Courage & Caffeine comment, OMB No. 0970-0509

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COURAGE & CAFFEINE
Submitted by email to [email protected]
Date:

September 23, 2026

To:

Office of Refugee Resettlement, Administration for Children and Families, U.S.
Department of Health and Human Services

Re:

Proposed Information Collection Activity; Mental Health Assessment Form and Onsite
Health Intervention Form, OMB No. 0970-0509, 91 Fed. Reg. 46,935 (July 27, 2026), FR
Doc. 2026-15087

I. Who I Am
I submit this comment as the founder of Courage & Caffeine, a policy publication with more than
125,000 Substack subscribers that reads legislation and regulation for its readers and publishes the
sources behind every claim. I am a researcher and author, and I worked on the Stop the Demand antitrafficking initiative and on Florida’s Buyer Beware bill. I have also filed a separate comment in my
individual capacity on the consent and records questions this notice raises. This comment addresses
one issue: trafficking risk at the point of repatriation. My attached white paper, Sent Home Unseen,
sets out the full record and sources for what follows.

II. My Position
The notice proposes to share children’s health information with the Department of Homeland
Security (DHS) “when a child in ORR custody has healthcare needs and is identified by DHS for
repatriation,” and to rely on the child’s own consent for mental health information: “Prior to sharing
mental health information with DHS, ORR will request consent from the child.” 91 Fed. Reg. at
46,936.
For a child who has been trafficked, the moment DHS decides to send her home is the most
dangerous moment in her case. I do not suggest that the Office of Refugee Resettlement (ORR)
intends any harm. My concern is the effect. As written, the proposal raises the risk that trafficked
children go unidentified, are returned without a real assessment of the danger waiting for them, and
have what they disclosed reach people who should never see it.
I support sharing what a child needs for safe travel. I ask the agency to build that sharing so it
protects trafficked children rather than exposing them.

III. Questions Addressed
I address the Department’s questions on (a) whether the collection will have practical utility and (c)
the quality, utility, and clarity of the information to be collected.

IV. What I Ask the Agency to Consider
A. Trafficking is found in exactly these conversations
ORR’s regulations require that when a child’s “responses to questions during any examination or
assessment indicate the possibility” of trafficking or labor exploitation, the care provider “must
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notify the ACF Office of Trafficking in Persons within twenty-four (24) hours.” 45 C.F.R. §
410.1302(c)(8)(ii). DHS depends on that screening: its Inspector General reported that ICE’s
Enforcement and Removal Operations “relies on HHS to screen for trafficking indicators for UACs
in HHS custody.” DHS OIG, OIG-25-21, at 7 (Mar. 25, 2025). HHS’s Office on Trafficking in
Persons (OTIP) reports that the number of unique children referred to it rose from 2,146 in 2021 to
4,539 in 2024. Each of those referrals began with someone learning what happened to a child. A
child who believes her words may travel to DHS at the point of her return has every reason to stay
silent, and a silent child is never referred.
That referral path may also be narrowing. The Associated Press reported on September 16, 2026 that
a September 10 ORR memo, which has not been published, directs care providers to send trafficking
concerns to ORR instead of OTIP, with ORR deciding which to forward. If that is accurate, fewer
trafficking concerns would reach OTIP at the same time more mental health information reaches
DHS. ORR’s regulation still requires notice to OTIP within 24 hours, 45 C.F.R. § 410.1302(c)(8)(ii),
and a report’s value to criminal investigators is not the test Congress set for helping a child, 22
U.S.C. § 7105(b)(1)(G)(iv)(III). I ask ACF to publish the memo and explain how it fits with this
proposal.
B. The request comes at the worst possible time
Traffickers control children through fear, and much of that fear points home, through threats against
family and debts owed by the family. Congress requires DHS to “consult the Department of State’s
Country Reports on Human Rights Practices and the Trafficking in Persons Report in assessing
whether to repatriate an unaccompanied alien child to a particular country.” 8 U.S.C. § 1232(a)(5)
(B). The 2025 Trafficking in Persons Report states that in Guatemala “[c]orruption and official
complicity in trafficking crimes remained a significant concern,” and that authorities have
investigated officials for “facilitating child sex trafficking.” In Mexico, “[s]ome current and former
government officials facilitated or participated in trafficking crimes.” Official complicity is also
reported as a concern in Honduras and El Salvador.
The notice places no limit on what DHS may do with a child’s information or with whom it may be
shared, and DHS’s central immigration records system already permits disclosure “[t]o foreign
governments for the purpose of coordinating and conducting the removal of individuals to other
nations under the INA.” 82 Fed. Reg. 43,556, 43,563 (Sept. 18, 2017). I do not assume a child’s
information would be sent abroad. But a child’s diagnoses and “concerns that require management”
can reveal what happened to her, and in a country where officials have facilitated child sex
trafficking, information that marks a returning child as a victim can reach the people she fled. For
most children, the missing use limit is a privacy question. For a trafficked child, it is a safety
question.
C. Neither the child nor an unscreened adult should decide
A child cannot be the one who decides, because a trafficker can coach, pressure, or frighten her. But
the adults closest to a child are not always safe either. The 2025 report states that in Guatemala
“[c]hild victims’ families are often complicit in their exploitation,” and ORR reported in June 2026
that “former UAC became victims of crimes by their sponsors, including incidents of trafficking and
sexual assault.” 91 Fed. Reg. 38,582, 38,584-85 (proposed June 26, 2026). Congress built the
answer: independent child advocates, authorized specifically “for child trafficking victims and other
vulnerable unaccompanied alien children.” 8 U.S.C. § 1232(c)(6)(A). Where trafficking indicators

