































Graduate Student Journal of  Psychology
2014, Vol. 15

Copyright 2014 by the Department of  Counseling and Clinical Psychology
Teachers College, Columbia University

3

The Mental Health Needs of  Unaccompanied 
Immigrant Children: 

Lawyers’ Role as a Conduit to Services

Charles D. R. Baily
Teachers College, Columbia University

Schuyler W. Henderson
New York University

Amanda R. Taub
Fordham University

 
Glynnis O’Shea

Teachers College, Columbia University

Honora Einhorn
Teachers College, Columbia University

Helen Verdeli
Teachers College, Columbia University

Unaccompanied immigrant children are a highly vulnerable population, but research into their mental health and 
psychosocial context remains limited. This study elicited lawyers’ perceptions of  the mental health needs of  unac-
companied children in U.S. deportation proceedings and their mental health referral practices with this population. 
A convenience sample of  26 lawyers who work with unaccompanied children completed a semi-structured, online 
survey. Lawyers surveyed frequently had mental health concerns about their unaccompanied child clients, used 
clinical and lay terminology to describe symptoms, referred for both expert testimony and treatment purposes, 
frequently encountered barriers to accessing appropriate services, and expressed interest in mental health training. 
The results of  this study suggest a complex intersection between the legal and mental health needs of  unaccom-
panied children, and the need for further research and improved service provision in support of  their wellbeing. 

The Mental Health Needs of  Unaccompanied 
Immigrant Children: Lawyers’ Role as a Con-

duit to Services

 Under the terms of  6 U.S.C. § 279(g)(2), federal 
law defines an unaccompanied alien child as any child 
or adolescent under the age of  18 who is in the United 
States without lawful immigration status and does not 
have a parent or other legal guardian present to provide 
custody. Of  the 14,299 unaccompanied children de-
tained by the Department of  Homeland Security be-
tween October 2008 and September 2010, 91% were 
from Latin America (mostly Central America), 70% 
were between the ages of  15 and 17, and 73% were 
male (Byrne & Miller, 2012). Due largely to increasing 

violence and insecurity in Central America, in recent 
years there has been a dramatic rise in the number 
of  apprehensions. In 2013, U.S. immigration author-
ities detained 21,537 unaccompanied children from 
Guatemala, Honduras, and El Salvador alone (Unit-
ed Nations High Commissioner for Refugees, 2014).

Psychosocial Stressors
 The available literature suggests that unaccom-
panied youth are at high risk for repeated exposure 
to psychosocial stressors before, during, and after 
their migration to the United States (Baily, Hender-
son, Taub, Ricks, & Verdeli, 2011). Children may be 
fleeing gangs, evading forced recruitment by military 
and paramilitary organizations, escaping war or civil 
unrest, avoiding coercion into child labor or prosti-
tution, or facing displacement following natural di-
sasters (Chavez & Menjívar, 2010). They can spend 
months traveling alone to the United States in treach-
erous conditions, and during the journey they are vul-

Correspondence concerning this article should be addressed 
to: Charles D. R. Baily; Department of  Counseling and Clin-
ical Psychology, Teachers College, Columbia University. 
Horace Mann Room 328, 525 West 120th Street. New York, 
NY, 10027, USA. Email address: cdb2123@tc.columbia.edu



4

nerable to abuse and physical and sexual exploitation 
by bandits, smugglers, and local officials (Bhaba & 
Schmidt, 2008; Casillas, 2006; Fazel & Stein, 2002; 
Seugling, 2004). Although government guidelines 
have been created to protect unaccompanied children 
apprehended by U.S. immigration, they may be de-
tained in prison-like conditions for extended periods 
of  time prior to release to family members or other 
less restrictive settings (Women’s Refugee Commit-
tee, 2009). Once released to less restrictive settings, 
they still face a long period of  instability and insecuri-
ty while they await immigration proceedings to deter-
mine whether they will be deported, during which they 
may also experience acculturation issues and discrim-
ination within the local culture (Perez Foster, 2001). 

Mental Health Needs
 Despite the well-documented psychosocial stress-
ors faced by unaccompanied children migrating to 
the United States, there has been limited research on 
their mental health needs. Research to date has largely 
taken the form of  reports and papers by legal and hu-
man rights researchers and advocacy groups, has fo-
cused predominantly on children living in detention 
(as opposed to children reunified with family mem-
bers in the community), has relied predominantly on 
qualitative interviews with key informants, and has 
discussed children’s experiences broadly rather than 
focusing on mental health specifically. Nevertheless, 
several papers have documented high rates of  Post-
traumatic Stress Disorder (PTSD), other anxiety con-
ditions, depression, aggression, psychosomatic com-
plaints, and suicidal ideation among unaccompanied 
children (Bhaba & Schmidt, 2008; Chavez & Men-
jívar, 2010; Women’s Refugee Commission, 2009). 
 To the authors’ knowledge, only two empirical 
studies have used standardized instruments to assess 
the mental health status of  unaccompanied children 
in the United States, both of  which looked at very 
specific populations of  unaccompanied children, and 
had very targeted research questions. Porte and Tor-
ney-Purta (1987) examined the relationship between 
different types of  foster care and depression and 
academic achievement in unaccompanied Indochi-
nese children. Geltman and colleagues (2005) looked 
at PTSD and its relationship to overall functioning 

among unaccompanied Sudanese youth. The majority 
of  empirical research on the mental health of  unac-
companied children has been conducted in Northern 
Europe, and has found that these children are at high 
risk for exposure to traumatic events (Bean, Derluyn, 
Eurelings-Bontekoe, Broekaert, & Spinhoven, 2007b), 
have elevated rates of  psychopathology (e.g., Derluyn, 
Broekaert, & Schuyten, 2008; Hodes, Jagdev, Chan-
dra, & Cunniff, 2008;  Lustig, Kia-Keating, & Knight, 
2004), and have limited access to psychological care 
(Bean, Eurelings-Bontekoe, Mooijaart, & Spinhoven, 
2006). However, the generalizability of  these find-
ings to unaccompanied children in the United States 
is likely limited, given differences in the countries 
of  origin, migration experiences, legal systems, and 
resettlement conditions of  unaccompanied youth 
in these European countries compared to America. 

Legal Context
  In contrast with unaccompanied children’s mental 
health needs, the legal challenges they face have been 
widely documented (e.g., Byrne, 2008; Georgopoulos, 
2005; Nafziger, 2006). These include lack of  access to 
counsel, difficulty meeting the high evidentiary stan-
dards required to obtain legal relief, and the legal sys-
tem’s failure to consistently apply a “best interests of  
the child” standard when making decisions in their 
cases. However, a sustained legal advocacy campaign 
over the last 30 years has led to an expansion in the 
types of  immigration relief  for which unaccompa-
nied children may be eligible, and increased access to 
legal services to help them prepare their cases (Byrne, 
2008). Unaccompanied children may be eligible for a 
variety of  forms of  immigration relief, including Spe-
cial Immigrant Juvenile Status, asylum, and petitions 
under the Victims of  Trafficking and Violence Pro-
tection Act (Byrne & Miller, 2012). These cases can 
take years to resolve, during which children are placed 
in the temporary custody of  family members residing 
legally in the United States or, when such an option 
is not available, in government-sponsored foster care 
or residential facilities (Women’s Refugee Commis-
sion, 2009). Lawyers’ advocacy role during this peri-
od often includes connecting children to a variety of  
services (e.g., academic, social, health) in support of  
their cases and overall wellbeing (Baily et al., 2011). In 

BAILY, HENDERSON, TAUB, O’SHEA, EINHORN, VERDELI



5

particular, legal and mental health advocacy frequent-
ly overlap: each of  the major forms of  immigration 
relief  available to unaccompanied children requires 
evidence of  psychosocial stress, and lawyers frequent-
ly refer clients for assessment and documentation of  
mental health difficulties to be provided to the court 
as expert testimony in support of  their cases (Baily et 
al., 2011). However, there has been little formal study 
of  the intersection of  mental health and legal needs 
in unaccompanied children in the United States.

