Documentation Status Research Articles

Increasing resuscitation status-related goals of care discussions for older adults with severe mental illness in a Canadian mental health setting: a retrospective study

BackgroundOlder adults with severe mental illness, including advanced dementia (AD), within geriatric admission units (GAU) often prioritise comfort care, avoiding life-prolonging procedures including cardiopulmonary resuscitation (CPR). Pre-2019, hospital policy lacked...

Long-term impact of immigration status on outcomes in pediatric kidney transplant recipients

This study aimed to investigate the effects of documentation status on pediatric kidney transplant outcomes in a single-center setting, emphasizing the significance of state insurance access for undocumented patients and federal policies like Deferred Action for Childhood Arrivals (DACA) on patient outcomes. A cohort of 283 patients, including 48 undocumented individuals, who received their first kidney transplant as children between 1998 and 2011 was analyzed. There was no significant difference in unadjusted all-cause (P = .91) and death-censored (P = .38) graft survival between undocumented patients and patients with permanent legal status, subsequently referred to as US residents. Additionally, in the Cox proportional hazards model, immigration status was not significantly associated with all-cause graft survival (hazard ratio 0.87, 95% CI 0.51-1.46, P = .6). Telephone interviews were conducted with the undocumented cohort. Forty-one of 48 of the undocumented recipients were contacted. Ninety-five percent had access to insurance with 68.3% on Medicaid or Medicare. DACA recipients exhibited higher employment rates (88% vs 67%, P = .11) and were more likely to complete a degree beyond high school (47.1% vs 12.5%, P = .01). Immigration status did not impact long-term graft survival, suggesting eligibility expansions for state-funded insurance and DACA may improve access to transplant care for undocumented patients. Moreover, DACA recipients showed trends toward increased employment and education compared to non-DACA recipients.

Persistent Gaps in Protection: Stateless and Forcibly Displaced in Ukraine and Abroad

Since the Russian invasion of Ukraine, beginning in February 2022, millions of Ukrainians have fled their homes. Among the forcibly displaced are stateless persons who lived in Ukraine prior to the war, who are particularly vulnerable because they do not possess any nationality. Unable to prove their identity, stateless internally displaced persons and refugees experience numerous challenges along their flight routes. The measures adopted by European countries to support Ukrainian refugees have been successful in many ways, but insufficiently consider the situation of stateless persons. This article explores the protection gaps in the laws of Ukraine and neighbouring countries, as well as at the European level, and critically evaluates those gaps in light of the relevant international protection regimes, ie, international statelessness law, international refugee law, international and European human rights law and international humanitarian law. From the analysis, it can be concluded that possession of identity documentation and legal status remain crucial conditions for crossing borders and accessing protection.

A model of collaborative immigration advocacy to prevent policy-based trauma and harm.

Research suggests that antiimmigrant policies enacted in the United States, magnified during the 2016-2020 period, propagate widespread trauma across communities of immigrants (von Werthern et al., 2018). While these policies harm all groups of immigrants, structural conditions (e.g., lack of documentation status, race, ethnicity, country of origin, and other social and legal determinants) shape how they are experienced. To address the widespread traumatic harm inflicted by racist and xenophobic policies, a group of leaders from eight Divisions of the American Psychological Association (APA) and the National Latinx Psychological Association (NLPA) launched an Interdivisional Immigration Project (IIP). The IIP served to develop a model for collaborative advocacy, bringing together mental health providers (i.e., psychologists, social workers), allied professionals, and immigration activists from community organizations across the country. This model was developed over the course of 1 year, coinciding with the global coronavirus disease 2019 (COVID-19) pandemic and the amplified movement for racial justice. This article describes the key components of the IIP collaborative advocacy model: (a) structuring leadership in a democratic and egalitarian manner, (b) centering and uplifting immigrant voices, (c) forming teams across five U.S. regions, (d) facilitating critical dialogues grounded in liberatory practices, (e) centering trauma and empowerment, and (f) developing advocacy strategies. The IIP collaborative advocacy model is informing advocacy to protect immigrants from harm. This model may be used as the basis for ongoing humane immigration policy activism that centers the voices of community activists, and that pushes psychologists and allied professionals to use their positionality to support community-based efforts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Large language models to evaluate racial discrepancies in performance status assignment.

