Immigrant Service Access Needs and Recommendations in the U.S.–Mexico Border Region: A Qualitative Study

Abstract

Immigrant and mixed-status families comprise a growing population in the United States, facing numerous barriers to accessing essential health and social services. This study examines service access barriers within the unique context of New Mexico’s borderlands, where constitutionally protected bilingualism and welcoming local policies contrast sharply with restrictive federal border enforcement. Using a qualitative approach, we conducted five focus groups with 36 immigrant caregivers in Doña Ana County, New Mexico, with the objective of understanding the factors that facilitate and hinder immigrant families’ access to health, behavioral health, and social services in this socio-politically complex border environment. Thematic analysis revealed three overarching themes: (1) structural and organizational limitations, including language barriers and transportation challenges exacerbated by border checkpoints; (2) the persistence of “chilling effects” on service use despite a Democratic presidency and post-pandemic policy shifts; and (3) community-defined recommendations for improving service access. The findings demonstrate how federal immigration enforcement undermines local inclusion efforts, creating enduring barriers to service access even in historically bilingual, immigrant-friendly regions. The participants proposed specific solutions, including mobile service units and integrated service centers, that account for both geographic and socio-political barriers unique to border regions. These community-generated recommendations offer practical strategies for improving immigrant service access in contexts where local welcome and federal enforcement create competing pressures on immigrant families.

1. Introduction

According to the most recent U.S. Census Bureau (2022c) estimates, immigrants comprise 13.7% of the U.S. population, nearly three times its share of the U.S. population in 1970 (Moslimani and Passel 2024). The percentage of children living in immigrant families (with at least one foreign-born parent) has also doubled from 13% in 1990 to 26% in 2022 (Batalova 2024). Half of all U.S. immigrants come from Latin America, including 23% whose country of origin is Mexico (Moslimani and Passel 2024; U.S. Census Bureau 2022c). Given the size of this population, increasing research has aimed to understand the varied factors that impact access to health, behavioral health, and other social services and public programs among Latin American immigrants that are critical to child and family health, behavioral health, and well-being.

The challenges to health and well-being faced by immigrant families in the U.S., especially those from Latin America, are also well-documented. Immigration-related stress, trauma, and acculturation difficulties can profoundly affect child and family mental health (Kim et al. 2018; Pinedo et al. 2021; Vos et al. 2021). Stressors like family separation, discrimination, and uncertain legal status can increase rates of anxiety, depression, and PTSD among immigrants (Sangalang et al. 2018), with long-lasting effects on child development and family functioning (Vos et al. 2021). While access to health, behavioral health, and social services is crucial for mitigating these outcomes, barriers such as language difficulties, cultural differences, lack of insurance, and deportation fears often hinder access (Katsiaficas and Park 2019).

Similar trends are evident globally, with immigrant populations facing comparable service access challenges across diverse national contexts. Research from Canada, Australia, and European nations documents remarkably consistent barriers including language difficulties, fear of enforcement, and structural discrimination, despite varying policy landscapes (Kalich et al. 2015; Khatri and Assefa 2022; Galanis et al. 2022; Satinsky et al. 2019). This international evidence suggests that the challenges facing immigrant families transcend specific national contexts, highlighting the importance of understanding how local policy environments can either exacerbate or mitigate these universal barriers. Furthermore, understanding these factors is essential for developing interventions and policies to improve service utilization and enhance immigrant families’ health and well-being. While barriers to immigrant service access have been well documented, less is known about how these barriers manifest in contexts with competing influences—where welcoming state and local policies contrast with restrictive federal immigration enforcement. While policy changes and COVID-19 have shifted the landscape of service access, limited research has examined whether long-documented “chilling effects” persisted throughout the Biden administration.

1.1. Barriers to Health and Social Service Receipt Among Immigrants

Immigrants to the U.S. experience unique barriers to health, behavioral health, and social service receipt. Citizenship and legal status significantly impact eligibility and participation in public programs and key health services, with children of undocumented parents less likely to receive health, dental, and mental health services (Finno-Velasquez et al. 2016; Ybarra et al. 2017; Yun et al. 2013). While the majority of immigrants (77%) have lawful status, including as naturalized citizens (49%) or lawful permanent residents (24%), 23% of the foreign-born population is unauthorized, i.e., without legal status (Moslimani and Passel 2024). Mexican immigrants represent over one-third of the unauthorized population. Nearly 91% of children in immigrant families are U.S. citizens, with 65% having at least one citizen parent and 26% having only non-citizen parents (Gonzalez et al. 2024).

Present-day barriers are rooted in decades-old policies. The 1996 Personal Responsibility and Work Opportunity Reconciliation Act instituted eligibility bars for immigrants’ use of federal safety net programs, causing “chilling effects” even among eligible immigrants (Fix and Passel 1999). “Chilling effects” refer to the phenomenon whereby restrictive policies discourage not only those directly targeted but also eligible individuals from accessing services due to fear, confusion, or mistrust of government systems. More recently, changes to the public charge rule under the Trump administration led immigrant families to avoid public benefits and supportive services, with fears persisting despite subsequent leniency (Ettinger de Cuba et al. 2023; Godinez-Puig et al. 2022; Haley et al. 2022; Lopez et al. 2024; Schumacher et al. 2023).

