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WASHINGTON, DCInteragency communication failures and poor internal management decisions impeded the ability of the U.S. Department of Health and Human Services (HHS) to provide prompt and appropriate care for separated children following the spring 2018 implementation of the zero-tolerance policy, according to a report released today by the HHS Office of Inspector General (OIG).
The report cites several factors that undercut HHS's efforts to care for separated children in its custody, including a lack of interagency coordination on immigration issues, despite a variety of channels that exist to facilitate high-level engagement. In addition, key senior HHS officials did not act on repeated, advance warnings from staff that family separations were occurring prior to the zero-tolerance policy and might increase. As a result, HHS was not prepared for family separation, according to the report, Communication and Management Challenges Impeded HHS's Response to the Zero-Tolerance Policy.
"Future immigration trends, practices, and policies will continue to affect the Unaccompanied Alien Children Program. In this quickly changing landscape, clear lines of communication across Federal agencies and within HHS are vital to its ability to adapt and respond effectively to new developments," said HHS OIG Principal Deputy Inspector General Christi A. Grimm. "The vulnerabilities we identified need to be addressed to ensure that HHS can effectively care for children in its custody. We commend HHS for taking several tangible steps and planning others to address our findings and recommendations."
Within HHS, the Unaccompanied Alien Children (UAC) Program serves minors who have no lawful immigration status in the United States and do not have a parent or legal guardian available in this country to provide care and physical custody. In 2017 and 2018, the Department of Justice (DOJ) and the Department of Homeland Security (DHS) took steps to increase enforcement of immigration laws, culminating in the spring 2018 implementation of a zero-tolerance policy for specified immigration offenses. Under this policy, families entering the United States without authorization were separated, with parents placed in Federal custody to await prosecution for illegal entry while their children, now unaccompanied, were transferred to the care of the HHS Office of Refugee Resettlement (ORR). In late June 2018, a Federal district court enjoined DHS from continuing to separate families, except in very limited circumstances largely related to criminal history and ordered the Government to reunite separated children still in the care of HHS with their parents.
Poor interagency communication and management decisions that failed to protect children's interests left HHS unprepared for the zero-tolerance policy.
Without a comprehensive plan for the possibility of large-scale family separations, ORR was unprepared for the surge in separated children after the zero-tolerance policy was implemented in 2018. This lack of preparation impeded HHS's ability to identify, care for, and reunify separated children.
ORR staff warned key senior HHS officials about family separation in 2017 and 2018, before the zero-tolerance policy was implemented, noting that the number of separated children had increased and might grow further. ORR staff raised concerns about the lack of "bed capacity to accommodate a large increase in separated children" and about the "trauma such a policy would inflict on children." However, key senior HHS officials did not elevate this information or direct any actions to prepare.
In the absence of a plan for the possibility of increased separations, the UAC Program was left to react to "changes as they occurred rather than taking proactive measures that might mitigate risk to children," the report noted. Furthermore, because no procedures or systems had been established to track separated families across HHS and DHS, HHS struggled to identify separated children after a Federal district court ordered the government to reunify separated families.
Care provider facilities faced significant operational challenges at every stage of the reunification process. These challenges were further complicated by poorly communicated guidance and directives from ORR.
Care provider facilities faced significant operational challenges at every stage of the reunification process. Facilities encountered difficulties locating and communicating with parents in DHS or DOJ custody, as well as determining whether parents and children could be safely reunified.
"Sometimes it's easier to find a parent in a rural village in Guatemala than to find them in detention," an ORR staff member told OIG.
Facilities also reported logistic and coordination problems, including extended delays at some DHS detention centers that served as reunification sites. In some cases, children and facility staff spent hours, late at night, waiting in vans in detention center parking lots.
Finally, facilities also reported that HHS poorly communicated its guidance and directives about separated children, with conflicting guidance coming from different sources within ORR. Inadequate communication contributed to confusion about the reunification process and increased children's stress.
"Not knowing what happened to their parents haunted the children. We couldn't tell them whether they would ultimately be reunited. It was challenging. We weren't notified initially about how to connect parents with their kids," said a facility lead mental health clinician. "The kids had lots of questions, but we had no answers for them."
HHS has taken steps to improve tracking of separated children, but the procedures include manual processes that are vulnerable to error.
In the wake of the zero-tolerance policy, HHS has taken steps to improve the tracking of separated children. However, even these improved procedures rely on multistep, manual processes that are inherently vulnerable to error. In addition, ORR continues to experience difficulties getting specific information from DHS about parents' criminal backgrounds, which impedes ORR's ability to provide appropriate care and placement.
OIG Recommendations to Better Serve Children in HHS Custody
HHS was not responsible for separating families, but HHS's inadequate communication, management, and planning made a difficult situation for separated children worse. HHS should address the communication and management concerns that we identified to ensure that it can provide

Janet and I had a bad sore throat and cough, when we returned from SE Asia (Singapore, Thailand, Cambodia, Vietnam, Hong Kong) on January 4. We immediately drove part way to Vegas that night and I emailed people in Las Vegas where I was scheduled for about 5 or 6 events, telling them it should be no go and I was sure I was sick. There was no coronavirus news or travel restrictions yet. I did make a couple of appearances in Vegas but I couldn't speak except nearly with laryngitis. We cancelled everything else to head home but I couldn't move out of bed for 2 days. I did tell everyone that I was sick and stayed away from almost all in Vegas.
This was the worst flu of our lives. Because we had GI symptoms, it may have been some other virulent flu. Janet was coughing up blood and went to the hospital and they said it was no American flu. We have not been able to get tested in this country. Had our return from SE Asia been today, we'd certainly have been tested and quarantined, with the symptoms we had. But it wasn't treated as important back then. I did notify the CDC early but they just came back with a boilerplate letter saying to wash our hands. There as no test for this COVID-19 then. Eventually, they did have a test but you could only get it done through the CDC and they wouldn't test people like myself and Janet, who were well past symptoms.
"Patient zero" was kind of a joke. I think that our GI symptoms would fit some other flu, because you rarely hear of that with COVID-19. But there's no way to ruse us out.

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