Impact of COVID 19 on Immigrants and Asylum Seekers Paper

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Write a brief thought paper that reflects on the readings for each class that includes your full name, date, and the class number on the top left corner.JOURNAL OF CLINICAL CHILD & ADOLESCENT PSYCHOLOGY
https://doi.org/10.1080/15374416.2022.2158841
Impact of COVID-19 on Unaccompanied Immigrant Minors and Families:
Perspectives from Clinical Experts and Providers
Amanda Venta a, Ashley Bautistaa, Luz M. Garcini b, Michelle Silva
Oscar F. Rojas Perez c, Norma Pimentele, and Kathryn Hamptonf
, Alfonso Mercado
c
,
d
Department of Psychology, University of Houston; bDepartment of Psychological Sciences, Rice University; cDepartment of Psychiatry, Yale
University School of Medicine; dDepartment of Psychological Science, University of Texas- Rio Grande Valley; eHumanitarian Respite Center,
Catholic Charities; fRainbow Railroad
a
ABSTRACT
The number of unaccompanied immigrant minors (UIMs) and families from Central America seeking
asylum in the U.S. continues to rise. This growth, combined with restrictive government policies, led
to crowded and suboptimal conditions in Customs and Border Patrol and non-governmental
organization facilities. COVID-19 further taxed facilities and exacerbated uncertainty surrounding
length of detention, basic human rights, and family reunification. The current project features
testimonies from the authors who work as clinical experts and providers in Texas – a top destination
for Central American immigrants. In collaboration with a deputy director of a not-for-profit human
rights organization, volunteer psychologists, and the director of a humanitarian respite center, we
describe challenges faced by administrators and clinical staff in addressing the mental health needs
of immigrant children and families during the COVID-19 pandemic. The primary themes identified
were anti-immigrant policies that occurred concurrently with COVID-19; difficulty implementing
COVID-19 protocols alongside scarcity of supplies and volunteers; increased mental health needs
among UIMs and immigrant families; and challenges in UIM placement upon release from custody.
Strategies for addressing clinical challenges in the near- and long-term and opportunities for
improvement in care systems to immigrant youth, including correcting anti-immigrant policies,
addressing ongoing COVID-19 protocols and challenges, meeting mental and physical health
needs, facilitating release and reunification for unaccompanied immigrant minors, and maximizing
youth resilience through trauma-informed interventions, are presented.
RESUMEN
El número de menores inmigrantes no acompañados (UIM) y familias de Centroamérica que buscan
asilo en los EE. UU. continúa aumentando. Este crecimiento, combinado con políticas restrictivas,
crearon hacinamiento y condiciones subóptimas en las instalaciones de la Aduana y la Patrulla
Fronteriza y de organizaciones no gubernamentales. La pandemia de COVID-19 agravó aún más las
condiciones de estas instalaciones y exacerbó la incertidumbre con respecto a la duración de la
detención, los derechos humanos básicos, y la reunificación familiar. El proyecto actual presenta
testimonios de los autores, que trabajan como expertos clínicos y proveedores de servicios para
migrantes en Tejas, un destino principal para los inmigrantes centroamericanos en EE.UU. En
colaboración con un subdirector de una organización de derechos humanos, psicólogos voluntarios, y el director de un centro de descanso humanitario, describimos los desafíos que enfrentan los
administradores y el personal clínico para abordar las necesidades de salud mental de los niños
y familias inmigrantes durante la pandemia de COVID-19. Los temas principales identificados fueron
políticas antiinmigrantes que ocurrieron simultáneamente con la pandemia; dificultad para implementar los protocolos COVID-19 junto con la escasez de suministros y voluntarios; mayores
necesidades de salud mental entre los UIM y las familias inmigrantes; y desafíos en la colocación
de UIM al ser puestos en libertad. Se presentan estrategias para abordar los desafíos clínicos a corto
y largo plazo y oportunidades para mejorar los sistemas de atención a los jóvenes inmigrantes,
incluyendo la corrección de las políticas antiinmigrantes, abordando los protocolos y desafíos
actuales de COVID-19, satisfaciendo las necesidades de salud mental y física, facilitando la
liberación y la reunificación de menores inmigrantes no acompañados, y maximizado de la
resiliencia de los jóvenes a través de intervenciones focalizadas en el trauma.
The number of unaccompanied immigrant minors
(UIMs) entering the U.S. from Central America skyrocketed in 2014 and recently exceeded the levels
CONTACT Amanda Venta
aventa@uh.edu
observed in that initial surge (Greenberg, 2021)—a crisis
compounded by the simultaneous influx of many
Central American families seeking asylum in the U.S.
Department of Psychology, University of Houston, 4849 Calhoun Rd. Room 373, Houston, TX 77204-6022
© 2023 Society of Clinical Child and Adolescent Psychology, Division 53, American Psychological Association. All Rights Reserved
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A. VENTA ET AL.
Record breaking levels of child migration in 2019 rapidly
exceeded the Office of Refugee Resettlement’s (ORR)
shelter capacity, leaving children in crowded and suboptimal Customs and Border Patrol (CBP) facilities and
spilling over into temporary youth-only facilities
(Greenberg, 2021). Large numbers of asylum-seeking
families also overcrowded respite facilities run by nongovernmental organizations (NGOs). Prior to the global
pandemic, existing anti-immigration policies, like the
“Remain in Mexico” policy—part of the Migrant
Protection Protocols that required asylum-seeking
migrants to await U.S. immigration court hearings in
Mexico rather than in the U.S.— created new obstacles
for migrants and increased the risk of trauma exposure
for children and families seeking asylum (Garcini et al.,
2020). The COVID-19 pandemic further taxed undersuitable CBP and under-resourced NGO facilities and
exacerbated uncertainty surrounding length of stay,
basic human rights, and family reunification (Garcini
et al., 2020). Though the crisis was temporarily assuaged
by a sharp decrease in migration in the early months of
the pandemic, arrivals rose precipitously in OctoberDecember 2020 and have remained high, reaching
record-breaking levels in Spring 2021 (Greenberg,
2021).
