PUBLIC HEALTH administrators can transform monumental unique challenges to “rapid response” opportunities. Think: Hurricanes Florence and Michael, the California wildfires, the mysterious polio-like illness, the opioid epidemic, mass shootings, and immigrant family separation.

You are the head of the Department of Public Health Sciences, The University of Texas at El Paso and have been “volunteered” to develop a Rapid Response “shadow” licensing program for the Tornillo, Texas detention camp housing 2300 teens.

Statement from the American Public Health Association and Trust for America’s Health
“As public health professionals we know that children living without their parents face immediate and long-term health consequences. Risks include the acute mental trauma of separation, the loss of critical health information that only parents would know about their children’s health status, and in the case of breastfeeding children, the significant loss of maternal child bonding essential for normal development. Parents’ health would also be affected by this unjust separation.
“More alarming is the interruption of these children’s chance at achieving a stable childhood. Decades of public health research have shown that family structure, stability and environment are key social determinants of a child’s and a community’s health.
“Furthermore, this practice places children at heightened risk of experiencing adverse childhood events and trauma, which research has definitively linked to poorer long-term health. Negative outcomes associated with adverse childhood events include some of society’s most intractable health issues: alcoholism, substance misuse, depression, suicide, poor physical health and obesity.” (A)

“Our field recognizes the importance of avoiding Adverse Childhood Experiences for the healthy growth and development of children. Trauma early in life contributes to a broad range of serious health outcomes, including social impairment, disease and disability, and early death. The harsh treatment of children at the border will affect their health and their lives for many years to come. The trauma to their parents is also devastating, and the lasting consequences to thousands of families will be profound.” (B)

“We also know that as each hour of separation goes by, children’s bodies continue to be flooded with stress hormones, thus creating long-term, disastrous injury and trauma for both the children and families who are separated.
Decades of research tells us that traumatic and forced parent-child separation immediately and permanently affects children’s brain development, educational attainment, mental health functioning, and long-term health outcomes – detailed in this Washington Post story. We also know that families seeking asylum are already traumatized from the circumstances that led to the migration and are exhausted by the journey to reach our borders…” (C)

“There is a significant body of evidence-based research detailing the vast public health implications of adverse childhood experiences. According to the Centers for Disease Control and Prevention, children exposed to adverse childhood experiences suffer from disrupted neurodevelopment; social, emotional, and cognitive impairment; are more likely to adopt health-risk behaviors; are at greater risk of developing chronic diseases, disabilities and social problems; and are susceptible to early death. Family stability is a key social determinant of health, and it’s imperative that we not disrupt these children’s chance at a healthy life.” (D)

“After the United States Department of Justice announced the “Zero Tolerance Policy for Criminal Illegal Entry,” Immigration and Custom Enforcement (ICE — an arm of the Department of Homeland Security) separated approximately 2,000 children from their parents in April and May 2018 as they approached the U.S. border. Children and parents were placed in separate facilities as they were being processed and were not told when or how they would be reunited. This policy and its consequences have raised significant concerns among researchers, child welfare advocates, policy makers, and the public, given the overwhelming scientific evidence that separation between children and parents, except in cases where there is evidence of maltreatment, is harmful to the development of children, families, and communities. Family separations occurring in the presence of other stressors, such as detention or natural disaster, only adds to their negative effects.” (E)

“The policy may have changed, but there’s still a concern over detention. Under the most recent policy change, the administration can still hold children in a confined space with their parents, and there’s a sense that they’re planning large-scale detention. We’ve ended for the moment, family separation, but now we have large-scale detention” (F)

“Reports from the National Academies of Sciences, Engineering, and Medicine contain an extensive body of evidence on the factors that affect the welfare of children – evidence that points to the danger of current immigration enforcement actions that separate children from their parents. Research indicates that these family separations jeopardize the short- and long-term health and well-being of the children involved.” (G)

