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. Author manuscript; available in PMC: 2020 Mar 1.
Published in final edited form as: Transl Issues Psychol Sci. 2019 Mar;5(1):4–16. doi: 10.1037/tps0000175

Psychological Practice with Unaccompanied Immigrant Minors: Clinical and Legal Considerations

Amanda NeMoyer 1, Trinidad Rodriguez 2, Kiara Alvarez 3
PMCID: PMC6415685  NIHMSID: NIHMS1011765  PMID: 30882017

Abstract

Among youth who migrate to the United States from Latin America, unaccompanied immigrant minors (UIMs)—traveling without a parent or caregiver—are a unique subpopulation facing substantial challenges before, during, and after migration. UIMs often migrate as a result of traumatic experiences in their home countries, but are also vulnerable to experiencing trauma pre and post-migration. These experiences are compounded by the impact of prolonged separation from caregivers who migrated earlier (pre-migration) and caregivers who were left behind (post-migration). Once in the US, UIMs are typically considered undocumented and often do not have the legal representation necessary to successfully navigate immigration proceedings in a system designed for adults. Further, they often live in areas with increased rates of poverty and community violence and can face stigmatization and exclusion from important protective activities. UIMs are therefore at risk for psychological distress, including depression, anxiety, and posttraumatic stress. This article provides an overview of typical experiences for UIMs, discusses the accompanying legal and clinical implications, and offers recommendations for psychological practice at the level of providers, training programs, and child-serving systems. For example, providers might incorporate family-based and trauma-focused interventions to enhance resilience and psychological well-being, in addition to support in navigating interactions with the legal system. Clinical training programs can provide education about the experiences of UIMs, while clinicians can advocate at the systems level to promote social integration of UIMs into school systems and a more humane immigration system focused on meeting the needs of these vulnerable children.

Migration to the United States by Latin American youth traveling without a parent or guardian reached a peak in 2014, drawing national attention. Between October 2013 and 2014, immigration officials encountered more than 67,000 unaccompanied youth (American Immigration Council, 2015), most of whom emigrated from Mexico, Guatemala, Honduras, and El Salvador (Seghetti, Siskin, & Wasem, 2014). Though the rate of migration has declined, nearly 150,000 more unaccompanied youth have been detained at the U.S./Mexico border since October 2014 (U.S. Custom and Border Protection, 2017). Upon apprehension and detention, youth are identified as “unaccompanied alien children” by agents of the U.S. Department of Homeland Security if they: are less than 18 years of age, have no lawful U.S. immigration status (i.e., are “undocumented”), and have no parent or guardian able to provide immediate care and physical custody in the United States1 (Manuel & Garcia, 2016; Ooi, 2011). In this article, we refer to these children as unaccompanied immigrant minors (UIMs).

Unaccompanied children have many motivations for leaving their countries of origin. Common reasons include: fleeing violence, gang activity, abuse, extortion, or poverty, and seeking family reunification (Ooi, 2011; Seghetti et al., 2014; Valdez, Valdez, & Sabo, 2015). In particular, increased rates of violence and homicide in Guatemala, Honduras, and El Salvador have been directly linked to an increase in the number of UIMs entering the United States (American Immigration Council, 2015). After apprehension and detainment at the border, many UIMs are released to family members or other sponsors to undergo immigration proceedings. During this time, UIMs may seek or be referred to mental health services (e.g., Baily et al., 2014; Grace & Roth, 2015; Schapiro et al., 2018). Psychologists and other mental health providers that serve these children should appreciate the often-traumatic journey they have undertaken before presenting for care. Further, basic awareness of immigration proceedings and potential options for legal relief can give needed context for best providing mental health services to this vulnerable population.2 In this review, we discuss common experiences of unaccompanied youth prior to, during, and after migration, with a focus on family context and unique stressors and resilience factors. We also review the legal issues these young people often face, and close with recommendations for psychologists and other mental health providers in clinical practice, training programs, and at the systems level.

Experiences Before and During Migration

Pre-migration.