There is reason to believe that the effects of the COVID19 pandemic on UIMs and immigrant families will be
particularly pronounced (Walker et al., 2022). Indeed, during the COVID-19 pandemic, young Latinx children have
experienced disparity in cognitive and social-emotional
domains compared with other racial and ethnic groups
(Yipp, 2020)—with this disparity being referred to as a “a
pandemic within a pandemic” (Schmit et al., 2020). Of note,
Latinx mothers in Texas have been disproportionately
exposed to COVID-19 hardships (Padilla & Tomson,
2021), indicating that their children are likely to be the
most vulnerable to disparate developmental outcomes.
Indeed, more than 29% of Latinx families report experiencing 3+ COVID-19-related hardships; these hardships are
expected to have implications for child development and
health (Padilla & Tomson, 2021). Further, Latinx children
have experienced disproportionate delay in cognitive development and achievement compared to White peers (i.e. 3-5
months behind compared with 1-3 months behind for
White peers), and Latinx children are the most likely of
any racial/ethnic group to have experienced complete disruption in educational placement and the least likely to
have live access to educators (Dorn et al., 2020). As the
pandemic has worn on, improvement in the cognitive and
social-emotional functioning of young children has been
noted among White families, whereas adverse outcomes
have persisted over time for young children of color (Center
for Translational Neuroscience [CTN], 2020; Dorn et al.,
2020). For many of these families, anti-immigrant policies
compounded COVID-19 stressors by creating fear of
detention, deportation, or other adverse enforcement
actions that would separate them (Garcini et al., 2020).
The impact of family separation due to immigration policies (like those enacted under the Trump administration
that forcibly separated parents and children) or immigration enforcement actions (i.e. deportation or detention) is
clear: “separations are linked with increased attachment
insecurity and other difficulties in the parent-child relationship as well as detriments to child well-being including
increased emotional and behavioral problems,” (see
Venta, Cuervo, 2022 for a review, p. 4). Together, the
aforementioned literature suggests a need to document
the challenges facing UIMs, immigrant families, and the
agencies that serve them amidst the COVID-19 pandemic
and overlapping immigration policy changes.
In this manuscript, we comment on the experiences
of key informants and frontline mental and physical
healthcare workers in meeting the needs of UIMs and
immigrant families during the surge in migration that
was compounded by the COVID-19 pandemic. Our aim
was to describe our experiences and perspectives in the
interest of answering two key questions: (a) what were
the major challenges faced in serving immigrant minors
and families on the front lines during the COVID-19
pandemic and (b) how can we improve the situation for
immigrant youth and families during and beyond the
current pandemic? As a descriptive piece, we elaborate
the main challenges and needs that front-line workers
encountered and continue to face while grappling with
large numbers of immigrants and the ongoing pandemic. The primary themes identified were antiimmigrant policies that occurred concurrently with
COVID-19; difficulty implementing COVID-19 protocols alongside scarcity of supplies and volunteers;
increased mental health needs among UIMs and immigrant families; and challenges in UIM placement upon
release from custody. Strategies for addressing clinical
challenges in the near- and long-term and opportunities
for improvement in care systems, including maximizing
youth resilience through trauma-informed interventions, are discussed. Both challenges and solutionfocused strategies described are summarized in
Table 1. We close with policy and practice implications
to improve the situation for immigrant youth and
families during and beyond the current pandemic.
Clinical Experts & Providers
The current project features testimonies from the
authors who work as clinical experts and providers in
Texas – a top destination for Central American
JOURNAL OF CLINICAL CHILD & ADOLESCENT PSYCHOLOGY
3
Table 1. Summary of challenges observed and solutions proposed.
Challenge Observed
Anti-immigrant policies occurring concurrently with COVID-19
Difficulty implementing COVID-19 protocols and scarcity of supplies and
volunteers
Increased mental health needs
Challenges in UIM placement upon release from custody
immigrants (Babich & Batalova, 2021) and a popular
migratory entry point for UIMs and immigrant and
refugee families seeking asylum in the U.S. In collaboration with a deputy director of a not-for-profit human
rights organization, volunteer psychologists, and the
director of a respite center serving families released by
CBP, we describe challenges faced by administrators,
clinicians, and direct care staff in addressing the mental
health needs of immigrant children and families in government custody during the COVID-19 pandemic.
Specifically, we describe the experiences of Sister
Norma Pimentel, director of the Catholic Charities
Humanitarian Respite Center in McAllen, Texas,
which houses migrant families upon immediate release
from CBP custody; Kathryn Hampton, deputy director
of the asylum program for Physicians for Human Rights,
a not-for profit human rights NGO; Dr. Alfonso
Mercado, a clinical psychologist who, during the
COVID-19 pandemic, volunteered on the front lines
on the U.S. Mexico border conducting clinical research
and leading efforts to assure trauma informed care was
available for unaccompanied minors and families seeking asylum; Dr. Luz Garcini, a clinical psychologist who,
during the pandemic, provided volunteer support,
resources, and consultation to address the mental health
needs of UIMs in government custody; and Dr. Amanda
Venta, a clinical psychologist who conducted mental
health assessments with UIMs before and during
COVID-19.
Gaps in Knowledge
Emerging research has begun to accumulate regarding
the experiences of immigrant youth and families during
COVID-19 from the perspective of front-line workers
and yet significant gaps remain which we sought to
Solution-Focused Strategy
Correcting anti-immigrant policies
● Rescind “Remain in Mexico”
● Develop collaborations between policy makers and immigrant serving
organizations
Addressing COVID-19 protocols and scarcity of supplies, volunteers, and staff
● Reliable access to PPE
● Vaccination efforts
● Reduce staff burnout
Meeting mental health needs in the COVID-19 era
● Telehealth equipment and platforms
● Adapting services to unique client needs
● Hybrid service delivery
● Specialized staff training
Facilitating UIM release and reunification
● Limit duration of stay even during emergency protocols
● Educate UIM about process and expectations
● Educate staff to recognize distress
● Ensure safety for UIM sponsors
address. Two important works have been published by
Lovato and colleagues. First, Lovato, Finno-Velasquez,
2022 authored a large-scale descriptive study which featured qualitative interviews with 31 child welfare agency
practitioners across 11 states centered on how the pandemic and immigration policies challenged child welfare
agencies. Notably, no providers from Texas were
included in their research – despite the importance of
this state both as an entry point for Central American
immigrant youth and families and a hotbed of antiimmigrant state policies and rhetoric. More research is
needed on conditions other than child welfare environments, which only a subset of Latinx immigrant families
will encounter (Dettlaff et al., 2009). Still, their research
highlights how considering the perspectives of front-line
workers allows for a deeper examination of children and
families’ needs (Lovato, Finno-Velasquez, 2022).
