Climate of Fear: Provider Perceptions of Latino Immigrant Service Utilization

Background and Purpose:

Immigration from Latin American presents opportunities to improve economic stability and safety. Simultaneously, the immigration process poses stressors that have been found to detrimentally impact health and well-being, and hence prompt a need for health and psychosocial services. Yet, Latino immigrants face considerable barriers to accessing and utilizing services. These barriers might be heightened under the current federal administration, which has implemented policies facilitating increased immigration enforcement. Data collected from providers who serve Latino immigrants in the border state of Texas were leveraged to better understand current immigrant service utilization behaviors.

Methods:

Individual interviews and focus groups were conducted shortly after the last presidential election with program staff (N = 207) at a social service program that delivers family-based services to strengthen overall well-being. Qualitative questions inquired about recruitment, retention, program completion, and resources to address key client risk factors (substance abuse, mental health, multigenerational trauma, and family violence). Interviews and focus groups were transcribed verbatim.

An initial coding scheme was developed for grounded theory analysis. A coding team consisting of the lead researcher and five research team members was established. Each member coded the first transcript, and then revised the coding scheme based on the first analysis and subsequent discussion. Upon finalization of the coding scheme, all remaining transcripts were coded by one of two final coders.

Results:

Data demonstrated central concerns held by providers serving immigrants, and especially those who are undocumented or in mixed-status families. Concerns were related to three themes: (1) undocumented immigrant stressors; (2) limited resources for undocumented immigrants; and (3) service utilization barriers. In regard to undocumented immigrant stressors, participants described the extreme stress and fear that can impede daily life for undocumented immigrants and their family members with documented status. In terms of resources for undocumented immigrants, services are highly limited. Even free health clinics require legal documentation, so do not serve individuals with undocumented status. The most prevalently discussed theme was service utilization barriers, which included three categories: fear of going to service organizations; fear of providers in home; and striving to build trust. While fear emerged as a critical utilization barrier, building trust was identified as the key step to overcoming this fear.

Conclusions & Implications:

Findings extend our knowledge of stressors and access and utilization barriers for immigrants during this time period of increased immigration enforcement. Undocumented immigrants live with numerous stressors that escalate need for health and psychosocial services but also encounter major barriers to using these services. Macro- and micro-level providers can take concrete actions to educate immigrants, regardless of documentation status, on how their identities will be protected. Services can be offered in locations (e.g., churches or community centers) where individuals feel most safe. Direct service providers could also help address the fear by evaluating fear as both a stressor and barrier to using services, and then leverage strategies to build trust as a means of overcoming the fear. Future research should ascertain perspectives of immigrants, as this study drew data only from providers.