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Psychiatric-Legal Partnerships Addressing Family Separation at the Border and the Long-Term Effects of Trauma

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Abstract

A look at medicolegal considerations around the intersection of immigration law, politics, and health.
ARTICLES
Psychiatric–Legal Partnerships Addressing Family Separation
at the Border and the Long-Term Effects of Trauma
BY NOSHENE RANJBAR, MELANIE GLEASON, ESQ., MATT ERB, PT, AND KAREN ALEXANDER, PhD
In April 2018, the Trump administration initi-
ated its “zero tolerance” immigration policy,
which forcibly separated migrant children from
their parents upon crossing the southern border.
Many of these families ed instability and violence
in their home countries—and wanted to request
asylum. As of January 2019, the Department of
Homeland Security (DHS) had separated at least
Noshene Ranjbar is Assistant Professor of
Psychiatry at the University of Arizona College of
Medicine – Tucson, where she serves as Training
Director of Child and Adolescent Psychiatry Fellowship,
Division Chief of Child and Adolescent Psychiatry,
Fellowship Faculty at the University of Arizona Center
for Integrative Medicine, and Medical Director of the
Child and Adolescent Psychiatry and the Integrative
Psychiatry Clinics at Banner (https://psychiatry.
arizona.edu/patient-care/banner-university-medicine-
integrative-psychiatry-clinic). Born and Raised in Iran,
her academic interests include integrative psychiatry,
physician wellbeing and burnout, mind–body medicine,
and health disparities with focus on Native American
health. She serves as a volunteer psychiatrist for evalu-
ating asylum seeking individuals with the Arizona
Asylum Network and is active in the MIND clinic, a
free mental health clinic at the University of Arizona
which serves immigrant and underserved families. In
addition to her other roles, she serves as faculty at the
Center for Mind Body Medicine where she is involved in
building health promotion programs within Native com-
munities (www.cmbm.org).
Melanie Gleason, Esq. is an immigrant rights attor-
ney and founder of Attorney on the Move (www.attor-
neyonthemove.com), a pro bono project for asylum seekers.
The project has served asylum seekers in multiple deten-
tion centers throughout the United States, and on both
sides of the U.S./Mexico border—predominantly in greater
southern Arizona and west Texas. In addition to being an
immigration lawyer, Gleason is a writer and consultant/
coach for organizations and individuals working for social
change. Gleason is based out of the South Bronx, New York,
where she continues to focus on community lawyering.
Matt Erb, PT, is a physical therapist with specializa-
tion in mind-body medicine and integrative healthcare.
VOLUME 33 NUMBER 3 FALL 2019
2 AMERICAN JOURNAL OF FAMILY LAW
2,737 children from their families since the “zero
tolerance” policy was enacted. However, fami-
lies have been separated at the border since well
before 2018.1 In fact, a Government Accountability
Ofce (GAO) report showed that the percentage of
children separated from their families increased
tenfold between November 2016 and August
2017.2 Furthermore, since the ruling by Judge Dana
Sabraw in June 2018 that the Trump administra-
tion must stop the practice and reunite separated
families, an additional 245 children (as of the end
of February 2019) have been taken from their
parents.3
Professional organizations in the medical and
legal elds have publicly responded to the prac-
tice of separating migrant families. The American
Academy of Pediatrics (AAP) voiced strong oppo-
sition to family separation, including issuing
multiple statements since late 2016 decrying the
practice.4 The American Psychological Association
(APA) noted that separating a child from their fam-
ily is an adverse childhood experience that is one of
the “important social determinants of mental health
disorders.” The APA also noted that the policy
adversely affects immigrants already in the United
States by causing “feelings of stigmatization, social
exclusion, anger, and hopelessness, as well as fear
for the future.”5 Providing a legal perspective, the
American Bar Association (ABA) has said, “Policies
that separate children from their parents or deny
legitimate asylum-seekers due process violate both
our values and established law.”6
Forcible separations are traumatic, with poten-
tially lasting consequences for the health of the
families themselves, in addition to high costs for
society at large. Forced family separations can thus
result in thousands of traumatized, hurt individu-
als in need of healing. Without signicant reha-
bilitation, forced family separation can result in
intergenerational and communal trauma, affect-
ing many more people in the years to come. These
larger consequences are easily overlooked in imple-
menting such inhumane immigration policies.
This article draws on the stories of real families
who have suffered forcible separation to demon-
strate the adverse effects of the practice. It details
the potential mental and physical health conse-
quences of separation and how they can lead to
further societal harm. A trauma-informed approach
that lawyers can use in encounters with separated
children and adults is outlined, as well as sug-
gested ways to collaborate with mental health pro-
fessionals, and how lawyers can help.
FACES OF FAMILY SEPARATION: A FEW
OF THE STORIES
Ivette
Ivette7 is from a small municipality in coastal
El Salvador that is dominated by the MS-13 gang.