“Detention, for even brief periods, has short- and long-term negative effects on the health of parents and children. Studies show high levels of psychiatric distress, including depression and post-traumatic stress, among detained asylum seekers, even after short detention periods, and that symptoms worsen over time. Global studies also show significant effects for children held in detention, including depression, post-traumatic stress, suicidal thoughts and behaviors, developmental delays, and behavioral issues. In a policy statement, the AAP notes that research documents negative physical and emotional symptoms among detained children and adults and also shows negative impacts on the parent-child relationship.
In the short term, toxic stress can increase the risk and frequency of infections in children as high levels of stress hormones suppress the body’s immune system. It can also result in developmental issues due to reduced neural connections to important areas of the brain. Toxic stress is associated with damage to areas of the brain responsible for learning and memory.
Over the long term, toxic stress may manifest as poor coping skills and stress management, unhealthy lifestyles, adoption of risky health behaviors, and mental health issues, such as depression. Toxic stress is also associated with increased rates of physical conditions into adulthood, including chronic obstructive pulmonary disease, obesity, ischemic heart disease, diabetes, asthma, cancer, and post-traumatic stress disorder.” (H)

“A top Health and Human Services official told Congress on Tuesday that he and others repeatedly warned the Trump administration that its policy of separating immigrant families apprehended at the U.S.-Mexico border would not be in “the best interest of the child.”
“During the deliberative process over the previous year, we raised a number of concerns in the (Office of Refugee Resettlement) program about any policy which would result in family separation due to concerns we had about the best interest of the child as well as about whether that would be operationally supportable with the bed capacity that we have,” Jonathan White, with the Public Health Service Commissioned Corps, told lawmakers at a Senate Judiciary Committee hearing”.… (I)

“The Department of Homeland Security was not ready to carry out the Trump administration’s family separation policy, and some of the government’s practices made the problem worse, according to a report issued Tuesday by the department’s inspector general…
“DHS was not fully prepared to implement the administration’s zero-tolerance policy or to deal with some of its after-effects,” said John Kelly, the acting inspector general.
Tuesday’s report said Customs and Border Protection held children for long periods in facilities intended to be used for only short terms, lacked the ability to reliably track children separated from their parents, and in some cases failed to adequately inform parents about the separation policy…
Computer systems used by CBP and Immigration and Customs Enforcement lacked the ability to share data about parents whose children were separated from them. And those systems were not integrated with the resettlement agency…
In a separate DHS inspector general report dated September 27, the Adelanto ICE Processing Center, a detention center housing up to 1,940 ICE detainees in California, was cited for serious violations including nooses found hanging in detainee cells, “improper and overly restrictive segregation,” and “untimely and inadequate medical care.” “ (J)

“In shelters from Kansas to New York, hundreds of migrant children have been roused in the middle of the night in recent weeks and loaded onto buses with backpacks and snacks for a cross-country journey to their new home: a barren tent city on a sprawling patch of desert in West Texas.
Until now, most undocumented children being held by federal immigration authorities had been housed in private foster homes or shelters, sleeping two or three to a room. They received formal schooling and regular visits with legal representatives assigned to their immigration cases…
But in the rows of sand-colored tents in Tornillo, Tex., children in groups of 20, separated by gender, sleep lined up in bunks. There is no school: The children are given workbooks that they have no obligation to complete. Access to legal services is limited…
The camp in Tornillo operates like a small, pop-up city, about 35 miles southeast of El Paso on the Mexico border, complete with portable toilets. Air-conditioned tents that vary in size are used for housing, recreation and medical care. Originally opened in June for 30 days with a capacity of 400, it expanded in September to be able to house 3,800, and is now expected to remain open at least through the end of the year.” …
The roughly 100 shelters that have, until now, been the main location for housing detained migrant children are licensed and monitored by state child welfare authorities, who impose requirements on safety and education as well as staff hiring and training.
The tent city in Tornillo, on the other hand, is unregulated, except for guidelines created by the Department of Health and Human Services. For example, schooling is not required there, as it is in regular migrant children shelters…” (K)

