Refugee Health Program: Humanitarian Parolee Health Resources

On April 21, 2022, President Biden announced that the U.S. will welcome up to 100,000 Ukrainians and others fleeing from Russian aggression in the ongoing Russia-Ukraine crisis. Most displaced persons will not be processed through the refugee resettlement program. Instead, they will participate in a new process called Uniting for Ukraine that launched on April 25, 2022. Participants need a U.S.-based supporter that has U.S. citizenship and can provide financial support. People approved through the program, referred to as humanitarian parolees, can stay in the U.S. for up to two years. Because the Department of Homeland Security is not facilitating travel, the Wisconsin Department of Health Services will not be able to provide local jurisdictions with information about humanitarian parolees.

CDC's (Centers for Disease Control and Prevention) translated resources

• Conversation guide for talking with your clients about screening for TB: Ukrainian | Russian | English
• TB fact sheet Ukrainian/English | Russian/English
• TB flyer Ukrainian/English | Russian/English
• TB poster Ukrainian/English | Russian/English
• Sample newsletter content | Ukrainian, Russian, and English
• Sample text message content | Ukrainian, Russian, and English
• Sample social media posts | Ukrainian, Russian, and English

Information on benefits

Due to current federal law, Ukrainian humanitarian parolees who are paroled into the United States on or after Oct. 1, 2023, are not eligible for federal public benefits and refugee resettlement services (unless they are spouses or child of an ORR-eligible Ukrainian parole OR parent(s) or legal guardian(s) or primary care giver(s) of an ORR-eligible unaccompanied child from Ukraine).

• Know Your Rights (PDF): Department of State Travel’s pamphlet describing individual’s rights while working in the United States. Ukrainian | Russian
• Covering Wisconsin is a free resource that helps connect Wisconsin residents with health insurance and other programs that support health.

Information on TB and vaccine attestation

• If not eligible for federal medical assistance, the Wisconsin Tuberculosis Program may be able to help. Contact your Local Health Department for more information.
• Tuberculosis (TB) Screening for People Arriving from Ukraine to Wisconsin, P-03293 (PDF): Recommendations by the Wisconsin Tuberculosis Program on tuberculosis screening for Ukrainians who are part of the Uniting for Ukraine program.
• Tuberculosis Testing for Ukrainian Arrivals and Sponsors, P-03430: An informational handout to provide Tuberculosis testing information and resources to Ukrainian arrivals and their sponsors available in English, Ukrainian, and Russian.
• Wisconsin Tuberculosis (TB) Screening Tool for Ukrainian Humanitarian Parolees (UHP) Participating in the Uniting for Ukraine Program (U4U), (P-03293a) (PDF): Tool for completing components of tuberculosis screening for Ukrainians participating in the Uniting for Ukraine program.
• Uniting for Ukraine Vaccine Attestation: A U.S. Citizenship and Immigration Services webpage. It has information on pre-travel vaccine attestations for Ukrainians. It also lists the vaccines required for refugees within 90 days of arrival.

Other resources

• Uniting for Ukraine: Department of Homeland Security's webpage. It provides an overview of Uniting for Ukraine and frequently asked questions.
• Ukrainian Clinical Guidance: A publication from the Minnesota Center of Excellence in Newcomer Health. It outlines health screening recommendations for providers who work with people arriving from Ukraine.
• Psychological First Aid: A Switchboard webinar on psychological first aid in the context of the events in Ukraine. It includes the basics of psychological first aid and cultural information on Ukraine.
• Uniting for Ukraine Overview and FAQ: Department of Homeland Security's webpage that provides an overview of Uniting for Ukraine and frequently asked questions.
• Cultural Backgrounder: Refugees from Ukraine: Guide on refugees from Ukraine from the International Rescue Committee

Want to find out how you can help Ukrainian arrivals? Go to the Wisconsin Department of Children and Families website to learn more.

