Examining the Current Access, Use, and Provision of Physical and Mental Health Services for Unaccompanied Immigrant Minors in Houston, Texas: A Qualitative Study

Background and Purpose: Asylum-seeking Unaccompanied Minors (UMs) who have crossed the United States (U.S.) border without a caregiver are likely the most vulnerable immigrants living in the U.S. These youth are initially cared for in shelters and then released into the community where their physical and mental health care needs often remain unmet. Studies have shown that UMs experience high levels of mental health distress and experience stress throughout their migration journey. Specifically, post-release, UMs continue to face uncertainty in multiple facets of their lives, including social, economic, physical, and environmental that are determinants to their health. The purpose of this study is to examine the current access, use, and provision of physical and mental health services by UMs currently living in Houston, Texas. The ultimate research aim is to create a coordinated system of access to health care services for UMs, based on the perspectives of UMs themselves, their caregivers, medical and mental health providers, and community leaders.

Methods: A qualitative case study method was used with community-based participatory research to examine the primary themes identified from six focus groups and two interviews with six former UMs, eight caregivers, and 22 community providers and leaders who interact with UMs regularly. Participants were asked about the needs and challenges of UMs, how UMs have felt about living in the U.S., how UMs are managing stress, and which services UMs are using in the community, including mental health services. The qualitative data was analyzed using a case study approach. Audio data from the focus groups and interviews were transcribed, translated, and organized. The qualitative data analysis computer program, MAXQDA Plus 2020 was used to organize and code all data.

Results: The qualitative results identified the following primary themes: (1) UMs biggest need is “everything,” (2) UMs are affected by discrimination and can be labeled as “bad,” and (3) the importance of working collaboratively with legal providers. The UMs, caregivers, and providers all noted that youth were often lacking basic needs in the community such as safe neighborhoods and access to medical and mental health services. Providers and caregivers noted that UMs experience discrimination in the U.S. and many caregivers talked about their UM as being labeled “bad” by other children. Caregivers and youth noted that legal issues were a significant source of stress that needed to be attended to first before addressing health needs.

Conclusions and Implications: Based on the qualitative themes, we propose the following framework of effective practices for health care providers working with UMs. First, all providers should work to understand UMs (e.g. each UMs situation is unique, everything is a challenge, there is uncertainty about the future, and UMs worry about deportation). Next, healthcare providers should consider the following sequential action steps with all UMs: (1) build trust, (2) empower UMs, and lastly (3) address the UMs physical and mental health needs. A best practices toolkit based on the qualitative data will be shared for supporting UMs in the community.