STANDING AND RESPONDING IN SOLIDARITY WITH DISENFRANCHISED IMMIGRANT FAMILIES IN THE UNITED STATES: AN ONGOING CALL FOR ACTION

Abstract

The status of immigrant families resettled to the United States in the past decade has been fraught with upsurges of governmental policies that have systematically increasing the levels of oppression, violence, and abuses of human rights. The socio-political-economic toll of xenophobic practices on specifically targeted immigrant populations is magnified by the psychological and relational impact they have on individuals, families, and communities. This manuscript is conceptualized as an ongoing call for social action and specific mobilization by mental health professionals in response to the increasing threats to civility and dignity faced by various immigrant communities. The paper is organized in three sections: (a) an overview of the effects of immigration policy on immigrant family experiences; (b) the impact of mental and relational health on immigrant populations; and (c) elaborations of three exemplar community projects designed to support immigrant families. The manuscript concludes with a discussion exploring avenues for promoting a stronger base for solidarity and social action.

The status of immigrant families living in the United States has been the topic of much controversial debate in recent decades with upsurges of governmental policies that have systematically increased the levels of distress, oppression, violence, and abuses of human rights faced by existing and recently resettled immigrant families to this country. The socio-political-economic toll of xenophobic practices on specifically targeted immigrant populations is magnified by the psychological and relational impact they have had ecologically on individuals, couples, families, and communities. These multifaceted and enduring political assaults are experienced directly by countless waves of resettled immigrant communities who endure the highest consequences as they search for the possibility of a full life in a new country. But being witnesses to increased hate crimes against immigrant groups and countless enactments of inhumane policies are also indictments on us as global and U.S. citizens, as neighbors, as agents of social change and as mental health and relational therapists, if we choose to stand in silence, unresponsive to what we are witnessing. Furthermore, the abusive stance toward immigrants highlights an additional modern-day form of slavery. That is, historically, undocumented workers have been a pillar of the U.S. economy (Capps et al., 2003; García, 1981; Hill & Wiehe, 2017; Orrenius, Zavodny, & Gullo, 2019). Despite our dependence on undocumented workers, they have historically been treated as disposable (García, 1981). Today, this cycle is perpetuated through stringent immigration policy, which creates the ideal conditions for labor trafficking. To preserve their income and residence in the United States, workers accept unfair compensation and unsafe conditions, along with no labor protections (Correa-Cabrera & Payan, 2018). Most recently, during the COVID crisis, meat packing plants and the agricultural industry did not collapse thanks to undocumented immigrants (Gelatt, 2020). However, this reality is not brought to the fore. Instead, political agendas drive a narrative of immigrants describing them as “abusers of the system.” In essence, the U.S. society continues to avoid addressing with accountability the essential role that immigrants have played in the construction of this nation.

This manuscript was conceptualized as an ongoing call for social action and for specific mobilization by mental health professionals in response to the increasing threats to civility and dignity faced by various immigrant communities. We define immigrant families as families in which one or more members was born in a foreign country and now reside in the United States. We hoped to raise awareness and share information with clinicians less informed about these realities and we wanted to showcase examples of how relational therapists around the country are modeling courage, deep community engagement, interdisciplinarity, and integration of social action into their systemic training programs. The authors of this manuscript are both seasoned and new family therapists, social workers, lawyers, academic scholars, and practicing clinicians. Several of us are also foreign-born, first- and second-generation immigrants to this country. We started this project prior to COVID-19 with a sense of urgency to underscore the need for scholarly and community-based practices in response to the atrocities many of us only hear about in the news (e.g., parents and children being ripped apart at the border, infants and children left in cages without their caregivers, mass shootings in faith centers, entire factories raided by the office of Immigration and Customs Deportations, ICE). Now that urgency takes on an unprecedented gravity as we see daily reports of the disparities of populations that are most exposed to COVID-19 and the structural inequalities represented in mortality rates based on racial and social location (Page, Venkataramani, Beyrer, & Polk, 2020; Solis et al., 2020; Tai et al., 2020). We have ample evidence from the stress literature that individuals who were at higher risk for developing mental health distress, including traumatic stress due to higher levels of exposure to traumatic events throughout their lifetime, are even more vulnerable to experiencing the sequala of maladaptive psychological consequences for individual and relational health after COVID-19 (e.g., Horesh & Brown, 2020). We also know that the immigrant families keeping the food supply available for our tables are some of the most affected economically and at greater risk for COVID-19 exposure (Gelatt, 2020; Solis et al., 2020). Even amidst the strongest of individuals, family, and community systems with high levels of resilience, the increased vulnerability of immigrant families as compared to the general population at this moment is real. The primary focus of this paper will remain on describing and inviting awareness of current realities faced by various immigrant communities and showcasing ways in which mental health professionals are responding; however, we ask that the severity of the unfolding context under COVID-19 also be held alongside the previously existing stressors. The manuscript is organized in three sections: (a) an overview of the effects of immigration policy on immigrant family experiences; (b) the impact of mental and relational health on immigrant populations; and (c) elaborations of three exemplar community projects designed to support immigrant families. The manuscript concludes with a discussion exploring potential avenues for promoting a stronger base for solidarity and social action, including broader infusion of social responsiveness into our clinical professionals, practices, and training programs.

