Health

In effort to help Central American children win asylum, two professions collide

Salvadoran immigrant Stefany Marjorie, 8, holds her doll while going home in July  2014 in Mission, Texas.
Salvadoran immigrant Stefany Marjorie, 8, holds her doll while going home in July 2014 in Mission, Texas.
John Moore/Getty Images

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Several weeks ago, Elena Fernandez, a mental health counselor in South L.A., got an urgent email from Judy London, a Los Angeles immigration attorney who represents many of the unaccompanied Central American children who have fled violence back home and arrived at the U.S. border in search of asylum.

"I just prepared this patient for court," London wrote in the email, "and this patient is suicidal now."

London needed Fernandez to meet with her client immediately. The child was due before a judge, and he would have to recount the trauma he suffered in Central America to have a chance of staying in the U.S. But preparing for court had reopened old wounds, and now the child wanted to take his own life.

Though a court deadline loomed, from Fernandez’s perch there was only one good option: to ask London to seek a court extension so Fernandez could help the child process the trauma and learn some coping skills.

In the effort to help the thousands of unaccompanied Central American children who have arrived at the nation’s border, doctors and therapists like Fernandez often work closely with attorneys like London. The evidence of physical and emotional trauma that clinicians document in exam rooms and in therapy sessions can be critical in helping the children’s attorneys make a case for why they should be allowed to stay in the U.S. But doing so effectively can be tricky, because the lawyers' and therapists' professional goals often collide.

"This is very difficult," Fernandez said. "Obviously the attorneys need to get the facts, and push and pressure the patient. But while we’re trying to work with all these emotions -- this stress, and anxiety and depression -- they’re re-traumatizing the patient."

London understands Fernandez' position. 

"If they go to an (asylum) interview and say, I don’t really want to talk about being afraid, they’re not going to be able to stay here," she said. "But the therapist’s goal may be, let’s get the child as far away from talking about the trauma, because they’re really not ready to process it. So it gets messy."

Their task is made even more difficult because of the time crunch that attorneys face to prepare a client’s case. Because of the huge numbers of children who have arrived and sought permission to stay, President Obama has called for expediting their cases.

Central American children and their families listen to a presentation about the importance of addressing mental health issues at the St. John's Well Child And Family Health Center in South Los Angeles on Nov. 8, 2014.  (Photo: Adrian Florido/KPCC)

London said she sometimes has as few as 10 days to prepare an asylum case. That’s not enough time, Fernandez said, for a child to work through emotional damage and feel comfortable enough to appear before a judge or asylum interviewer and talk about being beaten or raped back home.

To address these challenges, some therapists and lawyers are developing close relationships.

London, who works with the nonprofit Public Counsel, has held sessions with the mental health staff at the St. John’s Well Child and Family Health Center, which has seen thousands of unaccompanied children, and where Fernandez is behavioral health director.

In those sessions, the lawyer and the therapists strategize about how they can minimize the emotional trauma the children experience while maximizing the amount of information available to lawyers to make their cases. The sessions help the therapists prepare children for what they might expect in a courtroom.

The therapists also talk with their patients about how they’ll cope if their cases are ultimately unsuccessful and they are sent back to their countries.

"But our goal in working with our collaborating law firms," Fernandez said, "is to try and ensure that they do stay here."

To do that, her clinic, St. John’s, is leading an effort in partnership with L.A.’s Central American consulates to identify children who have not had contact with lawyers or health providers and connect them with services.