Chloe Learey: When policy creates trauma

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The Office of Inspector General for the Department of Health and Human Services released a report (https://oig.hhs.gov/oei/reports/oei-09-18-00431.pdf) in early September outlining findings from interviews with approximately 100 mental health clinicians from 45 facilities that house children separated from their parents at the US-Mexico border. It is not surprising to learn that these children experienced traumatic events in the countries from which they fled as well as during their journey to the United States. The fact that the trauma was extended once they arrived is perhaps more surprising. Separation from a parent or primary caregiver, particularly for children at a young age, can create traumatic stress when it is prolonged or chronic. Given what we know about the effect trauma has on brain development and health outcomes over the course of a lifetime it is imperative that we avoid creating circumstances in which trauma is perpetuated.

Prolonged separation of parents and children happens in different kinds of circumstances: incarceration, military deployment, deportation, immigration, and in the child protection system. Some responses to this type of trauma can include nightmares, physical ailments, self-harm, negative mood changes, negative beliefs about the self, changes in behavior, and difficulty thinking or paying attention. These reactions can interfere with a child's ability to adjust, particularly when they are in an environment that is not designed to optimize child development and where they do not receive the mental health supports needed. These are two factors at play in most of the facilities reviewed by the Inspector General, and there are multiple examples of children's reactions that one would expect. "Every heartbeat hurts," one child said; "I can't feel my heart," said another, even though there was nothing wrong physiologically. Even children who were initially seemingly well-adapted began to show a deterioration in behavior and resilience as their detainment became more extended, i.e. past two months, and there was an increase in instances of self-harm and suicidal thoughts. Some children were held for as long as 93 days when one policy requiring fingerprinting for possible sponsors was in effect.

Environment fundamentally shapes how young children develop. By having children in facilities, programs, or foster homes not designed to support their development we are helping to ensure that they will not thrive. Research shows that toxic stress and trauma lead to poor health outcomes including diabetes, obesity, and depression. The overall immune response can be weakened which increases the risk of everything from cancer to autoimmune diseases. Cognitive development may be limited due to neural pathways developing more towards the "survival" part of the brain vs. the "thinking" part of the brain. One child psychiatrist who interviewed children in detention said that even when children are reunited the impact of traumatic separation can continue into adulthood and create problems "that are costly to society as well as to the individual child grown up."

Research shows that responsive, nurturing caregiving is especially important during the earliest years when the brain is growing at its fastest pace. Even the most responsive caregiving might not be enough in the face of the survival tactics some children employ to survive traumatic separation. For instance, the parent who is not present might be idealized and seen as "perfect", and available caregivers might be rejected, viewed as not trustworthy. Or a child might feel they are betraying their parent if they have positive feelings towards a current caregiver, especially if there is the hope of reunification. One person interviewed for the IG report observed that children could not distinguish between immigration agents who separated them from their parents and the staff who were there to help (i.e. mental health clinicians).

We may not know the children being separated from their families due to immigration policy, but we do know children in our community who are suffering from traumatic separation. We know the lifelong cost they will bear, and that we will ultimately shoulder as a society.

We must do what we can to design programs and policies that do not create or exacerbate the trauma caused by the prolonged separation of young children from their primary caregivers — we will reap what we sow.

Chloe Learey is the executive director of Winston Prouty Center for Child and Family Development in Brattleboro that is celebrating its 50th anniversary this year. She serves on the Building Bright Futures State Advisory Council, a governor-appointed body that advises the Administration and Legislature on early childhood care, health and education systems. The opinions expressed by columnists do not necessarily reflect the views of the Brattleboro Reformer.

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