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are present, an advocate should be appointed before any request is made, and no parent, relative, or
sponsor who may be connected to the child’s exploitation should make the decision.
D. A child’s own decision is a weak safeguard at the point of return
Congress already allows some children from contiguous countries to be returned on the strength of
their own decision, but only if DHS determines that the child is not a trafficking victim, faces no
credible risk of being trafficked on return, and “is able to make an independent decision.” 8 U.S.C. §
1232(a)(2)(A). GAO found that CBP “repatriated about 93 percent of Mexican UAC under age 14
from fiscal years 2009 through 2014 without documenting the basis for decisions,” and that in
observed interviews agents “did not ask any questions pertaining to the risk of a child being
trafficked upon return.” GAO-15-521, Highlights & 35 (July 2015). Those findings are dated and
concern border screening, not ORR. The lesson still holds: a child’s decision, accepted near the point
of return without a defined standard, protects no one. The notice relies on a child’s consent with no
standard at all.
E. After return, no one is watching
Research from the International Organization for Migration found that “children and young people
are highly vulnerable to trafficking in the first instance and to re-trafficking upon return.” IOM, The
Causes and Consequences of Re-trafficking 58 (2010). UNICEF reported “very limited case
management or psychosocial support for returned migrant children and their families in northern
Central America.” UNICEF, Uprooted in Central America and Mexico 19 (2018). GAO found that in
El Salvador and Honduras “there are currently no systems in place to track migrants when they return
to their communities.” GAO-19-62, at 40 (2018). Identification has to happen before a child leaves,
because after she leaves no one may be positioned to protect her.
F. Congress kept child victims’ help separate from enforcement
HHS “may not require that the child cooperate with law enforcement as a condition for receiving” an
eligibility letter, 22 U.S.C. § 7105(b)(1)(G)(iv)(III); officials who discover a possible child victim
must notify HHS within 24 hours, id. § 7105(b)(1)(H); and a child advocate “shall not be compelled
to testify” about what the child said, 8 U.S.C. § 1232(c)(6)(A). When a child may be a trafficking
victim, federal law sends information toward protection. The notice creates a new flow in the other
direction, from the counselor’s office to the agency carrying out the child’s return, at the moment
return is imminent. I ask the agency to reconcile the two.

V. My Requests
1. Screen before sharing. When DHS identifies a child for repatriation, conduct and document a
trafficking screening, including the risk of trafficking on return, before any information is
shared with DHS.
2. Refer within 24 hours, then wait. Refer any trafficking indication to OTIP within 24 hours, as
45 C.F.R. § 410.1302(c)(8)(ii) requires, and hold any repatriation-related disclosure until OTIP
has made its interim eligibility determination.
3. Keep trafficking disclosures out. Exclude from anything sent to DHS any information about
trafficking, exploitation, abuse, or the people involved, beyond what a treating clinician
certifies is needed for safe travel.

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4. No onward disclosure. Condition any sharing on a written DHS commitment that a child’s
mental health information will not be disclosed to any foreign government or used in removal
proceedings, detention decisions, or enforcement against the child, her family, or her sponsor.
5. An independent adult decides. Never ask a child alone. Where trafficking indicators are
present, appoint a child advocate under 8 U.S.C. § 1232(c)(6) before any request, and exclude
any parent, relative, or sponsor who may be connected to the child’s exploitation.
6. Support the safe-repatriation assessment. Where ORR has information bearing on
trafficking risk, give DHS a risk flag that supports its duty under 8 U.S.C. § 1232(a)(5)(B),
rather than the child’s clinical record.
7. Measure and report. Track and publish how many children identified for repatriation were
screened for trafficking, referred to OTIP, asked for consent, and returned.

VI. Closing
A trafficked child is most often found because she finally tells someone what happened. This
proposal asks for her signature at the moment she is being sent home, without saying where her
words will go. I ask the agency to make sure that the last conversation a trafficked child has in
ORR’s care is one that protects her. Thank you for the opportunity to comment.
Respectfully submitted,
Rebekah Ricks
Founder, Courage & Caffeine
Winter Haven, Florida
[email protected]
Attachment: Sent Home Unseen (white paper)

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