1561 Background: Oncologic treatment eligibility relies heavily on “Performance Status” (PS), a subjective gauge of a patient's overall health. Despite frameworks aimed at quantifying PS, these assessments remain prone to potential bias. A systematic evaluation of discrepancies in language between ECOG PS and race has yet to be conducted. Large language models (LLMs) have the ability to synthesize text and may enable an assessment of the relationship between race, note text, and physician-documented PS. We hypothesize that LLMs can quantify these relationships to understand potential inconsistencies in ECOG PS. Methods: In our single-institution cohort study, we examined patients from medical or radiation oncology clinics between January 2012 to December 2023 with documented ECOG PS. PS was extracted from clinical notes and redacted from downstream analyses. Notes were categorized by patient-reported race (Asian, Black, White, Other). 1,500 matched subjective assessments (from oncologist clinical notes) and PS were randomly sampled for each race, except for Black patients, where only 640 entries were available. We divided training and test sets using an 80-20 ratio across each race. Using the training cohort, we trained race-specific models to assign ECOG PS based on subjective assessment, using two LLMs: UCSFBERT (BERT pretrained on UCSF data) and RoBERTa. In the hold-out test sets, we applied each model across all races to assign ECOG PS based on subjective assessments. These were evaluated by micro-F1 (model accuracy) and Multiway ANOVA to compute model-specific p-values. Results: 13.6% of patients had a documented ECOG 2+, with variation across races (Asian: 16.1%, Black: 17.7%, White: 7.7%, Other: 15.3%). Models tended to assign Black patients with ECOG 0-1 with worse performance status (ECOG 2+). Other than RoBERTa models trained on Asian and White cohorts, all models trained on a specific race showed disparate classification results when applied to other races (out-of-domain), highlighting potential biases in LLM models trained where a specific race predominates (Table; ANOVA). Conclusions: This study demonstrates a novel way to use LLM to assess discordance within physician documentation and performance status assignment. It underscores the need for incorporating diverse demographic data when using LLM in medical contexts. This research has potential to dissect how bias may be propagated within physician practice and provide insight into known disparities in clinical trial enrollment and standard of care implementation.[Table: see text]

The Role of Stigma and Resilience in Healthcare Engagement Among Transgender Latinas in the U.S. South: Baseline Findings from the ChiCAS Study

Research demonstrates that stigma and resilience influence transgender peoples’ healthcare use. Less is known about transgender Latinas in the U.S. South who face multilevel barriers to healthcare access. We used baseline data from the ChiCAS intervention study. Using logistic regression, we examined how stigma (perceived discrimination related to gender identity, race/ethnicity, sexual behavior and perceived documentation status and internalized transphobia), and resilience (ethnic group pride and social support) are associated with two healthcare outcomes (use of routine medical care and medically supervised gender-affirming hormones). We also explored barriers to accessing both types of care. After removing 13 participants with missing data, our sample size was 131 transgender Latinas in the U.S. South. Most participants (74.8%, n = 98) received routine medical care in the past year and 57.3% (n = 75) had ever received medically supervised gender-affirming hormones. Reports of discrimination were highest for gender identity and documentation status. Race/ethnicity-based discrimination was positively associated with accessing routine medical care in the past year (OR = 1.94, p = 0.048). Having more social support was positively associated with care (routine care: OR = 3.48, p = 0.002 and gender-affirming hormones: OR = 2.33, p = 0.003). The most commonly reported barriers to accessing both types of care included cost, insurance, and not knowing where to go. Findings highlight the importance of social support for healthcare use among transgender Latinas. Social support may be especially important when considering the unique experiences of discrimination faced by transgender Latinas in the U.S. South.

State Public Insurance Coverage Policies and Postpartum Care Among Immigrants

(JAMA. 2023;330(3):238–246) While physicians and professional medical organizations advocate for routine postpartum care for adults, some states impose restrictions on public insurance coverage for undocumented immigrants and immigrants granted legal documentation status within the past 5 years. The aim of this study was to investigate the relationship between public insurance coverage and postpartum care among low-income immigrants and to determine the difference in postpartum care receipt between immigrants and nonimmigrants.

