Feature

When three women who had been forcibly separated from their children by immigration officials filed a lawsuit on June 25, Claudette Antuña, PsyD, knew her training as a forensic evaluator would be in high demand. The women were among a group of 50 parents seeking asylum who had been transferred to a prison in Washington state. None had seen their children in more than a month.

Psychological testing and psychosocial histories could provide critical evidence for this case and many others now that more than a dozen states are suing the Trump administration over the family separations. "We need to be advocates for the refugees," says Antuña, whose pro bono evaluations have helped hundreds of immigrants obtain asylum or other forms of legal relief to stay in the United States. "There is greater demand than ever for psychologists who can do this work."

Antuña is one of more than 375 psychologists and other mental health professionals who are part of the Refugee Mental Health Resource Network, an APA interdivisional initiative led by Div. 56 (Trauma Psychology) to help agencies and organizations working with refugees. Psychologists in the network's database volunteer their services to asylum seekers, refugees, migrants and internally displaced individuals.

APA President Jessica Henderson Daniel, PhD, spoke out in May on the science behind this policy's impact on children and families, noting in a statement reported in The New York Times that "the administration's policy of separating children from their families as they attempt to cross into the United States without documentation is not only needless and cruel, it threatens the mental and physical health of both the children and their caregivers."

What science shows about separations

APA has continued to ratchet up efforts to put the psychological science in front of decision-makers, including those in the White House. Daniel and APA CEO Arthur C. Evans Jr., PhD, wrote to President Trump: "Based on empirical evidence of the psychological harm that children and parents experience when separated, we implore you to reconsider this policy and commit to the more humane practice of housing families together pending immigration proceedings to protect them from further trauma."

U.S. Border Patrol shines a spotlight on a mother and son from Honduras near the U.S.-Mexico border on June 12 in McAllen, Texas."Many immigrants are leaving traumatic situations in their home countries, and their journeys to get here are extremely arduous and inflict more trauma," says University of California, Los Angeles, professor Carola Suárez-Orozco, PhD, whose research was cited in APA's letter to President Trump. "To separate children from their parents inflicts further trauma. This is cruel to children and hugely disruptive to their sense of safety and well-being."

After the president signed an executive order on June 20 aiming to keep families together while they are in custody, APA expressed appreciation for the change yet voiced grave concern about the fate of the more than 2,300 children who had already been separated from their parents since May.

On June 21, Evans spoke on Capitol Hill about the importance of reuniting families, during a press conference with House Minority Leader Nancy Pelosi (D-Calif.), Minority Whip Steny Hoyer (D-Md.) and U.S. Rep. Raul Ruiz (D-Calif.).

Although the direct impact of the separation policy has not yet been studied, psychologists' research offers clues about what to expect in the coming years for children who are apart from parents during complex immigration processes. In a five-year study of more than 280 adolescent immigrant students in Boston and San Francisco, Suárez-Orozco and colleagues found that longer separations from parents during the immigration process led to higher rates of anxiety and depression. In many cases, the children in the study were left behind with relatives in a home country for years while parents found jobs and established lives in the United States (Journal of Adolescent Research, Vol. 26, No. 2, 2011).

Conditions in Guatemala, El Salvador and Honduras have worsened since then, and many parents worry that their children will not be safe if left behind. They give themselves up willingly at the border to seek help, which makes the separations even more traumatic than those that are planned, Suárez-Orozco says.

More recent research shows that immigrant children in shelters—some hundreds of miles from their parents with unclear plans for reunification—may also be at increased risk of post-traumatic stress disorder (PTSD). Lisseth Rojas-Flores, PhD, an associate professor of marital and family therapy at Fuller Theological Seminary in Pasadena, California, studied the effects of forced separations on children whose parents had a precarious legal status. In a study of Latino children ages 6 to 12 born in the United States who were living with at least one undocumented parent at risk for detention or deportation, Rojas-Flores and colleagues discovered that PTSD symptoms were significantly higher for children of detained or deported parents compared with those whose parents were legal permanent residents or were undocumented but had no contact with immigration enforcement. The children's teachers also reported increased behavioral problems among students with detained or deported parents (Psychological Trauma: Theory, Research, Practice, and Policy, Vol. 9, No. 3, 2017).