Conceptual Rationale 
 In this exploratory study, lawyers completed a 
survey about their perceptions of  the mental health 
needs of  their unaccompanied child clients and re-
ferral practices with this population. The goal was to 
provide qualitative, descriptive information about the 
experiences of  the lawyers surveyed, as opposed to 
quantitative data from which to draw inferences about 
the overall experiences of  lawyers working with un-
accompanied children or the mental health needs of  
these youth. The study was intended to provide a first 
step towards more extensive research to address the 
gap in the literature on the mental health needs of  un-
accompanied children in the U.S. immigration system. 
 This line of  research was initiated following re-
quests from several New York City lawyers to help 
them find mental health referrals for their unaccom-
panied child clients. Discussions with these lawyers 
suggested that they have concerns about the men-
tal health of  many of  these clients, and often seek 
psychological referrals, but have difficulty finding 
services appropriate to their clients’ needs. The 
lawyers mentioned a variety of  reasons for mental 
health referrals: for psychological evaluations and 
expert testimony that lend weight to children’s im-
migration petitions; for treatment to support chil-
dren through a stressful legal process that frequent-
ly requires recounting of  traumatic experiences; 
and because they are concerned more generally for 
children’s psychological welfare (Baily et al., 2011). 
These rationales mirror those reported in the wid-
er legal literature (e.g., Galowitz, 1999; Price & Mc-
Creary, 1976) as reasons lawyers request psychologi-
cal services for clients. The current survey explored 
whether the concerns raised by lawyers during 

these preliminary discussions were shared by other 
New York City lawyers who represent these youth.
  Given the emotionally and legally vulnerable 
status of  unaccompanied children, it seemed that 
an anonymous survey with an informed third party 
(as opposed to a study with unaccompanied chil-
dren and their families directly) would be the least 
intrusive and most ethically appropriate point of  
departure for our research. This is consistent with 
the ethical principles of  beneficence and nonmalef-
icence in conducting research with vulnerable popu-
lations (American Psychological Association [APA], 
2010). The study was also intended to generate initial 
information about the feasibility of  conducting re-
search on this topic, and to gain information about 
questions such as recruitment, protection of  sub-
jects, and data issues (e.g., reliability, generalizabil-
ity, qualitative versus quantitative methodology) in 
research on unaccompanied children. Thus, this re-
search sought both to generate hypotheses for future 
study and inform subsequent research methodology.
 The use of  key informants in research with im-
migrant children is complicated by these children’s 
diverse histories and experiences, as well as inconsis-
tent reporting due to varying cultural and experien-
tial perspectives (Suárez-Orozco & Suárez-Orozco, 
2001). The decision to use lawyers as informants in 
this study was based on multiple rationales. From 
an information-gathering point of  view, lawyers are 
often the professionals who know these children 
best: lawyers see their unaccompanied child clients 
at multiple time points during their often protract-
ed immigration processes; in the course of  devel-
oping immigration petitions, lawyers take detailed 
histories of  these children’s backgrounds (including 
their exposure and reactions to psychosocial stress-
ors); and their unique role as children’s advocates 
may help establish a relationship of  trust within an 
otherwise confusing and intimidating system. From a 
service-provision perspective, lawyers are frequently 
charged with helping children access other services 
and resources, and the study sought to understand 
lawyers’ role as a conduit to mental health services, to 
provide data on how mental health professionals can 
support them in this role, and to generate initial in-
formation about the possibility of  developing a more 

UNACCOMPANIED CHILD MENTAL HEALTH: LAWYERS’ ROLE



6

systematic mental health referral pathway for unac-
companied children via their legal processes in the 
future. From a research standpoint, this study with 
lawyers sought to contribute to the growing literature 
on the inter-relationship between unaccompanied 
children’s mental health and legal needs (e.g., Derluyn 
& Broekaert, 2008; Nugent, 2006). Of  note, the sur-
vey was not intended to provide epidemiological data 
about psychopathology in unaccompanied children. 
Accurately identifying psychological difficulties in 
their clients is outside attorneys’ professional exper-
tise and role, and was beyond the scope of  this study.
  The specific aims of  this study were to inves-
tigate whether participating lawyers were observ-
ing mental health problems in their unaccompa-
nied child clients, how lawyers characterized these 
problems, their referral practices with this popu-
lation, barriers they encountered to service access, 
and their interest in further mental health training.

Method

Measure 
 A 71-question survey titled “Mental Health 
Referral Practices of  Lawyers Representing Unac-
companied Immigrant Minors” was developed to 
assess lawyers’ perceptions of  their unaccompa-
nied child clients’ mental health needs, their men-
tal health referral practices, and their mental health 
training and experience. The survey content was 
informed by a review of  the available literature on 
the psychological needs of  unaccompanied chil-
dren and lawyers’ mental health referral practices, 
and then refined through consultation with a lawyer 
member of  the research team with experience rep-
resenting unaccompanied children. The format and 
structure of  the survey was revised through con-
sultation with researchers from the New York State 
Psychiatric Institute with expertise in public health 
research and the assessment of  child mental health.
  The survey combined selected-response, Likert-
style, and open-ended questions. Lawyers were asked 
to give some basic demographic information (e.g., 
number of  years in legal practice, primary area of  le-
gal practice etc.), to provide information on their at-
titudes towards mental health diagnosis and referrals 

(e.g., “In what ways does a diagnosis of  a mental health 
problem in unaccompanied minors typically influ-
ence immigration proceedings?”), to rate their men-
tal health knowledge (e.g., “Do you feel confident in 
your ability to identify mental health problems in your 
unaccompanied minor clients?”), and to describe ar-
eas of  interest for further mental health training. For 
their three most recent clients, whether or not they 
were referred for mental health services, lawyers were 
asked to describe any behavior, emotions, or thoughts 
that made them concerned for the client’s mental 
health. For their three most recent clients referred 
for mental health services, lawyers were asked about 
the reasons for referral and any barriers to obtain-
ing services. Participants were given the opportunity 
to write optional additional comments pertaining to 
each of  the above topic areas. The survey was hosted 
at SurveyMonkey, a service for web-based question-
naires that employs Secure Sockets Layer (SSL) en-
cryption to secure the data provided by participants. 
It took approximately 30-40 minutes to complete.

Participants
 Study participants were lawyers practicing in 
New York City who had represented at least one 
unaccompanied child client in immigration proceed-
ings within the last five years (N=26). The data con-
cerning the types of  legal organizations for which 
respondents worked, their primary areas of  legal 
practice, and the number of  unaccompanied chil-
dren they had represented are presented in Table 
1. Broadly speaking, the participants fell into one 
of  two categories: a majority of  lawyers worked for 
private law firms and other organizations special-
izing in corporate law, and had represented a small 
number (<5) of  unaccompanied children as a minor 
portion of  their practice; a smaller group of  lawyers 
worked for nonprofit legal services organizations, 
specialized in immigration law, and had represented 
a large number (>50) of  unaccompanied children.

