Unaccompanied Children: HHS Should Improve Monitoring and Information Sharing Policies to Enhance Child Advocate Program Effectiveness
Published: 2016-04-19T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: Thousands of unaccompanied children arrive in the United States each year. For a small number of especially vulnerable children—about 1 percent in fiscal year 2015—ORR provides an independent child advocate to develop safety and well-being recommendations to stakeholders, such as immigration judges. The Violence Against Women Reauthorization Act of 2013 directed HHS to expand the program and included a provision for GAO to review the child advocate program.
This report examines (1) the extent to which ORR increased the number of program locations, (2) the extent to which ORR ensured vulnerable children received advocate services, and (3) the program's benefits and challenges. GAO reviewed relevant federal laws and regulations; analyzed data from fiscal years 2012-2015 on the number and characteristics of child advocate cases served and recommendations made to stakeholders; and interviewed officials at ORR and the Department of Justice's immigration judges, and child advocate service providers in Chicago, Ill.; Brownsville, Tex.; and Washington, D.C.—selected to obtain variation in the number of children served and amount of time the program was operational, among other factors.
section_title: What GAO Found
paragraphs: In fiscal year 2015, the Department of Health and Human Services' (HHS) Office of Refugee Resettlement (ORR) expanded the child advocate program from two locations to five and added three more locations in fiscal year 2016. The child advocate program—operated by a contractor—was developed in 2004 to promote the best interests of especially vulnerable unaccompanied children in ORR custody. Advocates meet with children regularly and develop recommendations regarding their care and custody. Approximately 336 children were assigned an advocate in fiscal year 2015—97 of them in the three new locations. ORR expects the contractor to provide advocates to an increasing number of children in locations with larger numbers of children in ORR custody, and plans to monitor progress through monthly reports from the contractor.
Children are referred to the program primarily by shelter staff (care providers), who are expected to use a set of criteria established by ORR to determine eligibility. Once the program contractor receives the referral, it decides if an advocate is available to work with a child and then sends a recommendation to ORR to officially appoint an advocate. However, ORR does not receive a copy of referrals that the contractor is unable to serve. Further, GAO's data analysis shows and the program's contractor reported inconsistent referral practices. Contrary to federal internal control standards, ORR does not monitor referrals by care providers or contractor decisions about which children it serves. As a result, ORR cannot know whether eligible vulnerable children are overlooked.
Stakeholders GAO interviewed said the advocate program gives children a voice during the immigration process and aids decision making regarding their care and custody. However, the contractor said their efforts are hampered by ORR's information sharing policy. GAO found that from fiscal years 2012-2015, more than 70 percent of the 493 recommendations made by advocates were adopted by ORR, immigration courts, and others. However, the contractor said ORR does not provide them with some key information on children. For example, they do not receive significant incident reports that describe behavioral incidents while in ORR care, past abuse or neglect, or other concerns. The William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008 states that child advocates “shall be provided access to materials necessary to effectively advocate.” The contractor said creating recommendations without complete information limits their effectiveness. ORR officials told GAO that they are considering providing the contractor with copies of all significant incident reports and other key information; but as of April 6, 2016 the policy had not changed.
section_title: What GAO Recommends
paragraphs: GAO recommends that ORR improve its efforts to monitor care provider referrals and contractor decisions, and ensure that the contractor has timely access to key information on the children. HHS agreed with GAO's recommendations.

section_title: Letter
paragraphs: Thousands of unaccompanied children arrive in the United States on their  own each year from all over the world. Since fiscal year 2012, the United  States has experienced a rapid increase in the number of children from El  Salvador, Guatemala, and Honduras crossing the U.S.-Mexico border.  Children traveling to the United States from these countries are reportedly  fleeing crime, violence, or extreme poverty and may have undergone  trauma while in their home country or during transit to the United States.  When unaccompanied children are apprehended by the Department of  Homeland Security (DHS), most are transferred to the custody of the  Office of Refugee Resettlement (ORR) within the Department of Health  and Human Services (HHS). Children transferred to ORR custody are  placed in shelters, foster homes, or other types of facilities that are  operated by ORR-funded care providers until the children can be  released to a sponsor. Also, children are required to attend removal  proceedings in immigration court, which determine if they will be removed  from the United States or granted immigration relief. The proceedings are  the responsibility of the Department of Justice’s Executive Office for  Immigration Review.
Since 2004, ORR has appointed independent child advocates for a small  number of vulnerable unaccompanied children and victims of trafficking in  its care under a program operated by the Young Center for Immigrant  Children’s Rights (Young Center) primarily based out of Chicago, Ill. Child  advocates are expected to meet with children regularly, learn about their  life in their home country and their journey to the United States, and  provide recommendations to various stakeholders in the child’s life  regarding their care, custody, and release. Under ORR’s criteria,  unaccompanied children shall be appointed an advocate, where  available, if they are deemed to be especially vulnerable, such as victims  of trafficking or abuse, very young children, pregnant or parenting teens,  or children who are expected to stay in ORR custody longer than 4  months.
The Violence Against Women Reauthorization Act of 2013 (VAWA 2013)  directed HHS to expand the child advocate program to additional  locations. VAWA 2013 included a provision for GAO to evaluate the  effectiveness of the child advocate program and HHS’ implementation of  the program in new sites.
This report examines: (1) the extent to which ORR implemented  requirements to increase the number of child advocate program locations  and the impact of the expansion on program costs and number of children  served, (2) the extent to which ORR ensured vulnerable unaccompanied  children were receiving services, and (3) the benefits of the child  advocate program, and what challenges, if any, it faces.
To address all three objectives, we visited the Young Center’s original  child advocate program in Chicago, Ill., and a new program site in  Washington, D.C., and held phone interviews with staff from a program  site in Brownsville, Tex., that was established in 2012. These sites were  selected based on variation in the number of children served, amount of  time the program has been operational, and types of ORR care facilities  in operation. With one exception, in each location, we interviewed ORR  care providers, immigration judges, legal services providers, and  volunteer child advocates. In addition, we interviewed headquarters staff  for ORR and the Executive Office for Immigration Review. We also  interviewed two organizations that temporarily provided child advocate  services in fiscal year 2015. We reviewed ORR documents, such as child  advocate program policies and the contract between ORR and the Young  Center. We also reviewed relevant federal laws and regulations, including  VAWA 2013 and the William Wilberforce Trafficking Victims Protection  Reauthorization Act of 2008 (Trafficking Victims Protection and  Reauthorization Act).
