Addressing the Mental Health Needs of Latino Children in Immigrant Families

Between the lines: A mixed-methods study on the impacts of parental deportation on the health and well-being of U.S. citizen children

Objective

To explore the impacts of parental deportation on the health and well-being of U.S. citizen children of Mexican immigrants.

Methods

From 2019-2020, this ambi-directional cohort study recruited U.S.-based families with an undocumented Mexican immigrant parent and U.S.-citizen childrens (ages 13-17) recently exposed to parental deportation (N = 61), and similar families without a history of parental deportation (N = 51). Children health, behavioral, economic, and academic outcomes were measured via phone surveys upon enrollment and six months later. A subsample of "exposed" caregivers (N = 14) also completed in-depth semi-structured interviews. Data were analyzed using fixed-effects regression models and thematic analyses.

Results

Childrens exposed to parental deportation had significantly worse health status, behavioral problems, material hardship, and academic outcomes than children in the control arm (p<.05). Caregivers' interviews illustrated these health, behavioral, academic and family impacts.

Conclusions

Parental deportations have wide and potentially long-lasting health, behavioral, economic, and academic consequences for U.S. citizen youth. Changes in immigration policies and enforcement practices are urgently needed to protect the unity of mixed-legal status families in the U.S. and prevent the suffering of U.S. children in these families.

Screening for post-traumatic stress disorder among Latinx immigrant children

ABSTRACT

Latinx children face psychosocial, linguistic, and economic challenges that put them at an increased risk of developing mental health conditions. Primary care providers should be equipped to recognize the complex mental health needs of this growing population. This article explores some of the barriers to mental health screenings in Latinx children and presents culturally sensitive, validated screening tools for primary care providers.

Family Structure and Adolescent Mental Health Service Utilization During the COVID-19 Pandemic

PURPOSE

This study evaluated the relationship between sociodemographic factors including family structure and mental health service (MHS) utilization before and during the COVID-19 pandemic. We also investigated the moderation effects of the COVID-19 pandemic on MHS utilization.

METHODS

Our retrospective cohort study analyzed adolescents aged 12-17 years with a mental health diagnosis as identified in the electronic medical record enrolled in Kaiser Permanente Mid-Atlantic States in Maryland and Virginia, a comprehensive integrated health system. We used logistic regression models with an interaction term for the COVID-19 pandemic year to determine the relationship between family structure and adolescent MHS utilization ≥ one outpatient behavioral health visit within the measurement year, while adjusting for age, chronic medical condition (= physical illness lasting > 12 months), mental health condition, race, sex, and state of residence.

RESULTS

Among 5,420 adolescents, only those in two-parent households significantly increased MHS utilization during COVID-19 compared to the prepandemic year (McNemar's χ2 = 9.24, p < .01); however, family structure was not a significant predictor. Overall, the odds of adolescents using MHS were associated with a 12% increase during COVID-19 (odds ratio 1.12, 95% confidence interval [CI]: 1.02-1.22, p < .01). Higher odds of using MHS was associated with chronic medical condition (adjusted odds ratio = 1.15; 95% CI: 1.05-1.26, p < .01) and with White adolescents compared to all racial/ethnic minorities. The odds ratio of females using MHS compared to their male counterparts increased by 63% (ratio of adjusted odds ratio = 1.63; 95% CI: 1.39-1.91, p < .01) during the COVID-19 pandemic.

DISCUSSION

Individual-level demographic factors served as predictors of MHS utilization with effects moderated by COVID-19.

Health Care for Children in Immigrant Families: Key Considerations and Addressing Barriers

One in four US children is a child in an immigrant family. Children in immigrant families (CIF) have distinct health and health care needs that vary by documentation status, countries of origin, and health care and community experience caring for immigrant populations. Health insurance access and language services are fundamental to providing health care to CIF. Promoting health equity for CIF requires a comprehensive approach to both the health and social determinants of health needs of CIF. Child health providers can promote health equity for this population through tailored primary care services and partnerships with immigrant-serving community organizations.