One day, she was with her infant son in her home
when she heard a series of gunshots and saw peo-
ple running into the street. After this incident, the
police arrived and knocked on her door—and put
a gun to her head. They demanded to know where
the perpetrators had gone. With her son in her
arms, Ivette said that she did not know and did not
see them. The policemen accused her of lying to
them and implied she belonged to a gang herself,
though they did not arrest her. Days later, she was
beaten by a group of men who threatened to kill
her, knowing that she had spoken to police. When
she ed to her mother’s home in another neighbor-
hood, rivaling gangs there identied her as having
come from another region, so they targeted her, too.
She decided to make the risky and arduous journey
north to the United States to seek asylum with her
3-year-old son in March 2018. She and her son were
apprehended by Texas Border Patrol agents when
crossing the border near McAllen, Texas. Her son
He is a Senior Faculty member and clinical supervisor
for The Center for Mind-Body Medicine (www.cmbm.
org) and teaches regularly in the elds of mind-body
medicine, integrative medicine, wellness, stress, and
trauma. He maintains a clinical practice in Tucson,
Arizona, and is working to expand the role of integrative
physiotherapy as part of integrated mental health care.
Karen Alexander, PhD, has years of experience
in higher education ranging across teaching, program
design, journal editing, and college administration. Her
areas of specialization include art, literature, lm, and
cultural production. She earned her PhD in literature
from the University of London. Karen began working
in the eld of XR technologies after being inspired by
the concept of virtual reality as an “empathy machine.”
Based on her belief that affordable, consumer-grade
360-degree cameras can help democratize media produc-
tion and facilitate citizen journalism, Karen founded a
program that empowers youth to create 360-degree vid-
eos that provide their perspectives on issues they care
about.
was forcibly taken from her and sent to a children’s
shelter in Chicago, while she was transferred to an
ICE detention center.
During the course of her asylum proceedings, ICE
produced an inconsistent and vague El Salvadoran
warrant for Ivette’s arrest, in connection with the
incident in which she was questioned by police—
which led to her rst attack.8 Ivette did not know
anything about the warrant until she was detained
in the United States. Although the Immigration
Judge in Ivette’s case examined the warrant and
deemed her to not be a risk to the public, she was
still denied bond, and the situation presents a trou-
bling precedent for other separated families.
Ivette has reported poor sleep and recurring
nightmares about her child being taken from her.
She has experienced a spike in blood pressure and
uncontrollable shaking. When she was allowed to
speak with her son on the phone from Chicago, she
was told that he hadn’t been eating. He has increas-
ingly withdrawn from her during their telephone
conversations, and now remains mostly silent. The
case workers at the shelter where he is held say that
he has trouble understanding what people say to
him, and he has regressed developmentally, to the
point where he now needs diapers.9
Julio and Brayan
After years of attacks and threats from gangs in
his native El Salvador, Julio feared for his and his
family’s safety and sought to escape. He brought
his 4-year-old son, Brayan, to the United States.
After Julio asked for asylum upon crossing the bor-
der, Customs and Border Protection (CBP) agents
forcibly took Brayan from Julio’s arms and sent
him to a temporary foster care agency in New York.
Upon arriving in New York, Brayan was assigned
an attorney from Catholic Charities of New York.
Although Brayan’s name was among those children
for whom they had records, there was no indication
in those records that Brayan had been separated
from his father or who or where his father was.10
When Julio spoke to a reporter, he sobbed as he
recounted the memory of his son screaming dur-
ing the separation. When it was nally discovered
that Julio was Brayan’s father, they were allowed to
speak by telephone. Brayan said to Julio, “You are
not my Papa anymore. I have a new Papa.” He also
called him “Papi,” a name that Julio says he had
never used before and which made him distraught
at the widening distance between him and his
son.11 Julio and Brayan were reunited in December
2018 after 11 weeks and after their story was made
public. CBP did not provide evidence to reporters
of why Julio was deemed a danger to Brayan, and
after the decision was reversed, DHS would not say
why.12
Mabel, Mino, and Erik
When Mabel Gonzales and her two teenage sons
crossed into the United States after the journey
from Honduras, she tried to signal to Border Patrol
agents that she was seeking asylum by waving a
water bottle over her head to get their attention.
This was in the summer of 2017, before the “zero-
tolerance” policy was ofcially in place. Mabel had
ed because two of her brothers and four other
family members had been killed by a criminal
organization in Honduras, and she feared for the
lives of her sons after moving from place to place
and still not managing to escape the gang’s notice.
Mabel was separately detained by Border Patrol
while her children were taken away.13 As of January
2019, Mabel was still being held in an ICE deten-
tion facility and was facing deportation, with her
last appeal pending.14 Mabel was confronted with
the heart-wrenching possibility that she would be
permanently separated from her children, and if
deported together, they would be returned to a sit-
uation of continued fear for their lives.
Separating a child from his/her parents is an
adverse childhood experience.
Mabel’s children are living with her sister,
Claudia, in Philadelphia while she remains in
detention in Texas. Mino was 15 when they were
rst apprehended by border agents, and Erik was
14. Claudia also came to the United States as an
asylum seeker, when she ed with her daugh-
ter after her husband was murdered by a gang in
2016. Claudia struggles to make ends meet and
wonders how she can provide for her own family
as well as Mabel’s boys. As for Mino, he has been
the victim of bullying by gangs in Philadelphia.
