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.
Understanding their background, status, and best practices with unaccompanied youth:
United States Conference of Catholic Bishops. (2013). The United States Unaccompanied Refugee Minor Program: Guiding Principles and Promising Practices.
From the introduction: “Readers will find practical guidance gleaned from the expertise that USCCB/MRS and LIRS have honed over the past several decades on the delivery of optimal services to this particularly vulnerable population. Also included are guiding principles for programmatic design and implementation of holistic services to meet the unique needs of unaccompanied children. The best practices, service models, and insightful analysis of policy speak to an abiding commitment to the best interests of children made particularly vulnerable by forced migration.”
Walker, Chloe. (2019, November 22). Introduction to working with Unaccompanied Children
[Webinar], Children’s Immigration Law Academy: Immigration & Unaccompanied Children 101 series. From the webinar description: “This webinar provides an overview of the system designed to care for children who arrive in the United States unaccompanied seeking humanitarian protections under U.S. Law.”
The National Capacity Building Project. (2016). Working with Unaccompanied Minors in the U.S.
From the article summary: “An article that shares some considerations for providers working with unaccompanied minors in the U.S.”
Lutheran Immigration & Refugee Service. (2015). At the Crossroads for Unaccompanied Migrant Children.
From the Executive Summary: “This report by Lutheran Immigration and Refugee Service (LIRS) offers a range of policy and practice recommendations for the care and protection of unaccompanied children, informed by a series of three “Roundtable” meetings convened by LIRS in 2014 to consider current practice and ideal practice with unaccompanied children.”
A blog and webinar are available. MacDonnell, M., Suero-Stackl, I., and Clark, D. (2016, June 22). Refugee 101: With a Special Look at Child-Specific Issues
[Webinar]. MacDonnell, M. (2016). REFUGEE 101: With a Special Look at Child-Specific Issues
[Blog post]. From the introduction: “This webinar aims to humanize the refugee experience and will cover some of the basics: what is a refugee and the push/pull factors of migration. Presenters discuss the pre-arrival process, including security measures, and post-arrival services. There is a special emphasis on child-specific issues.”
The National Child Traumatic Stress Network. (2015). Unaccompanied Migrant Children.
From the description: “An overview of working with unaccompanied minors and the unique nature of the trauma they may have experienced. This resource describes symptoms or behaviors unaccompanied minors may display, cultural considerations for providers, and additional resources.”
Trauma-Informed care with unaccompanied youth:
HealTorture.org has an extensive section on Children and Youth
, developed after a National Capacity Building Project institute, in March of 2012, which focused on child survivors. Resources collected and developed at the institute along with other articles and videos are organized here as a reference for treatment centers beginning to do this work or looking to move their work in this area in a different direction. The topics range from developing a child and youth focused program to specialized interventions for children and youth. We invite you to browse the materials with special attention to a number of webinars and videos with experts in this field. All resources are listed on the left hand side of the page, and includes:
Resources from other sites:
Trauma-informed care: Understanding and addressing the needs of unaccompanied children.
[4 Webinars]. (2019). From the description: “This webinar series is designed to cover the impact of trauma on children during all phases of their migration journey. Nationally recognized speakers from NCTSN are joined by experts from the Irving Harris Foundation’s Professional Development Network to provide best practices for culturally responsive and trauma-informed provision of services. This series features diverse expertise from the fields of refugee and migrant health, cultural studies, mental health, early childhood development, childhood traumatic stress, trauma-informed systems of care, and secondary traumatic stress.”
The National Child Traumatic Stress Network. (2018). Understanding Refugee Trauma: For Primary Care Providers.
From the description: “Describes the mental health issues for Refugee children in resettlement. This white paper outlines Refugee experiences and mental health needs including exposure to trauma, access to mental health services, stresses in resettlement, and the need for comprehensive services. It offers a review of literature including trauma-informed treatments for refugee children, strategies to improve access to care, engagement strategies, approaches to cultural competence, and interventions designed to address the stresses of resettlement.”
The National Child Traumatic Stress Network. (2018). Understanding Refugee Trauma: For Mental Health Professionals
. From the description: “Outlines different considerations that mental health professionals need to take into account when working with refugee youth and their families. This fact sheet describes the cultural, child and youth, family, and provider considerations that professionals should understand when working with this population.”
