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Theses Doctoral

Investigating the Mental Health Needs of Unaccompanied Immigrant Children in Removal Proceedings: A Mixed Methods Study

Baily, Charles David Richard

In recent years there has been a dramatic increase in the number of
children migrating to the United States without a parent. In Fiscal Year
2014 alone, U.S. immigration authorities apprehended and detained almost
70,000 unaccompanied children, compared to less than 9,000 in 2010. This
rapid rise has been fueled primarily by children arriving from Central
America, one of the world’s most violent regions. The available literature
on unaccompanied children in the United States suggests that they are a
vulnerable and underserved population, who are at risk for repeated
exposure to extreme psychosocial adversities at every stage of their
migration and frequently face many of these challenges alone. However, to
date there has been little formal study of their mental health needs.
The aim of this exploratory study was to obtain initial data regarding the
psychosocial context, mental health presentation, and mental health service
utilization of unaccompanied children released to guardians in the
community pending immigration hearings to determine their eligibility to
remain in the United States. The study employed a mixed methodology
combining qualitative and quantitative data. The sample comprised 26
children and their guardians residing in the New York City metro area,
interviewed between September 2013 and December 2014.
Results showed that children in our sample had complex reasons for
migration, frequently combining push factors such as fleeing gang violence
and pull factors such as a desire for reunification with parents in the
United States after long separations. Most had been exposed repeatedly to
extreme psychosocial stressors prior to and during their migration,
including almost two-thirds who had witnessed violence, serious injury, or
death and over one-third who had witnessed domestic abuse or had been
physically abused themselves. However, children also described benefitting
from an array of supports that protected against stressors and promoted
their wellbeing, and in their narratives they emphasized overcoming
adversity rather than victimization.
On a structured mental health diagnostic interview, the majority of
children met criteria for one or more past-year anxiety and depressive
disorders. Few received diagnoses for behavioral problems. Compared against
these data, child-report measures screened more effectively for
internalizing disorder diagnoses and guardian-report measures screened more
effectively for externalizing disorder diagnoses. Despite the high rates of
diagnosable disorders in the sample, most children appeared to be
functioning well in family, social, and educational domains. No children
were receiving formal mental health services at the time of their study
interview, although several were being monitored by school counselors.
Children presenting with mental health concerns were provided with
referrals to mental health treatment services and contacted for a brief
telephone follow-up interview three months later. At follow-up, a number of
children had received counseling. Availability of school counselors and
referral to therapists in the community through pediatricians were the
primary facilitators of service access. Lack of knowledge of available,
Spanish-speaking services and cost of treatment were common obstacles to
seeking treatment. Some children and their guardians did not perceive a
need for services, and most of these children appeared to be functioning
well at follow-up.
This study was designed to be largely descriptive and to provide data to
inform future, theory-driven research. In the discussion section, social
ecological models of risk and resilience and Hobfoll’s Conservation of
Resources theory are presented as potential paradigms for understanding
unaccompanied children’s migration processes, with stressors and supportive
factors interacting across systemic levels and over time to determine
children’s access to resources and their mental health, functioning, and
wellbeing. Finally, the implications of the study’s findings for future
research, psychosocial intervention, and rights-based advocacy with
unaccompanied children are considered.


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More About This Work

Academic Units
Clinical Psychology
Thesis Advisors
Verdeli, Helen
Ph.D., Columbia University
Published Here
February 6, 2017