The embodiment of exclusionary displacement pressure: Intersections of housing insecurity and mental health in a Hispanic/Latinx immigrant neighborhood

Gentrification, growing income inequality, urban development, and the affordable housing crisis necessitate understanding the impact of the concern of displacement on health — prior to or even in the absence of a displacement event. In this paper, I use the term “exclusionary displacement pressure” to unify the literature on exclusionary displacement and displacement pressure, highlighting the disproportionate and inequitable impacts of displacement pressure among communities of color. Through following 35 residents over 2.5-years (2019–2022) in one predominantly low-income Hispanic/Latinx immigrant neighborhood in Denver, Colorado, I examine how exclusionary displacement pressure shapes their health and wellbeing over time. Through paying attention to how participants' lived experience is shaped by structural vulnerability (e.g. lack of documentation status, inadequate work, limited access to safety net systems), I identify how exclusionary displacement pressure is constantly internalized and responded to as a unique embodied health experience, wearing on individuals over time and reproducing population health inequities. The framework of embodied health experiences captures the wide range of health-related impacts, from diagnosable health conditions to idioms of distress, using participant's own language of suffering to express how they were feeling, battling, and enduring the pressure. Theorizing on structural vulnerability within specific subpopulations with intersecting identities, such as low-income immigrant Hispanic/Latinx communities, provides a bottom-up refinement to existing theories of embodied health. Understanding the place-health experiences of individuals in changing neighborhoods over time is also critically important to define time points at which context-specific supports and interventions are appropriate.

Immigration documentation statuses evoke racialized faceism in mental representations

U.S. immigration discourse has spurred interest in characterizing who illegalized immigrants are or perceived to be. What are the associated visual representations of migrant illegality? Across two studies with undergraduate and online samples (N = 686), we used face-based reverse correlation and similarity sorting to capture and compare mental representations of illegalized immigrants, native-born U.S. citizens, and documented immigrants. Documentation statuses evoked racialized imagery. Immigrant representations were dark-skinned and perceived as non-white, while citizen representations were light-skinned, evaluated positively, and perceived as white. Legality further differentiated immigrant representations: documentation conjured trustworthy representations, illegality conjured threatening representations. Participants spontaneously sorted unlabeled faces by documentation status in a spatial arrangement task. Faces’ spatial similarity correlated with their similarity in pixel luminance and “American” ratings, confirming racialized distinctions. Representations of illegalized immigrants were uniquely racialized as dark-skinned un-American threats, reflecting how U.S. imperialism and colorism set conditions of possibility for existing representations of migrant illegalization.

Attitudes Toward Police and Judges of Latina Immigrants With a Justice-Involved Child: Do Documentation Status and Family Deportations Matter?

Immigrants who are undocumented or who have experienced the deportation of family members may perceive legal actors such as police and judges differently than immigrants who are legal residents. Among a sample of 117 Latina immigrant women in California whose sons were arrested, we found that women who were undocumented had more negative specific attitudes toward police (i.e., stemming from their experience during their son’s arrest), and women with a history of family deportations had more negative general attitudes toward police (i.e., considering the police as an abstract group). Attitudes toward judges were neither associated with documentation status nor family deportations, suggesting that the association is unique to police during an era when police are increasingly involved in immigration enforcement.

Seeking care across the US-Mexico border: The experiences of Latinx and Indigenous Mexican caregivers of children with asthma or respiratory distress

BackgroundMany Latinx and Indigenous Mexican populations in the United States Southwest live in unincorporated communities in the US-Mexico borderlands called colonias. These environmental justice communities often lack basic infrastructure, including healthcare services, prompting many to seek services across the border. However, due to geopolitical factors more vulnerable caregivers are limited to utilize healthcare services in the US. This paper reports the experiences and healthcare decision-making of caregivers living in colonias in the US-Mexico border region who care for children with respiratory health conditions. MethodsThis study was carried out from September to December 2020. Focus groups and interviews were conducted with Latinx and Indigenous Mexican caregivers of children with asthma or respiratory distress. Qualitative interviews elicited caregivers' perspectives on the environmental factors affecting children's chronic health conditions and use of healthcare services. The analysis employed the concept of structure vulnerability to theorize geography as a structural determinant of health for caregivers faced with making healthcare decisions for their suffering from respiratory health conditions. A survey was administered to collect basic sociodemographic information. ResultsA total of 36 caregivers participated in the study. Structural factors including unincorporated community status and government inaction intersected with social determinants of health to prompt caregivers to cross the US-Mexico border to access healthcare services in Mexico for their children. Yet, more vulnerable caregivers (i.e., those without documentation status in the US) and their children, accessing healthcare services in the US was not an option limiting caregivers' ability to meet their children's healthcare needs. In such cases, geography acts as a structural determinant of health. ConclusionThis study shows the importance of geography in health. Rural unincorporated colonias located in the borderlands are precariously located and lack basic critical infrastructure including healthcare access. Within such places, historically and socially marginalized populations become invisible, are subject to the health effects of environmental hazards, and are limited depending on their positionality and thus vulnerability to healthcare services.

