MCH Bridges: The Official AMCHP Podcast

Episode #8: Public Health Across Borders: Unaccompanied Immigrant Children, Mental Health, and the U.S. Immigration System

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This episode explores the unique experiences of unaccompanied immigrant children (UICs) and the ways in which immigration impacts mental health. The Young Center, an organization dedicated to promoting immigrant children’s rights, ensures the safety and best interests of unaccompanied children in United States custody by advocating for them as they navigate the immigration system. In this episode, José Ortiz-Rosales, Deputy Director of the Young Center’s Child Advocate Program, and Anne Kelsey, Policy Analyst for Disability Rights at the Young Center, offer their perspectives on opportunities for the public health field to better support unaccompanied minors’ mental and physical health needs.

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[00:00:00] Ashley Sanchez-Garcia: Welcome to MCH Bridges, where we lift up innovative ideas and inspiring stories from people in the maternal and child health field. I'm Ashley Sanchez-Garcia. I'm a Behavioral Health intern at AMCHP, and I'm your guest host for today. 

[00:00:26] Ashley Sanchez-Garcia: In 2019, in the summer before my junior year of college, I came across devastating news. Carlos Gregorio Hernandez Vasquez, a 16 year old migrant from Guatemala, had died in US Border Patrol custody. He died in a station cell in Texas from the flu and other health complications. That summer was emotionally heavy for me. It felt like I was hearing name after name of minors who had passed away in immigration custody: Felipe Gomez Alonzo, eight years old, Jakelin Caal, seven years old, Wilmer Josue Ramirez Vasquez, two and a half years old, and so many more. I felt heartbroken, and I wanted to know why this was happening, what supports were being made available for children during the immigration process, and what I could do to help mitigate the issue. Several years later, I got involved in public health, and I am more interested than ever in the intersections between migrant health, mental health, and maternal and child health.

[00:01:32] As many of us know, there has been a public health crisis at the U.S.-Mexico border for decades now, and it has been escalating in recent years. At the beginning of last August, the Pew Research Center reported that monthly migrant encounters at the border were at an all time high, with 200,000 apprehensions in July of 2021. That is the highest monthly total in two decades. As of May 2022, there were almost 240,000 encounters at the border, which tells us that we should expect numbers to continue increasing.

[00:02:08] Unaccompanied immigrant children, also called “UICs” for short, are those under 18 who migrate to the United States alone. They do not have a parent or legal guardian in the U.S., or anyone who can provide care and physical custody upon their arrival. In 2020, there were only 33,000 UICs encountered at the border.

[00:02:32] Last year UIC encounters at the border increased to 147,000. So what does all of this mean? More children and families are struggling with the impacts of various social, political, and economic forces within their home countries. It also means that we have a growing population of children who are forced to navigate the immigration system, and then our public health system, completely alone.

[00:03:10] Most UICs are Central American, with roughly two-thirds of apprehended unaccompanied children coming from the Northern Triangle countries: Guatemala, Honduras, and El Salvador. There are lots of factors that contribute to the decision to arrive in the U.S. alone as a child, including poverty, gang violence, homicides, and the worsening effects of global climate change,

[00:03:36] to name a few. You might be wondering how the experience of UICs and public health intersect. UICs are known to be particularly vulnerable to developing mental health disorders, such as Post-Traumatic Stress Disorder, anxiety, and depression, due to the multiple traumatic experiences they may have lived through. 

[00:04:07] Anne Kelsey: We look at it as sort of a triple trauma paradigm, that they could have experienced trauma before migration.

[00:04:13] So in their home countries, during their migration journey, or once they arrive or are apprehended into U.S. custody after their release. 

[00:04:22] Ashley Sanchez-Garcia: That was Anne Kelsey, a Disability Rights Policy Analyst at the Young Center for Immigrant Children's Rights from New York. She was describing the triple trauma paradigm, which is a useful framework for understanding how trauma works within refugee and migrant populations.

[00:04:39] Anne Kelsey: As we know, experiences of trauma and particularly multiple experiences over time and complex trauma can have lifelong effects on the health and wellbeing of children. 

[00:04:51] Ashley Sanchez-Garcia: It's important to note that it is impossible to generalize how experiences of trauma manifest within individuals. However, studies do show that children who experience adversity and trauma are much more prone to negative physical and mental health outcomes.

[00:05:08] Jose Ortiz-Rosales: Encountering the U.S. immigration system in itself poses significant mental health challenges for immigrant children.