Before emigrating from their countries of origin, UIMs frequently experience physical and emotional abuse, poverty, and exposure to extreme violence (Chavez-Dueñas, Adames, & Goertz, 2014; Schapiro et al., 2013). Substantial proportions of migrating youth report experiencing and fearing violence—in one study, 58% of respondents reported personally experiencing or fearing “serious harm of a nature that raises international protection concerns” from state actors, transnational criminal organizations, community members, or even family members (UNHCR, 2014, p. 25). Children often report fleeing to avoid recruitment and exploitation by human smugglers, gangs, and drug cartels (UNHCR, 2014). For young girls in these regions, sexual violence serves as a leading motive for migration, as female UIMs frequently report being victims of rape (UNHCR, 2014). Interviews conducted with volunteers serving migrants in Arizona similarly found that adult immigrants from Central America are often fleeing to escape gang violence, sexual violence, extortion, and kidnapping, some with harrowing stories of gang violence towards children as a way of threatening the family (Valdez et al., 2015). A study of 234 immigrant adults from Salvador, Honduras, and Guatemala found that half of the participants had experienced death threats, about a third experienced extortion, and more than one fifth experienced domestic violence (Keller et al., 2017).

For many immigrant families, migration occurs in a “stepwise” fashion, such that parents first travel to the United States to secure employment and, eventually, children migrate to reunite with their family (Suárez-Orozco, Bang, & Kim, 2010; Zentgraf et al., 2012). During stepwise migration, children left behind in their countries of origin may feel proud of their parents—particularly if they migrated for safety reasons or to improve the family’s financial status—or they may feel abandoned (Schapiro et al., 2013). Children may be more likely to see their family’s migration as a stressor when they are not included in the family’s decision-making process (Potochnick & Perreira, 2010). Of note, children of different ages often respond differently to separation from their parents (Dreby, 2007). For example, preadolescents might become more attached to remaining caregivers (e.g., grandparents), withdraw from their biological parents, and express more reluctance to join their parents via migration. In contrast, although adolescents might initially act out, appear more resentful of their parents, and have more difficulties in school, as they grow older, they tend to have more interest in joining their parents (Dreby, 2007). Other studies have found that separation from mother and/or father due to migration may result in a child experiencing significant distress, which can manifest as depressive symptoms, nervios,3 medical conditions, and other emotional and behavioral problems (Heymann, 2009; Pribilsky, 2001; Suárez-Orozco, Todorova, & Louie, 2002).

Migration process.

Compounding pre-migration traumatic experiences, migration itself likely exposes youth to further trauma. The journey to the United States from Central America is perilous, entails crossing multiple borders through different means of transport, and can take almost two months to complete (Chavez-Dueñas et al., 2014). In addition to traveling via cars, buses, and boats, many migrants cross Mexico on the top and sides of a freight train known as “La Bestia [The Beast],” a free but dangerous alternative to other forms of transportation. During their journey on “La Bestia,” migrants are sometimes mutilated or killed from falling off the train due to exhaustion (Vogt, 2013). Survivors report witnessing and experiencing assaults, robberies, and sexual violence during the journey (Infante et al., 2012; Valdez et al., 2015; Vogt, 2013).

Travel is often arranged through use of “coyotes,” migrant guides who typically receive payment from families hoping to ensure their child is safely brought to the United States (Vogt, 2016). Coyotes frequently have established social networks for transporting individuals from shelter homes along the migration route to contacts on the U.S. side of the border. However, hiring a guide to navigate the migration process does not necessarily protect children from extortion, kidnappings, and violence. Coyotes themselves might be responsible for violent acts against children they were hired to transport. Vogt (2016) described coyotes as both “perpetrator and protector” (p. 367), as they risk their lives to guide youth but can also take advantage of the vulnerable. Migrants victimized by their coyote have been abandoned, have been kidnapped to demand more money from family members, and, in some cases, have died due to intolerable and inhumane traveling conditions (Vogt, 2013; Infante et al., 2011; Palacios, 2015).

Post-migration.

