Extreme Hardship Evaluations for

I-601 and I-601A Waivers

When a loved one faces deportation or is given an intent-to-deny letter or is unable to return to the United States, the emotional and psychological impact on their family can be profound. I provide trauma-informed services with understanding and compassion in a time of extreme stress.
An extreme hardship psychological evaluation documents that impact in clinical terms, giving attorneys, immigration judges, and USCIS adjudicators a clear picture of what is at stake for the qualifying relative left behind. 
As a Licensed Clinical Social Worker (LCSW) with specialized training in immigration evaluations, I provide comprehensive, well-documented hardship assessments that meet the standards attorneys rely on. I work across Missouri, Kansas, Kentucky, and Oregon via telehealth and in the greater St. Louis area in person.

What is an extreme hardship Evaluation?

A strong evaluation documents:
  • The qualifying relative's mental health history and current psychological status
  • The emotional, psychological, and practical impact of separation.
  • Any pre-existing conditions that would be worsened by the situation
  • The anticipated consequences of denial, including depression, anxiety, and disruption to daily functioning
An Extreme Hardship Evaluation is a psychological assessment used to support I-601 and I-601A applications. USCIS requires that applicants demonstrate their qualifying relative, typically a U.S. citizen or lawful permanent resident spouse or parent, would suffer hardship beyond the ordinary difficulties of family separation if the waiver were denied.
The evaluation is submitted as part of the waiver application and carries significant weight in the final decision.

what to expect

The evaluation process is straightforward, confidential, and designed to be as comfortable as possible for the qualifying relative. 
STEP 1: Initial ConsultationAfter you reach out, we will begin with a brief consultation to explain the process, answer questions, and gather background information from you and/or your attorney. 
STEP 2: Clinical InterviewI conduct a thorough clinical interview, in person or via telehealth, with the qualifying relative. This session typically lasts 60-90 minutes and covers mental health history, relationship history, family circumstances, and the anticipated impact of the immigration outcome. 
STEP 3: Psychological AssessmentWhen appropriate, standardized psychological assessments may be administered to document current symptom levels and functioning. These include, but are not limited to the PHQ-9 (measuring depressive symptoms), the GAD-7 (measuring anxiety symptoms) and the ACES (measuring childhood trauma experiences. 
STEP 4: Written ReportA detailed written evaluation is prepared, formatted to meet legal and evidentiary standards. Reports are delivered with a fast turnaround- typically within 5-7 business days of the completed review. You do have the option to request a quicker turnaround during the initial consultation. There may be a need for a shorter interview for me to ask clarifying questions as I am writing the report. 

Who I work with

I work directly with:
  • Individuals and families navigating the I-601 or the I-601A process who need a clinician who understands both the emotional weight and the legal context of their situation
  • Immigration attorneys seeking a trusted, reliable evaluation partner with consistent, attorney-ready reports

Why work with me

  • Specialized experience in immigration psychological evaluations, including hardship, VAWA, and asylum cases
  • Quick turnaround: reports typically completed within 5-7 business days of completed interview
  • Attorney-collaborative approach: I communicate clearly with legal teams and can address questions about the evaluation or report
  • Compassionate, accessible care: evaluations are conducted in a supportive, trauma-informed environment where clients feel heard, not just assessed
  • LCSW credentials: Licensed Clinical Social Worker, meeting USCIS standards for qualified mental health evaluators

Frequently asked questions

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Professional Therapy Services
At Pivot Therapeutic Services, we provide compassionate mental health therapy and immigration mental health and psychological evaluations.