Procedure
 A pool of  potential participants was recruited via 
outreach to legal advocacy programs that work with 
unaccompanied children. These included Catholic 
Charities and the Legal Aid Society, nonprofit orga-

BAILY, HENDERSON, TAUB, O’SHEA, EINHORN, VERDELI



7

nizations that provide free legal services to unaccom-
panied children, as well as Kids in Need of  Defense 
(KIND), a national organization that arranges legal 
representation for unaccompanied children by pro 
bono lawyers. Representatives from these organiza-
tions sent an email describing the study and providing 
a link to the survey to their listservs of  New York City 
lawyers representing unaccompanied children. Nei-
ther the contact details of  lawyers on these listservs 
nor any other identifying information about them 
was provided to the research team. Approximately 
150-200 attorneys were contacted via this method. In 
addition, participants were invited to forward the sur-
vey link to other lawyers who work with unaccompa-
nied children. This methodology, known as snowball 
sampling, is common to many survey studies. In par-
ticular, it has been used in studies concerning vulner-
able populations with heightened confidentiality and 
anonymity concerns (e.g., Kendall et al., 2008). These 
procedures were intended to recruit a convenience 
sample of  lawyers who could describe their experi-

ence of  the mental health issues involved in repre-
senting unaccompanied children. The sample and data 
collected were not intended to be representative of  or 
generalizable to the wider population of  lawyers rep-
resenting unaccompanied children in New York City.
  The e-link to the survey contained a consent 
form completed by all participants prior to complet-
ing the study. Participation was anonymous and vol-
untary, and neither the recruitment process nor the 
survey itself  required lawyers to provide identifying 
information about themselves, their clients, or their 
places of  work. The study was approved by the Inter-
nal Review Boards of  the New York State Psychiatric 
Institute and Teachers College, Columbia University. 
Data Analysis: Due to the descriptive nature of  this 
study, the nature of  the sample, and the types of  
questions asked, the data were primarily analyzed 
qualitatively. For questions with a selected-response 
format, frequency data were collected. These data 
were intended to be used descriptively, rather than 
for the purposes of  quantitative analysis. They are 
summarized in Tables 1-5. Variations in the n re-
ported in the tables relate to differences in response 
rate for different survey questions. In some cases 
lawyers provided reasons for omitting questions, 
including privacy concerns (e.g., “I can’t comment 
(case in progress)”) and lack of  knowledge in a par-
ticular area (e.g., “no experience”). In other cases, the 
reasons for omissions were unclear. The frequency 
data collected were used to supplement the qualita-
tive data provided by lawyers’ open-ended responses.

Results

Mental Health Difficulties Observed by Lawyers 
 The lawyers in this study were asked whether they 
had observed any behaviors, emotions, or thoughts in 
their last three unaccompanied child clients which had 
made them concerned about their mental health and, 
if  so, to describe them. Respondents were asked to 
comment separately on each of  these clients, regardless 
of  whether they were referred for mental health ser-
vices. Overall, lawyers reported concerning behaviors, 
thoughts, or emotions in about half  of  these youth.
 Lawyers used a mixture of  lay terminology (e.g., 
“frustration and sense of  rejection,” “just hyper 

UNACCOMPANIED CHILD MENTAL HEALTH: LAWYERS’ ROLE

UNACCOMPANIED CHILD MENTAL HEALTH: LAWYERS’ ROLE 34 

Table 1 

Participant Demographics (N=26) 

 n a 

Legal Organization Type ( /26) 

Private law firm 18 

Nonprofit legal services organization 5 

Solo practitioner 2 

In-house counsel 1 

Government attorney 0 

Primary Area of Legal Practice ( /24) 

Corporate law 16 

Immigration law 7 

Family law 1  

Number of Cases Completed ( /26) 

< 5 17 

6-10 1 

11-20 3 

21-50 0 

50+ 5 

 

 a differences in n reflect variations in response rate between different demographic questions



8

anxiety,” difficulty sleeping,” “tearfulness,” “reports 
of  stress”) and clinical terminology (e.g., “flat af-
fect,” “depression,” “separation anxiety,” “delusion-
al behaviors,” “schizophrenia”) to describe areas of  
concern. They noted a wide range of  difficulties, 
including what appeared to be internalizing symp-
toms (e.g., “poor self-esteem,” “nightmares,” “seem-
ingly despondent”) and externalizing symptoms (e.g., 
“behavioral problems,” “self-mutilation,” “suicide 
attempts”). In addition to apparent psychological 
symptoms, they also reported potentially psychoso-
matic symptoms (e.g., “sleepiness”) and contextual 
signs of  distress (e.g., “poor school performance,” 
“difficulties with personal relationships”). In some 
cases, they identified specific psychological stressors, 
including traumatic stressors (e.g., “Client expressed 
trouble sleeping, nightmares, [and] memory problems 
that appear to be related to trauma suffered in his 
home country”), family stressors (e.g., “not fully dealt 
with suicide of  mother,” “severe depression related to 
rape by a family member,” “resentment against father 
for physical and emotional abuse”), detention-related 
stressors (“frustration at having spent nine months 
in federal custody,” “anger at family members for 
not stepping up to get minor released from custody,” 
“sense of  rejection due to family not coming through 
for reunification”), and court-related stressors (“un-
willingness to discuss journey to the U.S.” and “star-
tle reaction to question by immigration judge”).
 In addition to the mental health concerns noted, 
several lawyers described resilience processes that ap-
peared to protect children from developing psycho-
logical symptoms despite the psychosocial stressors 
they may have endured. Some lawyers described pro-
tective individual characteristics in clients (e.g., “this 
kid was… very grounded”). Others emphasized sys-
temic factors contributing to resilience (e.g., “most 
of  my [unaccompanied child clients] have family sup-
port in the U.S., though not the mother and father”).

Reasons for Referral
 A little under half  of  the lawyers surveyed had re-
ferred unaccompanied child clients for mental health 
services. These lawyers were asked about the primary 
and other reasons for referral for the three most re-
cent unaccompanied child clients they had referred to 

mental health services (these are combined in Table 2). 

 In almost half  of  the referred cases lawyers de-
scribed, their primary reason for referral was to obtain 
expert psychological testimony in support of  their cli-
ents’ legal cases. Commenting more generally on their 
attitudes towards diagnostic evaluations, half  of  the 
lawyers surveyed agreed that having a mental health 
diagnosis typically assists in acquiring immigration re-
lief. Most of  the lawyers in this study who had made 
mental health referrals indicated that the potential le-
gal implications of  having a mental health diagnosis 
had been a factor causing them to refer unaccom-
panied child clients. Several lawyers’ comments sug-
gested a complex and nuanced relationship between 
mental health diagnoses and immigration petitions. 
For example, one respondent mentioned that the in-
fluence of  a mental health diagnosis on immigration 
proceedings  “depends on the diagnosis; generally [it] 
helps more that [it] hurts,” while another suggested 
that a diagnosis’s utility “depends on its relation to 
the claim being asserted.”  However, none of  the law-
yers surveyed agreed that the potential legal implica-
tions of  having a mental health diagnosis had caused 
them not to refer a client for mental health services. 
Among the lawyers surveyed who work for nonprofit 
legal service organizations that specialize in working 

BAILY, HENDERSON, TAUB, O’SHEA, EINHORN, VERDELI

UNACCOMPANIED CHILD MENTAL HEALTH: LAWYERS’ ROLE 35 

Table 2 

Reasons for Mental Health Referral in Three Most Recent Unaccompanied Child Clients 

Referred (N=25) 

 n a  ( /25) 

Reason  

Behavior observed by lawyer 17 

Expert testimony 16 

Child self-reported difficulties 15 

Interference with legal process 11 

Behavior reported by third party 7 

Child’s request for help 3 

Caretaker’s request for help 1 

a n reflects total number of clients in whom this was a reason for referral (some lawyers reported 

multiple reasons for referring a single client) 

