Blog: The Role of School-Based Health Centers in Supporting Unaccompanied Migrant Children

Author: Adam Elzarka

Federal encounters with unaccompanied migrant children reached an all-time high at the U.S. – Mexico border in 2022, with nearly 150,000 unaccompanied migrant children being apprehended. Unaccompanied migrant children are defined as minors under the age of 18 who do not have U.S. immigration status or a guardian who can provide reasonable care in the United States. Once apprehended by the Department of Homeland Security (DHS), children are either referred to the Office of Refugee Resettlement (ORR) or repatriated. Repatriation may occur for unaccompanied children who are not trafficking victims or do not fear persecution in their countries of origin.

In 2022, 128,904 unaccompanied children were referred to ORR which controls the care and custody of the children. The children live in ORR’s care until a sponsor is found which takes an average length of 30 days. While in ORR’s care, children receive classroom education, case management, mental and medical health services, recreation, and unification services. Most sponsors are believed to be a parent or family member living in the United States. All sponsors are vetted through a multi-step process that includes background checks and a sponsor assessment process that identifies risk factors. After being placed with a sponsor, children undergo immigration legal proceedings.

Yet, ORR does not acknowledge responsibility for safeguarding children from trafficking and exploitation post-placement as seen with its current actions. ORR checks on all minors by calling them a month after placement, however, the New York Times has found that more than 85,000 children could not be contacted over the last two years. Moreover, the Times also found that roughly two-thirds of all unaccompanied migrant children in the United States work full-time.

ORR requires sponsors to send migrant children to school, but many of those enrolled report working long shifts after their classes end. Other children are not enrolled and are often misguided by their sponsors to work full-time. As more unaccompanied minors arrive at the border, there is increasing pressure on ORR to find sponsors quicker, resulting in these pitfalls that worsen the post-migration experience for these children.

Importance of Schools Based Health Clinics

Considering the migration and newcomer experience, the majority of these children have experienced trauma to some degree and are at a higher risk of anxiety, depression, and PTSD compared to U.S.- born children. For those enrolled, school-based health centers play a foundational role in treating these health needs. Schools have obligations to ensure certain rights to unaccompanied children which include the right to enrollment, eligibility for English language services, eligibility for disability-related services, and the right to not share immigration status.

Schools can support the health needs of these children at the onset of enrollment as educational enrollment requires up-to-date vaccination records, leaving school staff with the ability to identify social determinants of health gaps and refer children to community organizations. Schools can also assist children with health insurance applications, but only roughly a dozen states currently offer insurance to migrant children. Regardless, schools may often miss these opportunities due to a lack of funding, staff shortages, and decreased understanding of these children’s lived experiences.

Schools further meet the needs of unaccompanied children at their onsite school-based health centers (SBHCs) as they can address mental health concerns, regardless of immigration or insurance status. However, if the school does not have a partnership with a community-based health system or a free/low-cost medical service, then children may not be able to attain these services. These clinics represent a direct way to better address the needs of this population, but they can be improved dramatically.


Addressing Language Barriers in SBHCs
When unaccompanied children have access to SBHCs, they often have to face a language barrier in communicating their health needs. Because many providers at these schools only speak English, the student may suffer from delays in treatment and correct diagnostic proceedings. Although medically certified interpreters are an option, a lack of insurance payment from this population may make it difficult for schools to pay for their services. Interpreters come with their own barriers are they may not speak the preferred language or dialect of the child.

Furthermore, a report by the Migration Policy Institute found that “clinicians who cannot read medical records in the language of a child’s home country will lack a more comprehensive understanding of the medical services the child received prior to arrival in the United States.” To address these language barriers, more funding should be spent to train health professionals on the language and cultural backgrounds of the children.

Increasing Health Literacy
Unaccompanied children also face barriers to accessing healthcare due to their limited knowledge of navigating the healthcare system. Increased health literacy allows individuals who have access to care to better navigate the healthcare system, leading to more effective healthcare utilization and distribution of resources. Increased health literacy also gives knowledge of resources to individuals who do not have access to care, allowing them to supplement their health care.

For unaccompanied children, language and literacy barriers further complicate their understanding as they impose additional constraints. Children may not know what resources are available to them and how not receiving care can impact their enrollment in school activities. The difference between a primary care clinic, emergency room, and urgent care may be unknown. A lack of health literacy also leads to insufficient awareness of health professionals, health policies, and preventative care options.

Decolonizing Mental Health
To ensure unaccompanied children access mental health services, it is essential to decolonize mental health. Decolonization is defined by Fellner as ”an active, intentional, moment-to-moment process that involves critically undoing colonial ways of knowing, being, and doing, while privileging and embodying Indigenous ways of knowing, being, and doing.” Stigma and cultural norms may prevent children from seeking care. However, this stigma is often rooted against the Eurocentric definition of mental health.

Mental health categories are often generalizable to non-Western countries which removes the context of people’s lived experiences. Mental well-being is often associated with individual happiness instead of collective happiness, leading to a mistrust that patients have with authority. Quantitative data is often preferred as opposed to qualitative stories. These forms of colonization often prevent unaccompanied minors from prioritizing their mental health and well-being.

SBHCs have the opportunity to reimagine mental health care for migrants and refugees. By prioritizing the work of healers and addressing the root causes of mental health, SBHCs can destigmatize and provide multicultural encounters to their students.

Looking Ahead
With the global refugee crisis expected to worsen from climate change, it is important to serve one of the world’s most vulnerable populations and ensure their access to healthcare. The increase in the migration of unaccompanied children speaks to the fleeing from violence and poverty. Many unaccompanied children will remain in the United States permanently and addressing their health needs will only further serve their contribution to society. SBHCs are placed in a unique position to correct linguistic and cultural barriers, increase health literacy, and decolonize mental health to ensure the safety and health of unaccompanied migrant children.