Key structural barriers include a lack of culturally and linguistically responsive services, which hinders effective communication and leads to misunderstandings and mistrust (Pandey et al. 2021). Many providers lack the cultural awareness and linguistic skills needed to serve these communities effectively (Jacquez et al. 2016; Rasi 2020). Immigrants also struggle to navigate complex U.S. systems (Hacker et al. 2015) and are disproportionately impacted by poverty and economic instability (Acevedo-Garcia et al. 2021). Psychological and social barriers further impact service access. Immigrants experience unique migration- and resettlement-related traumas affecting mental health and help-seeking behaviors (Sangalang et al. 2018). Mental health stigma and low mental health literacy pose additional challenges (Byrow et al. 2020). Social isolation and discrimination further marginalize immigrant communities (Hacker et al. 2015; Rhodes et al. 2015).

In the U.S.–Mexico borderlands, immigrants face additional challenges. These include limited service availability due to the rural nature of the region, geographic isolation, and a shortage of providers (Lopez et al. 2024). The militarization of the border region, with its 100-mile zone of U.S. Customs and Border Patrol checkpoints, acts as a deterrent to service receipt (Anthony 2020). This “band of isolation” (Branham 2015) or “constitution free-zone” (Misra 2018) impinges on basic rights and adds stress to border residents (American Civil Liberties Union n.d.; Flores-Gonzalez et al. 2024).

1.2. Supporting Immigrant Access to Services

Despite these many challenges, emerging research has documented important strategies to facilitate and support immigrant access to needed services. These approaches include better equipping practitioners who work with immigrant populations by developing specialized knowledge of immigration-related needs and practices and training immigrant service providers on mental health (Lovato et al. 2023; Salami et al. 2019). They also include expanding community-based services and growing community engagement, partnership, and cross-sector collaboration to build trust and navigate common immigration-related challenges (Alwan et al. 2021; Lovato et al. 2023; Salami et al. 2019). Recent literature has also documented the importance of implementing immigrant inclusive organizational policies, creating welcoming environments characterized by linguistic and cultural concordance and representation among providers, and implementing targeted immigrant engagement strategies, e.g., via cultural brokers, while also addressing concrete needs such as financial insecurity (Alwan et al. 2021; Lopez et al. 2024; Lovato et al. 2023; Salami et al. 2019; Villamil Grest et al. 2023).

1.3. The Present Study

This study seeks to expand knowledge of the factors that impact service access and service seeking behaviors among Spanish-speaking immigrants living in the U.S.–Mexico border region, in a hybrid socio-political context that includes welcoming local politics juxtaposed with heavily surveilled border communities. The primary aim is to identify community-defined recommendations and strategies for reducing barriers and promoting equity in immigrant families’ access to and receipt of essential health, behavioral health, and other social services.

2. Methods

2.1. Study Design

This study was part of a large community-based participatory research initiative that used mixed-methods to explore barriers and facilitators to health, behavioral health, and social service access for immigrant families with young children in the New Mexico borderlands along the U.S/Mexico border. Four community agency partners and an advisory group of community stakeholders, including social workers, educators, parents, faith leaders, and other frontline practitioners in immigrant-serving organizations, provided insight and feedback on the study aims and design, including on recruitment and data collection approaches, analysis and interpretation of the data. The study consisted of in-person surveys with immigrant caregivers of children under 8 years old (N = 240), and 5 follow-up focus groups with n = 36 survey participants. This paper reports qualitative findings from the focus groups.

2.2. Study Setting

This study was situated in Doña Ana County, New Mexico, a region that shares its southern border with Mexico and exemplifies the complex dynamics of immigrant service access. The state’s constitutional protections for bilingualism and the county’s welcoming local policies exist in tension with federal border enforcement activities, creating a unique natural laboratory for examining persistent barriers to service access. In total, 15.6% of county residents are foreign-born, compared to 9.2% in New Mexico overall and 13.7% in the U.S. (U.S. Census Bureau 2022c). In total, 29.9% of children in the county live in an immigrant family, compared to 19.0% in New Mexico and 25.7% in the U.S. (U.S. Census Bureau 2022a). In total, 30.0% of children under 18 in the county live below the poverty level, compared to 24.3% statewide (U.S. Census Bureau 2022b). Children here also reside in a state that is ranked the lowest in the U.S. for overall child well-being, and among the lowest for other key indicators including, economic well-being (48th), education (50th), health (44th), and family and community (49th) (The Annie E. Casey Foundation 2024). The county is home to over 25% of New Mexico’s approximately 142 colonias, which are unincorporated rural communities unique to the U.S.–Mexico border region that typically lack adequate water, sewer, housing, and other infrastructure, and are predominantly populated by immigrants (Henderson 2019; Housing Assistance Council 2013; Doña Ana County 2017). The county is also confined in all directions by U.S. Customs and Border Patrol checkpoints, including a checkpoint that divides the northern part of the county from the largest metropolitan area where most health, behavioral health, and social services are located.