UIMs are typically apprehended and detained by Customs and Border Protection (CBP) agents shortly after entering the country (American Immigration Council, 2015). UIMs who do not undergo “voluntary return”4 to their country of origin (Seghetti et al., 2014) remain at CBP holding facilities before transfer to the Department of Health and Human Services Office of Refugee Resettlement (ORR) (Cantor, 2015). Although federal law states that youth should be transferred to ORR within 72 hours, children have reported remaining in CBP facilities for nearly two weeks while awaiting transfer to an ORR facility (Women’s Refugee Commission, 2012). Conditions in CBP facilities—often called hieleras, Spanish for iceboxes—have been described as extreme and inhumane, as detainees must often sleep on concrete floors in freezing temperatures while lights remain on all day and night; these facilities have also been characterized by a lack of adequate food, water, and medical care (Cantor, 2015). Upon transfer to ORR, youth are typically housed in state-licensed, private facilities with one of three security levels: shelter, staff-secure, and secure (Hill, 2011). Federal law requires that youth be held in the least restrictive setting necessary to meet their best needs, and youth may only be held in secure placement if they are determined to be a danger to themselves or others and/or have been charged with committing a criminal/delinquent offense (Hill, 2011). Youth in ORR custody may be held for days, months, and sometimes years during the removal process: from 2008 to 2010, youth spent between 1 and 710 days in custody, approximately 61 days on average; in 2016 the average length of custody was 34 days (Kandel, 2017). Regardless of security level, these facilities are typically in remote areas, thereby limiting youths’ accessibility to family members, legal counsel, educators, and medical providers (Hill, 2011). Further, instances of physical and sexual mistreatment by staff have been reported in several facilities (Hill, 2011).

Although they continue to lack lawful immigration status until the conclusion of formal immigration proceedings, an estimated 85% of UIMs are released from ORR custody to await those proceedings (Seghetti et al., 2014). Specifically, ORR may release youth to “a family member, legal guardian, or other entity willing to ensure the child’s well-being and timely appearance in immigration court” as appropriate (Ooi, 2011). Prior to releasing a child, ORR should conduct background checks of the potential sponsor to identify previous arrests and convictions; they may also consult with the child, his/her family, and/or the consulate from the child’s country of origin (Seghetti et al., 2014). However, after several children were released to human traffickers posing as distant relatives or family friends of each child (VanSickle, 2016), a Senate Subcommittee investigation of ORR policies and practices regarding sponsor approval and child release revealed several concerning shortcomings (U.S. Senate, 2016). Specifically, the Subcommittee took issue with ORR’s unreliable methods of verifying alleged relationships between UIMs and potential sponsors, ORR’s failure to perform background checks on all adults in a potential sponsor’s household, the lack of home studies performed prior to placing UIMs with sponsors, and limited post-release follow up (U.S. Senate, 2016). These shortcomings place UIMs at heightened risk for trafficking and other forms of abuse upon their release from custody.

After release, UIMs frequently move with their sponsors to major metropolitan areas with large Central American immigrant communities, including but not limited to Los Angeles, Miami, Houston, Washington, DC, and New York City (Pierce, 2015). There, these youths may encounter additional risk factors for negative outcomes, including discrimination, poverty, acculturation difficulties, and community violence (Yoshikawa et al., 2017). For example, a survey of 164 Latino adolescents in California revealed that immigrant youth experienced more violence in the United States than in their home countries; immigrant youths also reported more exposure to weapon-related violence in the United States compared to their U.S.-born peers (Gudiño et al., 2011). Additionally, given their exclusion from many public services (e.g., public health insurance, TANF, federal college loans) and the recent rise of anti-immigrant policies and sentiment, many UIMs feel excluded from typical adolescent activities and stigmatized by peers and school personnel, impeding successful adjustment to school, social involvement, educational success, and other important protective factors (Gonzales et al., 2013; Roth & Grace, 2015).

Clinical Considerations

In addition to recognizing the challenging experiences UIMs may face before, during, and after migration, when developing treatment plans, clinicians should consider several individual- and family-level risk and protective factors. A risk and resilience framework acknowledges that human development over time is impacted by external stressors and traumas, as well as by personal assets and external resources that may promote healthy adaptation in the context of these events (Fergus & Zimmerman, 2005; Ungar, 2015).