Immigrant Family Experiences and the Effects of Immigration Policy

American immigration policy is inextricably connected to family structure and health; understanding it illuminates the grief, chronic stress, and tensions families may face in navigating this system. Unfortunately, the changes to immigration policy are constant, unpredictable, and difficult to follow. Immigration status and visa types also directly affect the resources and permissions families can access, and their experiences. While we cannot explain all the intricacies of immigration law, we hope to highlight that anti-immigrant messages, policies, and practices compound the stressors, insecurity, and injustices already faced by our immigrant communities and deeply impact the entire community regardless of status. Additionally, these policies should always be analyzed according to the lens of capitalism. Currently, several areas of the U.S. economy operate by relying on the cheap labor of undocumented immigrants (Correa-Cabrera & Payan, 2018; Gelatt, 2020; Zallman et al., 2019). In essence, the prosperity of the U.S. economy can never be addressed without making reference to the dependence on and treatment of the immigrant workforce, and the historical economic abuse of undocumented immigrants that sustain the U.S. economic activity. Finally, there are important contextual factors that potentially impact the health of immigrant families; systemic therapists should make sure to assess for the experiences described below. For more information and resources on immigration policy, readers are encouraged to see Data S1.

Motivations for migration.

Migration motives tend to be conceptualized as binary in nature: voluntary (seeking economic or educational opportunities or a better life) and forced (organized violence, threats to life). This conceptualization has important implications for the types of protections the U.S. grants immigrants and the way decisions are made about who is afforded these protections. Although these categorizations are useful in practicality, they also risk gatekeeping under-documented immigrants who may qualify for humanitarian protections. In actuality, voluntary and life-threatening motives are intricately connected, resulting in “no-win” contexts for many families (Schmidt, 2017). Although connections between the motives vary depending on country of origin, the binds in which families find themselves are clear. The resources necessary for upward mobility (such as education and employment) often make families vulnerable to being targeted by organized crime groups. Simultaneously, limited access to education, employment, and governmental protection push individuals to join organized crime groups for financial stability and protection (Schmidt, 2017). In situations like these, leaving their country of origin becomes the least worst option.

Furthermore, our assumptions about voluntary motives could stand to be challenged. Only from a privileged stance can we treat economic stability and educational opportunities as a luxury, rather than a human right. These assumptions should be further examined when we consider the historical involvement of the United States in fueling and escalating the political turmoil, corruption, and oppression in foreign countries, such as in various Latin American countries, that have contributed to the conditions discussed above (Braziel, 2006; McPherson, 2020). Critical pull factors also maintain the status of undocumented immigrants in the post-slavery capitalist era as central to the U.S. economy. However, this nation continues to perpetuate the myth of a benign relationship toward the immigrant labor force and does not hold accountability for some of the root causes of immigrant socio-political-economic problems.

Anti-immigrant rhetoric and policies.

Immigrant Americans have been increasingly villainized in the media (Quiñonez, 2018). For example, the “Latino immigrant threat” narrative was central to Donald Trump’s 2016 presidential campaign and continues to contribute to the representation of immigration issues in the media (Silber Mohamed & Farris, 2019). These messages directly impact immigrant health by increasing anti-immigrant behavior, reinforcing structural racism and further limiting access to protective institutions (e.g., healthcare, education, housing). The portrayal of immigrants as “criminals” is harmful, false, and politically imposed. Immigrants, including undocumented immigrants, tend to have lower crime rates compared to U.S.-born citizens (Orrenius & Zavodny, 2019) with some studies supporting a negative relationship between immigration and crime rate in sanctuary cities (Martínez-Schuldt & Martínez, 2019; Wong, 2017). U.S. immigration law has actively worked to criminalize immigration and incentivize detainment in the United States The Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA) expanded the list of crimes for which individuals could be deported (Kerwin, 2018a), leading to the addition of Section 287(g) to the Immigrant and Nationality Act, granting local law enforcements the ability to investigate immigration status within their jurisdictions (Juárez, Gómez-Aguiñaga, & Bettez, 2018). The privatization of detention centers has also turned detention and deportation into a lucrative business for the past several administrations. In 2009, Congress passed the “Bed Mandate,” lobbied for by CoreCivic and the Geo Group, two of the largest corporations involved in facilitating detention centers, mandating ICE to detain a minimum of 33,400 individuals per night (Juárez et al., 2018). This number was raised to 34,000 in 2012. President Trump’s election led to an almost 58% increase in stock for CoreCivic (Demefack, 2016).

These policies also threaten our economy and workforce while encouraging exploitation and economic abuse of undocumented workers. Current literature supports the economic contributions immigrants make. Refugees surpass the total American population in workforce participation by 5%, and contribute significantly to federal and state taxes (Kerwin, 2018b). Sanctuary cities also tend to have higher median household incomes, lower poverty rates, and less utilization of public assistance compared to non-sanctuary cities (Wong, 2017). The COVID-19 pandemic reminds us that immigrants fulfill a disproportionate segment of the labor considered most essential and high risk, such as farm workers, construction, manufacturing, healthcare, childcare, and food service. However, lack of work authorization for undocumented immigrant workers in particular significantly increases the prevalence of serious or fatal occupational injuries, labor violations, including receiving less than minimum wage, not being fully compensated for hours worked and ICE turning a blind eye to labor law violations when conducting workplace raids (Smith et al., 2009). A lack of screening for witnessing or experiencing workplace crime prior to deportation also means that individuals who could potentially qualify for U Visa protections¹ are not being identified (Smith et al., 2009). As immigration law becomes more stringent, many companies have turned to hiring undocumented workers through a broker, leading to even less oversight of their treatment and pay (Correa-Cabrera & Payan, 2018). Reports of conditions at detention facilities have also revealed examples of exploitation, with detainees being paid as little as $2–3 a day in exchange for janitorial tasks (Project South, 2017). In essence, the economy benefits from immigrant labor from various aspects while immigration enforcement ensures immigrant workers remain vulnerable to continued exploitation and abuse.

