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Testimony Submitted for the Record: Senate Democratic Policy and Communications Committee Hearing on “America Speaks Out: Stop Trump’s Cruel Treatment of Migrant Children at the Border”

Submitted by Amy Cohen, MD, Child Psychiatrist, Mental Health Consultant to Flores Settlement Agreement Counsel, Member of Physicians for Human Rights Asylum Network

Hello, and thank you for inviting me to speak today.

My name is Amy Cohen and I am a child and family psychiatrist who has devoted most of my career to addressing the psychological needs of vulnerable and traumatized children. Over the past year, I have mostly worked with newly migrated children and families at the border, with parents separated from their children at Port Isabel, and as a mental health and, sometimes, medical consultant to Flores Settlement Agreement counsel. In this last capacity, I have visited Office of Refugee Resettlement (ORR) facilities, interviewed many children, poured over thousands of pages of records, and worked with the Special Master tasked by the Flores court judge to have independent oversight of children in custody. I have, in this, gotten a rare look inside an otherwise very opaque system of detention which now holds about 14,000 migrant children.

Today I will ask you to look beyond the border and to listen to what we are doing to the tens of thousands of children currently in government detention. I will ask that you embrace the full and true picture, which shows that this “crisis” is, in many ways, manufactured. The atrocities we are seeing in places like Clint and Ursula are not – as some would have us believe – the consequence of a migrant “surge,” but rather of U.S. policies and procedures which result in the unnecessary, protracted, and damaging detention of children who belong instead with family, with sponsors, and in communities.

Let us first dispel the notion that these children are coming as the pawns of adults who wish to use them to exploit “loopholes” through our immigration laws. As outlined in detail by the most recent report from Physicians for Human Rights, these children are coming because of the terrifying, life-threatening conditions they face in their home countries, where their local agencies of government can’t or won’t protect them. These children are exposed to and endangered by violence in their schools, on the streets, in their homes. They and their families risk the perils of the journey they undertake to this country in order to save their lives.

These children arrive at our border already vulnerable. We know that the effects of trauma are treatable. But we also know that these effects multiply, amplify, and are less amenable to treatment the more trauma these children endure.

Unfortunately, our policies of removing these children from their family and subjecting them to protracted detention pile trauma upon trauma. The results can be devastating.

The terrible toll exacted on children when separated from their parents is the most extreme trauma that a child can endure. It often results in something we call “toxic stress” – a condition which impacts many systems of the body, the brain, and the mind, and can lead to irreversible damage, even early death.

But when you think “separation” think not only of the separation from a parent, but also separation from whomever serves as a child’s anchor to safety and stability. For the thousands of children who arrive here in the care of grandparents, aunts, uncles, siblings, and who are taken from those guardians – these children, too, experience the dire consequences of toxic stress.

Another form of separation is experienced by those children who arrive truly “unaccompanied,” but bearing a name and phone number of a relative ready and willing to receive them. Their protracted detention, along with delays and denials in being united with their families, can be devastating.

And then there is the detrimental impact of ORR detention itself.

We have been keeping children detained for longer and longer periods. We must understand that it is for this reason – and not some “surge” at the border – that the system has swelled and backed up. We are taking these children, detaining them, and then failing to let them go in a timely fashion. And this is what is clogging the system.

The average length of stay for children in ORR facilities has been, since 2017, two to three times the average length of stay during the Obama administration. Do the math: if you keep children twice as long you will, in effect, have twice as many children in your facility.

And ORR facilities are bad places for kids. Anyone who imagines them to be “summer camps” is ignorant of the experience of children there. Kept away from the nurturance of loving family, forbidden to interact with peers in age-appropriate ways, restricted from engaging in activities which are essential to their growth and development, locked in with no agency to impact even what food they eat or, sometimes, what clothes they wear, let alone the more essential elements of their lives – children do poorly when kept in these rigid institutional facilities.

Beyond the ravages of institutionalization in general, there are specific issues with ORR facilities which make them dangerous places for children. We have all read the reports of sexual and physical abuse, educational inadequacy, and inadequate staff often inexperienced or poorly trained in caring for this population. Additional stressors exist for the many indigenous children whose inability to communicate with staff or peers leaves them isolated and marginalized.

Medical neglect is one major issue which has been documented in two facilities in New Jersey but is evident in many more. An eight-year-old I’ve worked with suffered an accident at an ORR facility in Texas which caused leg pain so severe that he needed a wheelchair. It was five days before he received medical attention, six days before he saw an orthopedist. He was diagnosed with a fracture of the femur. This fracture had transected the growth plate, meaning that negligent care could result in permanent deformity of that leg, impeding his ability to run, jump or even walk. We routinely hear stories like these about children with medical complaints who receive no attention or follow up.

