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Coming of Age on the Margins: Mental Health and Wellbeing Among Latino Immigrant Young Adults Eligible for Deferred Action for Childhood Arrivals (DACA)

Article (PDF Available) inJournal of Immigrant and Minority Health 19(4) · February 2016with476 Reads
DOI: 10.1007/s10903-016-0354-x
Abstract
Undocumented immigrant young adults growing up in the United States face significant challenges. For those qualified, the Deferred Action for Childhood Arrivals (DACA) program's protections may alleviate stressors, with implications for their mental health and wellbeing (MHWB). We conducted nine focus groups with 61 DACA-eligible Latinos (ages 18-31) in California to investigate their health needs. Participants reported MHWB as their greatest health concern and viewed DACA as beneficial through increasing access to opportunities and promoting belonging and peer support. Participants found that DACA also introduced unanticipated challenges, including greater adult responsibilities and a new precarious identity. Thus, immigration policies such as DACA may influence undocumented young adults' MHWB in expected and unexpected ways. Research into the impacts of policy changes on young immigrants' MHWB can guide stakeholders to better address this population's health needs. MHWB implications include the need to reduce fear of deportation and increase access to services.
ORIGINAL PAPER
Coming of Age on the Margins: Mental Health and Wellbeing
Among Latino Immigrant Young Adults Eligible for Deferred
Action for Childhood Arrivals (DACA)
Rachel Siemons
1,2,3
Marissa Raymond-Flesh
4
Colette L. Auerswald
1,2,3
Claire D. Brindis
4
Springer Science+Business Media New York 2016
Abstract Undocumented immigrant young adults grow-
ing up in the United States face significant challenges. For
those qualified, the Deferred Action for Childhood Arrivals
(DACA) program’s protections may alleviate stressors,
with implications for their mental health and wellbeing
(MHWB). We conducted nine focus groups with 61
DACA-eligible Latinos (ages 18–31) in California to
investigate their health needs. Participants reported
MHWB as their greatest health concern and viewed DACA
as beneficial through increasing access to opportunities and
promoting belonging and peer support. Participants found
that DACA also introduced unanticipated challenges,
including greater adult responsibilities and a new precari-
ous identity. Thus, immigration policies such as DACA
may influence undocumented young adults’ MHWB in
expected and unexpected ways. Research into the impacts
of policy changes on young immigrants’ MHWB can guide
stakeholders to better address this population’s health
needs. MHWB implications include the need to reduce fear
of deportation and increase access to services.
Keywords Deferred Action for Childhood Arrivals
(DACA) Undocumented Mental health Well-being
Latino Immigrants Young adults Qualitative research
Introduction
The United States is home to approximately 11.4 million
undocumented immigrants, half of whom are of Latino ori-
gin [1,2]. Immigrants, regardless of legal status, face sig-
nificant stress both during and following migration [35].
The immigration experience itself has been shown to threa-
ten individual and family well-being due to separation from
family, exposure to traumatic events, discrimination, and
loss of social status [6]. While Latinos living in the US,
whether native born, documented or undocumented immi-
grants face marginalization, socioeconomic challenges, and
reduced social integration, the undocumented experience an
even greater degree of stigma associated with their ‘‘illegal’
status [3,715]. Stressors are further magnified for undoc-
umented immigrants who struggle even more for basic
necessities, experience perpetual fear of deportation, and are
often confined to the lowest-wage jobs [3,712,14,16,17].
Risks to mental health and wellbeing (MHWB) are
magnified for undocumented young adults who must nav-
igate these challenges, while simultaneously moving
through the critical developmental period between ado-
lescence and adulthood, normally a time marked by the
development of self-reliance and increased legal and social
responsibilities [1822]. In contrast to their US citizen and
legal resident peers, undocumented young adults’ ‘‘illegal’
status restricts access to structures of opportunity, obstructs
societal integration, limits social support, and challenges
their self-identity [2325]. Limited research indicates that
these destabilizing experiences can jeopardize these young
&Claire D. Brindis
Claire.Brindis@ucsf.edu
1
University of California, Berkeley, Berkeley, CA, USA
2
University of California, San Francisco, San Francisco, CA,
USA
3
Joint Medical Program, UC Berkeley School of Public
Health, Berkeley, CA, USA
4
Philip R. Lee Institute for Health Policy Studies, Division of
Adolescent & Young Adult Medicine, Department of
Pediatrics, University of California, San Francisco, 3333
California Street, Suite 265, San Francisco, CA 94118, USA
123
J Immigrant Minority Health
DOI 10.1007/s10903-016-0354-x
adults’ MHWB, leading to depression and suicidal
thoughts [1416,18,25].
