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tv   Hearing on Mental Health Needs of Migrant Children in Custody  CSPAN  September 20, 2019 6:58am-9:05am EDT

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and members of the department's office of inspector general to discuss the recently released report on the mental health needs of children and the care of the department of health and
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human services unaccompanied children program. i want to thank the witnesses for being here today. and maxwell, the office of inspector general department of health and human services, jonathan hayes, director of the office of refugee resettlement department of health and human services and jonathan white, commander public health service commissioned. this hearing is part of our oversight responsibility which we take this hearing is really part of our oversight responsibility which we take very seriously. taxpayer resources are at stake and something even more precious is at stake and that is the mental and physical well-being of children. that is why the office of inspector general's report was so alarming. it confirms our worst fears that intentional policy choices by this administration created
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what i would call a mental health crisis which the office of inspector general said health and human services and the office of refugee resettlement failed to address. it is a crisis of deliberate government sanctioned child abuse. we must stop the problem inflicted on these children. i believe the administration must quickly implement the proposed recommendations which are included in the report. administration for children and families have to be concurred with each of the recommendations but the gaps created a mental health crisis as children are still dealing with the effects. as maxwell summarized on page 8 of her testimony policy changes in 2018 exacerbated existing
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challenges resulting in an increase in the number of children separated from their parents and entering the united states. many of whom were younger people and longer stays in or in the custody of children. in 2018 the administration's 0-tolerance family separation policy which ripped children from their parents and changes, fingerprinting and screening requirements discharged to a halt. as a result, the average length of stay in government custody nearly tripled from 35 days to 93 days. the numbers of improved since the administration began implementing its operational directives to reverse their changes to the screening process. i will note those changes followed a consistent drumbeat for accountability and the
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subcommittee. now we need to see the agency's plan to improve the discharge process so we can get children in and out of or care as quickly as possible. so they don't experience toxic stress and mental trauma. we do not only need a plan for bed capacity. as i understand it, the respected discharges, the contractor, is responsible for the discharge, consistent with policies and regulations but the contractor is responsible. or has policies in and out as quickly as possible. homestead which is an influx facility, discharging $750 per night per child the motivation
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to move these kids may not be as strong as it needs to be. there must be changed because children have been suffering because of these intentional policy choices. miss maxwell wrote in her testimony on page 9 children who experience longer facility stays experience higher levels of defiance, hopelessness and frustration along with more instances of self-harm and suicide alleviation. also in her testimony separated children exhibited more fear, feelings of abandonment and posttraumatic stress than children who were not separated. the oig report described how some separated children expressed acute grief that caused them to cry inconsolably. in another story the oig report shared, quote, a 7 or 8-year-old boy separated from
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his father without explanation, the child was under the illusion his father had been killed, and believed she would also be killed. this child openly required emergency psychiatric care for mental health distress. the administration failed to adequately treat it. the executive summary, quote, facility struggle to address the mental health needs of children who experienced intense trauma and had difficulty accessing specialized treatment for children who need it. overwhelmed by the deluge, they reported case loads more than doubled
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read the report and testimony the administration policies traumatized youngsters who did not receive proper care they needed and i will say honestly, it is twisted and shameful. let me add that we do not know the mental state of the children who were separated in 2017. it is a matter that is still in the courts and we already know about 2017 children because of the office of the inspector general. and the aclu and it is interesting to the at the time of july in 2018, who made the decision to certify a list that was inaccurate?
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it was 2018. that would happen in 2017. what was the role? i don't know, mister hayes, about your role. what factors went into making that decision. we can assume the trauma of these children mirrors that of the children the oig identified in this report adding to the urgency we feel to stop the trauma. it is a child welfare agency. we must to be insuring it is upholding admission which brings me to the oig recommendation. one recommendation is or are should take all reasonable steps to reduce the time children remain, i wholeheartedly agree. i will reiterate what i have been saying to this administration, recent the memorandum of agreement between
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the department of homeland security, department of health and human services with respect to the agreement, the sub committee heard from outside, continues to scare potential sponsors who otherwise want to take care of a child but are too afraid to come forward. at our july hearing, secretary johnson agreed with the sub committee, the memorandum should be rescinded. it would appear the responsibility, in the hands of the white house. and it the recommendation the administration must rescind memorandum of agreement. another recommendation, or are, and to addressing trauma.
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the subcommittee has provided resources, the appropriation, the last two years and in the supplemental bill. with respect to the 2019 appropriation i want to see thank you to ranking member tom coles for accepting by voice, vote to provide funding for sensor, the substance abuse and mental health services administration through the national child traumatic stress network in what was a total increase of $10 million for the network, 4 million of which was for these children and we need more funding to the network to deal with this issue. we are committed to ensuring they are upholding their mission to care for those immigration enforcement, we
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need to see the administration and implement the necessary changes including oig recommendation. children did not just arrive at the border, they suffered from our hands and are suffering still with long-term mental health trauma. that is not something we can ignore or sweep under the rug. we need to stop the pain and suffering. caring for the most vulnerable and sensitive of our duties as members of this body and as people of this nation, there can be no greater sin than allowing ourselves to live by a lesser standard. i want to say thank you for this report, your work and look forward to hearing more about it and i hope to learn to
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prevent the traumatization of youngsters as a result of the way i characterize the administration's cruel, heartless policies moving forward. let me introduce the ranking member of subcommittee from oklahoma. >> i want to begin with four thank yous in the first is to you, your focus has been unrelenting and appropriate and we may disagree over this or that interpretation, you keep the focus where it needed to be on the welfare of these people and you deserve all our thanks, it is the right way to do oversights, we have igs because
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you are friends of people who tell you what you need to know, you told us what we needed to know, not what we wanted to hear but that is your job and appreciate it. i want to thank director hayes for the opportunity over the august break and i see a lot of effort to implement, to be responsive to criticism and correct the situation, and to a much-maligned congress i want to give thanks to congress. it took too little too long but we finally give the resources we need in the emergency supplemental. we haven't solved every problem but things were better than they were 120 days ago because congress acted. it took 6 weeks, did the same for president obama, it was a bipartisan action by congress to provide resources that let us address the problems mix mask well has wisely pointed
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out. we have a long way to go but this was a promising start. i want to welcome our witnesses for the third hearing on unaccompanied alien children program, we focus on the mental health needs for the part of human services. before we begin i want to focus over the past few years. we received appropriation of $169 million. this past year, fiscal year 2019 this committee provided $1.3 billion. and 7 years the appropriation has grown by 670%. this has been a focus here. in 2012 the department of health and human services had 13,000 children referred to them for the department of homeland security and in the current year hhs had 60,000 children referred to them for
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care by the end of fiscal year, hhs would likely care for 70,000 children. it is an increase of 370%, pretty staggering. democratic and republican president requested supplement appropriations in the building to support unanticipated arrivals of teenagers at the southern border. hhs cares for tens of thousands of children, travel thousands of miles most from el salvador, guatemala and honduras. objectively this is a crisis that needs a comprehensive bipartisan solution. federal law requires the department of homeland security to transfer to hhs any unauthorized minor not accompanied by children or legal guardian. this legal requirement means when customs and border protection or immigration and customs enforcement apprehension apprehend a minor with an uncle, aunt, grandmother, grandfather, older
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brother or sister, it is requiring transfer of that child. i understand there are many who believe these children should remain with the adult relative, that is not the law of the united states or something we should look at. i also want to address the topic of 0-tolerance policy by the department of justice in 2018. the administration has made several attempts to stem the flow of migration happening on the southern border. the 0-tolerance policy was clearly a mistake and i am glad the president quickly ended it in the implementation of it but the consequences continue. while we may all disagree on the merits of such a policy we can agree hhs does not play a role in the establishment of immigration policy. hhs does not separate family, does not separate children from their parents, hhs's responsibility to care for children and referred to them by dhs and find suitable
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sponsors and we have made considerable progress. children coming from mexico to central america. no surprise such a dangerous journey is traumatic. children left family members, poverty, dangerous conditions to come here. once apprehended by dhs, children are turned over to begin the process of finding a sponsor. a short time the children are in hhs's care, provide vaccinations, mental health screening, education and legal information. referral to mental health services can be part of the process. the office of inspector general highlighted the challenges with meeting mental health needs of children in care. i want to deck out a significant portion of america faces the challenge of assessing mental health service, accessing mental health services. according to the administration 34% of the american population lives in a mental health
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professional shortage area. the district alone has 22 such designated areas. challenges facing adequate access to mental health services is something many areas are having to deal with and when i was fortunate enough to be chairman of this committee, we passed 21st-century cures, there was a lot of mental health provisions, and you've got multiple things. we get a finite amount of money and got to live in a budget. we need more mental health care professionals. anything you do otherwise we are just competing back and forth for a small professional. we need to invest more healthcare professional service corps that we need. we have a desire for the care of these children to be
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expanded. given the number of unaccompanied children crossing the southern border hhs's primary focus should be establishment of small facilities to care for children to a place where sponsoring is possible. i commemorate you, you have done a lot more of that in the last 60 to 90 days and that is very helpful. i know my friends at hhs are doing their best with a challenging situation. i want to commend them the work they are performing a note they are facing many of the same challenges faced by the prior administration. it is my hope the committee will work with them in a bipartisan fashion to provide the resources to confront the urgent challenge. i yield back my time. >> i would like to yield to the ranking member.
