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The Proposed Public Charge Rule is an Attack on Family-Based Immigration

| November 28, 2018 |

Family unity is often a key motivation for immigration. Mothers, fathers, sons, and daughters who seek to sponsor their immediate family members may do so via a policy commonly known as family unification or family-based immigration.

While the origins of family-based immigration were flawed, it has been the backbone of immigration reform since 1965 and ultimately remains a reflection of our nation’s value of the importance of family unity.

Unfortunately, immigration hardliners refer to this policy as “chain migration” in an attempt to dehumanize immigrants and imply an effort to circumvent immigration procedures. The Trump administration has been among those to call for an end to family-based immigration.

In 2017, the administration supported legislation that would have ended some of the family-based categories that are in place and made deep cuts to family-based immigration. Additionally, the administration has had no misgivings about their assault on migrant families in their attempts to deter both legal and illegal immigration. Separating children from their parents at the border, ending prosecutorial discretion for parents of minor children, ending protections for families fleeing horrific conditions in their home countries, and arresting family sponsors of unaccompanied children are just a few of the horrific ways in which the administration has targeted families.

Similarly, the proposed public charge rule released by the U.S. Department of Homeland Security (DHS) on October 10 will have a devastating effect on families, and would be a direct attempt by the administration to cut family-based immigration. This proposed rule aims to drastically redefine what it means to be deemed a public charge and ultimately denied entrance to the U.S. or lawful permanent residency by punishing working class families for use of public assistance programs such as the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) Supplemental Security Income (SSI), Medicaid, and Home Energy Assistance Programs.

Those primarily affected by this proposed rule would be those applying through family-based visa petitions as the rule applies to two categories of immigrants:

  1. Those seeking admission to the United States.

  2. Those lawfully present in the U.S. seeking a change of status to obtain a green card or lawful permanent residency (LPR).

According to DHS, in 2016 approximately 68% of the total persons who obtained LPR status were immediate relatives of U.S. citizens or had a family-based sponsor. The proposed rule would make it more difficult for families to stay together or reunify, as families will be forced to meet the new requirements for a wide range of demands including relatively high income, education, language skills, and good health.

According to the Migration Policy Institute (MPI), “Many citizens, both U.S. and foreign born, would encounter new barriers to uniting with their family members.” The current application of the public charge test affects approximately 3 percent of family-based visas and applicants. DHS estimates that the new rule would drastically expand this test to affect approximately 382,000 family-based immigrants within the United States per year. MPI reports that in addition more than 550,00 persons living abroad would be subject to the rule as well. Implementing this rule will negatively impact the ability of low-income families to meet their basic needs and will unnecessarily result in family separations.

The open comment period for this proposed rule will end on December 10, 2018. First Focus strongly opposes this proposed rule and urges both individuals and organizations to submit comments fight this rule.

See our #ProtectChildren and #ProtectFamilies Resource center for child-focused model comments, more information, and other actions you can take to stand against this proposed public charge rule.



Universal Children’s Day: An Opportunity for Common Ground

| November 20, 2018 |

All parents share one thing in common. Whatever our differences – across race, religion, socio-economic status, political beliefs, and more – every parent wants the best for their children. We disagree on a lot these days, but I haven’t heard a single parent wish that their children will do worse than they did.

Now consider this ambitious vision proclaimed almost thirty years ago: Every child in the world “should grow up in a family environment, in an atmosphere of happiness, love and understanding” and be raised “in the spirit of peace, dignity, tolerance, freedom, equality and solidarity.” This ideal reflects what all of us would want for our children, for all children. After all, no parent hopes their children will suffer misery, war, and inequality.

This grand vision was announced in the UN Convention on the Rights of the Child (CRC). Adopted in 1989, the CRC was the first comprehensive human rights treaty on children. It established a holistic framework for ensuring the rights and well-being of all children. The CRC covers both civil and political rights (such as freedom from cruel, inhuman and degrading treatment) and economic, social, and cultural rights (such as the right to education). It also includes rights unique to children (such as the right to know and be cared for by one’s parents).