Mental health risk and protective factors.

Substantial research has demonstrated the impact of cumulative adversity, meaning the impact of multiple traumatic experiences and severe stressors, in impacting mental health across the lifespan (Turner & Lloyd, 1995). In one study of a nationally representative sample of U.S. youth, exposure to more types of victimization and adversity (also called poly-victimization) was associated with higher levels of both depression and anger/aggression (Turner, Finkelhor, & Omrod, 2006). In another study examining the impact of adverse childhood experiences on young adult health outcomes in an urban population, cumulative adversity was associated with a greater number of poor outcomes (Mersky, Topitzes, & Reynolds, 2013). Thus, cumulative adversity puts youth at risk not only for specific mental health conditions such as post-traumatic stress disorder (PTSD), but potentially for multiple mental health conditions and other forms of impairment in their adult life.

In the general youth population, individual risk factors for developing PTSD include exposure to violence and other traumatic events; existing mental health or developmental vulnerabilities; the meaning attributed to events, external locus of control, and exposure to daily stressors. Family factors include family conflict, separation from parents, the loss of a parent or experiencing the threat of losing a parent, and poor parent mental health and coping (Bonanno & Mancini, 2008). UIMs disproportionately experience many of these risk factors compared to accompanied immigrants and other youth. As noted earlier, rates of exposure to violence, other trauma, and daily stressors are high in this population (Chavez-Dueñas et al., 2014). Similarly, key family risk factors are commonly experienced by UIMs, given their prolonged family separation and the trauma and stress that may have been experienced by their parents (Suárez-Orozco et al., 2010; Suárez-Orozco, Yoshikawa, Teranishi, & Suárez-Orozco, 2011).

The stress of migration and post-migration experiences, including discrimination, may also represent a risk factor for this population. In a study of immigrant Latino youth, 24% reported experiencing a stressful experience while migrating, which was associated with increased anxiety (Potochnik & Perreira, 2010); prevalence of stressful migration experiences is likely higher among UIMs. In a study of migrant youth (both unaccompanied and accompanied) screened at a school-based health center in the US, 44% of youth were referred to behavioral health services; the most common diagnoses were adjustment disorder, depressive disorders, and anxiety disorders (Schapiro, Gutierrez, Blackshaw, & Chen, 2018). Given few studies documenting the experience of unaccompanied minors in the US, European studies can provide a reference point. For example, a study of unaccompanied minors in Belgium found high rates of depression, anxiety, and PTSD symptoms, with a quarter or more reporting severe depression and anxiety scores and more than 40% reporting severe PTSD at three time points over 18 months (Vervliet et al., 2014). The number of traumatic experiences and daily stressors reported by youth in this study were linked to higher levels of depression, anxiety, and PTSD at later time points (Vervliet et al., 2014).

It is important to note that not all youth exposed to trauma develop PTSD. In fact, some researchers note that many trauma-exposed individuals display resilience, experiencing few disruptions to typical functioning or improving without intervention in the years following the trauma event (Bonanno & Mancini, 2008). This research implicates the value of allowing natural coping processes to unfold and using targeted interventions for individuals with greater need. However, other researchers have argued that such recovery is not as common as some studies report, and note that a focus on natural resilience might impede investment in needed trauma-informed interventions (Infurna & Luthar, 2016). For example, one study suggested that youth who appear psychologically resilient to high levels of stress in early adolescence may still experience long-term biological impact, as measured by stress hormones, blood pressure, and body mass index at age 19 (Brody et al., 2013). Another study suggested that exposure to some adversity (as compared to either no experience of adversity or exposure to high levels of adversity) resulted in higher levels of resilience among children (Seery et al, 2010). Ungar (2015) emphasizes that among children exposed to high levels of adversity, features of the social context (e.g., supportive relationships and safe environments) are more critical to promoting resilience than individual traits. Overall, these studies highlight the importance of clinical assessment of resilience and positive adaptation at the level of both individuals and systems, as well as attention to the costs and benefits of different intervention approaches.