Detention.

At any given moment, over 50,000 individuals are held in immigration detention in the United States, largely in private prisons funded by and operating within a network of governmental and private entities. Individuals may experience detainment for a variety of reasons, such as after seeking asylum at a U.S. port-of-entry or apprehension after crossing the border, an ICE raid, or upon arrest for criminal charges. Immigration detention experiences vary in terms of length of stay, quality of services, and experience navigating the legal system. Although variability exists, poor conditions and inhumane treatment of detainees have been reported at several immigration detention facilities. Documented human rights violations include overcrowded and unhygienic living conditions; inadequate or spoiled food and water; verbal, physical, and sexual abuse; work exploitation; blocked access to legal aid and linguistically appropriate legal materials; and inappropriate medical and mental healthcare (Project South, 2017; Wong, Bonilla, & Coleman, 2019). There has also been a disturbing pattern of transgender immigrants being at increased risk for experiencing life-threatening medical neglect, sexual assault, harassment, misgendering, solitary confinement, and abuse under ICE custody (Anderson, 2010; Zitsch, 2015). Even if individuals do not experience inhumane treatment or conditions, detainment remains a painful experience regardless of duration. Research studies and reports (e.g., Brabeck, Lykes, & Hunter, 2014; Robjant, Hassan, & Katona, 2009) document the harmful impact of incarceration, including increase in suicidal ideation and suicide attempts, depression, anxiety, and traumatic stress. Additionally, families are often separated in different detention centers and families held together in family detention facilities can experience challenges such as role reversal between parents and children, undermined attachment relationships, and strain to family physical and mental well-being (Brabeck, Porterfield, & Loughry et al., 2015). Given the context of facilities that often exert power and control to monitor the actions and daily routines of those detained, as well as their access to services, these risk factors can compound in harmful ways during and following detention (Cook Heffron, Serrata, & Hurtado, 2019).

Family separations and the threat thereof.

In the Spring of 2018, the Trump Administration announced a “Zero Tolerance” stance, resulting in the separation of over 2,300 asylum-seeking children and infants from their parents (Wood, 2018). By August 2018, an estimated 700 children remained unable to be reunified with their parents due to poor organization and tracking (Wood, 2018). This highly unethical scare tactic has caused significant damage for thousands of immigrant families, with harmful consequences on child development, attachment, and mental health—including higher risk of mood disorders, posttraumatic stress, and suicidal ideation (Wood, 2018). Although this practice has since been stopped by court order, families and youth continue to experience the negative effects of detainment and parent–child separation in other ways. The fear of deportation alone significantly affects families, causing restriction of contact with law enforcement and access to medical care (Chaudry et al., 2010). U.S.-born children with detained and deported parents or who have witnessed a raid have higher incidences of symptoms of Posttraumatic Stress Disorder (PTSD), anxiety and depression (Chaudry et al., 2010; Rojas-Flores, Clements, Hwang Koo, & London, 2017). As long as aggressive immigration policy is in place, children will continue to witness the detainment of a parent, or, in the case of unaccompanied child migrants and young asylum seekers, may be detained themselves.

Mental Health Impact and Relational Consequences of Immigration

Displacement, resettlement, and adjustment in a new home, whether by choice or force, is always disorienting. Immigrants and refugees enter their new setting with a host of experiences pre, during, and after migration that often set the stage for risk and protective factors to emerge. Individual and relational vulnerabilities increase with experiences of multiple losses and the presence of ongoing cumulative stressors that exacerbate the challenges of resettlement adjustment (George, 2010; Miller & Rasmussen, 2017). To compound these difficulties, there are logistical complexities, such as lack of jobs, affordable housing, accessing culturally and linguistically appropriate health and mental health services, financial resources, and social support. As previously stated, families resettle to the United States for various reasons. Voluntary immigrants often resettle to the United States in search of better opportunities while many others resettle due to forced displacement fleeing war, persecution, political oppression, and organized violence. Many of these families are separated through the migration process. This is particularly true of refugee families, whose migration experiences are often traumatic in nature. Many refugee families have survived traumatic events and violence including persecution, torture, war, multiple relocations, and temporary resettlements in refugee camps (Glick, 2010; Patterson, Abu-Hassan, Vakili, & King, 2018; Steel et al., 2009). The destructive consequences of war and organized violence involve an entire reorganization of family life and society compounded by the long-lasting effects of collective traumatization (Rousseau, Drapeau, & Platt, 1999). After resettlement, individuals and families may continue to experience traumatic stress and relational disruptions related to those left behind and stressful living conditions in the country of resettlement.