Individuals from Cuba and Haiti are eligible for a humanitarian parole program through U.S. sponsorship similar to Uniting for Ukraine (U4U). These individuals will be considered on a case-by-case basis for advanced authorization to travel to the United States for a temporary period of humanitarian parole for up to two years. Cubans and Haitians may also arrive though The Cuban Family Reunification Parole Program or The Haitian Family Reunification Parole (HFRP) Program.

Cubans and Haitians paroled into the United States are eligible for certain Office of Refugee Resettlement (ORR) benefits and services. Those presenting to clinics or health departments seeking medical services should be encouraged to apply for Wisconsin Medicaid by contacting the Income Maintenance Consortium office in their region or apply online through the ACCESS online application portal.

Humanitarian parolees under this program are also eligible to apply for work authorization and a Social Security number. For more information, see ORR Benefits for Cuban/Haitian Entrants.

Processes for Cubans, Haitians, Nicaraguans, and Venezuelans

See below for more health resources on Cuban and Haitian entrants

New populations are eligible for humanitarian parole through federal sponsorship programs. Individuals from Venezuela and Nicaragua are eligible for a humanitarian parole program through U.S. sponsorship similar to Uniting for Ukraine (U4U). These individuals will be considered on a case-by-case basis for advanced authorization to travel to the United States for a temporary period of humanitarian parole for up to two years.

Nicaraguan and Venezuelan humanitarian parolees are not currently eligible for ORR-funded refugee benefits and services including resettlement assistance, a domestic medical screening, or refugee social services. As humanitarian parolees, Nicaraguan and Venezuelans who arrive to the U.S. under this process are eligible to apply for work authorization and a Social Security number.

See below for more health resources on Venezuelan and Nicaraguan entrants.

In April 2023, the Department of Homeland Security announced a new family reunification parole program for persons from Latin America. The new processes are for nationals of Colombia, Cuba, Ecuador, El Salvador, Guatemala, Haiti, or Honduras whose family members are U.S. citizens or lawful permanent residents and who have received approval to join their family in the United States. Specifically, nationals from these countries can be considered for parole on a case-by-case basis for a period of up to three years while they wait to apply to become lawful permanent residents. The purpose of the program is to provide additional, legal pathways for persons from Latin America to enter the United States. Please see USCIS's Family Reunification Parolee Processes webpage.

• Plain Talk About Childhood Immunization: A 50-page booklet for parents on immunizations and their benefits, risks, and effectiveness as well as vaccine safety: English | Ukrainian | Russian | Spanish
• Vaccination Record Interpretation Guide: Translation guide for school personnel, providers and other medical practitioners assessing immunization records in Ukrainian and Russian, created by the Washington State Department of Health.
• Vaccine Information Statements (VIS)
  • Ukrainian Translated VIS
  • Russian Translated VIS
  • Haitian-Creole Translated VIS
  • French Translated VIS
  • Spanish Translated VIS

• Picking up medications: scroll through right panel once hyperlink is opened to select from 15 languages
• 3HP, 3HR, and 4R Medication Trackers and Patient Information Sheets from CDC (including translations)
• Southeastern National Tuberculosis Center TB resources

• CDC Resources in Languages Other than English: Translated resources from the CDC on various health related topics. Additional health-related resources
• Know Your Rights: Department of State Travel's pamphlet describing individual's rights while working in the United States. Ukrainian | Russian | Haitian-Creole | Spanish | French
• Catholic Charities Milwaukee Educational Videos: Educational videos and resources from Catholic Charities Milwaukee available in multiple languages.

These newcomers are not screened for TB prior to arrival in the United States and must attest to screening with an interferon gamma release assay (IGRA) result within 90 days after arrival. Tuberculin skin tests (TSTs) are not accepted. The Wisconsin Department of Health Services will not be able to provide local jurisdictions with information about humanitarian parolees, including TB status.

Health department personnel who provide TB testing may be the first point of contact with the U.S. healthcare system for these individuals. If eligible for insurance, parolees should be encouraged to first apply for Medicaid. If not eligible, providers are encouraged to refer them to Federally Qualified Health Clinics or other local healthcare providers serving uninsured populations for basic healthcare.