Second, Lovato, Ramirez, 2022 conducted semistructured interviews with social service providers in
Los Angeles with the aim of assessing the stressors
faced by Latinx immigrants due to both COVID-19
and restrictive immigration policies. Just as we focus
on the unique and practically important context of
Texas, Lovato, Ramirez, 2022 focused on Los Angeles,
which is densely populated with Latinx immigrants, to
address a notable gap in the empirical literature – that
the perspectives and experiences of service providers are
largely omitted from existing research on the Latinx
community. Indeed, the perspectives of clinical experts
and service providers are often ignored in empirical
research, producing a scientific literature that is
divorced from the daily realities and practical barriers
faced by service providers, negatively impacting Latinx
communities as a result. In drawing attention to the
perspectives of clinical experts and service providers,
we hope to focus readers and scholars on the immediate,
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A. VENTA ET AL.
high-priority areas wherein future research and extramural funding can have the highest impact. Moreover,
we seek to identify strategies for addressing clinical
challenges that are practical and feasible from the perspective of service providers. In doing so, we recognize
that serving any clients – including UIMs – requires
more than mastery of available empirical facts, theories,
and knowledge (Tanenbaum, 1999) because the empirical literature does not always align directly with client
needs (Kazdin et al., 1986); adequately addressing existing challenges requires both empirical research and clinical expertise (Overholser, 2010).
Additionally, a mixed-methods study of 43 community health workers serving low-income Latinx communities conducted by Garcini et al. (2022) emphasized the
vulnerability of these communities during the COVID19 pandemic by documenting pronounced mental
health stressors related to economic difficulties, immigration, misinformation, family stress, health, and social
isolation. This study is important in highlighting two
prominent gaps in knowledge that we sought to address
in the present manuscript. First, immigration-related
stress, including undocumented or temporary immigration legal status and variation in acculturation, was
noted as a prominent stressor type among Latinx immigrant communities residing in South Texas by Garcini
et al. (2022) and, yet, little is known about how these
stressors operate for very new or hopeful immigrants to
the U.S.— including those continuing to reside in
Mexico while awaiting immigration proceedings and
those just arrived in the U.S. and released from CBP
custody. To date, the experiences of migrants forced to
Remain in Mexico and the challenges faced by service
providers attempting to meet their most pressing needs
are largely absent from the scientific literature (Mercado
et al., 2021). Second, changes in family dynamics and
loss and separation from family emerged as significant
stressors and yet, the perspectives of providers serving
unaccompanied children were not included in their
sample. Indeed, the perspectives of providers serving
unaccompanied immigrant minors are often absent
from the empirical literature because they work for
federal agencies that prohibit participation in research
or because the policies of confidentiality and nondisclosure mandated by their employers effectively
silence both their voices and those of the children they
serve (Feu & Venta, 2021).
Finally, the present study is unique in the range of
clinical experts and providers who participated in sharing their perspectives. In doing so, we build upon the
work of Falicov et al. (2020), mental health professionals
who shared their experiences working with immigrant
families during COVID-19. They identified several
mental health and daily living challenges facing immigrant families served by their mental health clinics in
San Diego and described problem-solving approaches
that supported their clients during the pandemic. We
add to their important work by featuring the perspectives of several clinical psychologists operating at the
Texas-Mexico border and working with ORR during
COVID-19. We add depth to these clinical perspectives
by sharing the testimonies of NGO frontline workers
and those working with immigrants at the very point of
entry to the U.S. including on the Mexico-side of the
border while immigrants await entry. To our knowledge,
no published research includes the perspectives of service providers interfacing with immigrants so early in
the asylum-seeking process during the Remain in
Mexico policy and very little literature exists on the
experiences of practitioners working with ORR (Feu &
Venta, 2021).
Challenge 1: Anti-Immigrant Policies Occurring
Concurrently with COVID-19
Context
We identified policies that increased distress and have
affected their ability to meet the needs of UIMs and
families during the COVID-19 pandemic. One policy
particularly damaging to efforts to help UIMs and
families is Title 42, a public health order that grants
the government the power to prohibit the entry of people and property to stop a contagious disease from
spreading in the U.S. Likewise, the government has
argued that Title 42 allows for the expedited removal
of immigrants, often just a few hours after being in
custody, to northern Mexico or their country of origin;
this application of public health law is currently under
litigation. In 2021, U.S. CBP reported a total of 1,071,075
Title 42 expulsions, of which 133,974 included individuals in family units, accompanied minors, and UIMs
(U.S. Customs and Border Protection, 2022). Indeed, it
must be noted that UIMs were not immune from Title
42 expulsions. This policy has magnified the obstacles
that frontline workers face when trying to provide aid to
immigrants during the pandemic. For example, there
was an initial decrease in the number of forensic evaluations conducted by Physicians for Human Rights for
asylum seekers to use as expert evidence in their immigration cases following the start of the pandemic.
However, this was not due to a decreased need for
services but instead resulted from Title 42 making it
complicated for attorneys to find and represent clients
who were removed from the U.S. quickly after being
taken into custody. From the perspective of our eighth
JOURNAL OF CLINICAL CHILD & ADOLESCENT PSYCHOLOGY
author, Title 42 has made it difficult for organizations
such as Physicians for Humans Rights to offer social
services since most of their services are based in the U.S.