Provider Perspectives on Multi-level Barriers and Facilitators to PrEP Access Among Latinx Sexual and Gender Minorities.

Although pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention intervention, inequities in access remain among Latinx sexual and gender minorities (LSGM). There is also a gap in the PrEP literature regarding providers' perspective on access inequities. This qualitative case study sought to explore barriers and facilitators to PrEP engagement in a community-based integrated health center primarily serving Latinx populations in Northern California. We conducted in-depth, semi-structured interviews with providers (9/15) involved in PrEP services and engaged in a constructivist grounded theory analysis consisting of memoing, coding, and identifying salient themes. Three participants worked as medical providers, three as outreach staff, and one each in planning, education, and research. The analysis surfaced four themes: geopolitical differences, culture as barrier, clinic as context, and patient strengths and needs. Participants referenced a lack of resources to promote PrEP, as well as the difficulties of working within an institution that still struggles with cultural and organizational mores that deprioritize sexual health. Another barrier is related to sexual health being positioned outside of patients' immediate needs owing to structural barriers, including poverty, documentation status, and education. Participants, however, observed that peer-based models, which emboldened their decision-making processes, were conducive to better access to PrEP, as well as allowing them to build stronger community ties. These data underscore the need for interventions to help reduce sexual stigma, promote peer support, and ameliorate structural barriers to sexual healthcare among LSGM.

“The spirit of a fighter”: Mixed‐status Latine immigrant families' experiences during COVID

AbstractObjectiveUsing a community‐based participatory research (CBPR) approach, this study documents Latine immigrant families' work, childcare, and education experiences during the COVID‐19 pandemic to inform policy and practice to support Latine families.BackgroundLatine immigrant communities, comprising undocumented and mixed‐status families, were among the hardest hit by the COVID‐19 pandemic. In addition to employment and housing challenges, children and families lost access to the important academic supports and social services built into childcare programs and schools.MethodFor this study, we collected in‐depth qualitative interview data from mothers who were immigrants from Central America and Mexico (N = 23) as part of an ongoing CBPR project. Using community coding techniques, data were analyzed in partnership with our Community Advisory Board, Amigas de la Comunidad.ResultsIn the context of illegality, participants and their families who already feared deportation and family separation, faced added burdens during the pandemic including job loss, school and childcare closures, and isolation. Parents worried about meeting their families' basic needs, getting sick, losing loved ones to COVID‐19, and being evicted from their housing.ConclusionWhile participants shared stories of resilience and resistance, they also reflected on stories loss and hardship—experiences that were exacerbated by anti‐immigrant laws and policies that made navigating the pandemic especially punishing for immigrant families.ImplicationsOn the basis of study findings, program and policy implications for serving Latine children and youth and their immigrant parents, especially those with mixed documentation status, are discussed.

Wage Theft of Nepali Migrant workers in Destination Countries: Grave Violation of Migrants’ Right

Wage theft is the grave violation of human rights and labour law of migrant workers which varies with background characteristics of migrants. Despite the international and national legal and policy provisions, the issue of wage theft has been increasing over time which compounds with the humanitarian crisis. The main objective of this article is to examine the drivers of wage theft of Nepali migrant workers at destination countries. Cross sectional design was used in this study in which 241 Nepali migrants were interviewed who were returned from Gulf Cooperation Council (GCC) countries, Malaysia and other countries. Of the total respondents majority were from age group 25-29 (26.14%), from Janajati caste (38.17%), married (78.42%) and from Koshi Province (33.20%). The duration of stay, documentation status, status and places of case filing of Nepali migrant workers has the strongest effect on implementation of salary agreement [24 months and above (OR=20.397, CI: 4.345-95.739), undocumented status is significantly lower i.e. (OR=0.278, CI: 0.147-0.526), and the absence of case file (OR=7.362, CI: 3.437-15.768)]. Similarly, the unpaid status of Nepali migrant workers is also significantly associated with duration of stay and caste/ethnicity [6-12 months (OR=16.6333, CI: 2.548-108.589) and Dalit (OR=0.763, CI: 0.202-2.885),]. The level of education and knowledge on minimum salary is also significantly associated with coercive working situations [lower secondary (OR=0.047, CI: 0.012-0.178) and having no knowledge (OR=0.993, CI: 0.509-1.938)]. The study reveal the fact that the prevalence of wage theft among Nepali migrant workers is high among migrant living in longer period of time, migrants with knowledge on minimum salary, illiterate migrants, undocumented, migrants without agreement paper, and low paid migrants. For improving both working situation and full with timely payment, the migrant sending and receiving countries need to adopt proper legal and policy provisions with their effective execution.