A transformative federal Executive Order, issued in June
2012, established the Deferred Action for Childhood Arri-
vals (DACA) [26], which allows an estimated 2.1 million
undocumented children and young adults (see Table 1)to
apply for legal work authorization and a 2-year deportation
reprieve [2729]. Given the previously-reported impacts of
undocumented status on immigrants’ MHWB, DACA pro-
vides new opportunities that may influence the MHWB of
eligible young adults.
Few studies have investigated the MHWB of eligible
undocumented young people, and none have done so within
the context of the DACA program. Some prior research on
DACA’s short-term impacts indicates that it has increased
young people’s access to new opportunities and removed
the fear of deportation [2729]. However, these young
adults remain constrained in their upward mobility and
continue to lack sufficient access to health care [18,28,29].
As more undocumented young adults gain DACA status,
additional information is needed regarding the potential
influence of DACA on their MHWB.
The data presented here were obtained during the course
of a parent study of the health needs of DACA-eligible
Latino young adults [18]. During focus groups, MHWB
emerged overwhelmingly as participants’ primary health
concern. Thus, this analysis further examines how partici-
pants perceive their MHWB needs and view the impact of
the DACA program thereon. Our analysis is informed by
the broader World Health Organization definition of mental
health as not simply the absence of mental illness, but ‘‘a
state of wellbeing in which every individual realizes his or
her own potential’’ [30]. We further recognize that certain
social support and resilience factors may be protective for
this population’s MHWB. Several studies documented that
young undocumented immigrants demonstrate substantial
resilience when facing obstacles, benefiting their MHWB
[18,24,31,32].
To organize our findings, we utilized the ecological
framework, which proposes that the wellbeing of the
individual is determined by interconnections of systems at
multiple levels (Fig. 1)[33,34]. Through this framework,
we analyzed participant perceptions regarding the influence
of DACA on community, interpersonal, and individual-
level determinants of MHWB [33,34].
Methods
Participants
In partnership with community-based organizations (CBOs),
research staff, including two DACA-eligible interns, recrui-
ted DACA-eligible Latinos (age 18–31) residing in Los
Angeles or the San Francisco Bay Area (Table 2)[18].
Recruitment at sites such as legal clinics, colleges, markets
and churches, was supplemented by social media-based
(Facebook)recruitment andphone and email outreach. While
all participants reported meeting DACA-eligibility criteria,
Table 1 Original DACA eligibility criteria (June 2012)
a
At least 15 years old at time of application
Under age 31 as of June 15, 2012
Arrived in the United States prior to age 16
Physically present in the United States since at least June 15, 2012
Lived continuously in the United States for at least 5 years as of June 15, 2007
Currently attend school, earned a high school diploma or GED, or have been honorably discharged veteran of the United States military
No convictions for a felony, significant misdemeanor or three or more misdemeanors, and do not pose a threat to public safety or national
security
a
President Obama issued a second executive order in November 2014 that expanded DACA eligibility by removing the upper age limit and
broadening the dates of US presence. For the purposes of this study, the original DACA eligibility criteria from 2012 were used
Community-level
Societal integraon
Interpersonal-level
Social support
Individual-level
Sense of self
Fig. 1 Ecological framework
J Immigrant Minority Health
123
for participants’ protection, researchers did not verify legal
status. Study protocol, approved by the Institutional Review
Board at the University of California, San Francisco, allowed
for verbal informed consent to minimize risk.
Data Collection
Nine focus groups, conducted in English,with 61 participants
(Group size: 4–12 participants, 7 on average), were held at
CBOs in summer 2013. The decision to conduct groups in
English was made in consultation with study advisors
familiar with participants’ language preference. Three
experienced, bilingual, qualitative researchers, two of whom
are Latina, facilitated the groups. Audio-recorded sessions
lasted 60–90 min. Participants received a $20 gift card, a
meal, and a resource guide to immigrant-accessible services.
