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Abstract

Background: In recent years, there has been a significant influx of Central American youth who cross the U.S.-Mexico border without a parent or legal guardian. While federal procedures are established to oversee the treatment and placement of unaccompanied minors, less is known about the needs of unaccompanied minors and available services afterthey are placed in appropriate custody.

Methods: Purposive and strategic sampling of professionals from medical, social work, education and legal fields was conducted. Fourteen informants were recruited across the U.S. for confidential semi-structured interviews, which were audio recorded and transcribed in 2016 to 2017. Standard anthropological methods were employed, including immersion and crystallization techniques that incorporated within-case and across-case analytic strategies.

Results: Recruited informants had previous or current direct experience working with immigrant minors for three or more years in addition to extensive public health experience.

Unaccompanied minors were described as predominantly adolescent boys, ranging from 2 to 18 years old. Children faced unmet mental, medical and psychosocial needs that are interconnected and largely unmet due to children’s legal status and ineligibility to access services in most jurisdictions. The most pressing challenge affecting the health of youth was their immigration status.

Across sectors,informants revealed an imbalance between the growing demand for services, including legal counsel, and the limited supply of professionals and well-funded services to meet children’s complex needs. Informants emphasized the value of trauma-informed practice, Spanish language proficiency, child-informed practice and intercultural awareness and humility towards their clients as key features of equipped professionals working with this vulnerable population. Regardless of sector, professionals emphasized the importance of culturally-informed care to immigrant youth. Building these skills is associated with greater confidence to provide services to unaccompanied minors, many of whom have experienced as significant burden of childhood trauma.

Conclusions: The health needs of unaccompanied minors are complex and span across medical, social work, education, and legal fields. Interdisciplinary collaboration is needed to address the challenges faced by unaccompanied minors in their efforts to integrate themselves into their new communities and promote their resilience. Promising initiatives include co-location of inter-sector services for increased access and efficiency of services and development of professional trainings and resources for professionals in sectors that serve this population.

Key Take Away Points

  • The needs of unaccompanied minors are complex and interconnected across medical, social work, educational and legal fields
  • The most pressing challenge affecting the well-being of unaccompanied minors is their legal status
  • Interdisciplinary collaboration is needed to address needs of unaccompanied minors in their efforts to integrate themselves into relocated communities and families.

Author Biography

Sheyla P. Medina is a medical student at the Warren Alpert Medical School of Brown University. She has a background in mixed methods research and management of public health initiatives in the U.S. and developing countries. Dr. Carol Lewis is a board-certified pediatrician and the Director of the Fostering Health Program at the Hasbro Children's Hospital in Providence, RI. She is affiliated with the Alpert Medical School of Brown University and serves as faculty mentor in student-led research surrounding the welfare of immigrant and refugee children. Dr. Roberta Goldman is a sociocultural anthropologist and clinical professor of family medicine at the Alpert Medical School of Brown University. She also serves as adjunct professor at the Harvard T.H. Chan School of Public Health. She is a faculty advisor in student-led qualitative research.

Acknowledgements

We thank Fadya El Rayess, Abigail Price, and Joseph Diaz for their support of this qualitative research.

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