'I Don't Know What Tomorrow will Bring': Understanding COVID-19’s Impact on the United States’ Stateless Population

In March 2020, COVID-19 was declared by the World Health Organisation (‘WHO’) as a global pandemic. Since the WHO’s declaration, it has become increasingly clear that the most vulnerable communities have experienced the brunt of the pandemic. Though race, ethnicity and economic status are considered in a majority of reports on the social, physical and financial impacts of COVID-19, there is little to no information on the impact of COVID-19 on stateless communities within the United States (‘US’). This research endeavours to add to the understanding of statelessness in the US by determining the impacts of COVID-19 on stateless people in the US through a survey scoping project. Through anonymous questionnaires completed by stateless individuals (n=19) in the United States, this study explores how stateless individuals have been impacted by the pandemic, including experiencing economic hardships, mental health challenges, physical health concerns and issues with documentation and legal status.

Nursing Care Plan Documentation Status and give Suggestions to Improve the Same

Nursing Care Plan Documentation Status and give Suggestions to Improve the Same

“What should I do? We still have to go to work”: Latino immigrant perceptions of the COVID-19 pandemic and vaccine

PurposeThe COVID-19 pandemic disproportionately impacted Latinos across the United States though data on emerging immigrant communities is lacking. The purpose of this study is to better understand how Latino immigrants were impacted by the COVID-19 pandemic, allowing a community health clinic in Charlotte, North Carolina to quickly respond to their needs.Design/methodology/approachA mixed method, rapid appraisal using community-based participatory research approaches conducted in February to April 2021 by a team of bilingual researchers. Project consisted of a Spanish, electronic survey distributed through community leaders and in-person interviews conducted in Spanish at COVID-19 vaccine clinics. SPSS Version 26 was used for quantitative analysis. Ordinal and binary logistic regression tests were performed to assess the associations among several outcome and four predictor variables: documentation status, status of health insurance, level of trust in the vaccine and place of birth. Qualitative analysis used rapid appraisal and grounded theory approaches.FindingsLatino immigrants experienced job and income loss, resulting in difficulty paying for food, housing and health care. Participants experienced emotional and financial stress and isolation from family. Undocumented immigrants were more likely to experience detrimental impacts than documented immigrants. Most wanted the vaccine but felt barriers like trust and insurance may prevent them.Research limitations/implicationsFindings from this study are locally relevant to Latino immigrants living in the Charlotte area of North Carolina and findings may not be generalizable to other Latinos. Participants were recruited through faith networks and those who are not connected may not be represented. In addition, interview participants were sampled during vaccination clinics and likely had positive views of the vaccine.Practical implicationsAs a direct result of this project, community health clinic (CHC) held vaccination clinics to instill more confidence in the vaccination process. Spanish-speaking staff were available to assist with paperwork and answer questions onsite. The importance of familismo in decision-making and the reported presence of misinformation about the vaccine prompted CHC to continue providing accurate information about the vaccine in Spanish, and to strategize marketing materials to reflect a family-centric approach to better appeal to Latinos. Findings were used to obtain funding for expansion of clinical and behavioral health services in the community through mobile units, increasing accessibility for Latino immigrants.Originality/valueTo the best of the authors’ knowledge, this was the first study to examine the effects of the pandemic on a growing and disproportionately underrepresented group in an emerging immigrant state. Findings informed culturally competent COVID-19 vaccine clinics, marketing strategies and the expansion of medical and behavioral health services for a local community clinic.

