Issue 1 | Fall 2009

Maternity Care Coalition (MCC), a community-based organization serving pregnant and newly parenting families, has been on the front lines of identifying and meeting community needs since 1980. From the emergence of HIV/AIDS and the crack epidemic in the 80s to more current challenges such as the rise in opioid use and changing patterns of immigration, MCC has been on the ground helping our community understand the impact of these issues on families with young children. As “first responders,” MCC has had to work quickly to meet families’ critical needs, often before adequate resources or infrastructure is available. Addressing the needs of our region’s growing immigrant population is a particular case in point. Through its organizational commitment to serving the most vulnerable, the resourcefulness of staff, collaboration with partner agencies and a strengths-based approach to service, MCC has become a trusted resource for immigrant women and their families in the Philadelphia region. 

Last summer, a woman was killed in a hit-and-run accident while standing on the sidewalk in South Philadelphia with her husband and two-year-old child. She was an Indonesian immigrant and a MCC client. Tragedies of this magnitude in the MCC community are fortunately rare; nevertheless, MCC was poised to respond to the immediate crisis and help the family develop both an immediate and long-term plan.

The woman was a client at MCC’s South Philadelphia Early Head Start (EHS) center. Upon hearing about the tragedy, the staff sprang into action. They began by using emergency funds to purchase and deliver groceries, diapers, and supplies for the family. The child’s father worked long hours for minimal pay and couldn’t afford reliable and consistent childcare. To accommodate the family’s new circumstances, the two-year-old child was transitioned from the home-based EHS program -- in which families receive services in their home on a weekly basis -- into the center-based program, which includes childcare. MCC staff supported the father as he began the difficult process of taking on his wife’s responsibilities, which included managing the household and the family’s finances. The Dad faced significant challenges during this process as he spoke limited English, was not accustomed to being the primary caregiver for his two children, and was working through the grief of losing his wife. MCC provided holistic support for the family during this difficult time including helping the father recover the PIN number for their SNAP card and shifting their benefits from the mother’s name to the father’s -- a transition that was additionally complicated by the family’s mixed immigration status. MCC’s Clinical Director worked to connect the family to mental health services in their own language, and helped EHS staff identify age-appropriate coping strategies for the two-year-old.

MCC’s response to this tragedy illustrates how and why the organization has become a trusted and vital resource for immigrants in the Philadelphia region. Across four counties, MCC provides services to extremely diverse immigrant communities. While, MCC does not track clients’ immigration status, in 2016, 25 percent of MCC clients who reported their country of origin were foreign-born. With high concentrations of clients from Central America, the Caribbean, Southeast Asia, and North and West Africa, MCC clients speak more than 40 languages. As MCC expands its footprint in Bucks County through its recent merger with Child, Home and Community, this list will continue to grow.

The capacity to serve such a wide range of immigrant communities is deeply rooted in MCC’s service model and organizational approach. MCC’s service model begins with the needs of the mother and her family and is rooted in a strengths-based approach. This model, combined with targeted and strategic staff recruitment, a refined and intensive workforce development program, and a demonstrated organizational commitment to innovation, is at the core of MCC’s success.

MCC was founded 37 years ago, with the mission to improve maternal and child health and wellbeing through the collaborative efforts of individuals, families, providers, and communities. MCC recognizes that everyone, regardless of their circumstances, brings their own strengths, which can be built upon. Similarly, MCC has developed a set of core values that guide its work across the organization. These core values include empowerment, integrity, inclusion, achievement, and innovation. MCC has institutionalized its mission, vision, core values, and approach and they inform all aspects of MCC’s work including the recruitment, training, and performance evaluation of all staff. Collectively these pieces make up the MCC model: a strengths-based approach that centralizes the need of the mother (and her family) and is ultimately predicated on the quality of the relationship between the mother and her Advocate (case manager/community health worker).

The efficacy of MCC’s model is based largely on the capacity of its Advocates to build strong relationships with their clients and is the primary reason MCC has become a trusted resource in immigrant communities. The strength and quality of the client-advocate relationship is particularly crucial in this context because many new immigrants face extraordinary challenges in accessing benefits and services due to language barriers, cultural and social isolation, fear, and the complexity and lack of coordination between social service systems. MCC conducts outreach though community events and by forming and maintaining relationships with entities such as hospitals, churches, and other social service organizations, but clients overwhelmingly seek MCC services as a result of receiving a referral from a friend or family member.

Week of the Young Child Celebration at Maternity Care Coalition
Photo Credit: Hannah Daly  

MCC’s approach to providing services for immigrant women is a prime example of how MCC operationalizes its commitment to providing quality services and improving client outcomes. With an organizational commitment to both inclusion and innovation, MCC is well positioned to serve both existing and emerging immigrant populations. These approaches include partnering with other community-based organizations serving immigrants, recruiting staff with relevant language skills, and establishing language access policies. 

First, when entering a new community, MCC prioritizes establishing relationships with other community-based organizations serving similar populations. In some cases, this means creating a formal partnership to establish a referral system to meet the community need. In other circumstances, it is a more informal process as MCC connects with hospitals, health clinics, and faith-based organizations to ensure pregnant and parenting women are aware of MCC’s programs and services. These partnerships and relationships are critical in immigrant communities, as many new immigrants are not yet connected to the full range of health and social services available. Next, MCC seeks to recruit advocates from the communities it serves; within established immigrant communities, this strategy can eliminate language barriers and provide a strong foundation for the client-advocate relationship. In some cases, former clients become MCC employees. 

Within emerging immigrant communities, it is not always possible to match clients with Advocates who speak their language or to find a local agency that can meet their needs. In such situations, MCC Advocates have been very resourceful in finding ways to communicate with clients, including using demonstrations to convey critical concepts and resources found through research. Although this is not a best practice and MCC continues to work towards establishing longer-term language access policies for these situations, it is a real-life example of meeting immediate needs on the front lines to ensure that vulnerable populations can access the support they need.

As a result of their efforts, MCC’s Advocates have developed an impressive reputation in the immigrant communities they serve and MCC’s outcomes among its immigrant clients are on par with overall agency outcomes. Simply put, MCC’s reputation, bolstered by a strategic commitment to establishing programs in the most underserved communities in Southeastern Pennsylvania, is MCC’s primary outreach mechanism. MCC serves as a resource and a point of connection to critical benefits and services for pregnant and newly parenting mothers. Depending on the program, a new mother may be eligible to receive services during pregnancy until her child is three years old. MCC’s Advocates connect with their clients at a particularly critical moment in their lives and build on that relationship over weeks, months, and years with an emphasis on empowering their clients and promoting self-determination.

MCC’s work in immigrant communities informs the organization’s advocacy efforts and results in impactful systems-level change. Recently MCC Advocates noted anomalies in where their immigrant clients were electing to give birth. They brought their concerns to the attention of MCC’s policy team. MCC conducted a survey of clients and discovered that some immigrant women were given misinformation about their payment options for prenatal care and labor and delivery. Feeling discriminated against and fearful, some immigrant women were not receiving consistent prenatal care and were traveling to hospitals outside their community to give birth. MCC’s Executive Director and Director of Public Policy met with the hospital’s administration and presented the findings of the survey. As a result, the hospital’s administration is exploring opportunities for collaboration with MCC in the future to improve its services for immigrants.

As MCC’s immigrant client base continues to grow, the challenges associated with providing quality services to diverse immigrant communities persist. The lack of cost-efficient interpretation services and technologies creates difficulties for clients and MCC staff. Identifying qualified staff that can serve new immigrant groups is often difficult. Utilizing telephonic or in-person interpretation services is very costly for a service model where staff meet as often as 60 to 90 minutes per week with families over a three-year period. Building support from public and private funders and finding innovative solutions to these challenges are high priorities as MCC looks to its future as an organization serving fast growing immigrant communities.

Early Head Start Socialization for children and caregivers at Maternity Care Coalition
Credit: MCC Staff

One year later and the toddler who lost his mother in the accident is preparing to transition out of MCC’s Early Head Start program and into a Head Start program. The family’s Advocate helped locate and secure a space for the child in a Head Start Center that is connected to before- and after-school care to help decrease the logistical burden on the now single father. In speaking about the experience, the child’s Advocate and teacher reflect on both the challenges and rewards of their work. Despite the challenges that include difficulties accessing quality services, the staff noted what a joy it is when former clients return to the center to share how their children have grown and flourished. The staff at MCC eagerly look forward to the day when the young toddler who lost his mother will return for a visit as a thriving and happy school-aged child.