In addition, to address our first and second objectives, we analyzed  Young Center child advocate case data from fiscal years 2012 through  fiscal year 2015, the four most recent years for which data were available.  These data were used to describe demographic characteristics of children  served by the program, reasons children were referred to the program,  and the source of those referrals. We also analyzed data on the number  of children the program was unable to serve from August 2013 through  September 2015. Additionally, we analyzed data on the numbers of  children in ORR custody and the amount of space available in ORR  facilities in child advocate program locations as of October 2015. To  address our third objective, we analyzed information collected on best  interest recommendations the Young Center provided to a variety of  stakeholders from fiscal year 2012 through fiscal year 2015. This  information included the number of these recommendations made, types  of decision-makers that received recommendations (such as immigration  judges, attorneys, or ORR), key issues on which recommendations were  provided (such as release, placement, legal relief, or repatriation), and  number of recommendations adopted. The case and best interest  recommendations data were provided by the Young Center. We  assessed the reliability of the case and recommendation data by (1)  performing electronic testing of required data elements, (2) reviewing  information about the data and the system that produced them, and (3)  interviewing knowledgeable Young Center staff about the data. We  assessed the reliability of ORR’s data by (1) reviewing ORR business  rules to ensure data reliability and (2) interviewing ORR officials and  contractors knowledgeable about the data. We determined that the data  were sufficiently reliable for our purposes.
We conducted this performance audit from April 2015 to April 2016 in  accordance with generally accepted government auditing standards.  Those standards require that we plan and perform the audit to obtain  sufficient, appropriate evidence to provide a reasonable basis for our  findings and conclusions based on our audit objectives. We believe that  the evidence obtained provides a reasonable basis for our findings and  conclusions based on our audit objectives.
subsections: section_title: Background
subsections: section_title: Unaccompanied Children
paragraphs: Compared to the nearly 6,600 children placed in ORR custody in fiscal  year 2011, more recent migration represents a historic increase in  unaccompanied children entering the United States. In fiscal years 2014  and 2015, more than 57,000 and 33,000 unaccompanied children,  respectively, were apprehended by DHS and transferred to ORR  custody. The majority of the children were from El Salvador, Guatemala,  and Honduras. Compared to prior years, there were significantly more  young and female children apprehended by DHS. For example, as we  previously found, in fiscal year 2011, 414 children under the age of 11  were apprehended by DHS, compared to 7,266 in fiscal year 2014. Also  in fiscal year 2011, 2,333 female unaccompanied children were  apprehended, compared to 21,881 in fiscal year 2014. We also  previously found that children from El Salvador, Guatemala, and  Honduras often leave their home country due to crime, violence, and lack  of economic opportunity, among other reasons.
While in ORR custody, children are placed in facilities with care providers  in 12 states (as of December 2015). ORR care providers are generally  non-profit organizations operating under cooperative agreements and  must be licensed by the state to provide residential, group, or foster care  services for dependent children. Care providers are required by ORR  policy to provide children with a variety of services, including an individual  needs assessment, classroom education, health care, counseling, and  recreation. In addition, ORR care providers are to identify and assess  relatives or other individuals as sponsors to whom children can be safely  released. ORR federal field specialists, referred to as ORR field staff in  this report, are local liaisons with ORR care providers and other  stakeholders and approve the transfer and release of unaccompanied  children in ORR custody. ORR also employs case coordinators, who are  contract staff in the field that work with care providers and provide ORR  field staff with transfer and release recommendations.
The Trafficking Victims Protection Reauthorization Act directs ORR to  place children in the least restrictive setting that is in the best interests of  the child. ORR care facilities include:
Shelters—The majority of children going through ORR care are  placed in shelters, the least restrictive shelter environment.
Foster care—Transitional (or short-term) foster care is an initial  placement option for young children, sibling groups, pregnant and  parenting teens, or children with special needs. Long-term foster care  is for children expected to be in ORR custody for 4 months or longer  and meet other criteria.
Staff-secure facilities—These facilities maintain stricter security  measures than a shelter in order to control disruptive behavior and  prevent escape. Security measures could include a higher staff-to- child ratio for supervision.
Secure care—These facilities have a physically secure structure and  staff able to control violent behavior. ORR uses a secure facility as the  most restrictive placement option for children who pose a danger to  themselves or others.
Residential treatment centers—These facilities offer therapeutic  programs for children diagnosed with a mental health disorder. These  centers provide services in a highly structured clinical program.
Group home—A group home specializes in caring for specific  populations (e.g., teen mothers). Extended care group homes are for  children who may be in ORR custody for an extended period.
The average number of days children remain in ORR shelters varies from  month-to-month as different children rotate in and out of care. According  to ORR data, the length of stay for children in shelters decreased from an  average of 72 days in fiscal year 2012 to 32 days in fiscal year 2015.
Unaccompanied children are also required to appear in immigration court  for removal proceedings, which are adjudicated by immigration judges  from the Department of Justice’s Executive Office for Immigration Review.  These proceedings may begin while the children are in ORR custody, but  often continue after their release to a sponsor. ORR provides funds to  legal services providers for certain legal services that include an  introduction to the U.S. legal system (known as “Know Your Rights”  presentations), screening for potential immigration relief, and direct  representation in some instances.
section_title: Child Advocate Program
paragraphs: The Young Center (formerly known as the Immigrant Child Advocacy  Center), a nonprofit organization, developed a pilot child advocate  program, and in 2004 the Center began serving children housed at ORR  care facilities in Chicago. The Trafficking Victims Protection  Reauthorization Act authorized HHS to appoint independent child  advocates for trafficking victims and other vulnerable unaccompanied  children. The Young Center expanded its child advocate program in  fiscal year 2012 and opened an office to serve children in Brownsville,  Tex., where a large number of unaccompanied children have traditionally  been placed until released to sponsors. VAWA 2013 directed HHS to  establish child advocate programs at six new locations—three initial  locations by March 2015 and three additional locations by March 2016.  The expansion required by VAWA 2013 largely predates the historic  numbers of unaccompanied children entering the United States since  fiscal year 2012.
While certain services such as education and health care are provided to  all children in ORR care, the child advocate program provides services to  a small number of vulnerable unaccompanied children who meet ORR’s  criteria. ORR defines vulnerable children eligible for advocate services as  those who are victims of abuse or trafficking, children age 12 and under,  pregnant and parenting children, those expected to be in ORR custody for  4 months or longer, and children who speak a different language than  their care provider, among other criteria. Any stakeholder involved in a  vulnerable child’s case may refer them to the child advocate program.  Stakeholders who commonly refer children to the advocate program  include their ORR care provider, ORR field staff, or legal services  provider.
