“All I Know Is That We Failed”: The Experiences of Human Service Workers Supporting the Health of Unaccompanied Minors

Unaccompanied children (UC) in the United States represent a vulnerable migrant population because they are under age 18, traveling without a parent or guardian, and apprehended by the United States Border Patrol after a dangerous journey. Many have experienced various forms of trauma prior to and while migrating, so the weeks (and, in some cases, months) they are in government-contracted programs and shelters are a critical opportunity to assess their health and mental health needs and to intervene as needed. This article examines how staff members working at government-contracted agencies address UC health and mental needs. Drawing from 65 in-depth interviews with human service workers at these agencies, the authors identify how staff navigate and influence UC access to care. The findings reveal how frontline staff shape UC access to medical, dental, and mental health services, often improvising within a complex system of policy constraints and limited resources. Staff described using strategies such as reframing medical needs to secure authorization for treatment, building and maintaining fragile provider networks, and adapting to persistent barriers in insurance and funding. These insights underscore the importance of policies that strengthen continuity of care and support staff discretion in advocating for UC health needs.