2.3. Sampling and Recruitment

This study utilized a combination of purposive and snowball sampling to recruit 240 participants between June 2022 and March 2023 to participate in an in-person quantitative survey. All participants provided written informed consent in their preferred language before participating. Eligible participants were adult primary caregivers of children aged 0–8, immigrants to the U.S., comfortable with English or Spanish interviews, and residents of the county in NM. A community research consultant, who directed an organization providing early childhood and wraparound services, led recruitment efforts [Note: This consultant is not an author of this manuscript]. They collaborated with three field interviewers: a local public-school administrator, a family services coordinator, and a community health worker. Two of the three interviewers were immigrant parents themselves, and all were bilingual in English and Spanish. The recruitment methods included community stakeholder referrals, on-site recruitment at local events (e.g., festivals, churches), advertising via print and media, and participant referrals. The consultant leveraged strong relationships with local schools and community organizations serving immigrant families to identify eligible participants throughout the county. From the survey participants, 36 were selected for focus groups based on their expressed interest at the end of the survey and availability for scheduled dates.

2.4. Data Collection

Five Spanish-language focus groups were conducted between November 2022 and March 2023, lasting approximately 90 min, each with 3–12 participants. The focus groups were conducted by the trained field interviewers described above, not by the study authors, to minimize potential bias and power dynamics between researchers and participants. At least one focus group was held in each of the three major areas of Doña Ana County: rural Northern, the metropolitan hub, and rural Southern. The participants were assigned to groups based on their geographic location. The focus groups took place in community locations, including a childcare facility, community center, and church hall. The field interviewers, who received qualitative interview training, used a semi-structured interview protocol. Topics included community needs and concerns, service experiences (including challenges and barriers), necessary changes to improve access, the policy environment, and the concept of a one-stop-shop approach for immigrant family services. The focus groups were audio-recorded with consent and transcribed. The full interview protocol is included in Appendix A, Table A1. The participants received a USD 25 gift card for both survey and focus group participation.

2.5. Participants

A total of 36 caregivers participated in one of five focus groups. The majority of participants had received a high school diploma or equivalent (52.8%). Most participants spoke Spanish at home (97.2%), were from Mexico (97.2%), and first arrived in the U.S. prior to 2017 (88.9%). Additional participant characteristics can be found in Table 1. In relationship to the full sample of 240 survey participants, a significantly higher percentage of focus group participants were mothers (91.7%) compared to the full survey sample (69.6%; p < 0.05) that included a greater mixture of caregivers (e.g., mothers, fathers, grandparents, etc.). A smaller percentage of the focus group’s participants were employed full time (16.7%), and a larger percentage were not in the workforce (44.4%), compared to the larger sample where 34.5% of participants were employed full time and 20.0% were not in the workforce (p < 0.05). The remaining demographic characteristics of focus group participants were not significantly different from the full survey sample.

In the quantitative survey, participants were asked about their need for and use of various supportive services, including medical, dental, and mental health services; housing, food, and income assistance; and services specific to children. Table 2 presents the services reported by focus group participants, highlighting differences between the percentage of participants who reported ever needing the service and those who actually utilized the service. Notable disparities were found in medical or dental services for caregivers (13.9%), mental health services for caregivers (8.3%), housing assistance (22.2%), income assistance (16.7%), and childcare services (8.3%).

2.6. Data Analysis

Given notable disparities between service need and utilization, we employed thematic analysis to examine participants’ narratives about their service access experiences, aiming to identify significant themes within the main topics discussed by participants (Braun and Clarke 2006). Thematic analysis, a widely used qualitative research method, enables the identification, analysis, and interpretation of patterns within data, offering a flexible yet rigorous means to explore complex social phenomena (Nowell et al. 2017). Guided by the key topics outlined in the interview protocol, two bilingual researchers independently reviewed each transcript and developed initial codes representing common themes across the data using Dedoose (Version 9.2.014), a qualitative data analysis software (Dedoose 2024).

A codebook was developed to define, categorize, and organize key codes, ensuring consistency in the analysis process (Guest et al. 2012). Code frequencies generated within Dedoose were also utilized to detect patterns in immigrant caregivers’ responses, helping to reveal the most salient issues and concerns. The thematic analysis followed an iterative process, wherein two additional researchers participated in the simultaneous refinement of emerging codes and their integration into broader themes. This collaborative approach helped ensure the credibility and validity of the identified themes (Lincoln and Guba 1985). Selected transcript excerpts, which were representative of the key themes and included in the final codebook and manuscript, were translated into English by one of the bilingual researchers to preserve the integrity of the participants’ narratives.

3. Results

Participant responses revealed multiple interconnected factors that influenced both their decisions to seek services and their ability to successfully access them. Key factors included structural barriers to service access, experiences of discrimination and xenophobia, concerns about immigration status and public charge implications, mistrust in service systems, and the impact of changing government administrations on service availability. In response to these challenges, participants offered concrete recommendations for improving service accessibility, with particular emphasis on developing a one-stop-shop service model and implementing broader policy and systems changes.

Three primary themes emerged from the analysis: (1) ongoing structural and organizational limitations, (2) persistent “chilling” effects, and (3) recommendations for change. Appendix A, Table A2 presents the codes identified within each theme, including code descriptions and frequency of occurrence across participant interviews.

