At a glance
The domestic medical screening guidance is for state public health departments and healthcare providers in the United States who conduct the initial medical screening for refugees. These screenings usually occur 30-90 days after the refugee arrives in the United States. This guidance aims to promote and improve refugee health, prevent disease, and familiarize refugees with the U.S. healthcare system.
Domestic Refugee Health Medical Screening
The domestic medical screening program was established as part of the Refugee Act of 1980. The domestic medical screening provides clinicians with an opportunity to follow-up on or identify new health concerns that may hinder successful resettlement and self-sufficiency, to promote wellbeing, and to connect refugees with routine and specialty care. A patient-centered approach to refugee screening is critical in evaluating initial health needs and ensuring that each refugee is linked to appropriate ongoing care.
The domestic refugee health screening guidance outlines the recommended components of health screenings for new arrivals with humanitarian-based immigration statusA in the United States. This guidance is not meant to provide comprehensive clinical guidance for longitudinal care, but to highlight key screening considerations during the first 90 days of arrival. The guidance emphasizes special considerations for refugee patients and highlights key differences in national recommendations due to unique geographic-based exposures, genetic predispositions, and known epidemiologic patterns among refugees.
- History and Physical
- Tuberculosis
- Immunizations
- Laboratory Testing
- Cancer Screening
- HIV Infection
- Intestinal Parasites
- Lead
- Mental Health
- Malaria
- Nutrition and Growth
- Sexual and Reproductive Health
- Viral Hepatitis
CareRef
The domestic medical screening can include up to three clinical visits, as lab results and other findings must be reviewed with the patient. Ideally, the domestic medical screening should be initiated and completed as soon as possible to ensure that ongoing and emergent health needs are addressed, and new arrivals are connected with appropriate follow-up care. For, additional details of timelines for initiation and completion of screening, which may vary by immigration status, refer to Policy | The Administration for Children and Families.
Key Clinical and Cultural Considerations for Domestic Screening
Many screening clinics and local jurisdictions use the CDC screening guidance, while others adapt CDC guidance for their populations. Local jurisdictions may choose to develop their own screening protocols. The order of components within the screening examination, scheduling protocols (e.g., block scheduling, use of electronic health record smart sets), the number of clinical visits, and available logistical capacity (including transportation and patient reminders) may vary by clinic. Additionally, some clinics complete all aspects of the refugee screening on site, while other clinics partner with outside entities for some parts of the screening (e.g., TB clinic or social workers for mental health screening). Availability and accessibility of local resources, community partnerships, and the number of arrivals may also impact screening protocols. Lastly, screenings may need to be adapted for certain patients. For example, if an individual has a known history of trauma, it is recommended to establish a supportive rapport with the patient before proceeding with more invasive or potentially distressing components of screening.
Centers of Excellence in Newcomer Health: Newcomer Health Profiles
Colorado Center of Excellence in Newcomer Health produced a series of infographics detailing demographic and health information for select newcomer groups arriving in the U.S. The infographics use domestic medical screening data collected by network partners across the U.S.
Minnesota Center of Excellence in Newcomer Health provides newcomer health profiles describing the demographic, cultural, and health characteristics of specific populations.
These resources may help providers, and others supporting newly arriving newcomer groups, approach a newcomer with an improved understanding of where they come from, circumstances of their displacement, living conditions during asylum, and health conditions for which they may be at increased risk.
- Humanitarian-based immigration status applies to refugees (including unaccompanied refugee minors), asylees, Amerasians, Afghan and Iraqi Special Immigrant Visa (SIV) holders, and Cuban and Haitian parolees. Certified victims of human trafficking are also eligible for refugee benefits, including the domestic medical screening (see Policy Letter 16-01 for additional information on benefits eligibility). Spouses and dependent children of adults with humanitarian-based immigration status are also eligible to receive a domestic medical screening. The Office of Refugee Resettlement (ORR) provides humanitarian-based newcomers with important resources, benefits, and services to help them become integrated members of American society. These benefits include a comprehensive domestic medical screening. For ease of use, the term refugee is used to refer to all humanitarian-based newcomers eligible for the screening program (historically, refugees account for the majority of screenings).