The Young Center recruits, screens, and trains volunteers, such as law  and social work students, teachers, retired attorneys, and community  members, to serve as child advocates. Volunteers are matched with  vulnerable unaccompanied children referred to the program, and are  expected to meet with them regularly to develop relationships, gather  information regarding their individual circumstances, and accompany  them to immigration court and other important meetings. Information  that advocates learn during these sessions is shared with Young Center  staff attorneys and social workers. Young Center staff then advocate on  behalf of the child based on information learned from the volunteer  advocates, as well as information obtained from other sources such as  ORR case files. To perform their advocate role, Young Center staff  assesses the child’s circumstances and promotes what it views as the  child’s best interests—safety, well-being, and the child’s expressed  wishes—to various stakeholders. This includes developing best interest  recommendations that are provided to ORR, immigration courts, asylum  officers, legal services providers, and other decision makers (see fig. 1  below).
According to the Young Center, the role of the child advocate is distinct  from that of a child’s attorney. The child advocate is to represent what he  or she views as the child’s best interests, and in rare cases, best interests  differ from the child’s expressed wishes. For example, a child may want to  return to his or her home country despite previously expressing a credible  fear of returning due to unsafe conditions. In such cases, the Young  Center can urge the child and relevant decision makers to consider other  options given concerns about the child’s safety in his or her country of  origin.
The Young Center served 904 children from fiscal year 2012 through  fiscal year 2015, which accounts for a small percentage of the  unaccompanied children who entered the United States during this time.  While the increases in the overall population of unaccompanied children  since fiscal year 2012 have been accompanied by changes in the  demographic characteristics of those children, the demographic  characteristics of children served by the Young Center have remained  relatively stable over a similar period of time (see table 1). In addition to  demographic differences, children assigned an advocate experience a  longer stay in ORR custody when compared to the overall population of  unaccompanied children. For example, in fiscal year 2015 the overall  population of unaccompanied children was released to sponsors in an  average 32 days, but many of the children who receive advocate services  are expected to stay in ORR care for 4 months or longer.
The child advocate program serves children from all over the world. Over  70 percent of children served by the Young Center from fiscal year 2012  through fiscal year 2015 are from one of four countries: El Salvador,  Guatemala, Honduras, or Mexico. About 10 percent of children are from  China or India. The remaining children are from a diverse collection of  countries, such as Bangladesh, Ghana, Romania, and Somalia (see fig.  2).
section_title: ORR Selected Six New Child Advocate Program Locations, but Advocates Are Not Available in Other Locations Where Services May Be Needed
subsections: section_title: ORR Selected New Locations in Cities with Large Numbers of Unaccompanied Children
paragraphs: ORR expanded the child advocate program to three locations in fiscal  year 2015, and selected an additional three locations for expansion in  fiscal year 2016 that each held more than 50 children in ORR custody, as  required by VAWA 2013. Additionally, VAWA 2013 required that ORR  give priority to locations with the largest numbers of unaccompanied  children and the most vulnerable populations of unaccompanied children.  ORR officials reported using two factors to determine the locations with  the largest numbers of unaccompanied children: (1) its bed capacity (i.e.  the space ORR care providers have to house and care for children) and  (2) locations where large numbers of children are released to sponsors.  However, ORR officials noted that they could not base expansion  decisions on the most vulnerable populations of unaccompanied children  because children are not assessed until they arrive at a care provider’s  facility. As a consequence, ORR officials said they do not know which  ORR care provider locations have more vulnerable children than others  until after children arrive.
Using its two selection factors, ORR first expanded the program to  Houston, Tex.; New York City, N.Y.; and Washington, D.C. The Young  Center opened offices in these areas in December 2014 and provided  advocates for children in ORR custody. Beginning September 30, 2015,  the child advocate program is funded under a contract between ORR and  the Young Center. On March 14, 2016 the contract was modified to  include reference to expanding the program to Los Angeles, Calif.;  Phoenix, Ariz.; and San Antonio, Tex. beginning in March 2016. See  figure 3 for a comparison of the number of children in ORR custody, ORR  bed capacity, and the number of children released to sponsors in all child  advocate program locations. These eight program locations are in cities  that account for 79 percent of ORR’s total bed capacity, as of October  2015.
To implement the program’s expansion, ORR allocated an increased  amount of funds. Specifically, in fiscal year 2015 ORR provided  approximately $1.8 million to the Young Center, up from $700,000 in  fiscal year 2014 (see fig. 4). According to Young Center staff, this  increase in funding in fiscal year 2015 allowed the Young Center to rent  additional office space in the three expansion cities; meet the  administrative costs of setting up new offices; and recruit, screen, and  train new staff. The Young Center provided child advocate services to 97  unaccompanied children in the new program locations during the first 10  months of operation, without fully staffed programs in many locations, in  addition to serving 230 children in pre-existing program locations. The  new contract provides $2 million for fiscal year 2016, with 2 extension  years at the government’s option. The Young Center anticipates using  future funding to provide services to an increased number of  unaccompanied children.
section_title: The Child Advocate Program’s Ability to Serve Children Is Limited by Location
paragraphs: Though ORR expanded the child advocate program to the required  number of new locations and allocated increased funds for the expansion,  the Young Center’s ability to advocate for children outside of its program  areas is limited by its geographical reach. ORR care providers are  generally limited to referring vulnerable children in the eight locations  where the Young Center has offices, although ORR has care facilities in  additional locations (see fig. 5). For instance, potentially vulnerable  children in ORR custody in areas in northern California, Oregon, and  Washington, where there are ORR care providers, typically do not receive  child advocate services because the Young Center is not located there. In  a small number of cases, the Young Center appointed advocates for  especially vulnerable children in locations where there is no program, and  refers to these as “national” cases. According to ORR officials, its care  providers and field staff in all locations are given information about how to  make referrals to the Young Center. However, the Young Center serves a  very small number of national cases. In fiscal years 2012 through 2015,  the Young Center provided advocates for 27 national cases, or 3 percent  of total cases served. Further, Young Center staff explained that they  have limited capacity to handle these cases under the new contract.  However, Young Center staff said they expect less demand for national  cases in the future because under the new contract, the Young Center is  expanding to locations where it historically received referrals for national  cases, such as San Antonio.
