The subcommittee will come to order. Good morning to all and welcome to the labor hhs and education appropriations subcommittee. Were here today for another oversight hearing. This time, with Administration Officials and members of the Departments Office of Inspector General to discuss the recently released report on the Mental Health needs of children in the care of the department of health and Human Services, unaccompanied Children Program. I want to thank our witnesses for being here today. And maxwell, office of the Inspector General, department of health and Human Services. Jonathan hayes, who is the director of the office of Refugee Resettlement. The department of health and Human Services. And jonathan white, department of health and Human Services. This hearing is really part of our oversight responsibility which we take very, very seriously. We must. Considerable taxpayer resources are at stake. And something even more presscis is at stake, the mental and physical well being of children. That is why the office of the Inspector Generals new report was so alarming. It confirms our worst fears that intentional policy choices by this administration created a mental crisis. Which the office of Inspector General said thats health and Human Services and the office of Refugee Resettlement failed to address. Its a crisis of deliberate government sanctioned child abuse. We must stop the trauma inflicted on these children so i believe the Administration Must quickly implement the oigs proposed recommendations which are included in the report. The administration for children and families has concurred with each of the recommendations, but words alone are not enough. The gaps created a Mental Health crisises as children are deali with the effects. As maxwell summarized on page 8 on her testimony, policy changes in 2018 exacerbated existing challenges as they resulted in one, a rapid increase in the number of children separated from their parents and entering the United States. Many of whom were younger. Two, longer stays in orr custody for children, end quote. Those policy changes in 2018 were the administrations zero tolerance family separation policy. It ripped children from their parents and the administrations grossly intentional changes for fingerprinting and screening requirements that ground discharge to a halt. As a result, the childs average length of stay in government custody nearly tripled from 35 days to 93 days. The numbers have improved. Since the administration began implementing its operational directives in december to reverse their changes to the screening process. I will note those changes followed a consistent drumbeat for accountability from the subcommittee. Now we need to see the agencys plan to improve the discharge process. So were able to get children in and out of orrs care as safely and as quickly as possible. So they do not experience toxic stress and mental trauma. We do not only need a plan for bed capacity. And as i understand it, the onus with respect to discharge is on the contractor, who is responsible for the discharge consistent with policies, o. R. R. Policies and regulations. But the contractor is responsible. So o. R. R. Must then have policies in place that get children in and out of the facility as quickly as possible. Because when homestead, which is an influx facility, is charging 750 per night per child, the motivation to move these kids may not be as strong as it needs to be. It must be changed because as the oig concluded people have been suffering because of these intentional policy choices. Ms. Maxwell wrote in her testimony, children who experience longer facility stays exhibited higher levels of defiance, hopelessness and frustration along with more instances of selfharm. Also in her testimony on page 8. Separated children exhibited more fear, feelings of abandonment and post Traumatic Stress than did children who were not separated. And the oigs report on page 10 also described how some separated children expressed acute grief that caused them to cry inconsolably. Another story, the oigs report shared a 7 or 8yearold boy who was separated from his father without any explanation as to why the separation occurred. The child was under the delusion that his father had been killed and believed that he would also be killed. This child ultimately required imagine Psychiatric Care to address his Mental Health distress. Its terrible. The administration failed today fully or adequately treat it. As the oig report spotlighted in its executive summary, they failed to address the Mental Health needs of children who had experienced intense trauma and had difficulty accessing specialized treatment for children who needed it. Overwhelmed, case loads were reported more than double what they should have been. Unprepared for the younger children, those Mental Health providers who were available were primarily prepared to serve teenagers, not the mental and the social needs of preschoolers who cannot communicate their backgrounds, their needs, or even their pain. So as i read the oigs report and testimony, the administrations intentional policies traumatized youngsters who then did not receive the proper care they needed. Ill say it honestly, i believe its twisted and shameful. Let me add that we do not know the mental state of the children who were separated in 2017. Thats a matter that is still in the courts. Understand we only know about the 2017 children because of the office of the Inspector General and the aclu. And its really very interesting to me as to at the time of july in 2018, who made the decision to certify a list that was inaccurate . It was 2018, not what happened in 2017. What was the role . I dont know, mr. Hayes, about your role. What factors went into making that decision. We can also assume that their trauma of these children mirrors that of the children that the oig identified in this report. It should add to the urgency we feel to stop the trauma. O. R. R. Is a Child Welfare agency. And we must be insuring it is upholding its mission which brings me to the oigs recommendation. One recommendation from oig is that o. R. R. Should take all the reasonable steps to reduce the time that children remain in o. R. R. s care. I wholeheartedly agree. Ill reiterate what ive been saying to this administration for months. Rescind the memorandum of agreement between the department of Homeland Security and the department of health and Human Services. With respect to the agreement the subcommittee has heard from outside witnesses and o. R. R. Who said it continues to scare away potential sponsors who otherwise want to take care of a child but are too afraid to come forward. In fact, in our july hearing, assistant secretary johnson agreed with the subcommittee that the memorandum of agreement should be rescinded. Since there have not yet been any action it would appear that the responsibility to rescind the moa is in the hands of the white house. Because if the administration wholehearted wholeheartedly agrees, then the Administration Must rescind the memorandum of agreement immediately. Another recommendation from the oig is that o. R. R. Should identify and disseminate evidence based approaches to addressing trauma. Again, i wholeheartedly agree. This subcommittee has repeatedly provided resources for the care of children and the Appropriations Bills that the house passed the last two years. And in the emergency supplemental bill. With respect to the 2019 appropriatati appropriatation i want to say thank you to chairman cole for accepting my voice, vote, my amendment to provide funding for the Substance Abuse and Mental Health Services Administration through the National Child Traumatic Stress network in what was a total increase of 10 million for the network. 4 million of which was for these children. We need more funding to the network to deal with this issue. We are committed today insuring o. R. R. And hhs are upholding their mission to care for children, not to act as a tool of immigration enforcement. Which is why we need to see the administration quickly implement the necessary changes including the oigs recommendation. Children did not just arrive at our border. They suffered by our hands and they are suffering still due to the longterm Mental Health trauma. Thats not something that we can ignore or that we can sweep under the rug. We need to stop the pain and the suffering. Caring for the most vulnerable, the most sensitive of our duties as members of this body and as a people of this great nation. There can be no greater sin than allowing ourselves to live by a lesser standard. So to close, i want to say a thank you to the oig to this report, for your work, i look forward today to hearing more about it. Hearing from the administration. I hope to learn from hhs how you intend to take to prevent the traumatization of youngsters as a result of the way i characterize it, the administrations cruel heartless immigration policies moving forward. First, let me introduce my republican colleague, the Ranking Member of the subcommittee, congressman tom cole from oklahoma. Thank you very much, madam chairman. Im going to depart from my prepared remarks for a second. I want to begin with four thanks. The first one is to you. Your focus on this issue has been unrelenting and i think appropriate. While we may disagree over this or that interpretation, the fact is youve kept this committee focused where it needed to be, on the welfare of these people. You deserve all of our thanks. Its the right way to do oversight. We be done weve done it. I want to thank the ig. My mom used to have a wonderful saying, your friends will tell you what you need to know, not what you wanted today hear. I think thats your job and you di did it very well. I want to thank director hayes. I had the opportunity to travel to the border region with him over the august break. I see a lot of effort to implement some of the changes and to be responsive to criticism and to correct the situation that we all agree. Finally, to a much and maligned congress, i want to give a thanks to the congress. It took us a little too long, but we finally gave the Administration Resources it needed in the emergency supplemental. It hasnt solved every problem, but things are better than they were 120 days ago because congress acted. It took us six weeks. Did the same thing for president obama in three. But in the end it was a bipartisan action by congress that provided the resources that began to let us address some of the problems that ms. Maxwell has appropriately and wisely pointed out. Still have a long way to go. This was a promising start. So with that, madam chair, i want to welcome our witnesses for the subcommittees third hearing on unaccompanied alien Children Program. Were here to focus on the Mental Health needs of the children in the care of the department of health and Human Services. I want to focus on the history of this program over the past few years. In 2012, this program received an appropriatation of 169 million. This past year, the fiscal year, 2019 appropriatation, this committee provided more than 1. 3 billion. In seven years, the appropriation for this program has grown by more than 670 . Theres been a focus on it here. In 2012, the department of health and Human Services office of Refugee Resettlement had over 13,000 children referred to them by the department of Homeland Security. In the current year, hhs has had over 60,000 children referred to them for care. By the end of the fiscal year, hhs will likely have cared for over 70,000 children. More children than at any prior year. Again, in just seven years, an increase of 370 . Pretty staggering. Both the democratic and a republican president have requested supplemental appropriations in the billions to support unanticipated arrivals of teenagers. Hhs routinely cares for tens of thousands of children who travelled thousands of miles. Objectively this is a crisis and one that needs a comprehensive bipartisan solution. Federal law requires the department of Homeland Security to transfer to hhs any unauthorized minor not accompanied by a parent or legal guardian. This means when Customs Enforcement apprehend a minor with an uncle, an aunt, grandmother, grandfather, older brother, sister, the law defines that minor as unaccompanied and requires transfer of that child to hhs. I understand there are many who believe these children should remain with the adult relative their traveling with. Thats not the law of the United States and thats probably something we should look at. I also want to address the topic of zero tolerance policy implemented by the department of justice in 2018. The administration has made several attempts to stem the flow of migration happening to our southern border. The zero tolerance policy was clearly a mistake. And im glad that the president quickly ended it and the implementation of it. But the consequences continue. And while we may all disagree on the merits of such a policy, we can all agree hhs does not play a role in the establishment of immigration policy. Hhs does not separate children from their parents. Hhss responsibility is to care for children referred to them by dhs and to find suitable sponsors. In that area weve made considerable progress. As i said, many children are coming to our borders through mexico from Central America. No surprise that such an arduous, dangerous journey is traumatic. Many children left Family Members, poverty and dangerous conditions to come here. Once apprehended by dhs, the children are turned over to hhs to begin the process of finding a sponsor. For a short time the children are in hhss care, theyre provided with education and legal information. Referral to Mental Health services can be part of that process. The office of Inspector General highlighted the challenges with meeting the Mental Health needs of the children in care. A significant portion of america, frankly also faces the challenge of assessing Mental Health service accessing Mental Health services. According to the administration, 34 of the American Population live in a Mental Health provider shortage area. The challenges facing adequate access to Mental Health services is something many areas are having to deal with. Ill add when i was fortunate to be chairman of this committee, there was a lot of Mental Health provisions in that. And a former member, congressman murphy, came to me and i said youve got multiple things here. I cant fund them all. Im not an authorizer, i got to live within a budget. He hesitated for a second. Number one thing is we need more Mental Health care professionals. Otherwise were just competing back and forth for a very small pool of professionals. We need to invest more in creating literally the healthcare professional service core that we need. I appreciate the desire for hhs role in the care of these children to be expanded. However, given the unprecedented surge in the number of children crossing our southern border, hhs primary focus should be the establishment of small facilities. I want to commend you, mr. Hayes, youve done a lot of that in the last 60 to 90 days. I know my friends at hhs are doing their best that they can with a challenging situation. I want to commend them and note that theyre facing in many of the same challenges faced by the prior administration. Its my hope this committee will work with them in a bipartisan fashion to provide the resources needed to confront this urgent challenge. That, madam chair, i yield back my time. Thank you, very much congressman cole. Id like to yield to the Ranking Member of the full appropriations committee. Shes the chairman. You can call me anything. I said the chair you said the Ranking Member. Make no mistake. She is a chair. I thank you, madam chair. My friend for a very long time. I want to thank the chair and Ranking Member for holding this hearing. I thank you specter general maxwell and mr. Hayes for joining us today. The fact were here again today is a clear example of how damaging and cruel the Trump Administrations actions have been on the Mental Health of vulnerable children. This could have been largely avoided. Children belong with their parents. Now, many of us have read this article in the New York Times, july 30th, 2019. And it says in testimony before Congress Earlier this month, the Border Patrols chief of Law Enforcement operations, brian hastings, said the agency has established that its agents may elect to separate a child from a parent if there is a determination that the parent or legal guardian poses a danger to the child. Is otherwise unfit to care for the child, has a criminal history or Communicable Disease or is transferred to facility for a prosecution of a crime other than improper entry. 