Given the universal appeal of its goals, it won’t be surprising to hear that it’s the most widely-accepted human rights treaty in history. Every country in the world has ratified the CRC, except the United States.

In the United States, the CRC has become a victim of much broader political and ideological battles, a phenomenon that too often tragically happens to children themselves. Highly charged rhetoric masks the reality of the CRC and children’s rights more broadly—that is, the fulfillment of children’s rights is consistent with what the vast majority of parents want for their kids. They want their children to have access to health care and education, to be free to observe their faith without government interference, to live without discrimination, and to grow up without suffering violence or exploitation.

Despite the major role the U.S. government played in drafting the CRC and the numerous similarities between U.S. law and the treaty, the U.S. government isn’t likely to ratify the CRC anytime soon.

But given the shared values in what parents dream of and what the CRC mandates for children, the idea of children’s rights remains relevant in the United States. We don’t have to wait passively for government to act; we can take action, guided by children’s rights values.

So, for Universal Children’s Day (November 20) or any day thereafter, here are three steps each of us can take to forge common ground and improve the lives of children:

  1. Read the CRC. Whether it is the CRC’s declaration that the family is “the fundamental group of society,” the 19 provisions of the CRC that recognize the vital role of parents and the family in the lives of children, the treaty’s support for education, its prohibition on torturing children, or something else, find an element of the CRC that resonates with your values as a parent, family member, American, or human being.
  2. Find and support (financially or as a volunteer) an organization in your community that advances an aspect of the CRC that you support.
  3. Vote for kids. And not just on election day. Make your voice heard often, by urging your representatives to support initiatives that help secure the rights and wellbeing of children.

If we all can do that, then this Universal Children’s Day can be a turning point, a day when we found common ground on which to build a world where every child can develop to their full potential.

Jonathan Todres is a professor of law at Georgia State University.

The Proposed Public Charge Rule Will Make Children Hungrier

| November 16, 2018 |

When children don’t have enough to eat, it makes it harder for them to learn, grow, and thrive. Unfortunately, the Department of Homeland Security (DHS) recently published a proposed rule on the Federal Register that will make it harder for immigrant families with children to put food on the table.

The proposed rule would allow government officials to now consider the use of an applicant’s broad range of services such as Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and housing assistance when determining eligibility for green cards and/or lawful admission to the U.S. This drastic expansion will cruelly force parents to choose between meeting their family’s basic needs or keeping their families together.

DHS claims it will not include a child’s use of SNAP in the public charge rule. But the agency also admits that, due to fear and misinformation, some parents will likely disenroll their children, even if they are eligible (3.9 million U.S. citizen children with immigrant parents accessed SNAP in 2015.)

New, worrisome data shows that immigrant families who have been in the United States for fewer than five years and who are legally eligible for SNAP have reduced their participation in the program by nearly 10 percent in the first half of 2018. The chilling effect of the public charge rule could be at least one factor driving these numbers.

Furthermore, SNAP is a pooled household resource—if even one member loses access to the program, there will be less food available for everyone, including children. Unsurprisingly, DHS says that an “indirect” cost of the rule will be increased rates of obesity and malnutrition, especially in pregnant and postpartum women, infants, and children.

This proposed rule is not only morally unconscionable, it is economically foolish. SNAP significantly reduces child poverty and stimulates the economy (every $5 in SNAP benefits generates $9 of economic activity). It also fights food insecurity in children—creating cost savings in the form of better child health, educational attainment, and long-term productivity. This is especially important for the children of immigrants, who face a higher risk of food insecurity than their peers in the same income bracket.

DHS has proposed this rule knowing full and well that it will mean more children in America are don’t know where their next meal is coming from. No family should have to go hungry in order to stay together.

First Focus strongly opposes this rule and its harmful repercussions on children and the country as a whole. We urge individuals and organizations to comment in opposition by the deadline of December 10th, 2018.


