Through its “zero tolerance policy” at the southwest border during 2018, which led to separation of migrant children from their parents, the Trump administration “added to the trauma that children had already experienced and put tremendous pressure on facility staff,” according to a report Wednesday by a government watchdog.
The Department of Health and Human Services’ Office of Inspector General visited 45 of about 90 facilities holding migrant children in August and September of 2018 and conducted interviews with operators, medical coordinators, mental health clinicians and other staff. In the resulting report, these officials and practitioners described significant challenges in meeting the mental health needs of children in their care, who had been traumatized long before coming to the United States, then were re-traumatized by policies at the border and further aggravated by being kept in government custody for long periods of time.
In their countries of origins, some of these children had experienced sexual and physical abuse or were first-hand witnesses to terrible crimes of violence. One harrowing story the report cites involves a young girl who had been held in captivity, tortured and raped — and become pregnant as a result. On their long journeys to the U.S., too, many migrant minors reported witnessing abductions and killings.
The children’s trauma only worsened upon arrival in the U.S., when many were abruptly separated from their parents. Separated children often “expressed acute grief that caused them to cry inconsolably,” the report reads. Some believed their parents abandoned them and were angry and confused. Others became anxious about their parents’ well-being. Many of the children often could not distinguish between the facility staff charged with their care and the Border Patrol officers who had separated them from their parents. They would often isolate themselves and refuse to eat or be social, the report said.
“The level of trauma and unique experiences of separated children made it more difficult to establish therapeutic relationships through which facilities could address children’s mental health needs,” the report’s authors wrote.
Family separations also led to younger and younger kids being relegated to the government’s care, and these children displayed “shorter attention spans, lacked the ability to comprehend the role of the facility, and more commonly exhibited defiance and other negative behaviors.”
Chaos and confusion followed even after the government was ordered by the courts to reunite the children with their parents, creating more distress. In one case, a child was sent from Florida to Texas but then returned “in shambles,” a mental health clinician told the OIG, because she never got to see her father.
Certain vetting policies and information-sharing agreements (which were later walked back and restricted by appropriations legislation, respectively) extended the duration of many children’s stay at Office of Refugee Resettlement facilities in 2018. The long periods in custody affected the mental state of even the outgoing, positive children, the report said.
“According to facility staff, longer stays resulted in higher levels of defiance, hopelessness, and frustration among children, along with more instances of self-harm and suicidal ideation,” the report notes.
All children in ORR custody are supposed to be screened for mental health issues and receive appropriate care. But in many cases, the facilities had inadequate clinicians and case workers at hand, or were not able to easily outsource care or transfer kids to more specialized facilities.
The mental health practitioners working with these children also felt unprepared to cope with these needs, the report found, despite meeting the educational and training requirements. The uncertainty around length of stay and the depth of the trauma some children faced created significant hurdles. Clinicians told the OIG “how challenging it was to hear about children’s traumatic experiences, which sometimes caused the clinicians to become overwhelmed or suffer their own mental distress,” the OIG report notes.
The report makes six recommendations to improve the capability at the facilities, all of which the Health and Human Services Department agreed with.
“Indeed, [the report] corroborates that [Unaccompanied Alien Children] generally receive all legally-required mental health care,” the agency said in response. “It is not, however, a quantitative or clinical review that assesses the reasonableness of the mental health care delivered to UAC against standards of ordinary care or best clinical practices.”
The past few months have seen immense national discussion on the treatment of children in government custody, and the issue is likely to continue playing a key role in budget negotiations in Congress to come this month.
Rep. Bennie Thompson, D-Mississippi, chairman of the Committee on Homeland Security, put out a statement slamming the Trump administration for its treatment of children in the wake of the report.
“President Trump’s zero tolerance and family separation policies inflicted massive pain and trauma on children and their families — but the suffering did not end there,” Thompson said. “Systematic inadequate care, as well as the added chaos that the administration constantly makes worse, created an environment where children suffered from post-traumatic stress and other critical mental health issues. These issues can impact these children for life.”