In addition to a limited geographical reach, the child advocate program  has not yet aligned the numbers of children served with potential program  demand in certain locations. For example, as of October 2015, ORR’s  capacity was 470 beds in Chicago, 930 beds in New York, and 2,028  beds in Brownsville. However, in fiscal year 2015, the Young Center  served 172 children in Chicago, more than the number of children they  served in New York and Brownsville combined. Young Center staff said  the advocate program began in Chicago and explained that the higher  number of children served in this location is due to a much larger and  more established base of volunteer advocates in the area. Additionally,  since the program began providing advocate services in Chicago in 2004,  the Chicago office has more developed relationships with stakeholders  who regularly refer children to the Young Center.
ORR officials and Young Center staff expect that the child advocate  program will serve an increasing number of children in locations with  larger bed capacity over time. ORR officials described the child advocate  program as a “capacity building project”—meaning that as the program  gets up and running in new locations they will obtain the infrastructure  needed to serve additional children. They said they hope to improve the  distribution of children served across program locations as the program  continues to expand. Young Center staff reported specific targets for  which they are aiming to accomplish this increase. For example, in fiscal  year 2015 the Young Center served 58 children in Brownsville and  anticipates an increase to 75 children in fiscal year 2016. Still, the Young  Center set targets to serve more children in Chicago than other program  locations in fiscal year 2016 (see fig. 6).
ORR officials said they will review monthly reports from the Young Center  that include details on numbers of referrals to the program and cases  served to monitor the Young Center’s progress towards meeting its  caseload targets. Officials also said they conduct monthly calls with the  Young Center to discuss the distribution of cases across program sites  and any challenges the Young Center has meeting its caseload targets.  Finally, ORR plans to examine the Young Center’s caseload distribution  at the end of each contract year to determine target caseloads for the  following year. As the program continues to expand, ORR’s efforts to  monitor the number of children receiving child advocate services in each  program site are important in order to ensure that child advocate services  are distributed to areas of need.
section_title: ORR Provides Guidance on Referrals but Lacks a Process to Monitor Referrals to Ensure Vulnerable Children Are Served
subsections: section_title: ORR Reports Plans to Review Referral Guidance in Light of the Changing Population of Children
paragraphs: To help vulnerable children receive advocate services, ORR provided  guidance in September 2011 to care providers and other relevant  stakeholders on referring vulnerable children to the child advocate  program. ORR officials said that its care providers are the most common  source of referrals, though ORR field staff and other stakeholders can  also make referrals. Our analysis of Young Center data found that among  cases served by the Young Center from fiscal years 2013 through 2015,  nearly 70 percent were referred by care providers (see table 2).
ORR requires care providers to conduct an assessment of all  unaccompanied children entering ORR custody that covers biographic,  family, legal, medical, and mental health history, among other topics.  Care providers are to use ORR’s child advocate program guidance, which  lists 17 criteria developed by the Young Center and ORR that qualify  children as vulnerable and eligible for advocate services, to help  determine if children should be referred. Referrals are to be submitted  directly to the Young Center which determines whether an advocate is  available to work with the child (see fig. 7). According to Young Center  staff, they have to make decisions about which cases can be staffed,  based on advocate availability, language needs of the child, urgency of  the case, or other factors. After the local Young Center office decides an  advocate is available to work with a child, it sends a recommendation to  ORR headquarters for ORR to officially appoint an advocate for the child.  ORR officials said that because the Young Center has already  determined that advocates are available to work with a child when the  Young Center recommends an advocate appointment, the agency  generally approves the Young Center’s requests. One exception noted by  ORR officials is that requests for Young Center advocates for children  who are released from ORR care are typically not approved, as advocate  appointment is generally limited to children in ORR custody.
Children served by the Young Center from fiscal years 2012 through 2015  met a range of ORR’s criteria and many children met multiple criteria,  according to our analysis of Young Center data (see fig. 8). For example,  the largest number of unaccompanied children who were appointed  advocates during this time period were referred to the program because  their potential sponsors were undergoing home studies, a possible  indicator that the child’s safety or well-being may be in question (23  percent). Additionally, many children who were appointed advocates  were referred because they were expected to be in ORR custody for 4  months or longer (21 percent), or they were from a country known to  traffic children or identified as trafficking victims (17 percent). Lower  percentages of children were referred to the Young Center and appointed  advocates because they lacked appropriate legal representation or  because they were in a residential treatment center.
According to Young Center staff, changes in the population of  unaccompanied children in ORR custody over time made it impractical to  rely solely on ORR’s 2011 guidance because many children currently in  custody meet the broad criteria outlined in that guidance. For example,  ORR’s criteria calls for all children under 13 years old to be referred to the  Young Center, and the Young Center used to automatically recommend  advocates for these children. However, Young Center staff told us that  due to the large increase in unaccompanied children entering the United  States, there are so many young children in ORR custody moving quickly  through ORR care that it does not consider age alone to determine  whether a child is vulnerable and should receive an advocate. For  example, according to the Young Center, a young child going to live with  biological parents, with no trauma history or other factors endangering the  child’s safety and well-being, would likely not need a child advocate since  the parent can speak to the child’s best interest.
In May 2014, the Young Center proposed modified referral criteria  categories, in close consultation with ORR and other stakeholders, to  supplement ORR’s criteria and distributed the modified criteria to care  providers and other stakeholders with ORR’s approval. The Young  Center’s modified criteria categories are intended to help cope with  increases in referrals and address the challenge of screening a changing  and increasing population of children. Specifically, the Young Center  prioritized cases for children who met more than one of ORR’s 17 referral  criteria and added additional vulnerability criteria (see table 3 for  examples).
Our analysis of Young Center data on cases served from fiscal years  2012 through 2015 found that 489 of 904 children served during this  period were referred for multiple reasons. Further, cases served that met  multiple criteria increased from 44 percent in fiscal year 2014 to 66  percent in fiscal year 2015. These data suggest that the Young Center’s  efforts to supplement ORR’s criteria resulted in more child advocates  appointed to children identified as having multiple vulnerabilities.
Under ORR’s new child advocate program contract for fiscal year 2016,  the Young Center is required to review and analyze the existing referral  criteria. In addition, it is required to submit monthly reports to ORR  assessing the strengths and weaknesses of the current referral process  and explaining any recommended changes or refinements to the criteria.  ORR officials said they plan to take time to evaluate the Young Center’s  findings and then decide on any needed changes. These efforts to refine  the child advocate program referral criteria are critical to ensure that ORR  makes changes to the referral criteria that help stakeholders and the  Young Center effectively identify the highest priority cases among the  changing population of vulnerable children.
section_title: Child Advocate Program Faces Challenges with the Referral Process and ORR Does Not Monitor Referrals to Address Challenges
paragraphs: Child advocate program stakeholders we interviewed highlighted  challenges with the referral process, including care provider discretion,  inconsistent referral practices, and unserved referrals.