Kamya, H., and Fontes, L. (2017, November 29). Managing Trauma: Tips for Supporting Refugee Teens in Schools, Refugee Resettlement, & Other Contexts
. [Webinar]. From the description: “Hugo Kamya, PhD, Professor and Fulbright Specialist Roster Scholar at the Simmons College School of Social Work and Lisa Fontes, PhD, Senior Lecturer at the University of Massachusetts will discuss some of the dilemmas facing refugee teenagers, how to converse helpfully and meaningfully with refugee teens, as well as ways to intervene more effectively with refugee teens, their families, and schools. This webinar builds off of BRYCS previous webinar on Understanding Trauma in Refugee Youth.”
Furman, B. (2019, Oct 15). Insoo Kim Berg: The miracle questions.
[Video file]. From the description: “Insoo Kim Berg, one of the founders of solution-focused therapy, speaks about the miracle question, at the Asian Pacific conference on solution-focused therapy in Singapore in 2006.”
Bellinger, G. A. (2016, September). To Speak or Not to Speak about Past Trauma: Shifting the Focus to the Present Impacts of Current Events and Assimilation on Immigrant Children
. [Webinar]. From the description: “BRYCS Consultant, Goli Amin Bellinger, MSW, LCSW-C, focuses on how to assess and respond to a child’s current difficulties arising from assimilation and tragic events in news reports. An emphasis is placed on avoiding the experience of a toxic trauma story by completing it with stories of resiliency from the past and present. The webinar includes how to recognize stress induced reactions in children and what to recommend to both children and their parents to support adjustment and healing.”
Masten, A. (2016, December). Resilience in Children Exposed to Trauma, Disaster and War: Global Perspectives
. [Online course]. From the description: “This free online course from Coursera covers how trauma can affect children and the systems they depend on, and how research is being applied in the real world through interventions that promote resilience. Participants can engage in discussions with others who are working with children at risk around the world.”
Cohen, J., Frymier, S., Abdi, S., and Rosado, J. (2018, July 10). Giving Immigrant Children a Voice: Understanding Traumatic Separation.
[Webinar]. From the description: “Focuses on helping providers, current caregivers, and others understand and recognize the effects of traumatic separation in immigrant children of different ages, understand immigrant children’s prior trauma experiences, and provide practical suggestions for how to support immigrant children who have been separated from parents and siblings.”
Power, E. (2014, November 19). Trauma, Spirituality, and Faith: An Overview of the Interplay as Survivors Risk Connection and Recovery.
[Webinar]. From the description: “Spirituality and faith can be leveraged to increase mental health for survivors of torture, displacement, immigration and other traumatic experiences by assisting in the process of rebuilding one's sense of self through strengthening self-capacities, such as managing feelings, positive inner connections, and feeling worthy of life. This webinar will provide a broad overview of the role of spirituality and faith in recovery from trauma, and in fostering mental health.”
The National Child Traumatic Stress Network. (2013). Child Welfare Trauma Training Toolkit
. From the description: “Teaches basic trauma-informed knowledge, skills, and values about working with children who are in the child welfare system who have experienced trauma. The Child Welfare Trauma Training Toolkit also provides information on how to support children's safety, permanency, and well-being through case analysis and corresponding interventions tailored for them, their biological, and resource families.”
The National Child Traumatic Stress Network. (2005). Culture and Trauma Brief: Promoting Culturally Competent Trauma-Informed Practices
. From the description: “Highlights the need for clinicians and policy makers to understand the links between trauma and culture. This brief outlines cultural competence in trauma treatments and practices to encompass race, ethnicity, immigrant status, sexuality, urbanity and rurality, and disability. Data from the National Child Traumatic Stress Core Data Set are summarized, demonstrating the significant differences between refugee/non-refugee, racial, and ethnic groups in lifetime exposure to trauma.”
The National Child Traumatic Stress Network. (2017). Data Collection Offers Opportunities for Unpacking the Refugee Experience
. From the description: “Offers information about risk and protective factors as related to suicide and refugee children and adolescents. This fact sheet gives strategies for talking with refugee children and adolescents about suicide.”
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.