ProviderResourceGuide:

Caringfor Newcomers inNovaScotia

Version 3.2

Date:Updated February27, 2017

UpdatedJanuary 3, 20171 | Page

Provider Resource Guide: Caring for Newcomers to Nova Scotia

Table of Contents

Introduction

Clinical Considerations

Post Arrival Health Assessment

Mental Health

Oral Health

TB Screening/Skin Testing

Resources

Transitional Health Clinic for Refugees (NSHA)

IWK Health Centre

Support for Children, Youth and Families

Interpretation Services

Pharmacare

811

Emergency Health Services (EHS)

Continuing Care

Administration

Medical Services Insurance (MSI)

Interim Federal Health Program (IFHP)

Annex A - Tips and Guidelines

Annex B – Comprehensive Health Record Example

Annex C – Patient’s Clinical Information

Annex D – Immunization Tables

Annex E - Contact Information

Annex F - Positive Patient / Client Identification

Annex G - Links and Resources

UpdatedJanuary 3, 20171 | Page

Provider Resource Guide: Caring for Newcomers to Nova Scotia

Introduction

Thisguide supports care providers across the health system to be aware of and navigate the clinical considerations and resources for newcomers to Nova Scotia. The focus of this guide is to provide an overview of the relevant programs and supports for Newcomers to Nova Scotia. This guide does not include policies for foreign visitors to the province and individuals on temporary work and study visas. These individuals require private coverage for all health services.

The term ‘Newcomer’ encompasses both immigrants and refugees. Immigrants have chosen to resettle in another country, whereas a refugee is someone who was forced to flee their home for a variety of reasons. Immigrants have access to the same resources as all Nova Scotians including income assistance and pharmacare. In addition, immigrants are able to access the wealth of supports from the Immigrant Settlement Association of Nova Scotia (ISANS), and in the rural communities, from the YMCA Y-Reach program. This programming ranges from language classes, employment supports, housing and many others. In contrast, refugees have access to additional supports during their settlement period which will be highlighted throughout the remainder of this guide.

According to o Immigration, Refugees and Citizenship Canada (IRCC), theCanadianrefugeesystemhastwomainparts: theRefugeeandHumanitarianResettlementProgram, forpeopleseekingprotectionfromoutsideCanada,forexample,GovernmentAssistedRefugees (GARs), the Blended Visa Office Referral Program (BVOR) and PrivatelySponsoredRefugees (PSR);andtheIn-CanadaAsylumProgramforpeoplemakingrefugeeprotectionclaimsfromwithinCanada(refugeeclaimants).Pleasevisitthefollowingwebsiteformoreinformationon Canada’s refugeesystem:

To help understand the settlement process, consider the following:

  • The federal government may complete medical screening prior to Newcomers departing their country of origin
  • Dental, vision and hearing screening is not part of the medical treatment prior to settlement

Health benefits for refugees are available for one year after their arrival in Canada under the Interim Federal Health Program (IFHP)

Clinical Considerations

The following section outlines a variety of components that will impact patient care. In some cases, approaches to care will be suggested based on best practice for refugee care as well as clinical experience. Annex A lists relevant tips and guidelines.

Post Arrival Health Assessment

The Post Arrival Health Assessment (PAHA) is the initial interaction with the arriving family and health care provider. Annex Bshows the Comprehensive Refugee Health Record used in the Transitional Health Clinic for Refugees (THCR) as a guide. This has been created by the THCR physicians based on Refugee Health Guidelines published by Kevin Pottie et al. (2011) (

There are links to various resources for providing primary care to refugee patients from the College of Family Physicians of Canada:

Normally the PAHA would occur within 1-2 weeks of arrival to the community, however, more pressing issues such as housing and social supports can modify this timeline if there are no urgent or emergent health concerns identified.

The PAHA will take longer than a regular office visit, and is done as a family, where applicable. It will require even more time if there are more adults in the family, as adults typically have more health needs than the children. For example, a (typical) five member family is usually booked for 1.5 hours for their PAHA with the primary care provider. When done individually, these should be scheduled for 30 minutes per person.

