Are we meeting the needs of Unaccompanied Minors? What clinicians can do better

Amanda NeMoyer, Massachusetts General Hospital; Harvard Medical School
Trinidad Rodriguez, Massachusetts General Hospital
Kiara Alvarez, Massachusetts General Hospital, Harvard Medical School

Among youth who migrate to the United States from Latin America, unaccompanied immigrant minors (UIMs)—traveling without a parent or caregiver—are a unique subpopulation facing substantial challenges before, during, and after migration. UIMs often migrate as a result of traumatic experiences in their home countries but are also vulnerable to experiencing trauma pre- and postmigration. These experiences are compounded by the impact of prolonged separation from caregivers who migrated earlier (premigration) and caregivers who were left behind (postmigration). Once in the United States, UIMs are typically considered undocumented and often do not have the legal representation necessary to successfully navigate immigration proceedings in a system designed for adults. Further, they often live in areas with increased rates of poverty and community violence and can face stigmatization and exclusion from important protective activities. UIMs are therefore at risk for psychological distress, including depression, anxiety, and posttraumatic stress. This article provides an overview of typical experiences for UIMs, discusses the accompanying legal and clinical implications, and offers recommendations for psychological practice at the level of providers, training programs, and child-serving systems. For example, providers might incorporate family-based and trauma-focused interventions to enhance resilience and psychological well-being, in addition to support in navigating interactions with the legal system. Clinical training programs can provide education about the experiences of UIMs, while clinicians can advocate at the systems level to promote social integration of UIMs into school systems and a more humane immigration system focused on meeting the needs of these vulnerable children.

Immigrant youth; unaccompanied immigrant minors; trauma; mental health; resilience

“Substantial proportions of migrating youth report experiencing and fearing violence—in one study, 58% of respondents reported personally experiencing or fearing “serious harm of a nature that raises international protection concerns” from state actors, transnational criminal organizations, community members, or even family members. Children often report fleeing to avoid recruitment and exploitation by human smugglers, gangs, and drug cartels. For young girls in these regions, sexual violence serves as a leading motive for migration, as female UIMs frequently report being victims of rape.” (p.5)

“Of note, children of different ages often respond differently to separation from their parents. For example, preadolescents might become more attached to remaining caregivers (e.g., grandparents), withdraw from their biological parents, and express more reluctance to join their parents via migration. In contrast, although adolescents might initially act out, appear more resentful of their parents, and have more difficulties in school, as they grow older, they tend to have more interest in joining their parents. Other studies have found that separation from mother and/or father due to migration may result in a child experiencing significant distress, which can manifest as depressive symptoms, nervios, medical conditions, and other emotional and behavioral problems.” (p.6)

“For children separated from their parents by migration, longer separations can create more challenging reunifications.” (p.9)

“Youth may face changes in family makeup, including family members they have never met (e.g., stepparents and siblings born after parents migrated; Suárez-Orozco et al., 2010). Such challenges may result in feelings of ambiguous loss” (p.9)

“During their journey on “La Bestia,” migrants are sometimes mutilated or killed from falling off the train due to exhaustion. Survivors report witnessing and experiencing assaults, robberies, and sexual violence during the journey.” (p.6)

“Although federal law states that youth should be transferred to an ORR facility within 72 hr, children have reported remaining in CBP facilities for nearly two weeks while awaiting transfer. Conditions in CBP facilities— often called hieleras, Spanish for iceboxes—have been described as extreme and inhumane, as detainees must often sleep on concrete floors in freezing temperatures while lights remain on all day and night; these facilities have also been characterized by a lack of adequate food, water, and medical care.” (p.7)

“Youth in ORR custody may be held for days, months, and sometimes years during the removal process: from 2008 to 2010, youth spent between 1 and 710 days in custody, approximately 61 days on average; in 2016 the average length of custody was 34 days. Regardless of security level, these facilities are typically in remote areas, thereby limiting youths’ accessibility to family members, legal counsel, educators, and medical providers. Further, instances of physical and sexual mistreatment by staff have been reported in several facilities.”(p.7)

