Unaccompanied Migrant Children in Long-Term Foster Care: What Predicts Placement Changes and Mental Health Services Use?

Background

The number of unaccompanied children (UC) coming to the US has reached unprecedented levels. 95% of these children are placed with a sponsor, but the remaining 5% for whom a sponsor is not found are placed in long-term foster care (LTFC) while they await deportation and refugee status proceedings. In the empirical literature, very little is known about outcomes for these children, or even how to define optimal outcomes in relation to traditional child welfare goals of safety, permanency, and well-being. The purpose of this study is to examine correlates of permanency (in terms of changes of placement [COP]) and well-being (in terms of mental health services use [MH]) for UC in LTFC.

Methods

Data were provided by Lutheran Immigration and Refugee Service (LIRS) from 288 children in care from CY2012-CY2015. Chi-square analyses examined differences in COP and MH, respectively, by the following independent variables: current substance use; abandonment by caregiver (in home country, and/or US); neglect by caregiver in home country; experiencing violence in home country; fear of returning to home country; experiencing trauma (during migration journey, and/or unrelated to the journey); and behavioral acting out. Generalized linear mixed models examined predictors of COP and MH over time with time points (quarters) nested within children.

Results

12.8% experienced COP while in LTFC, and 83.1% accessed MH services (n=288). Chi-square analyses revealed greater COP for children experiencing substance abuse issues (p<.05), abandonment by caregiver in the US (p<.001), and acting out (p<.001), and fewer COP related to fear of returning to the home country (p<.05) and experiencing trauma unrelated to migration (p<.001). MH access was higher for children experiencing violence in home countries (p<.05), who feared returning to home countries (p<.001) and who experienced non-journey related trauma (p<.05). GLMM models revealed COP was more likely when children experienced abandonment by caregivers (OR=22.6; CI=4.2-122.0), violence in the home country (OR=3.1; CI=1.8-5.3), and acting out (OR=4.2; CI= 2.1-8.7), and less likely with fear of returning to the home country (OR=.27; CI=.12-.61) and non-journey related trauma (OR=.31; CI=.13-.72). MH use was more likely when children feared returning to the home country (OR=2.5; CI=1.3-4.6) and non-journey related trauma (OR=1.9 ; CI=1.1-3.2) and less likely with migration-related trauma (OR=0.5; CI=0.3-0.9).

Conclusions and Implications

Unaccompanied children in LTFC function similarly to children in domestic foster care, in that experiencing violence, substance use, and behavioral acting out predict COP. Yet, COP is less likely if children fear returning to their home country or have experienced trauma unrelated to migration. These patterns suggest that the “push” factors of migration may serve alternatively as risk or protective factors in maintaining permanency, particularly if the child’s fear of returning to the home country outweighs the risks of previous trauma and acting out. MH access is more likely if the child fears returning home, although is less likely if the child experienced trauma during migration. Negative experiences in children’s countries of origin should be addressed therapeutically while in care, particularly if the child reports traumatic events during the migration journey.