AAP policy says no child should be in detention centers or separated from parents
Julie M.Linton, M.D., FAAP, MarshaGriffin, M.D., FAAP and Alan J.Shapiro, M.D., FAAP
Immigrant and refugee children should be treated with dignity and respect, and not
placed in settings that fail to meet basic standards for children’s physical and mental
health or expose them to additional risk, fear and trauma, according to a new AAP
policy statement released today. The statement also offers recommendations for the
care of children released into communities while their cases proceed.
The policy Detention of Immigrant Children, from the AAP Council on Community Pediatrics, was developed in response to increasing
concerns by pediatricians and child advocates regarding the conditions to which newly
arrived immigrant children are exposed when seeking protection at the U.S. southern
border. In particular, Department of Homeland Security (DHS) facilities do not meet
the basic standard of care for children in residential facilities.
Eyewitness accounts by pediatricians and advocacy groups, including two AAP delegations,
documented frequent separation of children from parents and detailed treatment of
children that exposes them to potentially traumatizing conditions. Evidence from both
within and beyond U.S. borders, described in the policy, demonstrates that detention
threatens children’s short- and long-term health and well-being.
Children in the custody of their parents should never be detained or separated from
a parent unless a competent family court makes that determination, according to the
policy, which is available at https://doi.org/10.1542/peds.2017-0483 and will be published in the May issue of Pediatrics.
Communities nationwide have become homes to immigrant and refugee children fleeing
countries across the globe. Yet more than 95% of children crossing the U.S. southern
border are from Guatemala, Honduras and El Salvador (Northern Triangle countries),
with smaller numbers from Mexico and other countries. Unprecedented violence, abject
poverty and lack of state protection in the Northern Triangle countries are driving
escalated migration to the United States.
In fiscal year 2016, 59,692 unaccompanied children and 77,674 family units sought
asylum or were apprehended crossing the southern border, according to U.S. Customs
and Border Protection (http://bit.ly/2mD6VPp). Interviews with children in detention from Mexico and the Northern Triangle revealed
that 58% had fear sufficient to merit protection under international law (http://bit.ly/2m2Wub7).
Complex evaluation, legal process
From the point of arrival through permanent resettlement in communities, immigrant
children seeking safe haven face a complicated evaluation and legal process. Children
apprehended with a parent or legal guardian are either repatriated back to their home
countries under expedited removal procedures, placed in Immigration and Customs Enforcement
(ICE)-family residential centers or released into the community awaiting their immigration
Intact family units often are separated from each other at the border and placed in
separate detention facilities, since no facilities accommodate both mother and father
with children. After processing by DHS, unaccompanied immigrant children are placed
in shelters or other facilities operated by the U.S. Department of Health and Human
Service’s Office of Refugee Resettlement, and the majority are subsequently released
to the care of community sponsors (parents, other adult family members or nonfamily
individuals) throughout the country for the duration of their immigration cases (http://bit.ly/2m2Uakq).
Pediatricians have the opportunity to advocate for systems that mitigate trauma and
protect the health and well-being of vulnerable immigrant children, including a coordinated
system that facilitates consistent access to medical care, education, child care,
interpretation services and legal services at all stages of the immigration journey.
Key recommendations regarding treatment of children and families who arrive at the
U.S. border include:
Separation of a parent or primary caregiver from his/her children should never occur,
unless there are concerns for the child’s safety at the hand of the parent.
Children should not be exposed to potentially traumatizing conditions, which currently
exist in DHS detention facilities.
Processing of children and family units should occur in a child-friendly manner, taking
place outside current Customs and Border Protection processing centers or conducted
by child welfare professionals, to provide conditions that emphasize the health and
well-being of children and families at this critical stage of immigration proceedings.
DHS should discontinue the general use of family detention and instead use community-based
alternatives to detention for children apprehended in family units.
Community-based case management should be implemented for children and families, thus
ending both detention and the placement of electronic tracking devices on parents.
Government funding should be provided to support case management programs.
Guideline-based care for all children
The Academy supports comprehensive health care in a medical home for all children
in the United States, including all immigrant children and those detained or otherwise
in the care of the state. Integrated behavioral health in the primary care setting
is an optimal model for care of immigrant and other vulnerable children, minimizing
the difficulty of navigating the health care system.
Further recommendations regarding community-based management include:
Pediatric providers serving previously detained immigrant children should elicit specific
history of abuse, neglect, abandonment, persecution, trafficking or violence to screen
children for legal needs and subsequently refer these children for legal services.
Integrated care strategies, such as medical-legal partnerships, may enhance connectivity.
Likewise, immigration lawyers should have opportunities to refer children to medical
homes if children reach the legal system prior to seeking medical care.
Pediatric practices should facilitate children’s enrollment in public educational
services, essential to children’s development and future well-being. School facilities
should be safe settings for immigrant children to access education. School records
and facilities should not be used in any immigration enforcement action.
No child, whether accompanied or unaccompanied, should ever represent himself or herself
in court. After release into the community, all previously detained immigrant children
should have access to legal services at no cost to the child or his or her sponsor.
Drs. Linton, Griffin and Shapiro are lead authors of the policy statement. Dr. Linton also is a member of the AAP Council on Community Pediatrics Executive Committee, and with
Dr. Griffin co-chairs the AAP Immigrant Health Special Interest Group. Dr. Shapiro is co-founder and medical director of a medical-legal partnership program
for unaccompanied immigrant children.