The Department of Health and Human Services’ Office of Inspector General commonly found “intense trauma” in its assessment of children assigned to the Office of Refugee Resettlement (ORR) during the year that the Trump administration was engaging in “zero-tolerance” family separations of migrants.
OIG’s series of reviews cover not only this report’s focus on the mental health situation of children in custody, but screening of the employees working with the kids, family reunification efforts, child safety and facility security.
“According to those who treat them, many children enter the facilities after fleeing violence and experiencing direct threats to their safety during their journey to the United States,” said the report, based on visits to 45 of 102 care sites in August and September of last year and interviews with about a hundred mental health clinicians who had regular interaction with children. “Some children also experienced the trauma of being unexpectedly separated from their parents as a result of U.S. immigration policies. Facilities must promptly address children’s mental health needs — not only to stabilize each child in crisis, but also to reduce the risk that the child will negatively influence or harm others.”
In fiscal year 2018, the ORR’s Unaccompanied Alien Children Program cared for at least 49,100 children — about 12,400 were in the program at the time of the OIG review — and received $1.6 billion in funding. Children remain there until an appropriate sponsor, most often a relative, takes them in or until they turn 18 and age out of custody.
Children in ORR custody are supposed to receive at least one individual session with a mental health counselor each week and two group sessions per week. Each child’s mental health is supposed to be assessed within five days of arrival. When ORR is overwhelmed by the number of new arrivals, though, children are sent to short-term care facilities that don’t require the same mental health care.
Numerous children suffered physical or sexual abuse, including kidnapping, torture and rape, in their home countries before fleeing for the United States, while others had their lives threatened or witnessed the rape or murder of family members. Then, “some children experienced or witnessed violence during the trip to the U.S. border.”
“Some children experienced additional trauma after they arrived in the United States. Some children faced additional trauma when they were unexpectedly separated from a parent,” the report continued. “Even for children who entered the United States without their parents — those not separated — some found it traumatic to adapt to new and unfamiliar situations in facilities.”
“Separated children experienced heightened feelings of anxiety and loss as a result of their unexpected separation from their parents after their arrival in the United States. For example, some separated children expressed acute grief that caused them to cry inconsolably,” the report added. “Children who did not understand why they were separated from their parents suffered elevated levels of mental distress. For example, program directors and mental health clinicians reported that children who believed their parents had abandoned them were angry and confused. Other children expressed feelings of fear or guilt and became concerned for their parents’ welfare.”
One program director told OIG officials that the children were “terrified” of employees because the kids “could not distinguish facility staff from the immigration agents who separated them from their parents.”
OIG recommended that ORR “identify and disseminate evidence-based approaches to addressing trauma in short-term therapy,” “develop and implement strategies to assist care provider facilities in overcoming obstacles to hiring and retaining qualified mental health clinicians,” “assess whether to establish maximum caseloads for individual mental health clinicians,” “help care provider facilities improve their access to mental health specialists,” “increase therapeutic placement options for children who require more intensive mental health treatment,” and “take all reasonable steps to minimize the time that children remain in ORR custody.”
HHS’ Administration for Children and Families concurred with the recommendations and detailed plans to address four of the six.