“Kids in Cages” at the Border Find Terra Firma in the Bronx

Issue 249

Renee Feltz Aug 9, 2019

Unaccompanied children who come alone from Central America to seek asylum in the United States have complex legal, medical and mental health needs. After their release from harsh conditions in U.S. border camps and detention centers run by the Office of Refugee Resettlement, some are released to New York City. In the Bronx, Terra Firma helps hundreds of kids pursue healthy lives when they are reunited with their parents or sent to live with a sponsor. The Indypendent spoke with co-founder Dr. Alan Shapiro.

What experience motivated you to work with migrant children?

I have dedicated my career to working with marginalized and vulnerable children. What led to Terra Firma was actually a Guatemalan boy that came to our mobile medical unit serving homeless youth in Harlem that we’ve operated since 1987. He had lost his psychiatric medications and needed to get new ones. Sadly, this boy was very severely mentally ill and unable to tell us anything about his history, except he had a business card from his lawyer, with Catholic Charities, and that was Brett Stark, who is now our Legal Director. We called Brett and he explained they were seeing an uptick in the number of “unaccompanied” children seeking legal services and they were also looking for medical and mental health services to send children to. When we learned that being an “unaccompanied” immigrant child granted them the ability to seek legal status in the United States, we set up a program to meet their needs in 2013. Then, when a large number of children came into the city in the spring of 2014, we were ready to accept many of them.

What kind of trauma have these children endured when you encounter them?

You have to remember children are in the stage of developing their identity, the sense of who they are, and that will be carried through to adulthood. These children often have sustained compounded trauma. They have been traumatized first by events in their home country. Then they leave their home countries, which in itself is extremely traumatic, and have to leave behind family, friends, school, culture, everything. They then travel often more than 2,000 miles to the U.S. border, and many are victimized, suffer from hunger, exposure to the elements, and travel in dangerous ways — on top of trains and in the back of trucks. By the time they get to your border, they are in a pretty fragile state. Then they either go to a port of entry, or cross the border through the desert or the Rio Grande. That in itself can be a frightening experience.

You would think the system should provide the most comforting, safe, healthy environment for children so they can recover from the trip and start feeling a sense of safety. Unfortunately, it puts kids at more risk of traumatization. We know from visiting Customs and Border processing centers, and from the government’s own reports, that they are freezing, have non-nutritious food such as bologna sandwiches, and children often have to sleep on cement floors with a mylar blanket. Children don’t understand what the next steps are, and why they’re there in the first place. Some are held up to a month, against regulations. To add to all that: the medical services in the Customs and Border processing centers are very cursory. 

When these children are released to the Bronx to live with their court-appointed sponsor or be reunited with their families, how does Terra Firma address their needs?

Terra Firma’s principal role is to care for the complex needs of migrant children once they are released from ORR detention and are living in New York City with their sponsors. We provide comprehensive pediatric care in a medical home model, integrated with on-site mental health services and pro bono immigration services. We also have a robust Youth Enrichment program that includes English, workshops, educational support and field trips throughout the year. It includes a summer program with English as a second language courses for children for two hours, followed by two hours of soccer, in collaboration with South Bronx United, a youth development program; a photography course in collaboration with the International Center for Photography and field trips to museums to other places around New York. 

You describe the program as a medical-legal partnership?

In this partnership, healthcare professionals work side by side with immigration attorneys and may uncover invaluable information that can be used to support the children’s legal cases. When children come to us they’re more likely to have been victims of community and/or domestic violence (e.g. physical and sexual abuse) but might not feel comfortable telling their lawyers about what happened. However, the medical providers and mental health providers are adept at identifying those problems and helping children retell these histories and process those traumas.

What’s so important about that is that many of these traumas are critical for children to win their legal cases to be allowed to remain in this country. The healthcare providers will write mental health and/or medical affidavits that explain the physical and psychological trauma that child has endured and how these findings corroborate the child’s own story. We had an adolescent boy who was run over by a car of gang members because he refused to join their gang. When he came to us, we referred him to an orthopedic specialty clinic where x-rays revealed past injuries and the metal plates in his leg. He originally lost his asylum hearing. The medical evidence, in this case, corroborated his history and that proved critical in winning his asylum case.

How does your program help the kids adjust to their new lives?

Terra Firma has a critical role in helping children acculturate into a new environment. Children who must now adjust to a new family, a new language and a new culture. We see children who come perhaps from rural Guatemala, and now they’re living in the South Bronx. You can imagine how incredibly disorienting that might be. We provide mental health services to help them process all of the trauma I spoke about and the incredible change of now living with a new family that many of them have never seen in their life or not for 10 or 15 years, even if it’s a parent. So there is this enormous amount of readjustment and a lot of emotional complexity, in the reunification process with family, both enormous joy but also feelings of guilt and anger.

All of this makes it important for us to be there for children, and for their sponsors, their new families, to help them, as we say, to land on solid ground, which is what Terra Firma means. We also run support groups for adolescents, preteens and the children’s sponsors. Our groups are based on a trauma-informed model of care. For unaccompanied children, the group meets weekly for 14 weeks and follows a curriculum that deals with the various phases of migration and living now in the United States. When we start the groups off, we always invite veterans of the group who are kids who have already gone through this to talk to the new cohort of children.

What kind of outcomes have you seen?

In general, the children we see are among the most resilient children I have ever cared for. Many of the kids that we first started to take care of back in 2013 are now in college and thriving. Just this year, one of our girls won a Beat the Odds $10,000 college scholarship from the Children’s Defense Fund. Another one just won a scholarship to CUNY’s Hunter College. What really upsets me so much is the negative rhetoric one hears about who these new immigrant children are from politicians who have never seen or worked with these kids and who don’t see their humanity or the incredible successes that we see. Many of these kids also want to give back to the community because they felt so thankful for the services they received.

Have others been able to replicate your model? 

We are in the process of writing a replication manual right now! We’ve given dozens and dozens of presentations and have received many requests to help replicate. So we’re looking for funding so that we can grow our own program and then help others develop the terra firma model as well.

How can people who read this support Terra Firma?

We’re asking folks to donate at If people are interested in volunteering, they can make a request through our website as well.

Renée Feltz is an investigative journalist who has covered immigration since 2006.

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