Health & Migration

Requires Standards 1–7 verified first

10 criteria

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [36] WHO Competency Standard 1 (Refugee and Migrant Health: Global Competency Standards for Health Workers, 2021) requires health workers to adapt practice to migration and displacement experiences, address trauma-informed care and psychosocial needs, and support continuity of care regardless of legal status.

A refugee or migrant patient's health needs are shaped by what happened before they ever reached this consultation — in their country of origin, in transit, on arrival — and telemedicine's ability to reach a patient in genuinely difficult circumstances makes this context, if anything, more likely to be actively relevant to the specific visit at hand, not less.

1 Adaptation happens for patients who disclose their history but isn't proactively considered otherwise.

Not every patient will volunteer this history unprompted, even when it is clinically relevant.

2 Providers are aware of the principle but haven't received specific training on applying it remotely.

General awareness doesn't reliably translate into genuine practice adaptation without specific training.

3 Adaptation is strong for the first consultation but isn't sustained across ongoing remote follow-up.

An ongoing relationship depends on this understanding genuinely persisting, not fading after the initial encounter.

Week 1 Review current practice for genuine adaptation to migration and displacement history.

Week 2 Train providers specifically on trauma-informed, migration-adapted practice.

Week 3 Build awareness of legal-status access barriers into standard practice.

Ongoing Revisit adaptation as the ongoing patient relationship develops.

Ask a provider to describe a specific example of adapting care for a patient's migration history.

A real, specific example reveals genuine practice, not familiarity with the principle.

Ask about continuity of care support specifically for patients without stable documentation.

This is where genuine adaptation is most tested.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [37] Systematic review of telemedicine for refugee populations identifies limited access to technology, unreliable internet connectivity, and insufficient digital literacy as key barriers hindering effective telemedicine use, requiring active strategies including affordable connectivity, digital literacy support, and multilingual platforms.

Real research specifically identifies limited technology access, unreliable connectivity, and insufficient digital literacy as key, documented barriers for refugee populations using telemedicine, and a patient who managed to connect today doesn't necessarily have reliable access for their next visit — active, genuine attention to these barriers, not an assumption of adequacy from one successful connection, is what actually sustains real access over time.

1 Assessment happens at intake but isn't revisited as a patient's actual circumstances may change.

A patient's access reliability can genuinely change, particularly for a population with real mobility.

2 Digital literacy support exists in the dominant local language but not in the patient's own language.

Genuine support needs to be usable in the language the patient actually understands.

3 An alternative access method exists but isn't proactively offered, relying on the patient to request it.

A patient who doesn't proactively receive this offer may not know to ask, and may quietly go without the access support they genuinely need.

Week 1 Review current practice for genuine assessment of device and connectivity barriers.

Week 2 Build digital literacy support materials in relevant languages.

Week 3 Establish and proactively offer a genuine alternative access method.

Ongoing Revisit access barrier assessment as patient circumstances change.

Ask how the service would identify a patient struggling with the platform who hasn't said so directly.

A specific, thoughtful answer reveals genuine, proactive attention, not reliance on the patient to report difficulty.

Ask what alternative exists for a patient whose smartphone or data access is genuinely unreliable.

A specific, real answer reveals a genuine alternative, not an assumption everyone has adequate access.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [38] WHO Competency Standard 3 explicitly states health workers have a responsibility not to engage minors to facilitate interpretation, given the associated significant risk, and identifies inaccuracy, information distortion, and compromised confidentiality as documented risks of family-member interpretation generally.

Family members interpreting, especially minors, carries real, well-documented risks — inaccurate interpretation, withheld or distorted information, compromised confidentiality, and trauma to the family member themselves — and telemedicine's remote format doesn't reduce this real risk, since a family member is often the only other person genuinely present in the room regardless.

1 Trained interpreters are engaged for scheduled consultations but not for urgent or same-day remote visits.

Risk doesn't scale down proportionally with how urgent or unscheduled an interaction feels.