He reports being distracted in school by thoughts
of his mother, and Claudia says he has been par-
ticularly hard hit by the separation from Mabel.
At one point, the boys considered going back into
government detention on the chance they could
be reunited and released with their mother. But
PSYCHIATRIC–LEGAL PARTNERSHIPS ADDRESSING FAMILY SEPARATION AT THE BORDER 3
4 AMERICAN JOURNAL OF FAMILY LAW
Mino refused because it caused Erik to become
fearful.15 The prospects for these boys are fright-
ening, no matter which way they turn. A reporter
who interviewed Mabel in detention said that she
misses her children terribly and is only able to
speak to them once per week. “Her body shud-
dered when she spoke about them,” he wrote,
“and she cried without removing her eyeglasses
from her face.”16
ICE produced an inconsistent and vague
warrant.
These cases provide examples through which
to examine the administration-imposed policies
and practices that allow family separations to take
place. They also illustrate some of the emotional
and psychological effects of the separation and
shed light on the long-term health consequences for
children and parents.
SEPARATION DECISIONS AND THE
CONDITIONS OF DETENTION
Judge Sabraw’s injunction ending “zero toler-
ance” made it clear that the only reasons parents
should be separated from their children are if the
government deems the parent to be unt or if the
parent declines reunication. It follows that discre-
tionary decisions to separate migrant families who
cross the border are made by Border Patrol eld
agents. These agents are not trained in psychology,
social work, or child welfare, and can broadly inter-
pret what it means for a parent to be a danger to
their child. Of the 245 separations since the court-
ordered end to “zero tolerance,” “law enforcement”
was cited as the reason in 225 cases. According to
American Civil Liberties Union (ACLU) attor-
ney Lee Gelernt, “Families are being separated for
either minor crimes or unveried crimes—crimes
that would have little bearing on one’s tness to
be a parent, such as driving without a license.”17
A review conducted by the New York Times deter-
mined that some of the separations since Judge
Sabraw’s injunction were based on fraud convic-
tions, having a communicable disease, “a drunken-
driving conviction in the past, or a 20-year-old
nonviolent robbery conviction. In one case, a parent
had been convicted of possession of a small amount
of marijuana.”18 In Julio’s case, the claim that he
was a danger to his son because of suspected gang
activity was seemingly forgotten, with no evidence
provided.19
According to a February 2019 GAO report,
“prior to April 2018, CBP’s and ORR [Ofce of
Refugee Resettlement]’s data systems did not
include a designated eld to indicate that a child
was unaccompanied as a result of separation from
his or her parent.”20 The Ofce of Inspector General
(OIG) believes that “thousands of children may
have been separated during an inux that began in
2017, before the accounting required by the Court,
and HHS [Health & Human Services] has faced
challenges in identifying separated children.”21 This
leaves open the possibility that children might be
lost in the system, never to be reunited with their
parent. Though updates were made in those sys-
tems between April and August 2018 “to help
notate in their records when children are sepa-
rated from their parents,” the information is not
always communicated properly and border agents
say they are not required to provide this informa-
tion to the ORR, in whose custody the separated
children are placed.22 It is worth noting that in Julio
and Brayan’s case, they entered the United States
after these changes in the system were supposedly
made. Yet it was only by chance that advocates for
migrant families were able to discover that Brayan
was Julio’s son and that they had been separated.
As of mid-January 2019, the Department of Health
and Human Services held more than 10,500 chil-
dren in more than 100 facilities.23 In some cases,
these are minors who originally crossed the border
unaccompanied, but there is growing evidence that
many instances of family separation have yet to be
exposed, as reported by the OIG and others.24
The average detention time was 59 days in late
2018.
Separation from one’s family is traumatic in
itself, and the conditions under which many chil-
dren are held by the US government are also liable
to cause damage. It is easy to imagine the sense
of disappointment and hopelessness as the days
pass in detention, far from loved ones and with
no control over one’s future. But that is not the
only potentially traumatic result of detaining chil-
dren. Many facilities in which children are held are
PSYCHIATRIC–LEGAL PARTNERSHIPS ADDRESSING FAMILY SEPARATION AT THE BORDER 5
deemed “temporary” and therefore are “not sub-
ject to state regulations and inspections intended to
guarantee child welfare.”25 Requests from advocacy
groups and politicians who have sought to visit
detention camps to check on conditions have fre-
quently been ignored or denied.26 Although previ-
ously minors could only be held for 20 days under
the Flores settlement, the average detention time
as of late 2018 was 59 days.27 The Tornillo camp in
Texas, which sprung up in the rst half of 2018 and
quickly grew,28 with 6,200 children detained there,
was closed in January 2019 after HHS warned
about “serious health and safety” concerns.29 But
other unregulated detention camps are expanding
in size, suggesting that the problem is simply shift-
ing elsewhere.30
Deaths of Children
Two immigrant children died in detention in
December 2018.31 Eight-year-old Felipe Gomez
Alonzo became ill, was treated and released, and
then died after having been held for more than
twice as long as Border Patrol standards recom-
mend. Seven-year-old Jakelin Caal died of dehy-
dration and shock after 27 hours in detention. The
AAP notes the “egregious conditions in many of
the centers, including lack of bedding (e.g., sleeping
on cement oors), open toilets, no bathing facilities,
constant light exposure, conscation of belongings,
insufcient food and water, lack of access to legal
counsel, and a history of extremely cold tempera-
tures.”32 Regardless of whether they were separated
from their families or crossed the border alone, the
circumstances under which children are detained
are liable to be traumatic and to have lasting con-
sequences for physical and mental health and
development.