Measures and Analysis
Focus group questions included the impact of DACA on
identity, health, and health care access (Appendix). Two
primary coders developed a codebook of 22 codes (Table 3),
incorporating the ecological framework and following
multiple rounds of transcript review. Coding involved con-
tent analyses guided by grounded theory, with codes drawn
directly from participants’ comments and from literature on
immigrants’ health experiences and human development
[35]. Consistent with a consensual coding process [36],
coding was iterative with frequent review of code use among
the primary coders. Shared memos summarized ongoing
findings and emerging sub-codes. Coders discussed dispar-
ities in coding until achieving consensus. A third team
member and the study’s senior author, acted as an ‘‘auditor’
of the data and codebook, reviewing final codes. Coding was
assisted by Dedoose, a web-based analysis program [37].
Results
We employed the levels of the ecological framework to
organize key findings regarding participants’ perceptions of
the impacts of DACA on their MHWB (Fig. 1). At each
level, we highlight participants’ most salient views of
DACA’s influence, including societal integration (com-
munity-level), social support (interpersonal-level), and
sense of self (individual-level).
Community-Level
Increased Societal Integration with DACA
Participants reported that DACA smoothed their integra-
tion into US society. Without DACA, participants
explained how their lack of legal status restricted their full
societal engagement, limiting their ability to apply to col-
lege, seek employment or obtain a driver’s license. When
comparing their situation to their peers, participants
described feeling isolated, stressed, and some, suicidal. A
female participant shared:
[I]t didn’t hit me what it really meant to be undocu-
mented until I got to Collegethat set me into a
depressionthere’s still a lot of things I can’t do,
whereas I see a lot of my friends who take it for
granted. It’s hard to deal with sometimes.
In contrast, participants discussed how DACA status
enabled their societal integration by providing them with
increased access to resources, greater autonomy, and an
improved sense of belonging. Access to a Social Security
number, driver’s license, and work permit allowed them to
engage in normal travel and employment activities, which
was beneficial for their MHWB: ‘‘I’ve been able to do
more it helps your self-esteem and your confidence, and
your mental health does get better.’
Without DACA, participants reported significant stress,
often living in survival mode, struggling to meet basic
Table 2 Characteristics of focus group participants
Total participants 61
Age, years ±SD 22.4 ±3
Female 36 (59 %)
Latino 61 (100 %)
Country of origin
Mexico 53 (87 %)
Other 8 (13 %)
Employment status
Full-time or part-time 46 (75 %)
Self-employed 3 (5 %)
Unemployed 15 (25 %)
Income \139 % federal poverty level 21 (43 %)
Student status
Full-time 31 (51 %)
Part-time 12 (20 %)
Not a student 17 (28 %)
High school graduate 58 (95 %)
Military veteran 0 (0 %)
Activist for immigration reform 44 (72 %)
Insurance status
Uninsured 32 (52 %)
Privately insured 24 (39 %)
Publically insured 5 (8 %)
Depressed in the past month 14 (23 %)
Source: This demographic data was drawn from the parent study:
Raymond-Flesch et al. [18]
J Immigrant Minority Health
123
needs while juggling school, work and family responsi-
bilities. Speaking of these challenges, a male participant
shared: ‘‘[Y]ou’re not only dealing with regular teenage
problems, you’re also being undocumented, having to work
sometimes two jobs, going to schoolIt really affects
mental health.’’ With DACA, participants described feeling
increased autonomy and hope for the future. One female
participant explained: ‘‘[I]t has really helped my mental
health, and I’m not stuck in a rut anymore. I just know what
to do with my life.’
Participants reported having gone to great lengths to
hide their undocumented status due to constant fear of
discovery and deportation. With DACA, they expressed an
improved sense of comfort in disclosing their status. A
male participant described how before DACA: ‘‘I built
mechanisms to lie because that’s what I thought I had to
do. But now that I’ve come out, I can be more myself, who
I really am.’’ Without the need to hide their status, par-
ticipants expressed feelings of belonging and normalcy;
one reported:
I was like a fish out of the water, gasping for stuff.
And then, DACA was announced. It was like some-
one threw me back in the river. I’ve been able to help
my family financiallyget back into school, and feel
more normal.