Despite heroic legacies of survival and resilience, refugees are also part of an especially vulnerable population. While many adjust to life in the United States without significant problems, studies have documented the adverse impact of trauma histories on the psychological and relational well-being of refugees (Shannon, Wielin, Simmelink, & Becher, 2014). Consistent and prolonged management of previous traumatic experiences may threaten an individual or family’s ability to successfully cope with additional multiple stressors during resettlement. While it is reported that refugees are at risk for higher rates of psychiatric disorders such as PTSD, depression, anxiety, complicated grief, addition, psychosis, and suicide (Akinsulure-Smith & O’Hara, 2012; Kandula, Kersey, & Lurie, 2004; Steel et al., 2009), immigrants exposed to multiple traumatic events in their lifetime would also be at risk for similar mental health complications. However, it is important to not assume that all members of an affected population are psychologically traumatized and will have the same mental health symptoms (Shannon et al., 2014). Furthermore, mental health symptomatology is expressed in a variety of culturally sanctioned ways. For example, somatic complaints such as dizziness, headaches, heart palpitations, and fatigue might be a way to avoid stigma and shame frequently associated with admitting to mental health problems (Shannon et al., 2014). We know that individual mental health does not exist in isolation; the experiences of one person in a family or community affect others. Although individual mental health treatment for traumatic stress is crucial, unfortunately, the systemic ramifications of trauma exposure continue to be understudied and underrepresented in the academic literature, also leaving a dearth of evidence-based relational treatments for trauma-affected populations (Nickerson et al., 2011; Slobodin & de Jong, 2015). For further information on traumatic stress impact on immigration, intergenerational transmission in families, and child mental health, see Hanson-Bradley and Wieling (2016).

RESPONDING TO IMMIGRANT MENTAL HEALTH IN U.S. COMMUNITIES

Systemic therapists can uniquely engage and mobilize within their communities to create meaningful and far-reaching impacts for local immigrant families. In this section, we showcase three interdisciplinary systemic community projects that share the common goal of addressing some facet of the multiple needs of immigrant families in this country. The co-authors and founders of these projects were asked to briefly (a) introduce the project and describe the target population; (b) summarize the systemic framework being implemented; (c) share any known impact on families and the community; and (d) provide lessons for the field. To learn more about each project, please see Data S1.

SAFE HARBORS AND RAPID RESPONSE

Jo Ellen Patterson

In fall 2018, the University of San Diego (USD) School of Nursing contacted the Marriage and Family Therapy (MFT) Program faculty to invite the MFT faculty and students to participate in a shared service project. About a year prior, USD nursing students had begun offering medical services at a local shelter, Safe Harbors, in San Diego, Ca. Safe Harbors was created by a local church, and primarily housed asylum-seeking families. Before the shelter was created, some asylum-seeking families were literally left on the streets of San Diego because they had no place to go. Over time, some ICE officials learned about the shelter and began helping asylum seekers find their way to Safe Harbors. Asylum seekers came from a range of countries, but the majority of asylum seekers came from Guatemala, Honduras, El Salvador, and Haiti. The goal of the service project led by the nursing students was to offer support services to asylum seekers who had legally crossed into the United States at the Tijuana–San Diego border. The collaboration between the USD Nursing Program and MFT Program was initiated in response to students observing a high prevalence of positive screenings for mental health concerns in adults at the shelter. The MFT Program was invited in hopes that faculty and students could offer mental health support.

Two MFT faculty members organized current students who were willing to volunteer at Safe Harbors. Each Saturday, USD nursing and MFT students would spend the morning doing activities with the families. In general, there were approximately eight nursing students and a nursing faculty member involved in the project. Over the life of the project, there has been a range of MFT student involvement from approximately 3 students to a total of 20 students. Some students contributed by purchasing socks and undergarments instead of volunteering time. But all MFT students had the chance to participate. Activities included preparing food, playing games with the children, and having informal discussions if a shared language existed. Students who could speak Spanish, French, or Russian had the opportunity for more in-depth conversations with the families.

Other students “spoke” to the children through the language of play or the arts. The MFT faculty consulted with an occupational therapist and some preventive medicine physicians who suggested therapeutic activities. From this consultation, the MFT faculty and students created two activities: “Rocks of Resilience” and the “Hallway of Hope.” The “Rocks of Resilience” was an activity in which rocks were painted by parents and children with meaningful pictures and words of strength and endurance. Individuals could then carry the rocks on their journey, or gift them to others. The “Hallway of Hope” was a compilation of mini-posters that the parents and children painted to encourage the next groups coming through the entrance of the shelter for the first time. Borrowing methods and skills from occupational therapists taught the students that healing could involve nonverbal interventions. Students did not need to speak a shared language with the families to create the rocks or the posters. In addition, the students learned to work as a team with other professionals and to expand their skill sets. The MFT students brought food, toys, and other goods to the shelter but they purposefully did not do clinical work including treatments for trauma. The Program decided from the beginning that the appropriate resources did not exist to do ethical clinical work. The goal of the project was to deliver practical services and kindness. Protective measures were not in place to deliver safe and effective therapeutic services, including the lack of onsite clinical supervision to support students in delivering effective treatment of traumatic stress symptoms. Additionally, shelter residents spoke a variety of languages, and students bilingual in languages other than Spanish were not always available. Eventually, Safe Harbors was shut down by the San Diego Fire Marshall. Fortunately, the MFT and Nursing students could move to another program, Rapid Response, that had more stable funding and paid staff who were funded by Jewish Family Services using grant money from the State of California. In addition to the volunteer MFTs and nurses, physicians from the University of California San Diego (UCSD) ran a health screening clinic for new arrivals. The Rapid Response shelter had been quickly set up in an old building that was going to be demolished. Instead, it became a hub for asylum seeking families who crossed into the United States legally and were brought by bus to the guarded and fenced shelter. Families with small children who had waited for months in Tijuana got off the bus carrying all their worldly goods and entered the shelter and their new lives.