Children as young as 11 are administered
psychotropic drugs.
Migrant children in detention are also vulner-
able to sexual abuse. Charges of sexual assault have
been brought against multiple workers at shelters
around the country, with 4,556 alleged incidents
taking place from October 2014 to July 2018.33 Lax
practices make it easy for children to be victim-
ized.34 “If you’re a predator, it’s a gold mine,” is
how one psychiatrist described the situation. “You
have full access and then you have kids that have
already had this history of being victimized.”35
Contributing to the possibility of victimization
is the use of medications to ensure compliance.
Children as young as 11 are often administered psy-
chotropic medications without appropriate consent.
A class action lawsuit on behalf of these children
is under way, centering on the Shiloh psychiatric
facility in Texas, which is under contract with the
ORR. Refusing to take medication can result in
loss of privileges or threats of being written up in a
“signicant incident report,” which can be used to
justify delays in reuniting children with their fami-
lies.36 Such practices are unethical. In effect, chil-
dren are traumatized, forced to take medication to
numb them and keep them under control, and pun-
ished if they refuse.37
Ultimately, the responsibility for the long-term
harm being done to these children lies with those
who enact and execute these policies. Therefore,
immigrant advocates must jointly employ legal and
organizing strategies to put an end to the aforemen-
tioned practices altogether.
FAMILY SEPARATION, ADVERSE CHILDHOOD
EXPERIENCES, AND THE EFFECTS OF TRAUMA
Traumatic experiences such as forcible separation
and detention can have short-term and long-term
neurodevelopmental consequences for children, and
the implications for their future mental health as
surviving adults must be considered when examin-
ing the impact of family separation policies. These
experiences may be equally traumatic for the par-
ents. Additionally, trauma is known to have adverse
ripple effects for the professionals and healthcare
providers supporting the needs of those affected
and ultimately society as a whole.
Traumatic experiences can dysregulate the
autonomic nervous system.
The science and research behind Adverse
Childhood Experiences (ACEs) provides insight
into the potential costs of separation and deten-
tion for the individual and society. In general,
ACEs are stressful events experienced early in
life that are potentially traumatic and that trig-
ger physiological responses that can have lasting
6 AMERICAN JOURNAL OF FAMILY LAW
negative health effects.38 ACEs rst began to be
recognized after a landmark study conducted
by the Centers for Disease Control and Kaiser
Permanente was published in 1998.39 The study
revealed striking connections between experience
in childhood with abuse, neglect, violence, or sub-
stance abuse in the home, mental illness of fam-
ily members, parental separation or divorce, or
the incarceration of a family member and health.
The more ACEs one experiences, the more likely
one is to suffer from a range of physical health
consequences and behavioral issues. Having four
ACEs means an increased likelihood of hepati-
tis by 230 percent; of chronic pulmonary disease,
emphysema, or chronic bronchitis by around 400
percent; depression by 460 percent; and suicide
by 1,220 percent. Adverse childhood experiences
can have an impact on neurophysiological devel-
opment and may negatively affect an individual’s
capacity for empathy. ACEs contribute to mental
and physical health challenges such as unhealthy
coping habits and addictions, attention decit
hyperactivity disorder, chronic pain, stroke, can-
cer, heart disease, anxiety, rage, psychosis, neu-
roses, violence, risky health behaviors, and other
psychopathology.40
Psychological Changes
At any age, traumatic experiences can dysregu-
late structures such as the autonomic nervous sys-
tem (ANS) and the limbic brain, which are primary
neurophysiological correlates of fear and emotional
learning. Alteration in the functioning and volume
of the hippocampus, a primary center for mem-
ory retention and activation, is also documented.
Hypoactivation of key prefrontal cortical areas
(brain regions necessary for planned behavior and
higher cognitive processes) contributes to hypersen-
sitivity to further stress and a decreased ability to
mobilize judgment, make decisions, feel grounded
in one’s body, and have empathy for others.41
Conditions at detention centers are detrimental.
Similarly, hormonal changes occur under duress.
