Standards for U.S. Customs and Border Protection facilities housing noncitizen children

(a) In general A noncitizen child may not be housed in a U.S. Customs and Border Protection facility that is not in compliance with this Act or the amendments made by this Act. (b) Humanitarian access (1) In general Not later than 90 days after the date of the enactment of this Act, the Secretary of Homeland Security and the Secretary of Health and Human Services shall jointly develop operating procedures to provide employees of the Department of Health and Human Services immediate access to any U.S. Customs and Border Protection facility so as to facilitate the humane treatment of individuals and families encountered at the border. (2) Elements The procedures developed under paragraph (1) shall, at a minimum, provide that— (A) for each U.S. Customs and Border Protection facility in which an individual may be detained in U.S. Customs and Border Protection custody longer than 72 hours, the Department of Health and Human Services shall have access to a separate designated space in the facility so that Department of Health and Human Services employees may conduct medical and mental health screenings, ensure opportunities for general hygiene, provide adequate food and hydration, offer nursing and diapering supplies, and provide appropriate space for children; and (B) employees of the Department of Health and Human Services at such a facility shall immediately begin efforts— (i) to reunify unaccompanied children with sponsors in the United States; and (ii) verify family relationships to ensure that unaccompanied children who arrive with a nonparent family member may remain in the care of such nonparent family member. (c) National Standards on Transport, Escort, Detention, and Search (1) Review Not later than 180 days after the date of the enactment of this Act, the Commissioner, in consultation with stakeholder organizations that serve immigrant and refugee children and families, shall conduct a review of the U.S. Customs and Border Protection standards entitled National Standards on Transport, Escort, Detention, and Search issued in October 2015, to identify necessary improvements with respect to the treatment and care of noncitizen children in U.S. Customs and Border Protection custody. (2) Revision Not later than 90 days after the date on which the review required by paragraph (1) is completed, the Commissioner shall revise such standards to incorporate the improvements identified by the review. (3) Compliance Not later than 180 days after the revision under paragraph (2), each U.S. Customs and Border Protection facility that houses 1 or more noncitizen children shall attain compliance with the revised standards. (d) Facility requirements (1) In general The Commissioner shall ensure that each U.S. Customs and Border Protection facility that houses 1 or more noncitizen children is safe and sanitary and promotes an appropriate and healthy environment for children. (2) Children's area (A) In general The Commissioner shall ensure that each U.S. Customs and Border Protection facility that houses 1 or more noncitizen children includes— (i) a dedicated physical environment that is appropriate for children of all ages and stages of development (referred to in this paragraph as a children’s area); and (ii) an outdoor recreation area. (B) Elements Each children's area shall be colorful and include— (i) low, warm lights; (ii) child-sized furniture and equipment, including developmentally appropriate books and toys that facilitate structured and unstructured play; (iii) child-friendly images and displays; (iv) a children’s bathroom; (v) a diaper-changing area and access to sanitation; (vi) nursing chairs for breastfeeding mothers; and (vii) an area in which children may sit and rest comfortably. (C) Child caregiver professional staffing Each children's area shall be staffed by 1 or more individuals who are professionally trained and licensed to provide services to children, including licensed childcare workers, licensed pediatric health professionals, and licensed child welfare professionals. (3) Medical screening and care (A) In general The Commissioner shall ensure that— (i) except as provided in subparagraph (F)(i), not later than 6 hours after the arrival of a noncitizen child at a U.S. Customs and Border Protection facility, the child receives a medical screening conducted by a licensed physician, advanced practice provider, nurse, or physician's assistant in accordance with this paragraph; (ii) a noncitizen child in the custody of the Commissioner shall have unrestricted access to appropriate medication for the management of an illness or injury of the child; (iii) in the case of such a child with a medical assistive device or other health care support item, the noncitizen child, or the parent, legal guardian, or nonparent family member of the child, is permitted unrestricted access to the device or item; (iv) on release from such custody, a noncitizen child, or the parent, legal guardian, or nonparent family member of the child, is provided with documentation of the child’s medical screening and care, including the need for any followup while in such custody, in accordance with subparagraph (B)(viii); and (v) medication in possession of a noncitizen child, or in the possession of the child’s parent, legal guardian, or nonparent family member, on arrival shall not be destroyed or discarded before the review and determination under subparagraph (B)(vi) occur. (B) Duties of medical professional With respect to a medical screening required by subparagraph (A) and the care of a noncitizen child at a U.S. Customs and Border