70,000 children have been separated from their parents. Im going to say a few more words, but i find that astonishing. Two months ago, the chair and several of our colleagues visited the homestead influx facility. As i looked through the Inspector Generals report on Mental Health needs of these children, its clear weve not been provided a full picture of those challenges. Im deeply concerned with the Inspector Generals finding, some of these include clinician shortage problems with access to external and specialized care and lack of preparedness among clinicians to treat the level of trauma in these children. What causes me even more concern is what we still dont know. Now, i just want to repeat this again because oh. Oh, then that is okay. I have just been corrected by my distinguished chair. Okay. I just want to conclude by saying whether it was 70,000 or this number is wrong. Im not going to debate that now. But my prime concern, no matter how clean homestead was, no matter how many smiles were on the face of everybody, no matter how many books they were given to read. No matter how many toys they were given to play with, i just feel very, very strongly that children belong with their parents. And to leave it to the Border Patrol who may elect to separate a Border Patrol person who may make the decision to separate a child from a parent. That Border Patrol person is making a decision as to whether the parent who brought the child here should be taking care of the child rather than putting it in a facility away from their child. This doesnt make sense to me. I cannot believe we met many of those children. I cannot believe that the parents of all of those children were unfit to take care of that child while theyre waiting for a hearing. So let me just say its clear, although we visited this facility and we saw some good things. But we saw many things that had to be corrected. I just want to conclude again because good as your clinicians are, maybe fine people doing the job. You cant tell me that thousands and thousands of children are better off in a facility as clean and as smiling people are and being with their own parents. Thats really my point. Thank you very very much madam chair. Were going to proceed to the opening remarks of ann maxwell, followed by Jonathan Hayes and we are also joined by commander jonathan white. U. S. Public Health Service commissions corp who will be available to respond to questions. Ms. Maxwell, welcome and thank you for being here today. Your full rwritten testimony wil be entered into the record. Youre now recognized for five minutes. Good morning, and other distinguished members of the subcommittee. Thank you for the opportunity to discuss oigs ongoing oversight of the unaccompanied alien Children Program administered by the office of Refugee Resettlement. Today ill be focusing on our findings regarding the challenges facilities face in addressing the Mental Health needs of children. These facilities serve children who arrive in the u. S. On their own. Prompt Mental Health treatment is not only required by o. R. R. , but is essential for a child. My testimony reflects what we heard firsthand from facility staff across the country about the obstacles they face. We were told that there are a number of symptomic challenges that make it difficult for staff to address the Mental Health needs of children. These include the ability to employ and support clinical staff. Mental Health Clinicians reported heavy case loads. They asked for more training and support to treat traumatized children. In addition, staff faced difficulties in accessing Specialty Care such as psychologists and psychiatrists to treat children with greater needs. One example, the only bilingual specialist in a facility was in a neighboring state. Finally, staff reported lack of Placement Options within the network that were equipped to treat children who needed a higher level of care. This was especially acute for children needing secure therapeutic settings do to their history of behavioral problems. To address the systemic challenges we recommend that o. R. R. Leverage the expertise and resources within hhs and the broader Mental Health community to insure there is staff that are fully supported and able to access the needed Specialty Care for children. The systemic challenges according to staff were exacerbated by policy changes made in 2018. In the spring of 2018, the department of Homeland Security formally adopted the zero tolerance policy of criminally prosecuting all adults for illegal entry and placing their children in o. R. R. Facilities. The facilities reported that addressing the needs of children separated from their parents was particularly challenging because the children exhibited more fear, more feelings of abandonment, more post Traumatic Stress than children who were not separated. One medical director told us separated children would present physical systems as manifestations of their psychological pain. These children would say their chest hurts even though there was nothing wrong with them. One child said every heartbeat hurts. These children didnt understand why they were separated. As a result, some were angry, believing their parents had abandoned them. Others were anxious, concerned for their parents safety. One 8yearold boy, who the chair talked about, separated from his father was under the delusion his father was killed and that he was next. And he required emergency Psychiatric Care. Caring for separated children is challenging because they were often younger than the teenagers the facility was used to serving. Staff reported younger children had shorter attention spans, needed greater supervision and exhibited defiance and other negative behaviors. Couldnt always accurately communicate. The little ones one Program Director said, dont know how to express how theyre feeling. There are other policy changes in 2018 as well. These involved the process for discharging children to sponsors. O. R. R. Adding new screening requirements and started sharing sponsor information with immigration officials. Staff noted that these changes led to longer stays in care for children and that the negative effect on their behavior and their Mental Health. They said even children who entered care with good coping skills became disillusioned as their time and care dragged on, resulting in higher levels of hopelessness, frustration, and more instances of selfharm. Well the policy changes made in 2018 have largely been reversed, facilities continue to serve separated children as well as children who are not quickly discharged from care to. Address these continuing challenges and to insure that children are not unnecessarily harmed, we recommend that o. R. R. Continue to reassess whether its current policies are negatively impacting children in any way and adjust as needed. We also recommend that o. R. R. Establish guard rails that insure that future changes prioritize Child Welfare considerations above all other competing demands. Thank you to the committee for the opportunity to present this information and your ongoing support of our oversight. Its greatly appreciated. Im happy to answer any questions you have. Many thanks. Director hayes, thank you for being here. Again, your full testimony will be in the record. So now i will recognize you for five minutes. Thank you, members of this committee. Its my honor to appear today on behalf of the department of health and Human Services. My name is Jonathan Hayes, i oversee the unaccompanied alien Children Program. I am joined by commander jonathan white, an officer in the u. S. Public Health Service who is currently assigned to the assistant secretary for preparedness and response at hhs. Commander white served as the federal Health Coordinating official for the interagency mission to reunify children separated from their parents in o. R. R. Care as of june 26, 2018. He also previously served as a Deputy Director at o. R. R. He has not prepared testimony, but is here to answer your questions. Thank you for the opportunity to discuss with you today the hhs office of Inspector General report titled care provider facilities described challenges addressing Mental Health needs of children in hhs custody. Hhs is committed to addressing the Mental Health needs of the uac in the care of o. R. R. We welcome the report as we continually improve the Mental Health Services Provided to the children in our care. O. R. R. Operates nearly 170 state licensed care provider facilities and programs in 23 different states. O. R. R. Has different types of facilities in order to meet the different new orleans of the minors in our care. In addition to our traditional state license facilities, o. R. R. Also operates in flux care facilities which receive the agency is at capacity. Hhs has detailed policies for when children can be sheltered at a temporary influx care facility. Mental Health Services are available at all of our facilities. O. R. R. Policy requires at a minimum that uac and o. R. R. State licensed facilities receive an independent counseling session and two Group Sessions every week. Initi Additional Services are available as needed. The children have a unique set of needs. We provide services to children from a wide range of backgrounds and cultures who speak a variety of languages. As documented in the oig report, many of the children placed in o. R. R. Care have experienced severe trauma. The Mental Health professionals working with the children must be bilingual and be able to assist traumatized children. The general shortage of qualified practitioners nationwide. The qualification requirements create difficulties in both recruiting onsite staff as well as finding referrals for Additional Services in the communities around the facilities. One challenge identified in the report is that some clinician staff told the oig that they are often unprepared to assist children with a severe trauma experienced by uac. Treating children with severe trauma is complicated and is only made more complicated by the relatively short time children reside in o. R. R. Care. Some clinicians told oig they were concerned about asking children to revisit their trauma when it was unclear whether the child would be in our care long enough to make progress and address their trauma fully. O. R. R. s Mission Remains to unify children with a suitable sponsor as safely as possible. Most children do not stay in o. R. R. Care for very long. Based on the clinical expertise, the focus on service has been to stabilize children and provide them with a sense of security. Staff assess each childs needs and provide Additional Services as appropriate. O. R. R. Is working to provide clinicians with tools to strengthen mental hent susalth services. Recently the ageno. R. R. Worked the nctsn to develop resources. O. R. R. Offers post release services. If a child needs Additional Services after they leave o. R. R. Care, a post release Services Case worker will work with both the child and the sponsor to find services in their community. O. R. R. Is working to expand the number oaf uac that receive post release services. I believe that a child should not remain in o. R. R. Care any longer than the time needed to find an appropriate sponsor for the child. A central part of o. R. R. s mission is to discharge children from our care as quickly as possible while still insuring the safety of the child. At the time the oig conducted its visits, the average length of care is 83 days. Its 50 days. A 40 reduction. O. R. R. Will continue to improve the process for release and reduce the time a child remains in our qucare. My top priority is the safety and well being of the children in the temporary care of hhs. We welcome this report because it explained the service that o. R. R. Currently provides and identified the obstacles we face in providing those services. My team is ready to face those obstacles and overcome them with help from our partners and with the continued support of congress. Thank you for the opportunity to discuss our important work. Commander white now will be happy to answer any questions you and your committee may have. Thank you. Thank you very much. To the questions here, ms. Maxwell you note that the policies that traumatize these children have largely been reversed. Ill just pick up your quote, but you say the facility still faced challenges addressing the trauma of separated kids. We ought to Pay Attention to that and to the deteriorating Mental Health of the children who remain in care. The policies have been reversed. What are still the challenges and what are the policies that ought to be examined Going Forward . Thank you, chair for allowing me to clarify that point. The additional challenges continue to be a concern. Despite some of the policies reversals. First of all, facilities continue to provide care for separated children. So the court order as you mentioned that stopped most separations allows for separations under certain conditions. There are separations . Absolutely. And the federal government recently certified to the court there were 911 children separated from a parent over the last year. In addition with respect to lengths of stay, or additional sponsor screening requirements and length of stay fell. However, they continue to share information about sponsors with dhs according to a 2016 moa. As you mentioned, there are concerns that that has a Chilling Effect on