Domestic Medical Screening Guidance for Newly Arrived Refugees

Development and Review Process

The Domestic Medical Screening Guidance (formerly known as the Domestic Medical Screening Guidelines) is the culmination of a collaborative process based on available evidence-based national screening recommendations and accepted clinical best practices in refugee health. These guidance documents:

  • outline what should be addressed during the domestic medical screening and initial primary care follow-up visits, and
  • discuss additional considerations for ongoing care.

The domestic screening guidance is intended to provide recommendations, not mandates, and each section is designed to be flexible, allowing clinicians to adapt the screening process to meet the needs of each refugee.

The Division of Global Migration and Quarantine (DGMQ) first began developing the Domestic Medical Screening Guidelines in September 2006. Each section was written and reviewed by refugee health and subject-matter experts. Additionally, sections were critically reviewed by a Federal Partners Working Group, which included representatives from the Department of Health and Human Services’ (HHS) Offices of Refugee Resettlement and Global Health Affairs; the Department of State’s Bureau of Population, Refugees, and Migration; and the Substance Abuse and Mental Health Services Administration. The original guidelines were subject to additional review by an elected body of state refugee health coordinators.

In 2015, DGMQ initiated a comprehensive review of the Domestic Medical Screening Guidance, in partnership with the Centers of Excellence in Refugee Health (Minnesota Department of Health). The revised guidance has been reviewed, written, and edited by a panel of experts in refugee health. Each section is then reviewed by refugee health and subject-matter experts outside CDC, including clinicians, social workers, and researchers who work domestically and internationally. Each section receives further critical review and editing through an official clearance process within CDC. DGMQ also receives comments regularly from clinicians at national conferences and meetings, and through individual inquiries. Guidance is updated as new information becomes available.

When the Domestic Screening Guidelines were first developed, much thought and discussion went into the naming of the guidelines, the intended audience, and how content would be maintained and revised. In 2012, the CDC Office of the Associate Director for Science introduced the Guidelines and Recommendations Team, which set new standards for CDC guidelines and implemented a rigorous review policy for guideline documents. This has prompted a change in terminology. As our content undergoes a different review process, as of October 2020, the Domestic Medical Screening Guidelines were renamed as the Domestic Medical Screening Guidance. DGMQ’s guidance draws heavily from existing domestic and international guidelines, and is tailored to a specific provider audience and patient population. As refugee populations are diverse and everchanging, it is important that DGMQ’s guidance is nimble, allowing for changes as new epidemiological and medical information becomes available.

Completed guidance documents are posted on the Immigrant and Refugee Health webpage as they become available. Partners receive notification letters from CDC regarding changes to the domestic screening guidance. The HHS Office of Refugee Resettlement, the Association for Refugee Health Coordinators (ARHC), and the Society of Refugee Healthcare Providers help distribute these CDC notification letters to their partners. Additionally, guidance is also uploaded to the clinical decision-making tool, CareRef (Minnesota Department of Health), as it becomes available.

Please contact the Domestic Team (irmhdomestic@cdc.gov) with questions regarding the Domestic Medical Screening Guidance.

Primary Authors
  • Marc Altshuler (Preventative Nutrition and Growth, Preventative Health*)
  • Jennifer Barker
  • Andrew Bauer
  • Jennifer Beeler
  • Megan Berthold
  • Maggie Chan (Iodine Deficiency)
  • Elizabeth Dawson-Hahn (Mental Health)
  • Malini DeSilva (Viral Hepatitis*)
  • Brittany DiVito (Preventative Health)
  • Ann O’ Fallon (Mental Health, STD & LGBTQI*)
  • Beth Farmer (Mental Health)
  • Ellen Frerich (Mental Health, LGBTQI*)
  • Amber Elizabeth Gray (Mental Health)
  • Emily Jentes
  • Crista Johnson Agbakwu (STD*)
  • Gayathri Kumar (Nutrition and Growth*)
  • Elizabeth Kvach (LGBTQI*)
  • Blain Mamo
  • Hope Pogemiller (Primary Author for Mental Health*)
  • Dan Savin (Mental Health)
  • Ann Settgast (Preventative Health)
  • Gretchen Shanfeld (Preventative Health & LGBTQI)
  • Hawthorne Smith (Mental Health)
  • Sharon Travers (Iodine Deficiency)
  • Patricia Walker (Preventative Health, LGBTQI)
  • Michael Westerhaus (Preventative Health)
  • Katherine Yun (Pediatrics)
  • Janine Young (Intestinal Parasites, STD [FGM/C], Pediatrics*, Panel Reviewer**)
  • Philip Zeitler (Iodine Deficiency)
Expert Reviewers
  • Marc Altshuler (Panel Reviewer**)
  • Megan Berthold
  • Malini Desilva (STD, Tuberculosis)
  • Ann O’ Fallon (Mental Health, HIV*)
  • Beth Farmer
  • Ellen Frerich (Mental Health, Women’s Health)
  • Amber Elizabeth Gray
  • Crista Johnson-Agbakwu (Women’s Health, FGCM)
  • Gayathri Kumar
  • Elizabeth Kvach (LGBTQI)
  • Gretchen Shanfeld (Mental Health, Women’s Health)
  • Hawthorne Smith
  • Ann Settgast (Tuberculosis)
  • Hope Pogemiller (Panel Reviewer**)
  • Patricia Walker (LGBTQI)
  • Michael Westerhaus (HIV*)
  • Janine Young (Intestinal Parasites, Malaria and HIV*)
  • Katherine Yun (STD, Panel Reviewer**)

*Lead Primary Author

**Centers of Excellence Panel Reviewer

Authorship and Reviewer lists will be updated quarterly. Contact irmhdomestic@cdc.gov for additional information.