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>> like the chairman. >> you can call me anything. >> make no mistake, she is the chair. i thank you, madam chair, my friend for a very long time. ranking member cole for holding this hearing. and maxwell, director hayes. and a clear example of how damaging the trump administration's actions have been on mental health of children. this could have been largely avoided, children along with their parents. many of us have read this article in the new york times
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in 2019. in testimony before congress earlier this month, border patrol chief of law enforcement operations, brian hastings said the agency established its agents may elect to separate a child from a parent if there's a determination the parent or legal guardian poses a danger to the child. is otherwise unfit to care for the child, has a history or communicable disease or transferred to a detention sitting for prosecution for a crime other than improper entry. 70,000 children have been separated from their parents. i am going to say a few more words but i find that astonishing.
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two months ago, chair delauro and several colleagues visited the influx facility. as i look through the inspector general's report on mental health needs of these children it is clear, there's a full picture of challenges. i am deeply concerned with the inspector general's finding, some of these include emission shortage problems with access to external and specialized care and lack of preparedness among clinicians to treat the level of trauma in these children. what causes me more concerned is what we still don't know. i want to repeat this again --
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i've been corrected by my distinguished chair. maybe this number is wrong. and no matter how many -- i feel strongly that children are with their parents. and a border patrol person. to do separated child from parents.
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a border patrol person is making a decision, a parent who brought the child here should be taking care of a child, putting in a facility away from the child. this doesn't make sense to me. i cannot believe, i cannot believe, that they were unfit. let me just say, we saw some
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good things and many things that had to be corrected. i want to conclude again, as good as your clinicians are, find people doing the job, you can't tell me thousands and thousands of children are better off when a facilities clean or smiling the people are and that is really it. >> thank you very very much, madam chair. we will proceed to opening remarks from and maxwell, assistant inspector general, office of the inspector general, the permit of human services, jonathan hayes, director of the office of refugee resettlement, the permit of health and human services and we are joined by commander jonathan white, public service commission who
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will be available to respond to questions. welcome and thank you for being here today, your full written testimony will be entered into the hearing record. you are recognized for 5 minutes. >> good morning distant wished members of the subcommittee. let's discuss the ongoing oversight of the children program administered by the office of settlement. and as funded facility space addressing the mental health needs of children and care. these facilities serve migrant children who arrive in the us on their own who are separated from their parents by immigration officials. they've experienced intense trauma before coming in 20 are care which prompted mental health treatment not only required by or are but is essential for child well-being. my testimony reflects what we heard firsthand from facility staff across the country about
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the obstacles they face. we were told there are a number of systemic challenges that make it difficult for staff to address the mental health needs of children. include the dirksen senate office building employee and support clinical staff and to help clinicians report heavy caseloads. they ask for more training and support for traumatized children. in addition staff face difficulty in accessing specialty care like psychologists and psychiatrists to treat children with greater needs with one example, the only bilingual specialists i could locate was in a neighboring state. finally staff reported lack of therapeutic options in the orr network equipped to treat children who need a higher level of care. this was especially acute for therapeutic settings due to history of behavioral problems. to address these systemic challenges we recommend orr leverage the expertise and resources within hhs and
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broader mental health community to ensure facilities have sufficient clinical staff who are fully supported and able to access the needed specialty care for children. the systemic challenges according to staff were exacerbated by policy changes in 2018. in spring of 2018 the department of homeland security formally adopted 0-tolerance policy of commonly prosecuting all adults for illegal entry and placing children in orr facilities. these facilities are important for addressing the needs of children separated from their parents was particularly challenging because the children exhibited more fear, more feelings of abandonment, more posttraumatic stress than children who are not separated. one medical director told us separated children would prevent -- present physical symptoms as manifestations of their psychological pain. they say their chest hurts even though there's nothing wrong with them ethically. once i'll even said every heartbeat hurts.
