Investigating the Mental Health Needs of Unaccompanied Immigrant Children in Removal Proceedings

In recent years there has been a dramatic increase in the number of children migrating to the United States without a parent. In Fiscal Year 2014 alone, U.S. immigration authorities apprehended and detained almost 70,000 unaccompanied children, compared to less than 9,000 in 2010. This rapid rise has been fueled primarily by children arriving from Central America, one of the world’s most violent regions. The available literature on unaccompanied children in the United States suggests that they are a vulnerable and underserved population, who are at risk for repeated exposure to extreme psychosocial adversities at every stage of their migration and frequently face many of these challenges alone. However, to date there has been little formal study of their mental health needs. The aim of this exploratory study was to obtain initial data regarding the psychosocial context, mental health presentation, and mental health service utilization of unaccompanied children released to guardians in the community pending immigration hearings to determine their eligibility to remain in the United States. The study employed a mixed methodology combining qualitative and quantitative data. The sample comprised 26 unaccompanied children and their guardians residing in the New York City metro area, interviewed between September 2013 and December 2014. Results showed that children in our sample had complex reasons for migration, frequently combining push factors such as fleeing gang violence and pull factors such as a desire for reunification with parents in the United States after long separations. Most had been exposed repeatedly to extreme psychosocial stressors prior to and during their migration, including almost two-thirds who had witnessed violence, serious injury, or death and over one-third who had witnessed domestic abuse or had been physically abused themselves. However, children also described benefitting from an array of supports that protected against stressors and promoted their wellbeing, and in their narratives they emphasized overcoming adversity rather than victimization. On a structured mental health diagnostic interview, the majority of children met criteria for one or more past-year anxiety and depressive disorders. Few received diagnoses for behavioral problems. Compared against these data, child-report measures screened more effectively for internalizing disorder diagnoses and guardian-report measures screened more effectively for externalizing disorder diagnoses. Despite the high rates of diagnosable disorders in the sample, most children appeared to be functioning well in family, social, and educational domains. No children were receiving formal mental health services at the time of their study interview, although several were being monitored by school counselors. Children presenting with mental health concerns were provided with referrals to mental health treatment services and contacted for a brief telephone follow-up interview three months later. At follow-up, a number of children had received counseling. Availability of school counselors and referral to therapists in the community through pediatricians were the primary facilitators of service access. Lack of knowledge of available, Spanish-speaking services and cost of treatment were common obstacles to seeking treatment. Some children and their guardians did not perceive a need for services, and most of these children appeared to be functioning well at follow-up. This study was designed to be largely descriptive and to provide data to inform future, theory-driven research. In the discussion section, social ecological models of risk and resilience and Hobfoll’s Conservation of Resources theory are presented as potential paradigms for understanding unaccompanied children’s migration processes, with stressors and supportive factors interacting across systemic levels and over time to determine children’s access to resources and their mental health, functioning, and wellbeing. Finally, the implications of the study’s findings for future research, psychosocial intervention, and rights-based advocacy with unaccompanied children are considered.