O3234: Identifying Barriers to Care and Evaluating a Healthcare Navigation Workshop for Adults and Children Seeking Asylum in Washington State

Background: Over 1,000 asylum-seeking children and adults (ASCA) arrived in King County, Washington in 2023 finding refuge in a large tent encampment on church grounds, a government-sponsored hotel, and shelters in the cities of Tukwila, SeaTac, and Seattle. Predominant languages spoken are Spanish, Lingala, Portuguese, and/or French. Most families traveled through multiple countries including the Darien Gap jungle to escape civil strife in Venezuela, Angola, and the Democratic Republic of Congo. They arrived with scarce resources and limited support, sometimes with medical needs, and without orientation to the U.S. healthcare system. A multidisciplinary team collaborated with site leadership from the church tent encampment and hotel, community health centers, the University of Washington, and King County public health to assess health priorities and barriers, and to develop and evaluate culturally-sensitive, linguistically appropriate workshops for healthcare navigation.

Methods: -Needs assessment: Interviews with site leadership, health care professionals, and ACSA to identify priority health needs and preferred communication channels
-Stakeholder engagement: Partnerships with community organizations to identify resources, develop educational materials, and connect individuals to care
-Design and implementation of culturally-sensitive workshops on healthcare navigation with native Spanish and Lingala/French-speaking health professionals with information on health insurance, types of healthcare settings and access, healthcare rights, medication access, and more
-Evaluation methods included surveys & qualitative listening sessions (x4) to ascertain barriers to care

Results: -102 attendees joined 4 sessions (48% in Lingala/French/Portuguese, 44.1% in Spanish), 57.9% from Angola, 23.7% from Venezuela, 15.8% from DRC, & 2.6% from Ecuador
-Survey completion was 41.2%; female (71.9%), male (21.8%)
-65.7% responded yes to having health concerns for their family
-Most valuable information learned was reported to be ‘insurance coverage’ (59.5 %) and ‘health care types’ (50%)
-Of respondents, 79.4% were ‘exceptionally satisfied’ with the workshop and 82.4% reported ‘understood everything’ presented
-There was much interest in further sessions
Themes regarding barriers to care by level of Socio Ecological Framework:
INTRAPERSONAL: Fear of medical bills impacting seeking care; uncertainty of rights and eligibility to health care; low health literacy; differences from home country healthcare settings
ORGANIZATIONAL: Limited on-site health care coordination, language barriers to resources; limited transportation, limited local healthcare understanding of ASCA health needs
COMMUNITY: Clinics & shelters with finite capacity
SYSTEMS: Lack of health insurance for adults, scarcity of legal support

Conclusion: Newly arrived ASCA in Washington state have significant needs for healthcare navigation education and resources. Involving ASCA community participation and partnering with sites to design and implement workshops was effective for identifying needs and barriers as well as communication strategies. Presenting culturally-sensitive and linguistically-appropriate workshops was effective for conveying information that addressed needs, were satisfying to participants, and led to interest in further sessions. Ongoing community participation and partnerships are essential for addressing barriers to care.