“Thousands of foster children may be getting powerful psychiatric drugs prescribed to them without basic safeguards, says a federal watchdog agency that found a failure to care for youngsters whose lives have already been disrupted.
A report released Monday by the Health and Human Services inspector general’s office found that about 1 in 3 foster kids from a sample of states were prescribed psychiatric drugs without treatment plans or follow-up, standard steps in sound medical care.
Kids getting mood-altering drugs they don’t need is only part of the problem. Investigators also said children who need medication to help them function at school or get along in social settings may be going untreated.
The drugs include medications for attention deficit disorder, anxiety, PTSD, depression, bipolar disorder and schizophrenia. Foster kids are much more likely to get psychiatric drugs than children overall.
“We are worried about the gap in compliance because it has an immediate, real-world impact on children’s lives,” said Ann Maxwell, an assistant inspector general.” (L)

“Traditionally, most sponsors have been undocumented themselves, and therefore are wary of risking deportation by stepping forward to claim sponsorship of a child. Even those who are willing to become sponsors have had to wait months to be fingerprinted and otherwise reviewed.
Federal officials say their vetting procedures are designed to safeguard the children in their care.
“Children who enter the country illegally are at high risk for exploitation by traffickers and smugglers,” Ms. Stauffer said in her statement.
But the longer children are detained, the more anxious and depressed they are likely to become, according to Mr. Greenberg, who oversaw the program under Mr. Obama. When that happens, children may try to harm themselves or escape, and can become violent with the staff and with one another, he said.
Stories of such behavior have emerged through reporting in recent months as the shelter system has faced intense criticism by members of Congress and the public…
The separated children injected a new degree of chaos into the facilities, according to several shelter operators, who spoke anonymously because they are barred by the government from speaking to the news media. The children were younger and more traumatized than those the shelters were used to dealing with, and they arrived without a plan for when they could be released or to whom.” (M)

“Deep within the fine print of a newly proposed federal rule change is an admission of its disastrous health consequences. The Department of Homeland Security’s plan would deny legal immigrants permanent residency status if they accept government assistance to which they are entitled, allegedly an effort to “promote immigrant self-sufficiency” and ensure “they are not likely to become burdens on American taxpayers” or “public charges.”
But the certain collateral damage of this misguided policy, which greatly expands an existing principle to make its application downright punitive, reveals it’s not about promoting self-sufficiency at all.
In describing the impact of this effort, the Department of Homeland Security states, “Disenrollment or foregoing enrollment…by aliens otherwise eligible for these programs could lead to:
“Worse health outcomes, including prevalence of obesity and malnutrition, especially for pregnant or breastfeeding women, infants or children…
“Increased use of emergency rooms and emergency care as a method of primary health care due to delayed treatment
“Increased prevalence of communicable diseases, including among members of the U.S. citizen population who are not vaccinated.”..
The rule change, if implemented, will cause legal immigrants, their spouses and children, including U.S. citizens, to withdraw from government assistance programs out of fear that it would endanger the chances for a family member to obtain a green card and become a legal permanent resident. Washington will, in effect, force individuals to choose between their welfare and a family member’s legal residency status…
Some children will not receive necessary vaccines, making them susceptible to preventable diseases, such as measles, mumps, Hepatitis A and B, and polio. Illnesses will not be addressed when they are easily treatable. Without proper prenatal and perinatal care, there will be an increase in birth complications.” (N)

“Complicating matters, the administration has decreed that reunifications must take place in the family’s country of origin. Which means that, once contacted, parents face an excruciating choice: give up their children’s asylum claims and have them returned home, or leave the children in the United States to try to navigate the asylum process on their own.” (O)

“The Trump administration wants to change how the government defines who is or is likely to become a “public charge.” The Department of Homeland Security released a draft regulation on Sept. 22, in which it proposed that any immigrant who is likely to use or who has already used Medicaid, public housing or a rent voucher, cash assistance or food stamps could be barred from the country or kept from getting permanent resident status.
“….The administration would remake the idea of self-sufficiency, admitting only those who never need to turn to the public safety net, but instead rely solely on “their own capabilities” or the resources of their families and private charity. It even asserts that people who use public programs “in a relatively small amount or for a relatively short duration” are still considered dependent on the welfare state.
This redefinition of self-sufficiency ignores the way that most people use these programs. Even people with jobs often cycle on and off assistance as work comes and goes, or to plug the gaps when it just doesn’t pay enough. These programs allow people to remain healthy and solvent — supporting their independence. This rule therefore hurts everyone, not just immigrants, by stigmatizing the safety net funded by all of us to help people survive when they fall on hard times.” (P)

