frequently asked questions for medical evaluatORS

Answers to inquiries we commonly receive from prospective medical evaluators are organized in the following Q&A sections:

  • Evaluator Qualifications & Requirements

  • Evaluation Logistics

  • Clinical Considerations

  • Volunteer Resources

Don’t see an answer to your question below? Send us a message!


Looking for more information about psychological evaluations? Check out the mental health evaluator FAQ here.

EVALUATOR QUALIFICATIONS AND REQUIREMENTS

Q: What qualifications are needed to become a medical evaluator for asylum & humanitarian protection cases?


A: U.S. immigration authorities currently accept evaluations submitted by medical professionals who are fully licensed to diagnose without supervision in their state.

  • Physicians: MD and DO licenses are accepted by immigration authorities in all states. (See question below for more information about medical residents.)

  • Nurse Practitioners: Nurse practitioners may serve as independent evaluators in Arizona, Washington, and other states where licensure laws permit NPs to diagnose patients without physician supervision. (See this map from the American Association of Nurse Practitioners.) In states with more restricted scope of practice, such as Texas, an NP would need to co-conduct the evaluation with a supervising physician, similar to the process for medical residents described below.

Physicians and nurse practitioners with all different types of specialties can leverage their unique expertise to make an impact. EAHR's dedicated team of medical evaluators currently includes volunteers who specialize in emergency medicine, family medicine, internal medicine, geriatrics, neurology, obstetrics and gynecology, pediatrics, psychiatry and cardiology.


Q: Can you do asylum evaluations as a resident (not licensed and/or boarded)?


A: An independent license is needed on affidavits submitted to immigration court, but there are some residents who volunteer with us in tandem with an attending physician or psychiatrist. In these cases, the resident will help co-conduct the evaluation, draft the affidavit, and sign the affidavit with the attending physician. The level of supervision required in this process depends on the resident’s year and how far along they are in the process of becoming fully licensed.


This resident-supported evaluations model helps expand our program’s capacity, and many of EAHR’s most prolific evaluators got started with asylum evaluations this way (and are now mentoring the next generation of medical student & resident evaluators!). This model tends to be most successful when a resident and attending within the same clinic/university choose to volunteer together, for ease of coordination.


To any residents looking to get involved: We highly recommend first reaching out to any fully-licensed faculty or colleagues in your network to gauge their interest in asylum evaluations! Our team can also support connecting you with an independently-licensed physician and/or clinic space if you are located near our program partners, but our resources to facilitate this are more limited.

Q: I am not located in Arizona, Texas or Washington. Can I still volunteer with EAHR?


A: Unfortunately, we do not have capacity to arrange evaluations in other states at this time, but we are deeply grateful for your interest in volunteering as an evaluator and strongly encourage you to seek another opportunity to engage in this vital work! You are welcome to access our EAHR Training Series and reach out to our team to see if we have a connection to a volunteer evaluator network in your area.

Q: Do I need to commit to a specific number of evaluations in order to volunteer?


A: As there is a cost associated with processing volunteers' background checks, we ask that onboarded volunteers complete at least one evaluation. Beyond this, there is no set requirement. Some of our medical evaluators take two cases per year, and others conduct upwards of two per month. The number of cases assigned and their respective deadlines are entirely up to the evaluator’s availability and capacity. We are happy to work with you on whatever timeframes and deadlines are most realistic for your schedule.

Q: Do I need to be willing to testify?


A: Experts cannot be subpoenaed in immigration court, and testimony is never required. If evaluators have any flexibility to clear an hour of their schedule for immigration court testimony, these optional additional hours can also make a meaningful difference for an asylum-seeker's case.

Q: Do I need malpractice or liability insurance?


A: In the evaluation context, asylum-seekers are not patients, and the evaluator is not acting as a care provider; evaluations are a one-time, optional assessment that cannot constitute any form of medical care or advocacy. As such, medical malpractice does not apply in these cases, and overall liability is quite low.