finding sponsors. Which is why we recommend o. R. R. Review all its current policies to see if they present any unnecessary barriers to releasing children to appropriate sponsors and adjust them as necessary. Thank you for the clarity on that issue. Let me move to exhibit 2 on page 12. Shows how the number of Young Children referred to o. R. R. Sharply increased as a result of family separation. I want to put this information into the record. O. R. R. Facilities typically serve teenagers. An answer to this question, did facilities have the right tools to adequately provide Mental Health services for younger children . Not according to the clinical staff we spoke to. They told us that they, as director hayes mentioned, that they expressed their concerns about being able to treat children who had encountered intense trauma before coming into care. Now this is a concern they had in terms of treating all children. They noted it was challenging treating younger children who had different needs and different therapeutic needs. And had less attention span. We recommend, again, that we help these facilities, help the clinicians by identifying and disseminating evidence based trauma informed shortterm therapy for children of all ages. Commander, earlier the subcommittee held a hearing with the president of the American Psychiatric association. Told us about toxic stress. Highly stressful experiences like separation of children from their families is resulting in toxic stress and can cause irreparable harm. I have heard you provided testimony in previous hearings and the warnings you gave to hhs officials about the traumatic impacts of family separation and the effects on children. Let me ask you with your medical background, with what you know about the children who end up in o. R. R. s care, what can you tell us about toxic stress that affects these children as a result of the trauma theyve experienced . Experienced in their countries of origin, during the journeys to the United States, and as a result of family separation. Thank you, madam chairman. To be clear, the uac program has long been trauma informed and is designed to serve unaccompanied children. That is an enormous challenge. Its an enormous challenge. But its dwarfed by the unique challenge of separated children. As ive testified before, its in my professional judgment impossible to build a program that can respond appropriately to the needs of separated children. The only way to address their trauma is prevention. This speaks to the need for a legislative fix to define those conditions under which its permissible to separate a child from a parent. To have remedies for parents who experience that. The uac program is the right place for children who enter the United States unaccompanied. But neither it nor any other federal program i could imagine can respond to the recentness, the severity, tparticularly whe the clinicians themselves will be seen bute children as part of the various system that separated it. Thank you, i am going to go for the last comment here. You have exhibit 3 page 13 of the report. Length of stay in o. R. R. Custody spiked after hhs signed the moa with dhs. So ms. Maxwell, what are the men Mental Health effects of children staying in the custody longer than the agreement . What we heard from clinicians in the field were that children who did not exhibit behavioral issues began reacting negatively the longer their stay wore on. So the longer children stay in care, the longer they are traumatized. Im going to make a final comment here. As long as the moa is still in place, there are sponsors who are terrified of coming forward. In our july hearing, assistant secretary johnson agreed that hhs should be terminated. Hhs is unnecessarily extending o. R. R. Custody for children, which further traumatizes them. The moa must be rescinded. Thank you very much, madam chair. Let me start with you, if i may. You had some really valuable i think and very helpful information on the damage done in terms of family separation to Young Children. We obviously have a Larger Population that is unaccompanied. They dont really do that. But if you could, distinguish and the last testimony actually did a good job of this. That second population, which we are dealing with in very large numbers, what is the differences you see between family separation which i think we all agree is a bad mistake and obviously the more normal situation that were now dealing with of unaccompanied children. Are they traumatized to the same extent . Thank you for that question. Our report largely deals with the entire population of children that the o. R. R. Facilities have to provide healthcare. Most of the challenges we heard about were systemic challenges that affected all the children in care and occurred again and again that all the children in care suffered severe trauma in home country, during the journey and that some children experienced the additional trauma of unexpectedly being separated from their parents. But as we move forward with our recommendations on practical steps o. R. R. Can take to address these systemic challenges, we have designed them such as they would help improve Mental Healthcare for all children that o. R. R. Facilities are responsible for caring for. Director hayes, could you give me some idea of the steps that youve taken to respond to some of the suggestions and recommendations that the ig has placed in front of you . Yes, sir, congressman. Happy to. So, again, we are working on a number of things in response to the oigs report. Were already are working on developing an Intern Program with college and universities in order to place students. Additional funding for continuing education to licensed clinicians as a retention strategy is also something that were undertaking. Were working to expand our presence at job fairs across the nation in order to find clinicians and case managers to work in our facilities. Ill note that a number of those job fairs have been protested and some staff potential staff verbally threatened. Thats not helpful. Weve partnered with the National Child Traumatic Stress network, the nctsn, to develop a four part Webinar Series as i referenced in my testimony on trauma in the uac. In april of 2019 we hired a Board Certified adolescence and adult psychiatrist thats at o. R. R. I commend you for those steps. Let me go back quickly to ms. Maxwell. Do you have a mechanism to follow up . I think theres a good faith effort going on at o. R. R. To try and respond. Its important that we have, as you provided us, sort of an outside view to make sure that that process continues. Absolutely, thank you. Were happy to see the steps that o. R. R. Has committed to. Some of which theyve already undertaken. Thats a good start. Our process is to always follow up the recommendations and be in conversation with the department to insure that all the commitments that they made are fulfilled and are fulfilled with the spirit of the recommendation as well. Well continue to work with the department to make sure i hope you as i know you will stay in touch with this committee. Weve got a resource requirement here. Let me go back to you, if i may, director hayes. Its got to be extraordinarily difficult to get the personnel you need. We know that, as i mentioned earlier, just in terms of Mental Health for the entire population. Thi you need bilingual professionals. There cant be a ton of those, particularly in a lot of the areas that you have your shelters. So, i mean, number one, what are you doing and what level of success are you having . So thank you, congressman. To your point, you know, the Settlement Agreement does require the majority of our shelters to be in the area with the majority of the children are apprehended. Southeast texas, northeast corridor, southern florida and southern california. Theres a challenge in those areas to identify and retain some of the licensed clinicians we need. Were looking to expand outside of some of those areas. You know, we work very closely with keeping the Committee Staff informed on our efforts to look into larger metropolitan areas where we can have some of these smaller and medium sized shelters and then hopefully tap into a fresh pool of clinician staff. Although, were seeing some resistance to that even here in our own backyard in d. C. And northern virginia. The desire of congress to open up smaller shelters that are licensed, were seeking to do that and not receiving a lot of support. Actually, opposition by both d. C. And northern virginia. Well continue to look at other areas and expand outside of that where we can pull from the local community the need of chairman. I too want to apologize. I am called to another hearing. I just wanted to thank you all for your thoughtful comments and particularly jonathan white, when you talked about the severity toxicity separation of children, and i just want to read this quote again because as a mother of three, grandmother of eight, i cant imagine that these children who were brought here by their parents for whatever reason are being separated so the New York Times is saying since the president officially ended family separations, authorities have removed more than 900 children from their families. More than half of the children, 481, were under the age of 10 at the time of separation. 185 of those were under the age of 5. The administration is still doing family separation under the guise that they are protecting children from their parents even though the criminal history they are citing is either wrong or shockingly minor. So i want to thank the chair for having this hearing again. Thank you for your good work, and trying to do the right thing. But this policy is outrageous and i do hope that we can all Work Together to change it. Thank you. Thank you, madame chair. Thank you, madame chair, congressman harris. Thank you very much, and thank you, madame chair for calling the hearing, you know, about Mental Health care. So i need to ask, and i dont know, i guess maybe im going to read it there, commander white, thats right. Its not on there, its on your arm. Yeah, its in small prinlt. Im t small print. Im too old to read that far. Youre a licensed clinical social worker. You understand the lack of Mental Health professional availability in the United States. In fact, as the Ranking Member said, according to, i believe its an hhs report, the designated shortage, there are 111 million americans who live in shortage areas, designated shortage areas. 60 are in rural areas. My district is largely rural area. Im going to estimate that i have tens of thousands if not hundreds of thousands of people who live without adequate Mental Health coverage. Is that something that you appreciate, that there are a lot of americans who dont have adequate Mental Health care. Congressman, theres no doubt that nationwide all of the evidence that we have and everything that our department has produced for many years affirms there is not enough Mental Health work force. Theres also particular deficiencies for many geographic areas, and in the case of the children we serve, there are also additional challenges both for those children and anyone who needs culturally and linguistically services, those from Central America would have, these are national problems. They are amplified for us because these children are a federal responsibility. This is a giant problem. Sure, you know, as policy makers, we always have to balance, you know, when we have a limited resource like Health Professions, where are we putting them. Now, it says, i guess in the igs report, o. R. Employees each facility to employ a Mental Health clinician, in a ration owe of 1 to 12. In Baltimore City, where theres one murder a day, where i bet almost every student knows someone who has been killed or some family has had a murder a day, the ratio of counselors in schools, Mental Health counselors to students is 980 to 1. 12 to 1 sounds pretty good. How are we getting to that goal . I dont know, you must be doing tremendous recruiting. We cant recruit into inner cities in maryland where we have students who unquestionably have the need for Mental Health care, unquestionably, so where does 12 to 1 come from . Because it seems like its a pretty low ratio compared to the 980 to 1 that are in Baltimore City schools and the 250 to 1 which is recommended nationwide for school counselors. Baltimore city has more problems. These children are exposed to trauma every day on their streets. Its a lawless environment, the president is absolutely right about baltimore. Where does the 12 to 1 ratio come from . So dr. Harris, the ratios of 1 to 12 for clinicians, one to eight for case managers is inside the orr policies and procedures. Perhaps my colleague commander white can speak to the history to that gl a. And you hit that ratio. You do have a 121 ratio, congratulation, its much Better Health care that exists in other high risk populations, like Baltimore City school students. There are two categories of students, general koircategorie ones who have been separated by their parents, some relative of theirs decided to send this child across a trek to i dont know, you cant call it selfseparation because the children had nothing to do with it, and the family separation that occurred at the border under our laws, whats the ratio, whats the highest its been, and what is that now of those two ill call them patient groups, im a doctor. Ill call they will patient groups. Congressman, i dont have the specific numbers. Were happy to work with your team to get the specifics. I can state the overwhelming majority of children in our care, the absolute overwhelming majority are not children separated by law. They came across the border either unaccompanied or someone other than a mom, dad. The overwhelming majority, so how do i explain to the people in my district who dont have Mental Health care that we have a 12 to 1 ratio in these facilities when the vast majority of children are there because their parents chose to separate them or their relative chose to separate them, and i dont have and thats a rhetorical question, youre not going to answer that. A 12 to 1 ratio is great. I congratulate you on finding those professionals. We cant do it in my district, madame chair, i yield back. Congresswoman royba. For a long time one of the things that has troubled me is the overuse of psych tropic drugs in our foster care system. When i read press reports including forced use in children, i found it to be extremely disturbing, and while the oig report showed the percentage of children in o. R. Custody who had been prescribed psychtropic medications there are still 300 more or children prescribed medications that can have significant impacts on their Psychological Development without any Family Involvement or consent. Ms. Maxwell, what percentage of the children reported to be taken these medications in your report came into o. R. Custody already on these medications and did your report quantify how many of the children receiving psychotropic medications were taking two or more medication