title: "We find a way": challenges and facilitators for health care access among immigrants and refugees with intellectual and developmental disabilities.
abstract: BACKGROUND
  Immigrant and refugee populations and people with disabilities are known to have inequitable access to a range of health services. Very little study has been undertaken, however, about immigrants who have disabilities and their experience of the American health care system.
  
  
  METHODS
  This qualitative study seeks to discover the particular challenges that immigrants with disabilities face when accessing health care, and the facilitating factors that assist them in this process. A complex multicase study design was utilized, and included purposively sampled individuals from 3 different immigrant communities, having an array of developmental disabilities. Interviews and participant observation provided the data that were analyzed in NVivo9 using a conventional content analysis approach.
  
  
  RESULTS
  Findings from this study suggest strong resilience among immigrant families with a member with a disability, as they continue to seek help despite experiencing confusion in navigating a complex health care system. Factors challenging access included difficulty finding accurate information on insurance and service providers, troubles with coordinating multiple specialist services, and a lack of cultural competence in all levels of health service provision. Access to health care services was facilitated by linguistically and culturally sensitive practitioners, favorable comparisons to the country or origin, and systems such as schools that helped to coordinate care.
  
  
  CONCLUSIONS
  Much can be done to integrate and improve health services to immigrants with developmental disabilities. Emerging models such as medical home may assist with coordination, and improvements in communication patterns could help to improve service access and outcomes.
authors.affiliation: Virginia Commonwealth University, School of Social Work, Academic Learning Commons, Richmond, VA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bogenschutz
mesh_terms: D000328:Adult; D054521:Cultural Competency; D002658:Developmental Disabilities / Q000208:ethnology*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000208:ethnology*; D044469:Racial Groups / Q000706:statistics & numerical data*; D012036:Refugees; D014481:United States