Persistence of Emotional Distress in Unaccompanied Migrant Children and Adolescents Primarily From the Northern Triangle of Central America.

Importance: In the US, unaccompanied migrant children and adolescents (hereinafter referred to as children) are predominantly from Central America's Northern Triangle. While unaccompanied migrant children are at high risk for psychiatric sequelae due to complex traumatic exposures, longitudinal investigations of psychiatric distress after resettlement are lacking. Objective: To identify factors associated with emotional distress and longitudinal changes in emotional distress among unaccompanied migrant children in the US. Design, Setting, and Participants: For this retrospective cohort study, the 15-item Refugee Health Screener (RHS-15) was administered between January 1, 2015, and December 31, 2019, to unaccompanied migrant children as part of their medical care to detect emotional distress. Follow-up RHS-15 results were included if they were completed before February 29, 2020. Median follow-up interval was 203 days (IQR, 113-375 days). The study was conducted in a federally qualified health center that provides medical, mental health, and legal services. Unaccompanied migrant children who completed the initial RHS-15 were eligible for analysis. Data were analyzed from April 18, 2022, to April 23, 2023. Exposures: Traumatic events before migration, during migration, during detention, and after resettlement in the US. Main Outcomes and Measures: Emotional distress, including symptoms of posttraumatic stress disorder, anxiety, and depressive symptoms, as indicated by the RHS-15 (ie, score ≥12 on items 1-14 or ≥5 on item 15). Results: In total, 176 unaccompanied migrant children completed an initial RHS-15. They were primarily from Central America's Northern Triangle (153 [86.9%]), were mostly male (126 [71.6%]), and had a mean (SD) age of 16.9 (2.1) years. Of the 176 unaccompanied migrant children, 101 (57.4%) had screen results above the positive cutoff. Girls were more likely to have positive screen results than boys (odds ratio, 2.48 [95% CI, 1.15-5.34]; P = .02). Follow-up scores were available for 68 unaccompanied migrant children (38.6%). On the follow-up RHS-15, most scored above the positive cutoff (44 [64.7%]). Three-quarters of unaccompanied migrant children who scored above the positive cutoff initially continued to have positive scores at follow-up (30 of 40), and half of those with negative screen scores initially had positive scores at follow-up (14 of 28). Female vs male unaccompanied migrant children (unstandardized ß = 5.14 [95% CI, 0.23-10.06]; P = .04) and initial total score (unstandardized ß = 0.41 [95% CI, 0.18-0.64]; P = .001) were independently associated with increased follow-up RHS-15 total score. Conclusions and Relevance: The findings suggest that unaccompanied migrant children are at high risk for emotional distress, including symptoms of depression, anxiety, and posttraumatic stress. The persistence of emotional distress suggests that unaccompanied migrant children would benefit from ongoing psychosocial and material support after resettlement.

Mental health as the cornerstone of effective medical-legal partnerships for asylum-seekers: The terra firma model.

OBJECTIVE: Challenges and traumas faced by asylum-seekers before, during, and after migration are compounded by the stressors of the asylum-seeking process, potentially compromising mental health (MH). Poor MH outcomes, in turn, complicate asylum-seekers' capacity to navigate the asylum-seeking legal process (e.g., hindering an individual's ability to provide an organized statement of their premigration experiences). Medical-legal partnerships are models of care that address legal problems as social determinants of health. However, when implementing medical-legal partnerships for asylum-seekers, standard definitions focusing on physical health do not appropriately capture the crucial role of MH services. Since 2013, the Terra Firma Program has provided services for asylum-seekers in the South Bronx, New York, by integrating MH, medical, and legal services along with enrichment activities, and concrete services. The present paper describes the benefits of this approach to working with asylum-seekers; highlights the importance of the MH component, including MH staff's dual therapist-evaluator role as a trauma-informed and ethical vehicle to support clients' asylum cases; and advocates for these partnerships to be recognized as MH-medical-legal partnerships. METHOD: Drawing from Terra Firma's experience with over 800 asylum-seekers, the authors provide a framework for addressing asylum-seekers' needs through MH-medical-legal partnerships. RESULTS: Terra Firma's work with asylum-seeking children and families provides evidence in support of the establishment of MH-medical-legal partnerships and highlights the importance of the MH component in addressing asylum-seekers' legal needs. CONCLUSIONS: MH-medical-legal partnerships are proposed as effective models for working with asylum-seekers, with potential benefits to MH, physical health, and legal outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Working with Parents and Children Separated at the Border: Examining the Impact of the Zero Tolerance Policy and beyond.

The crisis of family separation caused by Trump Administration's zero tolerance policy (ZTP) on the southern border has focused the nation's attention and provoked public uproar due to the violation of basic rights and the expected negative impact on children and parents. There is decades' worth of research documenting the damage of separating children from their parents in a wide diversity of circumstances and for a wide variety of reasons. There is also ample research evidence of the impact of any form of childhood trauma and consequent disruptions in development, cognitive impairments, and health problems through adulthood. However, there is no first-hand documentation published of how these children and families specifically experienced separation at the border and the effects it is having on them to date. The present article first provides an overview of the historical and socio-political context of family separation policies in the US, and a thorough description of how ZTP was implemented in actuality. Second, this article offers a review of the literature on the impact of family separation on children and parents in diverse contexts. Third, we describe direct clinical experiences with these children and parents receiving services at the Terra Firma program in the Bronx community in New York. Finally, this article delineates important recommendations for policy makers, service providers, and the community as a whole.