Prior to beginning the assessment, introductions should be done as well as an explanation of how the office works and when to book an appointment. Patients will arrive with varying experiences with health care which may differ widely from the Canadian approach to care. An overview is provided of the system in NS (routine appointments, urgent appointments and emergency department usage) as well as the social requirements around being on time for appointments. Patients need to be advised of patient confidentiality (especially important for women and adolescents).

Urgent health concerns for any of the family members should be addressed in this initial appointment, and bookings for more personal screening when appropriate (e.g Pap tests for women, etc).

Women should be offered contraception during the first visit and this should be discussed with her alone if possible.Patients often prefer IUDs. The federal formulary does not have coverage for this, but you may be able to get one for free from the SOGC compassionate program The Mirena is covered by the provincial formulary.

Screening should include routine baseline blood tests, age appropriate screening for diseases as well as screening for infectious diseases as listed on the comprehensive refugee health record as attached. It should be noted that Syria, Turkey, Lebanon and Jordan are not malaria endemic zones. However it is important to determine if any of your refugee patients have been in a malaria endemic zone, and you should have a low threshold to send them for a malaria smear if they have signs/symptoms of malaria.

There may be a high prevalence of mental health issues, such as Post Traumatic Stress Disorder (PTSD) in this population, however it is not recommended to do a routine screening for these. Any urgent or severe mental health issues do need to be addressed immediately, however, there may be some PTSD like symptoms initially that may diminish once the family has been established in their permanent residence in NS (detailed information is included in the Mental Health section of this guide).

The first round of vaccinations is usually booked as a separate appointment (detailed information is included in the immunization section of this guide – see Annex D).

Assessing the family members’ health literacy will occur over time, however it is important to assure the family will be able to access medications you have prescribed and understand how to get refills, and how to seek interpretation services when they need it right away. It is also extremely important to ensure patients understand any chronic conditions, and if they will need to continue taking their medication long term (important for managing hypertension, diabetes, cholesterol, hypothyroidism, etc).

Additional resources for preventative and primary care for refugees are here: (For Syrian Refugees) and (a good resource for children)

In order to ensure access to basic medical information for all new refugees, completed PAHA’s will be scanned and shared with the Horizon Patient Folder (HPF). If your patient’s PAHA was done by another provider and you would like to view it, call 1-877-410-0014 or fax a request on your letterhead including patient name, health card number and date of birth to (902) 473-4999. If you have completed a PAHA, this information should be made available to other providers. Please fax a copy to (902)-473-4999. The detailed process for this can be found in Annex C.

Mental Health

NovaScotiaHealthAuthorityand IWK Health Center haveidentifiedpsychiatristsandstaffwhospeakmultiple languagestoassist withtranslationservices.Allreferrals for mentalhealthand addictions will continue tobeaccessedbycontactinglocalmentalhealthandaddictionsservices.Thiswillinclude screeningforPTSD.Staffhavebeenidentifiedtoprovidespecializedtherapyasrequiredforthisdiagnosis.

Incaseswithmoreurgentneeds,orforquestionsafterhoursandontheweekends,anywhere inNovaScotia,contactMentalHealthMobileCrisis(youthandadults):available24hoursa day, 7 days a week at 1-888-429-8167,withinterpretationservicescapability.

CanadianMentalHealthAssociation(CMHA)has printedresourcesoncommonmentalhealthandaddictionsconditionsinmultiplelanguages,includingArabic.Tolearnmore,pleasevisit:

Oral Health

Accesstooralhealthcarecanbeachallengeforrefugees.Connectwithyourlocalsettlementagency(ISANSorYMCAYReach) forassistancewithaccesstooralhealthcare.Similarly,publichealthdentalhygienistsoftenhavelocalrelationshipsthatmayaidinsortingthroughtheseissues.FeelfreetocontactyourlocalPublicHealthofficetoseewhat assistancemaybeavailable.ThiscontactinformationcanbefoundinAnnex F.

