The U.S. Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR) facilities are responsible for the custody and care of unaccompanied alien children (UAC). The Office of Inspector General (OIG) report, Care Provider Facilities Described Challenges Addressing Mental Health Needs of Children in HHS Custody, on the facilities that care for children in ORR stated that “the facilities struggled to address the mental health needs of children who had experienced intense trauma and had difficulty accessing specialized treatment for children who needed it.”

The inspector general visited 45 ORR facilities in August and September 2018, speaking with approximately 100 mental health clinicians, as well as medical coordinators and other facility professionals. There were approximately 12,400 children in ORR’s custody and almost 9,000 children in facilities visited during the time of the OIG’s review. The majority of the children were from Guatemala, Honduras, and El Salvador. Findings indicated that many children experienced or witnessed abuse or violence during the trip to the U.S. border. The facilities managers and mental health clinicians described the trauma that children endured was only exacerbated after they arrived in the United States, when they were separated from a parent.

The mental health clinicians at ORR facilities are responsible for providing mental health services while a child is in the care of HHS according to the standards set under the 1997 Flores Settlement Agreement. At a minimum, each child in ORR custody must receive at least one individual counseling session from a trained mental health professional per week. Mental health professionals stated that they expressed to HHS that they were “not able to address the children’s mental health issues,” for part that the instability of the children was a factor due to the Trump Administration “zero tolerance” that increased the length of stay in ORR custody.

OIG found that the children in ORR facilities received inadequate mental health care and that the facilities struggled to retain and train mental health clinicians. One program director told investigators that they had difficulties in finding qualified clinicians and that high caseloads were a problem.

OIG report provided six recommendations to assist the ORR facilities in addressing the mental health care of children in its custody including consulting with mental health experts and others. The recommendations include the following:
1. Identify and disseminate evidence-based approaches to addressing trauma in short-term therapy
2. Develop and implement strategies to assist care provider facilities in overcoming obstacles to hiring and retaining qualified mental health clinicians
3. Assess whether to establish maximum caseloads for individual mental health clinicians
4. Help care provider facilities improve their access to mental health specialists
5. Increase therapeutic placement options for children who require more intensive mental health treatment
6. Take all reasonable steps to minimize the time that children remain in ORR custody

The Administration for Children and Families (ACF), which oversees ORR, concurred with all the recommendations in the report. ACF stated that they were taking actions such as creating “a webinar to train facility staff in the unique mental health needs of children in HHS custody.”

To read and download the report, visit