Healthcare pros:

Kids don't belong in jail.

Here's what's happening right now:

Trump is imprisoning traumatized immigrant children, even when they have family they could be released to.

Here's what's happening soon:

Trump has ordered DHS to adopt new rules allowing these children to be imprisoned indefinitely, in private facilities. These converted big box stores and tent camps are held to no meaningful standards of care and are subject to no meaningful oversight. But these rules will be challenged in court. Your comments will be a vital part of the record before the judge – your comments can help persuade the federal court to defend kids.

What you can do:

Use this guide to write a comment opposing Trump's barbaric proposal. Submit your comment to DHS by November 6th. Share this guide with colleagues.

Here's how you can fight indefinite imprisonment of immigrant children:

  1. Get up-to-date on the facts
  2. Write a comment using your expertise
  3. Submit your comment to DHS by Nov 6

I've prepared a step-by-step guide specifically for health professionals that will walk you through the facts, how to write a comment, and the commenting procedure.

Who am I and why should you listen to me?

I'm Matthew Cortland (@mattbc). I'm a healthcare lawyer – my graduate training is in law and in public health. As an attorney, I'm trained to work with regulatory materials (read, understand, comment on). And I've helped clinician communities succesfully oppose other bad rules from the Trump administration.

Your comment will matter, your effort will make an impact. Are you in?

Yes, I want to use my voice to help kids

1 Get up-to-date on the facts

Instead of releasing those immigrant children who have a family member or close friend to their custody "without unnecessary delay" Trump wants to keep those children imprisoned. Instead of holding those children in facilities that are licensed (for safety, etc) by state and local governments, Trump wants to let facilities be approved by private contractors at a later date. Instead of standards of care governing the treatment of imprisoned immigrant children designed to protect them, Trump wants, well, to not have those.

This particular rule isn't explicitly about "family separation" -- Trump is perfectly happy to lock entire families up in concentration camps. And that's what this rule would allow - indefinitely imprisoning children, with or without their caregiver.

The proposed regulations enabling the indefinite detention of child immigrants are open for public comment. After the commenting period, the new regulations will be challenged in federal court. Your comments will be part of the record before the federal judge deciding whether indefinite detention of child immigrants is legal. Your comments will make a difference in court.

The court will be tasked with determining whether these new DHS rules are consistent with the Flores Settlement, which requires federal immigration authorities “treat, all minors in its custody with dignity, respect and special concern for their particular vulnerability as minors.”

Want to write the best, most powerful comment possible? Take two minutes to read this New York Times story:

Cleaning Toilets, Following Rules, A Migrant Child’s Days in Detention: A portrait of life in the shelters for the children detained after crossing the U.S.-Mexico border

And this short piece from Buzzfeed touring a camp we're imprisoning these children in:

Immigrant Teens Are Stuck In An Expanding Tent City In Texas

I am a child-focused HCP I am other HCP I am not a HCP

2 Write a comment

As child-focused HCPs, your expert comment can help answer these vital questions for the court:


Here's how to write an effective comment that will help defend these kids in court:

Facts matter, evidence matters, science matters

You know better than most what indefinite detention of already traumatized children will do to them. Your goal is to convey that information to the reader – i.e. to the courts. Assume they don't know. Tell them.

As clinicians you are factual experts. Hammer the facts. Explain what these policies will do to children.

One highly effective strategy you may want to employ is citing to the literature – judges love citations to evidence. The entire practice of law and the enterprise of judging is built upon citations to evidence. The peer-reviewed literature is evidence that can be given special weight in these sorts of court cases. You are uniquely well-suited to use the literature as an advocacy tool. Find a good peer-reviewed publication relevant to what you're writing about - cite it.

Don't know where to start? Here are some resources:


Start with your qualifications

It is vital that you explicitly list your qualifications – in detail. Much of the power of your comment comes from your expertise, the most important way you establish your expertise is by describing your qualifications and experience. Your qualifications matter. If you have questions about how to present your qualifications, please feel free to contact me.

Start your comment by hammering your qualifications. Obviously, don't lie, but don't minimize either. The more impressive your qualifications read to a judge, the more impact your comment will have. You are not bragging, you are advocating for defenseless children who need you.

Physicians

If you're a physician, be explicit & assume the reader knows very little about medical education. e.g. "I graduated with an M.D. from Tufts University. I completed a 3 year residency in pediatrics at Stanford. I then completed a 3 year fellowship in Neonatal-Perinatal Medicine at Oregon Health and Science University.” Tell the reader if you're licensed. e.g. "I am licensed to practice medicine in New York." Are you board certified? List every board certification you have. "I am board certified in Pediatrics and Neonatal-Perinatal Medicine"

If you have multiple, relevant degrees (like an MD and PhD or MPH) explain them with the same specificity. Tell the court what your MPH concentration was or the topic of your PhD dissertation.

