100 Exploring the Experiences of Refugee Claimant Youth and their Caregivers with Navigating Healthcare in Canada

Abstract Background In 2022 alone, 27,000 refugee claimants entered Canada, seeking protection. Although refugee claimants are ineligible for provincial health insurance programs, the Interim Federal Health Program (IFHP) provides coverage for basic medical care and supplemental services. However, previous studies have shown that only 24% of paediatricians are registered for IFHP, suggesting limited access for refugee claimant youth (RCYs), who are already at increased risk of poor health outcomes. It is important to understand the perspectives and needs of RCYs and their caregivers to develop interventions to improve their access to care, but to date, no study has examined their experiences directly. Objectives This study aims to explore how RCY, their caregivers, service providers and health care providers understand and utilize the healthcare system after arrival in Canada. Design/Methods This was a qualitative study that was rooted in community-based participatory action methodology. In-depth interviews (IDIs) were conducted with RCYs (age 10-18), their caregivers, community service providers (ie. settlement workers) and health care providers (HCPs) that worked with RCYs in a large urban Canadian city in English, and with an interpreter, recorded and transcribed. Transcripts were coded using inductive coding methods, and analyzed within and across stakeholder groups using thematic analysis. Results A total of 27 IDIs were conducted (8 HCPs, 9 community service providers, 5 caregivers, and 5 RCYs). Youth and their caregivers had little to no understanding of how the healthcare system operated in Canada, including how IFHP provided coverage. Most explained that their limited knowledge about the healthcare system was provided informally through social contacts, or their community service providers, who in turn expressed limited understanding of IFHP coverage and difficulty finding IFHP registered providers. Although healthcare providers similarly found IFHP difficult to navigate, they did not appreciate how little RCYs and their families understood the healthcare system, nor the difficulties placed on community service providers. RCYs stated that a youth-oriented, multi-lingual resource that explained how to access care in Canada would be a useful tool to help them feel empowered to advocate for themselves and their families. Conclusion Although policies exist to provide coverage for medical care for RCYs, there are many barriers that prevent them from accessing care, including limited knowledge of the system and few navigational supports. Our findings suggest that working with RCY themselves to co-develop a youth-centred approach to understanding the healthcare system may increase youth empowerment and access to care.