Care Provider Facilities Described Challenges Addressing Mental Health Needs of Children in HHS Custody

WHY WE DID THIS STUDY

By law, the Office of Refugee Resettlement (ORR), which is within the Department of Health and Human Services (HHS), Administration for Children and Families (ACF) has custody of and must provide care for each unaccompanied child, including addressing their mental health needs. ORR-funded care provider facilities are required to provide counseling to children and arrange for more specialized mental health services, as needed. We conducted our fieldwork during a time when ORR was experiencing an influx of children. Our findings could inform the Unaccompanied Alien Children Program's preparation for future surges.

HOW WE DID THIS STUDY

In August and September 2018, OIG conducted site visits at 45 ORR-funded facilities, nearly half of all facilities in ORR's network at the time. These facilities were purposively selected and may not represent the experiences of staff in all ORR-funded facilities. This report relies primarily on data collected from interviews with: approximately 100 mental health clinicians who had regular interaction with children across the 45 facilities; medical coordinators in each of the 45 facilities; facility leadership in each of the 45 facilities, including the program director and lead mental health clinician; and the 28 ORR federal field specialists assigned to the 45 selected facilities. We conducted qualitative analysis to identify the most significant challenges that facilities faced in addressing the mental health needs of children in ORR custody. This report does not determine whether challenges resulted in care that failed to meet ORR requirements, nor does it assess the quality or appropriateness of mental health care provided to children.

WHAT WE FOUND

Facilities described the challenges inherent in addressing the mental health needs of children who had experienced significant trauma before coming into HHS care. Facilities reported that challenges employing mental health clinicians resulted in high caseloads and limited their effectiveness in addressing children's needs. Facilities also reported challenges accessing external mental health providers and transferring children to facilities within ORR's network that provide specialized treatment. Policy changes in 2018 exacerbated these concerns, as they resulted in longer stays in ORR custody and a rapid increase in the number of younger children-many of whom had been separated from their parents after entering the United States.

WHAT WE RECOMMEND

We make six recommendations for practical steps that ORR can take to assist facilities. ORR should provide facilities with evidence-based guidance on addressing trauma in short-term therapy. ORR should also develop strategies for overcoming obstacles to hiring and retaining qualified mental health clinicians and consider maximum caseloads for individual clinicians. Finally, ORR should address gaps in options for children who require more specialized treatment and take all reasonable steps to minimize the amount of time that children remain in custody. Specific recommendations are in the report. ACF concurred with all six of our recommendations.