Department of Homeland Security Public Charge Rule Would Increase Child Poverty in the United States

| October 23, 2018 |

The strength of our economic future is dependent on the well-being of our nation’s children. Yet child poverty remains high in the United States, with 12.8 million (17.5 percent) of children living below the poverty line in 2017. Children continue to disproportionately experience poverty in the U.S. and are 62 percent more likely to experience poverty than adults.

Due to unique structural and cultural barriers to economic security, children in immigrant families are more likely to be living in low-income households than children in U.S.-born families. These barriers include already narrow eligibility rules that prevent immigrant families from accessing critical assistance programs.

The proposed public charge rule released by the U.S. Department of Homeland Security on October 10th would only serve to further increase poverty among children in immigrant households, many of whom are U.S. citizens. The proposed rule would allow government officials to now consider the use of an applicant’s broad range of services such as Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and housing assistance when determining eligibility for green cards and/or lawful admission to the U.S. The proposed rule would also continue the existing consideration of cash assistance through the Temporary Assistance for Needy Families (TANF) program and the Supplemental Security Income (SSI) program.

The majority of children of immigrants live in a household where both parents are working and employed in essential, but lower-paying jobs that don’t provide access to employer-sponsored health insurance or a pension plan—diminishing these parents’ ability to invest in their children. Combined with skyrocketing rents and the high cost of everyday goods means, this means that immigrant parents still struggle to make ends meet and must turn to key assistance programs to supplement resources for their families.

The proposed rule would further limit access to healthcare, nutrition assistance, housing support and cash assistance for immigrant households. The result will be a future generation of children with weakened physical, mental health, nutritional, and educational outcomes.

This is not only cruel, but economically foolish. Child poverty already costs the U.S. over $1 trillion a year, representing 5.4 percent of our GDP. Stunningly, the Department of Homeland Security fails to account for the cost of increasing child poverty in its proposed rule’s cost benefit analysis. Indeed, though the agency acknowledges that the rule will result in “increased rates of poverty” among other harm, it treats this as a “non-monetized cost.” This assertion is misleading and vastly underestimates the economic damage this rule will impose on the nation.

We know what works to reduce child poverty. Programs such as SNAP and TANF lift millions of children out of poverty each year. When these resources are provided at an early age, they create a long-term positive impact on the child’s life and long-term economic contributions.

Everyone– regardless of socioeconomic status– benefits from strategies that reduce child poverty.

First Focus strongly opposes this rule and its harmful repercussions on children and the country as a whole. We urge individuals and organizations to comment in opposition by the deadline of December 10th, 2018.

Department of Homeland Security Public Charge Rule is a Disingenuous Attack on Children

| October 18, 2018 |

The Department of Homeland Security (DHS) recently published a proposed rule on the Federal Register that would drastically change the guidelines for applying to enter the country or for a change of residency status. The “Public Charge” rule, which is over 400 pages long and incredibly dense, contains contradictions and red herrings that will further confuse the affected population and drastically harm children.

One example is the deceptive way DHS delineates how this rule will impact children who participate in important assistance programs. On page 51175, the rule establishes that the receipt of public benefits by children will not be considered in the public charge determination of their parent: “DHS notes that while the number of children, including U.S. citizen children, may count towards an alien’s household size for purposes of determining inadmissibility on the public charge ground, the direct receipt of public benefits by those children would not factor into the public charge inadmissibility.”

On its face, the rule claims to exempt children’s use of benefits because they won’t factor into the cost-benefit analysis of their parent’s admissibility. However, this is not the whole story. That is because DHS is considering penalizing children for using benefits when they themselves apply for a green card once they turn 18, saying on page 51174, “because the public charge inadmissibility determination is a prospective determination in the totality of circumstances, the circumstances surrounding an alien’s receipt of public benefits as a child, including the age at which such benefits were received, are a relevant consideration.”

