P2.183: Evaluation of a Student Led Asylum Clinic Serving a Local Pediatric Asylum-Seeking Cohort

Background: Our Human Rights and Asylum Clinic (HRAC), partnered with Physicians for Human Rights (PHR), is a student-run clinic that connects immigration attorneys with clinicians to provide forensic evaluations for asylum seekers in the United States. Located in Houston, Texas, HRAC seeks to address the region’s low asylum approval rate for represented clients of 18% compared to the national rate of 46%. Notably, although Houston received the largest share of the 530,000 unaccompanied migrant children arriving in the United States between 2015-2023, the regional approval rate for pediatric asylum seekers is unknown. Therefore, this study aims to better understand the asylum application process for minors and evaluate HRAC’s impact on this vulnerable population.

Methods: A retrospective analysis of pediatric cases (≤18 years old) completed by our institution's HRAC over the past six years (2019-2024) was conducted using data from PHR, an internal case database, and Transactional Records Access Clearinghouse. Data on client demographics, asylum requests, evaluation specifics, and clinic personnel were collected, and descriptive analysis performed.

Results: The HRAC completed 74 forensic evaluations over six years, of which 13 were pediatric cases (18%). Among the pediatric clients, their ages ranged 3-18 years (average=14 years, median=16 years) and the majority were male (n=8). All clients were from Spanish-speaking countries, with Honduras (n=6) as the most common country of origin. All evaluations were conducted in Spanish and 10 (69%) did not require an interpreter. Evaluation types included psychological (n=11), neuropsychological (n=1), and physical (n=1). Most clients (n=10) sought asylum based on persecution due to membership in a particular social group. The nature of their trauma included experienced sexual violence (n=6), experienced physical violence (n=2), witnessed gang-related violence (n=4), witnessed murder (n=2), and witnessed domestic violence (n=1). Case outcomes for 5 clients were identified: 1 granted asylum, 1 ordered dismissal, 2 ordered removal, and 1 ordered termination. Case outcomes for 8 clients are unknown. The clinic has trained 122 evaluators, including physicians (32%), social workers (21%), counselors (15%), psychologists (8%), PhDs (5%), psychometricians (2%), physician assistants (2%), and nurses (15%).

Conclusion: This study is the first to demonstrate the complex process of securing asylum for minors in Houston, Texas. Asylum approval can be a life-saving intervention, making informed pediatric forensic evaluations critical. Consideration of cohort demographics, evaluations performed, and basis for asylum will ensure that evaluation stakeholders are well-prepared. Since case dismissal signifies the government is no longer pursuing removal, 40% of clients in this cohort with known legal decisions had improved legal outcomes. Although asylum outcomes are limited due to COVID-19-related delays and court backlogs, we are encouraged by the development of this database to identify the unique needs of this population. However, with most case outcomes unknown, HRAC efficacy cannot yet be drawn.