"It felt like hitting rock bottom": A qualitative exploration of the mental health impacts of immigration enforcement and discrimination on US-citizen, Mexican children

Latino immigrant families in the United States were disproportionately affected by intensified interior immigration enforcement under the Trump administration. US-citizen children are victimized by policies targeting their immigrant parents; research is sparse regarding how these polices affect children who experience parental deportation and children who are at risk for parental deportation. Additionally, anti-immigrant rhetoric can result in increased discrimination that also threatens children's psychological health. This qualitative study (N = 22) explores children's lived experiences of discrimination, parental deportation or threat of parental deportation, and perceived impacts on mental health. Interviews conducted from 2019 to 2020 revealed that children who are directly affected by or at risk for parental deportation experience detrimental impacts to their psychological well-being. Children experience discrimination as Latinos and children of immigrants, which is also detrimental to their mental/emotional health. Incorporating children's perspectives is critical to informing public health interventions. Findings demonstrate the need for family-friendly immigration reform.

Interdisciplinary Children's Behavioral Health Workforce Development for Social Work and Nursing

This paper will begin with a review of child health inequities globally, in the United States and in the State of New York. It will then describe a model training program that was designed to educate social workers and nurse practitioners to create a workforce able to address child behavioral health inequities in the United States (US), specifically New York State. Behavioral health care refers to prevention, care and treatment for mental health and substance abuse conditions as well as physical conditions caused by stress and life crises. This project uses an interdisciplinary training program for nurse practitioner and Master of Social Work students to address workforce shortages in underserved communities in New York State. It will present process evaluation findings to highlight the program's initial success and will conclude with a discussion of the data that are still needed and the challenges of obtaining this data.

Deconstructing Cultural Aspects of Mental Health Care in Hispanic/Latinx People

In the United States, 18.9% of the population identifies as Hispanic or Latin. The culture of these communities is as diverse, heterogenous, and rich as the history of this population. Culture shapes the perception of symptoms and psychiatric disorders. To provide culturally sensitive care, it is relevant to understand the history of these communities in the US, recognize cultural humility, and acknowledge aspects and values (eg, culturally bound syndromes, familism, paternalism, stigma of mental illness, machismo, immigration) inherent to the cultural experience and unique barriers to care. Incorporating these aspects into clinical practice is essential for positive outcomes. The purpose of this article is to give a brief historical context, encourage cultural humility, and describe cultural aspects that are essential when providing culturally sensitive care to the Hispanic and Latinx community in the US.

Mental health and adaptation among newcomer immigrant youth in United States educational settings

Schools play a vital role in the acculturation process of newly migrated youth. Social and academic factors within school settings predict a wide variety of adaptation outcomes. Age and grade also impact the ways that school experiences can shape the post-migration adjustment trajectories of migrant youth. Negative school experiences can exacerbate migration trauma, whereas positive school experiences play an important protective role in overcoming migration-related challenges and adjusting to a new cultural context. Emerging research also suggests that the school environment presents a valuable opportunity for service delivery, as students are readily accessible during the school day which reduces systemic barriers to engagement. Socio-emotional prevention and intervention can address migration trauma, foster resiliency, and help lead the way to acculturative and academic success. Teachers, counselors, coaches and mentors who engage with newcomer immigrant youth in schools can play a pivotal role in easing migration-related challenges by encouraging positive emotional attachments, linking to resources, and helping to navigate new systems. These professionals benefit from specialized training on the unique needs and best practices for supporting the learning, engagement, development, and adaptation of newcomer youth.

"We Need Health for All": Mental Health and Barriers to Care among Latinxs in California and Connecticut

Latinx (im)migrant groups remain underserved by existing mental health resources. Past research has illuminated the complex factors contributing to this problem, including migration-related trauma, discrimination, anti-immigrant policies, and structural vulnerability. This paper uses decolonial-inspired methods to present and analyze results from two studies of Latinx (im)migrant communities in central California and southern Connecticut in the United States. Using mixed quantitative and qualitative analysis, we demonstrate the intersectional complexities to be addressed in formulating effective mental health services. Relevant social and structural factors including knowledge of mental health, access to insurance, and experiencing discrimination were significantly associated with anxiety symptoms, based on linear regression analysis. Ethnographic interviews demonstrate how complex trauma informs mental health needs, especially through the gendered experiences of women. Overlapping aspects of gender, language barriers, fear of authorities, and immigration status contoured the lived experiences of Latinx (im)migrants. Thematic analyses of open-ended survey responses also provide recommendations for solutions based on the experiences of those directly affected by these health disparities, particularly relating to healthcare access, affordability, and capacity. Building from these findings and past research, we recommend the adoption of a comprehensive model of mental health service provision for Latinx (im)migrants that takes into account Indigenous language access, structural competency, expanded health insurance, and resources for community health workers.