3.1. Theme 1: Ongoing Structural and Organizational Limitations

The participants discussed persistent structural barriers hindering access to health, behavioral health, and social services despite supportive local infrastructure. The participants described many instances where poor service experiences contributed to discomfort or mistrust in seeking services. For example, one participant noted, “Oh, and seriously, their human resources is really annoying, really. I don’t know if it’s just happened to me, but human resources is really annoying too.” Another stated that

They made us wait in the waiting room for five hours…I went to the doctor and told her everything that was wrong with me, and she said “drink water and walk”…I tried to change my doctor, but I was told no.

Prohibitive costs for legal services, medical care, and childcare were also frequently cited as barriers. One participant shared that “the bills are enormous. And the truth is, I can’t pay them.” Another noted how high gas prices impacted their ability to attend doctor’s appointments. Many participants also identified language access as a service barrier. For example, one participant stated that “the language…struggling for Spanish. That’s my only barrier.”

Particularly in rural areas, participants noted a shortage of medical and therapy providers. As a rural-dwelling participant explained, “we really need medical attention. We are really struggling…We need a bigger clinic, and it takes a long time waiting before we see the doctor…There is no place to take your children when they are sick.” Even when services did exist, many participants were unaware of available services or eligibility criteria. One participant described years of struggling before finding a local childcare center, stating that “for that reason, now I feel a lot of nostalgia, a lot of sadness, because there is a huge lack of information among the community.” The lack of Spanish-speaking professionals, especially in medical settings, was also a common issue. A professional noted that “not all pediatricians speak Spanish. This is indeed an impediment to understanding and answering the doctors’ questions well”.

Time constraints were another significant barrier, with appointments often conflicting with work schedules, especially for those traveling from rural areas to the city. As one participant explained,

It’s a lot of time, to the point that it even prevents someone from keeping a job, because if I’m taking him twice a week, as we say, it’s an hour of travel, plus the time spent at the place.

Public transportation limitations and travel costs further exacerbate these issues. Long waitlists for appointments were another challenge, as one participant remarked, “when I applied for that, there were 200 people in front of me…there is a lot of waiting. And it’s that they are very slow, very very slow.” Many also reported being ineligible for services due to their immigration status, with one participant sharing that “they always told us we didn’t qualify. So, truthfully, we stopped trying because they always told us the same thing”.

3.2. Theme 2: Persistent Chilling Effects

The stark contrast between welcoming local policies and aggressive federal enforcement emerged clearly in participants’ descriptions of service-seeking decisions. This theme reflects the ongoing chilling effects—whereby restrictive immigration policies create fear and mistrust that discourage service utilization not only among those directly targeted but also among eligible individuals and families. Participant concerns about the public charge rule appeared to be a driving factor in decisions about accessing services, even for eligible children. A participant expressed the following concern:

I started using food stamps a year ago. Since I’m arranging my residence, is this…is this going to affect me in the future? I am receiving the benefit for my children, who are American citizens, but I receive nothing for myself.

Even in this officially designated sanctuary jurisdiction, fear remained a dominant theme, with participants describing persistent anxiety about immigration enforcement and legal consequences that prevented them from accessing needed services. One participant described losing sleep and not taking her child to school due to fear of encountering border patrol: “I am very scared, that is the truth. Sometimes I can’t sleep…There are days that I don’t take my daughter to school because immigration (border patrol) is hanging around. Of course, this affects my daughter a lot.” Another described a fear of being separated from their children, noting that “they could catch me or take me away, from the children, right? Because my children are from here, but I am not, that they could take me.” Another participant described how immigrants often feel disempowered to assert their rights or speak up about poor service in hospitals or schools:

As an immigrant you are always afraid to even demand your rights. If they give you bad service in the hospital or wherever, or in the school, sometimes one stays quiet and it’s not the same when people, for example the Americans, they never stay quiet for anything.

Discrimination in both agency and community settings was also reported as a dominant contributing factor to chilling effects. One participant described “I went to a shelter for abused women, and they were very racist with me.” Another participant described an incident of discrimination in the community: “Yesterday, a woman was seen hitting some people’s house with a hammer because they are migrants, with a hammer, destroying their house. I mean, they’re not taking anything from you. It’s your house.” Often discrimination included instances of microaggressions or was sometimes related to language capacity. One participant shared experiencing a language-related microaggression when being told to “go back to Mexico” when asking for Spanish-language assistance. Another described how they do not receive service if they do not speak English, noting that “when I go accompanied by someone that speaks English to them, right away they help us. But if I go alone, they ignore me, sometimes.”

Policy changes and uncertainty about future government administrations also impact service use. One participant described increased difficulty in accessing essential benefits under the previous administration, “when President Donald Trump started, everything became more difficult, not only for me, but for many families, of course. Because he removed the [food] stamps, one of our main assistance sources.” Another participant noted that “right now, Biden has his rules about public charge. But then a new president comes…Then we don’t know if another president will come and reestablish the public charge rule for food stamps, WIC, insurance…We don’t know.”

3.3. Theme 3: Recommendations for Change

Responding to the tension between local welcome and federal enforcement, participants proposed solutions that could bridge the policy divide while addressing the persistent culture of fear and exclusion. Their recommendations for change emphasized increased local service availability, expanded hours, and improved information dissemination. One participant emphasized that “we need brochures that inform us, because in reality we already have the stations…the help is there, but the information is not.” Enhanced language access through more bilingual, empathic staff was also suggested. A participant recommended,

To give the information in the language, that they try to look for people that speak Spanish…So, I would say that if they spoke Spanish, the people would feel more confident to ask questions…and sometimes to change staff, to make it better, because sometimes the staff are very insensitive.

