The U.S. began resettling Afghan Special Immigrant Visa (SIV) holders in 2009 who had worked alongside U.S. military forces or with the U.S. government during the war in Afghanistan. Additionally, many of the Afghans displaced by the Taliban takeover of Kabul in 2021 found refuge in the United States through Operation Allies Welcome (OAW) and the ongoing Operation Enduring Welcome (OEW) Response. OAW was an interagency initiative that coordinated efforts across the federal government, military, state and local governments, NGOs, and private partners to manage the resettlement of nearly 90,000 Afghans. As Afghan newcomers began arriving in the U.S. in 2021 amidst the COVID-19 pandemic, resettlement agencies worked alongside federal offices, healthcare systems, public health departments, social service providers, and community-based organizations to provide much-needed assistance. Afghan refugees and SIV holders continue to be resettled in the U.S.
Afghan newcomers are acclimating to life in the United States, enriching their new communities, securing public benefits, and seeking opportunities for their families. At the same time, they are experiencing ongoing challenges related to the trauma of sudden displacement and navigating complex systems like healthcare as English-language learners.
Obstacles Afghan Newcomers Face Accessing Healthcare
Afghan SIVs, refugees, and humanitarian parolees receive time-limited resettlement services funded by the U.S. government. These services address their immediate needs, such as housing, establishing primary care, enrolling children in school, and helping adults find employment. The goal is to support Afghan newcomers in recovering and gaining control over their future in the United States. Resettlement agencies work with individuals and families to ensure they understand how to navigate the U.S. healthcare system. However, many individuals, especially those who have more complex medical needs and barriers to accessing care, like the elderly, women, and children, require support beyond the resettlement period. Afghan women, in particular, face obstacles to healthcare access due to language differences, lack of transportation, low literacy levels, childcare needs, and cultural considerations. With ongoing support, immediate resettlement assistance may be sufficient for these vulnerable populations to continue navigating the intricate U.S. healthcare system independently. As a result, many Afghan newcomers need additional assistance accessing the care and services they require to address their unique healthcare needs.
The IRC Atlanta Home Health Visit Program
In September 2022, the International Rescue Committee (IRC) in Atlanta launched its Home Health Visit Program. This program was based on a need identified among the Afghan community to provide supplemental support beyond core resettlement services for Afghan newcomers to access healthcare services and understand the U.S. healthcare system. This program's primary activity is conducting in-person home visits with Afghan individuals and families to identify gaps in health services and address barriers to accessing appropriate medical support. IRC Atlanta conducts between 6-8 monthly home visits, ensuring one visit per household is completed.
Participant Identification and Prioritization
The IRC Atlanta team identifies potential Home Health Visit Program participants through their client database, contacting Afghan clients who no longer receive resettlement services. The program prioritizes vulnerable groups — women, children, the elderly, individuals with complex medical needs, and individuals with low literacy skills. These groups often face barriers to accessing healthcare services due to language barriers, social isolation, transportation challenges, lack of childcare, and sometimes religious and cultural reasons. The Home Health Visits Program focuses on maternal and child health. It addresses the healthcare needs of pregnant and postpartum women and their infants, including helping new mothers schedule their newborn’s first wellness and post-natal appointments and arranging transportation to ensure timely and appropriate pre- and post-natal healthcare. This initiative directly supports the well-being of mothers and their babies, highlighting the importance of preventive care.
Ensuring Accessibility
The Home Health Visit Program ensures all clients can access services through flexible scheduling, interpretation and transportation support, and culturally responsive approaches. Health Navigators work with clients to schedule home visits at the most convenient times for clients, including weekends, to accommodate those working during the week. Meeting families in their homes provides a comfortable and private setting for clients to discuss their health-related issues openly. The IRC Atlanta logistics department offers interpretation services and transportation assistance as needed. These approaches help eliminate barriers such as limited transportation, childcare needs, and single-vehicle families.
Additionally, the program prioritizes assigning female staff to work with female clients out of cultural and religious considerations. IRC Atlanta's Community Health Response Coordinator Feven Bekele explains, "The home visit model allows Health Navigators to understand each client's healthcare needs and concerns better than phone-based interactions." These adaptations help remove barriers and enable Afghan newcomers to fully utilize the Home Health Visit Program's resources.
Comprehensive Health Screening and Tailored Health Service Plans
During the home visit, IRC Health Navigators assess the client's needs with a comprehensive health screening questionnaire conducted in the privacy of their homes. The screening tool was reviewed by IRC staff members, leadership, and Afghan team members to ensure it was relevant, culturally validated, and comprehensive. The screening questionnaire assesses mental health, physical health needs, understanding of the U.S. healthcare system, and other social determinants of health, including English language assistance, Medicaid, and food stamp renewal. Health Navigators use client's responses to collaboratively develop a tailored health service plan to connect individuals and families to appropriate resources and support services that address their specific health needs and goals. Health Navigators offer prompt assistance, including scheduling medical appointments, while referring individuals to various IRC programs that can help address their long-term needs. This collaborative approach ensures that each client's unique circumstances drive the health service plan, connecting them to the full range of IRC services and community resources. The home visits are also an opportunity to provide education on navigating the U.S. healthcare system, and a PowerPoint presentation will be included that teaches clients how to handle potential health emergencies and obtain medical care.
After completing the home visits, IRC staff conduct follow-up phone calls with previous recipients to identify any remaining service needs or gaps. Health Navigators may provide referrals for program enrollment and invitations to community events on mental health, wellness, and stress management. Additionally, the home visit team may identify recurring issues, like mental health needs, among the households they serve. In those cases, the team will host events to address those specific needs and invite all clients to participate.
In collaboration with NRC-RIM, IRC developed a Home Visit Guide and Individualized Needs Assessment for Afghan Newcomers based on lessons learned from IRC Atlanta’s Home Visit model. The Home Visit Guide provides a framework for conducting home visits with Afghan newcomers and families to identify their immediate healthcare needs, evaluate their knowledge of navigating the U.S. healthcare system, and connect them to appropriate services and resources. The accompanying Individualized Health Needs Assessment is a fillable questionnaire to be used during a home visit.
Program Outcomes
From October 2022 to September 2023, Health Navigators conducted 56 family home visits, serving 258 individuals. The IRC staff performed follow-up calls with a small subset of families to assess if they could navigate medical appointments independently. Of the respondents (n-14), 86% reported they successfully attended the scheduled health-related appointments. In addition, IRC administers client satisfaction surveys to gauge the overall satisfaction of recipients of home visit services. Results indicated that client satisfaction was high, with many praising the program's responsiveness and effectiveness. As one IRC Atlanta client shared, the Home Health Visit Program is a "great program that helps our family any time we need."
Key Factors Contributing to the Success of the IRC Atlanta Home Health Visit Program
- Comprehensive Screening: The screening questionnaire covers health and social determinants of health, ensuring holistic care for Afghan families.
- Maternal and Child Health Focus: The team emphasizes maternal and child health, including scheduling wellness appointments, arranging transportation, and providing education on handling health emergencies.
- Flexible Scheduling: Home visits are scheduled based on clients' preferred days and times to ensure convenience and accessibility to accommodate personal (i.e., childcare, prayer times) and/or work schedules.
- Client-Centric Approach: The program identifies potential clients through a database, prioritizing vulnerable groups like women, children, the elderly, and those with low literacy levels and complex medical concerns.
- Cultural and Linguistic Sensitivity: Fluent Dari and Pashto speakers facilitate home visits, with female volunteers assisting with interpretation and transportation to respect cultural and religious considerations.