2 The no-minors rule is understood by providers but not consistently reinforced with support staff scheduling sessions.

A critical safeguard needs to be embedded across the whole team, not held only by the treating provider.

3 Remote interpreter access exists but connection quality issues sometimes lead to reverting to a family member mid-session.

A genuine backup for interpreter connection failure is what actually prevents reversion to an unqualified family member.

Week 1 Review recent language-discordant consultations for interpreter engagement patterns.

Week 2 Establish reliable remote interpreter access, tested for connection quality alongside the platform itself.

Week 3 Brief all staff on the firm exclusion of children as interpreters, without exception.

Ongoing Audit interpreter use records for consistency.

Ask staff directly whether a child has ever interpreted for a parent during a remote session.

A direct question often surfaces what a general policy question won't.

Ask what happens if the remote interpreter's own connection fails mid-session.

This reveals whether a genuine backup exists, not reversion to an unqualified family member.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Requires improvement plan.

REFERENCES

1. [39] Research on refugee telehealth implementation specifically cautions that health technologies should be designed to create space for refugees to practice and demonstrate genuine agency, rather than treating them as passive beneficiaries of the technology, a framing that itself perpetuates harmful assumptions about their capabilities.

Real, documented barriers to telemedicine access for this population are genuine and worth actively addressing, but treating every patient in this population as uniformly lacking technological capability — rather than recognising genuine, real variation and individual competence — replicates exactly the stereotype researchers in this field have specifically identified as harmful, denying patients the chance to demonstrate and exercise their own real agency.

1 Individual assessment happens for adult patients but assumptions persist more readily for older patients within this population.

Age within this population doesn't determine genuine technology competence any more than population background does.

2 Staff avoid overtly presumptive language but subtly simplify explanations more than the individual patient's demonstrated understanding warrants.

Genuine respect for agency means calibrating explanation to the actual person, not a background-based default.

3 Awareness of this concern exists informally but hasn't been specifically, formally trained.

Informal awareness is less reliable than specific, formal training in genuinely preventing this documented pattern.

Week 1 Review current practice for genuine, individual assessment versus population-based assumption.

Week 2 Train staff specifically on this documented stereotype risk and how to avoid it.

Week 3 Build communication practices that calibrate to individual demonstrated competence.

Ongoing Audit communication tone for continued respect of patient agency.

Observe how a provider explains platform use to a patient from this population, if possible.

Direct observation reveals genuine, individually calibrated respect, not a presumptive default tone.

Ask staff whether they've received specific training on avoiding this documented stereotype.

A specific, confident answer reveals genuine awareness, not an assumption good intentions are sufficient.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [40] Refugees experience genuine difficulty accessing their medical records and maintaining continuity of care due to mobility-related challenges, with the absence of standardized, interoperable procedures between health systems resulting in fragmented records, incomplete medical history, and documented medical errors.

Real, documented research specifically identifies that refugees experience genuine difficulty accessing their own medical records because of mobility, and that fragmented, incompatible health records between different systems can result in incomplete medical history and real, documented medical errors — telemedicine's own reliance on Standard 2's principle that care follows the patient's actual location makes this fragmentation risk genuinely more, not less, acute for a population whose location itself is often unstable.

1 A portable record format exists but isn't proactively offered unless the patient specifically requests it.

A patient who doesn't know to ask shouldn't be less likely to receive genuine continuity support.

2 The record is current at creation but isn't genuinely updated as the ongoing relationship continues.

Continuity value depends on the record reflecting the patient's actual, current status, not only their status at one point in time.

3 Patients are given the record but not specific instruction on how to actually use or share it with a future provider.

A portable record a patient doesn't know how to use provides limited real continuity value.

Week 1 Review current record practice for genuine portability versus system lock-in.

Week 2 Establish a standard, portable, patient-accessible record format, proactively offered.

Week 3 Build a process for keeping the record genuinely current, particularly near known relocations.

Ongoing Confirm patients understand how to access and use their own record independently.

