The separation of families at the U.S.-Mexico border could have long-term health consequences on immigrant children, according to Jeff Hild, policy director at the Sumner M. Redstone Global Center for Prevention and Wellness at the Milken Institute School of Public Health.
The Redstone Center works to reduce health disparities and inequities locally, nationally and globally, including identifying ways to make children, families and communities more resilient in the face of adversity. Mr. Hild served as chief of staff at the Administration for Children and Families under President Barack Obama from 2014 until January 2017. ACF is the operating division within the U.S. Department of Health and Human Services that houses the Office of Refugee Resettlement (ORR) and oversees the unaccompanied children program.
In June President Donald Trump signed an Executive Order to halt the forcible separation of children from their parents at the border, however advocates like Mr. Hild are concerned because the government has not met a court-imposed deadline to reunify families and the Executive Order would continue the “zero tolerance” enforcement policy and could lead to long-term detention of children and families. It also did not direct any agency to head up reunification of separated families or prevent parents from being deported. Those children negatively impacted by government actions need support to address their trauma, he said.
Read more below about the situation at the border and what Mr. Hild believes needs to be done:
Q: Why does it appear that HHS is having a hard time quickly reunifying separated families?
A: It seems clear that the Trump Administration put this policy in place without any forethought given to reuniting families at some later date. In fact, the government only began to reunify families because they were ordered to do so within 30 days by a federal judge. The court imposed deadline was July 26 and at that time over 700 children were still separated. Children were transferred from Customs and Border Patrol (CBP) custody to HHS custody without information tying them to a parent or as being in a different category from the thousands of “unaccompanied children” who enter the country alone each year. With no mechanism in place to identify separated children, HHS had to start from scratch to locate children in their care that were separated from their parents. This work is made more difficult with very young children who may not be able to reliably communicate. It also appears HHS is taking a very restrictive stance in terms of locating parents and running background checks on them, even going so far as to require DNA tests.
Q: What are the health impacts that young children face because of the long separations from their parents and how can those impacts be mitigated?
A: Traumatic experiences and prolonged stress in childhood, also called adverse childhood experiences or ACEs, effect development and also lead to poor health outcomes, including higher risk for various diseases and increased risk of substance abuse. The children and families in this case are also fleeing terrible violence and hardship in their home countries and have already experienced prior traumas. The journey from Central America to the U.S. border is often perilous for children. I remember talking to children in HHS custody during my time at the agency and hearing terrible stories about the journey, including sexual assault and other violence and riding with dozens of other children in an enclosed truck without food or bathrooms for over 24 hours.
We know from decades of research that the best way to buffer a child against the impacts of trauma and ACEs is through stable and supportive caregivers. By tearing away the supportive caregiver, the family separation policy both creates a new trauma and takes away the best way to mitigate the ACEs already experienced.
Q: The administration has suggested that families might be detained together while their immigration case proceeds. From a public health and child welfare perspective, what are the impacts of this type of family detention?
A: The President’s Executive Order expressly mentions detaining family units for the duration of their immigration case—often a months or years long process—as the preferred policy outcome. This would have disastrous consequences for children and the American Academy of Pediatrics and other child health experts have spoken out against this policy.
Detention facilities, even those designed to house family units, are still jails and cannot offer the types of supports that children, particularly children that have already suffered trauma, need to be healthy. Several family detention facilities run by ICE have been forced to close in recent years because of unsafe conditions.
There are long-standing principles in child welfare that children should remain with their parents absent a safety concern and that if not able to live with a parent that they be cared for in the least restrictive setting possible. This typically means as close to a community-like setting as practical and one that provides social, educational, recreational as well as physical and mental health support. In fact, the federal law that established the unaccompanied children’s program recognizes these principles and has children placed in HHS custody, where they live in shelters run by child welfare organizations that meet state licensure requirements for child serving facilities while HHS seeks to release the child as quickly as possible to a sponsor so that the child can live in a community setting.
Fortunately, there are legal safeguards that can hopefully prevent indefinite detention of children. The Flores settlement, recognizing the inappropriateness of detaining children even with their parents, limits family detention to 20 days and the presiding judge has thus far rejected efforts to change the terms of the settlement.
Q: How might the Redstone Center's work with Building Community Resilience help migrant children and families bounce back from the trauma of separations?
A: Our Building Community Resilience (BCR) work focuses on bringing together various systems to address both the trauma that individuals face as well as the underlying community conditions that cause stressors. In a number of the communities where we work, there has been increasing concern about the impacts that various immigration policies are having on children’s health. These concerns go beyond the family separation issue. Due to increased enforcement actions, many U.S. citizen children are fearful of having a parent deported. This has caused a ripple effect where parents do not pursue supports or benefits, including health care or nutritional supports, for their children out of fear of interacting with government agencies. There is also widespread concern that immigrant communities are less likely to report crimes, such as domestic violence, for fear of their immigration status becoming known by law enforcement.
Through our BCR work, we are trying to provide tools to those organizations and entities, including schools, child care providers and pediatric practices, that are serving children and families each day to allow them to understand the impacts of trauma and to work proactively to provide supports to mitigate the impact. This can involve training key staff at a school, helping doctors think through how to talk to patients about trauma, or co-locating mental health providers in early childhood centers to directly support children.
Q: In your view, what is the policy solution to the current situation?
A: The most immediate priority has to be reunifying families and developing a plan to offer those families supports to deal with the trauma caused by the government’s action.
Second, the administration or Congress should make it clear that indefinite detention of families is not an option. There are numerous alternatives to detention, including the use of electronics or regular check-ins with a case manager, that have proven effective in ensuring individuals appear for their immigration cases and allow families to live together in communities.
Third, the vast majority of families travelling to the United States have credible asylum claims. These claims need to be adjudicated fairly and with the help of counsel.
Finally, there needs to be a recognition that the United States has a role to play to stemming the terrible violence in parts of Central America that is causing families to flee and seek refuge in the United States.
Q: How can people interested in helping families that have been separated or immigrant families in general get involved?
A: Legal assistance is the area of greatest need. We have some information on our Redstone Center website with a list of groups doing exceptional work in this area.