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these children understand why they are separated, some are angry believing their parents abandoned them. others were anxious, concerned for their parents safety. 18-year-old boy, under the delusion his father was killed and he was next. and needed psychiatric care. it was additionally challenging because they were often younger than the teenagers of the facility, staff reported younger children had shorter attention spans, supervision and more commonly exhibited defiant and other negative behaviors, cannot always accurately communicate. the little ones has one program director said don't know how to express how they are feeling. there are other policy changes in 2018 as well as these
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involve discharging children to sponsors or added new screening requirements and started sharing sponsor information with immigration officials. staff noted these changes lead to longer stays of care for children and that a negative affect of their behavior and mental health. even children who entered care with good coping skills became disillusioned as time and care dragged on resulting in higher levels of hopelessness, frustration and more instances of self-harm. the policy changes made in 2018 have largely been reversed, facilities serve separated children as well as children who are not quickly discharged from care. to address these continuing challenges and to ensure children are not unnecessarily harmed we recommend orr continue to reassess whether it's current policies are negatively impacting children
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in any way and just as needed. we also recommend orr establish guardrails to ensure that future policy changes prioritize child welfare considerations above all other competing demands. thank you to the committee for the opportunity to present this information, and your ongoing support of our oversight, it is greatly appreciated. i'm happy to answer any questions you may have. >> many thanks. welcome back, thank you for being here and your testimony will be in the record. so now i will recognize you for 5 minutes. >> thank you, ranking member cole and representative committee, it is my honor to be here on behalf of the times of health and human services. my name is jonathan hayes and as director of refugee resettlement i oversee the accompanied alien children program. i'm joined by committee jonathan white, officer in the us public health service who is
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currently assigned to be assistant secretary for preparedness and response at hhs. commander white served as the coordinating official for interagency mission to reunify children separated from their parents and orr care as of june 26, 2018. he previously served as deputy director at orr. he has not prepared testimony but is here to answer your questions. thank you for the opportunity to discuss with you the hhs office of inspector general report titled care provider facilities described challenges addressing mental health needs of children in hhs custody. hhs is committed to the mental health needs of the care of orr. we welcome the report as we continually improve the mental health services provided to the children in our care. orr operates 170 state license care provider facility and programs. and to meet the different needs
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for our care. and influx care facility which receive uac when orr's licensed bed capacity is strained by referrals, with other emergencies. we have detailed policies when children can be sheltered at a temporary influx care facility. mental health services are available at all our facilities. orr policy requires at a minimum uac and orr statewide facilities receive individual counseling sessions and two group counseling sessions with a clinician every week. additional mental health services are available as needed. children in orr care have a unique set of needs. and a wide range of backgrounds and cultures who speak a variety of languages as document it in the oig report many of the children placed in orr care have experienced
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severe trauma. mental health professionals working with the children must be by the qualified into assist traumatized children. the report acknowledges the general shortage of qualified practitioners nationwide. qualification requirements to create difficulties in recruiting on-site staff as well as finding referrals for additional services in the community around the facilities. one challenge identified in the report is some clinician staff told the oig there often unprepared to assist children with severe trauma experienced by uac. treating children with severe trauma is complicated and only made more complicated by the relatively short time children residing in orr care. some clinicians told oig they were concerned about asking children to revisit their trauma when it was unclear whether the child would be in our care long enough to make progress and address their trauma fully. orr's mission remains to unify children with a suitable sponsor as expeditiously and safely as possible. most children don't stay in orr
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care very long. based on clinical expertise on staff, the focus of mental health service has been to stabilize children and provide them with a sense of security. program staff assess each child last mental health needs and provide additional services as appropriate. orr is working to provide clinicians with tools to strengthen mental health services. recently orr collaborated with the national stress network or to develop a four part webinar series addressing trauma in uac. orr is continuing to work with the in cts entities develop -- develop additional resources. orr also offers post release services to some uac. of a child need additional mental health services after they leave orr care post release services caseworker will work with the child and the sponsor, to provide
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services in their community. orr is working to expand the number of uacs it received postservice. i believe a child should not remain in orr care any longer than the time needed to find an appropriate sponsor for the child to jason for part of orr's mission is to discharge children from our care as quickly as possible while ensuring the safety of the child. at the time oig conducted its business the average length of care was 83 days. it is now 50 days, a 40% reduction. orr will assess the efficiency of operations to improve the process for release and reduce the time a child remains in our care in custody. my top priority and that of my team is safety and well-being of the children into temporary care of hhs. we welcome this report because it explained services orr currently provides and identify the obstacles we face in providing those services. my team is ready to face those obstacles and overcome them with help from our partners and continued support of congress. thank you for the opportunity
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to discuss our important work. we will be happy to answer any questions you and your committee may have. thank you, chair delauro. >> you note for policies that traumatized these children have largely been reversed. i pick up your quote at the end of your remarks and the facility still face challenges addressing the trauma of separated kids and pay attention to that into deteriorating mental health to remain in care. policies have been reversed, what are the challenges and policies to be examined? going forward? >> the additional challenges of facilities in 2018 continue to be a concern. despite policy reversals.
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and and -- and 111 over the past year. in addition to respect to length of stay, the additional feeding requirements. with dhs according to 2016, and a chilling effect on finding sponsors. we recommend orr review the current policies, present any unnecessary barriers to appropriate sponsors and adjust as necessary. >> let me move to exhibit 2 on page 2 of the report shows the number of young children referred to orr sharply increased as a result of family separation. i would like to put this into the record.
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orr facilities typically serve teenagers. an answer to this question, facilities and grantees have the right tool to provide mental health services for younger children. >> not according to the clinical staff we spoke to. they told us, as director hayes mentions, they express concerns about being able to treat children who encounter intense trauma before coming into care. in terms of treating all children, it is additionally challenging to younger children who had different needs and different therapeutic needs and less attention span. we recommend again facilities help the clinicians by identifying and disseminating evidence-based trauma informed short-term therapy for children of all ages. >> earlier the subcommittee held a hearing with doctor stewart, president of the
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american psychiatric association told us about toxic stress, separation of children and family resulting in toxic stress causing irreparable harm. a respected testimony that you have provided in previous hearings and warnings you gave to hhs officials about traumatic impact of family separation on children. let me ask with your medical background, what you know about children who end up in orr care, what can you tell us about toxic stress that affects these children as a result of the trauma you experienced in countries of origin, during the journeys to the united states and as a result of family separation. >> to be clear the uac program has long been trauma informed and designed to serve unaccompanied children. that is an enormous challenge, an enormous challenge but it is
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dwarfed by the unique challenge of separated children and i will say again today it is in my professional judgment impossible to build a program that can respond appropriately to the needs of separated children. the only way is prevention. this is a need for a coherent legislative fix to define those conditions under which it is permissible to separate a child from a parent at the border and have appropriate rights and remedies for parents who experienced that. the uac program is the right place for children who enter the united states unaccompanied. neither it nor any other federal program i could imagine can respond to the recent this, the severity, the toxicity of the trauma separation from parents particularly when clinicians themselves seen by children as part of the various systems that were separated. >> i will go to the last
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comments here, on page 13 of the report, our custody spiked after hhs signed the moe with dhs. miss maxwell, according to the mental health commission, investigators interviewed, what are the mental health effects of children staying in orr custody longer as a result of the memorandum of agreement. >> what we heard from clinicians in the field were children who did not initially exhibit mental health or behavioral issues began reacting negatively the longer their stay. >> the longer children stay in care the longer they are traumatized. the final comment here. as long as the moe is in place there are sponsors who are terrified of coming forward at a july hearing, assistant secretary johnson agreed hhs should be terminated as long as this moma is in place, hhs is unnecessarily extending orr custody for children which
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further traumatizes them. the moma must be rescinded. >> thank you. let me start with you. you had some really valuable and helpful information on the damage done in terms of family separation to young children. we obviously have a larger population that is unaccompanied. if you could distinguish, the last testimony did a good job. the second population we are dealing with in large numbers, what are the differences that you see between family separation which we all agree is a bad mistake and obviously the more normal situation we are dealing with unaccompanied children, are they traumatized to the same extent? >> thank you for that question. our report deals with the
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entire population of children facilities have to provide mental health care. most of the one we heard about were systemic challenges that affect all the children in care and we heard again and again that all the children in care suffered severe trauma during the journey and some children experienced additional trauma of unexpectedly being separated from their parents. as we move forward with prodigal steps or are can take with these challenges we have designed them so they would help improve the mental health care of all children responsible for caring. >> director hayes, can you give me some idea of the steps you have taken to respond to those suggestions and recommendations they placed in front of you? >> yes, congressman. we are working on a number of things in response to the
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report. we are working on developing a program with colleges and universities to place interest in students in program so they will one day come and join us. additional funding for continuing education to licensed clinicians is something we are undertaking, we are working to expand our presence at job fairs across the nation, clinicians and case managers to work in our facilities but i will note a number of those job fairs have been protested, potential staff verbally threatened so that is not helpful. we partnered with the national traumatic stress network to develop a 4-part webinar series, we hired a board certified psychiatrist employed inside a division of health and unaccompanied children in orr.