The Trump administration has put the safety of thousands of teens at a migrant detention camp at risk by waiving FBI fingerprint checks for their caregivers and short-staffing mental health workers, according to an Associated Press investigation and a new federal watchdog report.
None of the 2,100 staffers at a tent city holding more than 2,300 teens in the remote Texas desert are going through rigorous FBI fingerprint background checks, according to a Health and Human Services inspector general memo published Tuesday.
“Instead, Tornillo is using checks conducted by a private contractor that has access to less comprehensive data, thereby heightening the risk that an individual with a criminal history could have direct access to children,” the memo says.
In addition, the federal government is allowing the nonprofit running the facility — BCFS Health and Human Services — to sidestep mental health care requirements. Under federal policy, migrant youth shelters generally must have one mental health clinician for every 12 kids, but the federal agency’s contract with BCFS allows it to staff Tornillo with just one clinician for every 100 children. That’s not enough to provide adequate mental health care, the inspector general office said in the memo…
Because the detention camp is on federal property — part of a large U.S. Customs and Border facility — it is not subject to state licensing requirements…
Federal officials have said repeatedly that only children without special needs were being sent to Tornillo. But facility administrators recently acknowledged that the Tornillo detainees included children with serious mental health issues who needed to be transferred out to facilities in El Paso, according to a person with knowledge of the discussion…(Q)

“The deportation and forced separation of immigrants has negative effects that extend beyond individuals and families to entire communities in the United States, according to a division of the American Psychological Association, which has issued a policy statement calling for changes to U.S. policy.
Based on a review of the effects of three decades of U.S. immigration policy, the policy statement details the psychosocial and economic impacts of deportation on children and families, as well as broader community consequences that unfold as immigrants fearful of being targeted withdraw from civic engagement…
Studies reveal that children who lose a parent to sudden, forced deportation experience anxiety, anger, aggression, withdrawal, a heightened sense of fear, eating and sleeping disturbances, isolation, trauma, and depression.
Children also experience housing instability, academic withdrawal, and family dissolution; older children often need to take on jobs to help support the family.
Ten percent of U.S. families with children have at least one family member who lacks citizenship.
5.9 million children have at least one caregiver who lacks authorization to live in the country.” (R)

“Children tend to respond to separation from their caregiver in three fluid phases. First, children enter an acute phase of protest characterized by fear, distress, crying and urgent seeking of their caregiver that may last from a few hours to days. As the length of separation continues, children enter a phase of despair during which crying weakens, movement lessens and children reject the approach of alternative adults. With prolonged parental absence, children may become passively compliant with care staff, giving the appearance of having ‘settled in’ to their new environment. Disturbingly, this can signify that the child has detached from the parents and is now living in a perceived state of ‘fear without resolution’. Children reunited while they are in the early separation protest phase usually fare well. Children in despair may respond to the reappearance of their parent with hostility or ambivalence, taking many weeks to rebuild their bond. Children who have detached from their parents may reject their approaches or treat them as strangers. Additionally, when children interpret themselves as ‘abandoned’ by parents, they may develop a profound sense that they have done something wrong to cause their caregiver to leave, igniting shame and complex emotions that can damage the lifelong relationships with themselves and others.”(S)

“When children are reunited with parents, the reintegration process is sometimes difficult. Widespread videos of families being reunified have shown emotionless children, some even avoiding their parent’s embrace. A number of children do not even recognize their parents upon return, which speaks to the intense trauma that these children have experienced. “We think that we’ve made the family whole again by simply bringing them back together and letting them go on with their lives, when the reality is that there’s a lot of work that still needs to be done,” said Vivek Sankaran, a clinical professor of law at the University of Michigan Law School. After becoming reunited, the families affected by separation need continuing support in order to reestablish their relationships and routines.” (T)