“…after several children were released to human traffickers posing as distant relatives or family friends of each child, a Senate Subcommittee investigation of ORR policies and practices regarding sponsor approval and child release revealed several concerning shortcomings. Specifically, the Subcommittee took issue with ORR’s unreliable methods of verifying alleged relationships between UIMs and potential sponsors, ORR’s failure to perform background checks on all adults in a potential sponsor’s household, the lack of home studies performed prior to placing UIMs with sponsors, and limited post release follow up. These shortcomings place UIMs at heightened risk for trafficking and other forms of abuse upon their release from custody.”(p.7)

“…a survey of 164 Latino adolescents in California revealed that immigrant youth experienced more violence in the United States than in their home countries; immigrant youths also reported more exposure to weapon-related violence in the United States compared to their U.S.-born peers.”(p.7)

“…the recent rise of anti-immigrant policies and sentiment, many UIMs feel excluded from typical adolescent activities and stigmatized by peers and school personnel, impeding successful adjustment to school, social involvement, educational success, and other important protective factors.”(p.8)

“…a study of unaccompanied minors in Belgium found high rates of depression, anxiety, and PTSD symptoms, with a quarter or more youth reporting severe depression and anxiety scores and more than 40% reporting severe PTSD at three time points over 18 months.”(p.8)

“Unaccompanied immigrant children and adolescents from Latin America leave their home countries to escape traumatic and difficult experiences but remain vulnerable to continued trauma upon arrival to the United States. Psychologists and other mental health providers can support this group of youth by considering their unique circumstances, providing clinical services that address their distinct needs, and advocating that child-serving systems best facilitate these youths’ long-term health and resilience.”

“Overall, [these studies] highlight the importance of clinical assessment of resilience and positive adaptation at the level of both individuals and systems, as well as attention to the costs and benefits of different intervention approaches.”(p.9)

“Studies of refugee children emphasize the following individual protective factors: coping skills, adaptability, and positive emotions/optimism. Family and societal protective factors include family adaptability and cohesion, social support, community integration, experience of safety and security, and school belonging and connectedness.”(p.9)

“Despite their young age, UIMs are not categorically protected from deportation; however, each child can apply for one of several options for relief from removal as appropriate. These opportunities include: asylum, special immigrant juvenile status, T Visas, and U Visas” (p.10)

“Depending on the nature of services provided, clinicians may find it appropriate to help youth prepare for interfacing with various systems, including schools and legal systems. For example, youth experiencing anticipatory anxiety about meeting with school and/or immigration administrators might benefit from sessions aimed at addressing this issue. However, clinicians should be cognizant of their roles and goals as service providers and avoid taking on responsibilities associated with guardians ad litem or legal representation”(p.11)

“Clinicians providing services to UIMs should consider incorporating family-based services into an ongoing treatment plan as appropriate…Incorporating parents, caregivers, and other family members into therapy should be considered, including ways to include family members living in other countries.”(p.11)

“Though there is a dearth of evidence on the effectiveness of specific evidence-based therapies with UIMs, Trauma-Focused Cognitive Behavioral Therapy and Cognitive Behavioral Intervention for Trauma in Schools have both been adapted for use with Latino immigrant children. Trauma Systems Therapy, which has been adapted for Somali refugee youth, represents another potential intervention approach—particularly within systems that have the resources to implement multilevel interventions.”(p.12)

“…graduate psychology training programs may do their students a significant disservice if they do not incorporate some information about UIMs into their curriculum. Programs may address this issue through formal means (e.g., providing instruction about UIMs in relevant courses), or more informal means (e.g., inviting experts to speak to students and faculty). Programs that lack faculty with the necessary expertise to facilitate this learning opportunity might utilize teleconferencing technology and/or collaborate with other programs within the university (i.e., Latino/a Studies programs).”(p12)

“..given the intensity of common trauma experiences within a UIM population and the increased challenge of working within multiple complicated systems, an additional barrier may arise if clinicians providing services to these youth experience overload and/or burnout. Thus, it is particularly important for individuals working with UIMs to regularly seek consultation and/or supervision from providers with expertise in this area, obtain support from provider peers, and engage in self-care strategies to reduce the likelihood of burnout.” (p.12)

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