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>> i commend you for those steps. do you have a mechanism to follow up on a good faith effort going on at orr to try to respond but it is important obviously that we have as you provided us an outside view to make sure the process continues. >> absolutely. we are happy to see the steps that were already undertaken and that is a good start. our process, in conversation with the department to ensure that all the commitments they made are fulfilled and fulfilled to secure the recommendation as well. we will be tuned to the department. >> i know you will stay in touch with this committee because we have a resource requirement here. let me go back to you, director
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hayes. it has got to be extraordinarily difficult to get the personnel you need to. we know that as i mentioned earlier in terms of mental health, you need bilingual professionals, can't be a ton of those particularly in areas where there are shoulders. what level of success do you have? >> thank you, congressman. the settlement agreement does require the majority of our shelters to be there with a majority of the children apprehended, southeast texas, the northeast corridor, southern florida and southern california so there is a challenge in those areas to identify and retain the licensed clinicians we need. we are looking to expand outside those areas, worked closely with keeping committee staff informed of our efforts to look at larger metropolitan areas where we can have smaller
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and medium-sized shelters and tap into a fresh pool of clinicians staff. we are seeing resistance in our own backyard in northern virginia. and medium-sized shelters that are licensed and proceed to do that, and opposition by dc and northern virginia, we are looking to expand from the local community with licensed clinicians and youth care workers. >> i will be back. >> i want to apologize about another hearing. i wanted to thank you for your
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comments, particularly johnson wait when you talk about severity, toxicity, separation of children and as a mother of 3, grandmother of 8, can't imagine these children were brought here by their parents, being separated. new york times is saying since the president officially ended family separation, authorities remove 900 children, more than half of the children were under the age of ten at the time of separation. 185 of those under the age of
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5, the administration is doing family separation, protecting children from their parents even though criminal history there, citing long or shockingly -- i want to thank the chair for having this hearing again, thank you for your good work and trying to do the right thing. this policy is outrageous and i hope we can work together to change it. thank you, madam chair. >> congressman harris. >> thank you for calling the hearing about mental health care. i need to ask. maybe i am going to read it there, commander white. it is on your arm in small print.
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you are a licensed clinical social worker. you understand the lack of mental health professional availability in the united states. is ranking member, according to hhs report, designated shortage, 111 million americans live with -- in designated shortage areas, 60% in rural areas. my district is in largely rural areas. i estimate that i have tens of thousands if not hundreds of thousands who live without mental coverage. is that something you appreciate, there are a lot of americans who don't have adequate mental healthcare. >> there is no doubt nationwide all of the evidence we have,
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everything we produced for many years, there is not enough mental health workforce, there is particular deficiencies in geographic areas and for the children we serve, additional challenges for children and anyone who needs culturally and linguistically appropriate services, mental health needs from central america. these are national problems amplified for us because they are a federal responsibility but this is a giant problem. >> as policymakers we have to balance when we have limited resource, where are we putting them? it says in the ig report, or are requires each facility requirement mental health condition for every 12 in care. in baltimore city where there is one murder a day, i bet you almost every student knows someone who has been killed,
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the ratio of counselors in the schools is 980-1. that sounds pretty good. how are we ask getting to that goal? we can't recruit into inner cities in maryland where they have unquestionably had the need for mental health care so where does 12-1 come from? seems like a low ratio compared to those in baltimore city schools and the 250-1 which is recommended nationwide for school counselors. these children are exposed to trauma every day on their streets. it is a lawless environment, the president is right about baltimore. where does the 12-1 ratio come
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from? >> the ratio for clinicians, 1-8 for care workers and case managers inside the policies and procedures which perhaps my colleague can speak to that] is spelled out in our policy. >> you had that ratio. you have 12-1 ratio. it is much better, mental health care, that exists in higher populations in baltimore city, schools. and there are unaccompanied children. some relative decided to send this child across, they end up with nothing to do with it. they have family separation
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that occurred underlies. what is the highest it has been and what is that now? i will call them patient groups. >> i don't have specific numbers and happy to work with your team to get this but i can state the overwhelming majority of the children in our care are not separated by law but came across the border were unaccompanied or someone other than that. >> the overwhelming majority. how do i explain you on findin those professionals. i yield back.
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>> congresswoman? >> for a long time, one of the things, psychotropic drugs in foster care system, when i read press reports indicating forced use of these drugs, i found to be extremely disturbing. the oig report shows the percentage of children who had been prescribed psychotropic medication was lower than in the general population there are still 300 or more children currently prescribing with significant impact on the psychological development without any family involvement or consent. what percentage of the children reported to be taking these psychotropic medications in
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your report came into or custody on these medications and is your report quantify how many of the children receiving psychotropic medications were taking 2 or more medications? >> we do not have those specifics. we were talking to case managers and those who prescribed those medications and we have statistics about who was taking medications in care. it was one in the 30 in the 45 facilities we visited on those drugs. >> i think this is a very serious issue particularly in terms of follow-up, children involved in these drugs that are released. it can have serious consequences if they are not monitored and continue medication or brought down from it. since oig did not independently review the medical records or
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assess the appropriateness of medications prescribed for these children, who would be the proper person or agency to make these reviews? >> let me the for to mister hayes on the policies that have evolved, but within orr there is a team of unaccompanied children, career public health service officers like myself, board-certified pediatricians, epidemiologists and nurses, the supervisory role for the medical care of children and the processes whereby children are discharged with a plan for continuity of care is their responsibility but i will defer to mister hayes to talk about the current policy. >> commander white answered accurately. that's not how i would have
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answered it. when i became acting director at the end of 2018 i delegated those medical decisions to our deputy director over children's programs and her medical team as medical and child welfare experts. >> does that person review the medical records of these children to make sure they are prescribing the appropriate amount, and the children are released, that their follow-up records are appropriately done? >> yes, specific to medication prescribed i don't have details into that. i would d for that to our medical doctors on staff but i would say the professionals commander white mentioned that
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is an ongoing daily discussion with issues with all the medical professionals in our shelters, coordination effort back and forth with the division of health and of unaccompanied children in dc. an ongoing process. >> when a child is released, does that medical expert review the record and the plan for the child when the child is released? >> particularly for minors with higher acuity medical needs including higher acuity behavioral needs you are talking about he would be standard to have a member of the team work with the treating physician and treating medical team, on a plan for effective transition for continuity of care as the child exits the program bounded by the realities of what kinds of care actually exist in the community which is something we don't
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control but yes, that is a high priority for physicians on that team. >> if i may add that could be a situation where if there is a strong medical need that is something our team and our project officers identify community-based resources to commander white's point, to ensure that care. >> released to a sponsor, are those medications covered by insurance? maybe not every insurer. >> different sponsors will have different access to the healthcare system. we do not fund ongoing access to healthcare, we are not appropriated on ongoing access to healthcare. minors are discharged with supply of medication or referral to services in the community and part of the case