Remaining Challenges to Societal Integration with DACA
Even with DACA, participants described ongoing limita-
tions, with ramifications for their MHWB. While DACA
increased access to employment-based health benefits for a
few participants, the majority reported not being offered
coverage. As they are also disqualified for coverage
through the Affordable Care Act (ACA), many remained
uninsured. Similarly, DACA did not expand access to
federal financial aid, thus diminishing educational oppor-
tunities. A female participant described how ongoing
restrictions impacted her: ‘‘I still can’t really go to grad
school because it’s going to be really expensive and I can’t
get loansIt reminds you that you’re not fully there.’’
Table 3 Selected illustrative codes and example quotes
Code with brief definition Example quote
Isolation
This code captures participants’ real or perceived feelings and
experiences of not belonging or being separated from others
‘How am I supposed to exist in the world with this experience that’s so
much different than the majority of the US population?I just feel
like anxiety. I feel like I don’t belong. I feel like I’m different.’’
(SF1, M)
Belonging
This code captures participants’ feelings and experiences of being
integrated into mainstream society related to DACA eligibility or
status
‘It helps you feel normalIt does help you feel like ‘Oh, I’m now
capable of doing the things that my peers have been doing.’ Or I take
advantage, like being able to get a job, being able to work, and being
able [to]drive and apply for the things that you couldn’t before
without something like a social security number. That’s really a great
help. It’s like being able to havethat sense of normal, or at least for
the time being.’’ (LA5, M)
Transition to adulthood
This code captures participants’ experiences of moving from childhood
to adulthood. This can include achievement of normal adolescent or
young adult developmental milestones and experiences of
impediments to achievement of those milestones
‘[W]hen I wanted to apply to college, I had to apply to so many
scholarships and I saw all these restrictionsSo it was kind of like a
mental instability for me during my senior year, with collegeI was
just really depressed, really unstable during my senior year all
because I was undocumented and because I didn’t have money.’
(LA4, F)
Survival mode
This code captures participants’ experiences of having to devote great
amount of time, energy, or resources to meeting basic needs
‘[Y]ou’re trying to think about how to pay for school, how to pay rent.
There’s so many other stressors going through your mind You’re
just in survival mode.’’ (OAK3, F)
Resilience
This code captures participants’ reports of personal skills, abilities, and
experiences that promote success and allow effective coping
‘I think one of the things though that’s come out of this is, in general,
we’re all very self-sufficient people because we’ve had to
navigateI was pushed into the situation. So it’s like I needed to find
a way to progress pretty much on my ownin a sense, I feel more
empowered, like I did it by myself.’’ (LA3, F)
External supports
This code captures sources of help outside of one’s self that
participants report drawing on, including supports at the family,
community, and structural levels
‘[T]hey were trying to organize a undocumented support group, and
that’s when I started to meet other students who were in the same
situation. And we started talking about our experiences, being
undocumented, and trying to access higher education, and so forth.
And so, that was the first time that I actually felt like I could be
myself and I could express myself and talk about what is it like to live
here in the U.S., as an undocumented person.’’ (SF1, M)
J Immigrant Minority Health
123
Though participants credited DACA with providing
relief, many felt that the trauma of growing up undocu-
mented remained stressful. A male participant described
how emotional challenges became engrained: ‘‘Your
experiences with pre-DACA, of full-on undocumented life,
that fear or paranoiathat’s still there. You’re still going
to feel the residual of what that felt like.’’
Interpersonal-Level
Greater Peer Support with DACA
Participants viewed DACA as altering their previously-
available sources of support. Many reported limited social
support and fractured family networks related to their
undocumented status and inability to travel freely to visit
family in their native countries. In contrast, they described
how DACA expanded their support networks by providing
the impetus to freely connect with peers with similar
experiences for the first time. A female participant
explained: ‘‘It’s always good for me to see that I’m not
aloneI might have all of these anxieties and [be]
depressed, but I’m not the only one.’’ The opportunity to
process shared experiences with other young adults pro-
vided validation and much-needed support.
Increased Family Responsibilities with DACA
Participants described how DACA also influenced the nature
of their relationships with their families, resulting in shoul-
dering additional responsibilities. Many welcomed their
increased ability to contribute resources to their families. A
male participant expressed the relief brought by his options:
‘It impacts my life—being able to apply for a job and
contribute money for rent or for bills, and not just having to
see my dad work.’’ However, others felt overwhelmed by
their added responsibilities, which added to their stress. A
female participant described: ‘‘Everything’s more dependent
on you just because you have thisToo much pressure, like
what if I just crash? It’s like I’m ruined.’