Both Safe Harbors and Rapid Response were meant to be a brief, initial stopover for the families, ranging from one night to a week. ICE guidelines for asylum-seeking families required that they have family or other support in the United States to sponsor them to wait for their court date out of detention or the shelter. Thus, Rapid Response staff joked that they needed career training to be “travel agents.” Computers were set up and funding was secured to provide transportation to send the families to various parts of the United States after a “brief” stay at the shelter. Drivers were on call 24 hr a day to take the families to the bus station or airport. However, many possible sponsors fell through and some families ended up staying for longer periods of time. In a few cases, families had no place else to go and stayed at the shelter for several months. As they stayed for longer periods of time, the trauma they had experienced became apparent—especially during the long nights when they felt alone and afraid. For these families, MFT students who attended the shelter regularly were able to build strong rapport, and support parents and children through listening, unconditional positive regard, and psychoeducation around parenting and child behavior (when situationally and culturally appropriate).

Jewish Family Services also responded to these needs by finding longer-term housing for a few families and by making mental health services available to asylum seekers expressing a history of trauma. Initially, licensed, volunteer therapists from the community made themselves available to provide “on call” mental health services. The shelter also reached out to the USD MFT faculty about students delivering clinical services, to which the USD faculty were open. However, the MFT Program wanted to ensure that (a) a licensed therapist would be available to provide supervision at any time and (b) students had adequate training in trauma-informed treatments. At the time of this writing, these requirements are being organized.

Lessons to the Field

This project led us to challenge our current conceptualizations of relational clinical work in several ways. As faculty, we encountered several questions relevant to clinical training. Often, students built relationships with parents by playing with children. Was this systemic work? Were these non-clinical experiences worthwhile for students focused on accruing clinical hours? We also had to consider the balance of meeting the needs of the shelter for clinical mental health support while also adhering to our own boundaries, regulations, supervision guidelines, and ethics.

THE WITNESS TO WITNESS (W2W) PROGRAM

Kaethe Weingarten and Celia Falicov

The Witness to Witness Program (W2W) developed in response to a need that emerged at a workshop organized by Ruben Parra-Cardona, PhD, in connection with the American Family Therapy Academy (AFTA), in Austin, Texas in June, 2018. The workshop focused on work at the Southern border with asylum seekers, detainees, and undocumented individuals. Many people attending the workshop were motivated to offer assistance of some kind.

The Roots of W2W

The origin of W2W goes back decades. Kaethe Weingarten, PhD, founded and directs W2W and it is based on a model she established in 1999 with The Witnessing Project. The Witnessing Project, based on the witnessing model (Weingarten, 2000; Weingarten, 2003), worked with individual, families, and communities to transform the passive witnessing of violence and violation to effective action in a variety of contexts—from medical illness to post-war societies to violence in the home. One component offered was one-to-one virtual support for healthcare and community workers in different parts of the world, such as Kosovo and South Africa. Hearing the speakers’ stories at AFTA’s workshop, Weingarten thought the witnessing model would apply: the helpers needed help. Healthcare workers, community helpers, advocates, counselors, and attorneys (hereafter referred to as “partners”) were experiencing stress hearing the stories of hardship and trauma of their clients, patients, and community members. Later, W2W added journalists in the frontline to its roster of groups served.

Development of the Structure of the W2W Program

Within a week of the workshop at the Austin conference, Weingarten and AFTA convened a planning group to support the development of a program. By July 2018, there were eight volunteers that began to test the training materials. A year later, there were 38 volunteers, 6 of whom were bilingual. Claudine Lucena, MA, LMFT, an AFTA member and Kate Wotanowicz, an AFTA program manager, provided administrative support. In June 2019, the demand for W2W services escalated. At one point, W2W received six requests for services in a single hour. Celia Falicov, PhD, an internationally recognized clinician, author, and teacher joined W2W as a volunteer and in 2020 became the Coordinator of Spanish Language Programming (Falicov, 2014). In December 2019, W2W formed an Advisory Group with the Past President of AFTA, Victoria Dickerson, PhD, Sarah Berland, LCSW, Barbara Mitchell, JD, LLM, and Celia Falicov, PhD.

All volunteers are members of AFTA and are trained systemic clinicians. All clinicians also have experience doing clinical work with clients with histories of trauma. All volunteers read the same training materials. There is a clear protocol for how to make the initial contact, how to organize the sessions, and what concepts to emphasize. We call this a “uniquely applied standardized approach.” Before being assigned their first partner, volunteers attend a conference call with other volunteers and a final discussion with Kaethe Weingarten. Each volunteer sends a note about each conversation with their partner. The notes are reviewed by Weingarten and independently rated by an outside rater. The average rating on a 1–5 scale of helpfulness has been 4.9.