Referrer discretion. The child advocate program relies on other  stakeholders, primarily care providers, to initiate the referral,  according to ORR officials, Young Center staff, and our analysis of  Young Center data. According to ORR policy, care providers shall  refer any unaccompanied child in ORR care to the local child  advocate program within 3 days after the care provider staff discovers  that the child meets any of ORR’s referral criteria. However, ORR  headquarters officials said they prefer to allow care providers to use  their training, knowledge, and judgement to determine which children  need advocates, with the assistance of ORR field staff and the Young  Center. As a result, care providers exercise significant discretion  when deciding which children to refer to the Young Center, according  to Young Center staff. Referrals sometimes depend on the  stakeholders’ working relationship with the Young Center. For  example, when the Young Center advocates on behalf of vulnerable  children, there may be disagreements with care providers on the best  course of action and, at times, care providers have stopped referring  children due to those disagreements, according to Young Center  staff. Young Center staff suggested that to avoid this problem,  children should be automatically referred for advocates if certain  vulnerability criteria listed in ORR’s policy are met, such as trafficking  concerns. Without a better understanding of how care providers make  referral decisions, the Young Center and ORR lack assurance that  eligible, vulnerable children are being referred.
Inconsistent referral practices. In one program location, ORR field  staff submitted most of the referrals and served a “gatekeeper” role,  causing other stakeholders, including care providers, to make  referrals less often, according to Young Center staff. Our analysis of  Young Center data confirmed that in certain locations, care providers  and other stakeholders submit referrals less often. Specifically, in  fiscal year 2015 ORR field staff in one program location submitted  referrals for 65 percent of cases served by the local Young Center  office. Field staff in other locations submitted referrals for less than 4  percent of cases served by their local Young Center offices. ORR  officials confirmed that referral practices vary by region, stating that in  some locations, ORR field staff ask care providers to submit referrals,  while in other locations, the ORR field staff make the referral. In  locations where care providers and other stakeholders are not  encouraged to make referrals themselves, it is possible that some  vulnerable children may not be referred.
Unserved referrals. Even with the Young Center’s efforts to modify  referral criteria and prioritize cases, the Young Center continues to  receive referrals for more children than they have the resources to  serve. Five of six care providers we interviewed reported identifying  more vulnerable children in need of child advocate services than the  Young Center can serve. Further, our analysis of program data found  that the Young Center was unable to serve an increasing number of  referred cases. For example, from August 2013 to July 2014, the  Young Center received 279 referrals and was unable to serve 60 of  those cases. From August 2014 to July 2015, the Young Center  received 433 referrals and was unable to serve 116 cases. According  to the Young Center, children referred were not appointed advocates  because no advocates were available or children were released or  transferred before an advocate could begin working with them. For  example, one care provider said that their local Young Center office  was short on volunteer advocates and they experienced an average  wait time of 4 weeks or more for a referral decision from the Young  Center. Care providers in Chicago told us that in one shelter, 30 to 40  percent of children referred to the Young Center left ORR custody  before an advocate could be appointed.
ORR has not taken steps to monitor initial referrals to the Young Center  to determine the extent to which eligible vulnerable children are referred,  nor has ORR taken steps to monitor which children the Young Center has  determined it is unable to serve. Federal standards for internal control  state that ongoing monitoring should be performed continually, be  ingrained in agency operations, and include regular management and  supervisory activities, comparisons, and reconciliations, among other  actions. ORR officials said they had not monitored referrals to the  Young Center in the past because the child advocate program was a  subcontract under the Vera Institute of Justice (Vera) until September 30,  2015.
Under the new program contract, the Young Center is required to submit  to ORR certain information, including the number of children referred, the  number of children appointed advocates, as well as the reasons those  children were referred and appointed advocates. However, while  collecting this information is useful, it does not include a review of initial  referrals to the Young Center from care providers and others to determine  whether stakeholders decide to refer eligible, vulnerable children. Also,  the information collected does not include a review of the Young Center’s  decisions regarding which children it is unable to serve. Without these  reviews, ORR may not have sufficient data to (1) make informed  decisions about the kinds of vulnerable children care providers should  refer to the Young Center and how consistently referrals should be made,  and (2) ensure the program contractor effectively prioritizes children  recommended for advocate services given limited advocate availability.
section_title: Child Advocate Program Provides Recommendations to Various Stakeholders, but Faces Challenges Accessing Some Key Information
subsections: section_title: Child Advocate Program Develops Recommendations to Promote Children’s Best Interests That Aid Stakeholder Decision Making
paragraphs: The primary benefit of the child advocate program is its best interest  recommendations, according to ORR field staff, immigration judges, and  children’s attorneys we interviewed. The Young Center develops these  recommendations to help ensure a child’s safety and well-being at  different points in their case. Best interest recommendations vary  depending on each child’s circumstances, but generally are to incorporate  information on the child’s history, background, home country conditions,  and the rationale for the recommendations. For example,  recommendations could request that a child receive services while in  ORR custody, express an opinion on the appropriateness of release to a  sponsor, or provide information about whether a child can be safely  returned to their home country. These recommendations give children— especially those who are unable to make an independent decision due to  young age or trauma—a voice during the immigration process, according  to our interviews with various stakeholders. For example, the Young  Center was appointed as an advocate for a 2-year-old child. When the  Young Center was appointed as advocate, no one had been able to  locate the child’s biological mother. The Young Center gathered  information, located the child’s mother, and learned the mother’s wishes  for her child. Based on that information, the Young Center recommended  to ORR that the child be placed in a long-term foster care home.  According to the Young Center, recommendations are developed using  information gathered during one-on-one meetings with the child, from the  child’s ORR case file, in discussions with the ORR care provider, and  sometimes, with the child’s potential sponsor or family in their home  country.
We analyzed Young Center program data and found that from fiscal years  2012 through 2015 the child advocate program submitted 493  recommendations to ORR, immigration courts, children’s attorneys, and  others (see table 4). Over 70 percent of these recommendations were  adopted by the entity receiving them. For example, the Young Center  provided 70 recommendations to ORR that advocated for a particular  placement for a child, such as a less restrictive setting or a facility closer  to family members, and 67 percent were adopted.
ORR field staff, immigration judges, children’s attorneys, and others can  use the information in best interest recommendations to make decisions  about the child’s case. For example, ORR field staff said they rely on  these recommendations to make placement and release decisions,  particularly in complicated cases because the Young Center learns  information about the child that ORR may not be aware of.