 



9

with unaccompanied children, all reported that they 
had referred clients to mental health services. With-
in this highly experienced subset of  respondents, all 
agreed that having a mental health diagnosis gener-
ally assists in acquiring immigration relief  and that 
this had influenced their decision to make referrals.
 In many cases, lawyers referred for both expert 
testimony and ongoing psychological services. In 
almost half  of  the referral cases lawyers described, 
one reason for doing so was to assist with psycho-
logical difficulties affecting legal representation. One 
lawyer described a client’s “unwillingness to discuss 
the journey to the U.S.” Another lawyer described 
a client from whom, “we needed the expert testi-
mony for the case; also, I was concerned that I (as 
a lay-person) was not getting the full story from my 
client; that she was glossing over events that a pro-
fessional would have been better placed to uncover.” 
The possible legal benefits of  mental health assess-
ment and treatment aside, lawyers also frequently 
referred children out of  a more general concern for 
their wellbeing. One lawyer described being “deeply 
concerned about the [client’s] self-mutilation.” Com-
menting more generally, another lawyer suggested 
“I find that youth will self-medicate and this is ex-
tremely disconcerting for the long term health and 
stability of  the child.” Lawyers frequently described 
making referrals for a combination of  legal and 
mental health reasons. For example, one lawyer de-
scribed referring a client, “to help the kid’s mental 
health and to help the case and document the abuse.”
 In the majority of  cases where participating law-
yers had referred one of  their last three clients, they 
did so on the basis of  concerning thoughts, feelings, 
or behaviors that they observed directly or that chil-
dren reported to them. By contrast, a child or guard-
ian’s direct request for help was a factor in less than 
a quarter of  the cases lawyers described. One lawyer 
described a case in which the “child seemed like they 
wanted to speak to someone and I thought that they 
should speak to a qualified person,” alluding to the 
multiple needs lawyers may feel pulled to address. 
Some lawyers appeared to refer clients routinely as 
a form of  mental health screening. One reported, 
“I would assume they need an evaluation,” and an-
other noted “I err on the side of  referral… [there’s] 

no real downside to a single visit consultation.”

Barriers in Obtaining Mental Health Services
 Lawyers were also asked about barriers to access-
ing mental health services for the last three clients 
they had referred (see Table 3). In the great majority 
of  these cases they encountered obstacles, and in al-
most half  of  the referral cases described, the clients 
ultimately did not receive services. The most com-
monly endorsed difficulties were cost of  services, 
difficulty in finding services in the client’s/caretaker’s 
primary language, and distance/transportation issues. 
One lawyer described systemic issues in helping chil-
dren to access affordable resources: “We need social 
workers to help children sign up for medical and ed-
ucation programs and get Medicaid so they can pay 
for mental health treatment; for depressed clients 
(many) or those who are not motivated or savvy with 
adult bureaucracies in the US (most all), getting to 
a therapist is difficult.” Other lawyers indicated a 
more fundamental lack of  appropriate resources. As 
one lawyer suggested, “there are virtually no Span-
ish speaking counselors.” Another indicated, “I wish 
there were more free therapy sources that take Med-
icaid and where therapists speak Spanish.” Several 
lawyers contrasted the availability of  services when 
children are in detention versus out in the commu-
nity. As one explained, “All of  the detained children 
receive mental health services in the ORR [Office of  
Refugee Resettlement] custodial centers. Very few of  
the released children have access to these services.” 

UNACCOMPANIED CHILD MENTAL HEALTH: LAWYERS’ ROLE

UNACCOMPANIED CHILD MENTAL HEALTH: LAWYERS’ ROLE 36 

Table 3 

Barriers to Mental Health Services Encountered in Three Most Recent Unaccompanied Child 

Clients Referred (N=25) 

 n a ( /25) 

Reason  

Cost 18 

Language 14 

Distance/transport 11 

Confidentiality concerns 1 

No barriers 3 

a n reflects total number of clients for whom this was a barrier (some lawyers reported multiple 

barriers encountered by a single client) 

 

 

 



10

 Lawyers appeared to have particular difficulty 
finding ongoing treatment services as compared to 
expert testimony evaluations. One lawyer stated, “I 
only refer for expert testimony because I can only 
find therapists able to provide that type of  service. 
There are no programs for on-going therapy/care.” 
Another indicated, “If  there was a program/clin-
ic providing service, I would refer independent of  
the legal case need…Sadly, these programs do not 
exist.” Faced with a lack of  resources, some lawyers 
appeared to operate an informal triage system. One 
lawyer suggested, “I tend to only be able to get ac-
cess to mental health services for the most high risk 
cases.” Another commented, “I wish I could get 
counseling for all of  the children I work with because 
many who do not openly express depression/anxiety 
are actually experiencing it.” Almost half  of  the law-
yers surveyed indicated that they would have referred 
more unaccompanied child clients if  they had been 
aware of  available mental health services. One lawyer 
stated, “If  mental health services were more readily 
available, I would refer ever single client to services.” 
 Several lawyers mentioned stigma attached to 
mental health difficulties and treatment as a barrier 
to accessing services. One lawyer described a client 
who was “currently resisting assistance.” Another 
reported, “One of  the greatest challenges in work-
ing with youth is their reluctance to engage in treat-
ment because of  socio-cultural factors.” Caregiv-
ers’ attitudes towards mental health issues may also 
pose a barrier to service access. One lawyer “did not 
press for follow up treatment because I believed the 
[caregivers] were not engaged and would not take 
follow up steps.” Mental health stigma was not the 
only source of  reluctance to engage in treatment. 
For example, one lawyer cited a client’s “mistrust of  
systemic actors” as a barrier to obtaining services.

Mental Health Services Received
 Lawyers were asked about the types of  mental 
health services to which they had referred unaccom-
panied children (see Table 4). Private practice and 
community service/nonprofit organizations were the 
most common types of  referrals. None of  the law-
yers surveyed had ever referred clients to the emer-
gency room. Lawyers had mixed feelings regarding 

the effectiveness of  the services to which they had 
referred their clients. Approximately half  of  the par-
ticipating lawyers agreed that when they had referred 
unaccompanied child clients for mental health ser-
vices it had been beneficial to them. Concerns were 
raised about the mandated mental health services 
provided to children detained in government-spon-
sored facilities, however. One lawyer explained, “Al-
though detained minors ostensibly have access to 
mental health services in the shelters, there are real 
concerns about [the] confidentiality of  those services, 
as well as whether the services are sufficiently rigor-
ous to meet the needs of  unaccompanied children.” 