Both confirmed and suspected cases of active tuberculosis are category I conditions, reportable immediately to the patient’s local public health officer. Both confirmed and suspected latent tuberculosis infection are category II conditions, reportable to the patient’s local public health department within 72 hours of recognition of a case or a suspected case. Please see the Wisconsin Tuberculosis Program webpage on reporting for more information.

*WHO Global Tuberculosis Programme, 2021

ƗRR is TB resistant to rifampicin®; MDR is TB resistant to R + isoniazid

For humanitarian parolees resettled in Wisconsin presenting to clinics or local health departments for TB screening, the Wisconsin Tuberculosis Program and Refugee Health Program recommends the following TB screening components are completed:

• Symptom screening for tuberculosis for all individuals of all ages.
  • Persistent cough lasting more than 10 days and one or more of the following: coughing up blood, fever, night sweats, unexplained weight loss, or fatigue.
• Chest radiographs for persons aged 6 months and older if positive IGRA or symptom screen.
  • CXR postero-anterior (PA) view for those ≥10 years of age.
  • Anterior to posterior (AP) or PA view and lateral view for those <10 years of age.
• Medical examination for persons with positive IGRAs, abnormal chest radiographs consistent with tuberculosis, or positive symptom screening.
• Respiratory sampling if indicated by the chest radiograph, medical examination, or symptom screening

• Active Tuberculosis Disease Fact Sheet, P-42099: (Available in English, Dari, Hmong, Kirundi, Russian, Spanish, and Ukrainian)
• Latent Tuberculosis Infection Fact Sheet, P-2099B): (Available in English, Dari, Hmong, Kirundi, Russian, Spanish, and Ukrainian)
• General Tuberculosis Resources from King County, Washington: Haitian - Creole
• Tuberculosis: General Information Fact Sheet from CDC: English | Ukrainian | Spanish
• Questions and Answers About Tuberculosis from CDC: English | Ukrainian | Spanish
• The Wisconsin Tuberculosis Record cards can be given to clients who may need to present documentation of TB and latent TB infection (LTBI) screening and treatment and may not have ready access to their medical records. Wallet cards are also available in Dari, Hmong, Burmese, Kirundi, Russian, Ukrainian, and Spanish. Please see the Wisconsin TB Program Webpage for more information and ordering.
• Translated TB Resources from Massachusetts Department of Public Health (MDPH)
  • How to Take Your TB Medicine English | Ukrainian | Russian | Haitian-Creole | Spanish
  • Keep Taking Your TB Medicine: English | Ukrainian | Russian | Haitian-Creole | Spanish
  • You Can Have TB and Feel Healthy: English | Ukrainian | Russian | Haitian-Creole | Spanish
  • You Have TB Infection (A Type of TB): English | Ukrainian | Russian | Haitian-Creole | Spanish
• Translated resources by the Southeast National TB Center:
  • Cultural Quick Reference Guide: Ukraine, Haiti
  • You Can Prevent Tuberculosis: A Patient Educational Handout: Ukrainian | Haitian-Creole | Russian | Spanish | French
  • 12-Dose Regimen for LTBI Patient Educational Brochure: Ukrainian | Haitian Creole | Spanish | other languages
  • 12-Dose Regimen for Latent TB Infection Medication Tracker and Symptom Checklist: Ukrainian | Haitian Creole | Spanish | other languages
  • 4R Regimen For Latent Tb Infection Medication Tracker And Symptom Checklist: Ukrainian | Russian
  • 3HR Regimen For Latent Tb Infection Medication Tracker And Symptom Checklist: Ukrainian | Russian
  • Patient Fact Sheet Series - Isoniazid : Haitian Creole | Russian | French
  • Patient Fact Sheet Series - Rifampin: Haitian-Creole | Russian | French
  • Patient Fact Sheet Series -Isoniazid And Rifapentine: Haitian-Creole | Russian | French
  • Educational Tools To Address Tuberculosis In Spanish-speaking, Foreign-born Communities