Latino migrants’ healthcare use in the US and perceived immigration laws and consequences: A multivariable analysis

BackgroundUsing healthcare, whether for routine preventative examinations, chronic condition management, or emergent conditions, is an essential element of achieving and maintaining health. Over 44 million migrants live in the US today and nearly half (44.6 %) are Latino. To the extent that immigration law-related concerns deter US Latino migrants from using healthcare, they jeopardize the health of a substantial though marginalized US subpopulation. MethodsA multistate sample (N = 1750) of noncitizen adult, Spanish speaking Latino migrants (both undocumented and documented) living in the US completed a cross-sectional survey comprising a scale assessing perceptions of immigration laws and consequences related to healthcare use and whether they had received and/or needed but did not receive healthcare in the previous 12-months. Participants were recruited in community settings and by word-of-mouth. Univariate analyses examined associations among study outcomes and common predictors of healthcare use. Multivariable analyses examined the relative contribution of perceived immigration laws and consequences on healthcare use and unmet need. ResultsPerceptions of immigration laws and immigration consequences were a significant predictor of not having received healthcare in the previous 12-months and having needed and not received healthcare in the same period, even when considered relative to common predictors of healthcare use. Immigration documentation status and preferred language predicted healthcare use in univariate analyses but not in the multivariable model. ConclusionsPerceived immigration laws and consequences related to healthcare use may influence migrants’ healthcare use. Effective interventions should be developed to address immigration-related concerns.

Optimizing Education to Improve COVID-19 Vaccination Rates in a Federally Qualified Health Center.

COVID-19 vaccination hesitancy is prevalent in underserved communities, and family medicine clinics can combat hesitancy with vaccine education. However, due to general misinformation, physicians hesitate to educate patients because doing so can create conflict. A series of resident-run, team-based quality improvement projects were conducted at a federally qualified health center every 4 months between June 2021 and May 2022. First, staff documentation of vaccine status was addressed. Second, physician and staff education about COVID-19 vaccines was completed along with motivational interview training to avoid conflict with patients. Third, patient COVID-19 vaccine education was addressed. After Cycle 1, COVID-19 vaccine documentation status increased the number of patients who completed the vaccination series from 1% to 22%. Cycle 2 showed an increase in COVID-19 vaccination rate after health care team education. This reflected an increase from 35% to 76% of residents reporting that they discussed COVID-19 vaccines with unvaccinated patients after the intervention. Cycle 3 fought vaccine misinformation by educating patients. Most patients heard information about COVID-19 vaccines from friends and family (95%), social media (90%), and the news (80%). Physician confidence in providing COVID-19 vaccine education to patients increased from 2.8 (< somewhat confident) to 4.3 (moderately confident) out of 5 over 3 plan-do-study-act cycles. Vaccination rates were tracked alongside physician surveys regarding the experience of offering the vaccine to patients. Vaccination rates steadily increased over time, and physicians became more confident in COVID-19 vaccine discussions with patients. Primary care physicians are needed to approach public health concerns, such as vaccination completion, but ongoing education is also needed to promote confidence in health care pathways.

“I Don’t have a Pile of Money to Take Care of Things”: Financial Stress and Housing Insecurity Among Low-Income Hispanic/Latinx Immigrant Families During COVID-19

Housing, the single largest expense for low-income individuals, is inherently tied to economic security. During the COVID-19 pandemic, Hispanic/Latinx and Black communities experienced the highest rates of income loss, basic needs insecurity, and COVID-19 hospitalization and mortality. As part of an ethnographic case study, I conducted serial interviews over two years with 35 predominantly low-income Hispanic/Latinx immigrant families in one Denver, Colorado neighborhood during the COVID-19 pandemic. These interviews revealed that very few of these individuals were able to access governmental financial support as a result of limited dissemination despite facing unemployment, underemployment and rising rents. Although governmental financial support forestalled poor outcomes for many US families, these financial interventions were inaccessible for low-income Hispanic/Latinx immigrant families because of their documentation status and/or language barriers. Given no other options, families coped with their increasing economic insecurity by cutting back on non-essential items, doubling-up housing with other families, and relying on nonprofit emergency food assistance in order to maintain stable housing. These experiences highlight the need for further dissemination of information about supportive interventions, which can increase economic security among low-income immigrant families and non-English speaking communities. In tandem, policy efforts related to economic security are needed to mitigate the burden of wealth inequities through poverty-reduction programs, pathways to citizenship, and access to basic needs security – including safe and affordable housing, food security, health-promoting resources, and living wage work.