Migrant Children Traumatized After Separations, Report Says

NPR's Rachel Martin talks with Health and Human Services Assistant Inspector General for Evaluation and Inspections Ann Maxwell about a report on the mental health needs of children in HHS custody.

RACHEL MARTIN, HOST:

A new report by the U.S. government says children who were separated from their parents at the U.S.-Mexico border have suffered a severe kind of trauma that's still very present. The new report comes from the office of the inspector general at the Department of Health and Human Services, which visited 45 sites where migrant children were being held after being separated from their parents under the Trump administration's short-lived zero tolerance policy last year. The report describes one boy who cried inconsolably because he thought his father was dead after they'd been separated, another who said, quote, "I can't feel my heart."

Ann Maxwell is the assistant inspector general for evaluation and inspections with HHS. She oversaw the report, and she's in our studio. Thanks for coming in.

ANN MAXWELL: Thank you, Rachel, for having me to talk about this important report.

MARTIN: What precipitated it?

MAXWELL: We really wanted to offer a unique perspective on this topic. And in particular, this report offers insights from the staff who worked directly with the children. And the children, of course, are the children who've either come over the border unaccompanied by an adult or children who were separated from their parents after crossing the border.

MARTIN: So what struck you most about the results of this?

MAXWELL: You know, what we heard from the frontlines generally falls into two categories. First, there are a number of systemic challenges that make it more difficult for the frontline staff to provide health care to children in mental distress. Second, we heard that addressing children's mental health care in 2018 was particularly challenging. And this has to do with policy decisions that were - resulted in a rapid increase in the number of separated children in care and increased the length of time children were in care.

MARTIN: One medical director referenced in the study said there was physical pain associated with some kids' psychological pain, right? How did that manifest?

MAXWELL: Yeah. So one medical director told us that separated children would often come and express physical symptoms - and, for example, things like my chest hurts, even though they were physically fine. And this they understood to be manifestations of their psychological pain.

MARTIN: The report also talks about the trust deficit that these kids are experiencing. Can you explain what that means?

MAXWELL: Yeah, absolutely. And this has a significant impact on the ability to build a therapeutic relationship and actually help kids in mental distress. And what we heard from mental health clinicians was these children have been severely traumatized by the separation, and they were unable to distinguish between the immigration officials that separated them from their parents and the HHS officials who were trying to provide them care.

MARTIN: What are your recommendations to the federal government as a result of this?

MAXWELL: We have a number of practical steps we think the department can take to support these facilities and their efforts to overcome these challenges. For example, they can work with them to ensure they have adequate staff to treat these children and make sure that they have access to evidence-based care and trauma-informed care for treating children of all ages.

MARTIN: How well positioned is the Trump administration to carry these out?

MAXWELL: You know, in response to a report, the department reiterated its commitment to ongoing program improvements and offered us a variety of plans to implement changes to the program, and many of which are already underway.

MARTIN: Ann Maxwell, assistant inspector general with the Department of Health and Human Services.

We appreciate you coming in. Thank you so much.

MAXWELL: Thank you.

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