Academic Health Centers and Humanitarian Crises: One Health System’s Response to Unaccompanied Children at the Border

Abstract

University of California Health (UCH) provided a system-wide, rapid response to the humanitarian crisis of unaccompanied children crossing the southern U.S. border in the midst of the COVID-19 pandemic in 2021. In collaboration with multiple federal, state, and local agencies, UCH mobilized a multidisciplinary team to deliver acute general and specialty pediatric care to unaccompanied children at 2 Californian emergency intake sites (EISs). The response, which did not disrupt normal UCH operations, mobilized the capacities of the system and resulted in a safe and developmentally appropriate environment that supported the physical and mental health of migrant children during this traumatic period. The capacities of UCH’s 6 academic health centers ensured access to trauma-informed medical care and culturally sensitive psychological and social support. Child life professionals provided access to exercise, play, and entertainment. Overall, 260 physicians, 42 residents and fellows, 4 nurse practitioners participated as treating clinicians and were supported by hundreds of staff across the 2 EISs. Over 5 months and across both EISs, a total of 4,911 children aged 3 to 17 years were cared for. A total of 782 children had COVID-19, most infected before arrival. Most children (3,931) were reunified with family or sponsors. Continuity of care after reunification or placement in a long-term shelter was enhanced by use of an electronic health record. The effort provided an educational experience for residents and fellows with instruction in immigrant health and trauma-informed care. The effort benefitted from UCH’s recent experience of providing a system-wide response to the COVID-19 pandemic. Lessons learned are reported to encourage the alignment and integration of academic health centers’ capacities with federal, state, and local plans to better prepare for and respond to the accelerating need to care for those in the wake of disasters and humanitarian crises.

Strengthening Academic Medicine’s Response to Humanitarian Concerns

“…[3][4][5][6][7] In this issue of the journal, we are pleased to highlight the efforts and experiences of our colleagues in academic medicine that have addressed the humanitarian crisis of unaccompanied children received at the southern border of the United States, as described by Devaskar et al 8 As these authors detail, the numbers of children arriving at the border not accompanied by a biological parent reached unprecedented heights in 2021. 8,9 The majority of these children fled their home countries because of extreme poverty, violence, and social conditions that made it impossible to thrive and grow, seeking to join family members already living in the United States. Many children, then and now, arrive with complex and chronic histories of trauma and adversity, and reach the southern border after undertaking arduous journeys where they faced acute health, safety, and psychological risks.…”

“…15 In that moment of crisis, the federal government turned to academic medicine for support in addressing the medical and health needs of unaccompanied children in government custody at EISs. 8 Devaskar et al 8 tell the compelling account of a university health care system-in this case, the University of California Health system (UCH)mobilizing to meet the needs of both individual children and governmental systems in a critical moment in their respective experiences. This story exemplifies the crucial and influential role that academic medicine can play in responding to humanitarian concerns and crises.…”

“…Indeed, Devaskar et al document an impressive process within the UCH to organize and coordinate resources across big organizations and systems to address the humanitarian concerns regarding the health and safety of unaccompanied immigrant children. 8 The authors offer a roadmap for organizational processes within academic medicine that can inform or be replicated in future efforts (1) to pursue academic–governmental partnerships and/or (2) to advance academic medicine’s responses to humanitarian concerns and crises. Inspired by this effort, we call on other academic health centers to look to the UCH experience in considering the ways they can expand traditional boundaries and service efforts consistent with their missions and values.…”

“…15 In that moment of crisis, the federal government turned to academic medicine for support in addressing the medical and health needs of unaccompanied children in government custody at EISs. 8…”