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• W4360989813 abstract "Antiracism can be defined as the practice of opposing racism and promoting racial equity and justice. Within health care, antiracism also includes acknowledging and addressing the structural injustices resulting in health inequities. Racism plays a role in how the United States accepts and welcomes refugees and asylum seekers.1Young M.T. Crookes D.M. Dismantling structural racism by advancing immigrant health.Am J Public Health. 2023; 113 (Jan): S16-S20Crossref PubMed Scopus (1) Google Scholar From an intersectional perspective, children are innately in positions of disadvantage, with unaccompanied immigrant minors (UIMs) experiencing an even greater toll due to the lack of direct parental physical care. This editorial discusses antiracist care of UIMs and the need for institutional and structural support to sustain this important clinical work. In their Clinical Perspective article, Galvan et al.2Galvan T, Venta A, Silva MA, Moreno O, Mercado A, Garcini LM. Applying an anti-racist approach to promoting health equity and psychological well-being in unaccompanied immigrant minors. J Am Acad Child Adolesc Psychiatry. Published online March 20, 2023. https://doi.org/10.1016/j.jaac.2023.01.023Google Scholar provide succinct and clear guidance on how clinicians may apply antiracism to the clinical care of unaccompanied minors, a rapidly growing population within the United States. The authors note the importance of mental health clinicians, including child psychiatrists, to use an antiracist framework to improve the care of these youth. The authors propose 4 main areas of clinical focus: (1) self-reflection; (2) system-focused approach; (3) needs-based, resilience-focused, integrative therapeutic strategy; and (4) acknowledging and addressing uncertainty. When caring for UIMs with an antiracist approach, individual clinicians’ self-reflection increases their awareness about the negative impact of the unequal distribution of power. However, antiracism requires action beyond self-reflection. As clinicians working in systems known to exclude many from the services that we provide, we must also act to minimize the unwelcoming environments that often exist outside our clinic walls and within our institutions.3Robles-Ramamurthy B. Platt R. Filling in gaps in mental health care for children in immigrant families. American Academy of Pediatrics Council on Immigrant Child and Family Health Newsletter, 2022Google Scholar There are many reasons why immigrant populations do not generally receive care through traditional mental health care models.4Cerda I.H. Macaranas A.R. Liu C.H. Chen J.A. Strategies for naming and addressing structural racism in immigrant mental health.Am J Public Health. 2023; 113: S72-S79Crossref PubMed Scopus (2) Google Scholar Optimizing the quality of the limited time that we have with these children and youth may serve as a stepping stone toward promoting their future engagement with the mental health system. As we strive to engage unaccompanied children and youth with a resilience-focused therapeutic approach, we cannot ignore the ongoing erasure of indigenous history. Most unaccompanied immigrant youth entering the United States are from Central America—Honduras, Guatemala, and El Salvador.5Patel S.G. Bouche V. Martinez W. et al.“Se extraña todo”: family separation and reunification experiences among unaccompanied adolescent migrants from Central America.N Dir Child Adolesc Dev. 2021; 176: 227-244Crossref Scopus (5) Google Scholar A significant reason for displacement is ongoing violence against and erasure of indigenous communities. Yet, many youth have grown up without a meaningful understanding of their historical backgrounds and how intergenerational trauma may still be affecting their lives. This is where the resilience-focused therapeutic strategies can have powerful benefits. Acknowledging the child/youth’s strengths and the wish to understand their narratives with simple statements such as “I can see your strength in the way you communicate your needs” or “Thank you for sharing part of your story, it is powerful to see how you understand your narrative” can offer a small gesture of empowerment and affirmation to youth who may not receive this often. Antiracism in the mental health care of this population is worthy of increased attention and resources, including recognition of the intersectional racism these children and youth have experienced in their home countries. Discrimination is perpetuated in Latin American countries as in the United States. However, youth may not have robust awareness or discussions of how racism and other forms of oppression affects everyday lives. Mindful clinicians will often pick up traces of experiences of racism in the patient’s narrative as the patient describe fears, insecurities, and negative thought patterns. The effect of systems of oppression on children and youth can show up as anger and irritability, given that their voices have often gone unheard. It shows up as eating disorders in young people whose bodies have been objectified, and who have been left to believe that they can never meet Eurocentric beauty standards imposed by colonized society. It shows up as body dysmorphia and the desire to “change” their appearance, often resulting in poor personal relationships and self-care, as children and youth unsuccessfully strive to meet the harmful standards of those in power. The authors note that “clinicians are strongly discouraged” from immediately addressing UIMs’ trauma histories. This statement should not be confused with a call to not adequately assess and address trauma histories, especially when youth wish to do so. In our clinical practices, we find that youth are often ready to share when offered a safe, trauma-informed clinician and environment. Clinicians can be fearful to “open a can of worms'' and may avoid discussing past trauma. However, without the awareness of such past trauma, many of our patients’ symptoms can be misinterpreted as anxiety, depression, attention-deficit/hyperactivity disorder, oppositional defiant disorder, or other “disorders.” This can result in prescribing medications or