Care Provider Facilities Described Challenges Addressing Mental Health Needs of Children in HHS Custody

Joanne M. Chiedi, Acting Inspector General - U.S. Department of Health and Human Services, Office of Inspector General

Why OIG Did This Review

By law, the Office of Refugee Resettlement (ORR), which is within the Department of Health and Human Services, has custody of and must provide care for each unaccompanied child, including addressing their mental health needs. ORR-funded care provider facilities are required to provide counseling to children and arrange for more specialized mental health services, as needed. We conducted our fieldwork during a time when ORR was experiencing an influx of children. Our findings could inform the Unaccompanied Alien Children Program’s preparation for future surges.

How OIG Did This Review

In August and September 2018, OIG conducted site visits at 45 ORR-funded facilities, nearly half of all facilities in ORR’s network at the time. These facilities were purposively selected and may not represent the experiences of staff in all ORR-funded facilities.

This report relies primarily on data collected from interviews with: approximately 100 mental health clinicians who had regular interaction with children across the 45 facilities; medical coordinators in each of the 45 facilities; facility leadership in each of the 45 facilities, including the program director and lead mental health clinician; and the 28 ORR federal field specialists assigned to the 45 selected facilities. We conducted qualitative analysis to identify the most significant challenges that facilities faced in addressing the mental health needs of children in ORR custody. This report does not determine whether challenges resulted in care that failed to meet ORR requirements, nor does it assess the quality or appropriateness of mental health care provided to children.