TB Screening/Skin Testing

Newcomers may be atriskforacquiringtuberculosisduetoexposureinrefugeecampsandover-crowdedlivingconditions.ThisriskisamplifiedforthosecomingfromTBendemiccountries(incidenceof30per100,000peryear).ScreeningforlatentTBinfection(LTBI)isadvisableinimmigrantsandrefugeesfromthesecountries.Forpatientspresentingwithsymptomsconsistentwithtuberculosis,aCXRisrecommendedtoruleoutactivedisease.

NewcomersarrivinginNovaScotiamay haveundergonescreeningforactivetuberculosis(i.e.history, physicalandchestx-ray)aspartoftheirImmigrationMedicalExamination. Routinescreeningforlatenttuberculosisinfection (LTBI) withTuberculinSkinTest(TST)isNOTrecommendedforallimmigrants.YoucanrequestbaselineCXR(ifcompleted)ormedicalinformationfromimmigrationexamonacasebasis- email:.

“ThegoaloftestingforLTBIistoidentifyindividualswhoareatincreasedriskforthedevelopmentofactiveTB and thereforewould benefitfrom treatmentofLTBI.Onlythosewhowould benefitfrom treatmentshouldbe tested, soa decisiontotest presupposesadecisiontotreatifthetestispositive”(CanadianTuberculosisStandards, 7thedition).

ContactyourlocalPublicHealthofficeorthe TransitionalHealthClinicforRefugeesforTSTscreeningrecommendations,administrationandreadingofTSTresultsforindividualpatients. SeecontactinformationinAnnex E.

Resources

Transitional Health Clinic for Refugees (NSHA)

The Transitional Health Clinic for Refugees (THCR) provides preventative health and primary medical services for government assisted refugees, privately sponsored refugees and refugee claimantsin the greater Halifax area. Patients are supported with finding and transitioning to a family practice in the community within a two-year period.

There are a number of resources for Newcomers available on the THCR web site at

IWK Health Centre

The IWK Health Centre works with the NSHA to plan and support newcomer families as they arrive and settle in Nova Scotia. Key things to note regarding the IWK for Health Care Providers would be:

  • GeneralInformation

Normalreferralandtriageprocessesareinplaceacrosstheprovinceforspecialistaccess.TheIWKhasaninterpretationoflanguagespolicy,andhasaccesstoface-to-faceandtelephoneinterpretationforallprogramsacrosstheHealthCentre.

  • Women’s Health

The IWK has a specialty clinic for women with physical disabilities and/or functional limitations. This clinic has accessible equipment and facilities; including power female procedures chair system. This clinic is available to women through self-referral; to make an appointment please call 902-470-7432.

  • Prenatal Care

If there is a need for referral to IWK Family Practice Prenatal Care, the referral needs to specify exactly that. If it does not specify IWK Family Practice Prenatal Care, the referral will be sent to Obstetrics to be triaged. Once the referral clearly specifies IWK Family Practice Prenatal Care the referral can be faxed to the Perinatal Centre booking office at 902-470-7467. The phone number to the office is 902-470-6445 and the name of the booking clerk is Leslie Slaunwhite.

  • Pediatrics

Referrals will be received and triaged as per usual processes for children and youth up to their 16th birthday.

  • Mental Health and Addictions

The IWK Mental Health and Addictions programs and services are available through usual referral and triage, for any issues that are significant or prolonged. Services are available at the IWK for youth up to their 19th birthday. Please follow routine referral procedures, i.e. central referral or Emergency Department as appropriate for children and youth up to their 19th birthday.

  • Emergency Department

The Children's Emergency Department at the IWK Health Centre is available to provide care for any unscheduled illnesses or injuries. Medical care is provided until the 16th birthday, and mental health care is provided until the 19th birthday. The contact information for health care provider referral is 902-470-8050 with the Charge Nurse being the most appropriate contact. Telephone interpretative services are available to assist in providing care.

Support for Children, Youth and Families

  • Canadian Pediatric Society – Caring for Kids New To Canada Guide

Thiscomprehensiveonlineguidehasinformationonawiderangeoftopics,includingmedicalassessmentofrefugeechildren,adaptationandacculturation,Post-traumaticstressdisorder, etc.Thewebsitealsofeaturesresourcestohelpfamiliesnavigatethehealthsystemandtomakeconnections withlocalcommunities.