W2W Program Training Materials

A number of resources have been developed that provide the conceptual basis and the action applications of W2W. Chief among them is the Witnessing Model. The model asserts that there are four witnessing positions. Our positions vary depending on the situations we witness. Position Four may be the most common for helpers and others. In this position, a person is aware of what is going on but is either uncertain what to do or lacks the internal or external resources to act exactly as they know to do. This position saps energy, enthusiasm, and resolve. Aware of our witness position, we have a chance to change positions. Sometimes, when we are overwhelmed, we mistakenly believe that relief can come by moving into unawareness, using any number of tuning out strategies, like alcohol, devices, or excessive sleep. However, the only relief and benefit to the person comes from moving into the aware and empowered position, that is, moving up to position One from position Three and not over to position Four. In addition to the witnessing model, W2W uses materials related to stress reduction, coping with trauma responses, and developing vicarious resilience (Hernandez, Gangsei, Engstrom, 2007).

Structure of the Supportive Intervention to Partners by Volunteers

The W2W Program operates with a clear structure. There is a psychoeducational component that is made available to each partner via an archived webinar and then AFTA volunteers provide 3–4 phone sessions that are geared to deep listening of the person’s story of their work and its challenges; an inventory of the person’s current internal and external resources both in the present and the past; help with removal of barriers to those resources; and development of a personal toolkit to handle stress. While the conversations may be therapeutic, we do not offer therapy. There is a clear written protocol on how to initiate contact and what to offer to the partners (these materials can be made available upon request).

Examples of the Value found by partners in W2W program

Our partners have mostly been women, mostly under 40 years of age, practicing as pro bono attorneys, community health workers, counselors in prison settings, and journalists working with asylum seekers and climate refugees. They describe demoralization, moral injury, secondary traumatization, vicarious trauma, activation of their own trauma histories, overwhelmed work environments, inconsistent systemic support, and despair in relation to current administration policies that directly impact the people they serve. One attorney said that she and her colleagues call this “Monday morning in-box trauma.” A very stressed Latinx social service shelter liaison said, “I cannot talk or vent to anybody except you about the insane workload and the incompetence of the system as it will not go well with my supervisors.” A social service manager in NY told her partner: “I feel so grateful for this model, this way of working, and to you for implementing it… I believe things would be different if everyone working here was receiving this kind of partnership.”

Types of Programs Offered by W2W

While the program began by offering one-to-one supportive conversations, in response to the increase in demand we expanded to offer four components.

Clinician listening sessions.

We provide 3–4 sessions of listening and resource building to our partners who are committed to supporting vulnerable populations yet are experiencing harms themselves. Over 130 people have used this component.

Peer support.

Social support is the most effective and efficient way to cope with stress. W2W offers facilitated open enrollment peer support groups for providers. We have held 10 peer support groups.

Webinars.

W2W offers individualized webinars and accompanying resources, each of which is archived. We have offered six webinars, in English and Spanish, that have been viewed by over 1,000 people.

Consultation to organizations.

W2W offers a multi-week, practical learning collaborative for supervisors and administrators to help them develop both individual and organizational resilience in a trauma-informed manner. This is being further rolled out in 2020.

Current Structure and Organizational Support for W2W

In February 2020, W2W shifted its primary home base to Migrant Clinicians Network (MCN). MCN has a 35-year history of serving the vulnerable poor by providing support, technical assistance, and professional development to clinicians in Federally Qualified Health Centers (FQHCs) and other healthcare delivery sites. By adding the W2W programs to their resource portfolio, MCN added trauma-informed care to their offerings. Based on the work of Celia Falicov (2007), we have created a psychoeducational document for attorneys and healthcare workers to use with recently reunited families experiencing family and parenting tensions. We are conducting a number of “train the trainer” seminars to more widely disseminate the model. We provide a weekly update to all W2W volunteers and other interested parties to keep them informed about immigration news and specific developments within the W2W program itself. We hold regular volunteer conference calls to share experiences of doing the work with our partners.

Lessons for the Field

Testimonials of those served by W2W affirm that trained mental health professionals have skills to offer all those who serve families in a variety of public settings, particularly in contexts of witnessing high stress and trauma that cause worker burnout, empathic stress disorders, and moral distress. While this has always been the clear mission and vision of W2W, the relevance of W2W’s services became abundantly clear as sociopolitical stresses mounted on many fronts over the past year. In the context of the current Covid-19 pandemic, W2W is even more certain that emphasizing collective action is a key to alleviating suffering. We think the overarching lesson is that resilience and hope are something people do best together (Weingarten, 2010).

GIRASOL: BRINGING TRAUMA-INFORMED, INTER-PROFESSIONAL PRACTICE TO IMMIGRATION LEGAL SERVICES

Ana Hernandez, Laurie Cook Heffron, Monica Faulkner

Girasol, a program at the Texas Institute for Child and Family Wellbeing at the University of Texas at Austin, is committed to work at the intersection of immigration and mental health. Girasol provides practical trainings for attorneys on trauma-informed approaches and for mental health professionals on working alongside immigration legal service providers and the immigration system. In doing so, we aim to build broader capacity among mental health professionals, help immigration attorneys provide more effective services, center the importance of mental health in the immigration field, and provide support to immigrant individuals and families interacting with the immigration system. Here we describe three aspects of our collaborative work that has evolved over many years and come to be coordinated by (project name). These include providing psychosocial assessments and expert witness testimony, advancing inter-professional work in immigration detention, and engagement in policy advocacy initiatives.