The Intergenerational Health Effects of the Deferred Action for Childhood Arrivals Program on Families With Mixed Immigration Status

OBJECTIVE

Children of undocumented mothers with Deferred Action for Childhood Arrivals (DACA) have better mental health outcomes than children of DACA-ineligible mothers. This study explored the intergenerational health effects of DACA on undocumented parents and their children in families with mixed immigration status.

METHODS

Forty-eight semistructured interviews were selected from a study on life transitions of 50 undocumented immigrants. Prevalent themes related to the intergenerational health effects of DACA on undocumented immigrants were identified through thematic analysis of the transcripts, and quotes were selected to illustrate themes in the participants' own words.

RESULTS

Thirty-three of the 48 respondents were DACA recipients. Twenty-six respondents were parents with a total of 61 children, 73.8% of whom were US-born. Four themes were identified: 1) DACA recipients reported decreased familial stress because of protection from deportation and increased access to health care, 2) both DACA and DACA-ineligible parents prioritized regular pediatrician visits for their children, but DACA-ineligible parents suffered from poor health because of decreased access to health care, 3) adults with DACA mirror the health behaviors of their DACA-ineligible parents, and 4) the poor health access of DACA-ineligible family members appeared to stress DACA recipients and US-born children in these families.

CONCLUSIONS

DACA decreases children's fear of parental deportation and loss. However, the suffering of DACA-ineligible parents and family members may stress their children and influence their health-seeking behavior in adulthood. Health care access for all members of immigrant families needs to be examined, since their well-being impacts the well-being of their children.

Mental Health Surveillance Among Children - United States, 2013-2019

Mental health encompasses a range of mental, emotional, social, and behavioral functioning and occurs along a continuum from good to poor. Previous research has documented that mental health among children and adolescents is associated with immediate and long-term physical health and chronic disease, health risk behaviors, social relationships, education, and employment. Public health surveillance of children's mental health can be used to monitor trends in prevalence across populations, increase knowledge about demographic and geographic differences, and support decision-making about prevention and intervention. Numerous federal data systems collect data on various indicators of children's mental health, particularly mental disorders. The 2013-2019 data from these data systems show that mental disorders begin in early childhood and affect children with a range of sociodemographic characteristics. During this period, the most prevalent disorders diagnosed among U.S. children and adolescents aged 3-17 years were attention-deficit/hyperactivity disorder and anxiety, each affecting approximately one in 11 (9.4%-9.8%) children. Among children and adolescents aged 12-17 years, one fifth (20.9%) had ever experienced a major depressive episode. Among high school students in 2019, 36.7% reported persistently feeling sad or hopeless in the past year, and 18.8% had seriously considered attempting suicide. Approximately seven in 100,000 persons aged 10-19 years died by suicide in 2018 and 2019. Among children and adolescents aged 3-17 years, 9.6%-10.1% had received mental health services, and 7.8% of all children and adolescents aged 3-17 years had taken medication for mental health problems during the past year, based on parent report. Approximately one in four children and adolescents aged 12-17 years reported having received mental health services during the past year. In federal data systems, data on positive indicators of mental health (e.g., resilience) are limited. Although no comprehensive surveillance system for children's mental health exists and no single indicator can be used to define the mental health of children or to identify the overall number of children with mental disorders, these data confirm that mental disorders among children continue to be a substantial public health concern. These findings can be used by public health professionals, health care providers, state health officials, policymakers, and educators to understand the prevalence of specific mental disorders and other indicators of mental health and the challenges related to mental health surveillance.

Rating Scales for Behavioral Health Screening System Within Pediatric Primary Care

Barriers to conducting standardized behavioral health screening within pediatric primary care settings include engaging youth and families, limited time available for this activity, and difficulties related to obtaining behavioral health consultation and treatment from specialists. Child and adolescent psychiatrists may assist pediatric primary care practices with engaging youth and families around screening by assisting with identifying rating scales that have good psychometric characteristics across multiple languages and are validated in diverse samples and available within the public domain. Additionally, they may partner with pediatric primary care professionals to assist with optimizing screening workflows and linkage to specialized services.