Exempting a child’s use of benefits in their parents’ public charge determination signals that it is allowable for parents to enroll their children in much-needed programs for which they are legally eligible. DHS, however, is considering punishing those same children if they themselves are immigrants eventually hoping to receive a green card. This discrepancy is misleading and harmful. If implemented, this aspect of the rule would leave parents with the excruciating decision between forgoing essential benefits for their children or endangering their ability to become a Legal Permanent Resident in adulthood. On top of this, the complexity of the rule may mean parents are unaware that their child’s future status could be jeopardized by the use of housing, health care, and nutrition assistance. Cutting off a child from necessary benefits through scare tactics or denying them a fair path to permanent residency because of help they receive as children hurts our country’s future workers, leaders, and tax base, who we are going to rely on for years to come.

First Focus strongly opposes this deceptive consideration, the rule as a whole, and its harmful repercussions on children and the country as a whole. We urge individuals and organizations to comment in opposition.

Department of Homeland Security Public Charge Rule Would Make Children Less Healthy

| October 16, 2018 |

The Department of Homeland Security released their proposed rule to the public charge section of immigration law in early October. This rule would affect individuals who are present in the United States and seeking to adjust their status to that of a lawful permanent resident and those who are seeking admission to the United States.

On page 51270 of the proposed rule, the Department describes what they think will happen due to the “chilling effect”.

“Disenrollment or foregoing enrollment in public benefits program by aliens otherwise eligible for these programs could lead to:

  • Worse health outcomes, including increased prevalence of obesity and malnutrition, especially for pregnant or breastfeeding women, infants, or children, and reduced prescription adherence;
  • Increased use of emergency rooms and emergent care as a method of primary health care due to delayed treatment;
  • Increased prevalence of communicable diseases, including among members of the U.S. citizen population who are not vaccinated;
  • Increases in uncompensated care in which a treatment or service is not paid for by an insurer or patient; and
  • Increased rates of poverty and housing instability; and
  • Reduced productivity and educational attainment.

DHS notes that the proposed rule is likely to produce various other unanticipated consequences and indirect costs. For example, community based organizations, including small organizations, may provide charitable assistance, such as food or housing assistance, for individuals who forego enrollment in public benefit programs.”

The items in that list, in terms of children, pregnant women, and families, astound me. How could our own government propose a rule that will lead to “worse health outcomes” and “increased communicable disease”? Increasing the use of emergency rooms, delaying treatment, and uncompensated care will bring higher health costs for everyone. Increasing poverty and the lack of housing will neither promote prosperity in this country, nor support communities. Reducing productivity and educational achievement makes us less capable and competitive at home and globally.

First Focus strongly opposes this proposed rule, and urges individuals and organizations to comment in opposition.


2018 Children’s Budget Summit Highlights: It’s Time to Stop Shortchanging Our Children

| October 12, 2018 |

Last week, First Focus hosted the 2018 Children’s Budget Summit to introduce the 11th annual release of its signature publication, Children’s Budget 2018, which captures recent spending trends across nearly 200 federal programs benefitting children. With this data, Children’s Budget 2018 analyzes the share of federal spending on children, investments across nine areas of child wellbeing, and the president’s fiscal year (FY) 2019 budget proposal, which, if enacted, would eliminate 41 children’s programs. This comprehensive analysis shows where the federal government is investing wisely in our children–and where it is shortchanging them.

First Focus was pleased to present the event’s sponsor, Senator Debbie Stabenow (D-MI), with a 2017 Champion for Children award on behalf our sister organization, First Focus Campaign for Children, recognizing her as one of the top U.S. Senators who consistently and effectively advocates for children and families. Her record is outstanding, including her votes in support of the Affordable Care Act (ACA), the Children’s Health Insurance Program (CHIP) and improvements in the Child Tax Credit and her bipartisan work as co-chair of the Senate Caucus on Foster Youth with Senator Grassley (R-IA). In her inspiring remarks, Senator Stabenow highlighted her refusal to harm children and families as she leads Congressional negotiations over the 2018 Farm Bill. As a Michigander, I am thrilled that First Focus honored her awesome, thoughtful, and tireless advocacy for our nation’s children.

