Coming to the United States


Marta Valiente, LICSWMarta Valiente, LICSW
When I immigrated to the United States, I was escaping the civil war in El Salvador. That war ended in 1992 with a U.N. brokered peace. Today, El Salvador is struggling with the world’s highest murder rates. As a social worker at Cambridge Health Alliance, I provide therapy for children who leave their country of origin in fear for their lives.

Tips for practitioners

Things to remember when working with immigrant children:

  • Establishing a therapeutic relationship will allow these children to tell their story and validate their feelings. This can help them get documented. Be prepared to share clinical information with immigration officials.
  • Meditations can help kids find internal strength and calmness. But be careful with breathing exercises as sometimes these can be overwhelming, so guided meditations with specific imagery (e.g. the "mountain meditation") and words (e.g. the "loving kindness meditation") are often more grounding and effective in establishing a sense of safety and resilience with this population.
  • Encouraging self-care, like good nutrition and exercise, helps kids plan for the future.
  • Playing games creates a safe space and opens up opportunities of communication of hidden emotion and experience.e

Resources for Immigrants

CHA has compiled a series of helpful local immigration resources.

The Immigration Experience

In my work at CHA Anna May Powers Center (at the Keverian School in Everett), I create a safe space where I can develop relationships with these kids and others who have left similar situations from countries across the globe. It was here that I met Andrea, one of many children haunted by their past. These kids are survivors, and the trauma they have experienced often leads to mental health issues like Post Traumatic Stress Disorder (PTSD).

Andrea (not her real name) was determined to get an education when she lived in El Salvador, so she rode her bike to school every day in an attempt to avoid violence. She lived with her grandmother in an area heavily infiltrated by gangs, saw many mutilated bodies and lost a relative to gang violence. When she turned 13, Andrea noticed that the gang members were watching her, well aware that rape was the initiation ritual they used. When they shot and killed her friend, she knew it was time to leave.

By the time Andrea reached the U.S. border, her feet were filled with thorns. She shared one pair of shoes with her sister, who joined her on the journey. After turning themselves in to border control, they spent one month in detention - a small room that they called “the refrigerator” because it was so cold -- receiving one meal a day. They were eventually reunited with their mother in Massachusetts who they hadn’t seen for nine years.

Dealing With Long Term Stress

It’s common for kids to feel abandoned by their parents and then struggle when they are reunited. They also feel guilty for leaving loved ones and caretakers behind in dangerous situations.

One of the ways I create a safe space is by playing games with the kids. So many of them had to assume adult roles at young ages and they crave these opportunities to play. It often allows kids to speak more freely about their trauma.

I continued seeing Andrea for two years, and then her younger brother who survived the same harrowing migration. Both children are safely living with their mother today. They are doing well, but continue to carry the traumas of their childhood.

Inpatient Care

Young boy wearing a baseball cap.Resiliency is a term we may apply to immigrant children, especially when they appear to be doing well. However, there is a duality to their existence that fluctuates between wanting to succeed in school and the manifestation of trauma-induced mental health exacerbations. For many trauma survivors, dissociation – a sense of detachment from oneself and others – is common. That’s when Chris Pagano, Ph.D., gets involved at CHA’s child and adolescent inpatient units at Cambridge Hospital.

“These kids often initially present on the unit as very polite, respectful and well-adjusted,” Chris explained. “However, as soon as they are given a safe place to talk, a torrent of painful memories floods forth; they’re often quite explicit about the trauma they’ve experienced, from multiple types of abuse to witnessing horrific violence. We help them share their stories without feeling overwhelmed.”

The inpatient child psychiatry units use group therapy sessions where they gain support from each other. Often times when one person starts sharing, it allows other kids to get in touch with their own feelings of fear and sadness.

Group members are encouraged to consider their strengths and find hope for the future. While validated for their courage to share their stories, they develop a bond by knowing they’re not alone. It’s a group effort to break down the isolation.

Cambridge Health Alliance

Contributed By: Cambridge Health Alliance

Cambridge Health Alliance is an academic community health care system committed to serving all members of our communities. We have expertise in primary care, mental health and substance abuse, and caring for diverse and complex populations. CHA patients receive high quality care in convenient neighborhood locations, and have seamless access to advanced care through CHA’s affiliation with Beth Israel Deaconess Medical Center. With over 140,000 patients in Cambridge, Somerville Everett and Boston’s Metro North, CHA is working hard to offer the integrated services its communities need now, and in the future.