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At 15 years old, Javier Sandoval’s* mom told him it was time to leave his home in El Salvador for the U.S. She said he was now old enough to carry a gun and she was worried it was only days before local gang members would forcibly recruit him into their ranks.
Leaving behind his mom and siblings, Sandoval headed to the US-Mexico border on foot and crammed into vehicles with other migrants fleeing the violence and poverty of El Salvador.
It took Sandoval 15 days to reach the Rio Grande, which kept him a short distance from U.S. soil. “To cross, we had to go with 10 other people on a boat that looked like it could hold only one person,” said Sandoval in Spanish.
Once he reached U.S. soil, Sandoval was instructed to go to the top of a hill and wait for Border Patrol officers to find him and take him into custody. “I remember people saying that the officers would come get us and take us somewhere nice and that we wouldn’t need anything. We would have everything we needed,” said Sandoval.
He wasn’t prepared for what he faced once in the custody of U.S. Customs and Border Protection. Sandoval said he was taken to an overcrowded detention center in Texas, where he would be held for 10 days, surpassing the maximum 72 hours minors are to be held in detention before being transferred to the custody of the Health and Human Services, Office of Refugee Resettlement, who places unaccompanied minors in a shelter while family members are located to take them in.
“When I got there, it was so crowded. I was looking around and thinking, where am I going to sleep? There was a lot of kids standing, taking turns to lay down and go to sleep,” said Sandoval. “As they were booking me, the officers said ‘Welcome, this is your new home’. And when they said that, I got a really bad feeling.”
He said there were no private restrooms and they were not allowed to shower or go outdoors.
“We wanted to see the sun because the lights were on inside all the time. They would wake us up all the time, they wouldn’t let us sleep,” said Sandoval. “I wanted to cry. I thought, ‘God why am I here. Why did I come?’”
In 2014, Sandoval was one of nearly 70,000 unaccompanied minors who traveled to the U.S. without a parent or guardian to escape the widespread violence in El Salvador, Guatemala and Honduras. The region of Central America, known as the Northern Triangle, has been left with a legacy of violence, lack of economic opportunity and weak institutions following the CIA-backed coups and ensuing bloody civil wars that rocked the region in the 80s.
The ongoing migration has brought an additional 40,000 unaccompanied minors into the U.S. every year since 2014, who have faced harrowing journeys fraught with violence and danger. Many have been victims of sexual assault, robbery, forced labor and lengthy periods of time without food or water.
For Sandoval, arriving in the U.S. to be held in an overcrowded detention center was just one of numerous traumatic experiences throughout his journey and it wasn’t until he was enrolled in a high school in the Los Angeles Unified School District, that he was referred to see a mental health specialist at one of the district’s many Wellness Centers.
Like many unaccompanied minors that have faced similar circumstances, Sandoval was suffering from depression and post-traumatic stress disorder. Mental health organizations were unprepared for the influx of unaccompanied minors, but to ensure the 6,800 unaccompanied minors resettled in Los Angeles County since 2014 received proper care, nonprofit legal services organizations partnered with mental health organizations to refer children to mental health providers.
“As part of when we first started talking to these children for their cases, a lot of them were so traumatized that we found we really needed to integrate a psychological evaluation before we could even start talking to them about their stories,” said Teresa Borden, a spokesperson for the Central American Resource Center (CARECEN), that provides pro bono legal assistance to unaccompanied minors.
CARECEN, along with Esperanza Immigrants Rights Project and Public Counsel, partnered with nonprofit mental health services organizations, including Amanecer Community Counseling and St. John’s Well Child and Family Center, to refer children to mental health providers before forming their cases.
Many unaccompanied minors qualify for Special Immigrant Juvenile Status (SIJS) which gives children under the age of 21 a green card if they can prove in court that it is not in their best interest to return to their country.
St. John’s therapists do assessments for unaccompanied minors represented by CARECEN by documenting the child’s history of trauma, research of the country and the abuse - socially and familial - to show in court that if child returns to their country, it could lead to suicide or the debilitation of their mental state. Raza said the screenings they’ve conducted have determined most all the unaccompanied minors were in need of mental health services.
“Going into therapy is helpful because it helps them to first tell their story which helps us figure out what their asylum claim is, but it also helps in their grueling 2 to 3 hour interview with an asylum officer that is going to ask them about every detail of the harm that they’ve faced,” said Arisa Raza, a staff attorney with the unaccompanied minors department at CARECEN.
Undocumented children have always been eligible for services through the Los Angeles County Department of Mental Health, but in response to the crisis of 2014, the Department of Mental Health created the Unaccompanied Minor’s Program, said Rebeca Hurtado, mental health clinical supervisor with the Department of Mental Health.
In October 2015, the Department of Mental Health leveraged $1.7 million of Mental Health Services Act dollars to fund 13 different agencies throughout the county to provide mental health services free of charge to unaccompanied minors through June 2017.
Through the Unaccompanied Minors Program, the agencies, including the Los Angeles Unified School District (LAUSD) and Didi Hirsch Mental Health Services, have provided services to more than 100 unaccompanied minors since the program started in October 2015.
LAUSD offers physical and mental health screenings to immigrant and refugee students that enroll through the district’s School Enrollment and Placement Assessment Center and refers students for mental health services at one of 14 wellness centers and 8 mental health clinics.
“We know that mental health is keenly tied to the whole child and mental health could affect their schooling because they may have behavior where they’re distracted or checked out and may not take full opportunity of their academic grasp,” said Pia Escudero, director of LAUSD’s School Mental Health. “Early intervention is key, so as soon as we see symptoms, we connect students to resources.”
Sandoval is a sophomore at a high school in South Los Angeles where he participates in individual and group therapy sessions at a Wellness Center located on the school’s campus.