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management plan with the sponsor to identify how they will get those met in the future. the broader healthcare system is different. >> i am over. okay. okay. i have plenty of questions. questions. >> thank you, madam chair to think of having this hearing, i want to welcome her guest and i want to thank you also for real. in the committee and participating this way. they wanted to build on some of the discussion has already occurred on the health professional the health professional shortage. obviously we're concerned about people getting good access to mental health services and, of course, these children, given what they've been through, would want to really make sure they are well served. and the ratios that we were talking about, as some of my colleagues have mentioned, it's a challenge all over thehe country. my hope is that orr has been
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working with colleagues and hhs to come and look at what were learning on a national scale and apply it to the situation as well in order to expand these resources and make the most. one area, just in context of my district is in rural michigan. we actually have 62 health performance professional shortagess areas, which is prety significant so we're dealing with this in rural michigan. a couple of things we're looking at is innovative ways to partner with state, federal, and local agencies to maximize the resources. t another thing were looking at is telemedicine, you know, technology where people don't have to travel great distances and are able -- have you looked in the situation at the use ofte
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telemedicine, where it may be beneficial, where it wouldn't be helpful? because i'm doing that as a tremendous way of giving people the resources they need and specify treatment. but i want to get your perspective on what the potential is that. >> so i don't have specific numbers, congressman, but i will say we do utilize some telemedicine practices inside some of our shelters to meet some of the ratios that are required. >> and do you feel -- i know it requires technology, it requires an arcade room broadband access in every area. but what strikes me is your talking some people speak different languages, people of different cultural, and i did that you could taper that and have professionals from all over the country being available, that could be helpful, but i
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don't know the limits of the. >> congressman, one of the things i pointed out in my testimony and as did ms. maxwell, one of our requirement is that you areou bilingual, to be one of our grantee staff, and obviously have just that cultural understanding of whether children come from. that for the narrows the window of licensed clinicians we have available, again, having to be both meet our educational standards and experience standards but alsond be bilingu. >> other in resources you would need to expand opportunities for telemedicine? >> you know, i'm sure there could be some. i don't have any on the top of my head. be happy to circle back. >> i'd be interested in that. it's something we're with in rural michigan, and were kind of seeing areas greatest tremendous potential, maybe so there's not soar much. i the other question i had, are
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you looking at sort of ownerships with states and local entities that could help improve the situation? >> so i would say one thing. i'm going to go back to the division director of help for unaccompanied children and asked for telemedicine question. we'll get back to you on that. again, my goal and the goal of assistant secretary johnson and secretary azar is to increase our permanent network capacity so that w we have available pert state licensed beds for all the children that are referred to us from our federal partners. to that end that requires a partnership with the local and state governments, and we welcome local and state governments to partner with us in this mission to care for these very vulnerable children. and again we are seeing some resistance to that with certain communities and and i wish that wasn't so. again, we want to be able to have as directed by congress and
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as the expressed desire little dilley of a chest as he state license beds available to meet the needs of kids without having to rely on emergency influx beds. >> thank you very much. i yield back. >> i'm going to take a prerogative before introduce mr. pocan. if we had a discharge plan that was adequate to move these chilled out quickly, as was said earlier that the longer they are there the more traumatized they are. it's not about building capacity for beds. it is about building the capacity of the discharge plan to be able to get them out of the system in a safe place, as a mission has said, expeditiously as possible. might also add if you want to increase professionals, increase the reimbursement rates, stop private contracting and look at some of those issues in terms of increasing professionals, and in terms of united services and the
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dollars where you can find opportunity for different kinds of services for the children who are there, including mental health services. we just appropriated $2.9 billion. there ought to be real and there to be able to fund some of these efforts. mr. pocan. >> thank you, madam chair. thank you all for being here today. appreciate it. this is certainly a sad stain on our nation's history,io whatsapp and and were not through it yet soot we appreciate your being here. straight to you agree the trump family separation pulse has had a negative impact on your agency's ability to meet its legal mandate to provide mental health care to unaccompanied children? it's a yes or no. >> would you repeat the first part of that? >> are you agree the trump family separation pulse had negative impact on your agency's ability to meet its legal mandate to provide mental health care to unaccompanied children?
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>> i agree that the separation of you and children from their families was aof -- created a difficult environment to the office of refugee resettlement which i stepped into of june of last year. read the report and ne obviously read it and hear things like a neighboring state for specialist and clearly we know these kids are coming from should've not even been a one-to-one, it's a remedial level to provide assistance to folks -- you hear about a seven or 8-year-old child thinking they're about to be killed because of the policy. you don't get much worse as far as government policy and doing things like this. have a question to bring about, we all went to homestead and appreciate your time in coming to the committee. but to get back to why some of the conditions and put children
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in this place, people back home still to this day cannot understand how we spent $750 a day to house children for really long period of time until we made policy changes recently and we had 3000 kids plus a homestead one for $750 a day you could rent a four seasons, any trump hotel, which i'm sure he would've enjoyed, the fact that we finally get the children out very quickly, why it took so long for so long, people are making a lot of money in the private facility. in $750 a day and at the very end there were a couple hundred kids there were literally in the middle the night. can you address the couple hundred children that middle the night were whisked away for the final day? >> one thing, i think you referenced well over 3000 -- 2700 or so. >> the highest number was 26 or
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20 -- >> a pretty disgusting number. >> it was based on the number of children coming across the border. >> to the policy that we have all agreed has put us in -- >> the number started in january this year and escalated until june when the referral stopped. >> the reason i answer that way is because that was one of the effects on the ability with a share profit mid-june of referrals coming across the border. >> one of the girls i talked to, she had been there 60 days in the week before they finally reach out to her brother. so for 50 some days accompaniment a lot of money not doing their job which is trying to place a person outside and liked the story back on people cannot understand it. but the 200 people whisked away, i can't understand the. >> i asked for the percentage to the last 30 - 45 days a homestead. >> i'm talking about the middle of the night.
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>> well over 80% of the children that were discharged from homestead were released to the family. >> that was not my question. >> the woods that were transferred there is roughly 15% - 20%. >> i'm asking, a couple hundred children between two and six in the morning -- >> it would not be on. >> to transfer them to another shelter which is what we did for medical reasons or no identical spot in the u.s., we would relearn commercial transportation and that my involved a morning flight -- i don't know every single specific backing guarantee that's most likely will happen, a lot of time this doubtful escrow these children of very early morning -- is homestead completely empty of children? >> it as of august 3. >> what are we spending to keep empty?
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>> i don't know the exact number that we reduce the support capacity from 2700 to 1200 so a lot of staff were let go. >> are we taking equivalent of 1201200 a day or just a maintenance? >> we pay fully active shelte shelter -- >> 's were spending $750 a day on 1200 imaginary people. >> yes, sir we are. >> it's about $600 and they. >> so imaginary nonexistent human beings at homestead right now. >> it is the beds. >> but why 1200 if we have no one there. >> there's imaginary people there, there is no one there but your keeping and spending -- i've to explain beckham even his $600 a day you still to four seasons or trump hotel, but now not have a child getting mental health care, no one is there.
