Testimony Before the  
United States House Committee on Energy and Commerce 
Subcommittee on Oversight and Investigations 
 
 
 
 
Examining the Failures of the Trump Administrations Inhumane 
Family Separation Policy 
 
Testimony of: 
 
Ann Maxwell 
Assistant Inspector General 
Office of Evaluation and Inspections 
  Office of Inspector General    
U.S. Department of Health and Human Services 
 
 
 
 
 
February 7, 2019 
10:30 a.m. 
Location:  Rayburn House Office Building, Room 2123 
 
 
 
 
   
 
 Testimony of: 
Ann Maxwell 
Assistant Inspector General for Evaluation and Inspections 
Office of Inspector General, U.S. Department of Health and Human Services 
 
Good morning, Chair DeGette, Ranking Member Guthrie, and Members of the Subcommittee on 
Oversight and Investigations.  I am Ann Maxwell, Assistant Inspector General for Evaluation 
and Inspections for the Office of Inspector General (OIG), U.S. Department of Health and 
Human Services (HHS or Department).  I appreciate the opportunity to appear before you to 
discuss OIGs recent issue brief addressing the number of separated children in Office of 
Refugee Resettlement (ORR) care. 
OIG is charged with overseeing all HHS programs and operations.  OIG works to combat fraud, 
waste, and abuse in those programs; promote their efficiency and effectiveness; and protect the 
beneficiaries they serve.  To accomplish this, OIG employs an array of tools, including audits, 
evaluations, and investigations.  
Since responsibility for unaccompanied children was transferred to HHS by the Homeland 
Security Act of 2002, OIG has provided oversight of the Unaccompanied Alien Children (UAC) 
Program, which is administered by the ORR within HHSs Administration for Children and 
Families (ACF).  OIGs work in this area has been broad and multi-faceted.  For example, we 
have audited grantee expenditures and assessed their internal controls for administering UAC 
program funds; we have also examined whether ORR grantees met safety standards for the care 
and release of children in their custody.  All of these oversight efforts have one unifying purpose: 
to promote the protection of children in the Departments care. 
In 2018, numerous stakeholders raised serious concerns about the health and safety of immigrant 
children at HHS-funded facilities.  Given the urgency of this situation, and OIGs independent 
oversight role, we launched a series of reviews examining a variety of safety issues, including 
the background screening of facility staff that work with children, the challenges care 
facilities face in ensuring children are safe, and the physical security of the care facilities.  
We are also examining the challenges that ORR-funded care provider facilities face in meeting 
childrens physical and mental healthcare needs.  These reviews will be issued over the next 
year. 
 
As part of this initiative, we are paying particular attention to the subset of children who were 
separated from a parent or guardian by the U.S. Department of Homeland Security (DHS) and 
referred to HHS for care.  Consistent with that focus, in our recently published issue brief, 
Separated Children Placed in Office of Refugee Resettlement Care, we sought to confirm the 
number and status of children in ORR care who had been separated from a parent or guardian by 
immigration authorities. 
In short, OIG found that more children, over a longer period of time, were separated by 
immigration authorities and referred to ORR for care than has been commonly discussed.  In 
fact, the true number is unknown.    
 
1 
   
 
Pursuant to a June 26, 2018, Federal District Court order, HHS has thus far identified 2,737 
children who had been separated from their parents and were in ORR care as of that date.1  
However, prior to that Court order, HHS was not required to identify or track separated children.  
HHS officials estimated that thousands of additional children may have been separated from a 
parent or guardian during an influx that began in 2017, but were released from ORR care prior to 
the official accounting required by the Court.  Further, ORR has continued to receive children 
who have been separated since the June Court order, and DHS has provided limited information 
to ORR about those separations.  
Limited Data Complicated HHSs Efforts to Identify Separated Children To Be Reunited 
With Their Parents as Required by a June 2018 Court Order  
On June 26, 2018, in ruling on a class action lawsuit, Ms. L v. ICE, a Federal District Court 
ordered HHS to identify and reunify children who were in ORR care as of that date and who had 
been separated from a parent by immigration authorities.2  Historically, such separations had 
been rare and were typically done for reasons related to the childs best interest, such as a 
parents injury or illness or a DHS determination that the parent was a danger to the child.  
However, during a recent period of increased enforcement of immigration laws, large numbers of 
families were separated, with parents taken into Federal custody to await prosecution for 
immigration offenses and their children transferred to ORR care.   
Prior to the Court order, HHS had never been required to identify, categorize, or track separated 
children as distinct from any other children entering ORR care.  No integrated HHS-DHS data 
system existed to comprehensively identify and track separated children, nor did either agency 
independently maintain data about them.   
The absence of data about separated children severely complicated HHS efforts to comply with 
the Court order, and led to the development of a three-step process for identifying every child 
who had been separated from a parent and was in ORR care as of June 26, 2018:   
  First, an HHS-led data team (with support from DHS sub-agencies) mined more than 
60 HHS and DHS databases to identify indicators of possible separation, such as an adult 
and child with the same last name apprehended on the same day at the same location.    
  Additionally, ORR and other HHS staff, including agency officials and senior leadership, 
manually reviewed case files for each of the approximately 12,000 children in ORR care. 
  Finally, ORR asked all HHS-funded shelters to attest to any separated children they 
reasonably believed to be in their care.   
This effort resulted in an initial list of 3,600 potentially separated children, i.e., children for 
whom HHS found any information in any data source indicating that the child may have been 
separated from a parent.  On July 11, 2018, after conducting additional reviews, ORR certified a 
                                                           