Psychosocial Evaluations and Expert Witness Testimony

Given that immigration judges, officials, and attorneys do not receive consistent training in understanding trauma and the mental health impacts of abuse and violence, mental health professionals contribute important education, expertise, and evidence that can lead to better outcomes for immigrant families seeking legal protections in the United States. Immigration attorneys and their clients often seek written evaluations and/or testimony for the purpose of providing information and context related to claims for a variety of legal immigration remedies—U Visas, T Visas, Special Immigrant Juvenile Status, VAWA¹ cancellation of removal—or other immigration proceedings such as seeking release from detention or setting bonds for release from detention.

General and case-specific experts help attorneys and immigration judges understand the biopsychosocial impact of abuse, violence, persecution, family separation, and/or detention on wellbeing and help-seeking; dynamics of trauma; memory recall and retell among trauma survivors; and/or the dynamics of relationships that involve interpersonal violence or human trafficking. Experts summarize empirical and scholarly evidence to explain particular elements of a case. Experts may also be asked to provide country-specific information about the dynamics of violence, abuse, or persecution and available social services and criminal justice responses. Finally, experts may be asked to provide a professional opinion about the likelihood of continued violence or persecution in the event of denial and deportation.

Interprofessional Work in Immigration Detention

While interdisciplinary or interprofessional teams may be most associated with the medical field, law-mental health collaborations are an important innovation for work to support immigrants navigating detention and immigration legal systems. Combining knowledge on trauma, healing, and resource access with knowledge of legal systems, detention center hierarchies, and case strategy creates a powerful support mechanism for immigrant clients. In collaboration with University of Texas at Austin Immigration Law Clinic and RAICES, Girasol works to train social work students and law students in teams to provide compassionate and effective services for individuals and families detained in Texas, home to the largest stretch of the U.S.–Mexico border and multiple detention facilities. Teams primarily support families navigating the credible fear interview, during which they must detail for an immigration official their reasons for seeking safety in the United States, which often involves re-living traumatic experiences, such as intimate partner violence, gang violence, extortion, or witnessing assassinations.

The interdisciplinary law-social work teams are trained to build rapport, engage with clients in a transparent and empathetic way, and to bring an understanding of the neurobiology of trauma to help guide families through the questions they will be asked without overwhelming them. Social work students or social workers additionally invite clients to participate in breathing and grounding exercises while law students consult with lead attorneys regarding the details of the case. This collaborative effort helps to mitigate the harmful effects of re-telling one’s trauma experience within an oppressive detention space and to help individuals and families feel heard, supported, and validated. By centering the knowledge that human connection and relationships can be healing in and of themselves, this work serves to integrate trauma-informed care as closely as possible, within a trauma-producing setting. Lastly, teams receive information about secondary trauma and are encouraged to process their experiences after visiting detention.

Policy Advocacy

Mental health professionals may also leverage their expertise and power to inform policymaking and advocate for policies that protect and ensure the well-being of immigrants. Policy advocacy activities range from calling or writing elected officials; signing on to petitions or letters; contributing to public comment periods on rulemaking processes at state or federal levels; and delivering oral or written testimony to state and federal policymaking bodies. Mental health professionals can also contribute their expertise to more involved legal advocacy efforts such as participating in amicus briefs or as an expert witness in lawsuits related to the immigration detention system, and/or providing testimony to international entities investigating human rights abuses in detention.

As an example, we have been involved in policy advocacy activities related to family detention. In 2016 and 2017, the state of Texas attempted to license two large family immigration detention centers as childcare facilities, as strategic protection against the consistent and strong opposition to family detention brewing among medical and mental health professionals and immigration attorneys. This effort began with proposed changes to state-level licensing rules and a hearing to elicit public comment on proposed changes. More than 400 individuals testified in 2-minute increments about the impacts of detention on children and families and the risks of, and opposition to, licensing these facilities. Compelling testimony was provided by previously detained individuals, attorneys, child welfare workers, faith leaders, mental health professionals, and community activists. Individual mental health professionals presented practice-informed and research-based evidence against the bills. In a powerful addition, RAICES gathered written testimony from detained mothers and coordinated non-detained volunteers to read their testimony aloud to lawmakers.

Lessons for the Field

It is important to have a clear understanding of what kind of assessment, evaluation, and/or testimony is needed or requested and whether or not one’s skills, competence, and area of expertise are appropriate. The jargon used in legal settings often differ from that used in the mental health field, and mental health professionals must take care in navigating conversations with attorneys before agreeing to work on a case, in any policy advocacy initiatives, and throughout interprofessional work related to immigration detention.

DISCUSSION AND CONCLUSIONS

These interdisciplinary projects are exemplars of what is possible when systemic therapists transform their social constructionist and critical epistemologies into community-based action in the pursuit of social justice. Each project depicts a model of vision, leadership, resistance to a status quo that dehumanizes immigrant and refugee communities, and is symbolic of deep collaboration with other professionals and community partners. Each project honors the centrality of the family as a unit of change and as a critical space for organizing social life in a new country of resettlement. Each project underscores the political nature of our work as systemic clinicians motivated to address health and economic disparities, human rights violations, and social change. Much of our family therapy discipline is predicated on the foundation of an ecological framework that guides the relational and contextual mechanisms of change inherent in our interventions. Indeed, we have made tremendous strides in advancing the science and praxis of our relational work—recently documented in the multi-volume edited Handbook of Systemic Family Therapy (Wampler et al., 2020). Critical components of this work is also documented in a growing literature on cultural tailoring and responsiveness in underserved and marginalized Black, Indigenous and communities of color. However, more is missing, more is needed, more is urgent for the sake of millions of immigrant families in this country and displaced populations around the world.

