Case Studies

Saint Alphonsus Regional Medical Center - Culturally Appropriate Resources and Education (CARE) Clinic

Boise, ID

Far from home, a new life begins. Over the past decade, Boise has quietly become one of a select number of U.S. cities to serve as an official “resettlement” destination for international refugee families fleeing troubled regions across the globe. The refugee population resettling in Idaho has soared over the past five years, with the annual number of newly arrived men, women, and children more than doubling since 2006.

  • By 2008, more than 5,000 refugees from Africa, the Middle East, Asia, and Eastern Europe called the Treasure Valley home.
  • In 2009, a reported 1,231 refugees, asylees, and special immigrants relocated to Idaho, with the majority finding a new home in the Treasure Valley.
  • Of the refugee women who relocate to Boise, more than 50 percent are of child-bearing age. In 2008, area resettlement agencies observed that expectant mothers (including women as well as teen girls) comprise a large percentage of newly arrived refugee women; many others become pregnant shortly after arrival. In 2007, prior to the establishment of the Culturally Appropriate Resources and Education (CARE) Clinic, Saint Alphonsus estimated that of the 783 refugees who arrived in Idaho that year, nearly 150 were maternity patients who delivered their babies at its Family Maternity Center.

In 2009, the Saint Alphonsus Family Center established the CARE Maternal/Child Health Clinic, to provide highly specialized maternity and well-baby care on behalf of refugee families. CARE assists newly arrived families to adapt to the challenges of pregnancy and parenting in a new home, while respecting and honoring their culture of origin. CARE delivers culturally responsive prenatal and pediatric health care, supportive services, and parenting education outreach to address the unique concerns – and traumatic histories – of expectant refugee mothers to ensure healthy pregnancy outcomes and healthy growth/development for the Treasure Valley’s newest first-generation American citizens.

We are welcoming the newest first-generation American citizens:

  • In its first year of operation (May 2009-April 2010), the CARE Clinic provided support to more than 100 maternity patients, including more than 60 who elected to seek prenatal care and deliver their babies at Saint Alphonsus. Thirty-two of these expectant mothers delivered their newborns during this window of time. (Others were early in their pregnancies and did not deliver until the following service year.)
  • In its first year of operation, the CARE pediatric clinic provided well-baby services to 42 babies, including 31 infants born to CARE families, and their older siblings.
  • By October 2010 (halfway into its second year of operation), the CARE Clinic had already enrolled 72 maternity patients, including 62 who elected to enroll in prenatal care; 33 newborns were welcomed during this time, for a total of 55 infants born to CARE Clinic families since the program began.
  • Maternity patient ages have ranged from 15 to 41 years of age, with a mean age of 27; pediatric patient ages range from birth to 18 months of age.
  • To date, languages represented in the project include Arabic, Burmese, Chin, Dari, Farsi, French (African), Karen, Kirundi, Kizigua, Nepali, Pashtu, Russian, Somali, Swahili, Kinyarwanda, and Uzbek.
  • As of March 1, 2013, 92 prenatal patients have been enrolled in this fiscal year, and have more than 100 infants in the infant clinic. Four educational prenatal groups are now in operation and continue to add 2 to 3 new prenatal patients per week.

Challenges/success factors
Refugees arrive here with few possessions, limited English proficiency, and little understanding of “Western medicine.” They present complex medical needs after years of malnutrition, physical violence, and limited access to health care. The fear of unfamiliar medical practices is particularly troubling for expectant mothers, who face the anxiety of childbirth in a system where everything – from insurance coverage to appointment scheduling to basic prenatal exams – is overwhelmingly foreign. Saint Alphonsus has responded to the need to provide compassionate and culturally competent prenatal care to the steady number of refugee maternity patients arriving each year in Boise. Many pregnant refugee women have found safety within the walls of the Saint Alphonsus CARE Maternal/Child Health Program.

Future direction/sustainability
Trinity Health originally awarded Saint Alphonsus $524,000 as start-up funds to help support the CARE Clinic, and now has fully operationalized and sustained the clinic under the umbrella of the Saint Alphonsus Family Center. They have already expanded the clinic to include mental health services on site and partnership with a WIC dietician for nutritional information and guidance. They are continuously seeking grants and other funding sources to support the role of the health advisor and CARE Steps, the educational incentive store.

Advice to others
The CARE Clinic has afforded numerous opportunities for “lessons learned” due to the fact that this clinic is a new concept, with:

  • Group appointments with numerous languages addressed in the same group, in tandem with prenatal exams
  • A health advisor as “case coordinator” to expectant women, and cultural expert to staff
  • Mental health counselor on staff as part of the team to provide much needed support for our refugee women who have experienced trauma and torture
  • An educational incentive store, in which mothers can earn points through healthy behaviors and attending additional educational offerings; this incentive store allows mothers to purchase needed baby items for their new infants

The CARE Clinic is developing a “tool box” that will allow other agencies to replicate the program in their communities.

Contact: Corey Surber
Director of Advocacy & Community Benefit
Telephone: 208-367-7078

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