Child Advocate Case Example—Advocacy Related to Placement While in ORR  Custody   The Young Center was appointed as the advocate for an infant, apprehended while in the  care of an adult woman. Due to concerns about the relationship between the woman and  child, the two were separated and the infant was placed in an ORR short-term foster  home. The woman tried to sponsor the child out of ORR custody, initially claiming to be  the child’s biological mother and produced a birth certificate which was later determined to  be counterfeit. Concerned that the child might be a victim of trafficking, the Young Center  initiated an international home study. Through the home study, the Young Center  discovered that the child’s mother did not want a relationship with the child. The mother  had given the child to the woman; however, everything had been done outside of proper  legal channels. The mother did not have any opinions about where the child should be  placed. Faced with this information, the Young Center convened a best interest  determination panel, in order to assess the child’s options. The panel was concerned  about the number of caregivers and separations the child had experienced. The child, who  had been in ORR custody for nearly a year, had formed a strong bond with her foster  family. The panel concluded that it was in the child’s best interests to remain with the  foster family. The Young Center recommended that ORR convert the child’s short-term  foster care placement into a permanent home. ORR agreed with the recommendation and  allowed the foster family to begin the process of making the placement permanent.
These recommendations also inform attorneys and judges during  immigration court proceedings. Attorneys told us that even though the  recommendations are sometimes different from the child’s expressed  wishes that are represented by their attorney, it is valuable information for  the court. The three immigration judges we interviewed said they  welcomed Young Center best interest recommendations. One judge said  the Young Center provides information she would otherwise be unaware  of and gives her greater assurance she has all the information needed to  move forward with a case.
The child advocate program also provides support for children during  court proceedings and after release from ORR custody. Child advocates  accompany children to court. An immigration judge and volunteer  advocates told us that court proceedings are intimidating for children.  Volunteer advocates can help prepare children for court proceedings and  explain the legal process in an effort to ease their anxiety. Additionally, an  immigration judge told us he relies on advocates to explain to children  what occurred in court. ORR care providers noted that while they are  required to check in with children one time after their release, the Young  Center can have more frequent contact with unaccompanied children  after their release from ORR custody. For example, after a child is  placed with a sponsor, the Young Center may provide resources to the  child and his or her sponsor, such as assistance finding an attorney, help  with school enrollment, and finding housing for children aging out of care.
In addition to obtaining stakeholder views on the benefits of the program,  we also asked stakeholders to report any challenges regarding the role of  child advocates. Most commonly, interviewees identified limited capacity  and a need for additional advocates as a shortcoming of the program.  ORR officials mentioned that sometimes the Young Center’s  recommendations are not within the purview of ORR. For example, an  ORR field staff official told us that a Young Center recommendation  requested that she introduce a child to the new medical provider and  counselor at the child’s placement location, which would have been  outside of ORR’s scope of responsibility.
section_title: Incomplete Information from ORR Can Hinder Child Advocate Program Efforts
paragraphs: While stakeholders told us they found best interest recommendations  helpful, Young Center staff said their ability to advocate for children is  hampered by ORR’s information sharing policies. Young Center staff we  interviewed at the three program sites reported that obtaining complete  ORR case file information was a challenge and it affected their work with  children and the resulting recommendations. The Trafficking Victims  Protection Reauthorization Act states that “ child advocate shall be  provided access to materials necessary to effectively advocate for the  best interest of the child.” In addition, federal standards for internal  control state that relevant, reliable, and timely information should be  communicated to those who need it in a form and time frame that enables  them to carry out their responsibilities. However, ORR’s policies restrict  access to certain information in children’s case files that describe  children’s past circumstances and current conditions while in ORR care.
Specifically, child advocates do not have access to significant incident  reports, which Young Center staff described as critical information that  should be factored into its best interest recommendations. Significant  incident reports are prepared by care providers and include information  about abuse or neglect in ORR care, behavioral incidents that threaten  safety, incidences of running away or law enforcement involvement,  pregnancy or pregnancy-related issues, safety measures, past abuse and  neglect, criminal history, or contact or threats to the child while in ORR  care from smuggling syndicates, organized crime, or other criminal  actors. ORR officials told us that significant incident reports may include  information about other children or ORR care provider staff and as a  result, ORR does not provide copies to the Young Center to protect the  confidentiality of the other individuals. ORR’s information sharing policies  allow its care providers to verbally describe information contained in  significant incident reports when requested by the Young Center.  However, Young Center staff told us that crucial information can be lost  when communicated verbally, and they rely on care providers to inform  them if a significant incident report was placed in their assigned child’s  case file. If ORR care providers do not tell the child advocate, the Young  Center will not have that information to help develop their best interest  recommendation.
ORR does not deny the Young Center access to home study reports, but  the Young Center is required to take several steps to obtain them, which  can affect the timeliness of the advocates’ recommendations. ORR  conducts home studies to evaluate a potential sponsor’s readiness to  support an unaccompanied child upon his or her release from ORR  custody. The Young Center uses home study reports to develop  recommendations related to children’s reunification with potential  sponsors, sometimes at the request of ORR field staff. Although the  Young Center is an ORR contractor, ORR’s policies require that the  Young Center obtain the sponsor’s consent to receive a copy of the home  study (see fig. 9). ORR officials said they require the Young Center to  obtain consent from the child’s sponsor because the agency is concerned  about confidentiality, privacy, and the inadvertent release of sponsor  information. According to Young Center staff, the process for obtaining  home studies is cumbersome and lengthy due to challenges reaching  sponsors to obtain consent. For example, sometimes sponsors need  translation services when they receive a consent form, they may be wary  of an unfamiliar organization requesting information about their family, or  they may lack access to a fax machine to return completed forms. In  addition, Young Center staff said that there are cases where sponsors do  not consent to them receiving a copy of the home study. For example, in  complex cases where there are concerns about the potential sponsor, the  sponsor may not give consent, but those are the types of cases where  best interest recommendations have value. When a sponsor does not  consent to allowing the Young Center to review a home study reports, the  Young Center submits a recommendation to ORR without viewing the  report.