Personnel in these facilities are not equipped to deal with the psychological and behavioral symptoms of trauma and are quick to refer these children to be medicated or hospitalized. Time and again, children whose behavior deteriorates due to the twin assaults of separation trauma and institutionalization are given improper psychiatric diagnoses, administered medication, unnecessarily hospitalized, and often transferred to increasingly restrictive environments.

Early this year, the Flores counsel team discovered that the government had been hiding that children were being sent to “treatment centers” off the grid. At one such place in Arkansas, children were assigned to therapists who spoke no Spanish. All the children interviewed were mystified as to why they’d been sent to this facility. All were being medicated, most with multiple psychotropic agents which produced side effects. None had been examined by a child psychiatrist and none knew the names or purposes of their medications.

The process of getting these kids released from detention and into the care of families is itself draconian, involving several layers of agencies which do not communicate with each other, with the proposed sponsor, or with the child. The burden is routinely placed on caregivers, and even parents to prove that they are worthy of caring for their children, with no counterbalancing appreciation for the cost of ongoing detention. Indeed, one Federal Field Specialist whose task was to approve or deny releases openly admitted that she herself nearly never meets with children, never speaks with sponsors, and does not in any way consider length of stay in her decisions about release.

What sort of things are parents and others subjected to before being permitted to bring home their own child? One mother’s 14-year-old daughter was in an ORR facility in a distant state. For weeks, the child had been complaining about vision problems with painful and swollen eyes, but the facility had refused to get her seen by an eye doctor. The mother – anxious to care for her child’s medical needs – quickly submitted all required paperwork, but was then presented with an escalating list of demands for more paperwork. Not until the mother produced her elder daughter’s summer school transcripts was she finally permitted to bring her child home and get her the care she needed.

Another parent who’d undergone cancer treatment was told that she must produce a doctor’s note showing that she was cancer free before she could get her child back. In other cases, parents and other relatives may be told that their child must have a room of their own and cannot share even with a same-sex sibling. This despite the fact that all children in ORR custody are in shared rooms.

Decisions denying the release of children from the hardships of detention are inconsistent, often arbitrary, and in no way comport with the manner in which such decisions would be made by social service agencies.

ORR has at various times imposed new rules which they claim are designed to keep children from harm, but which are not consistent with any evidence or data. About 20 percent of the 14,000 children in ORR custody are without the option of being placed with family. But ORR has forbidden placement with non-related sponsors, leaving these children stranded in indefinite detention.

How broken is this system? Those children crammed into windowless rooms, sitting in filth, sleeping on concrete slabs at places like Clint, could not leave, even if their own parents arrived to take them home, with all identifying paperwork in hand.

There is currently no consistent professional oversight of the treatment of these vulnerable children in government custody. ORR, CBP, and ICE are opaque agencies, closed off from evaluation by independent child welfare groups, revealing little about what goes on in their facilities, refusing true inspections by almost anyone other than those mandated by the Flores agreement, and even then, imposing limits on those inspections. For this and many other reasons, the Flores Agreement – now under attack – must be protected. While its provisions must be updated and codified, it is the only instrument currently able to mandate any oversight of these facilities and to protect these vulnerable children.

Congress needs a far more robust mechanism to provide the information necessary to inform policy. I would hope to see an independent commission with free and unfettered access to these facilities, one with interdisciplinary expertise which could provide oversight, reporting back to Congress on its findings and studying the impact of current policy on the lives of these children and families.

It has become trite, perhaps, but it is nonetheless true from a medical, developmental, and psychological standpoint: children do indeed belong with families. Their growth and development, the health of their current and future relationships, of their prospects educationally and vocationally all rest squarely on that familial bond on which every child relies. And children belong in communities, where they can not only gain from the stimulation and experience of community fellowship but can learn to give back and to be a contributing member to the larger family of others.

The increase in migration of children to our borders is the consequence of terrible circumstances in their home countries: circumstances which must be addressed in those countries of origin. But until they are, can we not agree that children running for their lives deserve our care and a chance to heal and grow? That policies which seek to harm these children – that are entirely contrary to all that we know about what is in their best interest – are simply not who we are or should be? That these policies demean us all and reduce our standing in the world? Surely as doctors and legislators, as human beings, we must be able to come together on this.

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