Physical pain, post-traumatic stress and inconsolable crying are just some of the experiences of migrant children highlighted in a report out this month from the U.S. Department of Health and Human Services Office of Inspector General.
Last August and September, investigators visited 45 facilities funded by the Office of Refugee Resettlement, or ORR, including 20 facilities in Texas. They interviewed about 100 mental health clinicians who worked with the children detained there.
"Facility staff reported that longer lengths of stay led to deteriorating mental health for children and increased demands on staff," says Ann Maxwell, assistant inspector general with the Office of Evaluation and Inspections. "Facilities reported that addressing the needs of separated children was particularly challenging because these children exhibited more fear, feelings of abandonment and post-traumatic stress than did children who were not separated."
At the height of the Trump administration's "zero tolerance" immigration policy in 2018, the ORR saw a sharp increase in the number of children 12 and under in its care, and clinicians say they felt unprepared to address the children's mental health needs.
"In the report, they say that there's not enough clinical staff for the number of kids, and not just the number of kids, but the kinds of problems that the children appear with," says Luis Zayas, dean of the Steve Hicks School of Social Work at the University of Texas at Austin.
Zayas has researched the mental health impacts of family separation. After the "zero tolerance" policy was implemented, he warned the practice could do long-term psychological damage. Zayas says ideally, children facing such intense trauma would be treated in smaller settings.
ORR guidelines call for having one mental health clinician for every 12 children at a facility, but the OIG report shows some clinicians found themselves treating as many as 25 children. That meant less time for counseling and less individual attention, which could make it even harder to establish trust, Zayas says.
"Children in detention centers will be meeting new staff with every shift," Zayas says, "and they may not distinguish between clinical staff and the guards and the officials from the government."
On top of high caseloads, the OIG says the unpredictable length of the children's stays in custody made it hard to deliver meaningful treatment. Federal law requires that the children get one individual counseling session and two group therapy sessions a week. The OIG report didn't assess the quality of mental health care kids received, but clinicians said they were hesitant to have the kids they treated revisit traumatic memories because they might not be around to continue therapy and address those underlying issues. Instead, they reported focusing on a "Band-aid" approach to treatment, trying to helping children to cope and stabilize for the time being.
The OIG does offer some recommendations to better meet children's mental health care needs. That includes hiring and retaining more qualified staff, providing more specialized treatment and minimizing the amount of time children spend in these facilities. The Administration for Children and Families, which oversees the ORR, says it concurs with all of the recommendations. Federal officials say some of them are already being implemented.
"The longer a child stays in some kind of custody, the greater the damage that can be done," Zayas says, "so the idea is to get them in, screen them, examine them, treat them — do what you can, but get them some place where they can have a home-like environment, even if it's just a small group home where they can live with other children, but to really stabilize their lives."