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>> one thing we can agree on that this is a very expensive program to operate and if that's a point you are trained to make i would agree. if we move the staff at homestead, i was told by my planning and logistics team, you are looking at a minimum of 90 - will hundred and 20 days to get the stuff back for that. and given the extreme uncertainty of referrals coming across our southern border and how many kids we may have to care for, that was not a switch were ready to turn off. >> my time is out. thank you. >> thank you. >> thank you, chairwoman and thank you for holding thi this hearing. and thank you for taking a look at this. the three of us were having side conversations appear in congresswoman to my left was a grandson was less than a year
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old in congresswoman coleman who has a granddaughter who is six years old and i've to grandkids myself. were all listening to these words hopelessness, feelings of abandonment, fear, severe trauma and were all picturing our own grandchildren being in these situations and were heartbroken and when we look at this report in every page that we turn it's just heartbreaking. i don't care if it's a democrat or republican, i don't care who sitting appear with a democrat or republican, this is just heartbreaking to listen to this. commander white, the officer with the u.s. public health service, have you have you seen
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this up close and personal? >> i was a senior career official over the program previously and prior to that going back to 2012 i was the emergency management official used in everyone of the influx prices. i know these programs and their services pretty well from firsthand, i've also been in 2014 and the mortar stations. i know what it is when we don't have the capacity available filteforchildren in time. that's the other part of the story that is very important when we talk about. and yes, i have seen these programs. >> maybe you can talk us through when it's not a visit that even preplanned in the walk-in and
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when this is a plan visit by the member, tell us what you are seeing them another follow-up question as we get the full five minutes which is never enough time to have a decent conversation about all this. what are the long-term consequences of the kids were living to the severe trauma, the angry feelings, anxiousness, what will we see when these children are teenagers and what are we going to see in our societies as a result of what the government has done to these children? >> so what you see when in a program on a regular day without members of the united states congress is not in my experience, except the staff are much more nervous when their member of congress there. the children that you see in the environment which you encounter them or what you would also see
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in domestic congregant settings licensed by the state because that's what they are. the children we need talk and work with them represent a range of experiences and many have sustained extraordinary histories of trauma and home countries and transit in some cases the united states, separated children are different however, and that the traumas they have sustained are both extraordinarily severe in their currently ongoing and we are part of the traumatization in the united states government which is different in being a response. long-term the consequences of separation will be lifelong and it will involve behavioral and physical health harm that all the best available evidence
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including children separated from their parents would suggest will be both severe and difficult to manage even with high level of clinical care. >> all this can be prevented if united states government in this ministration did not have these policies allowing these children to go through the trauma. >> separation for strict cause is preventable however, congress has not passed legislation of any kind to define the conditions under which separation may occur. as in the previous committee, that is a gap in law and it is one that congress could in should address. >> i'm down to three seconds, thank you for those answers. i yield back.
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>> thank you all for being here and i can really tell from your expressions and from what you're saying, all of you are very sincere of trying to correct a very terrible situation which i know none of you really cost. i just want to echo before he asked my questions from my colleague, i am a new grandmother and when i think of the brutal group policy of taking children from their parents and to me, this is just government child abuse. i want to start because they want to emphasize of what they have been talking about, the agreement with hhs where they have agreed to share personal information of potential
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sponsors with agencies that can actually go to a home and perhaps take an undocumented citizen. i take what we experience when we were at the homestead, we all went to the homestead facility, that one of the feelings that we got was a big reason for the delay in getting the children back with any member of their family because of the fear that by giving an agency the ability to go to a home and pick up an undocumented citizen, i just want to know whether or not if anything are you doing of trying
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to get this agreement rescinded? >> so, i would just say one thing, i don't believe the staff at the facility in your district was here, i look forward to coming to the shelter. >> i agree. >> they even had your picture on the wall. [laughter] >> i think one thing is clear, confusion around the information that is shared and i think it's important, i noted this on the tour of homestead in as well a my last testimony, going back to 2004, every time a uac is discharged from orr, they then go to the jurisdiction of homeland security and the discharge form does go to dhs. with the sponsors information in the child because it falls on dhs and department of justice for price. >> i understand, but to the
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point were trained to make is that the processes keeping children and families separated. next question. i want to ask in the question. there is a new policy that i understand that the president has put in place that prohibits people seeking asylum to come into the country so they get stuck in mexico. is that correct? will that affect the number of the undocumented children coming into the country? >> i think the impact is unknown and there's a couple of things that are ongoing with the asylum laws and again, hhs was an enforcement agency and we issued a letter where certain components they don't believe
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it'll impact the folks that are eligible to come in on the refugee settlement side. >> they have to come into the country first. will it be hard? the reason i ask is because they can ask about spending a lot of money on visible people, are you actually expecting more undocumented individuals to get in here even the new policy? >> while i will acknowledge the term is correct, our referral numbers are low in a historical trend, if historical trends hold true, the expectation should be as we move into the cooler months is a pretty significant chance that the referrals will increase in as we get further into november and december even a greater chance. >> i wanted to say this, every
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influx crisis, i have been deeply involved in response to all of them. every one of them was preceded by a period of reduced referral and pressure to reduce capacity of expanding capacity. i have asked colleagues on the career side, appointed side and i will now ask congress, please not make this mistake again of thinking every time it goes down that is the future. this is an oscillating highly volatile system in the best way to keep children on the border stations is to not react when there's a downturn and say that the end of migration hi. >> two-point, i'm running out of time. one thing that we found on our visit the children who were between the age where they would age out, terrible stress on them
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because that meant they were going to be incarcerated in the second thing, we have to remember that these children, once they are released to a family, a lot of damage has been done in other intercommunity and my question is, is their follow-up? do they get mental health services? or is that it? >> whenever a child is discharge, we do have children that do age out, when she turned 18 the statutory be authority and inside the program. our teams work very closely with the local ice officials to come up with a game plan. as i said on the tour, if it were up to her grandkids in the or staff they could stay with us until the 22 but it's not our decision. we work closely and a lot of times they are released on a plan. but i would just add as far --
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what was the second question. >> what happens once a released -- >> there is a 30 day follow-up from martin and if there are post really services rebecc recd by the team we work with a different officer to identify post really services that might be available within the community. >> thank you very much. thank you for being here. and thank you for hosting us in this very important committee meeting. before ask questions, i need to make a comment, there was a comment made by one of my colleagues and i had to do with, i found it very offensive and it would suggest that parents are making a choice to re-separate their children. i cannot believe that that is a
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truth in any way shape or form. i am a grandmother and i'm sitting here listening to what ththese young children are going through, my daughter is six years old and it's breaking my heart. not only does it break my heart for the child, it breaks my heart for the parent or the relative of that child and i just think were moving in the wrong direction. do we or do we not have a no separation, family separation policy now? >> is that a yes or no feedback based on my understanding he issued an executive order stopping family separation as a result as your policy
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specifically for immigration violation. however, separations to continue for other reasons -- >> such as? >> passcode activity of the parent, legitimate child welfare concerns, there is a mere of issues and we'd be happy to get you a list. there has been separations and then this program. >> you are very successful in reducing the sentenc senses i yr facility. >> i like to know specifically what were some of the things that you did to facilitate that release and are those things part of the ongoing policy now? >> they are, i issued or operational directives, the first 13 weeks after i was named the acting director at the end of november, the first directive ended the household member fingerprint which is the council of my senior career staff, they did not deliver any new or additional information that would cause them to change a decision to discharge the child to his or her family member. the second director was in march of this year and that was in
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regards to the moms and dads who are seeking to sponsor their children and we quit fingerprinting them as well provided there is no red flag or hit on the public record check or offender he. number three had to do with immigration status checks and we suspended the ice back on checks results from the sponsors we rely on the testimony and communication with the sponsor and one thing we ask, if a potential sponsor is undocumented in here without status and could be purported, is there a safety plan, who will the child go to if you are deported. in the fourth directive was a sheer and still to this time a temporary action that we are treating the grandparents and adults settling stay why we would moms and dads meeting if they're seeking the sponsor the family member and no tips or red flags, we do not do the
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fingerprints which takes additional time. >> all add, i visited over 50 of the places and that was one of the recommendations that came that i brought back and discussed with the team and we implemented. >> were you able to facilitate the releases more quickly? did they suspend looking at everyone that lived in the household to determine what their status was? >> we still do the public record check. >> and looks at the federal, state and law enforcement background to see if there's hits or red flags for any concern. all point out, at the end of the day it's about the integrity of the sponsor. >> i know you're not the cause of these policies, you are the recipient of these policies so this memorandum of agreement or
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understanding really does not need to exist and you have the authority to withdraw from the agreement? >> i do not have the authority myself, i will not speak to the department myself. >> you agree that we can function without the? you've had safeguards in place that we used to facilitate the release of the children? >> i would say the actions that i've taken since becoming director speak to my overall belief of the majority of them away, i will flag that there is referral information and information learned by dhs after the child comes into our care and demoralizes the abuse reporting to dhs so there are some things left in them away, you agree that this can be suspended customer.