This historically unprecedented moment in our lives of witnessing the highest levels of forced human displacement since WWII (UNHCR, 2015), national and global political turmoil, climate change, increasing social and economic disparities, anti-Black racism, and now a global pandemic that disproportionately affects marginalized populations, all call for us to respond in unprecedented ways to this social order. This is a moment for coordinated action and family therapists have a unique role to contribute. Indeed, clinicians across mental health disciplines have historically been involved in addressing the health needs of various underrepresented populations, destigmatizing mental health diagnosis, and promoting relational health. This moment calls for a resurgence of activism with the need for scientist-practitioners in our field to raise the bar on resisting what bell Hooks (2013) famously referred to as Imperialist White-Supremacist Capitalist Patriarchy—and we might add heteronormative, misogynist, ableist, among other discriminatory beliefs and practices—to interrogate, innovate, and humbly but courageously forge new models of lived worlds, to create realities that capitalize on all of our accomplishments as civil and scientific communities around the world to create a better human experience. We have developed profound knowledge of mental and relational health grounded on evidence- and practice-based models of intervention yet we continue to struggle with translating this knowledge into the hands of those who need it most as structural inequalities persist (Fudge et al., 2016). We have learned much about the science and art of conducting linguistically and culturally relevant work with historically and currently marginalized communities, yet we have a long road ahead in systematically integrating culturally tailored practices into our research, clinical treatments, and training programs to reach broader segments of public life. We understand that new generations of relational scientist-practitioners and family therapists will need to be skilled in working collaboratively in interdisciplinary teams of professionals and paraprofessionals, striving for increasing innovations in task-sharing and uses of technology in the transfer/sharing of knowledge, and they will need to become more comprehensive producers and consumers of multiple methodologies—with less emphasis on entrenched unidimensional paradigmatic alliances. Most of all, current and new generations of family therapists must be called in greater numbers to become more integrated agents of social change working alongside legal, political, economic, and social structures as central to creating sustainable change in family life.

Challenges and Opportunities for the Field

Parallel to the need for promoting a culture of prevention and culturally relevant implementation sciences within the field, we must also promote an axiological approach that includes multi-systemic interdisciplinary praxis with historically and currently marginalized communities. Even though we have made strides in encouraging diversity and inclusion into our clinical training programs and community practices, we encourage ongoing accountability for developing even deeper immersion and connection with disenfranchised communities and the advancement of non-hierarchical and mutually beneficial collaborations. We believe that clinical students in accredited programs could expand their knowledge and experience by engaging in purposeful socialization to becoming the scientist-practitioners that the future will demand. Specifically, in addition to the standard curriculum and individual/relational hour requirements, we wonder about the potential impact of programs starting to require trainees to have at least one experience with vulnerable and underserved populations, with appropriate mentored and supervisory overview and incentives to credit this type of experience. Clinical programs might more readily be encouraged to establish collaborations that are community-based and interdisciplinary in nature if there were also equivalent incentives for faculty promotion and tenure based on this level of community outreach and engagement. These local and global collaborations could also serve to challenge traditionally White, elitist, educational boundaries to offer important incentives for partners, such as certificates for paraprofessionals, awards and recognitions for community agencies, and educational tracks for community members (e.g., school systems, community voluntary agencies, health clinics) to be mentored into joining academic mental health settings to serve marginalized communities. We could benefit from reconceptualizing what constitutes clinical hours and academic student learning outcomes to include collaborations with immigrant and marginalized communities in response to various needs—this means applying our systemic training and knowledge of family systems at broader ecological levels for motivated social change. Moreover, we encourage greater collaborations between academic disciplines, with systemic therapists working alongside professional colleagues in law, medicine, economics, and so forth, as part of these community collaborations. We understand that the ethics, boundaries, and safety issues present in conducting this type of complex work with populations that are already multiply disenfranchised is mammoth; however, the consequences of not moving the field in this direction with purpose and intention have even greater deleterious consequences.

The current pandemic has forced many of us to reinvent daily life, to reconsider how we train and supervise clinicians and how to reach clients and community partners through telehealth. This moment presents certain possibilities for also reconceptualizing our role and responsibility as a clinical community to be even more accountable for creating a culture that is responsive to economic and social injustices. We want to celebrate and honor all the critical relational work that we have advanced in recent decades and to also take a critical look at spaces where we might have become complacent in our journey to support all families to achieve their greatest potential. Finally, we urge family scholars to advance scientific prevention and intervention models for treating the relational consequences of traumatic stress for immigrant and refugee communities. We recommend that clinical programs systematically integrate training on evidence-based models for treating individual PTSD, and we must conduct research that leads to the development of culturally relevant evidence-based models for interrupting the intergenerational transmission of psychopathology and maladaptive coping, supporting strong parent–child relationships, healing couple relationships, strengthening family systems, and promoting community resilience and broader collective healing. Traumas related to structural oppression and disenfranchisement call for collective action and restoration of trust and human dignity.

Supplementary Material

Supp Material

Data S1. Supplemental File A.