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. 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). 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.

Summary: 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. 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. 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.