  • American Psychological Association

Working with Refugee Children and Families: Update for Mental Health Professionals

Interpretation Services

Interpretationservicesareessentialindeliveringcaretoyourpatient.Whenpatientshave limitedEnglishskills,theyrequireaninterpreterforbothunderstandingthelanguageaswellasexplainingmedicalterminology.Thisisalsoimpactedbytheculturalunderstandingofhealthandhealth carein theCanadian context.Patients mayindicatethey understandwhatprovidersaresayingtobepoliteandrespectful,althoughtheircomprehensionofinstructions orexplanationmaybequitelimited.Aninterpretercanensurethepatientfullyunderstandswhatyouhavediscussedduringyourinteraction.Patients newtoCanadawillneedtohaveexplanationoninformedconsentandtheirhealthcarerights.

Thiscanbeoneofthemostchallengingaspectsofcaringforyourpatients.Inthecommunity, weexpectpractitionerswillnothavefundingforfacetofaceinterpretationbutallproviderswillhaveaccessto phoneinterpretation.

Newcomers may begivenalanguagelinecardwithdual language informationonitdescribinghowtoaccessinterpretationservices.Intheeventthatapatientarrivesin youroffice and doesnot have their card, pleasecall 1-844-590-7765.

Whenusinganinterpreter,itisimportanttomakeeyecontactandlookatyourpatient,not theinterpreter(thiscantakepractice).Generallyspeaking,usingfamilymembersasinterpretersisnotrecommended;however,itisoftendoneasalastresortorinemergency situations.Judgmentshouldbeusedwhenworkingwithfamilymembersasinterpretersaroundtheappropriatenessbasedonthetestorservicethatisbeingdone.Forexample, usingateenagesonasinterpreterforamothertoexplainaPAPtest.TherisksinvolvedifyoudonotuseatrainedinterpretercanbefoundontheNSInterpretiveServiceswebsite.

Pleasenote:theIWKHealthCentrehascontractswithagenciestoprovidein-personand telephoneinterpretation.ForcarebeingprovidedattheIWK,pleasefollowthestandard policyandproceduresforaccessinginterpretationandlanguageservices.

AquickreferenceguideinhowtouseLanguageLinefortelephoneinterpretationisavailable fordownloadat:

Pharmacare

TheIFHPmay providecoverageforprescriptionmedicationsforoneyear . Additional information about IFHP is highlighted in the section below (Interim Federal Health Program).Additionally, assistancewiththecostofprescriptionmedicationsthroughNova ScotiaPharmacareprogramsmay be availableafterIFHP coveragehasended.

PharmaciesmustregistertobecomeanIFHPproviderbycontactingMedavieBlueCrossdirectly.Onceregistered,pharmaciesarerequiredtocontacttheirsoftwarevendorstoupdate their carriercodesso thatIFHPpharmacy claims canbe submitted electronically toMedavieBlueCross.

MoreinformationregardingNovaScotiaPharmacareprogramsmaybefoundontheNovaScotiaPharmacarewebsiteat

811

Thegoalof811istoprovidereliablehealthinformationandadvicefromaregisterednurse 24hoursperday,7daysper weekbysimplydialing8-1-1onyour home telephone or handhelddevice.Experiencedregisterednursesprovidehealthadviceandinformationonabroad rangeofhealthrelatedtopicsandsymptoms.Thisserviceisprovidedinover120languages throughathirdpartylanguageinterpretationservice.

IndividualswhorequireserviceinalanguageotherthanEnglishorFrenchoftenneed informationaboutthecallhandlingprocesstoensureaccesstothe811serviceintheirlanguageofchoice.Atanytime,onceacallermakescontactwith811 staff,theymayaccessserviceinanotherlanguagebysimplystatingthenameoftheirlanguageofchoice,“help”ortheword“interpreter”.

