doctors in the United States play an indispensable role in providing health care to undeserved communities and fill health care shortages that impact millions of Americans. One-quarter of all practicing physicians in the U.S., around 247,000 doctors, are foreign-trained and therefore likely to be foreign-born. This report examines foreign-trained doctors and the socio-demographic characteristics of the Primary Care Service Areas (PCSAs) where they serve. Data was obtained from the American Medical Association (AMA), the U.S. Census, the American Community Survey and the U.S. Healthcare Resources and Services Administration (HRSA) using zip codes of practice, medical specialty and location where medical degrees were earned. The report finds that foreign-trained doctors were more likely to work in primary-care positions like family medicine, therefore caring for a large swath of the U.S. population, while US-trained doctors pursued specializations such as dermatology and orthopedics. Furthermore, between 30 to 42.5 percent of all doctors in areas that are low income, less educated and have more ethnic minorities were foreign-trained. The projected shortfall of doctors by 2025 (estimated at 46,100 to 90,400 positions) will increase demand for foreign-trained doctors. However, immigration policies related to residency and visa requirements limit the ability of doctors to immigrate and practice medicine in the U.S. The authors urge policymakers to consider the important role foreign-trained doctors play in providing health care to underprivileged communities and to adjust immigration policy accordingly.

Immigrant Health-Care Workers in the United States

June 28, 2017

Despite making up only 13 percent of the total U.S. population, immigrants represent a vital portion of the growing health-care industry comprising 17 percent, or 2.1 million, of the 12.4 million medical professionals in the United States. This report uses data from the U.S. Census Bureau's 2015 American Community Survey and the Bureau of Labor Statistics to provide a demographic and socioeconomic overview of immigrants working in health-care occupations with particular attention to their proficiency in English, educational background, nationality, gender, and access to health insurance. The paper finds that three-quarters of immigrants in the field display a high level of English proficiency. Moreover, foreign-born medical professionals are more likely to possess a bachelor's degree compared to the U.S.-born in the same field. There are also a disproportionately high number of foreign-born medical professionals in both high- and low-skilled positions: 28 percent of physicians and surgeons and 24 percent of nurses and home health aides are foreign-born. The report suggests that there is a growing need for foreign-born professionals in the health-care workforce, which is projected to add 2.3 million jobs between 2014 and 2024. However, numerous obstacles exist for foreign-born doctors and others to obtain permanent resident status, as the U.S. immigration system does not prioritize the admission of immigrant health-care professionals. 

Pre-Migration Trauma Exposure and Mental Health Functioning among Central American Migrants Arriving at the US Border

January 10, 2017

In recent years, increasing numbers of families and individuals have arrived at the U.S. border from Central America, in particular, from Honduras, El Salvador, and Guatemala. This study sought to examine pre-migration trauma exposure and current mental health functioning of migrant families arriving at the U.S. border from the Northern Triangle region, with specific attention to the reasons offered for leaving their home country and the frequency with which migrant families appear to satisfy legal criteria for asylum We interviewed 234 adults in McAllen, Texas, using a structured interview and standardized questionnaires to assess exposure to trauma prior to migration, reasons for leaving their home country and symptoms of posttraumatic stress and depression. We found that 191 participants (83%) cited violence as a reason for fleeing their country, 119 individuals (69%) did not report the events to the police out of fear of gang-related retaliation or police corruption, and 90% (n = 204) reported being afraid to return to their native country. Based on self-report symptom checklists, 32% of the sample met diagnostic criteria for PTSD (n = 51), 24% for depression (n = 36), and 17% for both disorders (n = 25). Examining these data against the criteria for asylum in the U.S., we found that 70% of the overall sample (n = 159) met criteria for asylum, including 80% of those from El Salvador, 74% from Honduras, and 41% from Guatemala. These findings suggest that the majority of Central American migrants arriving at the U.S. border have significant mental health symptoms in response to violence and persecution, and warrant careful consideration for asylum status.

Creating conditions to support healthy people: State policies that affect the health of undocumented immigrants and their families

April 1, 2015

This report focuses on policies that affect the social determinants of health—the circumstances into which people are born, grow up, live, work, and age—and that impact immigrants' ability to live healthy lives. It reviews laws and regulations created through ballot initiatives, legislation, or administrative decisions that determine the benefits, rights, or resources for undocumented immigrants. The aims of this report are to identify a range of inclusive and exclusive state policies that directly or indirectly impact the health of undocumented immigrants; create a framework for assessing the level of inclusion of state policies; and identify policies that can be changed to improve the ability of undocumented workers and their families to have healthy lives.