Developing recommendations without critical information from significant  incident reports and delays in obtaining home study reports as a result of  ORR’s policy affects the completeness of the recommendations,  according to Young Center staff. The Young Center provided an example  in which they had been appointed as advocate for a child that was moved  to a more restrictive ORR care facility as a result of behavioral incidents  while in ORR care. These behavioral incidents were documented in  significant incident reports, and after the move, the child received  additional significant incident reports. However, the child’s care provider  could not provide the Young Center with copies of the reports. According  to the Young Center, without more detailed information about the child’s  behavioral issues, they were unable to provide recommendations on  services that might best meet the child’s needs. In another example  provided by the Young Center, they were appointed as the child advocate  for a 16-year-old girl, who had an extensive history of trauma and abuse.  The child was placed in ORR custody and the child’s uncle sought to  sponsor her out of custody. Because of the child’s extensive trauma  history and a lack of relationship between her and her uncle, ORR  conducted a home study. The Young Center reached out to the child’s  uncle twice to obtain authorization to view the home study report;  however, he declined to provide consent. As a result, the Young Center  was unable to provide ORR a recommendation regarding whether it was  in the child’s best interests to reunify with her uncle. Without relevant and  timely information, the Young Center is unable to fully carry out its  responsibilities.
As part of the new child advocate program contract that began on  September 30, 2015, ORR plans to work with the Young Center to draft  joint information sharing policies. The contract states that within 180 days  of the contract award, ORR and the Young Center will finalize information  sharing policies. In February 2016, ORR officials told us that the agency  was in the process of updating its information sharing policies, which  could include providing the child advocate program with copies of  significant incident reports and home study reports. Officials said they are  working with the child advocate program to develop procedures for  accessing this information. Officials plan to release new policies by late  April 2016.
section_title: Conclusions
paragraphs: The child advocate program provides vulnerable, unaccompanied  children an advocate who is committed to learning their history and  representing their best interests while in custody and during removal  proceedings. As the program expands to the six new locations, additional  children each year will receive help navigating the complex immigration  system. However, because the number of unaccompanied children  arriving in this country has increased significantly in recent years, the  program will continue to serve a very small percentage of the total  number of children in custody. Further, the program will likely continue to  receive more referrals than it can serve; however, ORR has no assurance  that all of the children who need services are being referred. Given this, it  will be important for ORR to monitor program performance through this  expansion and move forward in two key areas. First, by monitoring initial  referrals to the child advocate program, ORR will be better positioned to  know whether referrals are consistently being made by care providers  and field staff. Second, by monitoring the cases that are assigned  advocates by the contractor, ORR will be better able to assess whether  limited resources are being used for the most vulnerable children. Without  taking these steps to ensure thorough and consistent monitoring, ORR  cannot be assured that the child advocate program is operating as  effectively as intended.
Since its inception, the child advocate program has provided  recommendations to a variety of stakeholders to ensure that the best  interests of hundreds of children are met while in ORR custody and after  their release. Multiple stakeholders agree that these recommendations  are valuable assets that help them determine how best to support the  children. Although the program’s recommendations can contribute to  better outcomes for the children, ORR’s information sharing policies may  limit the program’s ability to effectively advocate on behalf of the children  it serves.
section_title: Recommendations for Executive Action
paragraphs: To help ensure vulnerable unaccompanied children receive child  advocate services, we recommend that the Secretary of the Department  of Health and Human Services direct ORR to develop a monitoring  process that includes: (1) regularly reviewing referrals to the program  contractor, including identifying which care providers in locations with a  child advocate program do not make referrals; and (2) reviewing  information on the children the program contractor determines it is unable  to serve.
To help the program’s contractor improve its recommendations on behalf  of vulnerable unaccompanied children, the Secretary of Health and  Human Services should direct ORR to work with the program’s contractor  to ensure access to key information is provided in a timely manner. For  example, this could include providing the program contractor with direct  access to significant incident reports or exploring ways to streamline  access to home studies without compromising the privacy of potential  sponsors or other individuals.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided a draft of this report to HHS for review and comment. HHS  provided formal comments that are reproduced in appendix IV. HHS also  provided technical comments that we incorporated, as appropriate.
HHS concurred with both of our recommendations and outlined steps it is  taking to implement them.
In response to our recommendation to develop a monitoring process that  includes regularly reviewing referrals to the child advocate program and  reviewing information on children who cannot be served, HHS stated that  ORR will be directly monitoring child advocate activities as required under  the contract with the Young Center and under the law, including applying  federal standards for internal control. In addition, HHS commented that  ORR policy allows for any stakeholder to make a referral for a child  advocate, a policy that has been standardized for over 5 years. However,  we observed inconsistent referral practices and continue to encourage  ORR to review the initial referrals to the Young Center from care  providers and others to determine whether stakeholders decide to refer  eligible, vulnerable children. HHS also said that ORR is continually  evaluating its service model to ensure appropriate accountability for  program staff and to provide improved services for children in the  agency’s care and custody.
In response to our recommendation to ensure the child advocate  program’s timely access to key information, HHS stated that ORR is  evaluating its information sharing policies and will consider how to meet  all legal obligations regarding the provision of information to child  advocates while protecting privacy and confidentiality rights of everyone  involved in the child’s case. The program contract that began on  September 30, 2015, states that within 180 days, ORR and the Young  Center will finalize information sharing policies. Given this timeframe, we  encourage ORR to expeditiously work with the Young Center to  determine the best way child advocate program staff can obtain timely  access to key information to best serve the children in need of the  advocate services.
We are sending copies of this report to the appropriate congressional  committees and the Secretary of Health and Human Services. In addition,  the report is available at no charge on the GAO website at  http://www.gao.gov.
If you or your staff have any questions about this report, please contact  me at (202) 512-7215 or brownke@gao.gov. Contact points for our  Offices of Congressional Relations and Public Affairs may be found on  the last page of this report. GAO staff who made key contributions to this  report are listed in appendix V.
section_title: Appendix I: Objectives, Scope, and Methodology
paragraphs: This report examines: (1) the extent to which the Office of Refugee  Resettlement (ORR) implemented requirements to increase the number  of child advocate program locations and the impact of the expansion on  program costs and number of children served, (2) the extent to which  ORR ensured vulnerable unaccompanied children were receiving  services, and (3) the benefits of the child advocate program, and what  challenges, if any, it faces. To address all three objectives, we conducted  interviews with stakeholders that either had experience referring children  to the child advocate program or had received recommendations from the  program. To conduct these interviews, we visited Young Center child  advocate programs in Chicago, Ill., and Washington, D.C., and spoke via  phone with the Brownsville, Tex. program site. The Young Center is  contracted to provide child advocate services for children in ORR  custody. These sites were selected based on variation in the number of  children served, amount of time the advocate program has been  operational, and types of ORR care facilities in operation. In Chicago, we  interviewed staff from three ORR care facilities (two shelters and one  staff-secure facility), one immigration judge, two groups of volunteer child  advocates, and the Young Center’s staff attorneys, social worker, and  management team. In the Washington, D.C. area, we interviewed staff  from one ORR facility with secure and staff-secure beds, one immigration  judge, and Young Center staff attorneys. For the Brownsville, Tex. area,  we interviewed care providers from two ORR facilities (one foster  program and one shelter), one immigration judge, one group of volunteer  child advocates, and Young Center staff attorneys. In addition, we  interviewed three legal services providers—located in Chicago, Ill.,  Corpus Christi, Tex., and Washington, D.C.—that had experience  representing children with an advocate. We also interviewed staff from  the U.S. Conference of Catholic Bishops and the U.S. Committee for  Refugees and Immigrants—the two organizations that operated  temporary child advocate programs for children released from ORR  custody in fiscal year 2015. The information obtained from these  interviews is not generalizable.