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>> we recommend we are doing something we can do. >> i yield back. >> thank you very much madame chairman. in thinkinand thank you rankingr being here. personally and as an elected official. i have to remind you, making the statement in a want to be very clear that we recognize that this is the 100th year that they were brought to america, one of the basic elements of the policy was to take children from their families. that was family separation. this is had generational impact and we are still addressing it in dealing with the trauma today. this is yet another stain on our
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country. i am not personalizing it towards any of you because i know what you're feeling and seen. i want to put this in context what we understand is taking place. i am very concerned that a lot of the recommendations that the american psychiatric associati association, and i would've read some of us, and also the american society of pediatrics, i'm not sure if that's the correct name of the group. but i want to explain a couple of recommendations that they made. first of all they said we needed an independent medical and health monitoring team, totally independent from the government. secondly the psychiatric association, let me read you some paragraphs. >> we know the children are more susceptible to trauma because their brain is still developing.
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when a person is exposed to a dramatic event, the brain naturally enters a state of stress and fear related hormones are released. although stress is a common element of life, when a child is exposed to chronic trauma or extreme stress the underdeveloped brain will remain in the elevated state. ultimately consistent exposure to the height and stress can change the emotional behavioral and cognitive functioning of the child in order to promote survival. psychiatrists are most qualified to help children and family recover from the trauma inflicted upon immigrants displaced with their home countries and provide direct cycles for intervention. each family and the leadership team should really address the appropriate care, suffering and identify this as posttraumatic symptoms and other rate enter
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migration symptoms of stress. then they go on to explain one more thing, i like to read from their testimony, the tension of innocent children should never occur in a civilized society. especially if they are less restrictive options because the harm cannot be justified. i want to find out from you, what happens to these children after the damage has been done by the policies of government put in place in terms of trauma and mental health care. i recognize dental healthcare is a variety of treatment modality. these children require specific trauma related treatment and it's not one, two, three, four,
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five, six, seven sessions. this is a treatment they will need how are you going to do this and what resources, have you met with and talk to the professionals who can probably get to a lot of help and which are doing? >> thank you congresswoman i would point out, thank you again for the finding that you provided, i know a part of that was not less than $100 million to increase legal services, post relief services and solv salt oa kid. we are working on that and we set on a request for proposal to expand the post relief services available to the children especially those who need long-term mental health care as they leave our care. >> are you saying that care related to ptsd? >> i don't have specific, it's a broad array of services that can be medical care, legal services. >> i'm focusing on the
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appropriate type of mental health treatment modalities that you will used to make sure that these kids do not end up, when their adult, that they're not happy with their own country. >> that is the focus of the efforts and among the challenges of the delivery of appropriate intensive psychotherapeutic services during the time the children are in care. so to answer your question absolutely. one of the key focus to further strengthen our ability with services. it is to work with experts including in c.p.s. and to identify what are the best evidence-based message to respond to scores, talking stress in a traumatic exposure the children half during the window of time that we have.
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absolutely. >> thank you madame chairwoman, thank you while we appreciate you coming back in for the new arrivals in your testimony here today, it is hard to know where to start. as commanders yet response to some previous questions, the only way is prevention. and we know many of these children are coming to this country already experienced in trauma where they lived at home, in transit but we have added to this. in a want to reiterate what my colleague congresswoman lee said, we know that you are trying to do jobs in changing situations but i think you have to understand how it looks from
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our advantage point, the children are being used in the immigration policy in the harm that we are inflicting on them and all these families may be irreparable. and that we have a role in that as the u.s. government. and what draws me deeply about homestead, this is a private contract. with caliber and international were secretary john kelly sits on the board and they wrote in the filings for the sec, they announced plans to go public. border enforcement and immigration policy is the driving significant for our company. at what cost? to the human experience. and to this stain on our country and the way were treating these
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children into here we continue to pray and not understand clearly that we need to understand that the migrant patterns are patterns and they go up and down and we want to be ready but there's other programs that exist like the case management that i understand, homeland security program not under your purview but it works and has great complaints with families getting to court, making to their asylum cases are heard and have a fair decision and what does it cost, $56 a day. these other programs that i would think, when we are experiencing a decline in population, why are we not looking at those type of programs that take kids out of detention and with their families in half compliance, why are we not looking at increasing
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the nonprofits that can save money instead of continuing to operate homestead empty the almost double the rate that we pay some agencies to take care of children. these are big questions, but if you could give me direction i would appreciate it. >> i think i would point out that again the homestead site and the operator was chosen back in 2015, long before john kelly joined in the of the companies that you mention. yes we renew the contract with them and i would say again, i want to reiterate my statements earlier, the challenge that we have congresswoman, at the end
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of the day, the final say in the facilities being licensed and receiving children does not lie with the federal government. it requires a partnership with the state and local community. we are again starting to see resistance of that and that's very unfortunate, i would respect this committee to help out and help us as one of the stakeholders, achieve the goal of expanding with the topic -- it's about 140 beds for teenage girls and a wonderful facility. that's what we want and were working towards that. but we see huge influxes in the need to be able to secure them, we have to have those beds available. >> are you working to redesign what we mean by family members? when i was at homestead we heard stories that children coming across the border.
