Unaccompanied Migrant Children and Trauma

Sep 11, 2019

A response to the Office of Inspector General Report on the Mental Health Needs of Children in HHS Custody

Every unaccompanied migrant child we care for at Cayuga Centers has undergone some form of trauma. It is impossible to imagine any child could be apart from their parents without being traumatized. Family members often send these children north to flee extreme hardship and violence, to join family members already established in the United States. These children have endured long, difficult journeys, often with strangers or traffickers. Their trauma can be compounded by confusion and fear when they arrive in a new country with a foreign language and a seemingly unsympathetic system.

This is why we welcome the Office of Inspector General (OIG) report on the Mental Health Needs of Children in HHS Custody. It is a timely and necessary reminder that, whatever the headlines, these children are not statistics. They are uniquely vulnerable individuals in need of specialist care and therapy. Cayuga Centers is proud to be taking the lead in providing the quality of support necessary to deal with these levels of trauma. We provide intensive training to our foster parents and staff in identifying and dealing with exactly this issue. 

A key element in the process is a safe, nurturing foster home: an environment which we believe is more conducive to a child’s recovery than group care. Another is high-level professional intervention. Upon arrival, alongside their physical check-up, each child receives an immediate mental health evaluation. This forms the basis of their personal care plan, which is revisited constantly. They are assigned a dedicated clinical therapist, who they see in individual and group sessions as frequently as needed. But we are clear that therapy does not begin and end with the clinician. Every educator, aide, case worker and manager is trauma-informed and focused upon the needs of the child.

Cayuga Centers opened our doors to the OIG and fully assisted in the preparation of the report. We are in full accordance with its findings, especially:

  • Take all reasonable steps to minimize time children spend in ORR custody.

The average time a child spends with Cayuga Centers from arrival to discharge (usually to a parent or family member) is currently 30 days. Our dedicated case workers do all they can to facilitate a safe discharge, but multiple agencies are involved in this process and a delay at any stage has a knock-on effect. We urge the Department of Health and Human Services (HSS) and the Office of Refugee Resettlement (ORR) to do all they can to streamline this process, increase interagency communication, and remove unnecessary bureaucratic obstacles to family reunion.

  • Develop and implement strategies to assist care provider facilities in overcoming obstacles to hiring and retaining qualified mental health clinicians.

While Cayuga Centers has a strong base of experienced mental health professionals, the increase in numbers of unaccompanied children at the Southern Border means that scaling up delivery of highly specialist services has been challenging at times. We welcome all assistance in increasing our capacity, especially in recruiting high-quality dedicated staff.


The report takes an overview of the system as a whole, and when it comes to the other four key findings, we believe that Cayuga Centers meets or exceeds the recommendations. These include:

  • Identify and disseminate evidence-based approaches to addressing trauma in short-term therapy.

Cayuga Centers is a pioneer in evidence-based trauma therapy, having championed the approach since the 1990s. We welcome the opportunity to share our expertise and insights with other agencies.

  • Assess whether to establish maximum caseloads for individual mental health clinicians.

We already have maximum caseloads of 12 children to each clinician; in more demanding cases, this can be lower. We supplement this with in-house Psychiatric Nurse Practitioners. At times of increased intake, maintaining these maximum caseloads can be challenging. This refers back to the point, above, about assistance with hiring staff to meet capacity.

  • Help care provider facilities improve their access to mental health specialists.

This is more applicable to non therapy-based organizations. 

  • Increase therapeutic placement options for children who require more intensive mental health treatment.

We agree with this entirely. 

We are always aiming to improve, and the OIG report is a welcome boost to that goal. The testimonies of individual children in the report are harrowing, and serve as a reminder of why we have chosen to work in this difficult field. We are also reminded every day, when we see progress and transformation among the children we serve: children who arrive frightened and withdrawn, but rediscover here the opportunity to laugh, play and express themselves. 

For more information about our services and programs, please visit www.cayugacenters.org.





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