“Before the therapy, I felt alone, I didn’t have any friends because I kept thinking about my family. I would isolate myself [...] But now, I have met more people and it has helped me a lot to come to the meetings and share with everybody else,” said Sandoval.
Sandoval has made friends from El Salvador, Honduras and Guatemala that he met through the group therapy sessions that are used throughout LAUSD to help unaccompanied minors meet one another and share their experiences in a safe space.
“I saw things I’ve never seen, I did things I’ve never done [...] and here we can discuss our different traumas, whatever is said there stays there. It has been very valuable for me because it has helped me to overcome things that I have lived through,” said Sandoval.
Adjusting to life in the U.S.
Sandoval said it has been difficult to adjust to life in the United States. He needed to get accustomed to life in a new home and a new school, but his biggest challenge he said has been learning English.
For unaccompanied minors, this period of adjustment could be drawn out and difficult and could prevent children from realizing their need for mental health services.
“Many kids try to deal with adjustment first, then the trauma later,” said Elena Fernandez, behavioral health director at St. John’s Well Child and Family Center, that started it’s Nuestra Promesa Program in 2014 to provide mental health services to unaccompanied minors.
Sandoval is now living with family members, that prior to coming, he hadn’t seen since he was a small child. “It’s not the same living with family that you know, but you’ve never lived with before. It’s hard,” said Sandoval.
Adjusting to life in a new home doesn’t go as smoothly for some children and problems between them and their sponsors can lead to them being transferred into the custody of the Department of Child and Family Services. In 2015, more than 30 unaccompanied minors were put in the custody of the Department of Child and Family Services.
“Sometimes the sponsor or relative doesn’t anticipate that the child will have mental health issues or behavioral problems. In some of those cases, the sponsors call us and say they no longer want to care for the minor,” said Cecilia Saco, supervising children’s social worker at the Department of Child and Family Services.
The Office of Refugee Resettlement is required to provide post-release services in cases in which a home study was conducted prior to an unaccompanied minor’s release to a sponsor or in cases in which children have mental health needs. The services include assistance to ensure the sponsor provides a safe environment, as well as assistance accessing legal, medical, mental health, and educational services, and initiating steps to establish guardianship.
According to a recent report by the Government Accountability Office, a relatively small percentage of unaccompanied minors received post-release services and the responsibility of the Office of Refugee Resettlement for most children typically ended once custody was transferred to their sponsors. According to the report, the Office of Refugee Resettlement recently expanded post-release services to children released to non-relative or distant relative sponsors.
“Sometimes the assessment of the home by the Office of Refugee Resettlement is done so quickly that they miss certain things. In some cases, these children don’t know their relatives or there’s issues when children are reunited with their parent after a long period of time. These issues can cause problems and the Office of Refugee Resettlement doesn’t monitor the stabilization of the cases,” said Saco.
To help with the adjustment process, St. John’s Nuestra Promesa Program and Didi Hirsch offer family counseling and support groups for sponsors who are having problems with the children.
“We try to include the whole family in the treatment because it’s not just the child. It usually affects the families and home environment,” said Oscar Gonzalez, program director of Didi Hirsch Metro’s Unaccompanied Minor Program.
Some may still be left without care
In May, more than 170,000 undocumented children became eligible for full-scope Medi-Cal when Senate Bill 75 took effect. Although eligible undocumented children can now receive mental health services, Gonzalez believes that many will still be hesitant to reach out for help.
"Based in experience of working with the [undocumented] population, they are hesitant in asking for help for various reasons. We’ve heard from people that they are worried they will be deported or that if they access a public service, it will affect their immigration case and they may not be eligible for residency,” said Gonzalez.
When Didi Hirsch’s Unaccompanied Minors Program started in 2015, Gonzalez said it was a challenge to get clients to access services through the program.
“It's taken a lot of outreach and we’ve been trying to develop partnerships with schools, legal providers and the Department of Child and Family Services to get clients. We’ve been trying to do everything we can to get the word out there and we are starting to see the fruits of our labor,” said Gonzalez.
The stigma surrounding mental illness in the Latino community has also proved to be an obstacle, said Gonzalez. But having children access services in order to form their asylum cases has helped break through the stigma. Gonzalez said many children have remained in therapy even after their cases are settled.
“The issue is convincing them that this is good for them because the stigma holds some people back. But on the legal side, we frame it as beneficial to their case and that opens up an opportunity for them to get therapy and healing,” said Raza.
Addressing other needs
Nuestra Promesa has 4 case managers whose job is to advocate for unaccompanied minors and get them enrolled in school, get them proper health care and proper placement in school.
“I would say these kids need two things - therapy for all the trauma they’ve experienced and someone to help them access resources because a lot of them come in with basic needs, like housing, food, clothing and legal resources,” said Gonzalez.
The need to expand services outside of L.A. County has been echoed by many working with this population.
“Sometimes they come from the Inland Empire or Ventura County and it's been a challenge finding mental health services organizations to refer them to outside of the county because there is no organizations out there or very few,” said Raza.
A bright future
Following a difficult adjustment period, Sandoval said he likes going to school now. “I have friends here, they have become like family,” said Sandoval.
“We find that these kids and these families are so resilient. They go through so much just looking for a better future and despite all the things that happen, they always come above it,” said Gonzalez. “Sometimes the therapy process helps instill the hope in them that things will get better,” said Oscar Gonzalez.
Sandoval said he misses his family, but he speaks to his mom over the phone often. “I want to study hard and get a career and one day be a journalist,” said Sandoval. “Eventually I want to go back to El Salvador and see my mom.”
This article was produced as a project for the USC Center for Health Journalism's California Fellowship.
*name changed for privacy.