To address all three objectives, we also interviewed ORR headquarters  and field staff. In addition, we interviewed headquarters staff for the  Department of Justice’s Executive Office for Immigration Review,  including the Assistant Chief Immigration Judge for Vulnerable  Populations. We reviewed ORR documents, such as child advocate  program policies and contracts that provided funding to the Young Center  to operate the child advocate program. We also reviewed relevant federal  laws and regulations, including the Violence Against Women  Reauthorization Act of 2013 and the William Wilberforce Trafficking  Victims Protection Reauthorization Act of 2008.
To address our first and second objective, we analyzed data on cases  served by the Young Center’s child advocate program from fiscal year  2012 through fiscal year 2015, the four most recent years for which data  were available. These case data included information on children’s age,  gender, country of origin, reasons they were referred to the program, and  the source of those referrals. To prepare the data on reasons children  were referred to the program for analysis, one analyst reviewed the data  and assigned a code for each reason children were referred. Codes for  each referral reason were based on categories of vulnerable,  unaccompanied children established in ORR and Young Center referral  guidance. In many cases children were referred to the program for  multiple reasons and multiple codes were assigned to their case. A  second analyst verified the coding to ensure reasons for referral were  coded consistently. A third analyst conducted a final review and resolved  any disputes over the appropriate codes. We also analyzed data on the  number of cases the Young Center was unable to serve from August  2013 through September 2015. The Young Center did not track this  information consistently for all program locations prior to August 2013.  The data on unserved cases included information on children’s age,  gender, the Young Center location that was unable to serve the case, and  the reason the Young Center was unable to serve the case. Additionally,  we analyzed data from ORR on care providers that included information  on the locations and types of care provider facilities, numbers of children  each facility could house, and numbers of children in custody in each  facility as of October 2015. We compiled information from ORR’s data on  facilities in current and proposed Young Center sites to determine (1) how  many children could be cared for in each location, and (2) how many  children were in custody in each location. We also used publically  available ORR data on the number of children released to sponsors by  county in fiscal year 2015 and data on counties included in metropolitan  areas from the United States Census Bureau to determine how many  children were released in the same metropolitan areas as current and  proposed Young Center sites.
To address our third objective, we analyzed information collected on  formal best interest recommendations the Young Center provided to a  variety of stakeholders from fiscal year 2012 through fiscal year 2015.  These recommendations are provided to stakeholders in writing and  verbally. The recommendations information we analyzed included all  written recommendations from fiscal years 2012 through 2015 and some  verbal recommendations tracked by the Young Center and provided to  stakeholders in fiscal years 2014 and 2015. Therefore, the information we  analyzed likely does not capture all of the Young Center’s formal best  interest recommendations from fiscal years 2012 through 2015. The  recommendation information included the number of recommendations  made; types of decision makers that received recommendations (such as  immigration judges, attorneys, ORR, etc.); key issues on which  recommendations were provided (such as release, placement, legal relief,  repatriation, etc.); and the outcome of those recommendations (such as  adopted, adopted in part, or declined). In addition to formal best interest  recommendations, the Young Center makes informal recommendations  to decision makers; however, we did not analyze information related to  informal recommendations. Additionally, in some instances one  recommendation was submitted to multiple stakeholders; however, the  data identified the primary recipient of the recommendation and did not  include information on additional recipients.
The case and recommendation data were provided by the Young Center.  We assessed the reliability of the case and recommendation data by (1)  performing electronic testing of required data elements, (2) reviewing  information about the data and the system that produced them, and (3)  interviewing knowledgeable Young Center staff about the data. We  assessed the reliability of ORR’s data by (1) reviewing ORR business  rules to ensure data reliability and (2) interviewing ORR officials and  contractors knowledgeable about the data. We determined that the data  were sufficiently reliable for our purposes.
section_title: Appendix II: ORR Appointment of Child Advocates Policy, ORR Operations Manual, Effective September 15, 2011
section_title: Appendix III: Young Center Criteria for Prioritizing the Assignment of Child Advocates, Effective May 21, 2014
section_title: Appendix IV: Comments from the Department of Health and Human Services
section_title: Appendix V: GAO Contact and Staff Acknowledgments
subsections: section_title: GAO Contact
section_title: Staff Acknowledgments
paragraphs: In addition to the contact named above, Sara Schibanoff Kelly (Assistant  Director), Andrea Dawson (Analyst-in-Charge), Paulissa Earl, and Aimee  Elivert made key contributions to this report. Also contributing to this  report were James Bennett, Kate van Gelder, Jean McSween, James  Rebbe, Jerry Sandau, Almeta Spencer, Ashanta Williams, and Paul  Wright.
section_title: Related GAO Products
paragraphs: Unaccompanied Children: HHS Can Improve Monitoring of Their Care.  GAO-16-429T. Washington, D.C.: February 23, 2016.
Unaccompanied Children: HHS Can Take Further Actions to Monitor their  Care. GAO-16-180. Washington, D.C.: February 5, 2016.
Unaccompanied Alien Children: Improved Evaluation Efforts Could  Enhance Agency Programs to Reduce Migration from Central America.  GAO-16-163T. Washington, D.C.: October 21, 2015.
Central America: Improved Evaluation Efforts Could Enhance Agency  Programs to Reduce Unaccompanied Child Migration. GAO-15-707.  Washington, D.C.: July 29, 2015.
Unaccompanied Alien Children: Actions Needed to Ensure Children  Receive Required Care in DHS Custody. GAO-15-521. Washington, D.C.:  July 14, 2015.
Central America: Information on Migration of Unaccompanied Children  from El Salvador, Guatemala, and Honduras. GAO-15-362. Washington,  D.C.: February 27, 2015.