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Page 1: Fraser Health Syrian Refugee Response Plan Refugees Response Plan_External... · High Level Summary of the Response Plan ... Between 3,000-4,000 of the incoming Syrian refugees

Fraser Health Syrian Refugee

Response Plan

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High Level Summary of the Response Plan

The Government of Canada has committed to the intake of 25,000 Syrian refugees

by the end of February 2016. Between 3,000-4,000 of the incoming Syrian refugees

will arrive in British Columbia (BC) and 80-90% of this population is expected to

settle in the Fraser Health region over time.

The Planning and Oversight Committee was convened to provide a forum for the

coordination of Fraser Health’s preparedness activities related to the arrival of

Syrian refugees and to ensure effective communication within Fraser Health and

with Fraser Health stakeholders, including other health authorities, the Ministry of

Health, local governments, NGOs, and agencies providing refugee support. Among

the objectives of the committee are:

Ensuring the effective use of Fraser Health resources by assigning clear

responsibility for tasks

Developing and implementing a plan to ensure Fraser Health is effectively

providing health services to Syrian refugees

Representing Fraser Health in externally led planning processes and

implement coordination with external partners

The committee provided oversight for the development of this response plan which

addresses the federal government’s initial announcement of 25,000 Syrian refugees

arriving in Canada throughout 2016. The plan will be revised and scaled in the

coming weeks to address any anticipated increases to the refugee numbers in

Fraser Health as a result of subsequent federal announcements.

Furthermore, while this plan is developed to address Fraser Health’s preparation for

the arrival of Syrian refugees, there is a need to ensure that the strategies are

sustained to benefit non-Syrian refugees and other vulnerable populations in the

Fraser Health region.

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Key Elements of the Plan

Key elements of this Fraser Health plan include specific programs and activities

aimed at wrapping health services around the Syrian refugee population.

Specifically, this plan outlines pre-existing and planned augmentations in the

following health and support service areas:

Health Services

Population and Public Health

Primary Health Care

Acute Care

Mental Health and Substance Use

Maternal Infant Child Youth

Support Services

Communication

Finance

Diversity Services

The plans that follow are based on an assumption that approximately 3,000

Government Assisted Refugees will arrive in BC by late February 2016, with 90%

residing in Fraser Health, 50% being children, and 75% of the children being under

12 years of age.

The following sections outline key activities to be undertaken by Fraser Health:

Community Integration Provide linkage between Fraser Health programs and services and the

services/efforts of municipalities, community organizations and interest

groups

Identify information or service gaps and escalate them as appropriate

All refugees landing in BC will meet Community Airport Newcomers Network

(CANN) settlement workers, part of the SUCCESS community agency, for a brief

orientation upon arrival at the Vancouver International Airport. While some may

travel on to their next destination outside of BC, Government Assisted Refugees will

be directed to temporary housing or Welcome House via ISSofBC, while Privately

Sponsored Refugees will go with their host sponsors to their new home.

Various departments and programs within Fraser Health will collaborate internally

to provide a coordinated response to the arriving refugees. This internal Fraser

Health response will be evolved in consultation with external partners. The internal-

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external coordination will happen through already-established partnerships,

relationships and purpose-specific meetings.

Fraser Health’s planning and preparations are focused in Burnaby and Surrey given

the expectation that Syrian refugees are most likely to resettle in these

municipalities based on historical refugee settlement patterns.

There are multiple community service agencies that provide refugees with

programs and services, generally fitting within seven categories: settlement,

language, employment, capacity building, outreach, information, and health. There

is however, variability and complexity in the reach and coverage of these services

across the Fraser Health region. Many organizations offer multiple services at single

sites, and some contract other service providers to deliver similar programs

throughout the region.

Population and Public Health:

Provide public health nurses for initial immunization screening and delivery

Provide ongoing immunization and other Public Health services through

Public Health Units and partners

Partner with Fraser Health Primary Health Care and Vancouver Coastal

Health’s Bridge Clinic to establish space for immunization screening/delivery

and initial medical screening

Population and Public Health services promote, protect and improve the health

and well-being of those living in the Fraser Health region through integrated and

collective actions. Population and Public Health services and programs include:

communicable disease prevention and control; maternal, child and family health;

environmental health; licensing of community care facilities; and healthy

living/healthier community partnerships.

