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Terra Firma: An Innovative Medical-Legal Partnership Supporting Unaccompanied Minors In The Bronx

Brett Stark, an attorney for Catholic Charities Community Services of the Archdiocese of New York, contacted a local clinic to arrange for vaccinations so that his young client could enroll in school. Like many unaccompanied children, his client needed more than just legal help. The clinic staff member scheduled the appointment, but added that the child’s parent would have to be there to sign several of the medical forms. Stark replied, “That won’t be possible, this is an unaccompanied minor.”[1]

The staff person asked, “What is an unaccompanied minor?”

Beginning in 2013, growing numbers of unaccompanied immigrant children began arriving in the United States. Primarily fleeing violence from El Salvador, Honduras, and Guatemala, these children made their way through Mexico and arrived at the US border without a parent or guardian. Between 2012 and 2014, the number of unaccompanied minors arriving from Central America increased from 10,146 to 51,705 respectively (USCBP 2015). In 2014, the US Office of Refugee Resettlement settled approximately 500 of these children in Bronx County, NY (ORR 2015).

As the number of immigrant children arriving in New York grew, Stark had similar conversations many times. After explaining to the clinic staff that a parent would not be able to accompany his client to the appointment, Stark knew that something had to change. “The complexity of the legal cases paired with the social, physical, and emotional needs made it a very challenging task for one professional to do,” he explains. “These things are absolutely vital for the kid, but they are things that are enhanced when different professionals are collaborating on them collectively. There are few people that have the answers for everything.”

In response to these challenges, in October of 2013, Catholic Charities Community Services of the Archdiocese of New York partnered with Montefiore Medical Center and the Children’s Health Fund to launch Terra Firma, a unique medical-legal partnership specifically tailored to the needs of unaccompanied immigrant children. In addition to Stark, the founding team includes pediatrician Dr. Alan Shapiro, Senior Medical Director, and Cristina Muñiz de la Peña, PhD., Mental Health Director of the program.

Located in the South Bronx, Terra Firma supports the integration of unaccompanied minors in a number of ways. Every week, the program hosts a group of unaccompanied children, alternating between girls one week and boys the next. An unaccompanied child who comes to Terra Firma can see a doctor for vaccinations, work with a lawyer to build his or her legal case, and meet with a psychologist—all under the same roof.

The Montefiore health professionals at Terra Firma provide medical screening for the children.[2] Beyond addressing medical needs, health professionals lend support to the children’s legal cases by uncovering medical history or experiences that are connected with abuse or violence that the children suffered in their home countries. They can then support legal claims with documentation and testimony.

This supporting evidence for the children’s cases is critical because many of the legal options the children have are complex and much stronger the more documentation their lawyers can provide. Many attorneys working with unaccompanied minors pursue Special Immigrant Juvenile Status (SIJS), which requires proving that a child was neglected, abused, or abandoned. Asylum claims also require proving that a child has been mistreated or fears future harm, most often through the child’s own testimony and supporting evidence. Having a dedicated team of doctors and mental health professionals working with the lawyer can help build a much stronger case.

As part of their weekly meetings, a psychiatrist partners with either a pediatrician or a social worker to facilitate a group therapy session for the children. The discussion gives the children an opportunity to process their trauma with children their own age who often have had similar experiences. Stark describes the group sessions as being a “profound experience for them, and for us.” Terra Firma administers mental health diagnostic tests and has found a preliminary reduction in the children’s stress levels after working with psychologists and participating in group therapy. Knowing that they can relate to others—whether medically, legally, or psychologically—greatly benefits these children.

Terra Firma also supports the adults who care for the children. Many of these sponsors lack immigration status themselves, and face challenges accessing community resources and integrating into their communities. In addition, many of the parents have been separated from their children for long periods, so the relationship with their newly arrived children, though loving, can be strained. In other instances the adults are not immediate family members and are not necessarily prepared to take care of these children and to meet their complex needs. Through Terra Firma, the psychologist can work with the guardians and children in order to facilitate healthier relationships and better prepare the adults to support these children.

Terra Firma also offers programs that go beyond addressing the immediate health and legal needs of unaccompanied children. During the weekly meetings in the Bronx, a nutritionist teaches the children how to prepare healthy meals with food that is affordable and available in their neighborhoods. Montefiore contributes ingredients to the children from their food pantry. During the summer, volunteers from Catholic Charities Community Services offer English-as-a-second-language (ESL) classes for the children. These classes help the children to keep pace in their English-only classrooms.

Another important way Terra Firma supports immigrant integration is by connecting children with their peers. Stark explains that through Terra Firma “they have allies, and they have each other.” Catholic Charities Community Services of the Archdiocese of New York co-organizes weekly soccer games that serve as a cultural bridge to help the children adjust to life in their new community and allow them to connect with members of their peer group. The Catholic Church provides a safe space for these children to become part of their new community and to socialize with children their own age. Stark explains, “Faith is something that is extremely important to the communities that we are serving. It gives them hope, and connects them with other people.”

Since 2013, Terra Firma has provided these services to nearly 200 children. Initially, children connected to the program through referrals from partner organizations, but soon children began to bring friends who were also in need of legal and medical help. “This has really become a community resource,” Stark says. “It has really grown because of word-of-mouth, so the success of the program is not just in our hands, but in the hands of the community.”

Read More on The Center for Migration Studies web site