For migrant children who cross the border alone, a new set of challenges getting health care awaits

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The number of migrant children traveling to the United States without a parent or guardian reached a record high last year, with nearly 130,000 eventually detained in federal shelters after crossing the border alone.

In the same time period, 19,071 unaccompanied migrant children were released from federal shelters to Texas relatives or sponsors while their immigration cases made their way through the U.S. legal system.

A new report released this week by the Migration Policy Institute and the American Academy of Pediatrics took a closer look at barriers to health care these children face once they are released to families and how those obstacles can impede their success in the United States.The report draws on visits to Los Angeles, New Orleans and Houston, as well as interviews with more than 100 providers and the children themselves.

“Given that unaccompanied children will be in the United States for several years and many ultimately remain in the country permanently, ensuring they are healthy, protected and able to contribute to their communities benefits society more broadly,” said Tamar Magarik Haro, a senior director at American Academy of Pediatrics.

Since fiscal year 2012, more than 600,000 migrant children have crossed into the United States by themselves, many of them fleeing poverty and violence in the Central American countries of Guatemala, El Salvador and Honduras. Once here, they are taken into federal shelters where they receive health care. But once children are released to relatives and sponsors, language barriers, the lack of health insurance in most states and lack of knowledge when it comes to the American medical system makes accessing health care, including mental health care, extremely difficult.

Karla Fredricks, director of the Program for Immigrant and Refugee Child Health at Texas Children’s Hospital in Houston and co-author of the unaccompanied children report, said the traditional health care structure in the United States that is based on brick-and-mortar facilities and open during typical work hours is not conducive to meeting the needs of undocumented children.

“School-based clinics can serve an important role here because most unaccompanied children enroll right after leaving the Office of Refugee Resettlement. The problem is a lot of these schools don’t have these options in a language other than English,” Fredricks said. “This means delays in cognitive and developmental evaluations of a student.”

According to the report, only about a dozen states offer health insurance coverage for migrant children, and there’s limited health care at schools or through community organizations.

Most unaccompanied children are physically healthy when they arrive but have likely experienced emotional trauma on their journeys and are in need of mental health services. Even when treatment is available, too few providers speak languages other than English, creating yet another barrier to access.

“There are not enough clinicians offering culturally appropriate trauma-informed services in a child’s and sponsor’s language of preference,” said Jonathan Beier, policy analyst for the Migration Policy Institute.

This means that a child who crossed the border into the United States might often not be able to explain their diagnosis to a medical professional.

“Clinicians who cannot read medical records in the language of a child’s home country will lack a more comprehensive understanding of the medical services the child received prior to arrival in the United States, and certified medical translations of the documents may be difficult to obtain,” the report states.

The mental health care workforce in Texas lacks diversity. A survey done by the state’s licensing agency earlier this year found that over 80% of the 5,599 licensed behavioral health providers who responded identified as white, and fewer than 20% of 5,371 providers who responded offered mental or behavioral health services in languages other than English.

The report suggests that more money be spent to train mental health clinicians with language and cultural backgrounds that match those of the children.

Beier said policies and funding can improve unaccompanied children’s access to critical medical services, including mental health. But he said policymakers must keep individuals’ circumstances in mind. For example, not every undocumented child speaks Spanish as there are many Indigenous languages in Central and South America.

The report also suggested that community health care facilities and programs place clinics in schools or have mobile health care options to allow for the families of those who take on undocumented children to get health care without having to take time off their jobs.

“All children deserve to reach their full potential and maximize their physical, mental and emotional health,” Fredricks said. “The implementation of these recommendations would help ensure that unaccompanied children are afforded the same opportunity to do so as other children in the U.S., to their great benefit as well as that of the families, schools and communities they join.”

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