The number of migrant children entering the United States without a parent or legal guardian has increased significantly over the past decade, reaching a record high in 2022. Most of these unaccompanied children temporarily enter the care of the U.S. government before joining parents or other sponsors in U.S. communities to await the outcome of their immigration proceedings. Once they have made this transition, the services and supports they need to thrive can be difficult to access. Among the most essential are medical and mental health care, which are critical in order for children to reach their full potential.
In 2022, the American Academy of Pediatrics and Migration Policy Institute came together to study unaccompanied children’s access to medical and mental health services in U.S. communities. The researchers conducted field visits to three U.S. cities (Houston, TX; Los Angeles, CA; and New Orleans, LA) and held interviews and focus groups with more than 100 professionals working with this population, as well as unaccompanied children themselves.
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A number of themes emerged in the site visits and discussions and are highlighted below. A PDF of the full report with detailed findings and recommendations is also available.
Barriers to Care and Promising Practices
Barriers to unaccompanied children’s care are related to various factors, including the Office of Refugee Resettlement (ORR) policies and practices, the structure of the U.S. health care system, the individual and immigration-related circumstances of unaccompanied children and their sponsors, and the overall lack of sufficient community-based supports.
Despite these barriers, promising practices exist in various U.S. communities that make it easier for unaccompanied children to access medical and mental health services. Examples include:
- multidisciplinary clinics for newcomer children that provide comprehensive, tailored services to meet their unique medical, mental health, legal, and social needs;
- school districts that offer enrollment centers to not only register children but also assist with health insurance applications, screen and refer for social determinants of health needs, and provide medical and mental health care on site;
- community-based, in-person case management to connect children with health care;
- multidisciplinary, community coalitions that establish processes for smoother referrals between organizations, host events to connect children with further resources, and advocate for needed policy changes.
These findings inform steps that governments, health systems, schools, and communities can take to improve unaccompanied children’s access to medical and mental health care.
The Office of Refugee Resettlement should:
- Provide complete and accessible information upon release to sponsors regarding the unaccompanied child’s health and diagnoses, written in their language of preference and reviewed with both the child (if age appropriate) and sponsor. Sponsors should also receive paperwork stating that they have the ability to provide medical consent for the child.
- Provide medical and mental health case management for all children following release. Initial contact between a sponsor and post-release case manager should, when possible, begin while the child is still in federal custody. Services should be offered locally, in person, and last for at least one year. Priority should be placed on utilizing case managers housed in multidisciplinary organizations in order to better facilitate referrals.
- Establish and fund medical and mental health orientations for unaccompanied children and sponsors in U.S. communities to help them better understand and utilize the U.S. health care system. These should be offered after release and, when possible, in conjunction with the Executive Office for Immigration Review’s Legal Orientation Program for Custodians of Unaccompanied Children.
- Continue payment for medical and mental health services for at least three months after release and provide at least a three-month supply of medication for chronic conditions to help prevent gaps in care.
- Simplify and expedite the process for community-based clinicians to obtain a child’s medical and mental health records (including vaccinations) from their time in ORR custody.
Federal, state, and local governments should:
- Extend eligibility for public health insurance to all low-income unaccompanied children, beginning as soon as they leave ORR custody. This should be accomplished at the federal level but, if not, states that have not yet done so should create state-funded public health insurance programs that include coverage of unaccompanied children. All public insurance expansions should be complemented with robust outreach campaigns and funding for program navigators.
- Expand funding to train more trauma-informed mental health clinicians with language and cultural backgrounds that match those of unaccompanied children. These clinicians should be positioned where they are needed most, particularly at schools and in rural areas where existing capacity is limited.
- Ensure that offices at all levels of government have staff who have the knowledge and ability to address the needs of immigrants, with a particular focus on children, health care, and language access.
Health care systems should:
- Create welcoming, accessible environments through inclusive messaging and signage, interpretation services, culturally sensitive and trauma-informed care, and policies that reduce logistical barriers, such as offering evening, weekend, and walk-in appointments.
- Bring appropriate medical and mental health services into the community through school-based clinics, telehealth services, mobile units, and community health workers.
- Create or expand financial assistance programs at all health facilities and make it easier for unaccompanied children to enroll. The application should be standardized as much as possible, especially across FQHCs (at least regionally, if not nationally).
- Co-locate medical and mental health services with other supports (such as social work, benefits enrollment, legal services, and supplemental food programs) to holistically address children’s needs.
School districts should:
- Screen all new students for social determinants of health around the time of enrollment and provide resources and referrals to address any identified issues.
- Help ensure all students and their families have access to affordable health care by collaborating with community organizations to either bring medical and mental health services to schools or partner with nearby health facilities.
- Consider establishing programs designed to help address the unique needs of newcomer students, taking care to avoid creating any disadvantage or stigma for students who participate in them.
- Build or strengthen multidisciplinary coalitions of organizations and individuals serving unaccompanied children to improve referrals and expand the supports available locally. Coalitions should develop community-based initiatives, such as improving service providers’ trauma-informed interactions with unaccompanied children and sponsors and helping to bridge the digital divide.
Unaccompanied children have experiences and circumstances that require a thoughtful approach to ensure their medical and mental health needs are met. These recommendations offer a path to improved physical, mental and emotional well-being for unaccompanied children, to their benefit as well as that of their communities.
American Academy of Pediatrics