1 See Ms. L v. Immigration and Customs Enforcement (ICE), (S.D. Cal. June 26, 2018 (Order Granting Plaintiffs 
Motion for Classwide Preliminary Injunction). 
2 Subject to certain exceptions, such as when the class member parent is unfit, poses a danger to the child or if the 
parent voluntarily declines to be reunited. 
2 
   
 
list of 2,654 children that it believed met the Courts criteria.  ORR determined that the 
remaining 946 children (from the original list of 3,600) did not meet all of the Courts criteria.  
Of the 946 children, approximately 300 were not included on the certified list because they had 
been released through standard processes between the date of the Court order and the date the list 
was certified by ORR.  The remaining children were excluded because: (1) they had been 
separated from a nonparent relative; (2) the adult with whom they traveled was determined to 
have made a fraudulent claim of parentage; or (3) the information in the childs case file was 
unclear, and the ORR Director determined that the balance of evidence did not support including 
the child on the certified list. 
HHS Has Revised the Number of Separated Children Who Meet the Courts Criteria 
Several Times 
Even as the initial list of 2,654 was being certified, some HHS staff believed that 50 to 100 
additional children should have been included.  At the same time, ORR began to receive new 
information (for example, from parents legal representatives contacting ORR) suggesting that 
some children excluded from the list had, in fact, been separated.  In the following months, HHS 
revised its initial number several times: 
  In October 2018, HHS added 13 children (all of whom were still in ORR care at that 
time) to the list, for a new total of 2,667. 
  In November 2018, HHS reported to the Court that 79 of the children previously reported 
as separated had not, in fact, been separated from a parent.  This reduced the count of 
separated children to 2,588. 
  In December 2018, HHS added 149 children to the list, bringing the number of separated 
children identified under the Court order to 2,737.  These 149 children had been in ORR 
custody on the date of the Court order and then discharged before being identified as 
separated.3   
In a December 2018 Court filing, HHS reported that only eight separated children eligible for 
reunification under Ms. L v. ICE remained in ORR care and that it was working towards their 
reunification or other appropriate discharge. 
Many Separated Children are Not Covered by the Court Order and Have Not Been 
Counted  
The June 2018 Court order required HHS to identify only those separated children who were in 
ORR care as of June 26, 2018.  However, HHS officials estimated that thousands of additional 
children were separated by DHS, referred to ORR care, and released through standard ORR 
processes prior to that date.   
                                                           
3 In most cases, they were released to a parent, guardian, or relative.  Nine had been released to distant relatives or 
unrelated adults, five had been voluntarily repatriated to their country of origin, and one had turned 18 in ORRs 
care (which means the individual aged out of the UAC program and typically results in transfer to DHS custody). 
3 
   
 
HHS officials based this estimate on ORR staff observations and informal monitoring.  
Specifically, in the summer of 2017, ORR noticed a steep increase in the number of separated 
children being referred by DHS.  Overall, ORR staff noted that the proportion of separated 
children (relative to all children) entering ORR care rose from approximately 0.3 percent of all 
intakes in 2016 to 3.6 percent in August 2017, a more than tenfold increase.  
The increase in separated children posed operational challenges for the UAC program.  In a 
November 2017 email that OIG reviewed, an ORR official stated that separated children were 
often very young, that these younger children required placement at specially licensed facilities, 
and that the numbers of these very young UAC resulting from separations has on some dates 
resulted in shortfalls of available beds.     
HHS was not able to provide a more precise estimate than thousands because, as previously 
noted, ORR did not have formal tracking systems in place that consistently identified separated 
children.  HHS similarly could not provide information on placements of separated childrenas 
distinct from other unaccompanied childrenwho were discharged from ORR care prior to the 
June 2018 Court order (e.g., the number who were released to relatives vs. nonrelatives or foster 
care).4   
DHS Has Provided ORR With Limited Information About the Reasons for Recent 
Separations, Which May Impede ORRs Ability To Appropriately Place Children 
In addition to requiring reunification of separated families who meet certain criteria, the June 
2018 Court order preliminarily enjoined the Federal Government from continuing to separate 
families entering the U.S. unless the parent has a criminal history, poses a danger to the child, is 
otherwise unfit or consents to the separation.  According to ORR tracking documents, ORR 
received at least 118 children separated by DHS from July 1 through November 7, 2018.5, 6  This 
number includes only children identified by DHS as separated at the time the child was 
transferred to ORR.  The proportion of separated children relative to all referrals increased every 
month during this period, from 0.47 percent in July to 0.91 percent in the first week of 
November.  Overall, separated children made up 0.69 percent of referrals to ORR during this 
period, a proportion that is more than twice the rate that ORR observed in 2016, but far lower 
than the rate ORR staff observed in the summer of 2017.  
As described earlier, DHS sometimes separates children from parents for the childs safety and 
well-being.  DHS reported to ORR that 65 of the 118 children were separated because the parent 
had a criminal history, although the nature of the criminal history was not always specified.  
Other reasons provided to explain a separation included the parents gang affiliation, illness or 
hospitalization, or immigration history only.  In some cases, little detail was provided to ORR by 
DHS.   
                                                           
