Separated Families Face Serious Challenges After Being Reunited

While President Donald Trump signed an executive order on Wednesday to end the practice of family separation after people have crossed the country’s southern border, there is concern from the medical community about what will happen when children are reunited with their parents--if those reunions happen at all.

The administration has no formal plan to reunite these families; some of the children have been sent thousands of miles away including to places like New York. A fact sheet shared Saturday night by several agencies claims the government knows the location of every separated child. (One Democratic representative has asked DNA testing company 23andMe to use its tests to help reunite the families, especially given that some kids are so young they don’t know their parents’ full names, but there are concerns about providing the DNA of undocumented immigrants to the government.)

About 500 of the 2,300 kids separated through June 9 have been reunited, a senior administration official said Thursday, but it’s unclear how many of them are simply being detained with their families while their legal cases play out. (The fact sheet released Saturday said 2,053 separated kids were in government-funded facilities.)

Still, if a child is reunited with their parents, it’s not an automatic happy ending.

There’s been much discussion about how the time spent separated from parents can damage children’s brains, and potentially their future health, but for those families that are brought back together, their relationships could be permanently strained if they don’t get proper mental health care. And that strain can affect future generations.

“These kids have fight or flight all the time. They’re on red alert. The younger they are, the more likely they are to develop long-term damage because of this,” Colleen Kraft, president of the American Academy of Pediatrics (AAP), said on Thursday during the Aspen Ideas Festival’s Spotlight Health Conference, which I attended as a guest. Kraft helped shine the national spotlight on family separation after telling NPR what she saw during an April visit to a “tender age” shelter for young children.

Even when they’re reunited, Kraft says there’s “the fear of ‘is this going to happen again? Are you going to stay with me now? What if I do something wrong, does that mean you’re going to leave me again?’” adding, “That’s part of that complex trauma that really requires trauma-focused therapy in order to help heal that bond, even with a loving parent and a child who wants to be with them again.”

Ann Thomas, president and CEO of The Children’s Place, an agency in Kansas City, Missouri, that treats traumatized children under the age of 8, reminded the audience that what’s going on at the border can be difficult even for adults to comprehend, and kids are certainly not going to understand what happened.

Thomas used as an example the case of a Guatemalan woman named Beata Mariana de Jesus Mejia-Mejia who would be reunited with her 7-year-old son, Darwin, after a month of separation; the Mejias were seeking political asylum.

“He will look the same but he may not respond the same way. In those times he’s experienced fear, he was in an unknown situation, and had to adapt,” says Thomas, who’s also a licensed clinical social worker. “We have to remember that young children are also very egocentric, and it’s not uncommon to think ‘Mom, why did you leave me? What did I do wrong?’ She has a child that’s gone through all of this and he may not just run into her arms and say ‘Mom, I’m so glad we’re safe, we’re back together.”

“Traumatized kids have been hurt, so they’re really, really good at keeping people away--‘I’ll do it myself, you won’t hurt me again,’” she says, adding, “We suddenly have to repair that bond between them, and then also help them both heal from what happened.”

Which is to say that reunification will be difficult for parents, too, and not just in seeing how their child might react to them differently now. “The other piece we have to remember is the parents have experienced a trauma, too,” Thomas says. “The parent had lost their child for this period of time.” When Mejia was reunited with her son at a Baltimore airport early Friday, she told the Associated Press that she was never going to be away from him again.

The Children’s Place program focuses on re-establishing routines and consistency before trying to repair relationships. They also focus on fun. “Life has not been fun, so we have to do a lot of being a kid,” she says. “Go outside and blow bubbles, run, get dirty, lots of sensory activities.” All of these things will be difficult to do if families are held in family detention centers, which often have insufficient medical and mental health care.

Kraft says the AAP has a toolkit doctors can use when treating kids who’ve experienced trauma, and the first thing pediatricians would want to do is make sure that families get connected to resources to help them live in a safe environment.

“This is a big fear that we have with the reunification of these kids, because we’re not sure that that’s going to happen. And, secondly, where are these families going to be? Because we know that a community-based situation is going to be best for these families. Having them go from being separated from their parent to living with a parent in a detention center is wrong—that will only re-traumatize these kids.”

After connecting families with resources, the AAP recommends pediatricians connect families with the legal community and the social work community, which can help families “get them involved in some trauma-focused care that can really help repair this relationship,” Kraft says. The legal system can make sure they come to court when necessary.

“It is going to involve psychoeducation around all of these steps so that people are aware there is a recipe—that if we follow these things, we will move towards healing,” Thomas says. “And we are going to have to have the community’s support.”

As Luis H. Zayas, professor of social work and psychiatry at the University of Texas at Austin told the Washington Post, “Our government should be paying for this. We did the harm; we should be responsible for fixing the damage. But the sad thing for most of these kids is this trauma is likely to go untreated.” Some of these families will be granted asylum and will become US residents who get American healthcare—and whose health costs will become an American concern.

Kraft emphasized the need to humanize the families. “Rather than, ‘What’s wrong with you?’ It’s ‘What’s happened to you?’ Rather than, ‘You’re an illegal crossing the border,’ it’s ‘You’re a human being escaping violence and something happened to you there,’” she says. “Enough of us made Donald Trump change the separation policy. Enough of us need to be talking about the next steps as well.”

“What we’re doing to these young children and their brains is really something that can cause lifelong trauma,” Kraft says. “As we move to the ‘now what?’ step, it’s looking at what do these families need and that there is healing that can happen.”

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