The Impact of Discretion on Human Service Workers Supporting the Health of Unaccompanied Minors in Foster Care

Unaccompanied children (UCs) are a vulnerable population that enters government custody and accesses healthcare via the Office of Refugee Resettlement (ORR)'s system of care. While prior research has focused on generating policy recommendations to improve healthcare services available to UCs both in ORR custody and following release from custody, this thesis will instead expand upon the experiences of staff members working at ORR-contracted agencies. These workers make decisions that have short- and long-term implications on the health and wellbeing of UCs. Drawing from 65 in-depth interviews with human service workers in ORR-contracted voluntary agencies, this thesis uses street-level bureaucracy framework to examine what discretion (scope of influence) staff have that may shape the continuum of care available to unaccompanied children and what factors influence decisions that staff make regarding assessment and treatment of unaccompanied child health needs. The findings suggest that bureaucratic oversight and age restrictions for ORR care decrease staff discretion, negatively impacting worker satisfaction and efficacy and potentially jeopardizing the health and wellbeing of UCs in custody and post-release.