For example, increased levels of corticosteroids
play an important role in activating the adaptive
and defensive behavioral responses of the auto-
nomic nervous system. This occurs in intimate
relationship to the hypothalamic pituitary adre-
nal (HPA) axis, which can further disrupt circa-
dian cycles, inhibit conscious memory (amnesia),
increase inammation, suppress the immune sys-
tem, and contribute to psychophysiological states
of dissociation. Prolonged arousal can also lead to
lasting maladaptive behaviors.42
The Polyvagal Theory (PVT), which integrates
developmental neuroscience/biology, attachment
research, animal ecology, anthropology, and trauma
research, posits an adaptive hierarchy of responses
to threat, mediated by the ANS, but involving a
full organism response. PVT argues that the most
primitive response to stress is immobilization, or
“freezing,” mediated by excessive parasympathetic
system overdrive. The parasympathetic system in
non-demand conditions is responsible for maintain-
ing the homeostasis of daily bodily functions (“rest
and digest”) and acts as a counterbalance to the
sympathetic system, which mobilizes the body’s
resources to respond to any demand. The immobi-
lization response is considered evolutionarily pre-
served and is activated by the oldest branch of the
vagus nerve in humans. It is sometimes described
as feeling stuck, inert, unable to feel or act, and
causes avoidance and inhibition of the capacity for
positive social engagement with others.43 A high
level of sympathetic activation is often coined the
“ght or ight” response and is evolutionarily con-
sidered the next step up from the freeze response as
a defensive option when faced with threat.
Figure 1 illustrates the autonomic nervous sys-
tem responses and examples of extremes. Ivette’s
young son’s increasing silence, his seeming loss
of the ability to hear or understand others, and
his regression to needing diapers may represent
immobilization due to parasympathetic overdrive
in response to stressful conditions, as illustrated by
the lower arc in Figure 1. At his young age, biologi-
cal systems that are still developing can be forever
compromised by high or sustained stress, resulting
in impaired functioning of the nervous, immune,
and endocrine systems, among others. Effects on
the ability to self-regulate can lead to physical
health problems as well as dysfunctional behav-
iors such as violence and substance abuse.44 Such
lifelong health consequences bear a societal cost as
well as an individual one.
Medical Evidence Shows . . .
Family separation and detention is also trau-
matic for the parents. Ivette’s symptoms—inability
to sleep, recurring nightmares, and a spike in
blood pressure—are characteristic of hyperac-
tivation of the sympathetic nervous system (as
represented by the upper arc in Figure 1). Post-
traumatic stress disorder (PTSD) is often accom-
panied by the re-experience of the original trauma
with intrusive recollections, nightmares, ash-
backs, and intense distress at any reminders of the
trauma. Sleep disturbances, persistent increased
or decreased arousal, irritability, concentration
impairment, hyper-vigilance, exaggerated startle
response, and heightened physiological reactiv-
ity are all examples of challenges associated with
PTSD. Furthermore, medical evidence shows that
even if Ivette, her child, or any of the other fami-
lies who have been separated at the border are
not diagnosed as having PTSD, the experiences
of extreme or prolonged stress can exist as under-
lying determinants of numerous adverse health
conditions.45
Adjustment disorder is the prolonged develop-
ment of anxiety and depression after an identi-
able psychological stressor. This can be triggered
by forced separation from a parent; for example,
early childhood divorce (before 6 years of age) has
been associated with long-term increases in anx-
ious, hyperactive, and oppositional behaviors.46
Attention decit hyperactivity disorder (ADHD)
can arise from a chronic stress response, resulting
in impaired memory and attention, hyperactiv-
ity, and impulsivity. Oppositional Deant Disorder
(ODD) is the inability to respect authority, build
trust, and manage difcult or unpleasant emotions,
as a result of chronic stress in a stressful environ-
ment. In Disruptive Mood Dysregulation Disorder
(DMDD), children are persistently irritable, with
angry outbursts, often as a response to overwhelm-
ing stressors in their lives. By minimizing and
addressing the harmful effects of trauma as soon
as possible, many of these adverse effects can be
reduced.47
Funding for expert assessments is often
lacking.
Research has shown that it is difcult to maintain
a sense of trust and intimacy among family members
when they are separated for long periods. Younger
children tend to withdraw emotionally from their
mothers in these circumstances, and to form attach-
ments with substitute caregivers. This process
appears to have begun in Brayan’s case, as evidenced
by his phone calls with his father before they were
reunited. Older children often react with aggressive
behavior. Reunication after an extended period can
be disorienting. Depending on the length of time and
the age of the children, the sense of familiarity with
the parents may have been dimmed. Reunication is
also made difcult by anxiety on the part of children,
as in the case of Mabel’s son Erik, and parents have
difculty reestablishing their authority.48
Figure 1
PSYCHIATRIC–LEGAL PARTNERSHIPS ADDRESSING FAMILY SEPARATION AT THE BORDER 7
8 AMERICAN JOURNAL OF FAMILY LAW
The experience of being forcibly separated from
one’s parents and placed into an unhospitable envi-
ronment is undoubtedly highly stressful. Early
loss of the experience of safety, nurturance, and/or
healthy boundaries also contributes to a loss of one’s
psychospiritual footing and/or moral compass. It is
important to note that the families separated at the
border are often eeing highly stressful and dan-
gerous situations to begin with, and the journey
to come to the United States may itself be rife with
stressors. As noted, conditions at detainment facili-
ties are themselves often highly detrimental to the
children. Thus, the potential for signicant health
consequences is increased for the children who are
taken from their families by adding on more ACEs.
