Addressing the Legal and Mental Health Needs of Undocumented Immigrant Children

Transcription

1 Reference Committee A - Advocacy Resolution #12 (15) 2015 Annual Leadership Forum TITLE: Addressing the Legal and Mental Health Needs of Undocumented Immigrant Children SPONSORED BY: District IX Section on Medical Students, Residents, and Fellowship Trainees DATE: November 24, 2014 DISPOSITION: Whereas, a substantial number of the children who attempt to immigrate to the United States without documentation have suffered human rights abuses that qualify them for asylum; and Whereas, the provision of screening for abuse and due process for these children within the United States is inconsistent and inadequate, often associated with prolonged detention, deprivation of legal counsel, and complete exclusion of accompanied children or those from Mexico; and Whereas, prompt identification and treatment of mental health needs of these children may lead to improved social, legal, and health outcomes, therefore be it RESOLVED, that the Academy advocate for assuring comprehensive due process, medical and mental health evaluation, and treatment in an appropriate timeframe for all children facing deportation, regardless of country of origin or whether arriving accompanied or alone, and to eliminate prolonged detention of children and their families, and be it further RESOLVED, that the Academy develop resources for pediatricians on the mental health challenges faced by immigrant and refugee children, including appropriate screening tools for anxiety, post-traumatic stress disorder, trauma and depression. FISCAL NOTE: REFER TO: 2015 Annual Leadership Forum LEAD AUTHOR: Peter Cooch, MD Telephone: (CA-1) peter.cooch@ucsf.edu

2 Resolution #12 Page Two CO-AUTHOR: Telephone: BACKGROUND INFORMATION: (15) 2015 Annual Leadership Forum Yasuko Fukuda, MD, FAAP (CA-1) Background Information from the Author The United Nations High Commissioner for Refugees (UNHCR) defines migrants as those who choose to move in order to improve their future prospects, whereas refugees have to move if they are to save their lives. (1) Starting in 2011, the number of children attempting to cross the U.S./Mexican border has dramatically increased.(2) The Academy believes this influx of child migrants represents a refugee crisis rather than an immigration crisis. The rise in numbers of those fleeing Mexico and Central America correlates with an upsurge in violence.(3) Among children fleeing these regions interviewed by the UNHCR, 48% had been personally affected by violence carried out by drug cartels and gangs. 21% of the children had survived abuse and violence in their homes. The report concluded at least 58% had been forcibly displaced because they suffered or faced harms that indicated a potential or actual need for international protection. (4) Despite the fact many of these children might qualify for asylum, they face enormous disparities, inadequacies, and hostilities within our legal system.(5,6) About half of the children apprehended at the border in 2014 were unaccompanied minors from Guatemala, Honduras, and El Salvador.(2) Anti-trafficking legislation mandates that children meeting these specific criteria appear before a hearing prior to deportation. Most are temporarily placed across the U.S. while awaiting their hearings.(7) Although they appear before a judge, these children are not afforded due process. They do not receive legal counsel or adequate interpretation. Many are rushed through expedited deportation proceedings, known as rocket dockets, which preclude even pro-bono legal assistance.(6) The situation is worse for those children who are never allowed within the public s eye. There is no system in place to screen children at risk of trafficking or persecution from any other countries, or those who arrived with family members. Children from Mexico face equal victimization as those children from

3 Central America. Yet nearly 100% of Mexican unaccompanied children are repatriated directly from the border.(4) There has also been a flood of children fleeing with mothers and other family members.(2) These families are immediately deported as well or more recently, placed in internment camps. Starting in 2014, the administration has placed over 1000 women and children in two new for-profit facilities, with an additional 2400-bed unit nearing completion.(8) These centers are operated by private, for-profit correctional companies. Families may be detained indefinitely and deprived of access to education and legal counsel.(9) Reports suggest conditions are wholly inappropriate for children, including new allegations of neglect, mistreatment, and sexual assault by prison staff.(10,11) Our society has a duty to not willfully return those who have faced victimization to harm s way. This is especially true regarding children. Pediatricians are mandated reporters held accountable to ensure the safety for minors we suspect are at risk. As such, the Academy calls for due process and freedom from detention for all children and their families seeking shelter across our borders. The urgency of these children s mental health needs is secondary only to their legal needs.(12,13) Studies following refugee children show that cumulative exposure to violence is a powerful risk factor for poor mental health outcomes.(14,15) Appropriate psychological interventions have been shown to benefit children with conditions like PTSD following trauma.(16 18) Helping youth address and cope with the traumas they have endured may also better allow them share to these experiences in legal hearings to gain asylum status. Pediatricians caring for these patients may be aware of the importance of screening for mental health conditions, such as PTSD. But current mental health screening tools in wide pediatric use may not be suited to the unique needs of these children.(13,19) Background Information from the Council on Community Pediatrics The Council on Community Pediatrics is updating the AAP Immigrant Health Toolkit to provide additional resources that address mental health. The AAP has been monitoring the unaccompanied immigrant children crisis and has communicated with federal agencies to obtain more information about the health needs and mental health status of the children. Federal officials have indicated the children are primarily in good health and do not pose any risks to communities. Many AAP members are also involved in local efforts to provide on the ground assistance to the children and families.