[00:05:15] And what I mean by that is that the immigration system, in the United States, wasn't developed nor was this structured for children to interact with it in a child friendly way. So with that, it comes with challenges, right? Being separated from their families, from adults who they feel safe around, can sometimes add to that challenge and increase their mental health needs for those reasons.

[00:05:39] Ashley Sanchez-Garcia: That was Jose Rosales, a Deputy Program Director within the Child Advocate Program at the Young Center. He's from Los Angeles, California. 

[00:05:49] Jose Ortiz-Rosales: Children also face a lack of language-inclusive and culturally competent resources, including mental health and other services that can be supportive in their journey.

[00:05:58] Ashley Sanchez-Garcia: As Jose clearly illustrates, there are many gaps in the system for UICs, and these gaps alienate children from networks of support and care.

[00:06:16] For the most part, a UIC's first experience of the us immigration system is being put in custody within a border patrol facility upon arriving at the border. 

[00:06:26] Anne Kelsey: So the average stay in custody is around 30 days. But the children that we work with, because of their vulnerabilities, because, you know, they might not have a viable sponsor or family in the community for any number of reasons,

[00:06:41] do often spend much longer in custody. So it can be months and years, which is sort of a compounding trauma, right? The detention fatigue sets in, the uncertainty, the stress of those longer stays in custody. 

[00:06:56] Jose Ortiz-Rosales: The longer they stay, of course, the more that they would be in need of services when they go into the community.

[00:07:04] So access is not always the only thing, but once they get access, it’s being able to get the services that they need that's tailored to them. 

[00:07:11] Ashley Sanchez-Garcia: Unsurprisingly, being placed in detention is linked to poor mental health outcomes. 

[00:07:18] Anne Kelsey: We know that children are safest, are healthiest, are most successful when they're with family members and caregivers rather than in custody.

[00:07:27] And so we really prioritize getting children released as soon as possible to families, to sponsors, with services in the community.

[00:07:35] Ashley Sanchez-Garcia: Outside of detention centers. Many UICs have to juggle navigating the immigration system while also dealing with acclimating to a new life in a new country. I'd like for everyone listening to imagine being stressed, due to a very long to do list, but all your deadlines are within a really tight timeframe,

[00:07:57] and the tasks that you have to accomplish are completely different. Maybe you have a deadline for a big project at work, but you also need to go to a doctor's appointment, and you also have an exam to study for. Jose explains this phenomenon and the impacts that it has on UICs. 

[00:08:16] Jose Ortiz-Rosales: Children find themselves isolated in each system.

[00:08:19] And what I mean by that is that they have to navigate, maneuver through the education system, behavioral health system, even the family community, in addition to the immigration system, right? All these systems don’t really communicate with each other or talk to each other. It really silos the child in its experience.

[00:08:36] And I like to use the example of: when a child has finals in school, but then they also have like an asylum interview that same week. The challenge there is that the child is having to think about their future in the U.S., because at the asylum interview, you're pretty much, uh, the government is assigning your future.

[00:08:55] And then at school you're worried about wanting to ace that test, right, but also understanding that there’s not that many language support systems that can get you there too. That's a good example of what immigrant children have to experience and the life that they have to kind of live until there's some certainty for them through their immigration case.

[00:09:17] Ashley Sanchez-Garcia: A lot of UICs are in a sort of limbo while their immigration hearings proceed. As Jose said, there's little to no communication within the systems that UICs will regularly encounter in their lives, creating even more isolation and uncertainty. This has a big impact on children's mental health. Most of us listening can only imagine the extreme levels of stress that this kind of situation would bring.

[00:09:52] Our interest in understanding the complex systems that UICs must navigate led us to The Young Center, an outstanding organization involved with supporting the needs of immigrant youth across the United States. 

[00:010:07] Anne Kelsey: The Young Center is a human rights organization that is dedicated to protecting the rights of unaccompanied children and not only rights, but rights, safety, best interest, wellbeing.

[00:010:18] The Young Center isn't appointed to all children in custody. We're only appointed to the most vulnerable. So for example, children who have disabilities or mental health concerns, children who are pregnant or parenting, young children, children who are possibly victims of trafficking, or who have otherwise experienced violence, or are at high risk. That really makes

[00:010:49] our work and our trauma-informed and our best-interest lens all the more important, just because of the unique vulnerabilities of the kids that we serve. 

[00:011:00] Ashley Sanchez-Garcia: Jose also told me that The Young Center is the only nonprofit in the country that trains and provides independent child advocates for immigrant children in government detention.

[00:011:12] Jose Ortiz-Rosales: Our volunteers who we train before interacting with children work alongside Young Center attorneys and social workers to make recommendations on all levels, to decision makers who are making these decisions for the children while they're in government custody. And these best interest recommendations really 

[00:11:30] look at what is in the child's best interest as it relates to their case. So it's very independent and it's very centered to the child, because one thing that we push for and we advocate for is to look at the child in a holistic way, and not just focus on one thing in their life. 

[00:11:45] Ashley Sanchez-Garcia: The Young Center makes a commitment to work for the best interest of those that they serve. Jose and Anne expanded on what the best interest paradigm looks like in practice when working with UICs. 

[00:11:57] Jose Ortiz-Rosales: When a child is having to make a decision, There's someone that wants to sponsor them out. Then what I mean by that is someone that has said, “I'm willing to take them in and care for them”. For us, the way that we would approach it as, and in the best interest, is we would

[00:12:12] speak with all stakeholders, speak with the child, and also speak with the adult. We’d kind of get a sense of what that would look like and how would the child's needs be met at release. In doing that, we look at the child's wishes and we look at the child's safety. So, those are like two guiding needs that we would look at.

[00:12:33] But then we also look at development, liberty, and access to their identity and being able to kind of access their identity. So encompassing all those things, we make sure that if it's in the child's best interest to go to this adult, especially, let's say, for example, if there's a child that has been in government custody for an extended amount of time, we’d want to make sure that, one, the

[00:12:57] adult is in a good position to care for the child, but then two, the child feels comfortable and safe enough to be able to go to this adult. That's willing to care for them. The idea there is to make sure that everything taken into account and we're seeing the child in a holistic way.  

[00:13:14] Anne Kelsey: The government system can sometimes be a little paternalistic about release decisions and what they think is best for the child. And they can sometimes, acting from, you know, what they think is a good spot, put really high bars to services that need to be in place in the community before the child is released, or sort of hoops that a sponsor might need to jump through.

[00:13:38] And so, you know, one thing I think our child advocates are great at is identifying, you know, the child's wishes and safety, but how really the best interest is in the community with services and supports in the community. And our child advocates will really go the extra mile to get those in place, to help for release.

[00:13:59] Ashley Sanchez-Garcia: I really want to highlight this idea of giving autonomy to those that we serve in our respective careers. A lot of times as professionals, we run the risk of entering spaces and assuming that we know the best ways to serve those we work with. This is especially true for this population because they are minors.

[00:14:18] But I completely agree with The Young Center's focus on addressing the specific best interests and needs of every child. Once I learned how the young center is working to promote equity for migrant children, I wanted to know how we as maternal and child health professionals can support the mental health needs of UICs.

[00:14:37] Anne Kelsey: There are a lot of ways that they can support this work and get involved. And one great one is listening to this podcast, right? So now they'll know more about unaccompanied children, and that's a huge step. Another one is, is we encourage, listeners to reach out to The Young Center.

[00:14:54] We work with children in custody and children who are released all over the country. And it's hard for us to know kind of what's available in each city, state, you know, area. And so we would love to know what you guys are working on. We'd love to work together to strengthen supports and services for unaccompanied kids and kind of, you know, make sure that we're all working together.

[00:15:19] So, for example, you know, you might be piloting a really exciting child mental health program. And we would love to know about that, and we'd love to know that it's available to our kids and to kids regardless of documentation status. So one is definitely, you know, reach out to us.

[00:15:37] Ashley Sanchez-Garcia: In New Mexico, Las Cumbres’s project, Santuario del Corazon, is providing trauma-informed care to UICs who relocated to Northern New Mexico. Their goal is to meet the critical human rights and social and emotional needs of migrant children who have experienced traumatic experiences, such as separation from a caregiver, family separation at the border, and/or deportation.

[00:16:05] They have received funding from the SAMHSA, also known as the Substance Abuse and Mental Health Services Administration, for this unique project. And it is just one example of a program like the one that Anne is describing.

[00:16:19] Anne Kelsey: Another way is to support federal, state, and local initiatives that support increased access to Medicaid. That's a big one, as well as, to go back to something that Jose said earlier, things that support cultural competency and language access are really huge.

[00:16:37] So on the federal level, that could look like supporting the LIFT the BAR Act or the HEAL Act. I also have my eye on Biden's National Mental Health Strategy, and some funding and legislation that might come out of that and how we can use that to support undocumented kids. 

[00:16:55] Ashley Sanchez-Garcia: California has a few state initiatives that are of note here.