"As psychologists, we know that when kids are dysregulated, they have a hard time learning and studying," Rojas-Flores says. "In the current sociopolitical context where aggressive immigration enforcement impacts many children of immigrants, teachers nationwide are requesting additional support to better serve these kids."

Researchers are also finding evidence that the trauma caused by family separation threatens mental health as much as the atrocities families experience in the countries they are fleeing. Investigators collected data on PTSD symptoms, depression and anxiety symptoms and psychological well-being in 165 adult refugees from Afghanistan, Iraq, Syria and the African Great Lakes region. They also measured 27 different types of trauma exposure in the participants, such as fear for their lives, the destruction of their homes and being kidnapped. Only two of the 27 types of trauma—family separation and physical assault, beatings, or torture—explained significant variance in all three measures of mental health after taking into account refugees' overall level of trauma exposure (American Journal of Orthopsychiatry, Vol. 88, No. 1, 2018).

"We were surprised to find that family separation was on par with beating and torture in terms of its relationship to mental health," says Jessica Goodkind, PhD, one of the authors and a professor in the department of sociology at the University of New Mexico. "This tells us that family separation is one of the driving factors that creates psychological distress."

Psychologists who study neurobehavioral development have also discovered that subjecting young children to an institutional environment can create irreversible changes in the brain. One study of 110 adolescents showed that those who had spent the first year of their life in an institution such as an orphanage had significantly lower volumes of the prefrontal cortex in the brain compared with the control group. "This would lead kids to have trouble with executive function tasks, working memory, inhibition control and cognitive flexibility," says one of the study's authors, Megan Gunnar, PhD, director of the Institute of Child Development at the University of Minnesota. She also found that the length of time in an institution was correlated with smaller volumes of the hippocampus (NeuroImage, Vol. 105, 2015).

"Even though the children in our study had been adopted at an average of 12 months and spent more than a decade in a supportive home, the brain changes early in life persisted," Gunnar says.

While studies like this can help psychologists understand the experiences of the children separated from their parents at the border, it is difficult to predict the extent of the impact because "researchers are not allowed to do to children what was being done to children at the border," Gunnar says.

Life in a shelter

Suzana Adams, PsyD, a clinical psychologist in Phoenix who evaluates and treats children for the federal Office of Refugee Resettlement, is among a handful of psychologists who are witnessing firsthand the experiences of immigrant children living in shelters because their parents were arrested for crossing the border illegally. Since spring, she has seen a surge in the number of children in the seven shelters she serves, and the average age has decreased. During her evaluations, she gets a glimpse into how these children are coping.

"Some of the kids are resilient, but many of them suffer from complex trauma, attachment problems, depression, generalized anxiety and social anxiety," Adams says. "I see adolescents who still urinate in bed and kids who exhibit self-harming behaviors, like cutting."

The children cannot be held or touched due to policies at the shelters, which were prepared to receive adolescents, not children, Adams says.

There is no space for a playroom and staff members do not know how to work with young children using strategies such as play therapy. Once the children understand that they cannot be touched, they sometimes resort to behaviors like spitting, biting or nagging the staff. "These children may be testing limits, needing a hug or expressing frustration about feeling trapped," Adams says.

Psychologists who have visited family detention centers also worry that the living conditions in these facilities will add to the trauma families have already endured. Forensic psychologist Giselle Hass, PsyD, of Washington, D.C., visited the Berks Family Residential Center in Leesport, Pennsylvania in 2016, reputed to be one of the best residential centers in the country, and she was shocked by what she saw.

"When the residents told staff that their children were not sleeping well or were having stomach pain, they were told to have the children simply drink more water," Hass says. "It requires special training to work with these vulnerable children." She was also surprised that the facility's library consisted of nothing but a few Bibles, and many of the staff members did not speak Spanish.

Such conditions motivate psychologists to continue advocating for refugees, especially for those families in which children have been separated from their parents. Regardless of the outcome in court, the one-on-one interactions with people are significant, says Antuña.

"My meetings with clients may be the first time they have shared their immigration stories with someone," she says. "You can see the change in their faces—the relief of letting go of deep, pent-up trauma. It's a cathartic moment for many people."

Read about an integrated-care practice in New York City that is dedicated to helping teen immigrants.