First Focus President Bruce Lesley opened the Summit with a detailed presentation about how the federal budget process shortchanges children, calling Children’s Budget 2018 a “good news/bad news story.”

The good news is that the share of total federal spending on children rose by a real 1.10 percent from FY 2017, thanks to increased investments stemming from the passage of the Bipartisan Budget Act of 2018 (BBA, P.L. 115-123).

The bad news is that this one-year improvement failed to overcome the long-term decline in the share of spending on children (a real 1.7 percent decrease) since FY 2014, and will keep shrinking, according to the Urban Institute.

Meanwhile, interest payment on the national debt is projected to exceed federal spending on Children by 2020. These funding challenges will only intensify as our deficit balloons and revenues decrease significantly due to 2017’s $2 trillion tax bill, which largely benefited wealthy individuals and corporations over children in poverty.

Bruce also highlighted the fact that the current budget process “rigs” the system against children and called for “inter-generational equity” in federal spending. As the Center for Responsible Federal Budget points out, spending on children is disproportionately discretionary, temporary, and capped and lacks built-in growth like Social Security and Medicare, which are mandatory and have successfully lifted many seniors out of poverty. This disadvantage, not surprisingly, leads to regular debates about funding cuts and reauthorization for important children’s programs like the Children’s Health Insurance Program (CHIP).

These trends must change, so that all of our children—17.5 percent of whom currently live in poverty—have equal opportunity to thrive and succeed. Bruce recommended structural solutions such as the creation of a children’s budget, a child poverty reduction target, and an independent commissioner for children. In addition, we could identify a dedicated revenue source for some children’s programs, convert CHIP to a permanent, mandatory program, reform TANF, raise the budget caps, and adopt the concept of inter-generational equity – so that both our seniors and kids win.

After this budget process discussion, I was honored to moderate a panel with incredible experts starting with Lynn Caroly, Ph.D., from the RAND Corporation, who also served as a key member of the 2018 National Academies of Science, Engineering and Medicine study “Transforming the Financing of Early Care and Education.” She gave an overview of the insufficiency of existing federal investments in our early care and education system and infrastructure, the need to incentivize high quality care, and different recommendations in the report.

Up next, Natasha Slesnick, Ph.D., a professor of Human Development and Family Science in the Department of Human Sciences at The Ohio State University and a licensed clinical psychologist, shared her research focusing on interventions for substance using homeless youth, and substance using mothers and their children. She underscored the need for prevention services and to continue to identify hidden populations of youth, such as those experiencing homelessness, who may have the highest opioid use rates.

Our third esteemed panelist was the Rev. Fr. Douglas Greenway, who has served as President and CEO for the National WIC Association since 1990. Rev. Greenway spotlighted the need for funding to expand the Special Supplemental Nutrition Program for Women, Infant and Children’s capacity for community health integration, breast-feeding peer counseling, and other important services—as well as protect complimentary programs like SNAP and Medicaid from harmful policy changes.

Dr. Mona Hanna-Attisha gave an inspiring keynote address, reminding the audience that “it is our responsibility no matter where we are, to fight for our children.” Though Dr. Hanna-Attisha’s own story centers around the lead crisis in her city of Flint, Michigan, she took care to remind us that everywhere in America, poverty and trauma are injustices that are harming the lives of our children and require multifaceted interventions.

She especially stressed the need to put kids first in spending and policy decisions: “Flint is what happens when the people charged with keeping us safe care more about money and power than our children.” But her message was also one of hope.

“Flint is also the story of people coming together and resisting for our kids,” Dr. Hanna-Attisha said, citing the city’s strides in investing in evidence-based prevention programs such as trauma-informed care, universal early childhood education, home visiting, and more. She hopes Flint can serve as a model for other communities around the nation seeking to create better futures for their children.