interventions that may not actually be indicated and could in fact be harmful. Galvan et al.’s discouragement can instead be interpreted as the need to assess past traumatic experiences in a way that is trauma-informed, patient-centered and empowering for the youth to guide when, to whom, and how much information is shared. When clinicians avoid discussing trauma with children and youth, we may inadvertently message that these experiences are not an important part of their story, or we may perpetuate societal taboos against discussing difficult topics. When using a systems-focused approach to care, it is important to recognize that children and youth may have forcefully found themselves “unaccompanied” when policies leave families with no choice but to send them alone across the border. They may also be reconnecting with family members whom they may not have seen in years. Along with coordination of care with all pertinent systems, clinicians can also support family reunification when necessary. This clinical work includes skillful family therapeutic strategies, particularly those fostering communication and problem solving between the youth and their caregivers. For all youth, but particularly those who are not reuniting with family, an antiracist approach to care must also include meaningful partnerships with community-based organizations (CBOs) that are already supporting those communities and elevating their voices. For example, La Puerta Abierta6La Puerta Abierta.https://lpa-theopendoor.org/Date accessed: February 27, 2023Google Scholar is a nonprofit organization in Philadelphia serving immigrant youth and families. They offer programming that supports the family reunification process, elevates youths’ voices through storytelling, and assists with the process of integration into schools. These efforts are an important component to strengthening a supportive post-migration environment as a protective factor.7Silva M.A. McQuaid J. Rojas Perez O. Paris M. Unaccompanied migrant youth from Central America: challenges and opportunities.Curr Opin Psychol. 2022; 47101415PubMed Google Scholar These partnerships can also sometimes result in medico-legal programs and higher levels of advocacy for the rights of these youth, which actively demonstrates to them our commitment to an antiracist approach. However, these partnerships take time and effort to foster. This work is often done by clinicians from underrepresented in medicine backgrounds who are already dealing with the “minority tax” (the burden of time and resources placed on minoritized persons to represent and advocate for their communities) and who do not receive adequate funding to support this important work. Burnout in mental health clinicians is estimated to be at least 50% and is expected to worsen in the coming years.8Kelly R.J. Hearld L.R. Burnout and leadership style in behavioral health care: a literature review.J Behav Health Serv Res. 2020; 47: 581-600Crossref PubMed Scopus (21) Google Scholar Providing clinical care with an antiracist approach, in a way that feels meaningful as described by Galvan et al., requires a substantial investment of one’s time—a precious resource that is currently nonexistent for many of us. Therefore, for clinicians to engage in meaningful antiracist care of UIMs, institutions must invest in supporting these efforts. Institutional commitment to antiracist clinical care will likely foster and predict individual clinician antiracist practices. Community partnerships, including joining with community-led advocacy, can begin to build trust in clinicians serving unaccompanied children and can create opportunities to better support families, communities, and work toward addressing structural and social determinants of health. Clinicians doing this work may seem scarce, yet we are present and easy to find when you look for us. Institutions must and can elevate and meaningfully support committed clinicians who have already formed partnerships and relationships with UIM-serving CBOs and offer financial support to carry out the additional tasks required to engage in antiracist, collaborative, trauma-informed care. An institutional and structural approach is ultimately what we need to help foster antiracist mental health care for unaccompanied immigrant children and youth and those who support them. Applying an Antiracist Approach to Promoting Health Equity and Psychological Well-Being in Unaccompanied Immigrant MinorsJournal of the American Academy of Child & Adolescent PsychiatryPreviewUnaccompanied immigrant minors (UIMs) are a fast-growing demographic in the United States, doubling in population since 2014.1 According to the Office of Refugee Resettlement, a UIM is someone under the age of 18 years who enters the United States without lawful status and an accompanying guardian.2 Most UIMs in the United States originate from the Central American northern triangle (ie, El Salvador, Guatemala, Honduras), with violence, extreme poverty, and family re-unification as the top 3 reasons for migration.1,3 Repeated exposure to stressful and/or traumatic events at home, during migration, and upon arrival increases UIMs’ risk for psychological distress and mental disorders.3 UIMs’ repeated encounters with race-based trauma (eg, racism, discrimination) further heightens this risk.3 The repercussions of these events are compounded by the fact that UIMs lack the adversity buffering effect that is traditionally associated with the presence of a caregiver.3 Furthermore, UIMs’ mental health risk is augmented by their interaction with US systems (eg, legal, immigration, child welfare, educational, healthcare) with policies and practices that are discriminatory, are exclusionary, propagate the view of UIMs as racialized threats to society, and fail to consider their developmental context.3,4 Considering these risks, it is imperative to the well-being and positive development of UIMs that they have access to quality mental health services (MHS). 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• W4360989813 title "Editorial: Institutional Commitment Is Needed to Promote Antiracist Care of Unaccompanied Immigrant Minors" @default.
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