Considering the thousands of migrant children who
have been separated from their families or who are
held in detention, the societal impacts will be great
when they become adults aficted by mental, physi-
cal, emotional, and behavioral problems.
TRAUMA AWARENESS FOR LEGAL
PROFESSIONALS
Professionals who interact with families and
individuals who have suffered through separations
need to be aware of the effects of ACEs, stress, and
trauma. Taking a trauma-informed approach to
encounters with separated families can help affected
individuals cope. While introducing trauma aware-
ness is important, it does not address the full impact
of the cruelties of the policy and should not be seen
as an adequate response or way to “x the problem.”
There is a need for lawyers to offer pro bono
services.
Knowledge about the mechanisms of trauma
and adverse childhood experiences can also inform
approaches to legal recourse on behalf of the sepa-
rated families. Lawyers who are equipped with med-
ical facts about the impact of traumatic events such
as forcible family separation can better advocate for
individuals as they struggle for justice within the
legal system. Additionally, information about the
health and societal consequences of family separation
can contribute to legal cases challenging the policy.
Understanding trauma and trauma-informed
care is essential for those who interact with
children, including juvenile detention centers, law
enforcement, parents and extended relatives, law-
yers, teachers, physicians, therapists, and orga-
nizations focused on supporting children. Every
profession or individual that engages with children
can take on the important role of making decisions
and providing services in a trauma-informed way
and referring children with warning signs of emo-
tional distress to community resources when avail-
able to address their needs.
The sad reality is that those held in detention are
unlikely to receive the mental health care and com-
passion needed to help alleviate their suffering and
mitigate the consequences of trauma. In the absence
of resources to provide mental health care to these
children in need, legal professionals who work with
forcibly separated families can adopt trauma-aware
behaviors in the client encounter that may help to
avoid exacerbating their suffering.
Trauma-Informed Care (TIC) “emphasizes
physical, psychological, and emotional safety for
both providers and survivors, and creates oppor-
tunities to rebuild a sense of control and empow-
erment.”49 Evidence has shown that the simple act
of inquiring about and listening to a person’s trau-
matic experiences such as ACEs can in itself have
a positive effect on health outcomes for that indi-
vidual.50 Practicing trauma awareness or trauma-
informed care does not equate to providing mental
health services. Nevertheless, even profession-
als who are not qualied mental health providers
can help traumatized children and adults through
taking a trauma-informed and compassionate
approach.51
Guidance for Lawyers
Drawing from a variety of sources in the mental
health and legal spheres, we have developed the
principles below to guide lawyers when working
with clients who may have experienced trauma.
Empowerment: Assume strengths and skills
on the part of the client and utilize those in the
encounter.
Choice: Provide options and allow for client
preferences.
Collaboration: Where possible and appropri-
ate, involve a team that may include other fam-
ily members, facility staff, healthcare providers,
or others.
Trustworthiness: Communicate clear expecta-
tions about the process to the client. Do not pro-
vide false assurances.
Safety: Avoid judgement or criticism in order
to maintain an atmosphere of emotional safety.52
In a trauma-aware encounter, the professional
engages in direct inquiry about the person’s story
and experiences without judgment, while remain-
ing mindful of their own and the client’s body lan-
guage and tone of voice. It is important to maintain
a relaxed posture, caring facial expression, and
soft tone of voice, regardless of the response. Give
the client time to respond, without rushing them.53
Simple practices like invitations to breathe softly
together can also help in the moment and serves as
a tool that can mitigate stress by accessing regula-
tion and resilience capacity.
BUILDING A CASE: PSYCHIATRIC–LEGAL
PARTNERSHIPS
Partnerships between mental health and legal
professionals can be strategically deployed in par-
ticular cases. Asylum cases are often bolstered by a
mental health professional’s psychiatric evaluation
and potential expert witness testimony. Lawyers
can help choose an evaluator who has specialized
knowledge of ACEs, trauma, and their effects. This
will allow the psychiatrist to speak to the ability of
the client to advocate for themselves and the ways
that traumatic experiences—whether those that
led the client to seek asylum, those experienced
on the arduous journey north, or those result-
ing from encounters with and detention by US
agents—affect the client’s health. This may include
expert testimony regarding the way memory can
be compromised by trauma exposure through
neurobiological effects, making the client appear
to be unreliable and potentially resulting in an
adverse credibility nding. Trauma exposure can
also inuence ways that clients present themselves
at hearings and proceedings. A client who is expe-
riencing parasympathetic overdrive, for example,
might appear withdrawn, apathetic, and disen-
gaged, which may send an unintended signal to
adjudicators.
Because funding for expert assessments is
often lacking, this work is mostly done on a pro
bono basis. Psychiatrists can contribute by per-
forming mental health evaluations and making
recommendations for asylum cases in collaboration
with community organizations who facilitate these
processes.
RECOMMENDATIONS
The authors of this article strongly believe that
forcible family separations are devastating and
have no place in this country. Based on the evi-
dence of long-term health effects and societal
consequences, we make the following recommen-
dations for lawyers, policy makers, and mental
health professionals.