Dr. Hanna-Attisha’s message gets to the heart of why First Focus founded the Children’s Budget Coalition nearly 10 years ago. The coalition is comprised of more than 70 children’s advocacy organizations with priorities across a wide range of issues, such as health, education, nutrition, the welfare system, juvenile justice, and more.

In a unified voice, this broad coalition of advocates, urges Congress to prioritize children in federal policy and budget decisions, and serves as a resource for our partners, lawmakers and their staff, and the public.

Thanks to dedication, determination, and collaboration, the Coalition successfully urged Congress to raise the budget caps for FY 2018 and FY 2019. But our work continues. The budget cap will drop dramatically by $55 billion in FY 2020, and we must push for another bipartisan agreement that builds on the priorities reflected in the BBA to avoid drastic cuts in programs and services that support our children and families. We invite you to join us in this fight. As Dr. Hanna-Attisha put it, “children everywhere are counting on you.”

CDC Is Taking the Right Steps to Boost Vaccination Rates for the Most Vulnerable Children and Pregnant Women

| October 9, 2018 |

We are delighted that the Centers for Disease Control (CDC) is spending $880,000 over the next three years in Colorado, Hawaii, Kentucky, Montana and New Mexico to develop registries for children and pregnant women enrolled in Medicaid. This program will enable providers and state agencies to track the immunizations of infants and pregnant women, in an effort to boost vaccination rates across the country.

Twenty percent of children see multiple providers before the age of two, which leads to gaps in their medical records, mostly because different parts of the U.S. health care system do not talk to each other. Children might get vaccinated at a clinic, their school, their physician’s office, or a hospital. The CDC has recognized that we need a more unified way for providers to communicate with each other and this three-year grant is trying to create that.

This is especially important since, nationally, Medicaid covers over 50 percent of births and 35.4 million children. During the 2016-2017 flu season, under 50 percent of pregnant women on public insurance received the flu vaccine, compared to the nearly 60 percent of expecting women with other forms of insurance.

Data also show that immunization rates are much lower for low-income people than the rest of the population, which can have life-long negative effects on the low-income kids. Until Medicaid has the resources to monitor all children with records from their medical home and work with their parents or guardians to ensure they are vaccinated, kids will not receive the requisite vaccinations they need.

Through the federally funded Vaccines for Children (VFC) program, Medicaid provides vaccines at no cost to children who are enrolled in the program who are uninsured, underinsured, or Native American through the age of 18. The CDC buys vaccines at a discounted rate and distributes them to grantees, who provide them to private physicians and public health clinics registered as VFC providers.

Developing a registry that integrates who health care providers are providing vaccines to with state Medicaid electronic health records can help the Federal Government target children who are not receiving the vaccinations they need.

First Focus applauds this initiative by the CDC and encourages the administration to provide additional funds to more states in order to help develop registries, which will ultimately improve the health outcomes of vulnerable children and pregnant women.


Inside the Tornillo Shelter for Unaccompanied Children

| October 1, 2018 |


The influx shelter or “tent city” located at the port of entry in Tornillo, TX is used to temporarily house unaccompanied children. I recently had the opportunity to tour the Tornillo shelter with a group of advocates and stakeholders.


From the very beginning I was impressed with the competence and transparency of the managing company, BCFS led by Kevin Dinnin, who has been vocal on the Trump administration’s recent family separation policy. Our tour through the campus was very thorough, and we were shown the operational headquarters, living quarters, medical facilities, and recreational areas.

The children in this facility, ages 13 to 17, were transferred from one of the Office of Refugee Resettlement’s (ORR) state licensed facilities where they were medically screened and have generally been identified as having a parent, legal guardian or immediate relative qualified to sponsor them. Initially, Tornillo was brought online in June 2018 with a capacity of 400 beds. That contract was extended again in July, and then in September, ORR renewed its contract with BCFS emergency management company to extend the shelter through the end of 2018.