[00:16:59] Medical, California's Medicaid program, provides coverage to all children and young adults who meet income eligibility requirements, regardless of their immigration status. The California Department of Social Services has a number of social support service programs for unaccompanied minors and other vulnerable immigrant and refugee children,

[00:17:22] and has just opened the Office of Immigrant Youth, which funds school districts and county offices of education to support newcomers, and provide youth mentoring services among other initiatives.

[00:17:35] Anne Kelsey: And then lastly, on the local level to support school care-based community based programs. Those are really proven interventions that will support kids.

[00:17:47] Ashley Sanchez-Garcia: One such local level intervention in Arizona is the Mariposa Community Health Center. Mariposa has integrated behavioral healthcare with regular medical care. The health center's licensed professional counselors are members of the medical staff, and they work hand in hand with the physicians to assure that patients, families, and children receive the help they need, both physically and emotionally. 

[00:18:12] Anne Kelsey: Another way you can take action to support our work is volunteering as a child advocate through The Young Center. So, well, yes, join us, join us all. It takes a village, right? It takes all of us to welcome and support and advocate for unaccompanied kids. We will look forward to any support from your listeners. 

[00:18:34] Ashley Sanchez-Garcia: I had reached out to AMCHP members in border states, and they shared a lot of great ideas for opportunities to support this population. Maternal and child health professionals can ensure coordinated messaging for families, workplaces, schools, social services, and communities to increase access to resources that support immigrant health;

[00:18:57] partner with community organizations to increase mental health literacy among immigrant families; and promote awareness of border health initiatives, and establish cooperative agreements with partners in border communities, to improve immigrant family health and wellbeing. Before we wrapped up, I asked what drives Jose and Anne to do this work.

[00:19:18] Jose Ortiz-Rosales: Well, what drives me, I think, is being able to be a partner to children and young people. Especially when they're maneuvering through so many systems specific to the immigration system, like, like I mentioned earlier, autonomy and agency is not always guaranteed. So when I could partner up with the children and the clients that we work with and kind of give them that sense of autonomy and agency,

[00:19:41] it kind of gives me hope for their future here in the U.S., because then you're setting up a model on how they can interact with other adults and other professionals who may be interested in supporting them and helping them maneuver through life in the United States. 

[00:19:57] Anne Kelsey: And for me, so I'm actually relatively new to The Young Center. I just joined last fall, and I come from the disability and health rights world.

[00:20:06] So this was an opportunity really identified by The Young Center itself to bring some of the best practices, the perspective and the experience of disability rights advocates and health rights advocates, to the world of immigration and particularly for the unaccompanied children that we serve. And what I mean by that is kind of, some of the things that we talked about before, but a real focus on community-based services, wrap-around services in the home.

[00:20:38] De-institutionalization and understanding that separation and isolation from family and from communities is in itself harmful. And so a system that really works in the best interests of children is one that supports them in a family- or a home-based setting as quickly as possible with supports and services.

[00:20:58] Ashley Sanchez-Garcia: I am so grateful to Jose and Anne for sharing their experiences with us on this episode. As a daughter of Central American migrants, this work is very near to my heart, and the work that The Young Center does has been really inspiring for me in such a politically heavy period. Exploring the experiences of UICs has highlighted for me the importance of community building and programs that will continue to promote the autonomy and health of unaccompanied immigrant children.

[00:21:28] We must affirm the humanity of children regardless of their immigration status in this country, by listening to them and their stories and providing equitable and comprehensive physical and mental health support. Creating a solution for those who have to navigate a broken immigration system requires collaboration across social systems and sectors and a reimagining of our public systems.

[00:21:53] This starts with those most affected by the issue because they're closest to the solution. If we hope to holistically advance child health outcomes, then we must make space for and uplift the experiences of migrant children.

[00:22:11] Maura Leahy: Thank you all for joining us on this MCH Bridges. We kindly ask that you take a few minutes to fill out a quick feedback survey and let us know what MCH related topics you're interested in. And who you want to hear from on future episodes, a link to the podcast feedback survey, as well as the transcript of this episode can be found at www.mchbridges.org.

[00:22:33] Be sure to follow AMCHP on social media. We're on Twitter and Instagram @DC_AMCHP. We hope this episode created new connections for you. Stay well, and I hope our paths cross on the next MCH Bridges.

[00:22:56] Maura Leahy: This project is supported by the Health, Resources and Services Administration, or HRSA, of the U.S. Department of Health and Human Services, or HHS, as part of an award totaling $1,963,039 with 0% finance with non-governmental sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of nor should any endorsements be inferred by HRSA, HHS, or the U.S. government.