Protection facility, a licensed physician, advanced practice provider, nurse, or physician's assistant attending the child at the facility shall— (i) assess and identify any illness, condition, or physical ailment; (ii) (I) identify any acute condition or elevated medical risk; and (II) in the case of a child for which such a condition or risk is identified, consult with a licensed pediatrician or pediatric subspecialist; (iii) ensure that appropriate health care is provided to the child as necessary, including pediatric and reproductive health care; (iv) in the case of a child under 12 years of age, conduct a physical examination of the child in the presence of a parent, legal guardian, or family member; (v) in the case of a child who is 12 years of age or older— (I) provide the child with the choice of— (aa) a physical examination in the presence of a parent, legal guardian, or nonparent family member; or (bb) a private physical examination without the presence of a parent, legal guardian, or nonparent family member; and (II) conduct such examination in accordance with the child’s preference; (vi) review any medication that is in the possession of the child on arrival to determine whether the medication shall be kept by the child or the child’s parent, legal guardian, or nonparent family member, as applicable; (vii) in the case of a medication described in clause (vi) that may not be kept by the child or the child’s parent, legal guardian, or nonparent family member for medical storage purposes, such as a medication that requires refrigeration, ensure storage with appropriate access for the child’s use while in U.S. Customs and Border Protection custody; (viii) ensure that the medical screening and care under this paragraph, and any other medical evaluation of or intervention for the child conducted while the child is in the custody of the Commissioner, is documented in accordance with commonly accepted standards in the United States for medical records documentation; and (ix) ensure that a copy of all medical records and documentation of any medical screening and any other medical evaluation of, or intervention for, the child conducted while the child is in the custody of the Commissioner is— (I) provided to the child and the child’s parent, legal guardian, or nonparent family member before the child is released from such custody; or (II) in the case of a child who is transferred to the custody of the Director, sent to the Office of Refugee Resettlement immediately upon such transfer. (C) Procedures for medical screenings The Commissioner shall establish procedures for medical screenings and examinations under this paragraph that are consistent with— (i) relevant guidelines set forth in the American Medical Association Code of Medical Ethics; and (ii) the recommendations of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. (D) Language services The Commissioner shall ensure— (i) the availability of in-person, language-appropriate interpretation services, including indigenous languages, for each noncitizen child in the custody of the Commissioner during any medical screening or examination; and (ii) that noncitizen children in such custody are informed of the availability of such services. (E) Location of medical screenings The Commissioner shall ensure that medical screenings, examinations, and any follow-up care under this paragraph are conducted in a location that— (i) is private and provides a comfortable and considerate atmosphere for children; (ii) ensures each noncitizen child's dignity and right to privacy; and (iii) contains all necessary and appropriate medical equipment and supplies, including basic over-the-counter medications appropriate for all age groups. (F) Acute medical conditions (i) In general The Commissioner shall ensure that any noncitizen child exhibiting symptoms of an acute medical condition, or who is at risk for an acute medical condition, receives immediate care from a licensed physician, advanced practice provider, nurse, or physician's assistant. (ii) Transfer to local health care facility (I) In general If appropriate medical care cannot be provided for a noncitizen child described in clause (i) at a U.S. Customs and Border Protection facility, the Commissioner shall expeditiously transfer the child to a local medical facility. (II) Accompaniment by family In the case of a noncitizen child transferred under subclause (I), 1 or more parents, legal guardians, or nonparent family members, shall be permitted to accompany the child to such medical facility and stay with the child if so accompanying the child does not pose a serious safety risk to the child, as determined by a child welfare expert. (iii) Ongoing availability of transportation The Commissioner shall maintain— (I) appropriate transportation at each U.S. Customs and Border Protection facility that houses 1 or more noncitizen children to ensure the availability of transport to outside medical facilities in the case of a medical emergency; or (II) an on-call service to provide such transportation to such a facility within 30 minutes. (G) Rule of construction Nothing in this paragraph shall be construed to require a noncitizen child, parent, legal guardian, or nonparent family member to disclose the child’s medical history. (4) Services and supplies The Commissioner shall ensure that each U.S. Customs and Border Protection facility that houses 1 or more noncitizen children is in compliance with the following standards at all times: (A) Temperature The temperature inside the facility shall be maintained between 70 and 73 degrees Fahrenheit. (B) Ventilation The facility shall comply with the most recent guidance