The 10-year old girl was living with her mother again, but she still couldn’t sleep alone.

A year had passed since their reunion, after being separated under the Trump administration, but the nightmares still jolted her awake.

It took three months of weekly therapy sessions for her to feel comfortable in her own bed and to stop blaming family members for what happened.

“It was a horrible trauma. I feel like there’s so much damage inside us,” said her mother, Jhoseline, whose last name is not being disclosed due to her immigration status.

Hundreds of children have been receiving counseling from therapists, who describe a range of troubling behavior: Some of the children feel like a burden on their families and have considered suicide. Others are taking anxiety medication after spending months in detention. Nightmares are common, and children struggle to sleep alone.

Such mental health counseling is considered so important that a federal judge in 2019 ordered the federal government to pay for the sessions, saying the “zero tolerance” immigration policy had inflicted severe psychological harm through “deliberate indifference.”

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But the future of these services is up in the air as a government contract to coordinate them is set to end in July. The uncertainty comes just as the number of people needing treatment is expected to increase as the Biden administration accelerates the pace of reunifications.

Just this month, the first four families reunited under Biden, including children as young as 3, were brought together at the San Diego border.

The Biden administration has not confirmed whether it will extend its contract with the California nonprofit Seneca Family of Agencies, which has coordinated services for more than 400 families. Homeland Security Secretary Alejandro N. Mayorkas in a statement last week did say the government recognized “the importance of providing these [reunited] families with the stability and resources they need to heal.”

A spokesperson for the Department of Homeland Security said a federal task force was working to “set up a system to provide mental health support and stability to … families who are here in the United States and still trying to heal from the trauma caused by their separation.”

Advocates say the mental health treatment will be crucial for the families to overcome their ordeals.

“The most astounding thing to me is how long-lasting this trauma has been,” said Stefanie Perez, a behavioral health clinician at La Clínica de la Raza who has worked with affected children. “We’re over two years out and there are still a lot children, caregivers, family units that are suffering and that are — on the daily — having a hard time getting through. For most families, it will be a lifelong process of healing.”

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The mental health services began last spring, five months after a judge ordered the government to provide families the option of screenings and treatment. Any family reunited and living in the U.S. qualifies under the order, encompassing about 2,200 potential families. About 415 families of the nearly 1,000 contacted by Seneca have received services.

Under terms of the $14.5 million contract, each family receives, on average, 18 sessions. Some have received more treatments, but others have stopped going — some say it’s because they don’t want to relive the trauma. And, adding pandemic tragedy to the trauma of separation, at least one man died from COVID-19 before he could start therapy with his 16-year-old son.

At La Clínica de la Raza in Oakland, some children undergoing therapy have blamed themselves or their parents for the separations, according to Perez, the clinician. In response, Perez tells them that the separations were due to U.S. policy. She shows them informational graphics with different locations where other families were separated.

“Going through that graphic with clients, I think, provides them with information where they’re able to see, ‘I was not the only person who went through this,'” Perez said. “Trauma can be very isolating; it’s helpful to them to see that, unfortunately, other people have also been through this.”

Perez has worked with a handful of children younger than 14. Often, Perez said, they have been reluctant to share about their time in detention or, in at least one case, time spent with a foster family.

Perez asks them to write stories or make picture books, which express who they were before they were separated at the border and their hopes for the future.

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One girl taken from her mother was asked to draw what she cherished most. She drew a house, with herself and her mom holding hands together in front of it. “Be with your family, no matter what happens,” she wrote, in Spanish, at the top.

Therapists say, often, the separations have compounded traumas experienced before children or their parents crossed the border. Many came to the U.S. after fleeing violence and criminal gangs in their home countries.

Elana Story, a licensed clinical social worker based in Oakland, said she helped children with breathing, grounding and muscle relaxation exercises. She incorporates art and stuffed animals. In one case, she offered supplies for a quitapena, a Guatemalan worry doll.

“There’s lots of examples,” Story said, “of ways that play can offer a child a tool for managing their feelings, or understanding their feelings and soothing some of those feelings in a healthy way.”

Story said she worried that children who were not reunited or able to access treatment after being separated could “be even more likely to develop health conditions and mental health conditions in childhood and through adolescence and adulthood.”

“The mental health impacts of these separations could affect families for generations,” she said.

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Jhoseline said she fled to the U.S. from El Salvador in 2018 to escape gang threats and extortion — only to be forced to explain to her daughter that the two would be separated.

She told her that it would only be for a little while and that the girl would be sent to a place where they took better care of children.

“I thought she would be better than in the place we were in, even if I suffered,” Jhoseline said, her voice breaking with emotion. “As a mother, you don’t want your children to suffer.”

The girl was detained for two months before being released to her father in Oakland. Jhoseline spent nearly a year detained in Texas, in which time her daughter cried often, talked back to her father and lashed out at family members.

Even after they reunited in March 2019, Jhoseline said, “she still had the trauma.” But with therapy arranged by Seneca, Jhoseline said she had slowly gained back her daughter’s love and trust.

“Sometimes kids don’t show their damages physically, but they do have them psychologically,” Jhoseline said. “I hope all these parents get help so that the trauma doesn’t affect their kids’ future.”