‘We Find a Way': Health Care Access Among Immigrants with Disabilities

Background and Purpose: Bodies of literature have emerged regarding disparities in health care access for individuals with intellectual and developmental disabilities and members of immigrant and refugee communities. Among people with disabilities, a multitude of disparities in access to health care (Larson, Anderson & Doljanic, 2005) and health outcomes has emerged (Krahn, Hammond & Turner, 2006). Likewise, literature on health of immigrants and refugees suggests that difficulties in access and utilization exist (Yu, Huang, Schwalberg & Kogan, 2006). However, there has been little attention given to the unique health care access and utilization concerns of immigrants and refugees who have disabilities. This project is among the initial efforts to gain insight into the specific health and social service needs of this population. Methods: This study used complex multiple case study methodology than enabled understanding of complicated human phenomenon within real life contexts (Yin, 2009). Purposive sampling yielded nine participants, three each from the Latino, Hmong, and Somali communities in one Midwestern metropolitan area. Each participant participated in a case study consisting of three segments: an interview about experiences accessing/utilizing health care services, an interview about experiences with social services, and an observation of each participant's visit to a health or social service provider. Interviews were conducted and audiorecorded in each participant's native language, and translated to English by a linguistically competent advocate with knowledge of disability and specific cultural issues. Data were analyzed in NVivo8 using a directed content analysis approach, and were member checked to improve trustworthiness. Results: A number of themes emerged pertaining to barriers to access as well as promising practices that may inform provision of future services. Among the barriers were difficulties in communication, complexities of insurance, and difficulties understanding the American service system. Having a strong advocate enhanced the ability of individuals to access services, as did centralization of service coordination (as occurs through school special education coordinators or case managers). Observations indicated that service providers specializing in either disability or immigrant health may facilitate quality care more than generalized service providers. Linguistic accommodations varied widely among service providers, and were strongly related to the overall perception of quality service among members of this sample. Drawing upon both observations and interviews, the importance of quality interpretation or linguistically competent service providers was strongly underscored. Informants placed more importance on culturally sensitive services than on disability-specific services, though some participants were unaware that disability-specific health and social services existed. Implications: Providers may wish to develop more specialized services and increase attention to service coordination. Communication and differing constructs of health and disability remain barriers, underscoring the importance of the use of competently trained interpreters, and ongoing cultural competency training for health and social service professionals. This need extends beyond contemporary constructions of ‘cultural competence' to the need for a highly specialized service system that can account for the needs of both immigrants' cultural preferences and the complex service needs of people with disabilities. Typical service models are often ill equipped to handle both needs simultaneously.