A one-stop-shop solution was proposed, with suggestions from participants including mobile units and centrally located facilities offering a wide range of services. One participant noted, “I think the mobile unit would be good, because it would go to several places and more people will know about it.” Participants from the rural areas of the county noted the need for services to be located in their area so that they don’t always have to travel to the urban area. Participants from the main urban area suggested that a brick-and-mortar location should be located in a central, well-frequented place, such as the downtown plaza or main shopping centers, as one participant commented “it would have more reach.” One participant also emphasized that the one-stop-shop should be a safe place for immigrants where they would not be at risk of encountering immigration enforcement.

Participants recommended a comprehensive range of services for a one-stop-shop, including medical, mental health, housing, food assistance, legal aid, childcare, and student support. One participant suggested, “doctors…food, food banks, day care, I mean, all the services that are required right? And in the mobile unit, well the same, right? They should offer information for everything.” To address the lack of awareness about available services, participants proposed using various outreach methods, including social media, television, and brochures in their language. Regarding staffing, several participants emphasized the need for experienced, bilingual personnel trained to assist immigrants. As one participant explained, “Yes, it would be…like a building where there were people trained to…to give you information about all the issues that we are talking about. Like how to search for mental services or look for work services.”

Finally, multiple participants advocated for policy changes, including pathways to legalization, legal work opportunities, and looser eligibility requirements for services. For example, one participant stated, “make it easier for us, so we don’t become a burden, like they think, right?” Another participant suggested, “don’t be so strict with the requirements that are asked to be able to qualify for more benefits as immigrants.”

4. Discussion

Research across diverse geographic contexts has documented remarkably consistent barriers to immigrant service access, despite varying policy environments. Studies from rural communities in the Midwest (Mirza et al. 2013; Sangaramoorthy and Guevara 2016), urban centers on the East Coast (Alulema and Pavilon 2022), and international contexts including Canada (Kalich et al. 2015) and Australia (Khatri and Assefa 2022) reveal similar patterns of language barriers, fear of immigration enforcement, and structural discrimination. European research has similarly documented how national immigration policies can undermine local integration efforts, with studies of policies in the Netherlands, Sweden, and Austria demonstrating the challenges that arise in localities where restrictive federal approaches collide with progressive inclusion policies (Van der Leun and Bouter 2015; Ataç et al. 2020). This body of literature suggests that the challenges identified in our border community reflect broader systemic issues that transcend geographic boundaries, highlighting the need for coordinated policy responses that align federal and local approaches to immigrant integration.

There is clear evidence of a rapidly increasing immigrant population in the U.S., predominantly consisting of families with immigrant caregivers and their children, who represent 26% of these households. Within these families, individuals often hold varying immigration statuses (Batalova 2024). Access to health, behavioral health, and other social services and programs provide a critical safeguard for the long-term health and well-being of immigrant families and their children (Ayón 2013; Brown et al. 1999; Linton et al. 2019). While the international literature demonstrates that service access barriers are widespread across immigrant-receiving communities globally, the unique characteristics of border regions—with their intersection of federal enforcement and local welcome—provide important insights for understanding how policy misalignment creates and perpetuates these challenges. The purpose of this study was to advance knowledge of those factors that hinder and support access to important services for immigrants living in a socio-politically juxtaposed, rural and urban, border community.

Our findings indicate the persistence of service access barriers even in contexts with strong linguistic and cultural infrastructure for immigrant inclusion. Despite New Mexico’s constitutional protections for bilingualism and local sanctuary policies, federal border enforcement activities appear to deter service utilization. Furthermore, while recent federal policy changes and post-COVID-19 adaptations might suggest reduced barriers, our results indicate that “chilling effects” may influence immigrant communities’ service-seeking behaviors. Notably, the community-driven solutions identified in this study directly address these contextual challenges, offering practical strategies for similar settings where local inclusion and federal enforcement create competing pressures on immigrant families.

Our results align with studies documenting the negative and cascading impacts of border militarization and complex barriers faced by rural communities, particularly in colonias (Lopez et al. 2024). Doña Ana County, for example, has five fixed Border Patrol checkpoints on major highways leading away from the border, effectively confining a substantial but undetermined population—particularly undocumented and mixed-status families—between the border area and the remainder of the state. In colonias, where commerce and services are far from reach, and where CBP, ICE, and local law enforcement regularly patrol, mixed-status and undocumented families face additional hurdles to accessing essential services. The confluence of remoteness, under-resourced communities, and heightened immigration enforcement creates a uniquely challenging environment for immigrant families seeking services (American Civil Liberties Union n.d.; Anthony 2020; Flores-Gonzalez et al. 2024), exacerbating the already poor health and well-being outcomes among children and families in southern New Mexico.

