WATCH | Jennifer immigrated alone to the US when she was 16 years old. For her, the hardest part wasn't crossing the border. It was finding the mental health services she needed once she got to America.
The 'border' after the border
El Salvador is known as the murder capital of the world. A nation that averaged one murder per hour during the first three months of 2016.
For many, relocating to another country is very difficult. For young people making the trek alone across the border you would think the journey would be the hardest part.
It's not. Sometimes it's trying to forget the violence they witnessed growing up -- and finding the counseling needed to better cope.
Jennifer (she didn't want to give her last name out of fear of being recruited by gangs) says she needed help learning to live with her dad, whom she hadn't seen in a decade. The last time she saw him was when she was 6 years old.
The river was something I was really scared to cross, but our guide put us inside a tire, and I just prayed to God.
Jennifer, 18, is one of the 68,000 unaccompanied refugee minors from Central America and abroad who arrived in the United States in 2014. "I saw my dad for the first time in 10 years," she said, "but I left my mom in El Salvador."
A 2008 study in the Journal of Child Psychology found that 61 percent of male unaccompanied refugee minors (URMs) were at a high risk of developing PTSD. 73 percent for female URMs. Unaccompanied minors are more likely to develop PTSD than accompanied minors.
A non-profit health center called La Clínica del Pueblo in Prince George's County, Maryland recently opened a clinic to serve the growing Latino community; and the influx of unaccompanied refugee minors among that population.
Jennifer lives and goes to high school in Maryland, a state which in 2015, had the sixth highest concentration of unaccompanied minors.
Because of this, the county she lives in, together with the La Clínica del Pueblo, is piloting a mental health clinic at one high school in Maryland.
It's called "Mi Refugio," Spanish for "my refuge."
About 'Mi Refugio'
"Our approach is strengths-based, not to talk about how much you've been victimized," said Catalina Sol, chief programs officer at La Clínica del Pueblo.
Sol says the program was launched because they noticed high schools in the area were overrun with "kids that couldn't sit still. They had gone through horrible experiences."
Experiences such as witnessing massacres or being sexually assaulted.
Sol says most schools don't have the cultural literacy to understand where these students are coming from. And most students don't have the wherewithal to seek out these mental health services.
Mental health in unaccompanied refugee minorsAs medical director of child and adolescent psychiatry at Boston Medical Center, Dr. Lisa Fortuna has worked with a lot of unaccompanied refugee minors from Central America.
"The youngest asylum evaluation I've done for a child that came by themselves was 6 years old," said Dr. Fortuna.
She says she sees signs of trauma across all ages and genders.
When Circa asked why she left El Salvador, Jennifer preferred not to answer. In the first three months of 2016, there was a homicide happening every hour in her country.
Overcoming the trauma
"There's a tremendous amount of violence," Fortuna adds. "The children that I'm seeing unaccompanied are sometimes coming because their parents have fled or are here."
After working with countless patients, she says the thing that works for these youths is to "depathologize" it, or not treat the issues these kids are facing as a medical disorder.
"I don't say disorder [in front of these kids]. What I try to say is 'what are your strengths?'"
Jennifer's high school counselor was the person who told her about "Mi Refugio," and the mental health services she could benefit from at La Clínica del Pueblo.
One success story
Jennifer is currently participating in "Mi Refugio," which to date has helped at least 96 high school students.
"La Clínica del Pueblo helped me a lot, in terms of the psychological help I needed to be comfortable with my dad [and] accept that I was no longer in my country."
Things are looking up for Jennifer. She's set to graduate from high school in May, recently got Medicaid and is hoping to go to college to study accounting.
QUIZ | How many unaccompanied minors are there?