sg. We do not have the specifics, we were talking to case managers that prescribe the medications and we have the statistics about who was taking medications in care, and as you mentioned, it was about 1 in 30, about 300 children in the 45 facilities we visited were on those drugs. Okay. Commander white, you think this is a very serious issue particularly in terms of, you know, follow ups, children who are on these drugs and then are released. It can have serious consequences if they arent monitored and either continue with the medication or are brought down from it. Since oig did not independently review the medical records or assess the appropriateness of the medications that were prescribed for these children, who would be the proper person or agency to go and make these reviews . In just a moment, im going to defer to mr. Hayes as the director because policies have evolved since i left o. R. R. , but within o. R. R. , there is a team of the division of health for unaccompanied children, Career Public Health officers like myself. They are Board Certified pediatricians, epidemiologists, pediatric psychiatrists and nurses. And the supervisory role for the care, medical care of children and also the processes whereby children are discharged with a plan for continuity of care is ultimately their responsibility, but ill defer to mr. Hayes to talk about the current policy. Yes, so commander white answered that question accurately. Thats how i would have answered it as well. Ill state that when i became the acting director at the very end of 2018, i delegated those medical type decisions to our Deputy Director over childrens programs, and her medical team as the both medical and Child Welfare experts. And so how often does that person review the medical records of these children to make sure that they are prescribing the appropriate amount and when they, the children, are released that their follow up records are also appropriately done. Yes, maam, so congresswoman, specific to medication prescribed, i dont have details into that. Again, thats something i would defer to the, you know, to our medical doctors on staff. But i would say that the professionals that commander white mentioned, that is an ongoing daily discussion across a myriad of issues with all of the medical professionals at each of our shelters, a coordination effort. Its an ongoing process. So when a child is released, then does that medical expert then review the record and the plan for that child when that child is released on a case by case basis. Particularly for minors who have higher acuity medical needs, including higher acuity medical needs like youre talking about. It would be standard to have a member of that team work with the treating physician and treating medical team in the Childs Program on a plan for effective transition for continuity of care if the child exits the program. Thats ultimately bound by the realities of what kind of care exists in the community, which is something we dont control. Yes, that is a very high priority for physicians on that team. If i may add, congresswoman, that could be a situation where if there is a strong medical need, that would be something where our grantee team and our project officers would work for sor po some post relief services, for Community Based resources to commander whites point, to ensure the continuity of care. Does the insurance, if say a sponsor, are those medications covered by insurance . Maybe not every insurance, but. Different sponsors will have different degrees of Family Access to the health care system. We in hhs do not fund ongoing access to health care. Were not appropriated for ongoing access to health care for discharged minors. Minors are discharged with a supply of medication, a referral to services in the community, and part of the Case Management plan with the sponsor and the child is to identify how they will get those needs met in the future. The Broader Health care system is evidence. Im over. Okay. Ive got plenty of questions. Congressman. Thank you madame chair for having this hearing, and i want to welcome our guests and i want to thank you for reappearing before the community and participating in this way. I wanted to, you know, just build on some of the discussion that has already occurred on the, you know, the Health Profession that will shortage areas. Obviously were concerned about people getting good access to Mental Health services and of course these children given what they have been through would want to really make sure they are well served and, you know, the ratios that we were talking about, you know, as some of our colleagues have mentioned, its a challenge all over the country and my hope is that o. R. R. Has been working with colleagues and hhs to kind of look at what were learning on a National Scale and applying it to this situation as well in order to, you know, expand these resources and make the most. One area and just in context of my district is in rural michigan. We actually have 62 Health Performance professional shortage areas, which is pretty significant. So were dealing with this in rural michigan. A couple of things were looking at is, you know, kind of innovative ways to partner with state, federal, and local agencies to maximize the resources. Another thing were looking at is telemedicine, and, you know, technology where, you know, people dont have to travel great distances, and youre able to have you looked in this situation, at the use of telemedicine, where it may be beneficial, where it wouldnt be helpful, because im viewing that as a tremendous way of, you know, giving people the resources they need, and specified treatment, but i want to get your perspective on, you know, how what the potential is for that. So i dont have specific numbers congressman, but i will say that we do utilize some telemedicine practices inside some of our shelters to help meet some of the ratios that are required. And do you feel that, you know, i know it requires technology, it requires, you know, in our case, rural broad band access in every area. But what strikes me as youre talking, people who speak different languages, people who have different cultural and the idea that you could taylor that and have professionals from all over the country being available, that could be helpful, but, you know, i dont know the limits of that. Congressman, i just, one of the things i had pointed out in my testimony and asked of ms. Maxwell, one of our requirements is that you are bilingual, to be one of our grantee staff, and obviously have just that cultural standing of where the children have come from. That further narrows the window of licensed clinicians that we have available, again, having to be both meet our educational standards and experience standards but also be bilingual. Are there any resources you would need to expand opportunities for telemedicine . You know, im sure there could be some. I dont have any on the top of my head. I would be interested in that, its something were dealing with in rural michigan, and were kind of seeing areas where it has tremendous potential, areas where it may not so much. But i think and the other question i had are, you know, are you looking at sort of partnerships with states and local entities that could help improve the situation . So i would say one thing, im going to go back to the Division Director of help for unaccompanied children and ask the telemedicine question, well get back to you on that. Again, sir, you know, my goal and the goal of secretary johnson, and secretary azar is to, you know, increase our Permanent Network capacity so that we, you know, have available permanent state licensed beds for all the children that are referred to us from our federal partners. And to that end, that requires a partnership with the local and state governments. And we welcome local and state governments to partner with us in this mission to care for these vulnerable children, and again, you know, were seeing some resistance to that with certain communities, and i wish that wasnt so. Because again, we want to be able to have as directed by congress, and as the expressed leadership of hhs as these state license events available to meet the needs of kids without having to rely on emergency influx beds. Thank you very much. Were going to take a prerogative before i introduce congressman po kan. If we had a discharge plan that was adequate and moved the children out quickly. The longer they are there, the more traumatized they are. Its not about building the capacity for beds. Its about building a capacity and a discharge plan to be able to get them out of the system in a safe place as the mission has said expeditiously as possible. Might also add that if you want to increase professionals, increase the reimbursement rates, stop private contracting, and look at some of those issues in terms of increasing professionals, and in terms of finding opportunities for children that are there, including Mental Health services, we appropriated 2. 9 billion, there ought to be room to fun some of these efforts. Congressman. Thank you, madame chair. Appreciate it. This is certainly a sad stain on our nations history of whats happened over this period, and were not through it yet, so we appreciate you all being here today. Mr. Hayes, i have a question for you, its a yes or no, do you agree that the trump family separation policy has had a negative impact on your agencys ability to meet its legal mandate to provide Mental Health care to unaccompanied children. Its a yes or no. Could you repeat the first part of that, sir im sorry. Do you agree that the trump family separation policy had a negative impact on your agencys ability to meet its legal mandate to provide medical care care to unaccompanied children. I agree that the separation of Young Children from their families was a created a difficult environment to the office of refugee settlement which i stepped into in june of last year. I appreciate that. When we read the report and i know you have obviously read the ror report, and hear things like having to go to a neighboring state for a bilingual specialist and clearly we know where these kids are coming from. Its not even a 101, Social Security its a remedial level of providing assistance. You hear about a 7 or 8yearold child thinking they are about to be killed because of this policy, you dont get much worse, i think, as far as government policy doing things like this. You know, i have a question just to kind of bring it back. We went to home study, we appreciate your time there. To get back to why and conditions that put children in this place, people back home still to this day cannot understand how we stand 750 a day to house children for really long periods of time until we made some policy changes recently and we had 3,000 plus kids at homestead, when for 750 a day, you could go to four seasons, any trump hotel, which im sure he would have enjoyed. The fact that we finally got the children out very quickly, just doesnt pass the smell test back home. Why it took so long for so long people were making a lot of money at a private facilities a 750 a day and then suddenly were able to move folks. At the very end, there were a couple hundred kids who were in the middle of the night whisked away, can you address that couple hundred children that were whisked away in the final day. Yes, sir, i think you referenced a number of well over 3,000. 2,700 or something. The highest number was around 2620. I want to clarify that. A disgusting number. It was based on the number of children coming across the border. Due to the policy we agree has put us the number started in january of this year, and escalated in june when the referrals dropped and the reason im answering that way congressman is because that was one of the effects on the ability to end out homestead, the sheer drop in mid june of referrals coming across border. One of the girls i talked to, she had been there 60 days, the week before they finally reached out to her brother, for 50 some days, a company made a lot of money not doing their job which was to try to place that person outside, and when i tell that story back home, people cant understand it, but the 200 people whisked away, thats something im trying to figure out. I asked for the percentages of the last 30 to 45 days at homestead. Im talking about the middle of the night, the last couple of hundred. Well over 80 of the children that were discharged from homestead were released to their family or sponsor. That wasnt my question, though. The ones that were transferred, the roughly 15 to 17 , they were transferred what im asking for, really specific, please if you can address that. Were just wondering, the couple hundred children between 2 and 6 in the morning were taken out of the facility, the last day, thats odd, right. No, it would not be odd for this reason. Its not odd . Interesting. If were going to transfer them to another shelter, for medical reasons or identifiable sponsor in the u. S. , we would rely on commercial transportation, that might involve in a commercial flight i dont know every single specific but i can guarantee thats most likely what happened. A lot of times staff will escort children on Early Morning flights. Is homestead completely empty of children right now. It is as of august 3rd. And what are we spending to keep it empty. I dont know the exact number. I know we reduced the support capacity from the 2,700 down to 1,200 so a lot of staff were let go. Are we paying an equivalent of 1200 a day, or a maintenance. Trying to get an understanding. Fully active shelter with the ability to take were spending 750 a delay on 1,200 imaginary people. Its not 750. What is it. 600 a day for 1,200 nonexistent human beings at homestead right now every single day. Its the beds, yes, sir, to keep them there. Why 1200 if they arent there. Couldnt we say 100 people there. Theres imaginary people there, but youre spending, again, i have to explain back home even 600 a day, youre at the four seasons, why were spending that much, and not to have a child get the Mental Health care, and not to have anyone stay there. One thing you and i can agree on is this is an expensive program to operate. If thats the point youre trying to make, ill agree with that. I will state if we remove the staff at homestead, what i was told by my planning and Logistics Team youre looking at a minimum of 90 to 120 days in order to reactivate the staff back for that, and again, given the extreme uncertainty of referrals coming across our nations southern boarder and how many kids we might have to care for, that wasnt a switch that was turned off at this point. Caused by the president s policies. My time is out. Thank you. Thank you, sir. Congresswoman bustas. Thank you, chairwoman, and thanks for holding this hearing and for the points you have made. Thanks to the office of Inspector General for taking a look at this. You know, the three of us, were having these little side conversations up here, congresswoman franco, a grandson less than a year old, congresswoman Watson