Introduction

Southeast Asian Mutual Assistance Associations Coalition (SEAMAAC) and the African Family Health Organization (AFAHO) are two community-based organizations in Philadelphia that were formed by immigrant and refugee leaders. These organizations are based in different parts of the city and have target populations from different parts of the world; however, their approaches and foundational beliefs are similar. Both organizations’ programs are built around community needs, their multilingual staff reflect the populations that they serve, and their offices are in the heart of the immigrant and refugee neighborhoods that they work with. SEAMAAC and AFAHO see clients not as consumers, but as active partners in the goal of stronger families and stronger communities.

A tragic story highlights the gaps in services and systemic barriers that led to the founding of AFAHO. In 2002, a young, undocumented, and uninsured woman from Mali felt ill but hesitated to go to the emergency room to seek care due to her immigration status. After a few days, she started hemorrhaging but was still afraid to seek help. She died alone in her apartment in West Philadelphia. Her body was not found until neighbors started to smell a decomposing corpse and alerted the authorities. Her death seriously impacted the founder of AFAHO, Ms. Tiguida Kaba -- herself an immigrant from Senegal -- who was determined to create an organization where African and Caribbean immigrants and refugees could seek access to healthcare regardless of insurance and legal status. AFAHO works to address the needs of underserved, vulnerable, and hard-to-reach community members who experience difficulties accessing health services due to cultural, geographic, linguistic, the lack of insurance, and other barriers. AFAHO aims to mitigate their barriers to service delivery and facilitate access to preventive and primary care services in an effort to reduce health disparities and improve healthcare outcomes.

SEAMAAC was founded in 1984 by refugees from Cambodia, Laos, and Vietnam. The founding vision was to unite several of Philadelphia’s Southeast Asian organizations into a dynamic refugee-led coalition, enabling small ethnic communities to share resources and create a unified voice for the city’s Southeast Asian community. In 1998, SEAMAAC expanded its services to other immigrants and refugees as well as to native-born Philadelphians. Today, SEAMAAC’s mission is “to support and serve immigrants and refugees and other politically, socially, and economically marginalized communities, as they seek to advance the condition of their lives in the United States.”

In broad strokes, the barriers addressed by Philadelphia community-based organizations such as SEAMAAC and AFAHO are caused by social, economic, and political marginalization, defined as treatment of a group as peripheral or insignificant. Marginalization for immigrant and refugee families often results in social isolation and limited ability to access mental, physical, and social resources. Despite the timeframe of resettlement, diverse countries of origin, and cultural and linguistic differences, Asian and African immigrants and refugees face many similar challenges. Many are isolated, with little support and few resources to understand and navigate mental/physical health care and social service systems in the city. They are not easily reached through traditional outreach/education methodologies.

Lack of adequate data on immigrant and refugee communities creates an invisibility of need. For example, there are an estimated 50,000 African immigrants and refugees residing in Philadelphia, but there is a dire lack of information about the health needs and trends within this population. A key reason for this is that Census and other data embed information on African population groups (also called “foreign-born blacks”) within data on African Americans. For example, in the most recent Community Health Assessment completed by the Philadelphia Department of Public Health, there was no mention of foreign-born blacks when examining the racial and ethnic disparities that are evident across a range of health issues. This categorization is detrimental to the health and wellbeing of African immigrants and refugees as it limits the ability to fully understand their healthcare needs, practices, and the health disparities they face. Similarly, “Asians” are frequently lumped together as one monolith -- the “Model Minority.” This is a myth that fails to recognize the wide range of socioeconomic and health complexities of various Asian ethnic groups. As more Asian and African immigrants from a greater diversity of nations come to the United States and Philadelphia, public health research and interventions will need to adapt to an intentional focus on culturally-informed outreach, screening, prevention, and treatment of mental health and physical health issues.

Many Asian and African immigrants and refugees have traditionally interacted with health systems for acute care only. For these cultures, chronic disease is a relatively new concept and creates a different way of interacting with providers, especially in terms of the Western medical model. For example, although African immigrants and refugees are at a high risk for diabetes, hypertension, heart attack, and stroke, they are under a misconception that their diet is healthy and not a risk factor for these chronic diseases. In their home countries, Asian and African immigrants and refugees accessed healthcare services only as an option of last resort, relying mostly on traditional medicine and healers. Upon arrival in the U.S., Asian and African immigrants are healthier than their U.S.-born counterparts but their health deteriorates the longer they stay in the U.S. This can mostly be attributed to lifestyle changes including increased consumption of unhealthy foods (even traditional foods are now processed and packaged), a more sedentary lifestyle, and a drastic increase in stress, exacerbated by the lack of community and social networks.

Immigrants and refugees’ layers of traumatic experiences can develop into physical and mental health issues without adequate support. For example, Bhutanese refugee elders have expressed concern about learning English to pass the citizenship exam, and suicidal thoughts if they perceive that they would become a financial burden on their families. Experiences in their home countries, refugee camps, as well as family disruptions, compounded by the difficulties of straddling two cultures and the pain of being marginalized in this new land can result in high rates of depression, anxiety, and other mental health concerns (Gozdiak, 2004 and Ater, 1998). Adjustment to life in the United States is complicated by the traumas of war, forced separation from family, and the lack of opportunities to grieve for losses in the home country.

In June 2017, SEAMAAC conducted focus groups with immigrant and refugee elders on mental health and addiction that highlighted that the elders see these issues as significant concerns in their community. Contrary to frequent misconceptions, it is not that immigrant and refugee families are not interested in mental health services; it is that current mental health services are not accessible or culturally relevant. Mental health programming has not adapted to engage the communities on a cultural level, are not within the neighborhoods that immigrants and refugees reside, and are not offered in their primary languages. City offices, institutions, and service providers too often are not prepared to meaningfully extend their services to diverse immigrant and refugee populations.

Innovative Models of Service Delivery

Culturally-Specific Program Design: SEAMAAC and AFAHO’s family and community-based intervention and linkage services as well as our cultural and linguistic expertise have distinguished us as providers of unique and strategic services to Asian and African communities. The majorities of our clients have Limited English Proficiency (LEP), low-literacy rates, and are low-income, which further isolates them from mainstream information and awareness. Our activities focus on outreach, prevention, education, and bringing people into care early. SEAMAAC and AFAHO have maintained a presence in our communities through outreach, engagement, and building relationships with community establishments. As our target population relies heavily on its community leaders and representatives for information and resources, SEAMAAC and AFAHO have been able to utilize their mutually benefiting relationships with community leaders to spread awareness and leverage support for our services.

Over the years, SEAMAAC and AFAHO have developed, implemented, and managed several preventive and linkage to care health programs including diabetes and heart disease awareness and screening; nutrition and physical fitness education for children and their caregivers; maternal and child health; family planning; breast cancer awareness and linkage to screening; teen pregnancy prevention; Hepatitis B & C; and HIV/AIDS. Our activities focus on health and prevention education workshops for men, women, and youth; health literacy; ESL classes; facilitating access to regular screenings at our office and community locations; developing bi-lingual and bi-cultural educational materials; offering medical escort services to our LEP clients to aid with language and cultural interpretation; cultural competency trainings, and language translation and interpretation. Many of AFAHO and SEAMAAC staff members are immigrants and refugees and/or former clients; who can sensitively challenge some of the cultural norms that increase risk.

Peer Navigator Model: Another model of care used by AFAHO and SEAMAAC is the Peer Navigator model which includes outreach, health education and promotion, linkage to screening services, and language/cultural/system navigation support services. Peer navigators are trained to normalize highly stigmatized diseases and conditions including HIV, Hepatitis B & C, and breast cancer in order to connect their peers with screening and treatment. Utilizing street and venue-based outreach at locations including churches, mosques, women’s savings groups, ethnic women’s associations, hair braiding salons, and other community gathering places, multilingual/bicultural Peer Navigators can link medically underserved friends and neighbors with pertinent health information to dispel myths, improve awareness of health issues, mitigate barriers to care, and increase access to care. Peer Educators utilize storytelling and personal journeys during outreach and educational sessions to empower clients.