“It is clear, then, that the families affected by the current administration’s separation policy need services to help them cope with the trauma that has occurred. It is possible for the individuals and the family units to find some healing, given the opportunity, resources, and tools to do so.
Griffith says that a key to working through such a trauma is bringing the families back together as quickly as possible. “If the core family unit can stay intact, that accomplishes a lot. [There’s a feeling of] ‘As long as we’re together, we can be okay, regardless of how harsh the circumstances,'” he says. However, the reunification process thus far has been plodding and uncoordinated. It appears that far too many families will remain separated long term.
In addition to reunification and in the face of indefinite separation, family members should have access to psychosocial services to help them cope. Unfortunately, it is unclear what services are currently available to the children still separated from their parents. “We don’t have access to those facilities,” Lusk says.” (U)

“The Trump administration did not tell key government agencies about its “zero tolerance” immigration policy before publicly announcing it in April, leaving the officials responsible for carrying it out unprepared to handle the resulting separations of thousands of children from their families, according to a government report released on Wednesday.
The Department of Homeland Security, which apprehends border crossers, and the Department of Health and Human Services, which cares for separated migrant children, were both caught off guard when Attorney General Jeff Sessions announced plans to criminally prosecute anyone who crossed the border illegally, the report said…
Because they did not know about the “zero tolerance” policy in advance, officials at the Department of Homeland Security said, they did not take steps to prepare for the resulting family separations. Staff members at the Department of Health and Human Services said their leaders told them not to prepare for an increase in children separated from their families because homeland security officials claimed that they did not have an official policy of separating parents and children, according to the report, which was prepared by the Government Accountability Office, Congress’s nonpartisan investigative arm.” (V)

In just six months, the Trump administration has built a detention camp for migrant kids in the Texas desert that is larger than 203 of the 204 U.S. federal prisons.
Driving the news: The Tornillo camp now holds 2,324 boys and girls, most from Central America, between the ages of 13-17, the AP reports.
Why it matters: “Confining and caring for so many children is a challenge. By day, minders walk the teen detainees to their meals, showers and recreation on the arid plot of land guarded by multiple levels of security. At night the area around the camp, that’s grown from a few dozen to more than 150 tents, is secured and lit up by flood lights.”
Between the lines: Among the list of issues at Tornillo discovered by an AP investigation:
1. Security: The 2,100 staffers haven’t done FBI fingerprint background checks.
2. Costs: “What began as an emergency, 30-day shelter has transformed into a vast tent city that could cost taxpayers more than $430 million.”
3. Rules: “Under federal policy, migrant youth shelters generally must have one mental health clinician for every 12 kids, but shelter officials have indicated that Tornillo can staff just one clinician for every 100 children…”..
The bottom line: There are more than 14,000 migrant children in U.S. detention, most from central America. Figuring out what to do with these kids is a challenge that doesn’t seem to be going away.” (W)

“”Aid workers and humanitarian organizations [are sounding the alarm on] unsanitary conditions at the sports complex in Tijuana where more than 6,000 Central American migrants are packed into a space adequate for half that many people,” AP reports.
Lice infestations and respiratory infections are rampant, and Mexico’s National Human Rights Commission reports four cases of chicken pox.” (X)

“The founder of Southwest Key made millions from housing migrant children..
Southwest Key has collected $1.7 billion in federal grants in the past decade, including $626 million in the past year alone. But as it has grown, tripling its revenue in three years, the organization has left a record of sloppy management and possible financial improprieties, according to dozens of interviews and an examination of documents. It has stockpiled tens of millions of taxpayer dollars with little government oversight and possibly engaged in self-dealing with top executives…
Shortly after, the federal government temporarily shuttered a third Arizona shelter, in Youngtown, after Southwest Key staff members were accused of physically abusing three children. In a recent agreement with Arizona officials, Southwest Key was fined $73,000 and agreed to close that facility and another troubled shelter in Phoenix. Mr. Weber, the government spokesman, said there were “numerous red flags and licensure problems” with the two shelters.” (Y)