“Throughout the U.S. there are immigration attorneys,
there are social service agencies, there are nonprofits
that work [with immigrants], and it is extremely difficult when everyone is expelled to northern Mexico
because all the services can’t relocate thousands of
miles to where migrants are forced to be. The most
critical thing is admitting [immigrants] to the
U.S. where they can be safe and further access
a variety of services and be reunified with friends and
family.” (Kathryn Hampton, Physicians for Human
Rights)
In addition to preventing immigrants from accessing
services, Title 42 has also contributed to ongoing family
separations, and therefore an increased number of UIMs
in the U.S. at the border. In practice, this policy has
targeted spouses with children and minors accompanied
by relatives who are the children’s primary caregivers,
even though they may not be their biological parent.
“A lot of family members were separated, especially
spouses with children, so they would send the mother
off with one child and the father off with another child
and then separate them. Sometimes, they would fly
them hundreds or thousands of miles away from each
other . . . Sometimes, people had primary custody of
a nephew or a granddaughter, and the
U.S. government was not recognizing those relationships and separating them from their primary caregiver,
and that is extremely traumatizing and increases the
number of UIMs in the U.S.” (Kathryn Hampton,
Physicians for Human Rights)
Strategy: Correcting Anti-Immigrant Policies
It is evident that the COVID-19 pandemic has shed light
on preexisting healthcare inequalities with people of
color specifically the Latinx population. Antiimmigrant policies enacted concurrently with the pandemic have made it much harder for immigrants and
families to seek refuge in the U.S. and anti-immigration
rhetoric and policies continue to exacerbate trauma
exposure and abuse, while also increasing health risk
(Mercado et al., 2021). It is critical for change that
professionals and advocates leverage science that can
inform advocacy and policy to reduce risk and prevent
further harm among immigrant youth and family in
government custody. For instance, it is now known
that the Remain in Mexico policy places families and
children at risk of trauma (Mercado et al., 2021) above
and beyond what is already embedded in the
pre-migration and migration experiences of UIMs and
immigrant families (DeBrabander & Venta, 2022).
5
Rescinding this policy would allow migrants to await
immigration court hearings in a safe environment
where they can access existing immigration support
agencies. Rescinding this policy would also avoid the
concentration of migrants in need at the U.S.-Mexico
border, reducing the burden on local providers who
cannot currently meet the needs of the large immigrant
population awaiting entry to the U.S.
Also, developing collaboration and support between
community organizations, interdisciplinary providers
and government agencies is essential for emergency
preparedness and policies that make this collaboration
difficult – like the executive order barring the transportation of immigrants by non-federal agents – must be
eliminated. For instance, collaboration across the aforesaid organizations and government agencies in the provision of medical and mental health screening services,
health resources and information to protect from infectious diseases (e.g. COVID-19) and other health conditions should be prioritized. Indeed, the provision of
services and resources needs to include care at immigration processing facilities, during shelter placement, and
post-release, with policies facilitating, rather than complicating, collaboration among these agencies.
Challenge 2: Difficulty Implementing COVID-19
Protocols & Scarcity of Supplies and Volunteers
Context
Although there was an initial decrease in migration due
to the pandemic, migration to and across the U.S. Mexico border reached its highest level in 2021
(Gramlich & Noe-Bustamante, 2019). Prior to the pandemic, charity organizations already struggled to house,
feed, and provide for (e.g., clean clothes) incoming
immigrants, challenges that were exacerbated within
the context of the pandemic. For instance, the
Humanitarian Respite Center, which is run by a small
permanent staff plus many volunteers and operates with
donations, found itself without volunteers or sufficient
supplies. Empty grocery shelves meant fewer available
food and hygiene donations; people afraid to leave their
houses meant fewer volunteers and fewer drop-offs of
gently used clothing and toys, leftover diapers, and other
essentials. The few available volunteers and staff provided only the most critical services – food and medicine
disbursement – leaving other important areas of care
unstaffed. With fewer volunteers available, it was difficult to hold recreational activities for children that could
serve as distractions to ameliorate distress while the
children endured hardship from the migration process,
leaving them bored and unstimulated. Donated clothing
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A. VENTA ET AL.
grew scarce and, what was available, went unsorted,
without volunteers to do the sorting, stalling the process
of providing clean clothes to immigrants. CBP often
removes migrants’ shoelaces and belts as a safety precaution. Without access to donated and sorted clothing
items, immigrants walked around the respite center
holding up their pants and with the tongues of their
sneakers sticking out. Children wore blankets as clothing because garments in their size had not been located.
Even a year into the pandemic, scarcity in personal
protective equipment (PPE) persisted, and volunteers
at the Humanitarian Respite Center and paid staff at
UIM shelters struggled to find masks to protect themselves as they served immigrant communities.
Immigrants requested masks and hand sanitizer at
rates that could not be met due to limited supply and
the reality that previously, such items were not needed
by immigrant serving organizations.
Paid staff in immigrant service organizations also
grew scarce, with many falling ill and others absent
due to concerns about the pandemic or burnout. To
meet the demands of thousands of immigrants, agencies had to recruit, hire, and train new employees and
volunteers while continuing to serve immigrants with
reduced direct care staff. The first author, Dr. Venta,
saw strains on clinical staff responsible for the care of
UIMs in the custody of the ORR during the early days
of the pandemic. UIMs were isolated at nonprofit shelters (where they reside after being released from CBP
custody and before being reunified with an immigration sponsor in the U.S.) because the scarcity of providers meant a bottleneck in the usual reunification
process.
responsible for more UIMs with less staff and administrative support – and still without sufficient PPE – leading to greater burnout and resignation.
