Addressing the Impact of COVID-19 on Immigrant and Refugee Children and Families at a Federally Qualified Health Center in Durham, North Carolina.

Thumbnail Image



Journal Title

Journal ISSN

Volume Title

Repository Usage Stats



Background: The COVID-19 pandemic amplified disparities experienced by children in immigrant and refugee families (CIRF). The pandemic coincided with a recognition that proactively screening and addressing social risk drivers is an efficacious population health intervention. We used the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework to set up a program to screen for social risks drivers at a Federally Qualified Health Center (FQHC). The study sought to demonstrate to what extent the proactive outreach program would a) capture at-risk persons and b) facilitate linkage of identified persons to community resources. We sought to c) quantify social needs among CIRF and d) understand whether addressing social risk drivers would lead to caregivers perceiving an improvement in their child’s health. Lastly, we sought to e) elucidate the experiences with and preferences of families in regard to screening efforts. Methods: The study was conducted at the Lincoln Community Health Center in Durham, North Carolina. Eligible participants were ages 0-5, non-English speaking, and were seen at the clinic within the last 2 years. A care coordinator reached out to the guardians of eligible children for baseline screening. Participants with social needs received referral placement and navigation support. We looked at the number of baseline questionnaires completed, linkage rates and resolution of social needs as well as perceptions of SDOH screening and perceived changes in child’s health using descriptive and univariate statistics. Results: We attempted to contact 342 guardians; to date, we did not reach 85 (24.85%) participants and 21 (6.14%) have incomplete outreach. 212 (61.99%) participants were enrolled and completed baseline screening. Most participants had at least one social need. Of the 212 individuals enrolled, the 39 who completed the intervention (100%) indicated that the calls helped them to gain a better understanding of community resources. When asked who they would be most comfortable talking with about their social needs, the majority indicated a case manager in person (34, 89.5%) or over the phone (36, 94.74%). When asked about what characteristics were important to them when considering who they might speak with about their social needs, 36 (92.1%) selected language and 22 (57.9%) indicated that cultural affiliation was important. The impact of the intervention on the perception of child’s health was unable to be quantified due to a small sample size. Conclusion: Our findings illustrate the burden of social risk drivers experienced by CIRF and demonstrate the capacity of a proactive outreach SDOH screening program to meet the needs of CIRF served by a FQHC. It is our hope that this screening tool and proactive outreach program can be used as a model to better identify and address the social needs of CIRF and to thus enhance health outcomes and population health.






Norton, Sarah Eastman (2021). Addressing the Impact of COVID-19 on Immigrant and Refugee Children and Families at a Federally Qualified Health Center in Durham, North Carolina. Master's thesis, Duke University. Retrieved from


Dukes student scholarship is made available to the public using a Creative Commons Attribution / Non-commercial / No derivative (CC-BY-NC-ND) license.