Coleman who has a granddaughter whos 6 years old. Ive got two grand kids myself, and we are all just up here listening to these words, hopelessness, feelings of abandonment, fear, severe trauma, and were all picturing our own grandchildren being in these situations and we are just heartbroken, and when we look at this report and every page we turn, just heartbreaking and i dont care who is in the white house. I dont care if its a democrat or republican, and i dont care whos sitting up here, whether were democrats or republican, this is just heartbreaking to listen to this. Commander white, i was looking at your bio, youre a ph. D. Licensed clinical social worker, a career officer with the u. S. Public Health Service, have you gone to these facilities and seen whats going on there and im just, i want to get like this, and have you also ms. Maxwell, have you seen this up close and personal . Congresswoman, a senior career official over the uac program previously, and prior to that, going back to 2012, ive been the Emergency Management official used in every one of the influx crises. I know these programs and their services pretty well from firsthand. Ive also been in 2014 in the border stations. And i know what it is when we dont have bed capacity available for children in time. And that is the other part of the story thats also very important when we talk about beds not being used and yes, i have seen these programs. I know them well, yes, maam. So if maybe you could talk us through, you know, when its not a visit that has been preplanned and as i think it was congresswoman deloro was saying, you walk in and see smiling kids when this is a planned visit by members of congress, what do you see, tell us what youre seeing, and my follow up question to that because we get our full five minutes here, which is never enough time to have a decent conversation about all of this, what are the longterm consequences of the kids who are living through the severe trauma, the angry feelings, the anxiousness, what are we going to see when these children are teenagers and what are we going to see in our society as a result of what the government has done to these children . So what you see when youre in a program on a regular day without members of the United States congress there is not in my experience very different than what you see on a tour, except the staff are much more nervous when there are members of congress there. The children that you see, and the environments in which you encounter them are what you would also see in domestic congregate Child Welfare settings, licensed by the state because thats what they are. The children, as you talk to them and work with them, represent a range of experiences, many of them have sustained extraordinary, extraordinary histories of trauma in home country in transit and in some cases in the United States. Separated children are intrinsically different, however, in that the traumas they have sustained are both extraordinarily severe, and they are currently ongoing. And we are part of that traumatization in the United States government, which is different than being the response to that traumatization. Longterm, the consequences of separation for many of these children will be lifelong. It will involve both behavioral and physical health harm that all the best Available Evidence we have on trauma and toxic stress, including that that focuses on children separated from their parents would suggest will be both severe and very difficult to manage even high levels of clinical care. And all this could be prevented in the United States government in this administration didnt have these kinds of policies that is allowing these children to go through this kind of trauma. Separation other than for strict causes preventable, however, congress has not passed legislation of any kind to define the conditions under which separation may occur. And as ive asked previous committees i will say again, that is a gap in law and it is one that this congress could and i would submit should address. Im down to three seconds, so thank you for those answers. Appreciate it. I yield back. Congresswoman frankel. Thank you. My little sponge here fell off. Thank you all for being here, really. And i really can tell from your expressions and what youre saying that all of you are very sincere about trying to correct a very terrible situation, which i know none of you really caused, but i just want to echo before i ask my questions what my colleague here says, because im a new grandmother and when i just think of whats the brutal, cruel policy of taking children from their parents and to me, this is just government child abuse. Its child abuse. I want to start because i want to emphasize what representative deloro has been talking about which is the agreement with hhs where hhs has agreed to share personal information of potential sponsors with agencies that can actually go to a home and perhaps take a seize in undocumented citizen. And i think what we experience when we were at the homestead, we all went to the homestead facility, is that one of the feelings that we got is that one of the big reasons for the delay in getting these children back with any member of the family was because of the fear, the fear that by giving her an Enforcement Agency the ability to go to a home and pick up an undocumented citizen. Mr. Hayes, i want to know whether or not what, if anything, youre doing about trying to get this agreement rescinded. So i just would say one thing, actually to correct commander white, i dont believe the staff at the facility in your district was scared of you. I think they actually looked forward to you coming to the shelter, maam. I agree. I agree. They even had your picture up on the wall. So you know, i think one thing thats clear. I think theres some confusion around the information thats shared. I think its important, i noted it on the tour at homestead as well at my last testimony here is that going back to 2004, every time a uac is discharged from o. R. R. , they then go to the jurisdiction of the department of Homeland Security, and that discharge Notification Form does go to dhs with the sponsors information and the child because it then falls on dhs and department of justice to keep them apprised of their Court Proceedings. I understand. Look, because i have some more questions, but theres a point were trying to make. Is that that process is keeping children and families separated. Next question. Wait, can i yes, maam. I just, i want to ask another question. Theres a new policy that the president has put in place that now prohibits people seeking asylum to come into the country so they get stuck in mexico. Is that going to affect the number of the undocumented children coming into the country. I think the impact is unknown. Theres a couple of things that is ongoing with some of the asylum laws. Hhs is not an immigration issue. We issued a Dear Colleague letter, where certain components we dont believe will impact the folks eligible to come into o. R. Care, both on the Refugee Resettlement side. They have to come into the country first. It will be harold. The reason i ask this question, mr. Pokan asked about spending a lot of money on invisible people. Are you actually expecting more undocumented individuals to get in here given the new policy . While i will acknowledge that the chairman was correct, our referral numbers are low, but if historical trends and i would yield to commander white in a second as well, but if historical trends hold true, the expectation should be as we move into the cooler months theres a pretty significant chance the referrals will increase and as we get into november and december, an even greater chance. I did just want to say this, and ill keep this brief out of respect for you, maam, every influx crisis in the history of this program, and in fairness, i have been deeply involved in response to all of them. I have experience to speak from. Every one of them was preceded by a period of reduced referral, and pressure to reduce capacity or stop expanding capacity and i have asked colleagues on the career side, on the appointed side and i will now ask congress can we please not make this mistake again of thinking every time it goes down that thats like the future. This is an oscillating, highly volatile system and the best way to keep children off the floors of border stations is to not react when theres a downturn and say, oh, look, thats the end of migration highs. Let me just say, two points, that i guess because im running out of time here, one thing that we found on our visit is children who were reaching the age of going to age out, terrible stress on them. That meant they were going to be incarcerated and the second thing, i think we have to remember, these children, once they are released to a family or whatever, you know, a lot of damage has been done and now theyre out in our community and my question is their follow up, do they get Mental Health services or is that it . Whenever a child is discharged, two separate questions, so we do have children that do age out. Once you turn 18, the Statutory Authority ends inside the o. R. R. , uac program. Our teams work with the local i. C. E. Officials to come up with a post 18 plan. If it was up to our grantees, the kids could stay until 22. Its in the our decision. A lot of times they are released on their own recognizance. I would add, what was the second question you asked. What happens once theyre released, they have this trauma. So there is a 30day follow up call from our team, and if there are postrelease services that are recommended by the team, we work with a particular project officer at o. R. R. With approximately 11 grantees to identify postrelief services that might be available within the community. Thank you. Congressman watsoncoleman. Thank you very much. Thank you for being here, and madame chair and Ranking Member, thank you for hosting us here in this very Important Committee meeting. If i start asking my questions, i need to make a comment. There was a comment made by one of my colleagues, what it suggested was that parents were making a choice to be separated from their children. And i just believe that is the truth in any way, shape or form. Im a grandmother, sitting up here listening to what these Young Children are going to. My granddaughter is 6 years old. It breaks my heart, not only does it break my heart for the child, it breaks my heart for the parent or the relative of that child. And i just think that were moving in the wrong direction here. Do we or do we not have a no separation, family separation policy now. Im going to ask you, mr. Hayes. So is that a yes or a no. Based on my understanding, the president did issue an executive order stopping family separation as a result of the zero tolerance policy, specifically for an immigration violation. However, separations do continue for other reasons and have such as . Such as criminal, past criminal activity of the parent, legitimate Child Welfare concerns. Theres a myriad of issues, be happy to get you a list of the categories that fit into there. Theres been separations in the entire ri entire history of this program. You were successful in reducing the census at your facilities, extremely. Yes, maam. And i would like to know specifically what were some of the things you did to facilitate that release and are part of those things part of the ongoing policy now. They are, maam. I issued four operational directives, the first one about three weeks after i was named the acting director at the end of november. The first operational directive ended the household member fingerprint checks, which the counsel of my senior career staff and Child Welfare experts did not deliver any new or Additional Information that would cause them to change the decision to discharge that child to his or her Family Member. The second operational directive was in march of this year, and that was in regards to the moms and dads seeking so sponsor their children. We quit finger printing as well, provided there is no red flag or hit on the sex offender registry. Immigration status checks, we suspended the reconciliation of the i. C. E. Background checks, results from sponsors, we rely on the testimony and communication with each sponsor. Only thing we ask is if a potential sponsor is undocumented and here without status and could be deported, is there a safety plan. Who will the child go to if you are deported and the fourth operation operational directive was done in june. Still to this time, this is a temporary action. We are treating the grandparents, and adult siblings the same way we would moms and dads, meaning if theyre seeking to sponsor the Family Member and there are no hits or red flags on the public records checks, we do not do fbi finger print checks. I visited over 50 of our shelters and that was one of the recommendations from the field that we implemented. During that period of time were you able to facilitate those releases more quickly, did they suspend looking at everyone that lived in the household, determining what their status was. We still do the public records check. What does that mean . Like a, you know, looks at both the federal, the state, Law Enforcement type background to see if there are hits or red flags to give us concern. I will point out at the end of the day, its about the integrity of the sponsor. I agree. They can only tell us whos in the house and we can move the next week. Thats where i want my team to focus. So, you know, i know youre not the cause of these policies, youre the recipient of these policies. So this memorandum of agreement or understanding really doesnt need to exist and do you have the authority or does your department have the authority to withdraw from that agreement . And if so, why havent you. I do not have the authority myself, im not going to speak for the department of health and Human Services. Do you agree that we can function without that, if we had the safeguards in place that were used to facilitate the release of those children . I would just say i think the actions i have taken since becoming acting director and director speak to my overall belief of the majority of the moa, i just will flag, though, that, you know, there is referral information, information learned by dhs after the child comes into our care. It kind of memorializes also the abuse reporting to dhs when we learn about it. So there are some things left in the moa, in regards to you processing the children. And ms. Maxwell, do you agree that this moa could be suspended . We recommend that o. R. Do what its continuing to do which is assess all policies to make sure there are no unintended consequences. I yield back, thank you. Congresswoman lee. Thank you very much, madame chairman, thank you and our Ranking Member for this hearing. Its a very troubling hearing for me personally, and as im an elected official. First of all, i have to remind you in making this statement, im going to be clear that we recognize this is the 400 year since the first enslaved africans were brought