Emergency Health Services (EHS)

ForthefirstyearofresidencyinCanada,refugees who qualify for IFHP willnothavetopayforanyambulanceservicesutilized.Whenpossible,EmergencyMedicalCare(EMC)willcontact MedavieBlue Crossto billIFHPdirectly forany ambulancefees incurred. Insomecases,identificationasarefugee maynotbepossibleandanambulancebillmaybeissued.Shouldabillbeinadvertentlysentdirectlytoarefugeefamily who qualifies for the IFHP withinthefirstyearofresidency,the EMCBillingofficeshouldbenotifiedat902-832-8337ortoll-free1-888-280-8884.Afteroneyearofresidency,theIFHPcoveragewillexpireand refugeeswillbesubjecttothesameambulanceservicefeesasallNSresidentsholdingaMSIcard.911shouldbeusedintheeventofanemergency.Furtherdetailsonthe 911servicearefoundat:

Continuing Care

ContinuingCareservespersonswhoneedongoingcare,eitheronalong-termorshort-term basis.InNovaScotia,ContinuingCareServices,includingarangeofhomeandcommunity careandlong-termcareservices,areadministeredanddeliveredbytheNova ScotiaHealth AuthorityandfundedbytheDepartmentofHealthandWellness(DHW).1-800-225-7225connectsindividualstocontinuingcareservicesorvisitnovascotia.ca/dhw/ccs.

Administration

Medical Services Insurance (MSI)

Refugees who are legally entitled to remain in Canada, makes his or her home in Nova Scotia, is ordinarily present in Nova Scotia (at least 183 days per calendar year), is not a tourist, transient or visitor, are considered a resident and entitled to MSI coverage. The provincial health system (MSI) will be the primary payer for refugee health care costs, however IFHP will cover aspects that are not paid for by MSI. MSI insured physician services, provided both in the hospital setting and outside the hospital setting, are billed as usual through MSI; this includes any physicians who are on AFP, APP and/or Fee for Service.

MSI Inquiries: 902-496-7008

Outside Halifax/Dartmouth: Toll Free 1-800-563-8880

Fax: 902-481-3160

E-Mail:

Interim Federal Health Program (IFHP)

The Interim Federal Health Program (IFHP) provides limited, temporary coverage of health-care benefits to people in the following groups who aren’t eligible for provincial or territorial (PT) health insurance:

  • protected persons, including resettled refugees;
  • refugee claimants; and
  • certain other groups

Description of IFHP coverage

Basic coverage (similar to health care coverage from provincial or territorial health insurance plans)

  • in-patient and out-patient hospital services
  • services from medical doctors, registered nurses and other health-care professionals licensed in Canada, including pre- and post-natal care
  • laboratory, diagnostic and ambulance services

Supplemental coverage (similar to the coverage given to social assistance recipients by provincial and territorial governments)

  • limited vision and urgent dental care
  • home care and long-term care
  • services from allied health care practitioners including clinical psychologists, occupational therapists, speech language therapists, physiotherapists
  • assistive devices, medical supplies and equipment, including:
  • orthopedic and prosthetic equipment
  • mobility aids
  • hearing aids
  • diabetic supplies
  • incontinence supplies
  • oxygen equipment

Prescription drug coverage

  • most prescription medications and other products listed on provincial/territorial public drug plan formularies

Coverage for the Immigration Medical Exam (IME)

For most categories of beneficiaries, the IFHP also covers the cost of one IME and IME-related diagnostic tests required under the Immigration Refugee Protection Act

The benefits covered by the IFHP have certain limits including maximum dollar amounts. For more details, please consult theIFHP benefit grids.

The IFHP is available for qualified newcomers for a twelve month period after arriving in Canada. This entitles newcomers to supplemental health care services over and above the usual MSI. In order for service providers to qualify for reimbursement, they must pre-register through IFHP:

Please note that patients who are Refugee Claimants are not eligible for MSI and rely solely on IFHP coverage. These may include medical issues that are of a public health concern (such as TB) or some supplemental services (dental, optometry, psychological). In order to bill with IFHP, providers need to be registered. The information on the Interim Federal Health Program can be found on their website:

Pleasenote:

  • If Hearing and Speech are located within the hospital setting and provide services, the providers MUST pre-register through IFHP and bill for services.
  • Dental and Oral Surgery uninsured services, requires the providers to pre-register through IFHP and are required to bill IFHP for services rendered.

