The Importance of Screening for Both Trauma and the Strengths of Children Living in an Immigrant Family

With 1 in 4 children in the United States living in an immigrant family, the health care needs of this pediatric population are a critical area of focus when addressing health disparities for children, said Albrey Love DNP, APRN, PNP-PC, during a session at the National Association of Pediatric Nurse Practitioners Virtual Conference 2021.

For the purposes of understanding exactly what qualifies as a child living in an immigrant family, Love explained that this population is defined as children who are foreign born or are born in the United States who live with at least 1 foreign-born parent.

Currently, a significant portion (64%) of children living in an immigrant family reside in 6 states: California, Texas, New York, Florida, Illinois, and New Jersey. However, from 1990 to 2019, the largest growth in this population occurred elsewhere, in states such as North Carolina, Nevada, Georgia, and Arkansas.

The reason children migrated to this country vary widely, but some reasons can be quite complex, Love explained.

“Children migrate to this country with or without their parents for a number of reasons,” Love said during the session. “Some of the most common that you might be the most familiar with are economic needs, possibly educational pursuits, but some may also be a victim of human trafficking or are escaping a country due to violence.”

The immigration status in this population can also be highly variable, with some children entering on a temporary visa, a tourist visa, or on a lawful permanent residence visa. Some also qualify for the Deferred Action for Childhood Arrivals (DACA) program, which defers deportation of certain people who came to the United States as children and meet several guidelines. DACA allows these individuals to request consideration of deferred action for a period of 2 years, with the ability to renew.

“DACA allows young adults who had arrived in the United States as children without legal status but grew up here to essentially apply for deportation relief and working visas,” Love said during the session.

Children living in an immigrant family are also approximately twice as likely as other children in the United States to not be covered by health insurance. Love explained that sometimes this lack of insurance is due to the services not being available, whereas other instances may be due to a lack of knowledge regarding the programs that exist that could provide them with health insurance coverage.

This pediatric population is also more likely to live below the poverty level, with access barriers to programs and benefits causing such problems to persist. Love noted that additionally, for these children, the threat of deportation or forced separations from their families are very real.

“The family immigration status represents an important and often neglected social determinant of health in this family,” Love said. “The immigration status affects their access to care and intertwines with other social determinants of health.”

Love explained that these social determinants of health can include poverty, food insecurity, health literacy, educational disparities, or discrimination, the latter of which they may experience based on their family’s immigration status.

In order to assess the mental, emotional, and behavioral health of immigrant children in light of the varying factors at play in their health and wellness, there are several screenings that can be used to help assess their wellbeing.

“Screening for trauma is very important in these children,” Love said during the session. “It’s really easy for us to kind of think of their journey as just hopping on a plane and crossing into the country. However, depending on their country of origin, it can be quite traumatic or it could be seamless. It really just depends on the country they’re coming from and the reason migration is happening.”

Upon arrival to the United States, immigrant children may actually also be healthier than native-born children, which is termed the “immigrant paradox” or “healthy immigrant effect” in the literature, according to Love. This is important to recognize as these children may require longer term care in order to develop a rapport with their provider, at which point signs of trauma may begin to appear.

“That’s why this ongoing screening is recommended,” Love said. “Trauma can occur before the migration journey, during the journey, on arrival, or post migration.”

There are also various types of trauma that could have occurred previously or are occurring, such as physical or sexual abuse, witnessing interpersonal violence, human trafficking, actual or threatened separation from parents, or exposure to armed conflicts.

Yet, immigrant families also bring strengths to the United States that may be less common in native-born families, which can be assessed using the Strengths and Difficulties Questionnaire. Love explained that a significant majority of immigrant families arrive intact, with multiple generations living in the same household. This can be a strength that can help build resilience in this pediatric population.

“Typically, what we see is that children in these families are not growing up in disjointed family units,” Love said during the session. “That’s an actual strength of these families and provides resilience for them, unlike children in the United States who are non-immigrants who are affected by divorce more commonly. These families are typically intact.”

REFERENCE

Love A, Whited T. Nursing Beyond the Borders: Addressing Healthcare Needs and Health Disparities for Children in Immigrant Families. Presented at: National Association of Pediatric Nurse Practitioners Virtual Conference 2021; March 26, 2021; virtual. https://napnap21.org/community/#/session-stream/42189. Accessed March 31, 2021.