• Building a Culturally Informed Network of Refugee Mental Healthcare Providers: A guide for refugee service providers to increase cultural awareness in mental health practitioners.
• Guide to Trauma-Informed Care: Preventing Crises and De-escalating Difficult Situations: A guide to help service providers interact with refugees in a trauma-informed way.
• Headington Institute Resources: A collection of resources, including articles, reading courses, exercises, videos, and other materials. These can help caregivers to address resiliency, self-care, and vicarious trauma.
• Institute on Trauma and Trauma-Informed Care: A website with talks, online modules, and manuals on trauma-informed care.
• Mental Health First Aid: A website with trainings, courses, and resources on how to identify and support those with mental health or substance abuse problems.
• Mental Health Resources for Clinicians and Researchers: Information from the International Trauma Consortium. It includes mental health materials and measures available in Ukrainian, Russian, and English.
• Mental Health Technology Transfer Center Network: Resources to support the mental health of refugees and asylum seekers.
• Psychological First Aid: A website by Unbound Medicine. with the “Who, What, Where, When, and Why” of psychological first aid as well as implementation.
• Psychological First Aid During COVID-19: A webinar on how to use psychological first aid in the context of refugee health and COVID-19.
• Psychological First Aid: Guide for Field Workers: A guide from the World Health Organization to practicing psychological first aid in crisis situations as well as how to care for oneself and colleagues.
• Refugee Trauma: From the National Child Traumatic Stress Network. A website with information on the experience of refugee, the effections of trauma, screening and assessment tools, interventions, and resources.
• The 5 Components of Psychological First Aid: An article on the tools of psychological first aid that can be used to "help patients as they respond to traumatic events."
• Resources from The National Child Traumatic Stress Network
  • Psychological First Aid: Tips for Adults: English | Ukrainian | Russian | Spanish
  • Psychological First Aid: Parent Tips for Helping Adolescents: English | Ukrainian | Russian | Spanish
  • Psychological First Aid: Parent Tips for Helping Infants and Toddlers: English | Ukrainian | Russian | Spanish
  • Psychological First Aid: Parent Tips for Helping Preschoolers: English | Ukrainian | Spanish
  • Psychological First Aid: Parent Tips for Helping School-Age Children: English | Russian | Spanish
  • Age-Related Reactions to Traumatic Events: English | Ukrainian | Russian
  • After a Crisis: Helping Young Children Heal: English | Ukrainian | Russian

• Bearing Witness: Traumatic Stress and the Helping Professional: A webinar by the University of Minnesota’s Center for Practice Transformation. It focuses on how to identify and manage secondary traumatic stress. It also details the differences between secondary traumatic stress, vicarious trauma, moral injury, compassion fatigue, and burnout.
• “I Was Already Burned Out, and Now This...” Strategies for Staff and Supervisors to Mitigate Burnout, Vicarious Trauma, and Other Occupational Hazards: A 2020 Switchboard training for front-line and management staff who work with refugees. It outlines types of occupational hazards for emotional distress and how to respond.
• Secondary Traumatic Stress: A webpage by the Administration for Children and Families. It offers a description of secondary traumatic stress, symptoms of compassion fatigue, and relevant ways to help.
• Secondary Traumatic Stress Handout: A PDF handout by ProQOL with English, Arabic, and Kiswahili translations. It outlines the definition of secondary traumatic stress. It also lists symptoms, risk factors, and self-care practices.
• Secondary Traumatic Stress Series: A series of webinars by the National Child Traumatic Stress Network. It includes “Cultural Implications of Secondary Traumatic Stress,” “Secondary Traumatic Stress and Provider Self Care in Disaster and Terrorism Settings, Organizational Secondary Traumatic Stress,” and “Secondary Traumatic Stress... What is it?”
• Wellbeing for Service Providers During COVID-19 — Managing our Own Emotional Needs While Helping Refugee Clients: A Switchboard article for those helping refugees. It discusses the emotional challenges in helping professions. It also gives ways to recognize and address them.
• Working with Young People in the Trauma Space — Vicarious Trauma: An Orygen webinar for professionals working with young people who have gone through trauma and injustice. It describes a framework of self-care rather than specific self-care practices.