ThemedicationscoveredbyIFHP(withbasiccoverage)includethosemedicationslistedon theMSIformularyaswellasthosefoundontheirwebsite: and

ThereisalistofIFHPprovidersontheirwebsite ( patientstotheseproviders,itisimportanttocalltoconfirmtheyareacceptingimmigrant patients,assomepractitioners,companiesandorganizationshaveregisteredtobilltoIFHP, buthavedecidedtostoptheseservicestoimmigrants.Ifyourpatientsaresenttoaproviderthatdoesn’ttakeIFHPclients,theywillbegivenaninvoicetheymaynotbeabletoaffordtopay.Accessto optometry, dentaland pharmacy servicesinyour area areimportant connectionstomake.PleasenotethatIFHPcoveragedoesnotallowpatientstopayupfront, submittheir own claim, and be reimbursed. It is the health care provider who must submittheclaim.

Asaprimary carepractitioner,theinitialPostArrivalHealthAssessment(if itisnotalready completed)willbebilledtoIFHP,astherateishigherthanaregularappointment(thisassessmentrequiresmoretimethanatypicalofficevisit).TheremainingprimarycarevisitsarebilledtoMSI.TheBridgeclinicinBritishColumbiahostsawebsite ( Forquestionsaboutbilling,pleasefeelfreetocontacttheTransitional HealthClinicforRefugeesofficeat902-487-0368ortollfree1-844-762-8080.

IFHP Client Eligibility Inquiries:

IRCC Call Centre: 1-888-242-2100

Website:

IFHP Provider Inquiries:

(for registered providers and those wanting to become a provider)

Toll Free 1-888-614-1880

Fax: 506-867-4651 (general inquiries)

Fax: 506-867-3841 (claim submission)

E-Mail:
Updates

Thisguideisintendedtobealivingdocumentwith continuedupdatesbeingaddedovertime.ThemostrecentversionofthisguidecanbefoundontheNovaScotiaHealth Authoritywebsite: to this guide should be sent to :

/ Graeme Kohler
Health Services Manager
Primary Health Care/Department of Family Practice
Nova Scotia Health Authority (Central Zone)
Office: 902-487-0204
Fax: 902-454-7107

UpdatedJanuary 3, 20171 | Page

Provider Resource Guide: Caring for Newcomers to Nova Scotia

Annex A - Tips and Guidelines

  • Allowextraappointmenttimeforyourpatientsinitially,andthenyoucandecrease theappointmentlengthovertime.
  • Useanappointmentremindersystemwith interpretationtoavoidno-showsfrom yourpatientsduetoalackofgoodcommunicationorunderstanding.
  • Useeitherfacetofaceinterpretation(iffundingisavailable)orphoneinterpretation forallinteractionsuntilyourpatientiscomfortabletocommunicatewell andcanunderstandeverythingrequiredforhealthcareinEnglish.
  • WhensendingareferraltoaspecialistyoucangoontheCPSNSwebsiteandsearch physiciansbyspecialtyandlanguage ( hospitalbasedspecialists wheneverpossibletoallow forfundedinterpretationservicesforappointments.
  • Whenreferringpatientsfordental,visionoranyotherpayablespecialtyservice, checkwithlocal resources toseewhois an IFHPproviderand will seeyour patients,oryourlocalpublichealth office.
  • CollaboratewithISANS(inHalifax)oryourlocalYMCA(outsideHalifax)astheyarethe settlementagenciesforNS.Theyprovidesupportforpatientsandcanhelpfindthe programsandservicesyourpatientsmightneed.
  • Use211forsupportwithappropriatesocialprogramsforpatients. Patients canalsocalltousethisnumberthemselvesandsaytheirlanguage(e.g.“Arabic”)andthe servicewillprovideinterpretationinthatlanguage.
  • Halifax Refugee Clinic(HRC)isanon-profit,nongovernmentalLEGALclinicwithspecializedservicestoserverefugeeclaimantsthatmayalsotakeonotherrefugee/immigrationrelatedmattersonacasebycasebasis.Donotcontactthemorsend them clinicalinformation in error dueto the similar natureof the name oftheorganization.

UpdatedJanuary 3, 20171 | Page