* 1. What is your site of employment?

* 2. What is your job title and level of training?

* 3. Please indicate how likely you would be to address the following topics during a clinical encounter with a recently arrived (within the last 5 years) pediatric immigrant patient:

  Not at all Likely Less Likely Somewhat Likely More Likely Most Likely
Routine vaccinations
Screening and treating for parasitic infection
Dental services
Behavioral health services (for example: referrals to counselors, psychologists, psychiatrists)
Legal services for immigration-related issues
English classes (including speaking, reading, and writing classes)
Nutrition education and tools to prevent obesity
Screen for unsafe housing and if needed, provide education on tenant rights
Academic resources for school difficulties
Screen for bullying at school or in the community and if needed, help parent advocate for child
Information about how to access local community resources (for example: church groups, boys and girls clubs, parks and recreation centers, libraries)

* 4. Are there any additional services for a recently arrived immigrant child that you feel are important that are not mentioned above?

* 5. Do you know where to refer your immigrant patients for legal aid?

* 6. Do you know where to refer your immigrant patients or their parents for English classes?

* 7. What do you wish to learn more about with respect to caring for recently arrived immigrant youth?

* 8. Are you a member of any special interest groups pertaining to immigrant health?

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