Ask a patient whether they have their own accessible copy of their health record, and whether they know how to use it.

A real, specific answer reveals genuine portability, not a record locked within the service's own system.

Ask how the record is updated when a patient reports an upcoming relocation.

A specific, confident answer reveals genuine, proactive practice, not passive record-keeping.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Requires improvement plan.

REFERENCES

1. [41] WHO Competency Standard 7 requires health workers to use evidence-informed guidelines specific to refugee and migrant health where they exist, recognise where the health needs of this population differ from the general population, and identify where evidence gaps remain.

Refugee and migrant health needs genuinely differ from the general population in ways that matter clinically, including documented, elevated risk of mental health disorders tied to trauma, displacement, and resettlement stress — care that ignores this and applies general guidelines uncritically can miss real, evidence-based adjustments this specific population needs.

1 Awareness exists for well-known differences but not for more specific or recent evidence.

Evidence in this area continues to develop, and awareness needs to stay genuinely current.

2 Guidelines are known but not consistently applied under time pressure.

Consistent application under real conditions is what gives awareness genuine protective value.

3 Evidence gaps are acknowledged but staff default to general population assumptions rather than flagging genuine uncertainty.

Genuine engagement with real uncertainty is more protective than defaulting to an assumption that may not actually apply.

Week 1 Review current awareness of population-specific evidence-informed guidelines.

Week 2 Establish access to current, relevant guidelines for staff.

Week 3 Train staff on specific, genuine population differences relevant to practice.

Ongoing Refresh awareness as evidence in this area develops.

Ask staff for a specific example of a practice adaptation based on population-specific evidence.

A real example reveals genuine application, not just familiarity with the concept.

Ask how staff would handle a genuine evidence gap for this population.

A thoughtful, honest answer reveals genuine engagement rather than a default assumption.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [42] WHO Competency Standards 8 and 9 (Refugee and Migrant Health: Global Competency Standards for Health Workers, 2021) require health workers to maintain structured awareness of their own biases and institutional discrimination's impact, and to engage in self-care within a supportive team environment addressing the wellbeing impacts of migration-context care.

Unacknowledged bias shapes clinical judgement in ways that are genuinely hard to see from the inside, and staff providing this care are regularly exposed, secondhand, to accounts of trauma and displacement — both are real, documented occupational realities of this work, and both require structured, deliberate support rather than being left to individual capacity alone, remote practice included.

1 Reflective practice happens informally but is not structured into any genuine, regular process.

Individual good practice does not reliably generalise without a defined, shared process.

2 Support exists but is genuinely difficult to access given remote staff working independently across locations.

A benefit's existence does not guarantee genuine, comfortable access to it, particularly for a dispersed remote team.

3 Support exists for acute incidents but not for the cumulative emotional weight of this work over time.

Cumulative emotional impact deserves the same genuine, structured support as any acute incident.

Week 1 Review current training content and support access for genuine coverage of bias and staff wellbeing.

Week 2 Establish a structured reflective practice process feasible for a remote or dispersed team.

Week 3 Identify genuine, accessible psychological support options appropriate to remote practice.

Ongoing Revisit reflective practice and wellbeing periodically, using real case examples where appropriate.

Ask for a specific personal example, not a general statement of awareness.

A concrete instance distinguishes genuine reflective practice from familiarity with the concept.

Ask directly whether support has been used, not just whether it exists.

Genuine uptake, not nominal availability, is the real test.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [43] Some governments have begun analyzing migrants' phone data as part of asylum adjudication processes, establishing genuine, documented grounds for displaced patients' distinct privacy concerns regarding digital health data, separate from general patient confidentiality practice.

Real, documented cases show some governments analyzing migrants' phone data as part of asylum adjudication, and a patient carrying genuine, well-founded fear that health information could similarly be accessed or used against their immigration status faces a real, distinct privacy concern beyond ordinary confidentiality — a service that doesn't genuinely address this specific fear risks patients withholding health information out of caution, or avoiding care altogether.