To ensure that activities are evidence-based and meet the needs of the

population, Population and Public Health monitors the health of the population in

the Fraser Health region through a wide range of population health assessment

and surveillance activities. This information is made available to decision-makers,

service providers, communities and the public to inform public health action; and

to prioritize efforts to those at greatest risk.

Population and Public Health is strengthening and expanding partnerships both

internally and externally with community partners across various sectors to

maximize collective impact on population health outcomes.

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Primary Health Care:

Increase capacity at New Canadian Clinics in Burnaby and Surrey to receive

refugees arriving in 2016

Provide Primary Health Care services to 700 refugee clients currently

residing in Fraser Health receiving care through the Bridge Clinic in

Vancouver

Provide nurse practitioner for the Bridge Clinic to perform initial assessment

in Fraser Health (Guildford)

The Primary Health Care team in Fraser Health delivers primary care services

through multiple clinics across the health authority. Primary Health Care services

for refugee populations are provided in three clinics in Fraser Health: two located

in Burnaby and one located in Surrey. The clinics partner with other Fraser Health

programs and physicians to deliver disease-specific interventions and education.

The team works closely with family physicians, nurse practitioners and specialists

throughout the region to deliver services, implement new systems, and organize

learning opportunities.

“Attachment” to quality primary care for Fraser Health residents is key to its

provision. Attachment occurs when a family physician or physician group agrees to

provide longitudinal care for a patient. This means maintaining a longitudinal

patient record and providing and/or coordinating comprehensive medical care with

other health care providers.

To address attachment challenges across the region, Fraser Health and the

Divisions of Family Practice have partnered to establish Rapid Access Clinics focused

on those living with mental health and substance use in every community across

Fraser Health.

Additionally, a number of Primary Health Care clinics have been established in

partnership with the Divisions of Family Practice, such as the Global Family Care

Clinic in Burnaby, Primary Care Seniors Clinic in Chilliwack, and the South Asian

Health Centre in Surrey.

Accelerated Integrated Primary and Community Care services available in Fraser

Health include:

BreatheWell (chronic obstructive pulmonary disease)

Psychosis Treatment Optimization Program (PTOP)

Home First

End of Life Care

Community REDi (Community Reintegration and Rehabilitation Services)

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Mental Health and Substance Use:

Create capacity at New Canadian Clinics by transitioning Mental Health and

Substance Use patients when possible

Review DIVERSEcity's capacity to provide general and trauma counselling,

and explore potential for contracting general and trauma counselling

services with other key community agencies

Inform refugee clients of private resources(IFHP-funded) for trauma

counselling

Ensure Mental Health and Substance Use clinicians are aware of the

provincial refugee mental health coordinator line to access referrals and case

consultation.

Mental health and substance use disorders impact all aspects of an individual’s life

regardless of his or her age, social or economic situation, physical wellbeing and

psychological functioning. The refugee experience which can involve experiences

of profound loss, displacement and trauma may precipitate or exacerbate existing

or underlying mental illness and substance use conditions.

Fraser Health Mental Health and Substance Use services provide a continuum of

care, with services ranging from health promotion, harm prevention and

community-based care to more intensive services, such as inpatient/day treatment,

tertiary care, and housing supports.

Acute Services:

Ensure all relevant Fraser Health and partner information and plans are

shared with Acute Care staff as required

Fraser Health operates 12 acute hospitals, three of which are considered referral

centres: Royal Columbian Hospital Abbotsford Regional Hospital, and Surrey

Memorial Hospital. Each of the hospitals forms part of a network and provides

services to the local community and region. Each hospital has a unique blend of

services complementing and supported by services within the network. Fraser

Health also operates the Jim Pattison Outpatient Care and Surgery Centre, a large

ambulatory care centre offering a broad range of primary, acute and chronic

disease services that do not require an overnight stay.

Among the Acute Care program areas anticipated to be utilized most quickly by

the arriving Syrian refugees are the Emergency departments, maternal and

paediatric services in the communities of Surrey and Burnaby. Each of the Acute

Care centres is positioned within a community and network of community-based

services. Similar to the general population and depending on the health needs of

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the Syrian refugees, services will be provided wherever along the community to

acute spectrum is most appropriate.