Language access emerged as a top structural barrier, consistent with other literature (Jacquez et al. 2016). This is particularly concerning given federal requirements for language access plans and the bilingual nature of the local community, within a historically bilingual (English–Spanish) state. The state of NM provides constitutional protections related to the Spanish language, including provisions to protect citizens’ rights regardless of language ability and support bilingual education (Stull 2012). New Mexico was also the first state to enact a bilingual multicultural education law and has issued an “English Plus” resolution to promote proficiency in more than one language (Lewelling 1997; Stull 2012). Regardless of these protections, language-related barriers continue to interfere with service access for immigrants in NM, impacting treatment adherence and risking adverse health outcomes (Pandey et al. 2021). In this dynamic context, limited awareness of available services and transportation-related barriers further contribute to the structural vulnerability of this population (Luque et al. 2018; Quesada et al. 2011). Transportation issues are further complicated by restricted free movement due to the presence of border checkpoints and federal immigration enforcement.

Building on the second theme, the impact of the socio-political context on service use decisions aligns with existing research on how restrictive federal immigration policies create a climate of fear. The participants highlighted how changing government administrations and limited information access contribute to prolonged uncertainty, perpetuating the “chilling effect” on service utilization. The participants conveyed concerns that protective policies might not endure through changes in administration, leading many to remain hidden through the recent Democratic presidency despite more lenient enforcement policies. These fears persist despite an immigrant-friendly local policy context, marked by city and county level resolutions that prohibit government employees from asking about immigration status or collaborating with federal immigration enforcement (Doña Ana County Board of County Commissioners 2014; Las Cruces City Council 2017).

Within this complex sociocultural context, participants’ insights on a one-stop-shop model emphasize the importance of integrated and holistic service delivery. This approach addresses the disparities between caregiver needs and actual service use revealed in our quantitative survey and underscores the interconnected nature of service utilization. One study exploring provider perspectives of practices facilitating access to health and social services among immigrant populations reported that offering wrap-around services, or the provision of multiple services in one setting, allowed them to meet several needs during one visit/encounter (Doshi et al. 2020). Recommendations for mobile units, provider training, and broadened eligibility criteria resonate with multilevel strategies employed to increase immigrant access to essential services post-COVID-19 (Villamil Grest et al. 2023).

The challenge of meeting diverse needs across a geographically expansive rural area underscores the potential of hub-and-spoke models and mobile units as effective solutions for serving immigrants. While telehealth services have emerged as a promising modality for service delivery to immigrants in a post-pandemic context (Hodges and Calvo 2023), participants in our study did not identify this as a preferred solution. This may reflect the realities of rural contexts where barriers such as limited broadband access, low digital literacy, and financial constraints impede effective telehealth utilization. Instead, participants advocated for placing services in well-frequented central locations, a preference that may reflect the local socio-political context, particularly the city’s sanctuary status. These findings emphasize that community-defined and community-led approaches are essential for addressing the complex needs of immigrant populations in border regions.

4.1. Limitations

This study has several limitations. First, our sample was predominantly Spanish-speaking immigrants from Mexico who had lived in the U.S. for 5 years or more. This may not represent the experiences of immigrants from other countries, those who speak other languages, or more recent arrivals. The experiences and service access needs may differ based on factors such as language, culture, religion, and legal status.

Second, the study’s context is specific to a region with heightened federal border enforcement policies within a historically welcoming rural community. This unique setting, influenced by broader U.S. policy climate and structural xenophobia (Samari et al. 2021), limits the generalizability of findings to other areas. However, it offers valuable insights for communities committed to improving health and social service access for immigrants.

Third, while we aimed to conduct five focus groups with 5–10 participants each (Krueger and Casey 2009; Masadeh 2012), recruitment and scheduling challenges resulted in groups ranging from 3 to 12 participants. This variation may have affected the depth and breadth of discussions in some groups.

Fourth, our recruitment methods, centered around community connections, may have led to selection bias. This approach potentially overrepresented families already engaged with services and underrepresented those more isolated or facing greater access barriers. While this is a common concern in community-based participatory research (de Graauw 2016; Wallerstein et al. 2018), it is worth noting that immigrant communities often rely on informal networks for information sharing (Menjívar 2000), suggesting that recruitment through these channels offers valuable insights into the broader population’s needs and experiences.

Lastly, the predominance of female participants may reflect a gendered view of service access and utilization. While this aligns with research showing women as primary coordinators of family health needs (Ciciolla and Luthar 2019; Macias 2023; Matoff-Stepp et al. 2014), it may overlook the perspectives of male caregivers and other household members. Future research could address these limitations by including more diverse participants, exploring different geographic contexts, ensuring consistent focus group sizes, employing varied recruitment strategies, and engaging a more gender-balanced sample.

4.2. Implications

The findings from this study yield three key implications for research, practice, and policy. First, our results demonstrate that barriers to immigrant service access persist even in ostensibly welcoming contexts. Despite New Mexico’s constitutional protections for bilingualism and local sanctuary policies, federal border enforcement activities still appear to deter service utilization. This suggests that meaningful change requires alignment between federal immigration enforcement and local service delivery policies.

Second, our findings reveal that “chilling effects” continue to influence service seeking behavior in immigrant communities, persisting through changes in presidential administration and even in sanctuary jurisdictions. This persistence through the recent Democratic presidency and post-COVID-19 era indicates these effects are more structurally rooted than previously understood. Addressing these effects requires not only policy change but also sustained community outreach and trust-building efforts to rebuild confidence in service systems. While these socio-political and structural challenges are significant, immigrant communities have demonstrated remarkable resilience and are a source of creativity and innovation in developing community-based solutions informed by lived experiences and cultural strengths.

