Immigration

Treating Traumatized Immigrant Children

Q&A with Julian Ford, Ph.D., Director, Center for Trauma Recovery and Juvenile Justice

Q

How is trauma impacting these young people?

They are impacted by violence in their countries of origin and on the journey to the U.S., as well as by race-related and institutional trauma in this country. Many develop a sense of fear, distrust, and even hopelessness that interferes with relationships, school, adjustment to new communities, and their physical health. These problems can persist for many years.


Q

What behaviors do they exhibit as a result?

These youth are often distrustful as a result of trauma, and can be very withdrawn or impulsive in an attempt to protect themselves from further trauma. This is a form of “survival coping,” which results from chronically not feeling safe. Justice involvement can occur when these youths feel that they must take extreme steps to protect themselves, which can lead to breaking rules — such as at school — or confrontations with law enforcement.


Q

How can physicians provide the best care to these patients?

Immigrant youths and their families, especially recent newcomers, have come to the United States in a period of turmoil and controversy that has heightened the stress they face in coming to a new country and new community. Many may feel reluctant to seek health care for fear of facing prejudice or discrimination. Providing a clear message of welcome and acceptance, in addition to showing interest in learning and respect for their culture and traditions, is essential to forging a positive treatment relationship — and can reduce patients’ anxieties and contribute to better health outcomes.

Expect that it will take some time, often several visits, for these youths and their families to feel sufficiently trusting and safe to fully and actively engage in dialogue and the treatment process. Patience and consistency on the part of the health care professional are a crucial counterbalance to the often harsh and even traumatic encounters many have had with putative helpers and institutional officials during their journey and once in the United States.

Explaining the nature and limits of confidentiality can help reduce fears about being subject to immigration sanctions.


Q

Is there a plan in place to help youths who suffer from this type of trauma?

The National Child Traumatic Stress Network has established more than 15 programs nationally for these youths. [The Center for Treatment of Developmental Trauma Disorders and The Center for Trauma Recovery and Juvenile Justice, of which Ford is the director, are members of the network.] This network was established by the federal government in 2001, and its centers provide public education, counseling, advocacy, and behavioral health treatment services for children and families, as well as consultation to community leaders and policymakers.

New Clinic Provides Health Evaluations to Asylum Seekers

UConn fourth-year medical student Kaitlin Markoja talks with Donna McKay, executive director of Physicians for Human Rights (PHR), and Glenn Mitoma, director of UConn’s Thomas J. Dodd Research Center.

UConn fourth-year medical student Kaitlin Markoja talks with Donna McKay, executive director of Physicians for Human Rights (PHR), and Glenn Mitoma, director of UConn’s Thomas J. Dodd Research Center. PHR was honored on Nov. 2, 2017, with UConn’s 2017 Thomas J. Dodd Prize in International Justice and Human Rights for its longtime global efforts to prevent human rights violations.


UConn School of Medicine students have launched the UConn Immigration Rights Initiative (UIRI) to aid individuals seeking asylum, providing medical and mental health evaluations to improve asylum seekers’ chances of being granted safe haven in the U.S.

The asylum advocacy effort is led by UConn medical school’s student chapter of the internationally renowned organization Physicians for Human Rights (PHR), which recently joined forces with the school’s Physicians for Social Responsibility (PSR) student chapter.

Currently, the PHR-PSR student chapter is co-led by second-year medical students Anastasia Barros and Martina Sinopoli. Together, the group of more than 30 medical and dental students is committed to addressing patient health through policy, advocacy, and community outreach.

The UConn Health Asylum Clinic, located in UConn Health’s Outpatient Pavilion, builds on the success of UConn Law School’s student Asylum and Human Rights Clinic, founded in 2002. That clinic’s work has provided legal help to more than 120 people who fled political, religious, or other persecution.

[Exposure to refugee health needs] offers students a window into the global health arena and an opportunity to gain unique skills … that are transferrable to the care of virtually any patient.

The pro-bono forensic physical and psychiatric examinations provided at the clinic will help immigration attorneys prepare asylum affidavits, Sinopoli says.

“With proper medical and mental health evaluations and legal guidance, a refugee is 90 percent more likely to be granted asylum,” says Barros. “Helping increase the chances of these refugees remaining safe here in the U.S. will be the best reward possible for us medical students.”

PHR’s national chapter was instrumental in helping the students establish the Asylum Clinic. PHR trained students participating in the UIRI to perform the forensic evaluations, looking for signs of physical or mental persecution that asylum seekers may have experienced. The national and regional PHR chapters plan to refer asylum seekers in Connecticut to UConn Health.

Dr. Susan Levine is the medical director of the student-run UIRI and heads UConn Immigrant Health, an entity that includes an immigrant health clinic in general medicine, as well as a student and a resident curriculum in refugee health.

“Exposing trainees to immigrant and refugee health needs is incredibly rewarding,” says Levine. “It offers students a window into the global health arena and an opportunity to gain unique skills in eliciting complex determinants of health, skills that are transferrable to the care of virtually any patient.”