There is a theoretical possibility that an evaluator could be accused of negligence, but in discussions with peer programs that offer evaluation services nationwide, we've verified that - among tens of thousands of medical & psychological asylum evaluations conducted all over the U.S. in the last 10+ years - our partners in this field have never heard of any lawsuit filed against an evaluator. To address this theoretical liability, some of our volunteers choose to include evaluations as part of their work under the malpractice/liability insurance plans they are already obtaining for their professional/private practice, but most others choose to go without.


EVALuation logistics

Q: When and where do evaluations take place?


A: Medical evaluations can be scheduled at all times of day, including weeknights and weekends, based on the evaluator’s availability. Once an evaluator notifies us that they have an opening in their schedule for an evaluation (e.g., “I’m available on the first Tuesday of next month from 8AM-10AM”), our staff will work with the volunteer to identify an appropriate referral to fill the opening.


Evaluations are most commonly hosted at the evaluator’s clinic space or a community clinic space partnering with EAHR, but evaluations also can be held at some IRC offices or at immigration detention facilities. At this time, we are not arranging telehealth medical evaluations, and all appointments are hosted in-person.

Q: Can I decline to do evaluations in immigration detention?


A: You can decline any evaluation request that isn’t a good fit for your expertise, availability or capacity. Detention evaluations often present additional clinical and logistical challenges that aren’t workable for everyone—and the majority of our referrals are for non-detained cases! EAHR staff will find another way to ensure the referral is served if you decide to decline.

Q: How much time does a medical evaluation take to complete?


A: The time it takes to complete an evaluation can vary widely, both due to evaluators' unique processes and the complexity of a given case. On average, medical evaluations involve 1-2 hours of face-to-face time for the evaluation appointment itself, plus 3-4 hours write, edit, and finalize the written affidavit.

Q: For the most efficient use of time, can we schedule multiple evaluation appointments in a day?


A: Logistically, yes. But while it is time efficient, these evaluations involve significant trauma content, and we do not advise scheduling more than 2 back-to-back evaluations in a day – especially for newer evaluators.

Q: How is interpretation arranged for evaluations?


A: Evaluation Alliance Support Team staff coordinate all logistics related to interpretation with the applicant’s legal representative. The interpreter may join the evaluation appointment via video, telephone, or in-person, depending on what is most clinically appropriate and logistically viable. Detention evaluations tend to use telephonic interpretation.


CLINICAL CONSIDERATIONS

Q: Is there any role for testing or imaging as part of the evaluation?


A: It is rare that testing and imaging are incorporated into an evaluation, but we do occasionally see the following scenarios:

  1. The applicant has existing medical records from a hospital or clinic where they received treatment for injuries attributed to torture/abuse in their country of origin.

  1. The applicant has existing medical records from a U.S.-based provider that documents treatment for injuries attributed to abuse in the U.S. or treatment for symptoms/diagnoses associated with their history of torture/abuse.

  1. The applicant’s persecution claim hinges on internal evidence—such as forced sterilization by vasectomy or tubal ligation— for which they have not yet been tested.


In situations #1 and #2, EAHR Staff will share any relevant medical records for you to review and include a ‘plain English summary’ of your findings in the affidavit. (Medical jargon in health records may be unfamiliar to immigration judges, so a concise and simple summary of relevant records can be especially helpful.)


In situation #3, EAHR Staff will support referring the applicant to medical resources where they can obtain the necessary labs or imaging, and then send the results to the evaluator to be incorporated into their affidavit.


In general, however, the vast majority of our referrals are exclusively focused on documenting visible, physical sequelae.

Q: Can medical evaluators include screenings for Traumatic Brain Injuries or mental health symptoms in their assessments?


A: Screening tools are an essential component of psychological evaluations and can be a helpful addition to medical evaluations if the evaluator is familiar with the instruments and comfortable using them in this context. Screening tools most commonly used by our medical evaluators are the GAD-7, PHQ-9, PCL-5, MOCA, MMSE and HELPS, and our team can provide validated translations of these tools in some other languages, as needed.