Elders Program Innovation: It is unusual for funders to offer financial support for culturally-specific needs that are invisible to those outside of the immigrant and refugee communities. Therefore, many of SEAMAAC and AFAHO’s programs began without funding, funneled via a recognition of needs within the community and goals to address these needs. For example, in 2007 SEAMAAC saw a spike in Asian refugee elders’ behavioral health issues including depression and attempted suicide. SEAMAAC responded by creating the Roots of Happiness: Elders Health & Wellness Program to reduce elders’ social isolation and support them to reclaim their lost status as respected elders. “Roots of Happiness” refers to cultural roots: language, arts, heritage, and communal meals. SEAMAAC began providing a weekly space for elders to gather and enjoy cultural heritage homemade meals. On a minimal budget and with volunteer engagement of elders themselves, the program has grown to include arts & crafts, cultural celebrations, leadership development, mental/physical health workshops, citizenship education, physical fitness, financial literacy, computer classes, case management, and intergenerational connections. Key to the success of the program is the “Elders Council” -- a group of program participants who volunteer to serve as peer leaders. They meet with program staff to debrief about program events, give suggestions about future activities, and recruit and mentor their peers. Elders Council members are essential partners in program development and evaluation. They volunteer alongside our bicultural/bilingual outreach staff to build community connections and trust -- and successfully provide education and support around culturally taboo topics such as abuse, addiction, sexual health, and mental health.

Laotian Elders enjoy breaking bread and connecting with the community at Key Elementary School in South Philadelphia on a chilly winter morning.

Utamaduni Wa Afya Program Innovation: There is a popular saying that “it takes a village to raise a child.” Likewise, AFAHO believes “it takes a village to improve one’s health.” AFAHO has begun exploring the benefits of using family members to promote healthy lifestyle changes among African immigrants and refugees dealing with chronic illness. Who could possibly have more interest in the health of a family member than another family member? This innovative model to improve health outcomes developed out of the understanding that African immigrants and refugees come from close-knit, family and community-oriented societies. Oftentimes, in African societies, family members serve as primary care providers. This was evident during the recent Ebola outbreak in West Africa where many people who lost their lives were family and/or community members caring for their loved ones. We aim to change this narrative into a positive one where family members are provided with the proper knowledge about how to assist their loved ones in making healthy lifestyle choices around nutrition and physical activity. Likewise, if an emergency happens, the family members are normally the first line of defense and should be educated on what to do to help, particularly in LEP populations. Not only does this “village” model improve the clients’ health, it improves the overall health of other family members with long term and possibly generational effects. With adequate funding and resources directed to planning and evaluation, AFAHO hopes to implement this Utamaduni Wa Afya (Culture of Health) model across all of its health programs.

Attendees at AFAHO’s Annual African Family Day
Photo Credit: Kiera Kenney

Domestic Violence Program Innovation: In 2011, SEAMAAC conducted an in-depth needs assessment of domestic violence in Philadelphia’s Asian communities. This included a literature review, examination of domestic violence projects in Asian communities around the country, and eight focus groups with members from Philadelphia’s Asian communities and domestic violence service professionals. A research intern helped SEAMAAC to develop a service model centered around bicultural/bilingual resource navigation and support. With seed money in 2013, SEAMAAC piloted the Safe Families Program in the Burmese refugee community. SEAMAAC formed a Women’s Leadership Group consisting of Burmese refugee women who speak the Burmese, Karen, and Chin dialects. Seed money supported training and hiring a bilingual/bicultural Outreach Worker to provide outreach education, safety planning, case management, and resource navigation to survivors. SEAMAAC developed collaborative partnerships with domestic violence service providers, who provide training and technical assistance, as well as intensive legal and shelter support services. The model has proven successful, and has expanded into the Bhutanese, Chinese, and Indonesian communities. Safe Families has received recognition awards for advocacy on systems change, and for supporting Asian domestic violence survivors to develop leadership, self-determination, and resilience.

In early December 2016, SEAMAAC’s Health Programs Coordinator received an urgent phone call from a colleague at the Philadelphia’s Mayor’s Office on Immigrant and Multicultural Affairs. A Chinese immigrant woman in South Philadelphia had recently been released from the emergency room after sustaining serious injuries perpetrated by her husband, and was looking for help. That afternoon, a SEAMAAC Outreach Worker met with the woman. Over two hours, she shared through tears what had transpired over the past 24 hours, and talked about her immediate needs such as childcare, safety, and not knowing how she’d afford her rent as a new single parent. The Outreach Worker spoke this woman’s language and understood her culture. She provided support for her trauma, and helped her to see her strengths and resiliency. Together, they worked on safety planning and brainstormed solutions for her urgent needs. That was the first day of what would become a long partnership between this incredible survivor and SEAMAAC. Since that day, SEAMAAC staff have supported her to navigate court hearings and police and landlord interactions. She has connected with attorneys, housing resources, SNAP benefits, and therapists. She received behavioral health support for her children and childcare. She is working toward financial stability after starting her own business. She also started volunteering as a SEAMAAC “Peer Educator” where she supports other immigrants. She dreams of the day when she will no longer be fearful due to immigration concerns and has a thriving business that will enable her to give more back to her community.

Conclusion

As community-based organizations, AFAHO and SEAMAAC are committed to immigrant and refugee health access and culturally-informed models of care. This includes advocacy to support research and disaggregation of data instead of just using the inaccurate terms “Asian” and “Black.” This also means having honest conversations with our funders and community partners. AFAHO and SEAMAAC also are thinking strategically about being proactive about growing immigrant/refugee community health issues despite the anticipated cuts to federal, state, and city funding. For example, SEAMAAC is building a volunteer program in which families who have lived in South Philadelphia for a long time are matched with newly-resettled refugee families. The vision is for these neighbors to forge friendships, develop mutual understanding of each other’s cultures, and build a united community in South Philadelphia.

Whether called Outreach Workers, Case Managers, Community Health Workers, or Peer Navigators, successful programs require leadership from and compensation for bilingual/bicultural community leaders. Staff and community members are our strength and most important asset. They care deeply for their communities, and we support them in boundary setting, safety, and professional development to sustain them in this work. We value their time, skills, knowledge, and connections. SEAMAAC and AFAHO fundraise extensively to compensate them appropriately, and appreciate partnerships and funders who are also interested in investing long-term in this important role of bridge builder. As our target populations rely heavily on community leaders for information and resources, we want to create mutually benefiting relationships with community leaders to spread awareness and leverage support for our services. 

Works Cited

Gozdziak EM. Training refugee mental health providers: Ethnography as a bride to multicultural practice. Human Organization. 2004; 63:203–210.

Ater, Richard. "Mental health issues of resettled refugees." Ethnomed. November 18, 1998.

Author Bios

Amy Jones is a licensed social worker who strongly believes in the connection of macro and clinical practice to larger social change movements. Her work in innovative program development and administration, and policy advocacy is fueled by working directly with people who seek help during challenging times in their lives. Their stories frequently highlight gaps in services and systemic barriers that need to be addressed. With the right support, they in turn can nurture others going through similar struggles. In her role at SEAMAAC, she directs the Health and Social Service Department including programs that are specialized in serving Asian immigrant and refugee communities in Philadelphia. Current program areas include health, senior services, safe families, post-resettlement refugee services, and civic engagement. Additionally, as a Therapist, she helps individuals, couples, and families from all backgrounds to accomplish their therapy goals at Northwestern Human Services (NHS) in the Mount Airy neighborhood of Philadelphia. Her primary clinical experience is in working with trauma survivors, those who struggle with anxiety, depression, grief and loss, building self-esteem, and those going through life transitions. She has prior work experience conducting community education and counseling around intimate partner violence at Women Against Abuse and the Lutheran Settlement House’s Bilingual Domestic Violence Program. Ms. Jones was recognized as a Champion of Change for the Affordable Care Act by the White House Initiative of Asian Americans and Pacific Islanders. Ms. Jones holds a bachelor’s degree in Social Work from Eastern University and a master’s in Social Work from the University of Pennsylvania. She is currently enrolled in a part-time post-graduate certification training in Marriage & Family Therapy at the Council for Relationships.

Christa Loffelman is a nonprofit consultant based in Philadelphia. She has a Masters Degree in Social Work from the University of Pennsylania, where she received the Ruth Smalley Award for her work on international social welfare issues. She is a licensed social worker in the State of Pennsylvania, and has 15 years of experience in working with immigrants, refugees, and other communities of color. Her expertise includes grantwriting, cultural competency, program development, intergenerational issues, urban social work, and nonprofit administration. 