The implementation of COVID-19 protocols disrupted care as usual for all immigrant-related organizations. In addition to physical distancing, hand washing,
and mask protocols, shelters had to implement a new
protocol to reduce virus transmission. At the
Humanitarian Respite Center, no individual who tested
positive was allowed to enter the shelter. Those who did
test positive were placed in hotel rooms for isolation
where they remained until they tested negative or
needed to be transported for treatment. These hotel
rooms were not readily available, and they were quick
to fill up; the cost of hotels posed financial stress for
immigrant serving organizations that already operate
with tight budgets and limited resources. At one point
during the pandemic, there were so many immigrants
that the respite center considered rejecting immigrants
with positive COVID-19 status. To avoid turning away
immigrants, Sister Norma contacted the city mayor for
aid. “I called him and told him, ‘If you don’t open space
for me, positive cases will be sleeping in the streets
tonight’ . . . that night, he opened space for me,” she
said (Sister Norma Pimentel, Humanitarian Respite
Center). This example highlights the important role
that community leaders and organizations can have in
advocating for immigrant health and safety in the face of
challenges such as the implementation of COVID-19
protocols.
With the courts closed and many professionals – like
lawyers, physicians, and mental health care providers –
suspending or limiting their practice, minors were stuck
in limbo with their care staff unable to coordinate the
services they needed for release. At the same time, the
kids themselves were isolated from one another due to
concerns about the spread of COVID-19 and insufficient access to masks due to increased demand for PPE.
Staff members weren’t coming to work, afraid for their
own health because they couldn’t get masks.
(Dr. Amanda Venta, clinical service provider for the
Office of Refugee Resettlement)
In the short-term, difficulties implementing COVID-19
protocols must be mitigated and strategies for addressing scarcity of supplies and volunteers are needed. The
continued emergence of COVID-19 variants compels
immediate action steps to increase security and reduce
health risk among staff, providers, UIMs, and immigrant
families. Observations and narratives from the front
lines emphasize the prevalence of fear, anxiety, and
grief among staff, UIMs, and their families, as everyone
navigated increased contamination fears and the loss of
predictability and routine in daily life. Reliable access to
quality PPE for staff and youth at immigrant-serving
institutions is essential. The delays in production and
distribution of supplies further challenged an already
burdened workforce. Although vaccines have mitigated
the risk of contracting the virus and experiencing serious
illness, the availability of PPE such as masks, gowns,
gloves, and other related items is essential to provide
a peace of mind and trust in the organizations.
Immigrant serving institutions were not immune to the
large-scale employee resignation seen across the U.S.
Direct care staff, who provide therapy and supervision
to UIMs, moved into administrative positions that
allowed for remote work at the same agencies or
switched industries altogether, like many Americans
(Fox, 2022). “This compounded the problem” said
Dr. Venta, noting that remaining staff were then
Strategy: Addressing COVID-19 Protocols & Scarcity
of Supplies, Volunteers, & Staff
JOURNAL OF CLINICAL CHILD & ADOLESCENT PSYCHOLOGY
Vaccination must become an international effort that
can reach immigrants on both sides of the U.S. -Mexico
border and their care providers. Maximizing a sense of
physical safety will facilitate necessary social contact and
engagement among staff and youth.
Moreover, staff and volunteers must feel psychologically safe and supported in order to continue serving
immigrants and mitigate the challenges associated with
resignation as well as hiring and training a new workforce. Equipping direct care staff and volunteers with the
skills to meet the mental and physical health of immigrants – either themselves or through collaboration with
healthcare providers and other agencies – is essential in
reducing burnout. In addition to training, staff wellness
must also be prioritized. One example of an organizational initiative to target staff wellness comes from
United We Dream (UWD), the largest immigrantyouth led network in the United States. UWD has partnered with psychologists from the National Latinx
Psychological Association to develop no-cost webinars,
guidelines, rapid response teams, and mental health
support for their staff.
Challenge 3: Increased Mental Health Needs
Context
The COVID-19 pandemic increased physical health
needs among immigrants who had encountered or contracted the virus, produced valid fears of becoming ill,
and made it more difficult to receive medical attention
for other common ailments including malnutrition,
exhaustion, dehydration, and physical injury during
migration (DeBrabander & Venta, 2022). Despite initially expecting high numbers of COVID-19 illness due to
overcrowding and unsanitary conditions in CBP custody and transportation, rates were not as high as initially predicted. In fact, according to the Hidalgo County
Health and Human Services Department, the rates of
positive COVID-19 cases in Hidalgo County Texas (border county of South Texas and Mexico) far exceeded the
positive rates of immigrants crossing the border
(Hidalgo County, 2020). Still, even with lower rates
than expected, the high volume of immigrants in northern Mexico alone (due to an increase in migration and
Title 42 expulsions) was enough for many medical
clinics to lack the capacity to meet the increased demand
for health services (Physicians for Human Rights,
2021a). “They saw many more immigrants [than they
were used to] trapped in northern Mexico without
access to medical services,” commented Kathryn
Hampton (Physicians for Human Rights). Put simply,
immigration policies that concentrated immigrants at
7
the U.S. -Mexico border did not concentrate health
service providers or medical supplies at the border,
leading to unmet needs. The fifth author
(Dr. Mercado) visited immigrant tent encampments in
Mexico.
What was most concerning were families at the refugee
camps in Matamoros, Tamaulipas, Mexico. Basic
hygiene necessities were not readily available, and we
knew that when COVID arrived in the tent encampments, it would spread like wildfire. This caused
Mexican authorities to encourage families to return to
their countries and offer a free bus ride to the border of
Mexico and Guatemala – asking migrants to return to
the place they feared most. Some families returned,
many did not. (Dr. Mercado, volunteer psychologist at
the U.S./Mexico border)
Dr. Mercado also witnessed an overwhelming need for
medical screening personnel on the U.S. side of the
border, particularly through volunteer work at the
Humanitarian Respite Center. He said, “Recently
arrived immigrant families were not tested for
COVID-19 at immigration processing centers thus giving the burden and cost to the respite center to test every
person and separate those families who tested positive,
which was approximately 1 of 100 families being
released, and assuring they were isolated and healthy
before traveling to their sponsor destinations.” The
demands of testing, treating, and isolating COVID-19
patients compounded the already pressing physical
health demands of immigrants and exacerbated difficulties meeting those needs that existed even prior to the
pandemic.