Many participants also took on increased emotional
responsibility for their undocumented parents and siblings
who remained ineligible for the protections bestowed by
DACA. This transfer of worry from their own survival to
their families had mental health consequences. A male
participant explained the shift in his anxiety:
I’m worried about my parents nowI’ve kind of
become the parenting figure. It’s no longer about
yourselfit’s more of a fear for what’s going to
happen to my parents.
Individual-Level
Improved Sense of Self with DACA
At the individual level, participants noted that DACA
influenced their self-image. Participants reported that
before DACA, their undocumented status imposed a bur-
den on their self-confidence. One male participant, speak-
ing of his parents, expressed how ‘‘they instilled shame
regarding [my] identity as an undocumented person.’’ In
contrast, participants described how DACA status gave
them a new sense of belonging that improved their self-
esteem, impacting their MHWB. A female participant
stated, ‘‘You don’t have to feel like, ‘I’m undocumented,
I’m not supposed to be here’.You’re worth something, so
now you can show it.’
DACA as a New Precarious Status
Participants reported that DACA, as a temporary status, also
imposed a new precarious identity that proved stressful. One
male participant described his feelings of uncertainty:
‘Yeah, we got DACA. But, it’s two years onlyIonlyhave
one year [of protection from DACA] left and that’s it. I have
to worry again.’’ Furthermore, a female participant
explained how the uncertainty of DACA status left her with
little confidence: ‘‘When I think about DACA, I also have
these feelings that I’m kind of just passing, that I’m not
really a citizenyou’re not really there yet.’’ Participants
also spoke of their fear of having DACA taken away: ‘‘It
also limits youYou have DACA, then you’re like ‘Crap, I
can’t do anything to risk that. If I make one mistakeI’m
screwed completely!’’ Thus, despite DACA’s benefits,
concern about its temporary nature provoked anxiety.
Discussion
While previous research has examined the mental health
implications of undocumented status, this analysis is the first
to shed light on the perceived influences of DACA on the
MHWB of eligible Latino Immigrant young adults from
their own perspective. Consistent with previous studies, our
participants experienced substantial mental health chal-
lenges related to reduced societal integration and lower self-
esteem while growing up undocumented [3,2426,32,38].
Our research is also consistent with findings of the
limited studies to date regarding the impacts of DACA.
These studies similarly found that increased access to
societal structures is a major benefit of DACA status [15,
28,29,39]. Our findings further expand on this research by
J Immigrant Minority Health
123
showing how DACA-eligible young adults perceive
increased societal integration as having protective effects
on their MHWB by decreasing stress and encouraging
greater autonomy. Thus, these results show that eligible
young adults view DACA as having both beneficial and
detrimental impacts on their MHWB.
A novel finding from our analysis was that participants
perceived DACA as enabling them to connect with and
experience social support from peers with similar life
experiences, resulting in an improved sense of MHWB.
The benefits of strong social support are aligned with
existing literature which points to the positive effects of
peer support for identity formation and wellbeing [6,40].
Another unique finding related to the importance of social
policy for individuals’ MHWB was participants’ recognition
that beyond the tangible benefits provided, DACA status
also helped reduce their shame about being undocumented.
This finding suggests that DACA status provides a new,
less-stigmatized way of defining themselves, providing a
greater sense of legitimacy. This finding is similar to those
of Abrego, who studied the impacts of AB540, a law
allowing in-state tuition for undocumented students in Cal-
ifornia. The law allowed these youth to use a more socially-
acceptable label as ‘‘AB540 students,’’ replacing the more
stigmatizing label of ‘‘undocumented’’ [41].
Despite the substantial benefits reported, DACA also has
unintended negative mental health consequences, including
the stress associated with increasing family responsibilities,
shifting concerns about deportation risk from oneself to
ineligible family members, and a new sense of precari-
ousness as they move from the tenuous existence of being
undocumented to their temporary DACA status. The pre-
carious nature of undocumented status was described by
Gonzales [24,25]; our study suggests that while there are
stabilizing benefits of DACA, recipients still perceive
DACA as a precarious temporary status.
Important to investigate further is the resilience of
undocumented Latino young adults [24,31,32]. While we
have documented their profound capacity to overcome
adversity in our prior work [18], this analysis further
contributes to the resilience literature by showing how
DACA facilitated supportive and meaningful connections
to peers with shared experiences.
