Working with Unaccompanied Minors in the U.S.

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Tuesday, July 7th to Wednesday, September 30th

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Directions: Please watch Eugene Augusterfer’s presentation and interview Telemedicine in Mental Health first. Then feel free to join us in this open forum. All are welcome to join this forum, whether you have an account on Healtorture.org or not. For more information on using the forum, please read the directions on the first post. Please keep your comments respectful, relevant, factual, and do not share identifying information about clients per client privacy and HIPAA regulations. This forum will be open from July 6, 2020 through September 30, 2020.

The following considerations for providers who are working with unaccompanied minors in the U.S. were written by Leora Hudak, MSW, LGSW, a psychotherapist at the Center for Victims of Torture, based on her experiences interviewing providers of services to unaccompanied Central American youth. For more information on working with children, see our section on that topic - particularly the expert presentations.

1. Address complex, developmental trauma

Central American youth rarely report just one isolated traumatic life event.  Often children have experienced multiple traumatic events occurring across the lifespan. Early and prolonged exposure to adverse life events is considered a primary risk factor for mental health complications.  This can present in a variety of different ways that derail a child’s development. Providers should be prepared to address mental health from this paradigm. This article on complex trauma may be of interest.

2. Consider children in the U.S. as in an ongoing state of traumatic threat due to their high vulnerability as unaccompanied and navigating complex systems

Unaccompanied minors who enter the United States are thrust into a complex legal and social service system that is difficult to navigate and often leaves them vulnerable to ongoing stress, abuse, and neglect. Children are reunified with distant family members, entering unfamiliar social environments, enrolled in schools without speaking the language, and must attend sophisticated legal appointments. For example, a child who speaks a native language who enters a rural or suburban community that lacks sufficient culturally-responsive and trauma-informed services may face social isolation, bullying, and abuse. Providers should consider safe navigation of the new social surroundings as a key component of service provision. See Craig Higson Smith's excellent discussion on Continuous Traumatic Stress and the special issue of Peace & Conflict for more.

3. Utilize a relational or attachment-focused lens

Central American youth are often coming from non-traditional, ruptured, or transnational family systems. Many have been raised without a primary caregiver or with a caregiver parenting from afar. When children come to the U.S. they may be reuniting with a parent after years of separation, and sometimes the parent has established a new family in the U.S.  Due to these circumstances, providers in the U.S. should consider working with children through an attachment lens.  Children are at a developmental stage when they lack the proper resources to assimilate traumatic experiences on their own. They require a secure caregiver relationship to understand and assimilate their realities of their lived experiences. The provider in the U.S. may assume part of this role in the context of the therapeutic alliance. This presentation on disrupted attachments may be helpful.

4. Work with the family system

This is particularly significant due to the importance of the family in Latino culture. Working with the family system is additionally important because an unaccompanied child will need to engage with several educational, legal, and social service systems that will require the coordination and support of the reunified family or sponsor. With the large prevalence of rupture and disintegration in the family system, navigating this aspect is likely to be challenging. Further reading:

5. Expect that violence and traumatic experience are often normalized

As noted, Central American youth report multiple traumatic events occurring throughout their lifespans. Navigating community and gang violence is a part of daily life. This may become normalized into a child’s lived experience, and children arriving as unaccompanied minors may not think to mention certain traumatic experiences such as threats of violence because they have become a normal part of the child’s lived experience for him/herself and peers. Providers should utilize sensitive exploration when interviewing children about their trauma histories.

6. Consider intensive therapeutic case management as a primary modality

Children arriving as unaccompanied minors come with histories of complex trauma.  At the same time, they are navigating new, unfamiliar social environments and interfacing with a complex and unforgiving legal system.  Service organizations should consider intensive therapeutic case management as a primary modality for services.  This would allow providers to give attention to the therapeutic alliance necessary to understand and attend to a child’s complex trauma history, while assisting the child in moving through the strains of the new system. See "Strengthening Case Management: The Value of the Therapeutic Dimension" for more information.

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