to america. One of the basic elements of the United States policy was to take children from their families. That was family separation. This has had generational impact. Were still addressing it and dealing with the trauma today. This is yet another stain, another stain on our country. And im not personalizing it toward any of you because i know what youre feeling and what youre seeing, but i want to put this in context, so we understand what is taking place. This policy did not just start. I am very concerned that a lot of the recommendations that the American Psychiatric association and i want to read some of their testimony to this committee, and also the National Pediatric or American Society of pediatrics, im not sure if thats the correct name of their group, but i want to explain a couple of recommendations they made. First of all, they said that we needed an independent medical and Mental Health monitoring team. Totally independent from the government. Secondly, the psychiatric association, let me just read you a couple of paragraphs from their statement, we know that children are more susceptible to trauma because their brain is still developing. When a person is exposed to a traumatic event, the brain naturally enters a heightened state of stress and fear related hormones are released and although stress is a Common Element of life, when a child is exposed to chronic trauma or , ultimately consistent exposure to heightened stress or trauma can change the emotional, behavioral, and cognitive functioning of the child in order to promote survival. Psychiatrists are most qualified to help children and family recover from the trauma inflicted upon immigrants and r refugees by displacement from and within their home countries and can provide direct psycho therapeutic, and psycho social intervention. Each staff and their Leadership Teams should really address the appropriate care, suffering and identify this as posttraumatic symptoms and other mi fwragrati related symptoms of distress, they go on to explain, one more thing i would like to read from their testimony, detention of innocent children should never occur in a civilized society. Especially if there are less restrictive options because the risk of harm to children simply cannot be justified. I want to find out from you, what in the world happened to these children, the policies the government has put in place Mental Health care. I recognize that Mental Health care, there are a variety of treatment modalities, but these children require specific trauma related treatment and its not one, two, three, four, five, six, seven sessions, this is years of treatment theyre going to need. How are you going to do this, and what type of resources have you met with and talked with the professionals on the outside who could probably give you a lot of help in what youre doing. Thank you again for the supplemental funding you provided. Part of that was not less than a hundred Million Dollars to increase both legal services, post release services and child advocates, and thats something that we are working on with our grantees, we have sent out a request for proposal to expand those post release Services Available to the children, especially those that need longterm Mental Health care and Behavioral Health issue as they leave o. R. R. Care. Are you saying trauma related care related to ptsd. I dont know how specific were getting. Its a broad array of post release services, medical care, legal services. I understand that, and im focussing on the Mental Health care right now in terms of the appropriate types of Mental Health treatment modalities that youre going to use to make sure that these kids dont end up when theyre adults not very happy with our own country. Right. Maam, that is a focus of the efforts and as you know, among the challenges are the delivery of appropriately intensive psycho Therapeutic Services during the duration of time the children are in care. So the answer to your question is absolutely. One of the key focuses for the current efforts to further strengthen our ability to deliver appropriate Trauma Informed Services to the children in our care is to work with experts including ntcsn to identify what are the best evidencebased methods to respond to the very high, both the high asis scores, the history of toxic stress and the traumatic exposures the children have during the window of time, and the answer to your question, congresswoman is absolutely. Thank you, madame chairwoman, thank you all. We appreciate you coming back and for our new arrivals, your testimony here today. It is hard to know where to start. As commanders you said in response to some previous questions, the only real way to address this level of trauma in children is prevention, and we know that many of these children are coming to this country already experiencing great trauma where they lived at home, in transit, but we have added to this. And i want to reiterate what my colleague, congresswoman lee said, we know that you are trying to do jobs in a tough and changing situation. But i think you have to understand how it looks from our vantage point, that children are being used in this immigration policy and the harm that we are inflicting on them and on these families may be irreparable, and we have a role in that as the u. S. Government, and what troubles me deeply about homestead is that this is a private contract with call burton international, where secretary john kelly sits on the board and they wrote in their filings with the s. E. C. As they announced plans to go public, border enforcement and immigration policy is driving Significant Growth for our company. Significant growth at what cost to the human experience. And to this stain on our country in the way we are treating these immigrant children, and to hear that we continue to pay and i understand very clearly that we need to understand that these, that migrant patterns are patterns and they go up and down, and we want to be ready, but there are other programs out there that exist, like the Case Management that i understand is, you know, a Homeland Security program not under your purview, but it works, and it has great compliance with families getting to court, to making sure their asylum cases are heard, have a fair decision and what does it cost, it costs 36 a day. These are the type of programs that i would think that when we are experiencing a decline in population, why arent we looking at those type of programs that get kids out of detention and with their families and have compliance, why arent we looking at increasing our nonprofits that can save money instead of continuing to operate homestead empty at almost double the rate at what we pay other agencies to take care of children. These are Big Questions but if you could give me some direction, mr. Hayes, i would appreciate it. Yes, i would just point out that again, the homestead site and the operator was chosen back in late 2015, long before general john kelly joined any of the companies that you mentioned. Yes, we did renew that contract with them. I would just say that, again, i want to reiterate my statements earlier, i am absolutely committed to, as is assistant secretary johnson, and secretary asar, to having as many Permanent Network beds as possible. The kchallenge we have is at th end of the day, the final say in the facilities being licensed does not lie with the federal government, it requires a partnership with the states and the local communities and we are as, again, starting to see some resistance to that, and thats very unfortunate, i would respectfully request this committee to help us as one of the stake holders in the process, help us achieve that goal of expanding the type of shelters that we have in ms. Frankels district that we went through, 140 beds for teenage girls and its a wonderful facility. Thats what we want, and were working towards that, but to commander whites point, when we see huge influxes of children coming across the border and the need to be able to secure them, you know, we have to be able to, you know, have those beds available. Mr. Hayes are you working at all to redefine what we mean by Family Members. When i was at homestead, we heard many stories of children coming across the border with grandparents who did not qualify and made these children unaccompanied minors. If were trying to reduce trauma to children, if were trying to keep children out of detention beds, not be separated, are you working actively to say why dont we include aunts and uncles and grandparents in the definition of family that is rational. That is not my decision. That authority lies with congress, and i know that the senior staff i speak to would absolutely support some modifications to the Trafficking Victim protection reauthorization and the Homeland Security act that drives that. The definition of children who cross the border with a loving grandparent, with an older brother whos over 18, to define those children as unaccompanied is a black letter law issue. Congress absolutely has the power to make that change if you wish but neither dhs or hhs has any Legal Authority to consider a child who crossed even with a loving grandparent, even with a loving older sister as anyone other than unaccompanied, thats not our call. Its not your call, but would you support that change . I would support that change. Would you, mr. Hayes. I would as well, and i have heard that from a number of staff. Thats at the heart of my fourth operational directive in late june where we are at this time when it comes to the background package, with the sponsored package, we are treating grandparents and adult siblings, the same as we would as moms and dads, as a father of five, i agree. I want these kids with Family Members as they wait for Court Proceedings to go forward. Anything i can do to to make that faster holding up an acceptable level of safety, i will do that in conjunction with the collaboration of my team. Thank you. Yes, maam. You can be sure we will address that issue and there will be legislation as quickly as possible, and im hopeful my colleagues on both sides of the aisle would be in agreement since you are all in support of it. The other piece is that i might add that assistant secretary johnson at our hearing who, with all due respect, mr. Hayes, is i think your boss, if you will. Yes, maam, she is. She said that we should rescind the memorandum of agreement. So im hoping that we can or the assistant secretary will be listened to by the administration of doing that. Thats why you put good solid bright people like the people who are here this morning who understand these issues and make recommendations about what we should do. Im going to get to my questions, but i got to say, the issue is discharge, discharge, discharge. Our focus is always on holding the influx facility and the numbers are going down. Yes, they can go up. However, however, with a change in one directive, in 2018 in december, we went from and you pointed out that i was in accurate, i said overnight, 15,000 kids, we let 4,000 out. You told me, mr. Hayes, it was 8,000. So if we can move kids that fast, we do not have to have them sleeping on the floor at a dhs facility, no one wants them to do that. We are able to move. We moved quickly, and were now down to as i understand it, 5,800 kids, we did not have to have a backlog. We did not. That was created. And you got the 2. 9 billion and now youre less engaged in dealing with 750 a night for a facility, which was the reason why we have a building capacity, building capacity, building capacity and what we need to do now, and i want to see that plan in october of how we move kids out as fast as we can to a safe, a safe placement, as expeditiously as possible. That is your goal. I dont speak for dhs. I dont know what their goals are. But that is hhs, which isnt under the jurisdiction of this committee. Mr. Hayes, you talked about the Webinar Series. Okay. And im proud and excited and Ranking Member understands this. National network, i will be selfserving for a moment. I was the first member of congress to put funding into that system because i understood what it did as my understanding of it through the Yale Child Study Program in new haven, connecticut. And we helped to craft that and provide money for it. So, we have done that. Im glad youre there. Youve talked about i want to hear about the direct services. You talked other than the webinar, a series. What have you done to increase access of child trauma experts to children in hhs facilities while children are in oor care and in the postrelease situations . As i said, you got 2. 9 billion, numbers are down, we dont have to pay the 750 a night. How are we rearranging those dollars to assist in this process . Were taking 600 a night. 750 to 650. 150 a night, thats real money, i believe that. It is, yes, maam. Talk to me about direct services. I just want to point out for the record, not of our grantees makes a decision about the children. That is the intake staff at oarr. Whether it be homestead or whether it be, you know, a bcf facility in the rio grande valley. Federal staff make oversight on where the children go. In regards to the children in our care, madame chair, i would just again point to the oigs report and to the counsel what direct services besides the webinar are you going to, please, because youre going to i understand. Gip the very short time these children are in our care, the focus of our clinical work of our team is to focus on both providing asae ining a safe and environment, right on you of oig report and the report you showed shows the length of care is significantly dropping. I always want to be the type of director that listens to the counsel of our medical team. Ive heard it firsthand, and ive heard it out in d. C. , there is a hesitation to really get into some of the deeper trauma given the fact they dont know how long theyre going to be in our care. But, up you know, you need t deal with direct services. Are you going to take any money from this 2. 