Very little research has examined resilience among UIMs; however, we can extrapolate from studies of refugee youth, who have fled their countries (often with family members) for fear of persecution, war, or violence, and thus, experience stressors similar to those UIMs experience. Studies of refugee children emphasize the following individual protective factors: coping skills, adaptability, and positive emotions/optimism. Family and societal protective factors include family adaptability and cohesion, social support, community integration, experience of safety and security, and school belonging and connectedness (Ehntholt & Yule, 2006; Fazel et al., 2013; Miller & Rasmussen, 2010). Schools may also represent an understudied protective factor for UIMs: a study of resettled refugee adolescents found that greater feelings of school belonging were associated with less depression and greater self-efficacy (Kia-Keating & Ellis, 2007). Among adolescent refugees in New York City, a caring school environment was identified as a key experience that counteracted the psychological effects of trauma exposure (Davies, 2008).

Family context.

Because many families with UIMs present to care after reunification—particularly if that process becomes challenging—providers should understand the effects migration can have on familial relationships. Migrant families are often called “transnational” because they undergo frequent separation and reunification as family members migrate and return (Suárez-Orozco et al., 2010). Adapting to this cycle, families frequently adopt parenting strategies that contrast with concepts of small nuclear families; for example, biological parents who migrate may transfer caretaking duties to other family members or friends while remaining in contact with their children from afar (Falicov, 2011; Suárez-Orozco et al., 2002). Thus, children become part of extended families that cross-national borders.

For children separated from their parents by migration, longer separations can create more challenging reunifications. In one study of immigrant youth, children who had previously been separated from their mothers or from both parents for four years or more reported significantly higher depressive and anxiety symptoms than those who experienced no separation; however, in a follow-up four years later, there were no differences in depression and anxiety symptoms between groups (Suárez-Orozco et al., 2002). This study suggests that the psychological effects of separation may not persist over time. However, longer periods of separation may contribute to difficulty establishing parent-child relationships and reluctance to adhere to biological parents’ rules and norms. Many children have ambivalent feelings toward reunifying with their family, especially if they are leaving behind long-term caretakers to join immediate family members they no longer know. Youth may face changes in family makeup, including family members they have never met (e.g., stepparents and siblings born after parents migrated; Suárez-Orozco et al., 2010). Such challenges may result in feelings of ambiguous loss (Gindling, 2012), as youth in both the pre-migration and post-migration phases have family members who are available at a distance but not physically present.

Legal Considerations

Given their lack of lawful immigration status, UIMs must undergo formal, adversarial proceedings before an immigration judge that could result in their deportation (Manuel & Garcia, 2016). Although existing guidelines encourage immigration judges to accommodate the unique capabilities of children (for example, by using simple, straightforward questions), the procedures and legal standards applied to these removal proceedings mimic those of adult proceedings (Somers, Herrera, & Rodriguez, 2010) and do not typically apply the “best interest of the child” standard usually applied to questions of a child’s welfare (Manuel & Garcia, 2016; Ooi, 2011). Further, because federal law prohibits the use of government funds to provide counsel for immigrants during removal proceedings, youth have no right to government-appointed legal representation during this process and must frequently rely on any available pro bono representation, which cannot serve all youth in need of counsel (Hill, 2011). Thus, more than half of UIMs face complicated immigration proceedings with no adult advocate, significantly reducing their chances at successfully avoiding deportation (Hill, 2011; Ooi, 2011).

Despite their young age, UIMs are not categorically protected from deportation; however, each child can apply for one of several options for relief from removal as appropriate (Manuel & Garcia, 2016). These opportunities include: asylum, special immigrant juvenile status, T Visas, and U Visas (Somers, Herrera, & Rodriguez, 2010), each of which is discussed further below. As they wait for their case to be heard and decided—which can take months or even years—youth may experience significant fear and anxiety about their uncertain fate (Teranishi et al., 2015).

Asylum.

Youth seeking asylum in the United States must meet the same standard applied to adults seeking asylum: they must be unable or unwilling to return to their home country because of a “well-founded fear of persecution on account of race, religion, nationality, political opinion, or membership in a particular social group” (Manuel & Garcia, 2016). However, given their age, developmental level, limited knowledge of status in their country of origin, and other relevant factors, children often struggle to explain how they fit into one of the groups eligible for asylum—especially when required to prove that their country’s government was unwilling or unable to protect them (Ooi, 2011). Additionally, although many UIMs travel to the United States to escape violence, potential gang recruitment, retaliation for opposing gang activities, and even police brutality toward “street children,” these groups are not explicitly identified in asylum guidelines and, therefore, asylum applications based on these realities are frequently unsuccessful (Manuel & Garcia, 2016). In fact, former child soldiers and former gang members often face the most difficulty in obtaining relief given negative perceptions of their past actions—despite their attempts to flee continued involvement in such organizations (Ooi, 2011).

Special Immigrant Juvenile Status (SIJS).

Youth meet criteria for SIJS when they are unmarried; under 21; identified as dependent on a juvenile court or legally committed to state custody; and unable to reunite with one or both parents because of abuse, neglect, or abandonment, as long as an administrative proceeding finds that returning to their previous country would not be in their best interest (Manuel & Garcia, 2016; Ooi, 2011). Obtaining SIJS provides youth with a path to citizenship (Ooi, 2011). However, only 25% of the 5,000 available SIJS opportunities are awarded each year, suggesting it is particularly difficult to obtain (Ooi, 2011). For example, youth seeking SIJS must work within two systems (the federal immigration system and the juvenile court system) whose requirements do not always align (e.g., SIJS allows for youth under 21 years but jurisdiction for many juvenile systems ends at 18) and whose procedures often include uncomfortable, potentially retraumatizing experiences for youth, such as interrogative interviews and adversarial procedures (Ooi, 2011). Further, SIJS is only available to youth who can prove that they were abused, neglected, or abandoned—children who have experienced other forms of trauma are not eligible.

T Visas and U Visas.

Both T Visas and U Visas may be available forms of relief for youth who were victims of specific criminal activity. Youth under 18 years of age who came to the United States as a victim of a “severe form of trafficking in persons” who would suffer hardship upon removal may qualify for a T Visa (Ooi, 2011). Additionally, U Visas are available for individuals who have suffered “substantial physical or mental abuse” after experiencing serious criminal activity (e.g., domestic violence, rape, kidnapping), as long as they have information about the criminal activity and will assist in the investigation or prosecution of the activity (Manuel & Garcia, 2016). Both forms of relief are available to individuals of any age (additional requirements apply for T Visa applicants older than 18 years of age) and allow an individual to live in the United States for up to four years; holders of T and U Visas may also apply for permanent resident status after three years (Manuel & Garcia, 2016).

Recommendations

Clearly, UIMs face significant challenges before, during, and after their migration to the United States. Consequently, providing clinical services to these youths can also present many challenges, especially to clinicians with little prior exposure to this population. Below, we offer several recommendations to individuals and systems that provide services to UIMs.

Provider-specific recommendations.

Service providers who work with youth should familiarize themselves with the typical process and procedures for newly arrived youth with no lawful immigration status. Even clinicians who work in regions of the country that are relatively removed from international borders should do so, as many UIMs apprehended by CBP officers are later released to family members or other guardians throughout the country. Becoming familiar with these procedures can increase clinicians’ understanding of the challenges a child has experienced before initiating services and the challenges they will likely face during subsequent immigration procedures. Depending on the nature of services provided, clinicians may find it appropriate to help youth prepare for interfacing with various systems, including schools and legal systems. For example, youth experiencing anticipatory anxiety about meeting with school and/or immigration administrators might benefit from sessions aimed at addressing this issue. However, clinicians should be cognizant of their roles and goals as service providers and avoid taking on responsibilities associated with guardians ad litem or legal representation.