4 The AAP is currently planning to host a collaborative meeting in 2015 that will focus on how diverse child serving sectors (including health and legal services) can collaborate to meet the needs of newly arrived immigrant children in resettlement communities across the country. Initial planning meetings have already occurred. 1. Refugees [Internet]. UN High Commissioner on Human Rights. [cited 2014 Nov 8]. Available from: 2. Southwest Border Unaccompanied Alien Children U.S. Customs and Border Protection [Internet]. [cited 2014 Nov 8]. Available from: 3. Kennedy E. No Childhood Here: Why Central American Children Are Fleeing Their Homes [Internet] Available from: ildhood_here_why_central_american_children_are_fleeing_thei r_homes_final.pdf 4. Goldberg P, Velez L, Boehner N, Schmidt S, Somers A. Children on the Run Unaccompanied Children leaving Central America and Mexico and the need for International Protection [Internet]. Washington, D.C.; 2014 p Available from: ldren on the Run_Full Report.pdf 5. Chen A. An Urgent Need: Unaccompanied Children and Access to Counsel in Immigration Proceedings Children s Rights Litigation ABA Section of Litigation [Internet]. American Bar Association [cited 2014 Nov 10]. Available from: ntent/articles/summer urgent-need-unaccompaniedchildren-access-counsel-immigration-proceedings.html 6. Frydman L, Dallam E, Bookey B. A Treacherous Journey: Child Migrants Navigating the U.S. Immigration System [Internet]. San Francisco; Available from: 7. Unaccompanied Children Released to Sponsors By State Office of Refugee Resettlement Administration for Children

5 and Families [Internet] [cited 2014 Nov 8]. Available from: 8. ICE to open additional facility in South Texas to house adults with children [Internet] [cited 2014 Nov 9]. Available from: 9. Parker C, Greene J, Libal B, Mazón A, Cunningham C. For- Profit Family Detention: Meet the Private Prison Corporations Making Millions By Locking Up Refugee Families [Internet]. Charlotte, NC; 2014 p. 20. Available from: Taylor M, Huusko S. Immigrant women allege sexual abuse at detention center. Al Jazeera America [Internet] [cited 2014 Nov 9]; Available from: Bono M, Hines B, Natarajan R, Guttin A, Maldonado J, Boyle A. Complaints Regarding Sexual Abuse of Women in DHS Custody at Karnes Regional County Residential Center [Internet] Available from: 30_Karnes_PREA_Letter_Complaint.pdf 12. Chilton L, Handal G. Providing care for immigrant, migrant, and border children. Pediatrics [Internet] [cited 2014 Nov 8];131(6):e Available from: f 13. Kennedy EG. Unnecessary suffering: potential unmet mental health needs of unaccompanied alien children. JAMA Pediatr [Internet]. American Medical Association; 2013 Apr 1 [cited 2014 Nov 8];167(4): Available from: 5&utm_source=twitter&utm_medium=twitter&utm_campaign= twitter 14. Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries : a

6 systematic review. Lancet [Internet] [cited 2014 Dec 22];365(panel 1): Available from: Fazel M, Reed R V, Panter-Brick C, Stein A. Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. Lancet [Internet]. Elsevier Ltd; 2012 Jan 21 [cited 2014 Oct 12];379(9812): Available from: Cohen J a, Deblinger E, Mannarino AP, Steer R a. A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. J Am Acad Child Adolesc Psychiatry [Internet]. The American Academy of Child and Adolescent Psychiatry; 2004 Apr [cited 2014 Nov 9];43(4): Available from: &tool=pmcentrez&rendertype=abstract 17. Smith P, Yule W, Perrin S, Tranah T, Dalgleish T, Clark DM. Cognitive-behavioral therapy for PTSD in children and adolescents: a preliminary randomized controlled trial. J Am Acad Child Adolesc Psychiatry [Internet]. The American Academy of Child and Adolescent Psychiatry; 2007 Aug [cited 2014 Oct 31];46(8): Available from: Betancourt T, Williams T. Building an evidence base on mental health interventions for children affected by armed conflict. Intervention (Amstelveen) [Internet] [cited 2014 Nov 10];6(1):1 15. Available from: Majumder P, O Reilly M, Karim K, Vostanis P. This doctor, I not trust him, I m not safe : The perceptions of mental health and services by unaccompanied refugee adolescents. Int J Soc Psychiatry [Internet] Jun 3 [cited 2014 Nov 8]; Available from: