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The longer children are in detention, the more their health deteriorates, says DHHS

Medical professionals and children’s welfare advocates have warned of health risks from detaining migrant children and separating them from family members. Now, a government agency has delivered a comprehensive report on the issue. Lisa Desjardins talks to Ann Maxwell, assistant inspector general for evaluations and inspections at the Department of Health and Human Services, who helped write it.

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  • Judy Woodruff:

    There have been a number of accounts from medical professionals and advocates warning of the health risks of detaining migrant children and especially about separating them at the border from family members.

    This week, we received the first substantiated report from a government agency looking at the mental health impacts and trauma for migrant kids in U.S. facilities.

    As Lisa Desjardins tells us, the report by the inspector general of the U.S. Health and Human Services Department includes a look at what happened last year, when the president implemented a zero tolerance policy.

  • Lisa Desjardins:

    The report looks at all children in HHS care. Some arrived on their own. Others were separated from their parents.

    For the latter especially, it points to a number of disturbing effects: accounts of inconsolable crying among children, heightened anxiety and feelings of abandonment. Some showed symptoms of post-traumatic stress disorder, even refusing to eat. And that comes after enduring extreme duress in the home countries they left behind.

    The inspector general's office visited 45 facilities between August and September 2018 and spoke with clinicians and other professional staff.

    Ann Maxwell is the assistant inspector general for evaluation and inspections. She oversaw this report, and joins us now.

    Thank you for coming on air.

    This report is not easy to read. I want to start by talking about the children who the U.S. separated from their parents. Specifically, among the many quotes here and examples is one of a 7- or 8-year-old boy. The report says he was under the delusion that his father had been killed and believed that he also would be killed.

    Can you talk specifically about how family separations seemed to affect these children?

  • Ann Maxwell:

    Yes.

    So, what we heard from the staff we interviewed, who were the staff that worked directly with these children, is that the children who were separated at the border from their parents experienced heightened fear, sense of abandonment, and even post-traumatic stress disorder.

    We heard from a medical director, for example, that separated children would often talk about physical symptoms as a manifestation of their psychological pain.

  • Lisa Desjardins:

    What does that mean, for example?

  • Ann Maxwell:

    Meaning that they would talk about their chest hurting, when they were medically fine, or they couldn't feel their heart or that every heartbeat hurt them.

  • Lisa Desjardins:

    Now, you also mentioned in one report that one child at least — that children felt terrified and felt that they couldn't distinguish between health care workers and the members of, for example, immigration teams that may have separated them.

    More broadly, there is the debate overall about why these children are coming to this country in general. And you spoke with the staffers who have perhaps the most firsthand experience with those kids and what they are saying.

    There's one line here that says: "Some children witnessed the rape or murder of family members who were fleeing threats or they were fleeing threats against their own lives."

    What kind of trauma is involved with these kids? And were our facilities ready to handle that?

  • Ann Maxwell:

    The facility told us that they were unprepared to address the intense trauma that children suffered.

    As you mentioned, they suffered it and were often fleeing from it from their home country. They often suffered threats to their safety on the journey to the U.S. And, of course, for some children, they experienced the additional trauma of being unexpectedly separated from their parents after coming into this country.

  • Lisa Desjardins:

    And you mentioned children witnessing, as we say, murders of family members, rape, some of them themselves being victims of rape, as they were telling staffers.

    Another debate in this area is over the length of detention. The Trump administration would like the ability to detain migrant families indefinitely. Right now, that is limited to 20 days, with a court order, out of concern for the kids.

    What did you learn about how the length of stay in detention may be affecting children?

  • Ann Maxwell:

    Right.

    So, just to be clear, we looked at HHS facilities, which is distinct from how long they could be in immigration detention.

    But you're absolutely right to point out that what the front-line staff told us is that there is a negative consequence on children's mental health and even their behavior the longer they are in care.

  • Lisa Desjardins:

    I saw a specific timeline. I saw one worker said set, at 70 days, they saw even well-behaved children kind of start to change.

  • Ann Maxwell:

    Right.

    What they talked about is even children who came into care with good — positive outlook and good coping skills became disillusioned after they were in care for a long time. And they saw increased hopelessness, increased activities like self-harm and even suicidal ideation.

  • Lisa Desjardins:

    It's significant, because you also look at the policy here that there were — and also the staffers told you they saw some changes.

    Can you talk specifically about how policy affected the number of children, how long they were there, and how old the kids were last year?

  • Ann Maxwell:

    Sure.

    So what we heard is that the challenges of providing mental health care for children were particularly challenging in 2018, due to those two policy changes you mentioned. So, one was the institution of the zero tolerance policy, which rapidly increased the number of separated children who were in care.

    And there were other changes to the sponsor assessment process, which lengthened the time that children were in care.

  • Lisa Desjardins:

    In order to leave care, then, there was a requirement, a new requirement, that sponsors or family members would have to be fingerprinted. And how did that affect the length of time?

  • Ann Maxwell:

    That's right. So there's always a balance, right, because they want to make sure — the department wants to make sure that children are safe when they are released from ORR care.

    And to do that, they instituted in 2008 policies in which parents need to be fingerprinted, which was new, and all the adults in the household had to be fingerprinted as well.

  • Lisa Desjardins:

    OK.

  • Ann Maxwell:

    That resulted in an enormous amount of fingerprints going through, which created a bottleneck, which slowed down the process.

    And we — people on the front lines also believe it made sponsors reluctant to come forward.

  • Lisa Desjardins:

    Yes, I saw, for sure, that the increase in fingerprint requirements sort of doubled in some cases the days or expanded it by a month for most kids.

  • Ann Maxwell:

    That's right.

  • Lisa Desjardins:

    What needs to happen now?

  • Ann Maxwell:

    Well, we have a number of recommendations for the department to take very practical steps to assist the facilities in overcoming the challenges that they laid out for us.

    And we believe that these are steps that can be taken in conjunction with experts in the field to delineate strategies to help support these facilities and change the outcomes for these children.

  • Lisa Desjardins:

    That sounds like that that's going to take time. That's a lot of process. What about the kids now?

  • Ann Maxwell:

    Well, some of the steps that we have recommended that the department take, they have, in fact, already instituted.

    So they detailed for us a plan of action, including things like hiring a new mental health clinician to guide their oversight and help support the facilities. They also are partnering with clinical experts to create more training around trauma-informed care.

    So some of these things can really be handled in a very immediate way. You're right, though, some of the challenges are more long-term. And the department has committed to addressing those over time.

  • Lisa Desjardins:

    OK.

    Ann Maxwell with the Inspector General's Office of HHS, thank you for joining us and for your work on this.

  • Ann Maxwell:

    Thank you for the interesting topic. Appreciate it.

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