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“Every heartbeat hurts” “I can’t feel my heart”

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Children Describing Emotional Pain of Trump Family Separation Policy, Documented by the HHS Inspector General


Yesterday, the Office of the Inspector General (OIG) at the Department of Health and Human Services (HHS) issued two reports on the treatment of immigrant children in federal custody in 2018. One report described severe challenges in addressing the mental health needs of children that were “exacerbated” by the Trump administration’s family separation and other policies that not only grew the number of immigrant children in federal custody, but also created even more challenging mental health needs.  The other HHS OIG report found that required background checks of employees working with children in custody were not conducted in some facilities, that over half the facilities allowed employees to begin work without completed background check results, and that HHS issued background check waivers at six facilities.

Ur Jaddou, Director of DHS Watch and former USCIS Chief Counsel, said:

These two Inspector General reports confirm what we have all suspected — under the Trump administration, the number of immigrant children in custody ballooned, already existing mental health challenges were exacerbated by the Trump family separation and other policies, and thousands of children were put at risk of abuse or other crimes against children because many federal employees were not required to complete appropriate background checks. Instead of recognizing this as a horrific, inhumane mistake, the Trump administration keeps asking Congress for even more legal authority to detain even more children for even longer periods of time. These OIG reports, among a multitude of other reports by the DHS OIG, Members of Congress, doctors, and the media, make it vividly clear that more detention of children is not the answer and it is time for Congress to greatly expand its oversight and exercise appropriations authority to ensure children in federal custody under the Trump administration are protected from harm.

David Leopold, Counsel to DHS Watch, Chair of Immigration at Ulmer & Berne and former President of the American Immigration Lawyers Association, said:

The Trump administration will be forever remembered for its unspeakable child abuse. The administration has amassed a disturbing record of cruelty and outright neglect of children. Children and toddlers, separated from their parents will forever be psychologically scarred as the result of Trump’s cruel and hateful policies. What kind of depraved mind devises a scheme to tear children from their parents and subject them to prolonged detention in facilities overseen by adults whose backgrounds haven’t even been properly vetted?  These two Inspector General reports make plain that the Trump administration is not to be trusted with children.

Key excerpts of the OIG reports are located below, and the full reports may be found here.

Care Provider Facilities Described Challenges Addressing Mental Health Needs of Children in HHS Custody

Trump administration policies exacerbated existing challenges

“Policy changes in 2018 exacerbated these concerns, as they resulted in longer stays in ORR custody and a rapid increase in the number of younger children—many of whom had been separated from their parents after entering the United States.”

Heightened anxiety, fears, PTSD, feelings of abandonment, anger, confusion  

“Facilities reported that addressing the unique mental health needs of separated children was particularly challenging. According to program directors and mental health clinicians, separated children exhibited more fear, feelings of abandonment, and post-traumatic stress than did children who were not separated. Separated children experienced heightened feelings of anxiety and loss as a result of their unexpected separation from their parents after their arrival in the United States. For example, some separated children expressed acute grief that caused them to cry inconsolably.”

“Children who did not understand why they were separated from their parents suffered elevated levels of mental distress. For example, program directors and mental health clinicians reported that children who believed their parents had abandoned them were angry and confused. Other children expressed feelings of fear or guilt and became concerned for their parents’ welfare. The difficulties that some facilities had in locating parents in detention and scheduling phone calls also contributed to children’s anxiety and fear for their parents’ well-being.”

“We’re seen as the enemy” — clinician challenges to gaining trust of traumatized children

“The level of trauma and unique experiences of separated children made it more difficult to establish therapeutic relationships through which facilities could address children’s mental health needs. Program directors and mental health clinicians described challenges gaining the trust of separated children. For example, one program director noted that separated children could not distinguish facility staff from the immigration agents who separated them from their parents: “Every single separated kid has been terrified. We’re [seen as] the enemy.” Program directors and mental health clinicians also noted that some separated children isolated themselves and took longer to adjust to the facility and its routines, for example, refusing to eat or participate in activities.”

Uncertainties of changing policies and responses to litigation added to distress

“Adding to the challenge of addressing the mental health needs of separated children was the uncertainty that came with a hectic reunification process for children covered by the Ms. L v. ICE lawsuit. This lawsuit established a different reunification process for Ms. L class members and their separated children, along with fixed court-imposed deadlines for family reunification. Program directors reported that the guidance that ORR provided to facilities in 2018 on how to carry out reunifications for children covered by the Ms. Lcase changed frequently and with little notice. Changing guidance resulted in uncertainty around how or when reunification would happen. For example, case managers in facilities were not always able to let children know when, or even if, they would be reunified with their parents, or whether that reunification would happen in the United States. This type of uncertainty added to the distress and mental health needs of separated children.”

“Even when they were prepared to reunify separated children covered by the Ms. L case with their parents, facilities reported that logistical issues introduced further uncertainty that could lead to emotional distress. Facilities reported that some reunifications were scheduled with little advance notice, or suddenly canceled or delayed, which increased the levels of uncertainty and anxiety in separated children and other children in the facility. In one case, a child was moved from a facility in Florida to a facility in Texas to be reunited with her father. However, a mental health clinician reported that after the child made several trips to the detention center, she was returned to the Florida facility “in shambles” without ever seeing her father.”