issued by the Centers for Disease Control and Prevention with respect to ventilation in buildings to mitigate the spread of COVID–19. (C) Food and Water (i) In general Food shall be provided— (I) in a manner that follows Federal food safety laws and regulations; and (II) according to the guidelines of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists with respect to nutrition, consistency, calories, and portion size, consistent with the age of each child. (ii) Meals and snacks (I) Arrival On arrival at the facility, a child shall be provided with a healthy, nutritious, and culturally appropriate meal. (II) Meals Meals shall— (aa) be served daily to all noncitizen children for breakfast, lunch, and dinner, of which not fewer than 2 meals daily shall be served hot; and (bb) include a variety of fresh fruit, vegetables, a protein, and grains. (III) Snacks Noncitizen children shall have unrestricted access to healthy snacks. (IV) Limitation on unhealthful foods The availability of highly processed foods and sugars shall be limited. (iii) Water Each noncitizen child shall— (I) be provided with not less than 1 gallon of drinking water or age-appropriate fluids daily; and (II) have unrestricted access to drinking water. (iv) Accommodation A noncitizen child's individual dietary needs or restrictions shall be accommodated. (v) Special considerations for infants and young children (I) Bottle feeding (aa) In general On arrival at a facility, the parent, legal guardian, or nonparent family member of a noncitizen child using a bottle for feeding shall be offered 2 clean baby bottles, a bottle brush, dish soap, and enough bottled water and baby formula for not less than 96 ounces of formula milk. (bb) Additional supplies Additional baby formula and bottled water, and access to a bottle warmer, shall be provided on request of the parent, legal guardian, or nonparent family member. (II) Breastfeeding In the case of any noncitizen child who is breastfeeding at the time of arrival at the facility— (aa) continued breastfeeding shall be supported; and (bb) the breastfeeding mother of each such noncitizen child shall be provided with privacy, blankets, a quiet area for breastfeeding, a nursing chair, and adequate amounts of food and water consistent with the dietary needs of a breastfeeding mother. (D) Hygiene (i) Clothes and shoes Each noncitizen child shall be provided with a set of clean clothes, and on request, a pair of shoes in good condition and warm clothing. (ii) Showers (I) In general Each noncitizen child shall be provided access to a hot shower with a barrier for privacy. (II) Access A noncitizen child shall be provided access to additional hot showers on request. (III) Temperature Hot water for a shower under this clause shall be set at a temperature consistent with the temperature required under childcare facility standards for childcare facilities licensed in the State in which the facility is located. (iii) Menstruation supplies Each female noncitizen child shall be offered immediately a supply of tampons and pads at no cost. (iv) Diapering (I) In general The parent, legal guardian, or other family member of each noncitizen child using diapers shall be provided immediately with 3 size-appropriate diapers and a packet of diaper wipes. (II) Additional diapers Additional diapers and diaper wipes shall be provided on request at no cost. (III) Diaper changing area The parent, legal guardian, or other family member of each such noncitizen child shall be provided— (aa) access to a safe and sanitary area in which to change the child's diaper; (bb) a clean diaper changing pad; and (cc) a handwashing station. (v) Bathrooms Each noncitizen child shall be provided access to bathrooms. (E) Sleep (i) Mats, blankets, and pillows (I) In general On arrival, each noncitizen child shall be provided with a clean mat that is not less than 3 inches thick, a clean cloth blanket, and a clean pillow. (II) Additional blankets A noncitizen child shall be provided with additional blankets on request by the child or the parent, legal guardian, or other family member of the child. (ii) Quiet location On request or if there are signs of a noncitizen child feeling tired, the child shall be provided with access to a quiet location in which to sleep that has dimmed lights. (iii) Schedule Between the hours of 9:00 p.m. and 6:00 a.m.— (I) noncitizen children shall have access to lighting that is safe and conducive to sleep; and (II) noise shall be at a level conducive to sleep. (F) Recreation (i) In general Noncitizen children shall have access to age-appropriate recreational activities, including indoor and outdoor spaces for physical activity, toys, art supplies, sports equipment, and books. (ii) Outdoor play Noncitizen children shall be allowed to play outside for not less than 30 minutes every 3 hours during daylight hours. (G) Religious practice Noncitizen children shall be permitted to practice their religion or to not practice a religion, as applicable. (5) Notice of rights (A) In general The Ombudsperson shall develop a notice of children's rights, which shall be posted in each U.S. Customs and Border Protection facility that houses children in any location in which noncitizen children are located. (B) Description of rights The notice required by subparagraph (A) shall include— (i) a description of— (I) all rights afforded to a noncitizen child under section 235 of the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008 (8 U.S.C. 1232) and this Act; (II) the right to a bond redetermination hearing; and (III) any other existing mechanism by which children may seek to enforce their rights, including placement review