(A) BUSSW Dean Statement on Migrant Family Separation Crisis, , Jorge Delva,
(B) Sign-on letter: Public health implications of family separation at the border,
(C) The Science is Clear: Separating Families has Long-term Damaging Psychological and Health Consequences for Children, Families, and Communities,
(D) Jacqueline Bhabha speaks to the human rights of children detained at the U.S.-Mexico border., Professor of the Practice of Health and Human Rights at the Harvard T.H. Chan School of Public Health
(E) Statement on Harmful Consequences of Separating Families at the U.S. Border,
(F) Separating parents and children at US border is inhumane and sets the stage for a public health crisis,
(G) Key Health Implications of Separation of Families at the Border (as of June 27, 2018),
(H) Top HHS official warned Trump administration against separating immigrant families, by Eliza Collins, Alan Gomez,
(I) DHS not prepared for family separations under Trump zero tolerance policy, watchdog finds, by Pete Williams and Jacob Soboroff,
(J) Migrant Children Moved Under Cover of Darkness to a Texas Tent City, by Caitlin Dickerson,
(K) Thousands of foster children may be getting psychiatric drugs without safeguards, watchdog agency says, by Ricardo Alonso-Zaldivar,
(L) Detention of Migrant Children Has Skyrocketed to Highest Levels Ever, by Mike Blake,
(M) One sick immigration rule: The ‘public charge’ regulation will make America less healthy, by KENNETH L. DAVIS,
(N) The Continuing Tragedy of the Separated Children,
(O) Trump Wants to Turn the Safety Net Into a Trap, by By Bryce Covert,
(P) Separating Families at U.S. Borders is a Public Health Issue, Ellen J. MacKenzie,
(Q) US waived FBI checks on staff at growing teen migrant camp, by GARANCE BURKE AND MARTHA MENDOZA,
(R) Deportation and family separation impact entire communities, researchers say, by Jennifer McNulty,
(S) Impact of punitive immigration policies, parent-child separation and child detention on the mental health and development of children, by Laura C N Wood,
(T) The Impact of Parent-Child Separation at the Border, by Hurley Riley,
(U) Children and Families Forum: The Impact of Immigrant Family Separation, by Sue Coyle,
(V) ‘Zero Tolerance’ Immigration Policy Surprised Agencies, Report Finds, by Ron Nixon,
(W) Axios PM: Trump’s detention camp for migrant teens; November 27, 2018
(X) Axios AM, November 30, 2018
(Y) He’s Built an Empire, With Detained Migrant Children as the Bricks, Tamir Kalifa for The New York Times, by Kim Barker, Nicholas Kulish and Rebecca R. Ruiz,

..The HHS needs to review thousands of case files by hand for clues to which children were taken from their parents…

“Most immigrants facing deportation wouldn’t climb onto a table during their court hearings. But then again, most 3-year-olds don’t go to court without parents or lawyers.

“President Trump has moved on from caring about the migrant children in cages

“Only a dead heart is unstirred by the intentional infliction of suffering on children and babies as a weapon of deterrence.”

“In 6 Days, Trump Admin Reunited Only 6 Immigrant Children With Their Families”,

“…the only way parents can quickly be reunited with their children is to drop their claims for asylum… and agree to be deported.”

White House Press Secretary Sarah Huckabee Sanders said the government was starting to
“run out of space” to house people apprehended crossing the border

Trump’s policy “could be creating thousands of immigrant orphans in the U.S.”,

Tender-Age Immigrant Children. “They need bilingual workers. Some kids speak indigenous languages, so that’s an issue as well.

“The idea of pulling a child out of a parent’s arms, or identifying a parent but still keeping them separate—it isn’t right.”

“The business of housing, transporting and watching over migrant children detained along the southwest border is not a multimillion-dollar business. It’s a billion-dollar one…

“If it could happen to them…why can’t it happen to us?”…separating children from their parents,

“…Trump’s (family separation) policy amounts to “government-sanctioned child abuse.””,

“The Trump administration’s policy of separating parents and children at the U.S.-Mexico border will have a dire impact on their health, both now and into the future.” (C)