Third, our community-informed findings point toward specific solutions for improving service access in rural border regions. The proposed one-stop-shop model, particularly utilizing mobile units and hub-and-spoke approaches, offers a promising framework for meeting diverse needs across geographically dispersed areas while accounting for the unique constraints of border enforcement. This model should incorporate bilingual and culturally competent staff; multiple service types under one roof; safe locations away from border patrol activity; mobile units to reach isolated rural areas; strong community partnerships to build trust; and clear communication about eligibility requirements. These findings suggest that improving immigrant service access requires a multi-level approach that addresses both structural barriers and local implementation challenges. Future research should examine the implementation and effectiveness of community-defined service models in similar contexts where local inclusion efforts compete with federal enforcement priorities.

5. Conclusions

This study illuminates the complex challenges facing immigrant families in accessing essential services within the unique context of a rural border community that maintains welcoming local policies amid intensive federal immigration enforcement. Despite New Mexico’s constitutional protections for bilingualism and local sanctuary policies, our findings reveal that structural barriers and deeply embedded “chilling effects” continue to impede service utilization, suggesting limited effectiveness of protective local policies when federal enforcement remains aggressive. The persistence of these barriers through changing administrations underscores that fear and mistrust have become structurally embedded within immigrant communities’ service-seeking behaviors. However, participants’ community-driven solutions—particularly the proposed one-stop-shop model utilizing mobile units and culturally responsive staff—offer promising pathways forward that directly address these contextual challenges. These findings emphasize that meaningful improvement in immigrant service access requires not only alignment between federal and local policies but also sustained implementation of community-informed, culturally responsive service delivery models that prioritize safety, accessibility, and trust-building. As immigrant populations continue to grow across the rural U.S., understanding and addressing these multilevel barriers becomes increasingly critical for ensuring the health and well-being of these vulnerable communities and their children.

Author Contributions

Conceptualization, M.F.-V.; methodology, M.F.-V. and C.V.G.; formal analysis, D.B. and G.B.; writing—original draft preparation, S.S.; writing—review and editing, M.F.-V., C.V.G., S.S. and D.B.; supervision, M.F.-V.; project administration, S.S.; funding acquisition, M.F.-V. and S.S. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

The study was conducted in accordance with the ethical standards of the Institutional Review Board at New Mexico State University (protocol code: 2205000479; date of approval: 04/19/2022) for studies involving humans.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study may be made available on request from the corresponding author due to privacy, confidentiality, and ethical reasons.

Acknowledgments

During the preparation of this manuscript, the authors used Claude AI for the purposes of improving manuscript readability. The authors have reviewed and edited the output and take full responsibility for the content of this publication.

Conflicts of Interest

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Abbreviations

The following abbreviations are used in this manuscript:

COVID-19	Coronavirus disease
PTSD	Post-traumatic stress disorder

Footnotes

Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Tables

Table 1

Focus group participant characteristics.

		n	%			n	%
Place of residence				Marital status
	Northern Doña Ana County	13	36.1%		Married	24	66.7%
	Las Cruces	17	47.2%		Domestic partner	4	11.1%
	Southern Doña Ana County	6	16.7%		Single	5	13.9%
Gender					Separated	3	8.3%
	Female	33	91.7%	Level of education
	Male	2	5.6%		Primary school	2	5.6%
	Non-binary	1	2.8%		Secondary school	3	8.3%
Age					High school diploma/equivalent	19	52.8%
	18–24	3	8.3%		Trade/technical/vocational training	1	2.8%
	25–34	16	44.4%		Some college/associate degree	1	2.8%
	35–44	14	38.9%		Bachelor’s degree or higher	3	8.3%
	45–54	2	5.6%		None	1	2.8%
	55+	1	2.8%		Prefer not to answer	6	16.7%
Age became parent				Employment status
	Under 18	6	16.7%		Full-time	6	16.7%
	18–24	21	58.3%		Not in the labor force	16	44.4%
	25–34	9	25.0%		Part-time	2	5.6%
	35–44				Seasonal employment	3	8.3%
Relationship to youngest child					Self employed	2	5.6%
	Mother	33	91.7%		Unemployed	7	19.4%
	Father	1	2.8%	Language spoken at home
	Grandparent	2	5.6%		Spanish	35	97.2%
Number of minor children in the home					English	5	13.9%
	1 child	5	13.9%	Year of first entry to U.S.
	2 children	11	30.6%		Before 2017	32	88.9%
	3 children	10	27.8%		2017–2019	4	11.1%
	4 children	5	13.9%	Country of birth
	5+ children	5	13.9%		Mexico	35	97.2%
Household structure					Guatemala	1	2.8%
	Two-parent household	25	69.4%
	Single-parent household	10	27.8%
	Grandparent guardian	1	2.8%

Table 2

Disparities in service need vs. service use.