panels; and (ii) a list of pro bono legal services providers and contact information for such providers. (C) Format and languages (i) In general Such notice shall be— (I) written in a manner that is child friendly and age-appropriate; and (II) made available and posted in multiple languages, including the top 20 preferred languages. (ii) Additional languages The Ombudsperson may require such notice to be made available and posted in any additional language the Ombudsperson considers necessary based on the demographics of arriving noncitizen children. (D) Availability A child caregiver professional of the Department of Homeland Security shall provide each noncitizen child with such notice on the child's arrival at the U.S. Customs and Border Protection facility. (e) Separation from unfamiliar adults (1) In general Except as provided in paragraph (2), an unaccompanied noncitizen child in the custody of the Commissioner shall be physically separated from any adult who is not related to the child. (2) Immediate separation not feasible In any circumstance in which such separation is not immediately feasible, such as during transport to a U.S. Customs and Border Protection facility, an unaccompanied noncitizen child shall not be left alone with such an adult or detained with such an adult for more than 6 hours. (f) Staff training (1) In general The Commissioner shall ensure that— (A) the staff of each U.S. Customs and Border Protection facility in which 1 or more noncitizen children are housed receives training on responding to the needs of children and families exposed to trauma, including training on— (i) the principles and practices of trauma-informed care and psychological first aid; (ii) vicarious traumatization and secondary stress; and (iii) recognizing the signs of a child in medical distress; and (B) every effort is made to ensure that the safety and well-being of noncitizen children in U.S. Customs and Border Protection custody are satisfactorily provided for by facility staff. (2) Rulemaking (A) In general The Commissioner shall issue regulations that require Border Patrol and Office of Field Operations officials to participate in regular training so as to ensure that such officials treat all individuals in their custody with dignity, prevent abuse, and ensure constitutionally guaranteed and humane conditions of confinement. (B) Elements The regulations required by subparagraph (A) shall do the following: (i) Prohibit U.S. Customs and Border Protection officials from— (I) discussing immigration outcomes with detained individuals; and (II) using derogatory language towards individuals in their custody. (ii) Address matters of child development, mental health and trauma, children with special needs, cultural competency, and any other matter the Commissioner considers appropriate. (iii) Require foreign language competency and interview protocols in cases in which interpretation is required. (iv) Require continuing education in any subject necessary to ensure compliance with this Act or the amendments made by this Act. (g) Monitoring and oversight (1) In general Compliance of U.S. Customs and Border Protection facilities with this Act and section 235 of the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008 (8 U.S.C. 1232) shall be monitored by the Ombudsperson, in accordance with section 601. (2) Posting of Ombudsperson's contact information (A) In general The Commissioner shall post, in each U.S. Customs and Border Protection facility in which 1 or more noncitizen children are housed, the contact information for the Ombudsperson in multiple languages, including the top 20 preferred languages. (B) Additional languages The Ombudsperson may require such contact information to be posted in any additional language the Ombudsperson considers necessary based on the demographics of arriving noncitizen children. (h) Age assessments (1) In general Any individual who claims to be under the age of 18 years shall be presumed to be so and shall be treated according to the law and standards applicable to noncitizen children in immigration custody, unless following an age assessment, it is established by clear and convincing evidence that the individual is 18 years of age or older. (2) Requirements (A) In general An age assessment may only be conducted if the Secretary or Secretary of Homeland Security has recent, credible, and documented evidence that the individual concerned is 18 years of age or older. (B) Considerations If an age assessment is conducted, the Secretary and the Secretary of Homeland Security shall take into consideration, to the extent such information is readily available— (i) written or photographic evidence; (ii) statements and representations of the individual concerned and of the family and community members who know such individual; and (iii) the relevant cultural and ethnic context. (C) Prohibited methods The Secretary or the Secretary of Homeland Security may not— (i) conduct any medical age assessment that consists of imaging studies, such as bone or dental radiography, dental examinations, or height, weight, skin, or sexual maturity ratings; or (ii) rely on the physical appearance of a child to justify an age assessment. (D) Legal counsel (i) In general An individual with respect to whom an age assessment is conducted shall be provided with legal counsel before receiving such assessment and may not be removed before receiving such counsel. (ii) Evidence Legal counsel provided under clause (i) shall be provided with all evidence upon which the Secretary or the Secretary of Homeland Security relies to justify conducting an age assessment or to support an age assessment determination.