It may also be helpful for providers to develop relevant resources for UIMs and their family members, including educational information about potential opportunities for removal relief and a list of law firms and organizations that may provide pro bono legal representation to UIMs. Kids In Need of Defense (KIND; https://supportkind.org) and the Young Center for Immigrant Children’s Rights (https://www.theyoungcenter.org), organizations dedicated to advocating for unaccompanied immigrant and refugee children, operate throughout the United States and may have useful information for clinicians in developing such resources.

Clinicians providing services to UIMs should consider incorporating family-based services into an ongoing treatment plan, as appropriate. Providing psychoeducation to parents and UIMs about common challenges faced by families reunifying after migration can be a way to validate their experiences and help them navigate obstacles over time (for an in-depth overview of these challenges, see Suárez-Orozco et al., 2010 and Falicov, 2011). Incorporating parents, caregivers, and other family members into therapy should be considered, including ways to include family members living in other countries. The complexities of transnational families should be considered in both assessment and intervention (e.g., ecological context of both the home and receiving communities; family constellation in both the home country and in the United States; periods of family separation; changes in family or household composition during separations; quantity and quality of interactions with family members who are not physically present). Working with parents and children to complete migration narratives may be a way to facilitate communication about their respective experiences, particularly during separations. However, given the likelihood of having experienced trauma before/during migration and the emotional difficulty of discussing family separations (Suarez Orozco et al., 2010), such an approach should be incorporated carefully and with appropriate supervision or consultation.

Though there is a dearth of evidence on the effectiveness of specific evidence-based therapies with UIMs, Trauma-Focused Cognitive Behavioral Therapy (Cohen & Mannarino, 2008) and Cognitive Behavioral Intervention for Trauma in Schools (Kataoka et al., 2003) have both been adapted for use with Latino immigrant children. Trauma Systems Therapy, which has been adapted for Somali refugee youth (Ellis et al., 2013), represents another potential intervention approach (particularly within systems that have the resources to implement multilevel interventions). In general, trauma-informed care approaches fit well in schools, healthcare settings, and organizations serving immigrant youth populations. Psychologists may provide consultation on the integration of these approaches within a given setting.

Recognizing the limited time and resources with which mental health providers frequently operate, it may prove challenging to implement these recommendations. For example, limitations related to billing and reimbursement might not allow for out-of-session time to focus on immigration needs with youth clients. Additionally, incorporating families in treatment might prove difficult if family members feel mistrustful of the healthcare system (Rhodes et al., 2015) or have demanding and unpredictable work schedules. In such cases, providers may need to work creatively and flexibly—that might include reserving in-session time to focus on tasks that could be helpful for youth navigating the immigration process; allowing family members to engage in whatever capacity they can, even sporadically; and conducting outreach to families over the phone. Clinicians should also identify what forms of instrumental support may be useful to families, such as medical documentation regarding appointments for employers and collateral contacts with attorneys. Finally, given the intensity of common trauma experiences within a UIM population and the increased challenge of working within multiple complicated systems, an additional barrier may arise if clinicians providing services to these youth experience overload and/or burnout. Thus, it is particularly important for individuals working with UIMs to regularly seek consultation and/or supervision from providers with expertise in this area, obtain support from provider peers, and engage in self-care strategies to reduce the likelihood of burnout.

Training program recommendations.

Clinicians with little to no foundational knowledge about UIMs will likely experience anxiety about and/or face difficulty providing services to this population. As a result, graduate psychology training programs may do their students a significant disservice if they do not incorporate some information about UIMs into their curriculum. Programs may address this issue through formal means (e.g., providing instruction about UIMs in relevant courses), or more informal means (e.g., inviting experts to speak to students and faculty). Programs that lack faculty with the necessary expertise to facilitate this learning opportunity might utilize teleconferencing technology and/or collaborate with other programs within the university (i.e., Latino/a Studies programs). Students can also play a role in raising awareness; for example, they might organize meetings to discuss relevant journal articles or host a movie screening so that students can become more familiar with the experiences of UIMs and consider how clinicians might best serve these youth. Students interested in this idea might screen and discuss Which Way Home, a documentary depicting several unaccompanied children traveling to the United States through Mexico.