Oni Richards-Waritay currently serves as the Executive Director of the African Family Health Organization (AFAHO) where she is responsible for developing, implementing, and managing health and human service programs for the African and Caribbean immigrant and refugee communities in Greater Philadelphia, as well as directing the administrative functions of the organization. She brings more than eight years of public health program development and management experience to the position. Under her leadership, she has expanded AFAHO’s focus, increased its funding by nearly 150 percent and diversified its programs and services to respond to community needs. Oni previously served as a consultant in the Africa Program of the American Friends Service Committee where she organized advocacy activities related to health, social, and economic justice issues in Africa; with a particular focus on developing campaigns to impact U.S. congressional decisions on debt cancellation for African nations. She also spent time in Durban, South Africa creating programs and conducting fundraising activities for orphans impacted by the HIV/AIDS epidemic. She is currently in the process of expanding AFAHO to Tambacounda, Senegal to open a health and wellness center there. Oni was selected as a Visionary Emerging Leader by the Valentine Foundation and awarded a scholarship to attend the Non-Profit Executive Leadership Institute at Bryn Mawr College. She was also given the 2012 Echoes of Africa Community Service Award by the Mayor’s Commission on African and Caribbean Immigrant Affairs and a Citation by the City Council of Philadelphia for her work and dedication to the community she serves. In 2015 she also received the Community Leadership Award from ACANA for her efforts in addressing the health needs of the African Diaspora. 

Summary

Migration and the internal and external displacement of youth and families is a complex social, cultural, and political process, the implications of which can overwhelm most service delivery systems, particularly in the face of growing political volatility and shrinking pools of funding. Stories shared in counseling relating to loss, displacement, and complex trauma, both personal and historical, and the vast and seemingly impossible task of surviving through the pre- and post-migration process, often feel overwhelming and impossible to manage by clients as well as by clinicians and other providers.

La Puerta Abierta (LPA) has evolved as a community-embedded, fully collaborative, and flexible model of behavioral health care and made great strides in improving access to care for immigrant youth and families, while also challenging traditional methodologies and approaches to be more appreciative of the challenges -- and strengths -- of this shifting demographic.

History of Transnational Partnerships 

The work of La Puerta Abierta (previously known as Intercultural Coalition for Family Wellness) began as an extension of a long-term relationship with several mental health programs in Latin America that aimed to address the marginalization of remote, mostly indigenous communities with little access to support for relationship health. While these communities were resourceful and tenacious in the face of many life stressors, there were multiple challenges imposed on the lives of these communities as many family members were forced to migrate to cities or other countries in search of safety and/or work. LPA developed a collaborative training model with these programs, through which a reciprocal learning process evolved over a 15-year span. As the need for improved access to mental health care became evident in the growing immigrant and refugee community in the U.S. and, more specifically, the Philadelphia region, LPA localized its work while maintaining ties to its colleagues “across the Americas.”

Hence, in 2010, LPA’s founding executive director embarked on a new phase of the organization’s work. By applying the lessons learned in its international work, LPA began building local partnerships and supporting collective efforts to promote and increase human capital of specially trained bilingual therapists and related clinical professionals to more fully respond to the growing needs of the local immigrant community. More broadly, the mission of the organization has maintained a central goal of shifting traditional systems of care to support the complex needs and circumstances of our newest community members, while staying small, flexible, and accessible.

Many Moving Parts

LPA’s constituents are comprised of youth and families who have limited or no access to clinical care due to legal, language, social, and economic barriers. Our model is “training, collaboration, and service;” through training bilingual volunteers and graduate interns, we are able to reach 200 to 300 individual youth and families annually while building the capacity of bilingual, culturally-informed professionals who are committed to serving this growing community of youth and families. Those who come through the doors of LPA represent a wide range of immigrant cultures, circumstances, struggles, and interactions with their home and new communities. In every aspect of training, supervision, and care, LPA staff, volunteers, and interns are expected to incorporate a functional understanding and appreciation for the socio-political realities that are woven through all of the life stories and presenting concerns in the counseling process. Much of this learning is a product of LPA’s close collaboration with other immigrant-serving organizations through which we are all, individually and collectively, able to tighten the safety net of supports offered in the immigrant community.

One key principle of LPA’s work is to provide the highest standard of holistic, behavioral health care while minimizing the amount of bureaucracy that could interfere with the delivery of these services and supports. Perhaps even more importantly, the model of LPA’s work is predicated on the belief that community members, including youth, have natural abilities, insights, and strengths that can be leveraged in the clinical work commonly referred to as mental health care. This culture of care is the groundwork for all aspects of LPA’s work. As such, clients referred to LPA for mental health care have doors opened to healing and also receive the clear message that they are looked upon as partners in the community-building work of LPA. A core belief in LPA’s work is that “healed people heal people,” and thus clients can be empowered to build and transform the very communities from which they come, promoting a message of stewardship of both personal and community life.

Shifting Systems of Care 

There is an ever-growing need for trauma-informed, fully accessible therapeutic environments and programs that appreciate the growing diversity in our local and national communities. Yet, there is a clear misalignment between this evident need and the constraints that are typically imposed by the multiple levels of bureaucracy that are an inherent part of the behavioral health system.

This work is complicated, as are the stories and challenges that are an integral part of the work with the transnational community members LPA serves. The majority of clients who seek care through LPA come with profound legacies of suffering, including personal, family, community, and historical trauma. LPA avoids a stance of diagnosing, pathologizing, and functioning in the role of “expert,” as is often the case in more traditional mental health systems. Still, the extent and depth of suffering that is shared in the rooms of LPA is palpable.

Creating a culture of care and sustaining it at every level of LPA’s organization is of paramount importance to its work. In all venues of LPA’s work -- community-based groups, co-location in different community centers, and the partnerships that anchor them, professional and community member interactions -- LPA team members and colleagues promote and encourage an environment of “cariño” for each other, the work, and the community at large.

Prevention vs. Intervention

Prevention strategies include increasing social connection, decreasing isolation, and creating networks of support. These things are not easily quantified or measured. The population that LPA serves is an emerging yet often “invisible” demographic in this country and as such there is not sufficient data or documented evidence-based practice for how best to serve them. LPA uses qualitative evidence to confirm the impact of our work, including the informal collection of feedback and anecdotes that show improved family relationships and prevention of more serious scenarios that could result in profound consequences for individuals and families who are already vulnerable due to their status in the community. Additionally, LPA informally tracks the lives of youth who have come into the organization’s care and is able to assess the overall impact of its work through measures such as school retention and improved academic success, successful reunification with family members, lower juvenile justice involvement, increased participation in positive activities, and sustained relationships with healthy forward moving peers.

Building Upon the Work, One Relationship at a Time

LPA does not receive funding through local municipalities for its delivery of mental health services, yet it’s able to provide these supports at no cost to eligible youth and families. While LPA is volunteer-driven and grateful for the in-kind donations of office space, volunteer hours, and many supplies, the organization also relies on training and service contracts and a strong donor base to sustain and grow its financial grounding. Organizational development has required a spirit of innovation, while soliciting and valuing the input of community members present in LPA’s community spaces. Whether in the community centers that donate space for therapy and group sessions, the schools in which newcomer immigrant youth meet in groups, or the “pláticas” (talks) that take place across the state through one of LPA’s mental health/legal partnerships, relationships are the cornerstone of the organizational fabric. More recently, LPA has begun to explore and apply the use of the “promotora” model of care, providing first responder training and support to community members who have the language and life experiences to serve as resources to the local immigrant community. This is a model of work that has been used in many public health sectors in Latino communities both in the U.S. and internationally. Promotoras are community members, both adults and youth, who commit to investing their time and energy to help others in the collective effort to create neighborhood environments that are healthy and healing for everyone.

African-American, Asian American/Pacific Islander (AAPI), and Latinx communities are the fastest growing segments of Pennsylvania’s population, according to U.S. Census data. 

Yet, you would never know it by looking at the members of Pennsylvania’s General Assembly.

The 253-member state legislature is 94 percent White and 82 percent Male. That means there are only 45 women in the state House and Senate combined, 25 people of color, and one Asian American member. If the legislature proportionately reflected the state’s racial demographics, Pennsylvania’s General Assembly would have a lot more members of color and women -- membership would be comprised of at least 28 African Americans, nine Asian Americans/Pacific Islanders, 17 Latinx, and 127 women. With this lack of representation, it goes without saying that the voices of immigrants -- at least, recent immigrants to the U.S. -- are rarely listened to in Harrisburg.

SEAMAAC sets goals for its volunteers.
Photo Credit: Andy Toy

Five AAPI-serving organizations (Asian Americans United, Pennsylvania Immigration and Citizenship Coalition, Philadelphia Chinatown Development Corporation, SEAMAAC, and VietLEAD) are running a pilot project, which if taken to scale, could change this. There are just over 50,000 eligible AAPI voters in Philadelphia (not all of whom are immigrants). Yet only half are registered. Compare this to the more than 90 percent registration rate among Black and White Philadelphians. Traditional efforts at increasing voter turnout -- outreach from political parties, candidates, or even multi-issue organizations -- rarely develop messages or strategies specific to AAPI communities. Government efforts, state, or county-level election administrators, are not required by law to provide voter registration or election information in languages spoken by limited English proficient (LEP) communities, and thus provide few resources to increase participation rates among these communities.