In early August, the shelter housed approximately 130 kids. At the time of our visit, and within just a few weeks from that time, there were 1,661 children being held at Tornillo.[1] Under the newest contract, the total bed capacity was expanded to 3,800. Part of the increased capacity includes 1,400 beds slotted for emergency hurricane shelters for unaccompanied children in the ORR influx facility in Florida. The recent expansion also includes the addition female children to the Tornillo shelters which previously only housed male children. A recent report by the New York Times details the circumstances in which kids are transferred to Tornillo, often in the middle of the night with no notice. The constant changing of norms for these young people will only compound anxious behaviors and fears.

The children are housed in air-conditioned pop-up tents (“Western shelters”) that are built to withstand winds up to 75 mph. There are 10 bunkbeds and 20 children in each tent with a staff ratio of 7-to-1. Three staff members are with the group of 20 at all times including overnight. Unfortunately, the sleeping quarters are tight, and there is no room for free space within the tents. Additionally, staff are not allowed any physical contact with the kids, and the kids are not permitted to touch even the bunk of another child. According to officials, at least one staff member per group is required to speak Spanish, and they use technology to support translating indigenous languages. By far the greatest number of children were from Guatemala, while Honduras and El Salvador followed respectively.


They have a daily schedule that includes time for sports, movies, and optional religious services on the weekends. Overall, recreational activities are encouraged, and a turf field was created for soccer. However, because these facilities are labeled as influx shelters, there is no requirement for BCFS to provide educational materials or classroom learning. We were informed that the children were provided with workbooks that they could choose to complete.

Because of the location of the facility, the entire site was created to be 100 percent self-sufficient. Water is brought in daily, food is catered by a food services group out of San Antonio, power is supplied by generators, and there are emergency services on site including a fire truck and ambulance. Officials on the tour admitted to trial and error in the types of foods the kids like—as well as the need for cultural adaptations to the menu.

The onsite medical clinic is available for children who experience a variety of minor medical problems. The nurses who run the clinic are mostly pediatric RNs with ER experience. The most common health issues served are influenza-like illnesses (ILIs) and injuries sustained during recreational time.

Prior to their transfer to the shelter, children are medically screened. Medical personnel at the facility explained that they do not administer psychotropic medications at Tornillo, and any child who requires such medications is sent to another ORR care provider. The clinic keeps a list of allergies as well as special restrictions regarding physical activity.


Unlike other non-influx ORR facilities, children in Tornillo do not have access to regular mental health services or counseling, as there is one mental health clinician to every 100 children. The mental health services provided for an influx facility consists of only of crisis intervention and behavioral response. This is concerning given the high number of kids in this population who have been exposed to trauma and sexual and physical abuse. This exposure can have significant negative consequences for the social, emotional, and physical well-being of children. It is vitally important that these needs are addressed so that the child may begin to heal and build the necessary skills to cope with the trauma he/she has experienced.

Another point of concern was the grievance process available to the kids. There were private rooms with phones available to report abuse allegations—yet these rooms are located in the middle of the common areas, and the children must be accompanied to the phones by a staff member. Additionally, there is a box for concerns where kids may write anonymous complaints. However, these complaints are handled internally by a staff member rather than an outside source.

New administrative procedures and enforcement measures targeting the sponsors for these children are causing the numbers to increase drastically even though the number of arrivals remains steady. Earlier this year ORR and Immigration and Customs Enforcement (ICE) entered into an agreement that requires close cooperation between the two agencies. Part of this agreement includes an exhaustive vetting process by ICE of those who come forward to sponsor these children. It has been documented that this information is used to target sponsors for deportation.

Another piece of this process is a new requirement for all adults in the household of a potential sponsor to be fingerprinted. According to officials at Tornillo, more than 60 percent of the kids in their care are waiting on the lengthy fingerprinting process before being released to a sponsor. As the process slows down there is growing concern for youth who turn 18 during their time in ORR and are then transferred into the custody of the Department of Homeland Security (DHS).

