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Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Sunday, September 9, 2018

Separation of Migrant Children: Commenting on Proposed HHS Rule Change

Some readers may be aware that the Department of Health and Human Services proposes to make a change in the Flores amendment that (in theory) limits separation of  undocumented migrant children from their parents to 20 days.  The new rule is described as:
The Department of Health and Human Services (HHS) Proposed Rule: Apprehension, Processing, Care, and Custody of Alien Minors and Unaccompanied Alien Children

You can comment on what rules should apply in these cases by going to 

Here is the comment I posted:

I am a developmental psychologist and the author of a book on infant development, one on emotional attachment in childhood, and textbooks on child development. I am concerned about the assumption that a HHS rule about separation of children from parents can be equally appropriate for children of all ages, birth to 18 years.  Clinical and observational studies of child development show that the impact of separation on children is most severe during the toddler period, roughly 10 months to 3 years of age. Preschool children are also negatively affected, but because of their better language development,  can tolerate separation somewhat better than toddlers can. Both toddlers and preschoolers show the impact of abrupt and long-term separations by crying, withdrawal, failure to play or explore, and problems with eating and sleeping. Notably, if separation  goes on for more than a few days, these effects will not disappear when the child is reunited with a parent, but will continue to be apparent for weeks or months, as the child has sleep problems or nightmares, is easily startled and frightened, and both clings to and behaves aggressively toward the parent. These reactions are difficult for any parent to cope with, but are especially so for a parent who is also frightened and distressed about an uncertain future.

School-age children are also distressed by separation, especially when they are confused by a new language, but their reactions and long-term responses are much less seriously negative than is the case for toddlers and preschoolers. In my opinion, decisions about rules on treatment of separated migrant children should focus on care of toddlers and preschoolers if triage needs to be done because of limited resources. Ideally, toddlers and preschoolers would remain with parents in whatever detention is used. A less ideal solution, but a better one than seems in place at this time, is that separation be limited to 20 days at the most, and that care for the separated young children follow guidelines for high-quality child care as provided by organizations like the National Association for Education of Young Children (NAEYC). These guidelines would set maximum numbers of children to be cared for by one caregiver , with a ratio of 1:3 for the youngest children in this group and 1:5 for older preschoolers; would provide that children have assigned caregivers rather  simply placing a number of caregivers to work with all of the children in a large group: would provide that these young children be cared for in small groups rather than large rooms full of children; and would emphasize individualized care for the children, with physical contact and talking prioritized.

Much concern has been expressed in recent years about the physical and mental health consequences of adverse childhood experiences (ACEs), and how these consequences continue into adult life. Most migrant children have already experienced a number of ACEs in their home countries-- these being the reason for the family's migration-- and have often experienced more on their journeys. For toddlers and preschoolers, separation from familiar caregivers is a seriously adverse childhood experience in and of itself. When this separation is abrupt and long-term, when the separation has occurred in frightening, even violent, circumstances, and when young children do not receive the care that could help them escape the worst effects of these events, we must consider the accumulation of traumas  that are being inflicted and their real consequences. Although we cannot undo the effects of earlier ACEs on migrant children, we can refrain from subjecting them  to further distress and further needs for social services that neither they nor their parents may have access to.

I do not mean by these statements to minimize the distress of 6- and 7-year-olds or of older children when confined to prison conditions following terrifying events before and on their journeys. However, my concern is that it is developmentally inappropriate and potentially harmful to assume that the youngest children can tolerate abrupt separation and the apparent loss of all they know in the same way that older children and adolescents can manage. It is time for the HHS rule to recognize the different needs of younger and older children and to assign resources accordingly.

*********** Readers, if you would like to comment on this issue, you should understand that you do not have to identify yourself or explain your credentials as I did. There is also a checklist that you can read before commenting that will give you an idea of how to approach this. I hope people will speak up while the chance exists. 

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