Q: What should I do if I identify a health concern that is unrelated to the legal case during my exam? Can I provide medical advice?


A: If you identify a health concern during your exam, please ask the applicant whether they are receiving care and encourage them to talk to their medical provider about it (or to speak with EAHR staff about finding a medical provider, if they do not have one!). Beyond encouraging the applicant to seek care and notifying our team that a referral is needed, medical advice should be avoided to maintain the boundaries of your role as an evaluator, not a care provider.


Here are some frequent scenarios that may arise during an evaluation:

  1. Applicants who have survived sexual torture or sex trafficking may not have been tested yet for STIs. In some cases, the fear of having contracted an STI like HIV/AIDS might be causing significant distress; in other cases, the applicant might not be aware that they should be tested.

  1. It is standard practice during evaluations to note any ongoing physical symptoms attributed to injuries sustained during torture, such as headaches, chronic pain, or dyspareunia. Some medical evaluators also document psychological symptoms. The applicant may not have a primary care provider to treat these ongoing physical/psychological symptoms, or they may report that they were forced to cease treatment or medication due to financial barriers.

  1. Medical neglect is unfortunately pervasive in U.S. immigration detention centers, and one of the most commonly-reported human rights abuses in ICE custody. Our evaluators often find that detained applicants are not receiving treatment for serious health concerns and/or are not receiving care in a language they understand (they might be taking medication but have no idea what it is for, as they are denied a medical interpreter).

When a health concern arises, the best course of action is to tell the applicant that the EAHR team can support connecting them to resources and you will notify EAHR to contact them about next steps! We provide all evaluators with a Post-Evaluation Needs Assessment form that can be used to quickly record these needs and share with EAHR staff. EAHR staff will then work on connecting the applicant to ongoing medical or mental health care, in addition to any other critical needs identified. (In detention, we’ll work with the applicant’s attorney on next steps for getting the support they need.)

If the applicant is in crisis, EAHR staff are on-call during every evaluation to handle suicidality assessment and safety planning, so that volunteers can responsibly maintain the boundaries of their role as evaluators rather than care providers.


volunteer resources

Q: Is there a template or collection of examples we can adapt for our affidavits?


A: Yes! We include a blank template in the training materials packet shared with all evaluators who attend our Medical Evaluations Workshop (Module 3). Once onboarded, EAHR evaluators also gain access to a library of volunteer resources that includes redacted sample affidavits, articles, and tip sheets.

Q: Can I shadow an experienced evaluator before doing it the first time alone?


A: We pair everyone with a mentor before their first evaluation. If you are physically located near our other volunteers, mentorship for medical evaluations may include shadowing an evaluation.

Q: What are the next steps to apply to become a volunteer?


A: Before submitting an application, all prospective evaluators must complete the EAHR Training Series, which includes Module 1: Introduction to the EAHR, Module 2: Introduction to Humanitarian-Based Immigration Protection, and Module 3: Medical Evaluations for Asylum and Humanitarian Protection. The training series takes roughly 3 hours total to complete and is designed to equip volunteers with the foundations to begin conducting evaluations for survivors of torture, persecution and human rights abuses.

Once you have completed the EAHR Training Series,
please click here to follow the steps to submit a volunteer application!

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Two unaccompanied children walk holding hands with a doctor and IRC staff member.

"It has been an honor and deeply rewarding for me to participate in conducting asylum medical evaluations. I reflect on this gratitude after each evaluation I complete. I will always remember the first time I received the feedback that someone I evaluated received asylum— tears of joy and relief! This is a way for me to contribute outside of direct medical care. It’s a way for me to continue to practice and improve my trauma informed skills and communication as well. I continue to learn from and admire the bravery of my clients and try to honor their stories by seeds for growth/improvement in my own life and medical practice."

- EAHR Volunteer