The key gap in any effort to increase AAPI civic engagement is trusted, authentic messengers to regularly and routinely encourage participation. “Philadelphia’s growing Asian and Latino immigrant populations are halting the city’s population decline, repopulating neighborhoods, and revitalizing commercial corridors,” says Alix Webb, executive director of Asian Americans United. “We know that these new and vulnerable immigrant communities must be engaged in civic life to ensure that their needs are met and that their voices are heard. We need leaders from our communities -- who know our communities -- to be making the decisions that affect our lives. So, we decided to double down on working to close the voter registration gap even before 2016. AAU sees this as a necessary continuation of its organizing and community building work of the last 30 years to ensure that people of Asian ancestry exercise leadership to build their communities and unite to challenge oppression.”

The lack of AAPI representation among elected leaders is one reason that AAPI communities register and vote much less than other voters. Other factors include cultural and political differences, language barriers, lack of understanding of the process, and concerns about whether voting even makes a difference. The people who are best positioned to run programs and execute innovative ideas that address these reasons -- not surprisingly -- are groups that serve AAPI communities year-round, and are AAPI-led. “Over the last three years, AAU has significantly expanded its programming designed to empower Asian immigrant youth and community members to become civically engaged and shape the future of their communities. More than one hundred youth leaders have been trained to register voters and get out the vote resulting in thousands of phone banking calls to non-English speaking citizens, articles published in local ethnic-language-based media, language specific voter education events, and hundreds of completed voter registrations,” says Webb.

The five AAPI-serving organizations have come together to put AAPI communities on the political map in towns, cities, and statewide races where the voice of AAPI community members is often ignored. Together, the groups have set collective goals for voter registration and election participation increases over the next four years and defined what each individual member of the collective will do to achieve them. The AAPI civic engagement effort is initially focused on five counties:

Each of the organizations involved has a different approach to reducing the voter registration gap and increasing voter participation.

Philadelphia Chinatown Development Corporation for instance registered hundreds of voters in 2016 by simply integrating a conversation about the importance of voter registration into existing services offered to clients. Asian Americans United empowered youth leaders to set up tables in public places to collect voter registrations from AAPI community members. Pennsylvania Immigration and Citizenship Coalition focused on registering voters at new citizen ceremonies.

Pennsylvania Chinatown Development Corporation works the polls on Election Day.
Photo Credit: John Chin

Beyond voter registration, all of the groups reached out directly to voters encouraging them to participate in the 2016 election. VietLEAD used the sophisticated data tools offered by Pennsylvania Voice to find Vietnamese voters and then talk to them about voting on the phone and sometimes at a prospective voter’s front door. These interactions were especially impactful when offered in both English and Vietnamese.

SEAMAAC employed a place-based strategy and knocked on hundreds of voters’ doors -- both AAPI and other races -- to have in-person conversations about the importance of voting. When possible, they also offered multi-lingual services.

Generating tens of thousands more votes from AAPI communities may not seem significant in a state with nine million registered voters. Take it county-by-county though and it doesn’t take a lot of extra voters, especially in a local race, to make a difference. 25,000 extra votes would have a major impact on a citywide race in Philadelphia, 10,000 extra votes could change the outcome of a district council race in Allegheny, and 3,000 extra voters in a Delaware County Mayor’s race could change the outcome. The AAPI civic engagement effort is not just focused on talking about voting with clients, youth leaders, and community members. Instead, through conversations about issues and legislation that affect AAPI communities, basic civics lessons, and a lot of listening to the needs of community members, these five organizations are creating a different way of engaging potential voters than the typical blitz of mail and robocalls that have become the norm at election time.

This work has largely been made possible by a nationally-focused grantmaker that promotes civic engagement, health, and well-being among the AAPI community. This foundation has made a five-year commitment to engaging the AAPI community in multiple states. Their investment in AAPI civic engagement is unique in that it is helping to build the basic infrastructure required for civic engagement programs in the AAPI community. The question is whether other national foundations, and even more importantly, Pennsylvania and regional funders, will chip in to support the effort too.

Another critical element of the AAPI civic engagement program has been the role of the entire Pennsylvania Voice partnership, this includes a statewide network of nearly 40 organizations. Partners share a vision of full participation and representation in our democracy of the New American Majority, historically underrepresented and marginalized communities, including young people (under the age of 34), single women, and people of color in Pennsylvania. “The vision and commitment that each partner organization brings to the table, along with the support of partnership staff and board leaders, has allowed Pennsylvania Voice to become the place where the state’s top progressive leaders work together on long-term strategies,” says Erin Casey, Pennsylvania Voice’s executive director. “The growth of immigrant communities, and the growth of people of color communities all over the state is the future of public policy in Pennsylvania.”

To be a part of the Pennsylvania Voice partnership, an organization makes a commitment to meet measurable goals, set collectively annually, that help build the power needed to break down barriers to civic participation, restore confidence in government, and bring historically marginalized populations and their issues to the forefront of public discourse. Pennsylvania Voice staff supports the AAPI civic engagement effort by making sure that plans and goals are aligned to achieve collective impact to the greatest extent possible. In addition, staff provide technical assistance, data and technology tools, and analysis about specific trends among AAPI voters in the state. Collective impact work around civic engagement cannot be successful without trust among participating organizations, a willingness to write and work from a shared plan, and an understanding of best practices in the field. This kind of collective impact model is something that all members of the Pennsylvania Voice partnership can help replicate and scale in other communities throughout the state.

Pennsylvania Immigration and Citizenship Coalition’s participation in this collective effort is an expansion of long-standing civic engagement programming. “From the legislative and legal attacks on sanctuary cities, to physical attacks on people of color and those perceived to be Muslim, to the gutting of public education and the lack of any real plan to create jobs in Washington and Harrisburg, it is clear that immigrant communities will be ignored or worse scapegoated if we don’t build political power," says Sundrop Carter, executive director of the Pennsylvania Immigration and Citizenship Coalition. Heightened political rhetoric attacking immigrant communities is going to have deleterious effects on the growth and vibrancy of cities like Philadelphia, especially the threat of elected officials federally, and at the state level, even potentially revoking funding from the city because of its “sanctuary city” policy. Philadelphia’s “sanctuary city” policy limits communication between local law enforcement and federal immigration authorities. The goal is to make sure that people who report, witness, or commit crimes are treated like any other resident of the city. In cities without a sanctuary policy, immigrant communities are less likely to extend trust to officers of the law, and sometimes by extension anyone in government. “We need to -- and plan to -- perfect voter education and political engagement among New Americans," says Carter. "We can’t get around the reality that immigrant and refugee communities are under attack by lawmakers. When anti-immigrant sentiment is codified in law, the best defense we have is the power of the vote.”

Members of the AAPI community care about many issues in addition to “sanctuary city” status. From the debate about the Affordable Care Act to the push at the state level to provide adequate funding for public education to gentrification, there are many ways to engage potential AAPI voters, including those who live in suburbs and cities alike. With the support of an innovative funder, and strong backbone support from Pennsylvania Voice, this coordinated effort is building a model that shows why and how supporting organizations that are already embedded in communities are the most likely to make real change. This model could be taken to scale in other communities of color -- whose share of the population grows in every part of Pennsylvania. In the meantime, the five AAPI-serving organizations are working together to enact a plan that will ultimately make the AAPI community a political force to be reckoned with in Pennsylvania’s future.

Three weeks after the 2016 Presidential inauguration, a coalition of Philadelphia City Council members, immigrant advocacy groups, the Philadelphia School District, public school teachers, and the faculty and staff union members of the Community College of Philadelphia hosted a town hall to address issues affecting K-12 immigrant students in Philadelphia public schools. A crowd of more than 200 parents, students, educators, and advocates packed into an auditorium at the Community College of Philadelphia to provide testimony regarding their concerns. In the current fear-driven and religiously divisive environment, public schools can play a key role in providing safe spaces for and engaging immigrants. This article describes three types of initiatives to promote inclusiveness in K-12 public schools: (1) working with schools to provide outreach to immigrant students and parents to alleviate fear and promote advocacy; (2) immigration legal clinics and education through school-based sessions; and (3) collaborations that supplement English Language Learning in out-of-school time settings.