Include any academic medical appointments you may have, e.g. "I am a (lecturer/assistant professor/associate professor/professor) of (medicine) at the University of Chicago School of Medicine."

If you've contributed to an academic text or published in the peer-reviewed literature on any pediatrics topic, tell the reader. Use the phrasing that's most impressive. e.g. "I have 5 publications in the pediatrics peer-reviewed literature" or "I've published on pediatrics in the peer-reviewed literature, including in NEJM.”

I cannot overemphasize the importance of maximizing the impact of your qualifications. Have you presented at conferences? Taught at grand rounds? Delivered peds related CME teaching to other physicians? Tell the reader.

Applies to those in academic medicine and those in private practice

Have you been in practice more than a few of years? If so, tell the reader how long you've been a pediatrician. Do you see a lot of patients? Tell the reader your panel size. Do spend a couple of weeks every quarter taking care of kids at the local community hospital? Tell the reader.

Mental Health Professionals

If you're a child-focused mental health professional (be it MSW/LCSW, PsyD, PhD) tell the reader about your qualifications. Assume the reader knows very little about the educational requirements for your degree. Did you write a thesis relevant to child mental health? Did you complete hundreds of hours of supervised field work with children? Have you trained/supervised others in this area? Tell the reader.

If you are board certified, tell the reader. Tell the reader if you’re licensed, e.g. "I am a licensed psychologist in New York."

Include any academic appointments you may have, e.g. "I am a (lecturer/assistant professor/associate professor/professor) of (psychology/social work) at Columbia University.”

If you've contributed to an academic text or published in the peer-reviewed literature on any child-related topics, tell the reader. Use the phrasing that's most impressive. e.g. "I have 7 publications in the peer-reviewed literature" or "I've published on ACEs in the peer-reviewed literature, including in Educational Psychologist.”

Have you worked with immigrant children? Tell the reader. Have you worked with children who have suffered Adverse Childhood Experiences? Tell the reader.

Students / Trainees

Your voice matters. Just as I would expect the CV of a professor of medicine with 30 years experience to be longer than the CV of a PGY-2, the amount of experience you have, will, obviously, dictate how lengthy the qualifications section of your comment is. But you have a particularly vital role to fulfill here – you are incredibly well positioned to submit comments that do the vital work of citing to the literature. You can start with this American Academy of Pediatrics Policy Statement on the Detention of Immigrant Children


Audience

You're writing, ultimately, to a federal judge. Obviously, belligerence or snark aren't likely to persuade that reader. Your knowledge, expertise, experience, and command of the peer-reviewed literature, on the other hand, are persuasive.

Use headings and subheadings

Make your comment as user-friendly for the reader as possible by using headings and sub-headings as sign-posts to guide your reader through your points.

Topic sentences

Don't hide the ball. Your reader should be able to understand the crux of your comment from the first sentence of each paragraph.

Tell, don't ask questions

Make statements, don't ask questions. Questions leave the reader with wiggle-room.


Remember, because of your expertise, you can answer these questions for the court:

Those are the questions that will decide this case. As experts, your answers to those questions will matter in court.


If you have any questions, or would like help with your comment, please reach out to me via email or twitter. I will provide any sort of assistance I can.

Teach me how to submit a comment

2 Write a comment

Non-child-focused HCPs, your expert comment can help answer this vital question for the court:

how do the lifelong effects of Adverse Childhood Experiences (ACEs) impact your patients?

Your child-focused colleagues will be making the case that indefinite detention in prison camps constitutes an Adverse Childhood Experience. Your job is to hammer the point home by explaining to the court how ACEs cause lifelong harm.

Probably the best way to connect ACEs with your practice taking care of your patients is by starting with the peer-reviewed literature. This list of journal articles is primarily from the CDC's ACEs site:

2 Write a comment

Teach me how to submit a comment

3 Submit your comment to DHS by Nov 6

We submit comments via this Regulations.gov page or via email.

Comments submitted via email have no size limit, but the text box on the Regulations.gov page limits comments to 5000 characters (if you upload your comment as a pdf, there is no character limit). What else can I do?

What else can you do

Subscribe to our mailing list

We'll notify you when there are other opportunities to use your expertise to comment on rules that will hurt the health and welfare of kids (like the public charge rule)

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