Lawyers’ Mental Health Knowledge/Training
 Lawyers were asked to comment on their men-
tal health knowledge and training. Approximately 
half  did not feel confident in their ability to identify 
mental health problems in their clients or confident 
knowing when to refer clients. One lawyer stated 
succinctly, “I am not a mental health professional, so 
[it’s] difficult to know when to refer.” Most of  the 
lawyers surveyed did not know where to refer cli-
ents. Among the lawyers surveyed who worked in 
programs in nonprofit organizations specializing in 
representation of  unaccompanied children, all but 
one had received training in mental health issues re-
lated to working with unaccompanied children (and 

BAILY, HENDERSON, TAUB, O’SHEA, EINHORN, VERDELI

UNACCOMPANIED CHILD MENTAL HEALTH: LAWYERS’ ROLE 37 

Table 4 

Types of Mental Health Services to which Lawyers Have Referred Unaccompanied Child Clients 

(N=14) 

 n a ( /14) 

Service Type  

Private practice 10 

Community service/NPO organization 7 

Primary care provider 2 

Student mental health clinic 2 

Faith-based organization 1 

Support group 1 

Emergency room  0 

a n reflects total number of lawyers who referred to this type of service (some lawyers reported 

making multiple types of referral) 

 



11

in this subset of  respondents, all but one felt con-
fident in their ability to identify mental health prob-
lems in their clients and in knowing when to refer). 
By contrast, among the larger subset of  corporate 
lawyers representing unaccompanied children pro 
bono, only one had received such training. Describ-
ing a previous case, one such lawyer commented, “As 
a new practitioner in removal defense, at the time I 
wasn’t aware of  the possibility or need of  referring; 
and only one such behavior was exhibited, so I felt it 
was not a major issue. I might act differently now.” 
Another lawyer implied that lack of  awareness about 
psychological issues is a systemic problem: “Proba-
bly the immigration bar generally needs to be bet-
ter informed about health issues concerning unac-
companied minor clients and relevant resources.”
 The great majority of  the lawyers surveyed agreed 
that it was within the scope of  their role as lawyers to 
recommend mental health services for clients. All but 
two indicated that they would be interested in receiv-
ing further training. The most popular suggestions for 
future training were methods for interviewing unac-
companied children with a traumatic history, recogniz-
ing common mental disorder symptoms, and means 
of  accessing mental health resources (see Table 5).

Discussion

 Derluyn and Broekaert (2008) describe how dif-
fering legal and psychological perspectives on un-
accompanied children may lead to neglect of  their 

mental health, and suggest that the overall standpoint 
for understanding these children should be primarily 
psychological rather than legal (i.e., seeing them first 
and foremost as youth with specific developmental 
needs, not as “unaccompanied alien children”). The 
lawyers in this study find themselves in precisely this 
predicament, moving between legal and psycholog-
ical responsibilities, addressing children’s mental 
health in both a legal context (e.g., requesting expert 
testimony to support clients’ immigration claims) 
and a psychological one (e.g., requesting treatment 
for clients’ emotional and behavioral concerns).
 Given the legal context, one might imagine that 
lawyers would be primed to identify mental health 
difficulties such as anxiety, depression, and traumatic 
stress that could be seen as evidence of  prior abuse 
and so might lend support to legal claims and bol-
ster a case that a child needs further protections in 
the United States. Similarly, one might anticipate that 
lawyers would less readily identify problematic be-
haviors that could present a negative impression of  
their clients in court. However, lawyers in this sur-
vey reported a wide range of  symptoms in their cli-
ents, including some that might potentially be viewed 
less favorably, such as “anger and resentment,” 
“self-medication by drinking,” and “out of  control 
teenage behavioral problems.” The range of  mental 
health and behavioral problems noted by the lawyers 
in the survey mirrored symptoms found in previous 
studies with unaccompanied and other vulnerable im-
migrant children, including anxiety symptoms (Der-
luyn & Broekaert, 2007; Fazel & Stein, 2002; Silove 
& Steel, 1998; Sourander, 1998), depression (Derluyn 
& Broekaert, 2007; Fazel & Stein, 2002; Hodes et al., 
2008; Silove & Steel, 1998), sadness (Fazel & Stein, 
2002; Silove & Steel, 1998; Sourander, 1998), with-
drawal (Ajdukovic & Ajdukovic, 1998; Fazel & Stein, 
2002; Silove & Steel, 1998), tearfulness (Ajdukovic 
& Ajdukovic, 1998), loss of  interest (Fazel & Stein, 
2002; Silove & Steel, 1998), sleep disturbances (Fa-
zel & Stein, 2002; Silove & Steel, 1998), nightmares 
(Ajdukovic & Ajdukovic, 1998; Fazel & Stein, 2002; 
Silove & Steel, 1998), concentration problems (Ajdu-
kovic & Ajdukovic, 1998; Fazel & Stein, 2002; Silove 
& Steel, 1998; Sourander, 1998), hyperarousal (Fa-
zel & Stein, 2002; Silove & Steel, 1998),  psychosis 

UNACCOMPANIED CHILD MENTAL HEALTH: LAWYERS’ ROLE

UNACCOMPANIED CHILD MENTAL HEALTH: LAWYERS’ ROLE 38 

Table 5 

Areas for Future Mental Health Training with Lawyers (N=19) 

 n a ( /19) 

Topic  

Interviewing unaccompanied children with trauma histories 16 

Recognizing symptoms of common mental disorders 14 

Means of accessing mental health resources 13 

Encouraging unaccompanied child clients to follow-up on referrals 10 

Presenting mental health concerns to children and their families 7 

a n reflects total number of lawyers who expressed interest in this type of training (some lawyers 

reported interest in multiple topics) 



12

(Hodes & Tolmac, 2005), suicidality (Silove & Steel, 
1998), and behavioral problems (Ajdukovic & Ajdu-
kovic, 1998; Fazel & Stein, 2002; Sourander, 1998). 
 The overlap between legal and mental health 
concerns was most apparent in the context of  refer-
rals. Among the referral cases lawyers described ex-
pert testimony was the most commonly cited primary 
reason for referral, and most of  the lawyers who had 
made referrals suggested that the possible legal ben-
efits of  a mental health diagnosis had factored into 
their decision to do so. However, the potential for 
clients’ psychological difficulties to have an impact on 
legal proceedings extends beyond giving expert tes-
timony and providing mental health diagnoses. For 
example, posttraumatic stress can affect refugee peti-
tioners’ ability to testify and the content of  their tes-
timonies (Rousseau, Crépeau, Foxen, & Houle, 2002). 
In this study, lawyers described enlisting mental health 
professionals to support children in disclosing trau-
matic histories that were important to their cases but 
that they might otherwise have been unable to report. 
Similarly, some lawyers referred children to help them 
combat posttraumatic symptoms associated with 
appearing in court. The contrast between legal and 
psychological perspectives on unaccompanied chil-
dren can create the impression that it is impossible 
to balance the two. However, lawyers in this survey 
frequently expressed great concern for their clients’ 
well-being, over and above any potential relevance 
of  the child’s psychological presentation to their im-
migration cases. Likewise, in their great majority, the 
lawyers surveyed suggested that advocating for their 
clients’ mental health needs was part of  their role.
 The surveyed lawyers’ difficulty in accessing ap-
propriate services for their clients was one of  the 
most salient findings of  the survey. The main barriers 
to care that lawyers described were similar to those 
commonly described in previous studies assessing ac-
cess to mental health services for unaccompanied ref-
ugee children and adolescents in Europe (Derluyn & 
Broekaert, 2008). Although, for reasons of  confiden-
tiality, the survey did not include any questions about 
clients’ ethnicity, most unaccompanied children are 
from Latin America (Byrne & Miller, 2012) and bar-
riers to care lawyers reported were similar to those 
described elsewhere in the literature on Latino mental 

health care access (e.g., Aguilar-Gaxiola, Loera, Mén-
dez, & Sala, 2012): lack of  affordable options, lack 
of  local resources, and language difficulties. These 
same factors of  course hinder service access for im-
migrants from many parts of  the world (APA, 2012). 
 Some lawyers surveyed also cited stigma to-
wards mental health issues and clients’ wariness of  
treatment seeking as barriers to care, again mirror-
ing the wider literature on immigrant mental health 
service utilization (e.g., Ishikawa, Caedemil, & Fal-
magne, 2010; Sue, Fujino, Hu, Li-Tze, & Takeuchi, 
1991). In Latino immigrants, reluctance to seek men-
tal health assistance has been linked to cultural val-
ues such as marianismo, which encourages females 
to be self-sacrificing and not to talk about personal 
problems, and machismo, which encourages males to 
show strength and not to demonstrate vulnerability 
(Workgroup on Adapting Latino Services [WALS], 
2008). In addition, unaccompanied children often 
live in communities in which many people are un-
documented and there is a culture of  mistrust to-
wards professional institutions, and this may dissuade 
them from seeking mental health services (Agui-
lar-Gaxiola et al., 2012; ter Kuile, Rousseau, Munoz, 
Nadeau, & Ouimet, 2007; WALS, 2008). Howev-
er, further research is required to understand how 
these and other factors influence treatment-seeking 
in this socio-culturally diverse population of  youth.