Mental health professionals around the world have
noted increased mental health needs because of
COVID-19. These increased needs were compounded
for Latinx immigrant communities which were affected
by anti-immigrant policies, job losses, financial hardship, and illness/death at higher rates than other demographic groups (Garcini et al., 2020; Venta, Bick, et al.,
2021). At the U.S.- Mexico border, Physicians for
Human Rights has found high rates of major mental
health diagnoses among immigrants, especially posttraumatic stress disorder (PTSD; Physicians for
Human Rights, 2021b). At a youth shelter for more
than 5,000 UIMs, the third author (Dr. Garcini) saw
a full range of mental health experiences “from sadness
and irritability and uncertainty to some severe cases
like non-suicidal self-injury and social withdrawal.”
Concerningly, immigrants are reporting traumas
related to the migration process and as a result of
delays in migrant processing that translate to longer
periods of detainment – which may be especially challenging for UIMs.
8
A. VENTA ET AL.
A big source of stress for UIMs at the shelters was the
length of time that they had to spend at the shelter
before being release to their hosting families. Many
children spent more than 60 days in crowded shelters
without many opportunities to spend time outside in
daylight. This was particularly difficult for the kids who
came from a life in the farms or near the ocean and were
used to spending a lot of time outdoors. (Dr. Luz
Garcini, volunteer psychologist).
“They start scratching the walls until they feel pain,” said
the seventh author (Sister Norma Pimentel) of children
at the Humanitarian Respite Center, echoing
Dr. Garcini’s sentiment. The fifth author
(Dr. Mercado) and his students also witnessed significant anxiety and depressive symptoms in children. It
was evident that children were experiencing multiple
pandemics, including one of mental health characterized
by more pronounced mental health concerns than previously witnessed.
We have seen the cases referred for evaluation growing
more and more severe. We see presenting problems
including psychosis, suicide-related thoughts and behaviors, and intense behavioral disruption more frequently than we did before. Psychological evaluations
are more difficult to conduct, and rapport is more
difficult to establish because we rely on tele-health platforms. And the kids are unhappy, often having to quarantine in their rooms due to COVID-19 concerns or
spend long periods of time masked. (Dr. Amanda
Venta, clinical service provider for the Office of
Refugee Resettlement)
The first author (Dr. Venta) also emphasized that there
was a delay in providing evaluations for UIMs as both
she and the shelter staff sorted out the technology
needed for remote service delivery.
Responding to the mental health toll of COVID-19
isolation and compounded stressors has been taxing for
staff and providers working at immigrant shelters and
service organizations. “They [volunteers and direct care
staff] are all feeling very drained and exhausted, and that
makes it difficult for us to keep up with the demand,”
said the eighth author (Kathryn Hampton; Physicians
for Human Rights). The sentiment of exhaustion is
shared among clinical staff at ORR shelters who, first
author Dr. Venta reports, have resigned at higher rates
during the COVID-19 pandemic. She recalled clinical
staff “growing accustomed to working remotely during
the early days of the pandemic and not wanting to return
to face-to-face services without available vaccines and
PPE.” Although some organizations implemented practices such as quarterly wellness sessions, as done by
Physicians for Human Rights for their staff, many mental health professionals and other frontline workers are
left to deal with their emotional wellbeing on their own.
Among staff at the Humanitarian Respite Center, not
being able to provide immediate care to all immigrants
was overwhelming. Although most immigrants are only
at the respite center for about 24 hours, the stress, anxiety, and desperation that immigrant children and
families were facing was evident to staff.
Strategy: Meeting Mental Health Needs in the
COVID-19 Era
Beyond PPE, the availability of HIPAA compliant telehealth equipment has proven critical to timely and
responsive services. From a practice stance, telehealth
has become a necessity in health care, and emerged as
a useful approach to care delivery. Studies evaluating the
delivery of care through virtual platforms with vulnerable populations (e.g., immigrants, asylum seekers, refugees) have found telephonic and video psychiatric
evaluations to be comparable to those conducted in
person (Bayne et al., 2019; Mishori et al., 2021; Mucic,
2009). Immigrant-serving institutions varied in their
ability to offer and maintain technology for staff and
youth. Consequently, much needed evaluations that
could be offered through virtual platforms were delayed.
Promoting low-cost or free options to these organizations can increase the availability of quality services that
are necessary to expedite processing for immigrant
youth. In addition to facilitating access to evaluations
and communication with legal representatives, virtual
platforms may promote emotional wellness through
online counseling, education resources such as tutoring,
and peer-led support groups.
While telehealth has previously been found to be
effective with vulnerable populations, it is important to
recognize that a one-size-fits-all approach is invalidating, inappropriate, and unethical (Drake et al., 2022).
Therefore, it is imperative to adapt services to the local
context and situation, and to consider the role of trauma
and trauma histories. Moreover, organizations may consider the use of a hybrid (telehealth and in person)
model of service delivery (Augusterfer et al., 2018),
which can assist with efficiency and the reallocation of
resources. A hybrid approach can enhance staff flexibility (e.g., scheduling), therefore, expediting timely care
and number of individuals who can be helped.
Further, training staff to assess for trauma symptoms
and possible dissociation activated by the pandemic can
aid service providers in their ability to accurately recognize signs of trauma-related distress, including PTSD.
A helpful resource for staff and providers on how to
address and work with trauma via teleservices can be
found at the Oxford Center for Anxiety Disorders and
Trauma (OxCADAT). The guidelines developed by
JOURNAL OF CLINICAL CHILD & ADOLESCENT PSYCHOLOGY
OxCADAT have been found helpful in the adaptation of
services and to front line providers (OxCADAT
Resources, 2020). In addition to guidelines, staff and
providers are encouraged to utilize clinical consultation
to identify and work through ethnical concerns related
to remote approaches to trauma services. The challenge
moving forward is determining how to best address the
ethical considerations for delivering services to vulnerable populations with histories of trauma.