Background

In a landmark 1982 decision, Plyler v. Doe, the U.S. Supreme Court ruled that it was unconstitutional for school districts to deny children a public education based on their immigration status. In order to comply with this constitutional mandate, school districts do not inquire about a child’s immigration status, and therefore obtaining precise data on the number and status of foreign-born students in the Philadelphia system is difficult. However, we do know that more than 10 percent of Philadelphia’s 130,000 students are enrolled in English for Speakers of Other Languages (ESOL) programs. This is only an indicator; some immigrant children speak English and are not enrolled in ESOL programs and some English Language Learners (ELLs) are Puerto Ricans and U.S. citizens. Most ELL students are concentrated in Northeast Philadelphia, with some in South and West Philadelphia and Kensington. Solis-Cohen, a K-6 elementary school in lower Northeast Philadelphia (zip code 19149) has the largest number of elementary ELL children including Spanish, Chinese, Arabic, Portuguese, and Pashtun/Dari speakers, followed by Southwark (K-8) in South Philadelphia (zip code 19148), with Spanish, Indonesian, Burmese, Karen and Chin, Vietnamese, Khmer, and Nepali speakers. At the high school level, Northeast High, with more than 600 ELLs, surpasses all other high schools with respect to the number of ELL youth. In addition to offering ESOL classes in select schools, Philadelphia has one comprehensive “sheltered learning” environment at the Franklin Learning Center for high school students newly arrived to the U.S.

Immigrant and refugee children, regardless of status, face common issues in the school system.  ELL students struggle with learning English and keeping up in their subjects. In most cases, students study English in a separate class and then return to learn subjects in English during the day. At the town hall meeting and in other discussions, students expressed frustration about not understanding the subjects taught in English. They reported a lack of individual attention in ESOL classes and the rapid “promotion” out of those classes once they achieved a certain level, which in their view was not adequate and did not enable them to keep up in other subjects. Some students wanted to have access to more art, music, and sports (especially soccer), as these are activities where language does not matter.

Refugee and immigrant students and former teachers also pointed to traumatic and sometimes physically violent incidents of bullying both within schools and on the way to and from school. The report of bullying is consistent with national trends. The Southern Poverty Law Center reported that following the election, in a survey sent to 10,000 teachers, 2,500 teachers reported increased incidents of harassment ranging from racist graffiti to assaults, while four in 10 teachers reported derogatory language directed at students of color, Muslims, and immigrants. Undocumented students not only struggle with academics but many also feel hopeless and unable to plan for the future because of their status. Currently, many undocumented students can only attend college by paying the rate foreign students pay -- two or three times as much as residents. They are not eligible for any government grants or loans. Students without status cannot work legally and are pushed into the underground economy. Although, students who arrived in the U.S. before June 15, 2007, and are in or completed a high school program, are eligible for the Deferred Action for Childhood Arrivals (DACA) program created by President Obama in 2012. DACA recipients can achieve a modicum of stability, as they can obtain legal work authorization and be protected from deportation. However, DACA’s status under the current administration is not yet resolved, and those enrolled may revert to being undocumented and subject to deportation.

Immigrant parents face barriers to involvement in their children’s education, based on difficulties in communicating with teaching staff and fears concerning their immigration status being revealed. The Philadelphia School District employs close to 60 Bilingual Teaching Assistants (BCA) who provide interpretation to parents; these staff function as cultural and linguistic bridges for parents, but most are assigned to several schools. Several years ago, there were one hundred BCAs.

Against this backdrop, public schools can serve as the vehicle to conduct outreach, provide support, and educational initiatives that create a welcoming environment for students and parents. School-based efforts, such as those described below, will encourage students to stay in school, while offering support to immigrant and refugee families.

Developing Welcoming Schools Policies

Welcoming Schools policies provide students, parents, community members, and schools with tools for affirming a school’s dedication to ensuring that all students regardless of immigration status are welcome, safe, and protected in the school environment. The Pennsylvania Immigration and Citizenship Coalition (PICC) and the Temple Sheller Center for Social Justice have successfully created a statewide “Welcoming Schools Campaign” including a toolkit for families, educators, and administrators to learn about the rights of immigrants. The Toolkit also contains ways schools, school boards, and school districts can create safety and show support by enacting resolutions and policy changes to help address the fears and needs of the immigrant and refugee community.

PICC understands that it is important for the immigrant community to lead the way and express their needs before attempting to advocate on their behalf. Therefore, PICC spent months before and after the election having one-on-one and group discussions with students, as well as parents, advocacy leaders, teachers, and school officials. All expressed concerns related to the new administration and increased Immigration and Customs Enforcement (ICE) presence in their communities, high levels of bullying, and the lack of clarity about what schools will do to support families impacted by immigration raids.

As PICC began doing school presentations in classrooms across Philadelphia and other parts of the state, we heard children as young as third graders ask questions such as “Will my parents get deported?” and “What is going to happen to my siblings and me if my parents are sent back to their country?”  PICC staff also heard parents and teachers asking if sending their kids to school (especially undocumented children) was safe. To address such concerns, PICC provided Know Your Rights sessions, gave out Know Your Rights cards for children to carry, and give to parents, and conducted role plays on how to deal with ICE during classroom visits, school, and community events. PICC has worked with the Caucus for Working Educators (WE), a group of educators and staff in the Philadelphia school system, to provide training to, and actively engage school staff in educational workshops and advocacy. Many educators have brought speakers to their classrooms, created lesson plans to learn about the immigration system, and worked with immigrant rights groups to make classrooms more welcoming. Others have prepared students, parents, and colleagues to testify about their needs in front of the School Reform Commission, the local governmental body that oversees public and charter schools.

PICC, together with union and community allies, seeks to have the School Reform Commission pass a “Welcoming Schools Resolution” that clarifies Philadelphia School District policies on protecting students from ICE enforcement activities. It is important that students, parents, and school personnel are aware of ICE’s current policy (called “Sensitive Locations Memo”) which states that ICE will generally not conduct enforcement activities in schools, at educational activities, or at school bus stops. Policies such as this and model resolutions are contained in the Toolkit. A campaign that involves students, parents, educators, and advocates to achieve a school district-wide resolution empowers participants and promotes leadership. PICC seeks to put an end to the policing of students of color, to stop the school-to-prison-to-deportation pipeline, and to ensure our schools provide language access and culturally trained staff for students and families.

Access to Immigration Legal Service Providers

The government’s recent crackdown has left many immigrants desperate for quality legal advice. Public schools, as a trusted place in the community, are well positioned to help meet this need by connecting students and parents with trusted legal service providers.

Offering legal education to undocumented students, in particular, makes sense: certain immigration protections, such as DACA and Special Immigrant Juvenile Status (SIJS), are available to young people, and the latter requires that an attorney has identified the child's eligibility and taken certain steps before the child turns 18 years old. Gaining lawful status for a child who is eligible also takes time -- often years. Identifying and assisting an eligible child early on can therefore be key to ensuring her access to higher education and employment as she approaches adulthood.

With this in mind, HIAS Pennsylvania, through a $20,000 pass-through grant from the School District and in partnership with La Puerta Abierta, created an initiative to support outreach and education around immigration issues for students and school district personnel.  HIAS Pennsylvania's part of the project involved two components: professional development (PD) for teachers and staff, and direct outreach and education to students. The project centered around three schools with high numbers of immigrant students: Franklin Learning Center, Furness High School, and Northeast High School. HIAS Pennsylvania attorneys first conducted a PD session for teachers at each school during the spring of 2017. The session provided an "Immigration 101" with particular focus on the current immigration enforcement landscape and the forms of legal relief most often pursued by undocumented children. The sessions also addressed how immigration status impacts access to higher education and highlighted resources students and staff can turn to for support.

Following each session, HIAS Pennsylvania attorney staff conducted in-school “Know Your Rights” workshops for students. Teachers, administrators, and bilingual case aides publicized these workshops, and each workshop drew a diverse crowd of between 20 to 60 students. Students learned about their rights under the law and how certain undocumented immigrants might seek legal status. Afterwards, students were offered free consultations with an immigration attorney. Several undocumented students learned, for the first time, that they might have a pathway toward legalization.

The reception and reaction to these events were overwhelmingly positive. While limited in its scope, this small project showed what a sustainable, long-term partnership between schools and immigration legal service providers might look like and might achieve. Such a project could provide ongoing education and support to immigrant students and families, connecting many with needed resources that they would not otherwise find. Integrating this approach into Philadelphia’s Community Schools initiative which is poised to deliver a panoply of human and health services through targeted public schools would expand the program. A fully-funded project would include funding to cover free immigration legal representation for certain students or family members (similar to ActionNYC’s program). Such an investment would go a long way toward giving some of our city’s most vulnerable youth a chance to reach their full potential.