Diversity Services:

Provide in-person workshops for Fraser Health employees about culturally

sensitive care for refugees

Provide culturally sensitive care training for Emergency staff

Ensure capacity and provision of translation and interpreter

In the context of this plan, Diversity Services’ role is to increase Fraser Health

employees’ capacity in providing high quality care to diverse populations through

education (training and resources), interpreter services (in-person or on the phone

spoken translation from one language to another using medical interpreters), and

translation services (translation of written material from one language to another).

Background

Currently, Canada has finalized 500 Syrian refugee applications while 17,500 are

still in progress. In December 2015, 6,300 Syrian refugees arrived in Toronto of

which nearly 400 were Government Assisted Refugees (GARs) who carried on their

journey to BC. It is anticipated that over 3,000 refugees will be arriving in BC by

late February 2016. Around 90% or more of these refugees are expected to resettle

in the Fraser Health region.

The exact number of refugees being brought to Canada, BC and Fraser Health in

turn is difficult to confirm. All of the volume-based plans and preparations that

follow are therefore speculative, although they do rely on the best information

available at the time of preparing this document. As new or more accurate

information becomes available, this plan will be adapted and/or scaled.

Immigration, Refugees & Citizenship Canada (IRCC) continues to publish updates

on Privately Sponsored Refugee (PSR) settlement regions and numbers. 1

Information is available on the resettlement communities of GARs on government-

sponsored flights on the IRCC website2.

All Government Assisted Refugees arriving into BC will be oriented by Immigrant

Services Society of BC (ISSofBC). Privately Sponsored Refugee sponsors are

oriented by ISSofBC and will link the people they have sponsored to the necessary

programs and services.

1 http://www.cic.gc.ca/english/refugees/welcome/map.asp.

2 http://www.cic.gc.ca/english/refugees/welcome/milestones/flights.asp

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Information shared with Fraser Health is that the overall health of the refugee

population is assessed as being generally good. Many individuals will have specific

health needs related to having experienced war in their country, and/or the difficult

living conditions of refugee camps. Health needs could be physical (e.g. injury,

chronic illness, nutritional deficits) or mental (e.g. post-traumatic stress,

depression, anxiety). The latest figures indicate that 50% of refugees are children,

of which 75% are under the age of 12.

Information regarding the health screening and coverage process collected from the

Ontario Health System Action Plan includes the following:

Refugees will be given a paper copy of their immigration medical examination

(IME) results prior to departure for Canada, and will bring it with them to

Canada.

As part of the immigration process, refugees will undergo a full immigration

medical examination overseas prior to departure. They will also undergo a

fit-to-fly assessment prior to boarding flights to Canada. Once they land in

Canada, refugees will be screened for symptoms and signs of infectious

disease by Canadian Border Services Agency (CBSA). Individuals who may

be ill will be referred to a Public Health Agency of Canada (PHAC) quarantine

officer. Quarantine officers will assess whether there is a need to apply

measures authorized under the Quarantine Act.

CBSA officers will issue Interim Federal Health Program (IFHP) Certificates,

valid for 12 months, to refugees at the point of entry. Arriving Syrian

refugees will receive type 1 health benefits3 covered under the Interim

Federal Health Program. In addition, the IFHP will also provide Syrian

refugees with coverage for supplemental services and prescription

medications.

All Syrian refugees who settle in BC are eligible for coverage under the Medical

Services Plan (MSP) and the waiting period is waived. Enrolment and coverage in

MSP is not automatic. Individuals must complete the MSP Application for Enrolment

form and provide copies of their immigration documentation confirming their

immigrant status. Once a refugee is eligible for coverage under the MSP, basic

health care coverage under the IFHP, will cease. However, the Supplemental and

Prescription Drug Coverage will continue for up to one year.

This Fraser Health Syrian Refugee Response Plan is prepared by the Planning and

Oversight Committee under the leadership of the Vice President Population and

Public Health and Chief Medical Health Officer.

3 http://www.ifhp-pfsi.ca

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Fertility rates are higher among Syrian refugees than the general population. About

50% of the refugee population is comprised of children and 75% of these children

are under 12 years of age. At this time, Maternal Infant Child and Youth

services have not been informed of any significant needs of pregnant and expecting

moms.