Future Directions
 Although this is small study with a conve-
nience sample, the responses of  the lawyers sur-
veyed are suggestive of  a need for more system-
atic identification of  unaccompanied children in 
need of  mental health services, more comprehen-
sive and cohesive referral pathways, and greater 
availability of  services appropriate to their needs.
 With few exceptions, the lawyers surveyed were 
the only source of  referral for their unaccompanied 
child clients. Lawyers may represent one potential 
pathway into services, and training should be pro-
vided to support them in this role. However, in or-
der to provide a more comprehensive approach to 
meeting unaccompanied children’s needs, other men-
tal health care pathways for unaccompanied children 
should be developed, such as schools (Hodes et al., 

BAILY, HENDERSON, TAUB, O’SHEA, EINHORN, VERDELI



13

2008; Kataoka et al., 2003) and primary health care 
clinics (Rousseau, Measham, & Nadeau, 2013). As 
several of  the lawyers surveyed noted, the only un-
accompanied children who routinely receive mental 
health services are those mandated to do so because 
they are detained in government-sponsored deten-
tion facilities (Women’s Refugee Commission, 2009). 
The fact that provision of  services is determined 
more by children’s custodial status than their particu-
lar mental health needs is, as Derluyn and Broekaert 
(2008) note, a clear example of  the favoring of  a 
legal over a psychological framework for their care.
 The lawyers surveyed consistently voiced the 
need to increase the availability of  appropriate and 
feasible mental health services for their unaccompa-
nied child clients. The fact that more respondents had 
referred clients to private practitioners than to other 
types of  mental health care that more typically serve 
immigrant communities, such as community-based 
service organizations (WALS, 2008), speaks to the 
lack of  programming currently available to unaccom-
panied  children and, presumably, other undocument-
ed immigrant youth. In the absence of  such services, 
lawyers may look to private practitioners to provide 
services on an occasional, pro bono basis. However, 
this type of  provider is unlikely to be able to respond 
to a high service demand, or to lead to the devel-
opment of  specialized mental health programming 
for unaccompanied children. When surveyed law-
yers were successful in finding care for their clients, 
they had mixed opinions regarding the effectiveness 
of  the services they accessed. In particular, sever-
al respondents’ comments echoed concerns raised 
in previous studies about the consistency (United 
States Department of  Health and Human Services, 
2008) and confidentiality (Byrne, 2008) of  the ser-
vices provided to detained unaccompanied children.
 Taken together, the surveyed lawyers’ comments 
suggest a need for an improved mental health infra-
structure for unaccompanied children. Such an ap-
proach might include aspects of  the child advocacy 
center (CAC) model for victims of  abuse, which 
emphasizes the coordination of  investigation and 
intervention services (e.g., law enforcement, child 
protective services, prosecution, victim advocacy, 
medical care, and mental health services) to care for 

children and minimize the number of  times they 
have to retell their stories. The CAC model has been 
shown to improve the effectiveness and efficiency 
of  responding to child abuse cases while reducing 
harm and discomfort to children and their families 
(e.g., Smith, Witte, & Fricker-Elhair, 2006; Jones, 
Cross, Walsh, & Simone, 2007). Community collab-
orative care models, whereby mental health provid-
ers with specialized cultural expertise in the patient 
population work with other providers (e.g., primary 
care and social service professionals) to offer sensi-
tive care to vulnerable children and families, have also 
been proposed as a way of  addressing the challeng-
es faced in delivering psychological services to im-
migrant and refugee children (Rousseau et al., 2013).
 Expanding mental health training for lawyers 
should be prioritized as an important part of  any 
integrated program of  services for unaccompanied 
children. Almost all of  the lawyers surveyed indicat-
ed that they would be interested in further training 
in mental health considerations when working with 
unaccompanied children. The large percentage of  
lawyers who represent unaccompanied youth on an 
occasional pro bono basis (as opposed to working 
for a nonprofit organization specializing in work with 
this population) may benefit particularly from mental 
health education: this subset of  respondents was less 
likely to have received mental health training, had rep-
resented fewer unaccompanied clients, expressed less 
confidence in identifying these clients’ mental health 
needs and knowing when to refer, and appeared less 
aware of  the possible benefits of  mental health as-
sessment and treatment for their clients’ legal cases. 
Future training should, as respondents suggested, 
include areas such as identifying common psychiat-
ric symptoms in children, interviewing traumatized 
children, and facilitating mental health referrals. Re-
gardless of  the topic area, training should be framed 
within a child-centered perspective, that takes into 
account children’s needs, experiences, and develop-
mental (i.e., physical, cognitive, social) processes (Nu-
gent, 2006; Steinberg, Woodhouse, & Cowan, 2002). 
 Developments in programming for unaccompa-
nied children and the professionals who serve them 
should go hand in hand with research examining 
the mental health needs of  these youth. The meth-

UNACCOMPANIED CHILD MENTAL HEALTH: LAWYERS’ ROLE MEDIA



14

odology used in this study (combining outreach via 
legal organizations and snowball sampling) provid-
ed an anonymous and confidential format through 
which respondents could ethically disclose sensitive 
and informative details about their cases. The de-
tailed qualitative data provided by respondents sug-
gest that unaccompanied children are a population 
with complex and frequently unmet psychological 
needs. Further study should investigate children’s 
psychological needs directly (i.e., through interviews 
with children and their caregivers). This research 
should seek to examine risk and resilience process-
es in this population, and differences in experiences 
and need between different subsets of  unaccompa-
nied children (e.g., youth living in detention versus 
in the community). Research should also investigate 
the feasibility of  different pathways into care (e.g., 
via primary care, schools, and child welfare services) 
and different models of  service provision. Wherever 
possible, research and programming should seek to 
enhance a psychological perspective and to identify 
unaccompanied children’s individual differences, as 
opposed to their common legal status and predic-
ament (Henderson, Baily, & Weine, 2010). Finally, 
future research and programming should place a 
strong emphasis on children’s strengths and protec-
tive factors, in addition to the challenges they face.

Limitations
 This study had a small number of  respondents. 
Due to the recruitment procedure, it was not possible 
to ascertain the survey response rate or how represen-
tative the participants were of  the general population 
of  lawyers serving this population. Of  particular rele-
vance for this study, lawyers who chose to participate 
may have been more invested in mental health refer-
rals and may have been more likely to have observed 
mental health problems in their unaccompanied child 
clients than lawyers who chose not to. Differential 
response rates for different survey questions may 
have created additional bias. Furthermore, a survey 
may not provide the best format in which to inquire 
about certain sensitive questions, such as the poten-
tial legal benefits of  a mental health diagnosis. All of  
these factors limit the generalizability of  the findings.

New Contribution to the Literature
 This is, to the authors’ knowledge, the first study 
to investigate the mental health needs of  immigrant 
youth from lawyers’ perspectives. It is intended as a 
first step in research to help address the gap in the 
literature on the psychological needs of  unaccom-
panied children in the United States. It is also in-
tended to inform psychoeducational interventions 
for lawyers working with unaccompanied children. 
The long-term goal of  this research is to contribute 
to the development of  feasible, appropriate, effec-
tive, and sustainable mental health assessment and 
treatment services for this underserved population.
 