Community Collaborations to Promote English Language and Academic Support

The need for supplemental ESOL programs and assistance has been an ongoing issue in public schools. K-12 refugee students may face special barriers, including suffering from trauma if they witnessed violence and/or the death of a loved one. Often isolated in camps, some refugees speak tribal languages that may not be widely spoken in the U.S. or even among their own national group. Thus, English becomes the only language refugees can use to communicate with others, even those sharing the same nationality. In recognition of the special situation of refugees, the federal Office of Refugee Resettlement/Administration for Children and Families provides Refugee School Impact Grants to aid in providing targeted assistance to K-12 refugee youth. Funding is provided on a per capita basis related to the number of refugees arriving in a region, and in Pennsylvania, it is provided to the Pennsylvania Refugee Resettlement Program. Through an RFP process, HIAS Pennsylvania received a grant to provide out-of-school academic and English language support in Philadelphia.

During the 2016-17 academic year, 50 refugee students were enrolled in after-school programming for grades K-12 at Gilbert Spruance School and Northeast High School. These schools in Northeast Philadelphia serve large populations of non-native English speakers composed of both immigrants and refugees. The two after-school programs provide homework help, English language support through interactive activities, and an opportunity for socialization with peers and adults. Additionally, both programs encourage creative expression through workshops by visiting teaching artists and personal narrative writing through the Writers Matter curriculum.  

The refugee after-school program, held from three in the afternoon to five in the evening three days a week expanded to a full day in the summer. The summer classes help to close the academic grade level gap between refugee youth and their native English-speaking peers by reinforcing language concepts learned in school, while also providing a safe and friendly social space. The summer program is not limited to Spruance and Northeast High School students but open to all refugee students who attend schools in Northeast Philadelphia. The 2017 summer program will reach 50 to 60 refugee students through programs for students in grades K-4 and 8-12.

The role of HIAS Pennsylvania’s Refugee Education Coordinator has been crucial in establishing a rapport with school district administrators in departments such as the Office of Multilingual Curriculum and Programming and the Office of Family and Community Engagement. HIAS Pennsylvania and other refugee-serving agencies maintain these relationships through the Philadelphia Refugee Education Collaborative, a coalition that meets quarterly to share concerns about refugee students and to problem-solve. Issues such as enrollment procedure, high school selection, and testing are addressed. The wider Refugee Education Collaborative has resulted in increased communication between refugee-serving organizations and the School District.

The success of HIAS Pennsylvania’s refugee youth programming depends largely on trained volunteer participation. With the assistance of volunteers, refugee students can receive individualized homework help and language instruction. An intentional and invaluable byproduct of these volunteer-student interactions is the learning about different faith and racial backgrounds that takes place. Most volunteers identify as Jewish or Christian, and for the students, who are primarily Muslim, this presents an opportunity to build bridges across religious divides.

The growth of these student-volunteer relationships is among several informal measures of program success. More formal measures include reports on students’ progress from their ESOL and subject area teachers, scores on the tiered ACCESS assessment for ELLs, and student surveys. Additionally, HIAS Pennsylvania program staff communicates regularly about observed growth in students’ language use and confidence and increased socialization with peers in both their first languages and in English. 

In an effort to expand programming for all ELL students regardless of status, HIAS Pennsylvania will partner with the Philadelphia School District to bring summer arts enrichment programming to 120 middle school-age immigrant and refugee beginner language learners in Northeast Philadelphia, grades five to eight, not served by the current refugee program. Through five art-based learning tracks that include creative writing and visual art, students will grow as English language users and community members who are valued for their diverse cultural and linguistic backgrounds. In a tearful farewell after the close of the 2016 summer program which enrolled ninety students, students and bi-lingual community volunteers described how the programs made them feel accepted and valued, and motivated them to learn and serve. The need to expand the program to enroll one hundred and twenty youth is a strong indicator of its popularity with immigrant families and recognition of its importance by the School District.

Once after-school ESOL programs are integrated into the school, they form a basis for additional parent and community engagement. For example, both the elementary and high school Northeast programs included parent workshops that dealt with school selection processes, a crime prevention discussion with a police guest speaker, presentations by successful immigrant graduate students, discussions on conflict resolution, and the introduction of cultural opportunities to the students such as an Arabic drumming group from Al Bustan.

Looking to the future, coordinating the after-school efforts targeting refugee and ESOL students with other after-school/out of school time programs (OSP) would be an important way to share best practices and to increase involvement of ESOL/immigrant students in OSPs across Philadelphia.

Conclusion

Public schools are critical to promoting inclusion of immigrant and refugee children and their families. Local school districts can respond to the current harsh environment that stigmatizes immigrants and refugees by developing district-wide policies that protect children from entanglement in the immigration system and that deal with bullying based on ethnicity or religion. Schools are also key sites where access to critical immigration legal services and education can be delivered. Finally, providing quality supplemental ESOL programing by partnering with immigrant- and refugee-serving organizations not only helps immigrant and refugee students advance academically, but also engages the larger community in building relationships with diverse populations.

Works Cited

“The Trump Effect; The Impact of the 2016 Presidential Election on Our Nation’s Schools,” last updated November 28, 2016, https://www.splcenter.org/20161128/trump-effect-impact-2016-presidential-election-our-nations-schools

Author Bios

Judith Bernstein-Baker is the former Director of HIAS Pennsylvania and currently teaches immigration law at Community College of Philadelphia.

Valeri Harteg is the Refugee Education Coordinator of HIAS Pennsylvania.

Maria Sotomayor-Giacomucci is Deputy Director at the Pennsylvania Immigration and Citizenship Coalition.

Elizabeth Yaeger is the Supervising Attorney of the Immigrant Youth Advocacy Project of HIAS Pennsylvania.

The Inspiration and Creation

When discussing the beginnings of Puentes de Salud (Bridges of Health), Dr. Steven Larson, an emergency physician at the University of Pennsylvania, tells the story of treating a 17-year-old gunshot victim in his emergency room. The circumstances leading up to the teenager’s admission into the hospital were largely preventable, with the recognition that positive environments, enriching education, improved self-esteem, and a strong sense of community are essential to achieve true prevention. Operating in a community with so many underserved individuals, he wondered how to fix what had systematically gone wrong. More importantly, what could he, as a medical professional, do to improve the lives of these individuals?  

As a young physician who spent time in Central America after medical school, Larson observed local health workers investing their energy in prevention activities, and upon moving to the United States he wondered about the high prevalence of chronic illness in immigrants from these very same countries.  While caring for Latino workers in the mushroom fields of Kennett Square in Chester County, Pennsylvania, Larson recognized that Latinos in particular were underserved and often shut out of the mainstream healthcare system. Often living in the shadows and working jobs requiring hard labor, an incapacitating or ill-managed condition could wreak havoc on an entire family -- havoc further compounded by linguistic and cultural barriers, few health benefits, and a lack of culturally-competent care. In order to better serve this community, Larson would have to take a multi-faceted approach and harness their potential.  

In 2003, Dr. Steven Larson and colleague Dr. Jack Ludmir organized a series of meetings with local stakeholders to address the healthcare needs of South Philadelphia’s Latino community. In Philadelphia, nearly three out of 10 residents live below the poverty line , and more than half of the visits to the eight city-run health centers are made by people with no health insurance.  Demographic shifts have been in motion since the 1990s due to economic instability in Mexico and other surrounding countries, all serving to feed the increased labor demand in the United States. Today, 37,000 Latino immigrants reside in Philadelphia, making up around 19 percent of the City’s foreign-born population.  

The needs of the community are complex, and were not being addressed by existing programming at the time. Larson and Ludmir, joined by Dr. Matthew O’Brien, were acutely aware of this fact, and decided to design and build a new immigrant health and wellness center. The center would serve the needs of the City’s Latino population (and other minority groups), with an eye toward addressing the social determinants of health and long-term sustainability. 

With this vision, Puentes de Salud was born. It started out, in the words of Larson, as a “shoestring operation,” with the three physicians and support staff seeing patients two nights a week in an office space at the University of Pennsylvania Medical Center. In the fourteen years since its inception, the organization has taken flight, with nearly 6,500 patients receiving care and many more impacted by the organization’s community programming.

