"Suicidal ideation" and "inconsolable crying" are among the fallout from Trump's immigration policies, watchdog finds.
Facilities contracted by the Trump administration to provide housing for young migrants fell short of staffing requirements and failed to provide adequate mental health care, according to two new audits, problems that were exacerbated by the short-lived policy to separate families arriving at the southwest border.
The grantees and contractors responsible for caring for unaccompanied minors and children separated from their parents after crossing the U.S.-Mexico border did not maintain the staffing levels required by their agreements with the Health and Human Services Department, the HHS inspector general found, leading to extended stays, improper vetting of sponsors, a failure to help children adjust to their new conditions and a general harmful effect on the children’s well-being. Mental health clinicians faced high caseloads, giving them less time to develop a rapport with and provide counseling for the migrant children.
Those employees had as many as 25 children under their care at a time, the IG found, despite a requirement that facilities operating under the purview of HHS’ Office of Refugee Resettlement maintain a ratio of at least one mental health professional for every 12 children. The administration’s “zero-tolerance” policy that led to family separations created an influx of children at the facilities and compounded the trauma the children faced, the IG said. They already had endured tremendous stress in their countries of origin, on the journey to the United States and in coping with their new circumstances.
The IG said the separated children dealt with fear, feelings of abandonment, post-traumatic stress, anxiety, guilt and anger. Some children, especially those too young to understand their circumstances, refused to eat, would not participate in activities and cried inconsolably. Clinicians told the IG they felt ill-prepared to handle the influx of children, especially those under 12, and had to take a “band-aid approach” to help the migrants cope rather than addressing underlying issues. The employees said they could not adjust to the unpredictable timelines children would be at the facilities and felt “unprepared to handle the level of trauma” the kids presented.
“Mental health clinicians play a vital role in ensuring children receive the mental health services they need to adjust to their current living situation,” the IG said. “Inadequate clinical services could have significant and long-term consequences for the children’s well-being and development.”
Employees at the facilities were often treated as “the enemy,” one facility program manager said, as all the separated children in its care had “been terrified.” Another manager said children developed psychosomatic physical symptoms, complaining of heart pains due to psychological trauma. One child believed his father had been killed and he soon would be too, and eventually required emergency psychiatric care.
More than 60% of the 45 facilities the IG visited reported staffing shortages, either with mental health clinicians or case managers. About half of the facilities pointed to issues with the screening process, noting it took up to three months for applicants to receive background checks. Finding bilingual employees and applicants who met the requirements of the job also proved challenging, officials said. Low pay, demanding work schedules and competing job opportunities made it difficult for the facilities to retain employees, the IG found.
HHS said it would use its resources to help facilities recruit mental health professionals, while also using its data to make “better placement decisions” at facilities that can handle more children.
Six facilities with about 3,000 employees the IG reviewed waived the requirement for child protective services checks, including one that made no effort to replace that process. Five facilities relied on applicants to self-certify they had no record of abusing children, a practice the IG said “creates a vulnerability to the health and safety of children” as those records “could easily create false information.” HHS said it has revoked those waivers for non-influx facilities.
While most facilities generally met requirements for child protective services and FBI fingerprint checks, many allowed employees to begin work before completing that process. HHS also agreed to end that practice.
President Trump last year eventually ordered the end of the family separation policy, but that led to new problems with reunifying children with their parents. Mental health clinicians said the uncertainty surrounding the “hectic” reunification process led to increased anxiety and uncertainty for the children.
HHS also experienced a dramatic 50% spike in the average length of stay for children in its custody last year, thanks to an administration policy to enhance the screening of potential sponsors. The department shared sponsor information with Immigration and Customs Enforcement, which could have led to deportation action and in turn led to fewer sponsors willing to come forward.
Behavioral and mental health issues worsened during extended detentions, the IG found, even among children who did not demonstrate any issues upon entering facilities.
“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 auditors said.
The average length of detention in HHS custody for migrant children dropped in half after the administration ended its enhanced sponsor screening process earlier this year. The IG suggested HHS take “all reasonable steps” to reduce the time children spend in the department’s custody, which management said it has since completed.
In cases in which the needs of a child surpassed the capacity of a facility, the centers failed to make appropriate transfers. Children with higher needs, such as those experiencing psychotic episodes, engaged in self harm or “actively attempting suicide,” were not sent to facilities that could treat them, the IG found.
HHS accepted all of the IG’s recommendations, noting several improvements had already taken place. The department said it would improve training for mental health clinicians to deal with short-term trauma and children of all ages. It will also examine the benefits of installing a maximum caseload for mental health workers. The Office of Refugee Resettlement has hired a psychiatrist to serve as team leader for its mental health services.
The IG made a point to reject ORR’s claim that its audits cleared the agency as meeting all of its legal requirements for mental health care, saying such a judgment was outside the bounds of its review and it simply wanted to highlight the administration’s “significant challenges.”