References

Aguilar-Gaxiola, S., Loera, G., Méndez, L., Sala, M., 
Latino Mental Health Concilio, & Nakamoto, J. 
(2012). Community-defined solutions for Latino 
mental health care disparities: California Reduc-
ing Disparities Project, Latino Strategic Planning 
Workgroup population report (Research Report). 
Sacramento, CA: U.C. Davis. Retrieved from U.C. 
Davis Health System website: http://www.ucd-
mc.ucdavis.edu/newsroom/pdf/Latino_men-
tal_health_report-6-25-2012-1.pdf

Ajdukovic, M., & Ajdukovic, D. (1998). Impact of  
displacement on the psychological well-being of  
refugee children. International Review of  Psychi-
atry, 10, 186−195. doi:10.1080/09540269874763

American Psychological Association. (2010). Ethical 
principles of  psychologists and code of  conduct. 
Retrieved from APA website: http://www.apa.
org/ethics/code/principles.pdf

American Psychological Association, Presidential 
Task Force on Immigration. (2012). Crossroads: 
The psychology of  immigration in the new cen-
tury (Research Report). Retrieved from APA 
website: http://www.apa.org/topics/immigra-
tion/report.aspx

Baily, C. D. R., Henderson, S. W., Taub, A. R., Ricks, 
A. S., & Verdeli, H. (2011). The psychological 
context and mental health needs of  unaccompa-
nied children in United States immigration pro-
ceedings. Graduate Student Journal of  Psychol-

BAILY, HENDERSON, TAUB, O’SHEA, EINHORN, VERDELI



15

ogy, 13, 4-11. Retrieved from Graduate Student 
Journal of  Psychology website: http://www.
tc.columbia.edu/i/a/document/19225_V13_1_
Baily.pdf  

Bhabha, J., & Schmidt, S. (2008). Seeking asylum 
alone: Unaccompanied and separated children 
and refugee protection in the U.S. The Journal 
of  the History of  Childhood and Youth, 1, 127–
138. doi:10.1353/ hcy.2008.0007

Bean, T., Derluyn, I., Eurelings-Bontekoe, E., Broe-
kaert, E., & Spinhoven, P. (2007). Comparing 
psychological distress, traumatic stress reactions, 
and experiences of  unaccompanied refugee mi-
nors with experiences of  adolescents accompa-
nied by parents. The Journal of  Nervous and 
Mental Disease, 195, 288–97. doi:10.1097/01.
nmd.0000243751.49499.93

Bean, T., Eurelings-Bontekoe, E., Mooijaart, A., & 
Spinhoven, P. (2006). Factors associated with 
mental health service need and utilization among 
unaccompanied refugee adolescents. Adminis-
tration and Policy in Mental Health, 33, 342–55. 
doi:10.1007/s10488-006-0046-2

Bean, T. M., Eurelings-Bontekoe, E., & Spinhoven, P. 
(2007). Course and predictors of  mental health 
of  unaccompanied refugee minors in the Neth-
erlands: One year follow-up. Social Science & 
Medicine (1982), 64, 1204–1215. doi:1887/13176

Byrne, O. (2008). Unaccompanied children in the 
United States: A literature review (Research Re-
port). Retrieved from Vera Institute of  Justice 
website: http://www.vera.org/sites/default/
files/resources/downloads/UAC_literature_re-
view_FINAL.pdf

Byrne, O., & Miller, E. (2012). The flow of  unaccom-
panied children through the immigration system: 
A resource for practitioners, policy makers, and 
researchers (Research Report). Retrieved from 
Vera Institute of  Justice website: http://www.
vera.org/download?file=3483/the-flow-of-un-
accompanied-children-through-the-immigra-
tion-system.pdf

Casillas, R. R. (2006). La trata de mujeres, adoles-
centes, niñas y niños en Mexico: Un estudio ex-
ploratorio en Tapachula, Chiapas. Organization 
of  America States. Retrieved from Organiza-

tion of  American States website: http://www.
oas.org/atip/Reports/Estudio.Exploratorio.
en.Tapachula.pdf  

Chavez, L., & Menjívar, C. (2010). Children with-
out borders: A mapping of  the literature on 
unaccompanied migrant children to the United 
States. Migraciones Internacionales, 5, 71–111. 
Retrieved from Red de Revistas Científicas de 
América Latina y el Caribe, España y Portu-
gal website:  http://www.redalyc.org/articulo.
oa?id=15112895003

Derluyn, I., & Broekaert, E. (2007). Different per-
spectives on emotional and behavioural prob-
lems in unaccompanied refugee children and 
adolescents. Ethnicity & Health, 12, 141–162. 
doi:10.1080/13557850601002296

Derluyn, I., & Broekaert, E. (2008). Unaccompanied 
refugee children and adolescents: The glaring con-
trast between a legal and a psychological perspec-
tive. International Journal of  Law and Psychiatry, 
31, 319-330. doi:10.1016/j.ijlp.2008.06.006

Derluyn, I., Broekaert, E., & Schuyten, G. (2008). 
Emotional and behavioural problems in migrant 
adolescents in Belgium. European Child & Ad-
olescent Psychiatry, 17, 54–62. doi:10.1007/
s00787-007-0636-x

Fazel, M., & Stein, A. (2002). The mental health of  
refugee children. Archives of  Disease in Child-
hood, 87, 366-370. doi:10.1136/adc.87.5.366

Fazel, M., Reed, R. V., Panter-Brick, C., & Stein, A. 
(2012). Mental health of  displaced and refugee 
children resettled in high-income countries: Risk 
and protective factors. Lancet, 379, 266–82. 
doi:10.1016/S0140-6736(11)60051-2

Galowitz, P. (1999). Collaboration between lawyers 
and social workers: Re-examining the nature and 
potential of  the relationship. Fordham Law Re-
view, 67, 2123-2154. Retrieved from Fordham 
Law Review website: http://ir.lawnet.fordham.
edu/cgi/viewcontent.cgi?article=3556&contex-
t=flr

Geltman, P. L., Grant-Knight, W., Mehta, S. D., 
Lloyd-Travaglini, C., Lustig, S., Landgraf, J. M., 
& Wise, P. H. (2005). The “lost boys of  Sudan”: 
Functional and behavioral health of  unaccom-
panied refugee minors re-settled in the Unit-

UNACCOMPANIED CHILD MENTAL HEALTH: LAWYERS’ ROLE



16

ed States. Archives of  Pediatrics & Adolescent 
Medicine, 159, 585–91. doi:10.1001/archpe-
di.159.6.585

Georgopoulos, A. (2005). Beyond the reach of  juve-
nile justice: The crisis facing unaccompanied im-
migrant children detained by the United States. 
Law and Inequality Journal, 23, 117-155. 

Henderson, S. W., Baily, C., & Weine, S. (2010). Child 
refugee mental health. In M. E. Garralda & J. P. 
Raynaud (Eds.), Increasing awareness of  child 
and adolescent mental health (pp.93-119). Lon-
don: Rowman & Littlefield.