1. Children should never be forcibly separated
from their parents, except in cases of abuse
or neglect where the child’s safety is com-
promised and separation is clearly in the best
interest of the child.
2. Migrant children who have been separated
from their parents outside of the exceptions
above must be reunited immediately to mini-
mize the trauma and should be provided
with nurturing resources to mitigate the lin-
gering adverse effects.
3. When families are not reunied, profession-
als who work with them should be trained
in trauma-informed models in order to avoid
invalidating or exacerbating the wounds
caused by separation or magnifying the effect
of the already existing trauma. This includes:
Do not punish children when they
exhibit aggressive behaviors or other
manifestations of a hyper-aroused
trauma-state. Instead support a forum for
regulation (e.g., breathing) and sharing.
Do not tell children or adults that they
shouldn’t cry, scream, or express their
difcult emotions such as fear, horror,
disgust, sadness, grief, etc. Instead, nor-
malize feelings and express care and
understanding.
Do not expect or tell those who have
been separated from their families
to “just get over it” or “pull yourself
together.” Instead, let the individual
know that you are there for them.
PSYCHIATRIC–LEGAL PARTNERSHIPS ADDRESSING FAMILY SEPARATION AT THE BORDER 9
10 AMERICAN JOURNAL OF FAMILY LAW
Treat asylees and migrants as human
beings deserving of respect and dignity.
Provide a compassionate listening ear,
a shoulder to cry on, validation, and
support.
Be honest about expectations of the pro-
cess and don’t seed false hopes.
As a background for all of this, the pro-
fessional working with traumatized chil-
dren and families must be capable of
their own self-care including emotional
awareness and self-regulation.
4. When preparing an asylum case, attorneys
should seek the assistance of mental health
professionals trained in trauma who can
evaluate asylees/separated family members
to bolster the asylum claim and who can
potentially serve as expert witnesses.
5. Attorneys should continue to advocate for
the cessation of the family separation policy
and should strategically challenge such poli-
cies, including collaborative impact litigation.
6. The public should continue to be made
aware of the societal effects of family separa-
tion. ACEs and trauma are devastating, and
when thousands are affected, harm can rip-
ple out with highly detrimental results.
7. Political leaders making policy decisions
related to immigrant families must be alerted
to the adverse consequences of trauma on
the lives of the families and the communities
affected by their plights. They must know
this trauma takes a grave human and societal
toll and that it requires ongoing and costly
resources to address the continued impact of
these policies.
A Call to Action for All Lawyers
There is also a need for attorneys to offer pro
bono services both on the border and throughout
the United States, and for mental health profession-
als to collaborate with the legal team in providing
care and advocacy. Pro bono lawyers taking on asy-
lum cases can reach out to local universities, who
may have psychiatry or psychology faculty willing
to provide evaluations and mental health services
on a volunteer basis. Some medical schools also
offer free clinics that can be a valuable resource;
examples include the University of Arizona’s
Mental Illness and Neuropsychiatric Disorders
(MIND) Clinic and Commitment to Underserved
People (CUP) Program.
There are a number of pro bono opportunities
for lawyers, and one need not be a trained immi-
gration attorney, as aid organizations often work
with a variety of pro bono lawyers. There are
volunteer opportunities ranging in time commit-
ments from going to the border to volunteer for
a week or two, to fully representing an asylum
seeker during their individual hearing in immi-
gration court or representing them on appeal. In
general, lawyers are encouraged to contribute
however they can, and ideally to take on an entire
asylum case.
Immigration Legal Services Organizations Along
the Border (Ideal for a One- or Two-Week
Commitment)
Al Otro Lado (Tijuana, Mexico)
CARA Pro Bono Project (Dilley, Texas)
RAICES (Karnes City and throughout Texas)
To nd the closest immigration legal services
organization/detention center near you to volun-
teer (ideal for short-term to longer-term commit-
ments, such as directly representing an asylum
seeker at their individual hearing):
Immigrationlawhelp.org
To represent an asylum seeker on appeal (via
a written appeal to the Board of Immigration
Appeals):
CLINIC’s BIA Pro Bono Appeals Project
By doing pro bono work, lawyers have the
opportunity to help families cope with the extreme
stresses and trauma of separation and detention.
Lawyers using methods of trauma awareness can
also help reassure separated families that their lives
and stories matter. The simple validation and afr-
mation of humanity inherent in trauma-informed
approaches are small but meaningful victories in
the battle against dehumanization.
Immigrant detention and family separation are
inhumane. The policy of family separation inicts
devastating wounds on migrant families already
in a precarious situation. Legal professionals
have the opportunity to come into contact with
those who have suffered under these inhumane
policies. Understanding the potential long-term
health consequences of events such as family sep-
aration can help lawyers better represent asylum
seekers and build a case for stopping the practice
via impact litigation and working closely with
activist organizations calling for an end to these
practices.