9 billion and provide it there, because you say youre going to add your own funds to what is going on at the nctsa. We will continue to seek ways to properly invest that none in the care of the children, yes, maam. I will come back to additional questions. Thank you very much. The point i want to make and then a couple of questions i want to ask. The point is, and you were there, director hayes, we were down along the border. Theres a lot of manipulation of these unaccompanied minors by people coming into the country. We were told that only 1 of adult males in 2015 coming across that border had an unaccompanied child with them. Its 50 now. Clearly some of these kids are being used by adults thinking it enhances their chances of getting in the country and being able to stay. I dont know how you deal with that, but its something we out to recognize theyre having to confront down there. It was very interesting to see. Again, the Money Congress voted gave them the capability for doing dna tests on selected individuals just to see if the people they were related. About one out of three were not related in the manner they described. So, these children have been us used, literally, by people to get into this country and by cartels. Thats just a fact. Youre confronted, we ask you to deal with it up. Dont deal with the apprehensions. Youre dealing with the kids we turn over to you. The question i have, and theres a tension here, and i know were trying to get to the right point, but tension between getting them placed as quickly as possible and giving them the best care we can give them after a very traumatic experience. Because you dont have them, as the commander pointed out, very long, and as you pointed out. Can you describe a little bit how you handle that dilemma and what you know, in what ways, if any, does the care follow the child or you might not even have had time to actually assess the full needs of the child in the amount of time you have them there. This is a real problem area, i think. Thank you, congressman. To your point, i know of a recent example where a child was in our care for three or four days before she was discharged to her mother. It was not a separation. So, if there is circumstances surrounding, you know, what happened back in home country, the journey, you know, and then coming into our care, she was only with our shelter for maybe 3 1 2 days before where i think its a more appropriate environment, she moved with her mom. So, that is you know, that is a question that, you know, i would not seek to answer. Im not a Mental Health clinician, but i receive counsel from a large number of them and their focus, again not knowing how long the children are going to be in our care, they focus on stabilizing the child and making sure the child feels secure because i think to a point earlier, they do view initially at least all of us as kind of the same bucket in regards to it the u. S. Government. But we see that as they spend more time in an hhs shelter and, its you know, like not in detention and theyre surrounded by medical professionals and clinicians and youth care workers and other kids, you know, their Comfort Level and confidence in our team does absolutely increase. We learn more about the child and his or her journey and the history. As that stuff is told, that is incorporated into the clinical work our team does. Again, to the oig reports point, it is tough when you dont know how long youre going to have that child and the licensed Mental Health professional tell us there is a hesitation to try to want to get into that too deep if they might be gone within a week or two. Commander, i would like your thoughts on this. Again, we obviously want to place them as quickly as we can in an appropriate environment. How do we make sure these kids have been traumatized before they get here, either by conditions at home or the journey, what are your thoughts on how we make sure that while were placing them rapidly, they get diagnosed and we do something about it . They move out of hhss care pretty rapidly and thats got to be a challenge in this area. Yes, sir. There are three things we have to do. I want to be clear. Theyre hard. Theyre hard but theyre necessary. The first thing we have to do is we have to built every one of our programs from a traumainformed lens so not just the minute the child sit issing with his or her clinician but every moment theyre in the program were doing what we can to mitigate the traumatic experiences theyve sustained as well as the distress of the time they spend they spend in congregate care. We have to provide psychointerventions to every child. These are not a random crosssection of children. The Life Experiences of children particularly for the more than 90 of the children in the o. R. Program who come from the northern triangle of Central America, these are children literally coming from the worst places on earth to be a child. Where the vast majority of these children have observed homicides, have experienced personal traumatic loshgs have been victimized themselves through physical assaults and sexual assaults. That is not uncommon. That is the norm. We need to have those methods in place recognizing all of the incredible challenges to doing that. The third is we need to continue to work as we do to with sponsors to identify the resources that they can access individually in the communities where they live to provide continuing care for the children. I want to be really clear. All of these things are incredibly hard. Thats why the guidance from oig matters. We are not failing at an easy thing. We are continuing to struggle at an incredibly difficult thing. Im very proud of what my colleagues in oor do every day on this problem. Thank you very much. Thank you, madame chair. Followup quickly on something congressman cole said. I think you made reference to it, commander, is the postrelease services and we know, i think we all know, that there is a serious, serious backlog and there are children on this wait list. Thousands of kids flagged to receive Services Weeks or months before they receive the kind of services. Im going to yield to congressman roy alerd. I would like to pursue postrelease services and that backlog. Before i ask my question, i am a little concerned, as was miss watson, an impression may have been left that somehow parents are just sending their kids here, picking and choosing and sending their kids here. We heard from the immigrants we spoke to as to the various reasons with which weve all heard, rape, gang, and so forth. I was on the trip to the northern triangle with speaker pelosi. And the reason we went there was to hear from our own government agencies, the ngos, u. S. Aid, the coast guard, cbp, the agencies there on the ground as to what their thinking was and the reasons why so many young people and parents were coming to the United States. And they validated everything we had been told by the immigrants ourselves as to why they were coming. In fact, in some cases what we learned was even more horrific. For example, u. S. Aid was saying, and some of the other agencies were saying they were now focusing on the 8 to 12yearold kids and using the money or the foreign aid were sending there to focus on the 8 to 12yearold kids because thats where the gaction were focused on recruiting the 8 to 12. If these kids didnt join, they would then threaten them with killing their parents or a subling. And to be part of that gang, the 8 to 12yearolds had to kill five people. That is why parents are sendinging their children here. Also when i went to texas with congresswoman escovad, we crossed over to a shelter on the mexican side. There were 80 or more immigrants there from different countries. The congresswoman asked why they were there. We heard similar things, including the fact they could no longer grow crops in their country and they were hungry. They couldnt feed their families and were coming to the United States. She then asked them, if you could provide for your family and if you could feel safe in your country, how many of you would still want to come to the United States . Not one person raised their hand. They said, no, we love our country. We want to be in our country. Were here because we had no choice. I just want to make it clear that parents are just not deciding for the heck of it to send their kids to the United States. Miss maxwell, according to your report, even Mental Health clinicians with Prior Experience in this field felt unprepared to handle the level of trauma that these children had experienced. If the trained Mental Health providers felt unprepared, i would assume oor caretaking staff must be completely overwhelmed when faced with these with the needs of these children. And i understand that your investigator spoke with a Mental Health and physical Health Clinicians during the investigation, but did you speak did your investigator speak directly with the caretaking staff about their training on how to meet the Mental Health needs of the severely traumatized children who were under their care . Thank you for that question. We have a broad body of work that we are undertaking and we asked a whole host of questions. We did talk to the youth care workers. That is for a future study coming out later this fall. In this particular study we focused only on the Mental Health clinicians. Do you know when that study will be coming out . As soon as we can get it through our rigorous control process, well have it in your hands. According to the flora Settlement Agreement, each child should have a comprehensive and individualized plan. Did your caretakers see if there were care plans in place for these sexually traumatized children . We have audits that look the at six grantees and we looked at whether grantees were compliant with rules and regulations and one of the regulations we looked at if this they had care plans. In some cases with he did find documentation missing in childrens files. A lot of the issues were bringing up will be in subsequent studies . The audits im talking about it, a number are already public. Id be happy to share with you so you could see specifically whats happening at various grantees. The study i was referring to looks at the safety in the facilities and that will be come out later this fall. Thank you. I see my time is up. Not people separated by legal policy, is that correct . Thats one city. To say the Trump Administration is somehow responsible because of the pitiful conditions in the northern triangle, that make a parent choose to separate themselves from their child is not this Trump Administration, neither the Obama Administration or any of our policies. Its a problem in those home countries. The northern triangle, lets talk about the northern triangle. Lets get back to baltimore or detroit and new orleans, all of which have a murder rate thats higher than guatemala. Baltimores is on level with honduras. El salvador does take the cake. Theyre higher. Again, i would just offer that we have a Public Health issue in this country, were taking care of the Mental Health of children exposed in the failure, the failure to control the murder rates in large American Cities that certainly the Trump Administration doesnt control. Lets talk about fingerprinting. Under your policy do you fingerprint more people or fewer categories of people than the Obama Administration fingerprinted . My understanding, for instance, is you dont fingerprint grandparents who have taken care of children when the Obama Administration were doing less less. Thats interesting. I didnt hear that as a compliment from anyone. Saying, oh, by the way, congratulations, youre actually doing less fingerprinting, therefore, resulting in less fear of family unification than under the last administration. So, thank you for doing that. No question about it. Let me get to the crux of how separation occurs because if you are a parent with your child, youre a single mother with your child, and you go to a port of entry and go through the Legal Process of filing for asylum, you dont end up the child doesnt end up in oor custody unless theres a question about the qualifications of that parent. Theyre not a criminal, et cetera. Is that right . Youre only taking care of children whose parents broke the law. Right . Because you dont break the law. If you request asylum at the port of entry, you dont break the law. Theres no question of separation unless youre a criminal yourself. Is that correct . The children in your custody, in fact, are not children whose parents have followed the asylum law of the United States by entering through a port of entry . I think i want to clarify, congressman, that the majority of children in the care of hhs did not come across the border with a mom or a dad. Yeah. I fully get that. Now im talking about whether this administration is responsible for the parent breaking the law and not following because if my point is, if the parent followed the law, and we know the vast majority request asylum. Thats not your bailiwick, but if they asylum at the point. Of entry following our asylum law, theres no question of automatic separation, there never was, is that right . Again, maybe i should be asked dhs. Unfortunately, congressman, among the separated people in the mezel class, including the named parent i think the take home is the vast majority of children in the care of orr are truly unaccompany al qaeda, not separated children. Thats correct. In fact, their parents broke the law. One solution, prophylactic solution, would be, i guess, to enforce border law . Maybe if we actually enforced the law we would not allow people to enter illegally with their children, which has resulted in separation. Im not going to judge, but is that more or less correct . We really are im going to have to look at those cases. My understanding of the law is, if you enter, you are legally present in the United States, if you entered a port of entry, requesting asylum. Doing everything you need to do at a port of entry. Ill check on that. Again, if we just enforce border law, we wouldnt need to have separations. We dont we probably dont need to have it anyway but we certainly wouldnt auto need it. I suggest we just do a simple thing and maybe just agree with the president that the border should be enforced. We shouldnt have an open border. I yield back. Congresswoman lee. Go for it. Let me ask a question just to clarify who has the authority well, in terms of the mou and its rescission, who has the authority to sign for the recession and who signed it . I do know the former director of orr signed it as well as the acting director the acting assistant secretary of children and families. Im not sure who signed it. I have read it but i who can recind it . I would assume the agencies who all signed it, definitely above my pay grade. Would it be the secretary of hhs . Maybe . No, it was the assistant secretary level. I can, without a doubt, say the former director of orr and the former acting assisting director of children and families inside hhs were two of the signatories. I cannot remember who signed it. Does anyone know . Miss maxwell, does anyone know who has the authority to recind this . No. Can you get back to us in writing who has the authority to recind the authority of mou . Ill work our team and get back to you. Thank you. Let me ask you another question with regard to the children and the treatment. First of all, policies that have been created by this administration have very serious future potential problems. If not dealt with properly as it relates to the appropriate type of Mental Health services. I want to read to you again the national this is from the National Child Traumatic Stress network which gives us a glimpse of what could happen if, in fact, these children arent treated properly. They said complexly traumatized children are more likely to engage in highrisk behavior such as selfharm, unsafe Sexual Practices and excessive risktaking such as operating a vehicle at high speeds. They may also engage in illegal activities, such as alcohol and Substance Abuse, assaulting others, stealing, running away and or