These procedures are causing widespread fear among sponsors and family members as well as a logistical nightmare to accommodate the drastic increase in the number of persons being fingerprinted. Consequently, the average number of days a child spends in ORR custody has dramatically increased from 34 days in 2015 to 59 days as of last month.


I left Tornillo feeling as though I had participated in a state inspection of a medical facility. While I am grateful to ORR and BCFS for mitigating the harm and further traumatization of these children, I would be remised if I did not acknowledge the feeling of helplessness that I felt as I saw the incredible number of children waiting to be released. They are far away from their home, family, and cultural norms and must live on a schedule that does not allow for any variance from routine. As a mother of two children, one of whom deals with anxiety, I cannot imagine what it must be like for the children to not be allowed any physical human contact during one the most fearful times in their lives. While I understand that children are resilient and strong, they also need love and nurturing that they cannot receive in the custody of the federal government.

Institutionalized care is not in the best interest of these children. Policy makers must review changes to the process that have prolonged the stay for so many of these children and youth. They have experienced so much trauma in their short life spans, and it is important that they are quickly placed with loved ones who can offer the love and support that they so desperately need. The number of kids in federal custody across the nation is at a record high, and this reality is visible in the expansion in Tornillo.


[1] Official number as of tour date, September 24th, 2018.

House Energy and Commerce Committee Turns Attention to Maternal Mortality

| September 28, 2018 |

First Focus applauds the effort of the House Energy and Commerce Committee to shine a light on the crisis of maternal and infant mortality. The committee held a hearing yesterday that brought in views from health care providers, advocates, and a victim’s spouse—Mr. Charles Johnson IV, whose wife tragically passed away from the pregnancy of their second son.

It is clear that the United States has a significant problem on its hands. We are facing a health care crisis among African-American mothers, and, as the hearing highlighted, it is rooted in the past and current implicit bias in our society and health care system.

Multiple witnesses who addressed the committee argued for more states to create maternal mortality review committees (MMRC’s). According to testimony by the American College of Obstetricians and Gynecologists (ACOG) and others, MMRCs can play a pivotal role in reducing the rate of maternal and infant mortality. First Focus agrees that MMRCs can ultimately collect data and determine where the “administrative responsibilities lie.”

Another critical step that can help all pregnant women, but in particular African-American women, is the expansion of Medicaid. A National Institutes of Health (NIH) report released in April this year stated, “Because of the large proportion of maternal, infant, and child health care and preventive services funded by Medicaid, Medicaid expansion may be among the most important ways in which the ACA could improve maternal and child health indicators, such as the infant mortality rate.”

The NIH went on to say that the decline in infant mortality “in Medicaid expansion states was more than 50 percent greater than in non-Medicaid expansion states. Declines… [in mortality] were greatest in African American infants.”

Half of the states in the country reported that 50 percent or more of births were financed by Medicaid. However, the program goes beyond that. It covers development screenings, preventive care, and allows health care providers to detect problems sooner than later.

During yesterday’s hearing, Dr. Joia Crear-Perry, MD, Founder and President of the National Birth Equity Collaborative and Advisory Board Member of the Black Mamas Matter Alliance, spoke about what it meant for her state, Louisiana, to expand Medicaid, but also how the underlying cause of this issue continues to be a problem. According to Dr. Crear-Perry, “maternal mortality extends beyond the period of pregnancy or birth. Nine months of prenatal care cannot counter underlying social determinants of health inequities in housing, political participation, transportation, education, food, environmental conditions, and economic security; all of which have racism as their root cause. We have data that shows that a Black woman who initiates prenatal care in the first trimester has a worse outcome in birth than a white woman with late or no prenatal care.”

This is a problem that must be addressed immediately. First Focus urges the Department of Health and Human Services and Congress to do more, so we can prevent any more senseless deaths, and thanks the Energy and Commerce Committee for holding this vitally important hearing.