Challenge 4: Challenges in UIM Placement Upon
Release from Custody
Context
Prior to the pandemic, family reunification efforts were
already difficult due to a lack of contact information for
parents, people in hiding because of danger in their
home countries, and people’s mistrust of the
U.S. government. Following implementation of harsh
immigration policies like the Remain in Mexico policy
and zero-tolerance policies that resulted in family
separation, many undocumented immigrants in the
U.S. who might have otherwise served as sponsors for
UIMs became afraid to do so. The first author
(Dr. Venta) recalled, “In the last few years I have seen
many more children who lose an immigration sponsor
because that person is afraid to collaborate with the
U.S. government. For children who were separated
from the parent that they traveled with, there is often
no sponsor available. Moms and dads that brought their
children with them and then got separated at the border
did not prepare for their child to be alone in the U.S.
They didn’t have a sponsor ready and willing to take the
child. They didn’t intend for their child to need
a sponsor at all.” For years, there was no existing government entity working to address family separation,
but following a backlash in 2018, a Family
Reunification Task Force was created. Still, COVID-19
protocols have made it difficult for the Task Force to
conduct reunification efforts. For example, the Task
Force worked on identifying immigration sponsors
while navigating physical distancing mandates and fear
due to anti-immigrant rhetoric and actions. Immigrant
organizations were also limited in their ability to provide
services across different locations and settings during
various points of the COVID-19 pandemic. Although
not much is known about the impact of delayed family
reunification due to the pandemic, our eight author
highlights the lasting negative impact of family separations that occurred prior to the pandemic.
We followed parents 3–4 years after being separated from
their children and deported by the U.S. government and
9
[found] high levels of trauma even 3 to 4 years later . . . In
the case of one little boy, the father said that even following reunification, his son was having nightmares several
times a week, and 2 years following reunification, he was
having nightmares once a month . . . that’s a concrete
example of how long it takes symptom severity to
decrease. (Kathryn Hampton, Physicians for Human
Rights, referencing report Physicians for Human Rights,
2022)
The third author (Dr. Garcini) witnessed many challenges in the reunification of UIMs with family members
and/or sponsors in the U.S.
A salient problem faced by immigrant shelters to UIMs
was to locate sponsor families for placement once the
children were released from government custody. Also,
for UIMs with family in the U.S., the challenges were
many. Many of these children had been separated from
their parents or families for many years . . . in some
cases the children did not even remember what their
parents looked like . . . so there were a lot of concerns
about reunification and how to prepare these families
for the encounter in the short and long-term. (Dr. Luz
Garcini, volunteer psychologist)
Challenges in family reunification following migrationrelated separation are beginning to be increasingly highlighted in the psychological literature for their deleterious mental health and attachment consequences (Venta
et al., 2020, Venta, Bailey, etal., 2021). Professional and
policy resources for mitigating these challenges are few:
“our organization was asked for resources to try to
facilitate conversations pertaining to reunification with
these families, but a lot of time passed before the
resources could be delivered to the families,” said the
third author (Dr. Garcini), stressing “This continues to
be a salient problem with no easy solution. Guidelines
are needed to ensure that children are released into safe
environments and that families are equipped with
knowledge and skills to face the many challenges, such
as coping with feelings of guilt, shame, and anger that
stemmed from family separation.”
The first author (Dr. Venta) observed that difficulties
associated with family separation and reunification were
made more complex by COVID-19. In her provision of
psychological services to UIMs in ORR custody, she
witnessed, “kids couldn’t be reunified, even if they and
their sponsors wanted to be, because COVID-19 slowed
everything down. Home studies couldn’t be conducted
on time. Even my evaluations, which are sometimes
needed prior to reunification, couldn’t happen as
quickly because my team was working remotely, we
were dealing with technology challenges, and we were
having to collaborate with direct care staff that was
working remotely or maybe even out sick.” She added,
“sponsors also seemed to drop out more frequently as
10
A. VENTA ET AL.
COVID-19 started to affect their livelihoods. Maybe
they realized they wouldn’t be able to provide the financial or housing stability the child would need. Or maybe
they realized they would have a child who they’d have to
educate remotely and care for full-time in the home.”
Strategy: Facilitating UIM Release and Reunification
Although the long-term goal of eliminating family
separations and detention remains, if UIMs or children
separated from immigrant parents are to be housed
temporarily, there should be clear limits to the duration
of the stay in these facilities and a concrete plan that
details the release and placement. In addition, finding
ways to improve communication and transparency with
youth about what they can expect as part of their immigration proceedings is recommended. This will require
training and support for staff who are the first line for
the immigrant youth and families. Teaching staff to
accurately recognize signs of distress among the youth,
communicate with empathy, and deescalate high risk
behaviors are all important components of staff wellness. Lacking attention to these training gaps risks perpetuating staff burnout, demoralization, and a sense of
defeat and hopelessness among all parties.
Reunification efforts have largely returned to preCOVID operations with more providers (e.g., lawyers,
psychologists) returning to practice face-to-face or
implementing telehealth delivery systems. Still, sponsors
remained frightened of interaction with ORR and other
government organizations. Aforementioned policy
changes as well as community building and rhetoric
changes are needed to assuage the aforementioned
fears. Furthermore, ORR must prioritize support services for family reunification. The science is now
clear – families and UIMs struggle after reunification
with trauma, attachment disruption, guilt, and mental
health problems challenging reunification (Berger
Cardoso et al., 2022; Venta, Brabeck et al., 2021).
Evidence based interventions for enhancing family
cohesion and addressing pronounced mental health problems in UIMs and their caregivers must be built into
the reunification process.
Limitations & Future Research Directions
Our aim was to describe our experiences and perspectives in the interest of answering two key questions:
(a) what were the major challenges faced in serving
immigrant minors and families on the front lines during
the COVID-19 pandemic and (b) how can we improve
the situation for immigrant youth and families during
and beyond the current pandemic? Several important
limitations to fully addressing these questions must be
noted and serve as a springboard for future research.