prostitution. Thereby making it more likely they will enter the juvenile justice system. This characterization really does outline the high stakes associated with pro actively mitigating the impacts of childhood trauma. Im wondering, commander white, have you all thought this through all the way out . I foresee some difficult issues that these children are going to face as a result of the trauma that they have experienced and not treating them properly, just in terms of some of these issues and also in terms of other public safety, National Security issues. How do you think someone is going to feel at 18 years old if they were taken from their parents and then treated in a way that wasnt healthy and did not help restore their Mental Health . As a result of ptsd . Congresswoman with, a, all o outkoms you mentioned are well supported. This has long been part of the planning within oor. This is before children pose a unique problem, one the program has not designed to respond to. The one caveat that i would say in the list of outcomes you said is that the best evidence we have would suggest that the children in our program are at lower risk of committing serious crimes than children in the domestic Child Welfare environment. Given that sometimes they have been characterized publicly as a highcrime risk, i want to clarify that record. Im not saying they are now. Im talking about long term if you dont treat traumatized children with the appropriate psychotherapy longterm care. We agree, maam. In is part of the longstanding and evolving process of planning for the Mental Health needs of the very specific population of unaccompanied children who enter the country without parents often fleeing poverty and violence, which is the population we serve. With children separated from their parents, you have that added element of anger. Yes, maam. How do you address anger management and how do they work through that anger and the type of treatment youre proposing . Fundamentally, i do not believe the uac program is designed or capable of meeting the Behavioral Health needs of separated children. The only way to prevent that harm is you have children now. Youve got to address. We have to figure this out. I believe some outside Mental Health organizations such as the American Psychiatric association, such as the National Child trauma stress network, such as the pediatricians. I think you need some help with this. Many of those partnerships are under way. I just want to speak to the reality that separation cannot be managed with a tertiary i understand that. I started my comment earlier by africanamericans. The policy of separation of children 400 years ago. Generation the verdict on family separation is in. Its in. Hopefully you will have learned from this and hopefully i dont want to hear saying, we cant do anything or this is a population of children that we just dont have an approach or solution to because youre going to have thousands of children with this longterm trauma thats going to be transmitted to their children through dna changes. Yes, maam. Thats how i came across. That was not my intention. The reality is most of the separated children were discharged under an expedited court order reunification process. The fundamental reality is while we continue to work on best efforts to respond to their needs, we cannot plan for future separations. Instead, it is the job of everyone, including congress, to prevent them. Congresswoman clark. Thank you, madame chairwoman. I want to tell our witnesses, us Congress Ladies do understand the complex, social and economic factors in the northern triangle that impact immigration into this country. We also understand threats to withdrawal aid from those countries do not help. That policies like remain in mexico do not help and make your jobs trying to meet the needs of these children and families and deal with the trauma they have suffered in their longterm Mental Health even more difficult. Director hayes, back when you were here on july 1st, we talked about providing the subcommittee with Additional Information on sexual assaults. I wondered if you could give me an updated timeline for the release of sexual abuse reports. If you have any preview for the subcommittee on some of those findings, and how they may impact change in orr policies. I believe those reports have been posted. If not, they will be in the very near future. Ill work with the team and work with the atsdz ant secretary for Financial Resources and her team to communicate that back to you. What was the second question . If you could give us a preview of any of those reports and any proposed change in policies you might be proposing in response. Well, i would just say that we have late end of last year we did hire the prevention of sexual abuse coordinator. Miss maxwell, the oig also recently released a report on orrs facilitys adherence to background checks. Thank you. Thats correct. We did release that report in conjunction with this report and found that generally speaking facilities were adhering to the required background checks, screenings necessary to protect children. We did find some gaps, as you mentioned. In one area, over half the facilities were allowing clinicians to work with children prior to the background check being submitted to the facility. We did alert or are immediately about that fact or has taken action, putting out information and reminding facilities that clinicians should not work with children until the back aground checks are again, that issue has been addressed by orr. We have other recommendations out there but we continue to work with the administration to make sure all the background checks are in place. Great. Do you have anything to add, director hayes, and to how you are addressing your issues and background checks . No. I would just add, i think it was on the tour yall both were on but to potential changes to tppr and hhs, one of your colleagues talked about aunts and uncles being in that category. When you have that discussion, i would consider you to have that as well, being close families in a lot of these situations and families. I yield back. Thank you. Let me now yield to the Ranking Member congressman cole for any further comments or questions. Thank you very much. Ill try and be brief, madame chair, but i want to end where i began. I want to thank you for the hearing and your focus on this issue. We have a lot of pretty fierce debates about immigration, whats appropriate, whats not appropriate. But i think we all agree that any child that comes into the custody of the government of the United States needs to be taken care of and well treated. And i think weve come short in some cases, but i think youve pushed us in the right direction and you ought to be proud of that. Im proud of you for doing it. Second, again, i want to thank you, madame Inspector General maxwell. I know youre an assistant but were going to elevate you because i think youve done a great job. This is a great service. This is exactly what we ask Inspector Generals to do. To provide us with the information we need to make appropriate decision. I want to thank you, be you too, director hayes. Again and commander. Had the opportunity to visit at the border with you. I think things have gotten measurably better during your tenure. I have no doubt about your dedication to take what miss maxwell gave you and respond within the limits of your resources. Fortunately, Congress Expanded those resources in july. Something we need to think about Going Forward. We were overtaken by this crisis in 2014. Were reliving this. Im not sure that we prepared very well in between for this happening to us again. Again, i dont have any Magic Solutions for whats going on in the northern triangle countries but i suspect this wont be the last surge we see. Being a little better prepared and recognizing this may come again and institutionalizing some of these things, i think, is important as we go forward. I know youre dealing with the challenge you have now, but at a future time, i would welcome your thoughts and i know you guys are thinking about this as to what we need to do to make sure that if we have a situation like this, that were a little bit better prepared to deal with it than i think we were this particular time. With that, again, this is a little case study in how congress ought to work. Its a real oversight. Its good information from the executive branch to act on. Its a response by the executive branch and a list of what you need. An expiration in this whole discussion about what we need to do going fwa orward. I dont have the answers but i think this moved us in the right directions and certainly the manner in which each of you have discharged your responsibilities to the country, quite frankly. I thank all three of you for doing that. Good hearing. I think we made good progress. Thank you very much, congressman cole. Let me do a couple of housekeeping items. This is in regard to two letters to hhs. There was a letter sent by the aclu regarding the influx of facilities. That was flagged for the administration so we can get you further information on that. If you could respond to a letter that was sent by Public Health officials regarding the flu vaccinations. The vice chair and i flagged this letter for hhs as well. Were awaiting the response on those letters. If we could get that, that would be terrific. Madame chair, do you have dates on those, by chance . We will get that, no question. Well be wanting to submit some questions for the record you do not have to address these. Its because tbpra has mandated postrelease services that i understand that there are hundreds of children who qualify and they are on a wait list. If we can just know how long the children are waiting before they are connected with postrelease service and have the wait times increased. Well get you the questions. You dont have to what are the efforts oor is taking to expand the postrelease Services Capacity and the use of the 2. 9 billion in the in the supplemental and how we go forward for 2020 and i will get a couple of other questions that deal with postrelease services. Let me just comment on a service that congressman allard mentioned to me. Theres something of a traveling Nurse Program where theres a pool of nurses who you can apparently tap into and that are available. They get back in a day, et cetera, et cetera. We with find more about that. I am continued to be interested in the kind of direct services you are able to provide and just a point, its less than 600 a day. Let me let me come to a conclusion here today. I sincerely thank you for the time and the thoughtfulness of your testimony and the thoughtfulness of the work you do every day. I think one of the things we have established is that administrations policies, in fact, have traumatized thousands of children. Im not going to dwell on that. I dwell on that a lot. But i do think we need to move forward. But i think we have established that some of these policies have put children at grave risk. And so the fact is is that how do we try to deal with it . And commander, you spoke about prevention. Just as you talked about and how do we prevent this from happening . You also did something very special, i think, commander. So often we all hear that these children are programmed to tell us a story about what happened to them and theyre just given a line and whether it is a coyote or someone else who got them here or how they got here, that they you know, and that they are parroting something someone told them to say in order to gain access to the United States. One of the things that you talked about, the horrific circumstances that some of these children have faced. Congressman allard pointed out the directives that some were giv given, so its not made up. Theres a reality here, which i believe we have to face and have to address and deal with in a humanitarian way. And that we added to that trauma for these children. We have to take responsibility for that. I too someone said, you know, my colleagues will tell you on both sides of the aisle, i suppose im an equal opportunity antagonist to whomever is in the white house because we have to do what is right. Improvements have been made and take credit for the directives. But as we know from the testimony that there are current policies that we need to address and specifically, i know im a broken record, but the memorandum of agreement, its got to go. Lets find out who has the authority. I know what the assistant secretary said. She would recind it. Lets do that. Lets do it and make the changes. Accountability is where we need to go and we talked about that. Chairman cole spoke about that as well as where do we go subsequently here to follow up, to make sure of whats happening here. We have to carry out the recommendations. Concurrence with the recommendations is not enough and i say that to you, both of you. I say that to the ig. And you are following up. And that is our responsibility as well. Its not here today, gone tomorrow. We cannot forget about it. We cannot forget about it. You have tough jobs. Very difficult jobs. But you have a lot of good people who want to do the right thing. And we need to Work Together. I commit to you, as we have in the past that with regard to services, if were going to be carried out, well have to provide the resources for that because this was wrong. I also would talk about the discharge. I am singularly focused on the discharge and i believe we can do it. Weve been able to do it. Weve demonstrated that we can do it so that we do not need influx facilities which are not state licensed but that we have a way and will help to try to make sure that we have state licensed facilities that can deal with the issue rather than case managers, people taking care of kids who have not been checked out, have not been vetted the way they should. Lets follow both the letter and the spirit of the law where we want to try to address these issues. You know, and it is the state of texas, i will just say, defining child abuse as inflicting or failing to responsibly prevent others from inflicting mental or emotional injury in preparing your childs growth, development or psychological functioning. Im not saying this to you because youve you have trying to take us down a good road, but people have to be accountable. Those who employed a policy that would take us in this direction have to be brought to tafsk in some way. Lets not follow a path of child abuse. No one here wants to do that. Thats not what you came to do in terms of your public service. Ist not who you are. So lets use the power of the agency to make the decisions about what happens to those children who are in our care. And lets make sure we take good care of them while theyre here and make sure they have good care when they are discharged and to discharge them as quickly as we possibly can and safely as we possibly can. I want to, again, say thank you for your time, for your commitment. That concludes todays hearing. Thank you very much
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