The U.S. has seen a marked increase in the number of unaccompanied youths arriving at the southwest border from around the world, and Central American countries in particular. Many of the youths arriving at the border have experienced severe trauma which may include gang violence, extreme poverty, gender-based violence, abuse, and discrimination based on their sexual or gender identity, and/or violence by family members.
Relative to other youths who arrive in a host country as refugees, unaccompanied youth face unique challenges that place them at elevated risk for experiencing anxiety, depression, and posttraumatic stress. In many cases, the initial dangers and persecution that force a child to flee their country are compounded by a host of additional threats and dangers they encounter during the migration journey as well as post-migration stressors including the complexity and uncertainty of the asylum and resettlement process. Unaccompanied asylum-seeking minors might have experienced criminal victimization, physical, verbal, or sexual abuse, as well as vicarious traumatization. These experiences may vary in intensity and pervasiveness; they are often severe enough to warrant close examination and psychological treatment. Symptoms of depression may be observed once the reality of their situation begins to settle, sometimes including loss of appetite, sleep disturbances, crying, low energy, and somatic complaints. Young children may demonstrate irritability, mood swings, aggression, and hyperactivity. Consequently, mental health professionals working with this population must consider many factors including the individual’s cultural background and history, trauma story, journey of migration to the U.S., the trauma of family separations, and the complexities and the uncertainty in the asylum process. In addition, resettlement related stressors are also critical to consider which may include language-related difficulties, discrimination, bullying at school, academic challenges, and feeling isolated from their peers and alone in their experience.
Consistent, culturally competent counseling that prioritizes a felt sense of safety and incorporates evidence-based treatment strategies that are developmentally sensitive, trauma informed, and contextually and culturally adapted as appropriate, is key when working with this population. Creating a safe, calming environment in therapy sessions is crucial to building rapport and a trusting relationship and can be done in many engaging ways including through use of art, music, yoga, games, puppetry, and sand-trays to name several.
The implementation of culturally appropriate screening methods is encouraged. Discussing the negative emotions related to experiences, unaccompanied minors should be encouraged to develop a new narrative to allow them to develop a sense of hope for the future. The use of the “Miracle Question
” in which minors are encouraged to think about how things will be different if their current situation did not exist. Most importantly, the stabilization of symptoms in confidential spaces, and family inclusion in therapy by providing additional coping skills and basic needs is essential.
Another resource for information on working with youth is the CVT's PATH Bibliography on healtorture.org and go to the Children and Youth section. Click here to view their latest bibliography
A special thanks to all of our contributors on this topic including: Thomas Berkas our volunteer at NCB, Switchboard, BRYCS, and CVT's PATH project. Without their assistance we would not have been able to put this together.