System-specific recommendations.

Upon their arrival to the United States, UIMs must interface with several systems, including legal systems, medical systems, and school systems, which can all improve the ways in which they serve UIMs. For example, school systems with an appreciable UIM population should identify trusted adults that could work directly with these youth, help them navigate the system, and advocate on their behalf as appropriate. Some schools have established welcome centers that assist with school enrollment and referral to resources for English Language Learners. In addition to providing instrumental support, these centers can facilitate social integration and inclusion of UIM and their families by providing orientation to expectations in the school system, points of contact, and outside resources for families.5

Given the deficit of available pro bono legal representation, lawmakers might consider altering current restrictions on government-provided attorneys during immigration removal proceedings, at least as applied to youth. Doing so would significantly reduce the number of children without representation expected to mount their own legal arguments for relief, despite no legal training. Even if current restrictions remain, they should not prevent the provision of guardians ad litem and other youth advocates within youths’ immigration proceedings. Researchers should investigate the feasibility and benefits of implementing programs that provide this needed service to UIMs facing removal. Although substantial political barriers impede such changes in policy, developing the evidence base for these services may demonstrate long-term benefits for agencies seeking additional funding and lawmakers seeking strategies to better support UIMs and other immigrant youth.

Conclusion

The migration of thousands of unaccompanied Latin American youth, and the barriers they subsequently face in the United States, represents a humanitarian crisis with no signs of abatement. Although the legal and policy context for UIM immigration cases is complex, psychologists can play an important role in serving these youth by applying evidence to clinical intervention, training other professionals to work with these youth, consulting with schools and healthcare settings, and advocating for a more just and humane immigration system.

Public significance statement.

Unaccompanied immigrant children and adolescents from Latin America leave their home countries to escape traumatic and difficult experiences, but remain vulnerable to continued trauma upon arrival to the United States. Psychologists and other mental health providers can support this group of youth by considering their unique circumstances, providing clinical services that address their distinct needs, and advocating that child-serving systems best facilitate these youths’ long-term health and resilience.

Acknowledgments

Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under Award Numbers K23MH112841 and T32MH019733. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

1

If a child is apprehended with no parent or guardian and cannot be reunited with such an adult within several hours, they will frequently be treated as an unaccompanied alien child, even if an adult willing to assume care of the child can eventually be located within the United States (Manuel & Garcia, 2016).

2

For the purposes of this review, we focus on clinical assessment and service delivery. Psychologists may also be involved in forensic assessments for immigrant youth wanting to document circumstances that may qualify them for relief from deportation; however, discussion of this topic is beyond the scope of the current paper.

3

Nervios directly translated means “nerves,” but here it refers to a cultural idiom of distress among Latinos that has been observed and validated in epidemiologic studies. Also known as ataque de nervios, symptoms of this syndrome can include attacks of crying, shaking, shouting, or being physically aggressive; individuals experiencing nervios frequently report feeling a loss of control (Guarnaccia et al., 2010). There is overlap between symptoms of nervios and a variety of psychiatric symptoms, including depression and anxiety (Guarnaccia et al., 2010; Pribilsky, 2001).

4

Voluntary return, in this context, is a specific process for children from Canada or Mexico who: do not have a possible asylum claim; are not potential victims of trafficking; and can make an independent decision to voluntarily return to their home country. If they meet these criteria they undergo “voluntary return” to their country without standard immigration proceedings (Seghetti, Siskin, & Wasem, 2014).

5

For detailed strategies to engage immigrant families in schools, see Breiseth, Robertson, & Lafond, 2011. Additionally, The Center for Health and Health Care in Schools (n.d.) hosts a website with a compilation of resources to assist school administrators in serving immigrant and UIM students.

Contributor Information

Amanda NeMoyer, Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Department of Health Care Policy, Harvard Medical School.

Trinidad Rodriguez, Disparities Research Unit, Department of Medicine, Massachusetts General Hospital.

Kiara Alvarez, Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Department of Medicine, Harvard Medical School.

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