4 HHS told OIG that it has no plans to retroactively identify these children, explaining that any effort to do so would 
divert limited resources from ORRs primary focus on children currently in care. 
5 The newly separated children ranged in age from under 1 year old to 17 years old.  Of the 118 children, 82 were 
under the age of 13 when transferred to ORR care, including 27 who were under the age of 5. 
6 In its comments to our report, HHS provided updated information about new separations, reporting that ORR had 
received a total of 218 separated children between June 26 and December 26, 2018.   
4 
   
 
Incomplete or inaccurate information about the reason for separation, and a parents criminal 
history in particular, may impede ORRs ability to determine the appropriate placement for a 
child.  When a proposed sponsor (including a parent) has a criminal history, ORR policy is to 
evaluate the severity and type of crime and the length of time that has passed since the criminal 
act, along with any mitigating factors.  ORR officials and staff noted that, from a child welfare 
perspective, not all criminal history rises to a level that would preclude a child from being placed 
with his or her parent.  ORR officials stated that when DHS provided insufficiently detailed 
explanations for a childs separation, ORR staff would contact DHS for followup information.  
However, the tracking document we reviewed indicated that DHS did not always respond to such 
followup requests.   
ORR Has Taken Steps To Improve its Ability To Track Separated Children 
At the time of the Court order, ORR had no reliable means of determining whether specific 
children in its care were separated.  To address this challenge moving forward, ORR has taken 
several steps to improve its ability to identify and track these children.  First, in July 2018, ORR 
modified its online case management system to include a checkbox that can be used to indicate 
whether a child was separated before referral to ORR care.  The checkbox is accessible to both 
DHS and ORR staff.  Additionally, the online referral DHS completes in order to transfer a child 
to ORR care now includes a notes section where DHS staff can enter information about a 
separated adult associated with a child; this information can also be entered into a 
parent/relative section of the referral.  Finally, in August 2018, ORR developed a tracking 
spreadsheet that draws information about separated children from its online case management 
system, enabling staff to produce a consolidated list of these children. 
Improved Tracking and Communication Will Better Enable ORR to Provide Appropriate 
Care and Placements for Separated Children 
Although HHS has taken several significant steps to better track separated children, it is not yet 
clear whether these recent changes will be sufficient to ensure that HHS can accurately identify 
these children in the future.  Further, there is still no integrated data system to account for 
separated families across DHS and HHS.   
Therefore, OIG encourages continued efforts to improve communication, transparency, and 
accountability for the identification, care, and placement of separated children.  Maintaining 
accurate and comprehensive information about separated children would improve ORRs ability 
to ensure that they receive the most appropriate care and placement.  ACF agreed that 
improvements are always warranted and has committed to look for opportunities to improve 
inter-departmental data-sharing and operations with DHS.  
Conclusion  
In conclusion, the total number of children separated from a parent or guardian by U.S. 
immigration authorities and transferred to HHS for care is not known.  According to HHS 
officials, it is certainly morelikely thousands morethan the 2,737 who meet the criteria of 
the Ms. L v. ICE court order.  Moreover, because HHS cannot provide details specifically about 
5 
   
 
children who were separated, transferred to ORR custody, and released prior to the lawsuit, 
whether these children were reunified with their parents remains an open question.  
The issue brief discussed in my testimony is one in a series of reports that OIG will release in 
2019 related to the care and well-being of children in ORR-funded facilities.  In the coming 
months, we will issue a report examining challenges that HHS and care facilities faced in 
reunifying separated children.  In addition, OIG is engaged in multiple reviews that will assess 
HHS-funded facilities efforts to protect all children in their care from harm, as well as facilities 
provision of physical and mental health services, including efforts to address trauma.  We have 
already released an early alert from this body of work, The Tornillo Influx Care Facility: 
Concerns about Staff Background Checks and Number of Clinicians on Staff, which highlighted 
two significant vulnerabilities we identified during our review of the Tornillo influx facility, 
operated by BCFS Health and Human Services: (1) required Federal Bureau of Investigation 
fingerprint background checks were not conducted for staff, and (2) insufficient number of staff 
clinicians to provide adequate mental health care for UAC.  Taken as a whole, this work 
reaffirms OIGs goal of ensuring that children in ORR facilities receive appropriate care and 
protection. 
Thank you for the opportunity to testify today on this important topic.  
6