How does a clinical evaluation strengthen an immigration case?

There are many ways in which a psychosocial evaluation can strengthen a client’s asylum or other type of immigration case. Listed below are a few:

  • Corroboration of a client’s story by an outside source
  • Provide detailed explanation of a client’s mental and emotional state that can help to explain any unusual behaviors in court such as withdrawal.
  • Helping to establish the client as a reliable source of information by providing expert assessment of their credibility.
  • Explanation of any inconsistencies in the client’s story – for example, victims of crimes sometimes block out the event and have great difficulty recalling details related to the event, which can make the client seem unreliable.  Shame can also play a factor, as sometimes a client does not want to admit to what has happened to them.
  • Humanize the people involved in the case by providing a more personal account of the client’s life and impacts on themselves and their family members if client is deported.
  • In talking with the therapist about their situation, the client can become more open to speaking in court and to other professionals involved in their case.
  • Because of the clinician’s expertise in talking to clients about highly personal life events , the therapist is sometimes able to ascertain information from a client that the client did not reveal to the attorney.
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Why have your evaluation completed by a clinical social worker??

In this article about types of clinical evaluations that are often used to support immigration cases ( http://www.msba.org/departments/commpubl/publications/bar_bult/2007/oct/evaluation.asp) it is noted that many of the tests used by clinical psychologists in their evaluations with immigrants are not appropriate with this diverse population, and the tests are therefore of limited or no use. The author indicates that because the tests do not account for diversity in cultural backgrounds, they cannot be reliably used for immigration evaluations.

Because clinical psychologists use testing in their evaluations, the time for the evaluation is significantly lengthened and therefore the cost of the evaluation is substantially higher.

Inherent in our training as social workers is the idea that all people should be able to have access to services that will support them. In offering a reduced, sliding-scale fee for my reports, I open the door to people who would not have been able to previously afford these evaluations.  I believe that not just wealthy clients should have access to high quality legal and mental health services

In addition to offering a reduced price for an evaluation, I also offer a payment plan.  This has meant that I have successfully completed evaluations with clients who would not have been able to afford this much needed service.

Finally, social workers are trained to look at a person as part of a larger community, family and social network, and that any complete evaluation will focus on the impact of outside influences on the individual, and how the person fits into their environment.  This holistic view provides for a more expansive understanding of a person’s functioning rather than looking more specifically on diagnostic criteria.  Although a diagnosis is often a piece of the evaluation, providing an overall picture of a person in light of where they fit in their larger world is the job of a successful psychosocial evaluation.

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Mary’s Center for Maternal and Child Care

One of the community agencies I most commonly refer clients to is Mary’s Center for Maternal and Child Care.  With several DC locations as well as a clinic in Silver Spring and Adelphi, Maryland, Mary’s Center offers an array of bilingual/Spanish services that include medical, dental, mental health and community-based support.   These services can be accessed even without health insurance and are often offered for no or low-fee.  Support services include an array of community, home-based and educational services along with individual therapy.

http://www.maryscenter.org/

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Female-specific trauma evaluations

One of the specialized types of evaluations I conduct are with women who have undergone Female Genital Mutilation (FGM) procedures.  These brutal mutilations are still performed, according to the World Health Organization, in 28 countries, mainly in Africa and the Middle East.  Because this practice is so physically and emotionally harmful, women who have undergone FGM are considered for asylum applications.  My evaluations help to describe the life-long negative consequences these procedures nearly always cause.

The women I have met with report having their FGM as young as in infancy up until as old at 12 or 13.  Many are so young they don’t remember the actual procedure.  For those that do remember it, they often describe PTSD-like reactions, with high startle responses, flashbacks and avoidance and fear of anyone who reminded them of the event.  They also describe a change in socialization, going from having been more outgoing and confident prior to the FGM, to becoming withdrawn and self-conscious afterward.  Over time, these feelings become more specific to relationships with men.  Nearly all the women I have interviewed admit that they feel like they are somehow not whole  or real women, that because their most sensitive female body part has been mutilated, that they are somehow not able to be fully feminine, or to please a man intimately.

For many of the women I meet with, talking to me about their experience is one of the few times they have ever admitted to or discussed this event.  Despite the fact that they were usually raised in communities where many young girls experienced FGMs, they never  vocalized what they went through.  Growing up with a feeling that they were not supposed to talk about their FGM added to the feeling that it was shameful and secretive.  These women all feel that they are carrying around a horrible secret that will only be discovered if they ever enter into a romantic relationship.  Because of this, many avoid relationships entirely.  Others enter into relationships, but nearly all report problems with intimacy, and none have reported enjoying intimacy, but instead enduring it for their partner’s sake.  I often meet with women who have had to let go of their dream of ever having children, having passed their childbearing years and not been able to engage in a long-term relationship.

The stigma of the FGM, and the additional shame of living illegally in this country, can cause these women to completely isolate themselves.  Many have suffered from a Major Depressive Disorder for years.  Frequently they report having difficulty forming relationships even with women, feeling withdrawn and alone.

For these women who have endured so much hardship and pain, the prospect of gaining their legal status and being able to access educational and vocational opportunities, is the one hope they have for their futures.   My reports lend a voice to these immigrants who have carried around such a heavy burden for so long.

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Domestic Abuse Evaluations

The Violence against Women Act (VaWA), passed in 1994, allows spouses who were filing for their legal status through their marriage to a US citizen, and were abused during this marriage, to file for their legal status independently.  My evaluations assess the mental, physical and/or sexual abuse a spouse experienced, and the emotional ramifications such abuse has caused the client to suffer.