Hodes, M., & Tolmac, J. (2005). Severely impaired young 
refugees. Clinical Child Psychology and Psychia-
try, 10, 251-261. doi:10.1177/1359104505051213

Hodes, M., Jagdev, D., Chandra, N., & Cunniff, A. 
(2008). Risk and resilience for psychological dis-
tress amongst unaccompanied asylum seeking 
adolescents. Journal of  Child Psychology and 
Psychiatry, 49, 723-732. doi:10.1111/j.1469-
7610.2008.01912.x

Ishikawa, R. Z., Cardemil, E. V., & Falmagne, R. J. 
(2010). Help seeking and help receiving for emo-
tional distress among Latino men and wom-
en. Qualitative Health Research, 20, 1558–72. 
doi:10.1177/1049732310369140

Jones, L. M., Cross, T. P., Walsh, W. A., & Simone, M. 
(2007). Do Children’s Advocacy Centers improve 
families’ experiences of  child sexual abuse inves-
tigations? Child Abuse & Neglect, 31, 1069-1085. 
doi:10.1016/j.chiabu.2007.07.003

Kataoka, S. H., Stein, B. D., Jaycox, L. H., Wong, 
M., Escudero, P., Tu, W., … & Fink, A. (2003) 
A school-based mental health program for trau-
matized Latino immigrant children. Journal of  
the American Academy of  Child and Adoles-
cent Psychiatry, 42, 311-318. doi:10.1097/01.
CHI.0000037038.04952.8E

Kendall, C., Kerr, L. R. F. S., Gondim, R. C., Werneck, 
G. L., Macena, R. H. M., Pontes, M. K., … & 
McFarland, W. (2008). An empirical comparison 
of  respondent-driven sampling, time location 
sampling, and snowball sampling for behavioral 
surveillance in men who have sex with men, For-
taleza, Brazil. AIDS & Behavior, 12, S97-S104. 
doi:10.1007/s10461-008-9390-4 

Lustig, S. L., Kia-Keating, M., & Knight, W. G. 
(2004). Review of  child and adolescent refugee 
mental health. Journal of  the American Academy 
of  Child and Adolescent Psychiatry, 43, 24–36. 
doi:10.1097/01.chi.0000096619.64367.37

Nafziger, L. Y. (2006). Protection or persecution?: 
The Detention of  unaccompanied immigrant 
children in the United States. Hamline Journal of  
Public Law and Policy, 28, 358–403.

Nugent, C. (2005-2006). Whose children are these? 
Towards ensuring the best interests and em-
powerment of  unaccompanied alien children. 
Public Interest Law Journal, 15, 219-235. Re-
trieved from Boston University School of  Law 
website: http://www.bu.edu/law/central/jd/
organizations/journals/pilj/vol15no2/docu-
ments/15-2NugentArticle.pdf

Perez Foster, R. (2001). When immigration is trauma: 
Guidelines for the individual and family clinician. 
The American Journal of  Orthopsychiatry, 71, 
153–70. doi:10.1037/0002-9432.71.2.153

Porte, Z., & Torney-Purta, J. (1987). Depression 
and academic achievement among Indochi-
nese refugee unaccompanied minors in eth-
nic and nonethnic placements. The Ameri-
can Journal of  Orthopsychiatry, 57, 536–47. 
doi:10.1111/j.1939-0025.1987.tb03569.x

Price, S., & McCreary, C. (1976). Mental health con-
sultation for a clinical law training program. 
Journal of  Community Psychology, 4, 168-173. 
doi:10.1002/1520-6629(197604)4:2<168::AID-
JCOP2290040212>3.0.CO;2-O

Rousseau, C., Crépeau, F., Foxen, P., & Houle, F. 
(2002). The complexity of  determining refu-
geehood: A multidisciplinary analysis of  the 
decision-making process of  the Canadian Immi-
gration and Refugee Board. Journal of  Refugee 
Studies, 15, 43-70. doi:10.1093/jrs/15.1.43

Rousseau, C., Measham, T., & Nadeau, L. (2013). 
Addressing trauma in collaborative men-
tal health care for refugee children. Clinical 
Child Psychology and Psychiatry, 18, 121-136. 
doi:10.1177/1359104512444117

Seugling, C. J. (2004). Toward a comprehensive re-
sponse to the transnational migration of  unac-
companied minors in the United States. Van-

BAILY, HENDERSON, TAUB, O’SHEA, EINHORN, VERDELI



17

UNACCOMPANIED CHILD MENTAL HEALTH: LAWYERS’ ROLE

derbilt Journal Transnational Law, 37, 861–895. 
Retrieved from Center for Human Rights and 
Constitutional Law website: http://immi-
grantchildren.org/Articles/law_review_articles/
Document.2004-07-21.6763731823

Silove, D., & Steel, Z. (1998). The mental health and 
well-being of  on-shore asylum seekers in Aus-
tralia (Research Report). Sydney: Psychiatry Re-
search and Teaching Unit, University of  New 
South Wales. Retrieved from Project SafeCom 
website: http://www.safecom.org.au/pdfs/zach-
ary-steel-report.pdf

Smith, D. W., Witte, T. H., & Fricker-Elhair, 
A. E. (2006). Services outcomes in physi-
cal and sexual abuse cases: A comparison of  
child advocacy center-based and standard 
services. Child Maltreatment, 11, 354-360. 
doi:10.1177/1077559506292277

Sourander, A. (1998). Behavior problems and trau-
matic events of  unaccompanied refugee mi-
nors. Child Abuse & Neglect, 22, 719–727. 
doi:10.1016/S0145-2134(98)00053-2,

Steinberg, A. G., Woodhouse, B. B., & Cowan, 
A. B. (2002). Child-centered, vertically struc-
tured, and interdisciplinary: An integrative ap-
proach to children’s policy, practice, and re-
search. Family Court Review, 40, 116-134. 
doi:10.1111/j.174-1617.2002.tb00823.x

Suárez-Orozco, C., & Suárez-Orozco, M. M. (2001). 
Children of  immigration. Cambridge, MA: Har-
vard University Press.

Sue, S., Fujino, D. C., Hu, L., & Takeuchi, D. T. 
(1991). Community mental health services for 
ethnic minority groups: A test of  the cultur-
al responsiveness hypothesis. Journal of  Con-
sulting and Clinical Psychology, 59, 533–540. 
doi:10.1037/0022-006X.59.4.533

ter Kuile, S., Rousseau, C., Munoz, M., Nadeau, L., 
& Ouimet, M. J. (2007). The universality of  the 
Canadian health care system in question: Barriers 
to services for immigrants and refugees. Interna-
tional Journal for Migration, Health and Social 
Care, 3, 15-26. doi:10.1108/17479894200700003 

United Nations High Commissioner for Refugees 
(2014). Children on the run: Unaccompanied 
children leaving Central America and Mexico 

and the need for international protection (Re-
search Report). Retrieved from UNHCR web-
site: http://www.unhcrwashington.org/sites/
default/files/UAC_Children%20on%20the%20
Run_Full%20Report_May2014.pdf

United States Department of  Health and Human 
Services: Office of  the Inspector General. (2008, 
March). Division of  Unaccompanied Children’s 
Services: Efforts to serve children (OEI-07-06-
00290) (Research Report). Retrieved from DHHS 
website: http://oig.hhs.gov/oei/reports/oei-07-
06-00290.pdf

Workgroup on Adapting Latino Services (2008). Ad-
aptation guidelines for serving Latino children 
and families affected by trauma (1st ed.) (Re-
search Report). San Diego, CA: Chadwick Center 
for Children and Families. Retrieved from Chad-
wick Center for Children and Families website: 
http://www.chadwickcenter.org/Documents/
WALS/Adaptation%20Guidelines%20for%20
Serving%20Latino%20Children%20and%20
Families%20Affected%20by%20Trauma.pdf

Women’s Refugee Commission. (2009). Halfway 
home: Unaccompanied children in immigra-
tion custody (Research Report). Retrieved 
from Women’s Refugee Commission website: 
http://www.womenscommission.org/reports/
cat_view/68-reports/71-detention-a-asy-
lum?start=10


