The Baltimore Banner recently reported that more unaccompanied migrant children settle in Maryland, per capita, than in any other state. This did not surprise us. Only 13 ZIP codes in the U.S. are home to more unaccompanied migrant children per capita than 21224 in East Baltimore, where our work with Centro SOL addresses the mental health needs of Latino children in immigrant families. Beyond Baltimore, high numbers of migrant children settle in Prince George’s County, where one ZIP code has received even more than 21224.
Indeed, Latino children who migrated to the U.S. without a parent or guardian have been living in Maryland in significant numbers since 2015. It is time for the state’s response to evolve from a reactive, crisis response to an enduring, coordinated effort.
Most migrant children are physically healthy, though they need access to health care for the vaccines and physical exams required by schools. Migrant children are at high risk, however, of mental health problems. We have seen children who have endured separation from parents or other caregivers due to migration or death, exposure to violence and sexual assault, and the mental strain of a months-long journey, largely by foot, to the U.S. Some of these children need individualized mental health care, and all would benefit from preventive mental health strategies such as opportunities to practice coping skills, support from caring adults and opportunities to engage in enriching recreational programs and activities.
Supporting the health and wellbeing of migrant children requires a comprehensive response from schools, pediatric providers and community organizations serving families. Children do not exist in isolation, and sometimes the best intervention for a child is to address their caregiver’s or their community’s needs.
Fortunately, many organizations are engaged in this work already. These organizations have important institutional knowledge, and the best work closely with migrant Marylanders. The challenge is that networks are informal and not sufficient to the scale of the need. For example, major gaps exist in access to mental health services for children who do not speak English, in apparent violation of federal law.
We propose three initial collective actions.
First, Maryland counties should make sure migrant children can enter school expeditiously. As part of this effort, all counties should implement a streamlined process through which migrant children can receive the required vaccines and physical examinations. These resources cannot be tucked away in a dark hallway by appointment only. These resources need to be available on a standing basis in welcoming spaces, accessible by foot or public transportation, coordinated with school personnel and rotating around each county on a predictable basis to allow word of mouth to drive uptake. County health departments can coordinate the supply of vaccines through Maryland’s Vaccines for Children program. The pediatric care needs to be free and could be a community benefit activity of county-based health systems. School staff should enroll children and orient parents on site.
Second, Maryland counties should develop expedited pathways to provide health care to migrant children with chronic or urgent health needs. These children will need access to free or low-cost care through a Federally Qualified Health Center. These centers could staff school entry events and help parents of children needing urgent ongoing care apply for the Federally Qualified Health Center discount plan. Each center could provide a modest number of new patient appointments, and children with complex medical needs could leave with a prompt appointment at a medical home.
Third, the state should develop and implement a plan for the prevention and treatment of mental health problems. Schools are an ideal setting for preventive efforts. School-based treatment is also critical, as it relieves the need for children and their families to balance mental health appointments with work responsibilities outside of school hours.
The nationally recognized University of Maryland School Mental Health Program can guide best practices. In Baltimore City Public Schools, the Newcomer Project is an office created to address the needs of migrant children, including the prevention of post-traumatic stress disorder. The Newcomer Project offers an example of how to pool shared resources with needed language skills and content expertise, but the investment in these services needs to be greater to meet the need.
Policy change is essential as well. In a report last year, we found that children and adolescents in immigrant families in Maryland struggle to access mental health care and are not receiving legally required interpretation and translation services, in contravention of federal legal requirements, and that mental health providers in Maryland report multiple challenges to offering translation and interpretation services. Key recommendations included that the Maryland Department of Health should provide a guide to interpretation and translation services for mental health providers serving immigrant families, that all mental health providers should have a language access plan and policy, and that the Maryland Department of Health should provide financial support for interpretation and translation services.
If what we propose were easy, it would already have been done. To push through the obstacles, it’s important to remember the importance of immigrants to the past, present, and future of Maryland. The economic contributions of migrants to Maryland are well catalogued in a just-released report from the Maryland Comptroller’s Office. The personal role of migrants as part of the fabric of vibrant Maryland communities is less tangible, but no less important. That’s why Baltimore has created, and Baltimore County is creating, a position in leadership for immigrant affairs. The Spanish phrase, “mas vale prevenir que curar” is similar to the English aphorism “an ounce of prevention is worth a pound of cure.” The healthier and happier our children are, the more they flourish as adults with the benefits accruing to us all.
Sarah Polk is a primary care pediatrician and medical director of Yard 56 Pediatrics. She is an associate professor of pediatrics at the Johns Hopkins School of Medicine.
Kiara Álvarez is a Bloomberg assistant professor of American health in the area of adolescent health in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health, with a joint appointment in the School of Medicine.
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