Father involvement in infancy predicts behavior and response to chronic stress in middle childhood in a low-income Latinx sample

Fathers' involvement in early childhood is important for children's physical, emotional, and cognitive development, particularly in low-income families. However, little is known about the longitudinal relations between early father involvement and children's later physiological responses to chronic stress and behaviors impacted by stress in the context of poverty. These issues are particularly important among Latinx immigrant families who face significant psychosocial and poverty-related risk. In the current study, we examined the relationship between father involvement in infancy and physiological chronic stress in the middle childhood period, as measured through hair cortisol concentration (HCC), and several behavioral measures (attention problems, working memory) in a Latinx immigrant sample with low income. Father involvement in infancy predicted children's later HCC, and working memory in second to third grade. Father involvement also moderated the effect of HCC on working memory, such that increased HCC predicted better working memory when fathers were not involved. These findings suggest that the fathers' involvement in infancy has lasting impacts on health and behavior and that associations between physiological and behavioral measures of stress may be moderated by differences in early father involvement.

Prolonged Emergency Department Length of Stay for US Pediatric Mental Health Visits (2005-2015)

BACKGROUND AND OBJECTIVES

Children seeking care in the emergency department (ED) for mental health conditions are at risk for prolonged length of stay (LOS). A more contemporary description of trends and visit characteristics associated with prolonged ED LOS at the national level is lacking in the literature. Our objectives were to (1) compare LOS trends for pediatric mental health versus non-mental health ED visits and (2) explore patient-level characteristics associated with prolonged LOS for mental health ED visits.

METHODS

We conducted an observational analysis of ED visits among children 6 to 17 years of age using the National Hospital Ambulatory Medical Care Survey (2005-2015). We assessed trends in rates of prolonged LOS and the association between prolonged LOS and demographic and clinical characteristics (race and ethnicity, payer type, and presence of a concurrent physical health diagnosis) using descriptive statistics and survey-weighted logistic regression.

RESULTS

From 2005 to 2015, rates of prolonged LOS for pediatric mental health ED visits increased over time from 16.3% to 24.6% (LOS >6 hours) and 5.3% to 12.7% (LOS >12 hours), in contrast to non-mental health visits for which LOS remained stable. For mental health visits, Hispanic ethnicity was associated with an almost threefold odds of LOS >12 hours (odds ratio 2.74; 95% confidence interval 1.69-4.44); there was no difference in LOS by payer type.

CONCLUSIONS

The substantial rise in prolonged LOS for mental health ED visits and disparity for Hispanic children suggest worsening and inequitable access to definitive pediatric mental health care. Policy makers and health systems should work to provide equitable and timely access to pediatric mental health care.

Latinx Family Perspectives on Social Needs Screening and Referral during Well-Child Visits

OBJECTIVE

To understand Latinx parent perspectives on screening and referral approaches to identify social determinants of health and address social and material needs during well-child visits and to identify techniques that promote their engagement with these approaches.

STUDY DESIGN

We investigated parent perspectives and engagement with social needs screening and referral practices during well-child visits using focus group methodology.

RESULTS

We conducted 17 focus groups (n = 134 parents and other primary caregivers) with families receiving care at sites operated by eight pediatric primary care clinics. Adding social needs screening and referral shifted the social context of well-child visits for Latinx parents. Participants reported greater engagement with the practices where they perceived an emotional connection with nurses and other clinicians and cultural brokering to ensure their screening responses accurately reflected family needs and priorities. Participants highlighted the importance of having a personal patient-provider relationship as many preferred to discuss social needs outside of the exam room.

CLINICAL IMPLICATIONS

Nurses and other clinicians play a critical role in establishing systems needed to systematically screen and refer families for social needs. Future policy development should consider implications for nursing practice and leadership in adopting these approaches.

Who is Taking Care of Central American Immigrant Youth? Preliminary Data on Caregiving Arrangements and Emotional-Behavioral Symptoms Post-Migration

Migrant youth are at increased risk for mental health problems. Given increases in families migrating to the U.S. and family separations at the U.S.-Mexico border, understanding migrant youth home environments and impacts of family disruption are growing concerns. This study assessed caregiver arrangements and reports of youth emotional and behavioral symptoms from recently immigrated adolescents (N = 111) and respective caregivers (n = 64). 47.7% of youth indicated living with their mother, father, or both; 24.3% another relative, 2.7% a non-relative, and 25.2% reported no caregiver. 25% indicated caretaking responsibilities of their own. Caregiving arrangements were related to emotional and behavioral symptoms. Caregiver documentation status was related to caregiver-reported conduct problems, prosocial behavior, and total symptoms. The migration process is disruptive for youth and home environments. Many youth experience disrupted caregiving post-migration and caregiver features are significant to youth emotional and behavioral symptoms-which were elevated in this sample. The study provides novel insight into effects of family disruption on migrant youth post-migration.