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>> if we're trained to reduce trauma to children, and for trying to keep children out of detention beds, not be separated, are you working actively to say, why don't we say the definition of family that is rational. >> that is not my decision, i know the senior staff with support the modification to the traffic victim reauthorization nation. the definite thing would children, if they cross the border a loving grumpy and was over 18 and define those children as unaccompanied is a black letter law issue, congress has the power to make that change if you wish but neither ghs or hhs has any legal authority to consider a child who crossed even with a loving grandparent or sister is anyone
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other than unaccompanied. >> it's not your call but would you support the change? >> i would support that change. >> i would as well and i heard from my stuff, i believe that's what it is at the heart in late june where we are this time when it comes to back on track promise, we're treating grandparents and adults and similes in moms and dads as they wait for the court proceedings to go forward. anything i can do to make that faster while it's holding up an acceptable level of safety i will do that in conjunction with collaboration of my teen. >> thank you. >> yes-man. >> you can be sure we will address the issue and there will be legislation as quickly as possible, and i'm hopeful my colleagues on both sides of the i would be an agreement since you were all in support of it. the other h piece is that i migt add that assistant secretary johnson at our hearing, who,
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with all due respect, mr. hayes, is i think your boss, if you will. >> yes-man, she is. >> she said we should resend the memorandum of agreement. so i'm hoping that the assistant secretary will be listened to by of doingistration that. that's why you put good solid bright people like the people who are here this morning who understand these issues and make recommendations about what we should do. i'm going to get to my questionu but i forgot to say, the issue is discharge, discharge, discharge. our focus is always on holding the influx facility and the numbers are going down. yes, they can go up. however, however, with a change in one directive, in 2018 in
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december, we went from -- and you pointed out that i was inaccurate, i said overnight, 15,000 kids, we let 4000 out. you you told me, mr. hayes, it was 8000. so if we can move kids that asked, we do not have to have them sleeping on the floor at at dhs facility, which no one wants him to do that. we were able to move. we moved quickly and we are now down to come as i understand, some 5800 kids. we do not have to have a backlog. we did not. that was created and you got the $2.9 billion, and now you are less engaged in dealing with $750 a night for a facility which was the reason why we had to build the capacity, building capacity, build the capacity. and what we need to do now, and i want to see that plan in
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october, of how we move kids out as fast as we can to a safe, a safe placement, as expeditiously as possible. that is your goal. i don't speak for dhs. i don't know what their goals are. but that is hhs, is under the jurisdiction of thisti committe. mr. hayes, he talked about the webinar series, okay. and i'm proud and excited and ranking member understands it. national network, i will be self-serving for the moment. i was the first member of congress tost put funding into that system because i understood what it did as my understanding of it through the yale child study program in new haven, connecticut. and we helped to craft that and provide money for it. so we're done that. i'm glad you are there. i want to hear about the direct
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services. other than the webinar, series. what if you done to increase access of child trauma experts to children in hhs facilities while children are in o.r. care and in the post release situation -- orr care. i i said, yes 2.9 billion. numbers are down. we don't have to pay the 750 a night. how are we rearranging those dollars to assist in this process? [inaudible] >> whipping 600 600 and night,. when hundred $50 a night, that's real money. i believe that. >> it is. >> talk to me about direct services. >> i just want to point out for thee records, none of our grantees makes a decision about the children. that is the orr.
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i want to make sure people understand that whether it be homestead or whether itde be, yu know, a dcf facility in the rio grande valley, thatt is not a decision any grantees make. in regards to the children that are in our care, madam chair, i just went again point to the oig report and to the council -- >> what direct services besidesr the webinar are you going to, please, because -- >> i understand. given the short time the children are in our care, the focus of the clinical work of our team is the focus on both providing a safe and secure environment and stabilizing the child. again, that's right out of the oig report. the report you showed come show the length of care isgt significant drop in. i always want to be the type of director that listens to the council of our medical team, and i put it firsthand out in the field and also here in d.c., that there is a hesitation to
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really get into some of the deeper trauma given the fact they don't know how long it will be in our care. >> but you need to deal with direct services.s. i are you going to take any of this money from the $2.9 billion and provide there? because you say you're going tot add your own funds to what is going on at the dnc tsa. >> will continue to seek ways to properly invest that money in the care of the children, yes, ma'am. >> i will come back to additional questions. >> thank you very much. point what to make and a couple of questions to ask, the point is, you were there, director hayes, down along the border. there's a lot of manipulation of these unaccompanied minors by people coming into the country. we were told that literally only 1% of adult males and 2015
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overcoming cross a border had a unaccompanied child with them and now it is 50% now. there's clearly some of a these kids are being used by adults the think that enhances their chances of getting in the country and being able to stay. i don't how you deal with that, but it's something want to recognize their having to confront. it was her interesting to see. again, the money congress voted gave them the capability for doing dna tests on selected individuals just to see if the people related and about one out of three tested were not related in the manner described. these children have been used, literally, in these kinds of cases by people trying to get into the country illegally and by cartels. fact. just ahe you're confronted and we ask you to deal with it and you don't do the apprehensions. you're dealing with the kids we turn over to you. question i have, and there's a tensioner and in no, we are all try to get to the right point but a tension between getting
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them laced as quickly as possible and giving the best care that we can give them after a very traumatic experience. because you don't have beense there as the commander pointed t out. long, as you point out. could you describe a little bit how you handle that dilemma, and in what ways, if any, does they care follow the child? you might not even have had time to actually assess the full needs of the child in the amount of time you have them there. this is a real problem area, i think. >> thank you, congressman. to your point, i know at a recent example where a child ws in our care for three or four days before she was discharged to her mother. it was not a separation. if there is circumstances surrounding what happened back in home country, theg journey, you know, didn't come into our care, she was only with our shelter for maybe three and half days before what i think is
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appropriate environment she moved in with her mom. that is a question that i would not seek to answer. i'm not a mental health clinician, but again i received counsel from a number -- large number of them and their focus, not knowing exactly how long the children will be in our care, they focus on stabilizing thens child making sure the child feels secure. because i think two-point earlier they do view initially at least all of us as kind of the same bucket with regards to the just bucket. but we see as he spend more time in an hhs shelter, and it's like not a detention and they are surrounded by medical professionals and clinicians and useon care workers and other ki, you know, their comfort level and confidence in our team does absolutely increase. we learn more about the child and his or her journey and her history. as that stuff c c is told, thats incorporated into the clinical work that our team does.
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but again, to the oig reports point, it is tough when you look don't know how long you have that child is a licensed mental health professional tells us there is a hesitation to try to what to get into that too deep if it might be gone within a week or two. >> commander, if i could, i would like your thoughts on this in terms of again we want to place them as quickly as we can in an appropriate environment. how do we make sure, , and agai, this gets even traumatized before they get here in many cases can either buy conditions at home or the journey.ur what are your thoughts on how we make sure while we are placing them rapidly, you know, we can both diagnose the problem and see if there's something we can do about it? they moved out of hhs care pretty rapidly and that's got to be a challenge in this area. >> yes, sir. there are three things where to do and i want to be really clear both as a personal manages the program and as a clinician.
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they are hard but necessary. the first thing you have to do is we have to build everyone of our programs from a trauma informed linens so not just the minute the child is sitting with his or p her clinician but every moment there in a program where doing what we can to mitigate the traumatic experiences they had sustained as well as the distress of the time they spend, that they spend in concord get care. the second thing that we have to do is read to provide both individual and group modality, psychotherapeutic interventions to every child. these are not a random cross-section of children. the life expenses of children particularly for the more than 90% of the children in the orr program who come from northern triangle of central america, these are children come in from the worst places on earth to be a child. whether past vast majority of e children have observed homicides, have experienced personal traumatic loss, have been victimized themselves
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through physical assault and sexual assault. that is not uncommon in this program. the second thing is we need to have those methods in place recognize all of the incredible challenges to do that. and the third is we need to. continue to work as we do, with sponsors, to identify -- >> we will leave this hearing at this point with a quick reminder you can watch all of our programs online at we're going live now to the white house here this is the start of the arrival ceremony for australia's prime minister scott morrison and his wife. live coverage here on c-span2. ♪ ♪ ♪
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