1 Recognition exists informally among some staff but isn't consistently, formally addressed across the whole team.

Every staff member interacting with this population deserves the same genuine, formal understanding.

2 Communication is honest but not proactively offered, relying on the patient to raise the concern themselves.

A patient may not know to ask, and proactive communication reaches concerns that would otherwise go unaddressed.

3 Training references data privacy generally but doesn't specifically name this population's documented, distinct concern.

General privacy training doesn't reliably surface this specific, documented concern without being named directly.

Week 1 Review current practice for genuine recognition of this population's distinct digital privacy concerns.

Week 2 Build specific, honest, proactive patient communication addressing this concern directly.

Week 3 Train all staff specifically on this documented, distinct concern, not general privacy training alone.

Ongoing Revisit communication and training as the relevant regulatory landscape evolves.

Ask staff directly whether they've discussed this specific concern with patients from this population.

A specific, real answer reveals genuine recognition, not an assumption general privacy practice covers it.

Ask to see the actual, specific language used to communicate this to a patient.

A real, specific example reveals genuine, honest communication, not a vague general assurance.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Requires improvement plan.

REFERENCES

1. [44] WHO's Competency Standards explicitly distinguish these legal status categories throughout, noting that access to health care and legal entitlements vary meaningfully by status and by country, and that health workers need specific awareness of this rather than a single generalised assumption.

Asylum seeker, recognised refugee, and stateless person are not interchangeable categories — they carry genuinely different legal access rights in different countries, and treating them as one undifferentiated group risks either wrongly denying care someone is entitled to, or missing a specific vulnerability tied to a particular status.

1 Staff can name the most common category served but not less frequent ones the service still encounters.

Even infrequent categories deserve genuine, specific awareness, not the risk of misapplied assumptions.

2 Differentiation exists in one provider's own understanding but isn't shared with the wider team.

Every staff member interacting with patients benefits from the same genuine understanding.

3 A verification process exists but staff are inconsistently confident applying it.

Consistent, confident application across the whole team is what makes this process genuinely reliable.

Week 1 Review current staff awareness of the specific legal status categories actually served.

Week 2 Build specific, differentiated access guidance for each relevant status category.

Week 3 Establish a clear verification process for genuinely unclear status.

Ongoing Refresh staff awareness periodically, particularly for less frequently encountered categories.

Ask staff to name every specific legal status category the service has served recently.

Specificity reveals genuine, current awareness rather than a general assumption.

Ask what happens when a patient's specific status is genuinely unclear.

A confident, specific answer reveals a genuine process, not improvisation.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [45] Equal standard of care and documentation regardless of immigration or legal status, without differential record-keeping practice, is established practice in international guidance on healthcare access for migrant and refugee populations.

A patient who fears that seeking remote care will expose their immigration status to consequences may delay or avoid care entirely, and any indication that this service applies a different standard based on status only reinforces that fear — genuine equal treatment, documented the same way for everyone, is what makes telemedicine genuinely accessible to this population.

1 The principle is understood by treating providers but not consistently by administrative or scheduling staff.

A patient's first interaction is often with administrative staff, where the same principle needs to hold.

2 Care is consistent but documentation habits vary informally based on individual staff assumptions.

Consistency needs to extend to documentation practice specifically, not only the clinical care itself.

3 The principle is followed but has never been specifically, formally trained.

Informal adherence is less reliable than specific, formal training, particularly as staff change over time.

Week 1 Review current practice for any differential treatment based on status.

Week 2 Establish specific staff training on this principle, covering all staff, not only clinical roles.

Week 3 Confirm documentation practice is genuinely consistent regardless of status.

Ongoing Reinforce training periodically, particularly for new staff.

Ask administrative or scheduling staff, not only providers, about this principle.

This reveals whether the principle genuinely extends beyond clinical staff.

Ask how patient status information, where it becomes known, is protected.

A specific, confident answer reveals genuine practice, not just a stated value.