Parent activation and pediatric primary care outcomes for vulnerable children: A mixed methods study

OBJECTIVE

Among children in low-income families 1) examine associations between parent activation and pediatric primary care outcomes and 2) explore parent perspectives on Parent-Patient Activation Measure (P-PAM) questions in relation to pediatric primary care experiences.

METHODS

We examined associations between P-PAM score via Spanish- or English-language survey and healthcare outcomes abstracted from electronic medical records for parent/child dyads at an urban general pediatrics clinic. Parent perspectives were elicited via qualitative interviews with a subsample of parents who "thought aloud" during P-PAM completion.

RESULTS

Among 316 Spanish (68%) and English-language parent/child dyads, we found associations between parent activation and primary care outcomes only among Spanish-language dyads and only for weight and health status. Findings from 21 interviews provided possible explanations for quantitative findings including question limitations in assessing knowledge, skills, and confidence in pediatric primary care and P-PAM cultural and linguistic appropriateness for low-income Latino populations.

CONCLUSIONS

Pairing quantitative and qualitative methods provided insight on P-PAM measurement limitations and raised questions about its use in patient engagement interventions to reduce health disparities.

PRACTICE IMPLICATIONS

Practices serving vulnerable children and families should consider the limitations of the P-PAM for measuring parent healthcare engagement before utilizing the P-PAM in patient engagement interventions.

The Health of Children Who Are Immigrants and Refugees: A Review for the General Pediatrician

The United States is home to many immigrants and refugees; therefore, pediatricians who care for these vulnerable patients must be familiar with their unique medical, developmental, and psychosocial needs. Thankfully, there are resources that describe the recommended components of the medical visit for newly arrived immigrants and refugees. In this article, we review these resources while focusing on the resettlement process, mental health, trauma-informed care resources, and other important psychosocial needs such as legal and educational resources that are available for this patient population. [Pediatr Ann. 2019;48(11):e455-e460.].

Providing Care for Children in Immigrant Families

Children in immigrant families (CIF), who represent 1 in 4 children in the United States, represent a growing and ever more diverse US demographic that pediatric medical providers nationwide will increasingly encounter in clinical care. Immigrant children are those born outside the United States to non-US citizen parents, and CIF are defined as those who are either foreign born or have at least 1 parent who is foreign born. Some families immigrate for economic or educational reasons, and others come fleeing persecution and seeking safe haven. Some US-born children with a foreign-born parent may share vulnerabilities with children who themselves are foreign born, particularly regarding access to care and other social determinants of health. Therefore, the larger umbrella term of CIF is used in this statement. CIF, like all children, have diverse experiences that interact with their biopsychosocial development. CIF may face inequities that can threaten their health and well-being, and CIF also offer strengths and embody resilience that can surpass challenges experienced before and during integration. This policy statement describes the evolving population of CIF in the United States, briefly introduces core competencies to enhance care within a framework of cultural humility and safety, and discusses barriers and opportunities at the practice and systems levels. Practice-level recommendations describe how pediatricians can promote health equity for CIF through careful attention to core competencies in clinical care, thoughtful community engagement, and system-level support. Advocacy and policy recommendations offer ways pediatricians can advocate for policies that promote health equity for CIF.

Clinical Tools Working at Home with Immigrants and Refugees

At a time of evolving demographics and turbulent policy changes, pediatric providers have a critical role in the care of all children, regardless of where the child or parent was born. Pediatric providers can facilitate access to high-quality care and critical community-based resources for immigrant children and families. In this article, we delineate the primary domains for clinical care and offer clinical tools to achieve the provision of accessible, comprehensive, high-quality care within a family-centered medical home.

Protecting unauthorized immigrant mothers improves their children's mental health

The United States is embroiled in a debate about whether to protect or deport its estimated 11 million unauthorized immigrants, but the fact that these immigrants are also parents to more than 4 million U.S.-born children is often overlooked. We provide causal evidence of the impact of parents' unauthorized immigration status on the health of their U.S. citizen children. The Deferred Action for Childhood Arrivals (DACA) program granted temporary protection from deportation to more than 780,000 unauthorized immigrants. We used Medicaid claims data from Oregon and exploited the quasi-random assignment of DACA eligibility among mothers with birthdates close to the DACA age qualification cutoff. Mothers' DACA eligibility significantly decreased adjustment and anxiety disorder diagnoses among their children. Parents' unauthorized status is thus a substantial barrier to normal child development and perpetuates health inequalities through the intergenerational transmission of disadvantage.