		Ever Needed		Ever Used		Difference Between Need vs. Use
		n	%	n	%	%
Medical, dental, and mental health services
	Medical services for child	34	94.4%	35	97.2%	−2.8%
	Dental services for child	34	94.4%	35	97.2%	−2.8%
	Mental health services for child	4	11.1%	4	11.1%	0.0%
	Medical or dental services for self	32	88.9%	27	75.0%	13.9%
	Mental health services for self	10	27.8%	7	19.4%	8.3%
Housing, food, and income assistance
	Housing assistance	13	36.1%	5	13.9%	22.2%
	Food assistance	35	97.2%	34	94.4%	2.8%
	Income assistance	20	55.6%	14	38.9%	16.7%
Services for children
	Early childhood services	24	66.7%	24	66.7%	0.0%
	Preschool programs	26	72.2%	26	72.2%	0.0%
	Childcare services	12	33.3%	9	25.0%	8.3%
	School-aged services	14	38.9%	15	41.7%	−2.8%

Appendix A

Table A1

Interview questions.

Introduction
	Can you tell us a little about yourself, your family, your children?
Concerns/needs of immigrant community
	2. What are the biggest concerns/needs of immigrants in your community?
Service experiences
	3. How comfortable have you felt about receiving services from these agencies [participants provided a list of local agencies/programs]?
	4. Are there any factors that have contributed to feelings of discomfort or lack of trust in these services/agencies? If so, what are they?
	5. What types of challenges or barriers have you experienced when trying to get services for your child/family?
	6. Are there any reasons you have not gotten the services for your children that they are eligible for?
	7. Has/how has your experience as an immigrant impacted your decisions to seek services?
	8. Has/how has the presence of immigration officials, including border patrol checkpoints, and/or law enforcement impacted your decisions to seek out services for your child? Please describe.
	9. What would help more families like yours find out about available services?
Policy environment
	10. Have you heard about the public charge rule? If so, has this policy impacted your decisions to seek out services for your child?
	11. Has the change in the presidential administration from President Trump to President Biden changed how comfortable you feel to seek out the services you need for your family? If so, how?
The One-stop-shop
	12. If there were an ideal setting/format (e.g., central hub) for services for immigrant families, what would it look like?
	13. Would it have a physical location? Would it be mobile/have satellite offices? Or somewhere/someone you could call? Or online?
	14. What services would be provided? (e.g., access to legal services, food bank, public assistance, childcare, etc.)
	15. What kinds of agencies/providers/professionals (e.g., childcare, Drs, education, social workers, other parents, promotoras) would you trust to run it?
	16. How would families find out about it (especially those who are not as connected to services/community agencies)?
Conclusion
	17. Is there anything you would like to add that you did not have a chance to discuss?

Table A2

Themes and code frequencies.

Code	Description	Frequency
Theme #1: Ongoing structural and organizational limitations
Discomfort/mistrust in services—General	Feelings of discomfort or lack of trust in services	7
Discomfort/mistrust in services—Bad service experience	Discomfort/mistrust due to bad experience related to the services provided	82
Discomfort/mistrust in services—High Cost	Discomfort/mistrust due to the high cost of the services provided	8
Service access barriers-General	Mention of barriers to receiving needed services.	3
Service access barriers—Cost	Cost as a barrier/reason for not accessing services	32
Service access barriers—Immigration status	Not qualifying for a service due to legal status, or legal status as a reason for not seeking services	18
Service access barriers—Lack of information/awareness	Lack of information or awareness of services as a reason for not getting services.	20
Service access barriers—Language barrier	Language as a barrier to service access, e.g., lack of personnel that speak the language of the clients, translation/interpretation issues, etc.	22
Service access barriers—Not qualifying	The service was denied due to not qualifying	24
Service access barriers—Service doesn’t exist/lack of option	Service does not exist or there are lack of options for a needed service	18
Service access barriers—Time	Time as a barrier to accessing services	14
Service access barriers—Transportation	Transportation as a barrier to accessing services	11
Service access barriers—Unfair service approval/assignment practices	The service is provided to persons who do not necessarily qualify at the expense of those that do qualify	4
Service access barriers—Waiting list	Long wait list as a barrier to access the service	16
Theme #2: Persistent “chilling” effects
Discrimination in agency setting	Discrimination that occurred at an agency/organization	26
Discrimination in the community	Discrimination that occurred in the community, e.g., from neighbors or other community members.	18
Discrimination—Language	Discrimination specific to language, e.g., due to speaking a language other than English	4
Discrimination—Microaggressions	A subtle, indirect, or unintentional statement, action, or incident that is considered discrimination towards members of marginalized groups like racial or ethnic minorities.	18
Fear causing service barriers	Fear of public charge, immigration detention, etc., reducing use of services	21
Government administration change	How the change in the government administration (e.g., Trump to Biden) impacted decisions to seek services	20
Immigrant voice/lack of voice	Lack of voice for immigrants and/or participation in study as an opportunity to uplift immigrant voices	5
Public charge	Mention of public charge and/or how it has impacted service seeking decisions	31
Theme #3: Recommendations for change
Changes needed to increase access	Changes needed to help increase access to services for immigrants	26
“One-stop-shop”—Dissemination of Information	How to disseminate the information about available services for immigrant families	23
“One-stop-shop”—Format	Suggestions related to format of one-stop-shop	18
“One-stop-shop”—Location	Suggestions related to location of one-stop-shop	15
“One-stop-shop”—Staffing	Suggestions related to staffing of one-stop-shop	3
“One-stop-shop”—Types of Services	Suggestions related to types of services that should be offered at one-stop-shop	27
Policy/systems change suggestions	Suggestions for needed changes to policy/systems level change	6

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