Young child fears father was killed and he, too, would be killed

A program director said, “A 7- or 8-year-old boy was separated from his father, without any explanation as to why the separation occurred. The child was under the delusion that his father had been killed and believed that he would also be killed. This child ultimately required emergency psychiatric care to address his mental health distress.”

“I can’t feel my heart” — inability of separated children to describe pain of separation

A medical director said, “Physical symptoms felt by separated children are manifestations of their psychological pain. You get a lot of “my chest hurts,” even though everything is fine [medically]. Children describe symptoms, ‘Every heartbeat hurts,’ ‘I can’t feel my heart,’ of emotional pain.”

Number of children ballooned, especially young children, under Trump family separation policy

“[F]acilities cared for an increasing number of younger children in 2018. The number of young children, age 12 and younger, in ORR’s care increased sharply in May 2018 when DHS formally adopted the zero-tolerance policy of criminally prosecuting all adults for illegal entry into the United States. This policy led to children, some of them quite young, being separated from their parents. The proportion of young children in ORR care rose from 14 percent of referrals to ORR in April 2018 to 24 percent of referrals in May 2018.”

“Faced with a sudden and dramatic increase in young children, staff reported feeling challenged to care for children who presented different needs from the teenagers they typically served. Facilities noted that elementary-school- aged children had shorter attention spans, lacked the ability to comprehend the role of the facility, and more commonly exhibited defiance and other negative behaviors. Facilities noted the difficulties associated with completing assessments and other screenings for pre-school aged and younger children who could not accurately communicate their background information, needs, or the source of any distress.”

A program director said, “The little ones don’t know how to express what they are feeling, what has happened. Communication is limited and difficult. They need more attention.”

Lengthier stays in custody as a result of Trump policy changes = more stress, anxiety

“Facilities attributed longer stays for children to ORR’s new sponsor screening requirements. As mentioned earlier, in June 2018, ORR revised its sponsor screening requirements and began mandating fingerprint-based FBI criminal history checks of all potential sponsors, including parents, and all adult members of their households.29 Further, these fingerprints were shared with ICE and could be used for immigration enforcement purposes.30Facilities reported that it became more difficult to identify sponsors willing to accept children after the new fingerprinting requirements were implemented, which delayed placing children with sponsors, adding further stress and uncertainty.”

“As shown in Exhibit 3, children’s average length of stay in ORR custody increased markedly after ORR implemented the new fingerprinting policy in June 2018. The average length of stay reached a high of 93 days for children who were released from ORR custody in November 2018. The average length of stay that children spent in ORR’s custody began to decline after December 2018, when ORR ended the requirement for fingerprint background checks for all non-sponsor adult members of households. In March 2019, ORR further modified its policy, ending fingerprint background checks for parents or legal guardians, in most circumstances. By April 2019, the average length of stay had declined to 48 days.”

“Facilities reported that children with longer stays experienced more stress, anxiety, and behavioral issues, which staff had to manage. Some children who did not initially exhibit mental health or behavioral issues began reacting negatively as their stays grew longer. For example, one mental health clinician explained that even children who were outgoing and personable started getting more frustrated and concerned about their cases around the 70th day in care. According to facility staff, longer stays resulted in higher levels of defiance, hopelessness, and frustration among children, along with more instances of self-harm and suicidal ideation. One mental health clinician, for example, remarked that even children who come into care with good coping skills become disillusioned after a lengthy stay. Facilities also reported that children who had arrived in the United States on their own felt a sense of frustration in the summer of 2018 as they witnessed the expedited reunification of separated children, while seeing little movement in their own cases.”

Unaccompanied Alien Children Care Provider Facilities Generally Conducted Required Background Checks but Faced Challenges in Hiring, Screening, and Retaining Employees

Failure to keep children safe through employee background checks

“Care provider facilities are prohibited from hiring or enlisting the services of any individual who will have direct contact with children if the applicant has engaged in sexual abuse, sexual harassment or any type of inappropriate sexual behavior.7 To implement these safeguards, facilities must complete background investigations on all prospective staff, contractors, and volunteers who will have access to children in ORR care.8 Background checks must be completed “prior to being hired and gaining access to children or youth.”9 ORR’s “prior to hire” requirement is stricter than some State licensing standards, which permit applicants to begin work while background check results are pending to avoid staff shortages.”

Despite these protections, “some facilities did not have evidence of the required Federal Bureau of Investigation (FBI) fingerprint or Child Protective Services (CPS) check results and did not always ensure that the out-of-State CPS checks were conducted. In addition, we found that over half of the facilities we reviewed allowed employees to begin employment before receiving the results of either the FBI fingerprint check or the CPS check, or both…In addition to the compliance- related issues, ORR granted six facilities a waiver from conducting the CPS check for employees with direct access to children.”

“Although only a small number of employees in our review required a followup background check, we found that these checks were not completed or not completed in a timely way for more than a third of these employees.”