Assessing Emotional Abuse:

Most people think of abuse as physical in nature.  However, in many of the evaluations I perform, there was little or no physical domination.  The abuse is emotional in nature and because there are no bruises, cuts, broken bones and often no police reports, this abuse can be harder to substantiate.  However, the emotional control and exertion of power of one spouse over another can cause a similar reaction of trauma and/or depression in the victim.  Because emotional control can be difficult to quantify, my evaluations are critical in confirming the presence of such abuse, and describing the ways in which this abuse causes emotional pain.

Some ways in which a partner can exert abusive emotional control are:

-Limiting their spouse’s access to work, money or material resources

-Isolating their spouse from friends or groups

-Throwing away spouse’s belongings

-Criticizing, humiliating and undermining spouse’s self-esteem

-Ridiculing spouse for expressing opinions

In cases where one spouse has their legal status and the other does not, threats of having the spouse deported, or calling the police, are often part of the pattern of control.  Clients applying for their legal status are often terrified that they might at any time be deported and separated from their family, friends and life in the U.S.  This threat often adds significantly to the feeling that they need to do anything the spouse asks to avoid being turned in, and to have the opportunity to obtain their legal status.

The impact of being in an abusive relationship often has a long-term, damaging impact on the victim’s self-esteem, which can lead to depression.  Being stripped away of all power and being made to feel ashamed and helpless causes the spouse to internalize the belief that he/she is of low importance.  Even people who previously had high self-esteem begin to question themselves, to feel unattractive, uninteresting, and/or unintelligent.

Over time, and especially if the client engages with a good therapist, these symptoms can improve or even resolve.

The ability of the client to file for their legal status and begin to forge an independent and empowered life is critical in their recovery from the damage of the abusive marriage.  My reports professionally detail the client’s experience during their marriage, and describe the suffering they experienced during and after the marriage.  As it is often difficult and painful for clients to describe this, my reports are critical in highlighting the extent of abuse and suffering that occurred, and strengthen the cases of these suffering clients.

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Hardship Evaluations

I often conduct hardship evaluations, during which I assess the negative impact U.S. citizen family members would suffer if their relative was deported.  Usually, this is a parent and/or spouse. I assess the emotional and financial impact a deportation would have on these family members, and how this can lead to poor future outcomes for all.

Emotional Hardship:

Often family members are already showing significant signs of depression and/or anxiety when I meet with them, even if the family member has not yet left the country.  The possibility that a spouse might lose their life partner for an indefinite and possibly permanent amount of time is devastating for most I see.  This loss is often exacerbated when the couple has children.  Not only does the spouse have the additional strain of raising the children on their own, but the spouse often worries about the impact on the children, who often suffer significantly emotionally as well. I have seen many examples of increased behavioral issues and academic decline linked to a departing parent. Children can start to act out at home or school or become withdrawn and depressed.

Financial Hardship:

The loss of income when the deportee leaves the country often causes the family to fall into financial despair.  The result frequently means moving out of and/or selling the family home, incurring massive debt and quite often falling into a state of poverty or bankrupcy.   This financial pressure exacerbates the depression and anxiety for the single parent, already struggling emotionally in trying to come to terms with the departure of their loved one.

Future Outcomes:

Finally, I look at how the decreased income and emotional strain can lead to poor future outcomes for the family. Educational and vocational opportunities are narrowed for both spouse and children with the limited financial situation. In addition, the emotional toll over time to a single parent and to children living in separation from a spouse/parent is devastating.

My hardship evaluations help to illustrate that it is not only the deportee who suffers in these situations.  In describing the detailed ways in which the spouse and children of a deportee are impacted by such a forced move, my reports illuminate the human suffering of U.S. citizens left behind in a real and concrete way.  My narratives help to remind the court that real people, both adults and children, are imminently impacted by the decisions made in these cases.

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Clinical Evaluations with U-Visa clients

The purpose of the U-visa is to give immigrant victims of certain crimes temporary legal status and work eligibility in the United States.   These crime victims have experienced a “felonious assault” and have cooperated with the police in helping to identify the perpetrator.

In my evaluations with these clients, the experience of the assault has frequently left the victim with symptoms of Post-Traumatic Stress Disorder (PTSD).  Often these symptoms constitute a diagnosis of PTSD.  In other cases, the symptoms may have lessened over time, and although may not warrant a full PTSD diagnosis, still negatively impact the person significantly.

Symptoms of PTSD include:

  • Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions
  • Recurrent distressing dreams of the event
  • Acting or feeling as if the traumatic even were recurring
  • Efforts to avoid thoughts, feelings or conversations associated with the trauma
  • Efforts to avoid activities, places or people that arouse recollections of the trauma
  • Difficulty falling or staying asleep
  • Irritability or outbursts of anger
  • Difficulty concentrating
  • Exaggerated startle response.

In my experience with U-visa evaluations, many victims experienced their crime while at work.  Because of their legal status, they often feel locked into their jobs, without opportunities to change their work location or vocational field.  The need to continue to report to work, in a site where a traumatic event occurred, re-traumatizes these clients each day.  They cannot afford to quit their jobs, but the stress, anxiety and fear they face daily, psychologically reliving their trauma again and again, causes extreme emotional discomfort.

In addition to the lack of ability to change their jobs, these individuals usually do not have access to mental health services.  I am usually the first mental health professional they have ever spoken with.  No health insurance and limited access to community agencies where languages other than English are spoken create huge barriers to receiving needed mental health treatment.  Additionally, cultural stigma often plays a role in a client’s motivation to seek out services.

During my evaluations, I make referrals and recommendations for longer-term mental health services based on my knowledge of community resources.  I encourage clients to follow up with mental health services and I discuss the benefits of processing their feelings with a mental health professional in order to diminish the trauma reaction.

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