This study has several limitations. First, focus groups
were held with Latino participants and results cannot be
generalized to immigrants of different ethnic backgrounds.
Second, we conducted focus groups primarily in English.
Although this decision was informed by knowledgeable
key informants and participants were free to use Spanish
given the study’s bilingual facilitators, this may have
excluded recent immigrants, for whom groups held in
Spanish would have been preferable. Third, we conducted
our study in two relatively immigrant-friendly California
cities. DACA-eligible young adults living in less-wel-
coming communities may have different, perhaps more
isolated experiences. Fourth, our approach to recruiting this
hidden population was biased towards recruitment of stu-
dents, college-educated young adults, and those connected
to CBOs. This limits our study’s generalizability to broader
undocumented immigrant populations, and future studies
should target harder-to-reach and less-privileged individu-
als who may experience substantial mental health needs,
but have fewer resources to address them. Despite these
limitations, the depth of MHWB issues that participants
relayed is noteworthy.
Both the substantial MHWB needs described by partici-
pants and the limited research on DACA’s impacts call for
continued evaluation of the program’s health implications
and greater consideration of the multi-layered ways in which
immigration policies may influence health. Specifically, our
findings point to the unintended negative consequences of
policy changes for target populations. One step towards
averting such unintended impacts could involve encouraging
governments to adopt a ‘‘health in all policies’ approach to
policy development that ‘‘emphasizes the consequences of
public policies on health determinants, and aims to improve
the accountability of policymakers for health impacts at all
levels of policy-making’’ [42]. Inherent in this approach is
the need to better understand the population for which
policies are being designed.
Our findings also highlight the need for increased avail-
ability of and access to mental health services for DACA-
eligible young adults. Our results suggest that such improved
services should incorporate peer-led counseling resources,
given the positive mental health effects of peer support
described by participants. Similarly our findings suggest that,
given their profound mental health needs, DACA recipients
could benefit from better access to health insurance.
In conclusion, while DACA is a positive first step, it
provides only a short-term policy solution to the challenges
of our country’s piecemeal immigration system. Immigra-
tion policy changes that are longer-lasting, for example,
expanding the length of time that DACA eligible youth
may reside lawfully in this country, or immigration policy
reform, such as DAPA, announced by President Obama in
November, 2014, but blocked by a number of states and
currently under review by the Supreme Court [43], would
likely provide more sustained benefits for the MHWB of
young adults and their families. The policy implications of
this research is that removing the residual fear, stigma, and
uncertainty that the undocumented live with on a daily
basis could play a substantial role in improving the mental
health of nearly half of the country’s 11.4 million undoc-
umented immigrants. Further efforts by policymakers,
providers and advocates to understand and address the
MHWB needs of DACA-eligible youth immigrants and
J Immigrant Minority Health
123
their families can help assure that this young, ambitious
population successfully pursues their goal to more fully
participate in US society.
Acknowledgments This research was made possible by funding
from the Blue Shield of California Foundation. Rachel Siemons’ time
was also supported by the UCSF Dean’s Office Medical Student
Research Program, the Philip R. Lee Institute for Health Policy
Studies, the UC Berkeley-UCSF Joint Medical Program Thesis Grant,
and the Schoeneman Grant. Dr. Marissa Raymond-Flesch’s time was
supported by the Leadership Education in Adolescent Health Program
from the Maternal and Child Health Department (T71MC00003) and
the Philip R. Lee Institute for Health Policy Studies. Dr. Colette
Auerswald’s time was supported by the UC Berkeley-UCSF Joint
Medical Program. Dr. Claire Brindis’ time was supported by grants
from the Maternal and Child Health Bureau, Health Resources and
Services Administration, U.S. Department of Health and Human
Services (U45MC 00002 and U45MC 00023). We are grateful to the
following people for their valuable contributions to this project: Irene
Bloemraad, PhD (UC Berkeley, Department of Sociology), Ken
Jacobs, BA (UC Berkeley Center for Labor Research and Education),
as well as Laurel Lucia, MPP (UC Berkeley Center for Labor
Research and Education), Nadereh Pourat, PhD, Efrain Talamantes,
MD, MBA, and Max Handler, MPH, MA (UCLA Center for Health
Policy Research), our interns Arlette Lozano and Kathy Latthi-
vongskorn, our advisory board members, and our community-based
organization partners. Most of all we thank the participants who
shared their personal experiences with us.
