Assessment of Mental Distress with Unaccompanied Children the United States: Case Manager Experiences and Perspectives

Background and Purpose: Unaccompanied Children are a growing and at-risk population of immigrants arriving to the United States, mostly from El Salvador, Guatemala, or Honduras. Research indicates unaccompanied children experience trauma before, during, and after their migration to the US, and mental health symptoms may not align with existing assessment tools. A gap in the literature is understanding how mental health of unaccompanied children is measured. This qualitative study examines the perspective of case managers and their experiences using assessment tools, including the Strengths and Difficulties Questionnaire (SDQ). This qualitative study explores the following research question: How do case managers describe the challenges and opportunities of using mental health assessment tools?

Methods: This study is based on a collaborative partnership with a non-profit based in Chicago, IL that provides social services for immigrants and refugees in the United States. Study participants (n=16) included case managers who provide case management services that help connect unaccompanied children with educational, legal, and health supports in the community. Case managers in this study used the SDQ as an assessment tool. Data were collected during four focus groups conducted in Fall 2022. The focus groups were conducted in English and were audio recorded and transcribed. Data analysis occurred in two cycles and was guided by a thematic analysis framework. The first cycle of coding included descriptive, initial, and in-vivo coding. The second cycle of coding used code mapping to create themes that were informed by the first cycle of coding.

Results: Findings from this study reveal challenges with how the SDQ is implemented in clinical settings, as well as how the SDQ is constructed. The study also showed how assessment is an opportunity for supporting unaccompanied children. First, findings reveal that the assessment process complicates the rapport building stage. One participant reported: “It just feels more like numbers than it does like connecting with the family and trying to help them...as a practical thing, I guess it's a disconnect.” Findings also indicate that the SDQ lacks cultural context, and that lack of migration related stressors is a gap in the SDQ: “For example, the stealing question, right? Like we don't get down to like, ‘Well, why did you steal?’”. Finally, participants view assessment as an opportunity to further understand client strengths and needs. One participant reported: “So I think like just being able to start with certain questions that kind of open other doors for you, I think, is really important.”

Conclusions and Implications: This qualitative exploratory study sheds light on important clinician perspectives on mental health assessment with vulnerable immigrants. While the SDQ can enhance understanding of client mental health functioning, findings from this study reveal the importance of culturally-informed assessment tools, especially for children who experience forced migration. Lack of context for migration experiences raises the possibility of measurement validity issues. The results of the study can inform the future adaptation of existing measures, like the SDQ, as well as the development of new culturally-informed mental health assessments.