NOTES
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PSYCHIATRIC–LEGAL PARTNERSHIPS ADDRESSING FAMILY SEPARATION AT THE BORDER 13
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Reprinted from American Journal of Family Law, Volume 33, Number 3, Fall 2019,
pages 325–337, with permission from Wolters Kluwer, New York, NY,
1-800-638-8437, www.WoltersKluwerLR.com
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The trauma field must develop theories and methods that are capable of describing a range of adaptive and maladaptive posttraumatic adjustment trajectories, predicting which subgroups are at risk for moving into specific adjustment trajectories, explaining the configurations and causal pathways through which beneficial and adverse causal factors intersect to influence the course of posttraumatic adjustment; and guiding wellness-oriented interventions to maximize the proportion of trauma-exposed groups that enter adaptive posttraumatic adjustment trajectories. Accordingly, this chapter will address four basic questions: (1) What configurations are adverse and beneficial life events and circumstances likely to form as they intersect and combine to influence wellness-related outcomes in populations at risk for various forms of trauma exposure? (2) What common adaptive and maladaptive posttraumatic adjustment trajectories may trauma-exposed individuals enter as the joint consequence of their trauma exposure and the adverse (e.g. vulnerability) and beneficial (e.g. protective) factors that make up their surrounding ecological contexts? (3) What specific attributes of beneficial resources may influence the degree to which they help individuals to cope with specific types of trauma or other major adversities? (4) What constellations of beneficial and adverse causal factors make up the life caravans of individuals who exhibit similar posttraumatic adjustment trajectories? In responding to these questions, we first unpack five content domains relevant to designing wellness-oriented public health interventions, and then integrate these strands in clinically and theoretically informative ways. We then draw on Conservation of Resources (COR) theory (Hobfoll 1988, 1998) to illustrate the implications that interweaving these five elements holds for designing and implementing wellness-oriented interventions. Our aim is to assist in laying the groundwork for a general wellness-oriented public health approach to intervention across a diverse range of trauma types and severe hardships, an approach that places high priority on prevention, the accurate identification of at-risk subgroups, and effective early intervention with subgroups deemed at high risk. We hope that this framework will serve as a heuristic tool that stimulates further research and intervention-related applications. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Objective: Early adverse childhood experiences (ACEs) have been linked to the development of both internalizing and externalizing psychopathology. In our prior work, we found that ACEs predicted reductions in the volume of the inferior frontal gyrus (IFG), a brain region important for impulse control and emotion regulation. Here we tested the hypothesis that ACEs might influence child behavioral outcomes through an impact on IFG functional connectivity, which may influence impulsive or risk-taking behavior. Method: We examined the effects of prospectively assessed ACEs on IFG connectivity in childhood, and their relationship to the trajectory of subsequent psychopathology from late school age and early adolescence, using data from an 11-year longitudinal study of children starting in preschool that included 3 waves of resting state functional connectivity across childhood and early adolescence. Results: ACEs predicted functional connectivity of both left and right IFG. Multi-level modeling of symptoms across 3 waves of assessments indicated that more ACEs predicted both internalizing and externalizing symptoms. However, altered IFG connectivity specifically predicted greater externalizing symptoms over time in middle childhood and early adolescence, as compared to internalizing symptoms. Longitudinal modeling indicating that the relationships between externalizing and functional connectivity were maintained across 3 waves of functional connectivity assessment. Conclusion: These findings underscore the relationship of ACEs to later psychopathology, and suggest that connectivity of the IFG, a region known to play an important role in impulse control and emotion regulation, may play a key role in the risk trajectory of ACEs to externalizing problems. However, further work is needed to understand whether these relationships reflect a direct effect of ACEs or whether ACEs are a marker for other environmental or genetic factors that may also influence brain development and behavior.
Article
When The Body Bears the Burden made its debut in 2001, it changed the way people thought about trauma, PTSD, and the treatment of chronic stress disorders. Now in its third edition, this revered text offers a fully updated and revised analysis of the relationship between mind, body, and the processing of trauma. Here, clinicians will find detailed, thorough explorations of some of neurobiology’s fundamental tenets, the connections between mind, brain, and body, and the many and varied ways that symptoms of traumatic stress become visible to those who know to look for them.
Article
We employed an autoregressive modelling technique with data from the Québec Longitudinal Study to prospectively examine the developmental impact of family transition on behaviour while controlling for predivorce and preremarriage effects. Teachers rated children's anxious, hyperactive, physically aggressive, oppositional, and prosocial behaviour every 2 years from kindergarten through to the end of elementary school. Once individual and parental characteristics and antecedent family events were controlled, children who experienced parental divorce before age 6 exhibited comparatively more behavioural disturbance than their peers whose parents divorced later. With the exception of a protective effect on hyperactive behaviour, remarriage did not have a significant impact on children's behaviour when the legacy of divorce was controlled. Although the results suggest that children of divorced parents show difficulty in many areas of functioning, the effects of family transition on behavioural development were dependent on the child's age and the specific behavioural dimension assessed. Compared to other points in development, early childhood divorce was associated with long-term increases in anxious, hyperactive, and oppositional behaviour during later childhood. The effects of divorce on children's fighting were short-lived. Unlike previous prospective studies that suggest predivorce effects, we did not observe behavioural disturbance prior to divorce or remarriage.