First, none of the authors is an employee of the federal
government and we therefore cannot represent the challenges faced by CBP and public officials during the
COVID-19 pandemic. While we take a humanitarian
lens and view immigration policy and enforcement
actions as punitive and damaging to immigrant
well-being, the perspectives of those responsible for
ensuring public safety, securing borders, and interpreting/enacting U.S., state, and local laws are not reflected
here. As we encourage policy changes and interdisciplinary collaboration, it is essential to include policymakers and enforcers in future research and
cooperation. Second, our perspectives, while valuable
and unique in an empirical literature that does not
often hear from service providers, should not be taken
as reflective of the voices of UIMs or immigrant families.
These voices are silenced for a multitude of reasons (Feu
& Venta, 2021) and our efforts to describe our own
experiences should not be interpreted as silencing or
speaking on behalf of marginalized groups, rather, we
aim to use the power of our own voices to draw attention
to ongoing difficulties in meeting the needs of UIMs and
immigrant families. Still, future research must endeavor
to showcase the experiences of UIMs and immigrant
families through their first-hand narratives through
community based participatory research and anonymous research that can mitigate barriers to participation (Feu & Venta, 2021). Finally, our contribution is
descriptive – compiled by a diverse group with combined decades of service to the UIM and immigrant
family communities – and addresses existing gaps in
knowledge but does so from a relatively narrow perspective. Future research, both qualitative and quantitative,
is needed to gather information on challenges facing
UIMs and immigrant families, sources of resilience in
these groups, and directions for growth and improvement from service providers on a large scale that is
capable of representing many regions, perspectives,
employment settings, etc. Critically, prospective longitudinal research with UIMs is needed to determine
how they adjust into adolescence and adulthood and
identify both sources of risk and resilience.
Conclusions
This project uncovered serious challenges in meeting the
needs of UIMs and immigrant families during the
COVID-19 era. Our observations highlight several primary challenges including anti-immigrant policies that
occurred concurrently with COVID-19; difficulty implementing COVID-19 protocols alongside scarcity of
JOURNAL OF CLINICAL CHILD & ADOLESCENT PSYCHOLOGY
supplies and volunteers; increased mental health needs
among UIMs and migrant families; and challenges in
UIM placement upon release from custody. Our experience and expertise highlighted deleterious antiimmigrant policies that made their work more difficult,
traumatized immigrants, and taxed the already overburdened care systems available to immigrants.
Compounding these challenges, staff resignation, scarcity of supplies and volunteers, and difficulties implementing COVID-19 protocols were prominent during
the early pandemic and, to some extent, continue. Amid
these difficulties in caring for immigrants, UIMs and
arriving families appeared to present with increased
mental healthcare needs that remain pressing, despite
growing service provision through telehealth modalities.
Family separations and difficulties in UIM reunification
with immigration sponsors continue, albeit without the
media attention seen previously, and UIMs that are
reunified with a family member do not receive the
needed support and intervention.
Alongside these challenges, sources of resilience
including gratitude, selflessness, and spirituality were
noted and must be capitalized upon in addressing
ongoing and future challenges for immigrant serving
organizations. The pandemic highlighted opportunities
to identify and implement sustainable strategies that
lead to resilient systems of care. Organizations that can
adjust to changing conditions, including public health
recommendations, and continue to provide needed clinical services, are an important component of individual
and staff wellness. Understanding the parallel experience
between staff and the youth they care for can help to
inform strategies for improvement. For example, at the
staff level, consistent and clear communication on
expectations can build confidence, and in turn, promote
a sense of stability among the youth seeking direction
from the adults charged with caring for them. Lacking
clarity, inconsistent messaging, and little direction is
likely to heighten anxiety and the vulnerability for emotional distress. This is important to note as beyond the
obvious loss of language, culture, and home, youth and
families served at these organizations have often experienced multiple traumatic events and are therefore at risk
of mental health symptoms. Therefore, attention to the
physical environment and the promotion of traumainformed interventions that increase the opportunity
for reconnection and success are imperative. We witnessed selflessness, gratitude, and spirituality as sources
of resilience in immigrants. Indeed, UIM and immigrant
family resilience is pronounced and seemingly impervious to the challenges we observed, and difficulties
associated with COVID-19. All of these sources of
11
resilience – as well as cultural values, personal strength,
and other sources of resilience – should be attended to
by healthcare providers as well as frontline workers.
Policy changes, government and NGO collaboration,
emergency preparations, international vaccine efforts,
staff training programs, trauma informed care, and
new standards of care for UIM and family reunification
are needed. But policy changes, intervention development, and any other efforts to mitigate the challenges
described in this manuscript will fall short if they do not
leverage the fountain of resilience found in immigrants
themselves. These changes will be most effective when
they leverage immigrants’ fortitude and resilience.
Acknowledgments
This article is part of the special issue ‘Understanding the Impact
of the COVID-19 Pandemic on the Mental Health of Latinx
Children, Youth, and Families: Clinical Challenges and
Opportunities’ edited by José M. Causadias and Enrique
W. Neblett, Jr.
Disclosure Statement
No potential conflict of interest was reported by the authors.
Funding
Time commitment for this study was partially supported by
a grant from the National Institutes of Health, National Heart,
Lung, and Blood Institute (NHLBI) (K01HL150247; PI:
Garcini).
ORCID
Amanda Venta
http://orcid.org/0000-0002-1641-123X
http://orcid.org/0000-0002-3834-9107
Luz M. Garcini
Michelle Silva
http://orcid.org/0000-0003-4036-2279
http://orcid.org/0000-0002-3127-9724
Alfonso Mercado
Oscar F. Rojas Perez http://orcid.org/0000-0002-5754-5250
Positionality Statement
As in all research, it is helpful to understand our positionality
and, therefore, the lens we use in interpreting extant literature
and current events. All of the authors interface with immigrant
and Latinx communities through service, clinical care, teaching,
and/or scholarship. We belong to the immigrant and Latinx
communities to differing extents. The first seven authors identify
as Latinx and many of us identify as immigrants, though our
countries of origin, immigration histories, and generational statuses differ. All authors were educated at least in part in the U.S.
We worked as a team to describe and synthesize our experiences
serving the immigrant community during the COVID-19 pandemic, guided by our collective cultural knowledge and expertise.
12
A. VENTA ET AL.
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