A Synergistic Community-Based Model

The organization’s greatest strength in meeting the demands of patients has been its inclusive nature and interest in building diverse community partnerships. By involving medical residents and students, nurse practitioners, promotoras (lay Latino community members who receive specialized training to provide basic health education), graduate students from various fields, and even undergraduate students in providing care and support services, Puentes de Salud has curated a conscious, innovative, and holistic workforce. In return, it provides valuable experience and training for young physicians, nurses, and allied health workers interested in serving diverse populations. 

In an effort to design sustainable, long-term strategies for health promotion and disease prevention Puentes de Salud has partnered with local public schools, universities, governmental institutions, nonprofit organizations, small business owners, and community members. Recognizing that long-term benefits to the population can only occur with sustained upstream work that will influence the lives of the city’s youth, the clinic started Puentes Hacia el Futuro (Bridges Toward the Future), an after-school enrichment program for kindergarten and elementary school children. The program is based at Southwark School, a local elementary school where many of the students attend classes. Volunteers from various institutions work to improve the educational achievement of the children through after-school tutoring and mentoring, kindergarten in-class support, adolescent empowerment groups, a coding program (STEM Dragon Coders), art and dance classes, and a summer literacy enrichment camp.

However, the program’s benefits extend far beyond the classroom. It provides youngsters the opportunity to interact with peers who are interested in their development and growth, and educates parents on how to better adapt to the needs of their children. Clinic volunteers will often describe how mothers, fathers, and caregivers coming in for visits express concerns to physicians about their children’s education, including not feeling like they are able to help with homework or participate in their schooling. Puentes de Salud has differentiated itself by encouraging staff to harness the capabilities of parents in its programming. Parents participate by signing up to read aloud to children or teaching them about cultural holidays. Family events are held at least twice a year, in addition to a new workshop series that surveys parents ahead of time on topics they’d like to learn about (health, legal, etc.) which allows families as a whole to benefit from community resources. Addressing the additional needs of the population through a joint effort at the school and in the clinic has allowed Puentes de Salud to empower both parents and children to adapt, understand, and excel.

For the medical community, such interventions are a powerful reminder of the importance of interdisciplinary action. The Philadelphia Latino community stands to benefit most from such an approach, due to the complex range of geopolitical, national, and local factors affecting their allostatic load. A nearly toxic level of stress related to deep poverty, concerns for safety, and a loss of social support affects nearly all who walk through the doors of the clinic. In an effort to encourage universal good health and support patients and families as they navigate difficult situations, Puentes de Salud added a behavioral health consultant to the care team.  Present during open clinic hours, the consultant is able to have seamless access to patients in need of services. The consultant plays a vital role in supporting patients and families suffering from trauma experienced in their home countries, here in the United States, or during their migration journeys. Additionally, the consultant guides individuals as they navigate complex family dynamics, marital struggles, and other mental, emotional, and psychological concerns.

While there is universal consensus among healthcare professionals on the importance of addressing the social determinants of health in communities, few providers are engaged, nimble, and equipped enough to identify stressors in communities and respond adequately. The holistic clinical team at Puentes has positioned itself well to do so. In the fall of 2016 following the presidential election, clinic staff noted that many individuals had questions about the future direction of immigration policies in the United States, and how it may affect them. The Puentes behavioral health team, along with legal partners from Friends of Farmworkers, put together a town hall meeting to allay fears in the community. In order to directly address questions from children and parents, Puentes Hacia el Futuro staff organized meetings at Southwark School to provide further information.

The Puentes model treats education, capacity building, and empowerment as key pieces of the prevention puzzle -- pieces that positively impact health outcomes in the long run. Larson, Ludmir, and O’Brien have a deep recognition that involving various types of professionals in educating patients will serve the community well in the long run. The learnings from these efforts and the creation of strong local partnerships have helped Puentes de Salud become an established leader in the community health landscape of Philadelphia.

Building Up: Puentes de Salud’s Next Chapter

As a leader, Puentes de Salud continues to make strides in building programs, encouraging the next generation of volunteer leaders, and engaging more deeply with organizations in Philadelphia. In April 2015, the clinic moved into a new space, customized to accommodate the high volume of patients and various programs occurring at the organization. Instead of two nights a week, providers are now able to see patients throughout the week. The new environment enhances the ability of Puentes de Salud to function as a true medical home. Recognizing that access to medical care often gets patients through the door, the new site has the capacity to host various learning and education activities such as: yoga and ESL classes, GED certification courses, art classes, and other support and learning groups parents and children can take advantage of.

The solid foundation that Puentes de Salud has built so far -- not only as a source of healthcare but as a community resource -- has allowed the organization to grow into its next iteration. In an effort to actively grow systems and programs, the organization is working to identify gaps in care and communication in order to further enhance prevention activities. Recognizing that less than half of Latino children are enrolled in early learning programs, and Latino families are least likely of all ethnic groups to attend preschool due to limited geographic availability and affordability, Puentes de Salud is working to create an early childhood education program aimed at building strong foundations in literacy prior to enrolling in school. By engaging parents, caregivers, and babies in play with a literacy component in their early years, staff hope that children will be better equipped to begin school in the long run. Combined with parenting classes and health workshops with promotoras, Puentes de Salud hopes to better prepare parents while enhancing family strength and communication.

Another key element of Puentes de Salud’s next chapter includes fostering leadership among young, engaged volunteers. A group of three volunteers studying at the University of Pennsylvania were recently awarded the President’s Engagement Prize, a university award providing them with funding to translate their passions into an impactful project. The three students -- studying neuroscience, nursing, and urban studies -- conceptualized a project called Lanzando Líderes aimed at bringing together high schoolers (who were in elementary school at the inception of Puentes Hacia el Futuro) and equipping them with the necessary support and tools to succeed during and after high school. The program includes academic tutoring, workshops and mentoring on college and/or job preparedness, health and wellness training, guest speakers, and field trips to inspire self-confidence in students and provide encouragement as they navigate adolescence. By building on an existing foundation of programming and remaining aware of the adapting needs of the community it serves, Puentes de Salud remains dedicated to cohesive capacity-building in Philadelphia’s immigrant community.

Looking ahead, Puentes aims to not only strengthen its own core medical, educational, and wellness programming, but also partner with organizations similarly invested in a holistic, interdisciplinary view of community work. In September 2017, Puentes de Salud and the Barnes Foundation will partner to create an arts-based literacy enrichment program for young children called “Puentes a las Artes/Bridges to the Arts.” The Barnes Foundation’s educational mission, outlined by founder Albert C. Barnes, emphasizes that art should be accessible to individuals of all educational levels and cultural backgrounds, and that visual literacy and critical thinking skills are essential to every individual’s ability to being a participating, productive member of society. The new program will help develop cognitive and linguistic skills in children and provide adult caregivers with activities and teaching strategies that will enable them to reinforce and extend learning at home. Additionally, the foundation will facilitate family engagement through monthly museum visits and art based activities, intended to educate youth about observation, reflection, and communication. With the launch of this effort, Puentes de Salud takes another step toward its goal of joining forces with local partners to create innovative programming to enrich the lives of the children and families it serves.

Puentes de Salud was started with a broader vision to break the cycle of poverty and meet the needs of a vulnerable population through customized programming. By providing opportunities for patients and community members to express their needs, and working across sectors to construct a model, Larson, Ludmir, and O’Brien have sought to address the social determinants of health in a way that truly makes a difference. With a vigilant eye, Puentes de Salud continues to expand its medical, educational, and wellness programming in a way that best fits the needs of its patients -- while providing creative opportunities for meaningful enrichment. Having done the legwork to engage community members while building its organizational foundation, Puentes de Salud remains able to respond to the changing needs of the community it serves -- a microcosm of the changing international, political, and local landscape in which we live. The clinic began based on a physician’s moral and ethical responsibility to take care of patients in need; what has occurred since can only be described as taking the fight for better health outcomes beyond the emergency room and into the community.

Author Info

Bhakthi Sahgal is a Program Associate at the Patient Centered Outcomes Research Institute (PCORI) in Washington, DC. She has engaged in community health initiatives and has worked on health legislation and policy on Capitol Hill, the White House Office of Drug Control Policy, and as an academic researcher.  She holds a master’s degree in Public Health from the Milken Institute School of Public Health at GWU, and a B.A. in Political Science from Bryn Mawr College in Pennsylvania.

Works Cited

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The Pew Charitable Trusts. Philadelphia: The State of the City: A 2016 Update. Link. March 2016.

The United States Census Bureau. 2011-2015 American Community Survey 5-Year Estimates. Link. Accessed August 21, 2017.