Compliance with Ethical Standards
Conflict of interest None of the authors have conflicts of interest to
disclose regarding this research. The study sponsor, Blue Shield
Foundation of California, had one representative on the study’s
advisory board, but was not directly involved in data collection or
analysis, nor required review of this manuscript.
Human and Animal Rights and Informed Consent All proce-
dures performed in studies involving human participants were in
accordance with the ethical standards of the institutional and/or
national research committee and with the 1964 Helsinki declaration
and its later amendments or comparable ethical standards. Informed
consent was obtained from all individual participants included in the
study. This article does not contain any studies with animals per-
formed by any of the authors.
Appendix: Focus Group Questions
1. What health problems do you think DACA-eligible
young people face?
Probes: What health conditions do you think are
particularly challenging for this group? How are
health problems for young people like yourselves
different from other young adults? Are stress or
mental health issues something that DACA-eligi-
ble young people struggle with?
2. What decisions or actions affect the health of young
adults like yourselves, who are eligible for DACA?
Probes: In your experience, how easy is it for young
adults like yourselves to maintain a healthy diet and
lifestyle? Can you tell me about experiences with
tobacco use among young adults like you? What
about alcohol or other substances?
3. What do young adults like yourselves do when you
need health care?
Probes: Where do you think that DACA-eligible
young adults get health care? Do you, or other
DACA-eligible young adults that you know,
have a regular doctor? Are there particular
programs in your area that give health care to
immigrants without documentation? What is it
like to get care in those places? What about
mental health care access?
4. What is it like for young people like yourselves to
get health care?
Probes: What factors do young people like you
consider when deciding whether to go the
doctor? What barriers make it challenging for
you to get medical care? Mental health care? Do
you feel like your doctor understands you? Have
you ever gone without seeing a doctor for a long
time? If so, why?
5. Have you heard of young adults who might be
eligible for DACA not getting the health care that
they need because it is too expensive? Can you tell
me about that?
Probes: Have you heard of someone who might
be DACA-eligible ever deciding to skip a
doctor’s appointment or not to have a test done
because of cost? How much is ‘‘too expensive’
for a doctor’s visit? Is cost a barrier for mental
health care as well?
6. Do you think that having insurance is important to
DACA-eligible young adults? Do you know what
type of insurance they might have or how they find
out about insurance and where they get it?
Probes: What might be some reasons that
DACA-eligible young adults may not have
health insurance? Have you or someone you
know had a period of time in which they lost
their insurance in the last few years? Why? How
did that change the ways you or that person got
health care? If you could design an insurance
program for DACA-eligible young people what
would you want it to look like? What services
would you include in your health insurance?
J Immigrant Minority Health
123
Who would you trust to tell you about an
insurance program like this?
7. If you were able to get health insurance under a public
program, whatwould be the best way to reach out to you
to enroll you in a health insurance program?
Probes: What types of information would you
want to know about the program before you
decided to enroll? Would you enroll? If so why
or why not?
8. What specific types of health services do you think
are most needed or most in-demand by DACA-
eligible young adults?
Probes: How about general primary care ser-
vices? Reproductive health care services? Dental
care services? Stress can be a very challenging
thing for young adults to manage. Do you know
young adults like yourselves who have used
mental health services like therapists to manage
stress? Where do DACA-eligible young adults
get these different types of care?
9. Are there any medical services that are hard for
young adults like yourselves to find or access?
Probes: What are these services? What makes
them hard to access? Are there things that have
made it particularly difficult for young adults like
yourselves to get mental health care?
10. What other barriers exist that might prevent DACA-
eligible young adults from seeking care? For exam-
ple, concerns about their citizenship status? Stigma?
Probes: Since the DACA program went into effect
last year, has this concern changed among your
friends or family members who are your age?
11. What do you think DACA has done for you? Have
you had any increased stress or responsibility
because of DACA?
12. Do you have any other thoughts that you would like
to share with us about health or health care needs of
young adults like yourselves?
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The evaluation was completed in 2010, resulting in numerous reports, issue briefs and peer review articles describing program accomplishments and insights into advocacy and policy change evaluation…" [more]
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Evaluation of California's Medicaid family planning program, Family PACT
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Bringing to bear scholarship, models, resources, and examples of useful evaluation designs and tools so that advocacy can fulfill its vision more effectively.
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