In the spring of 2013, Drs. Alan Shapiro and Cristina Muñiz, pediatrician and psychologist, respectively, were providing healthcare to homeless street youth on a mobile medical clinic at a drop-incenter in Harlem. An adolescent from Guatemala, Jorge, was brought to the mobile clinic for care. Jorge had a history of severe mental health problems and had lost his medications. He did not know which medications he was prescribed or where he was receiving psychiatric care. Fortunately, he carried the business card of Catholic Charities, where he was receiving pro bono legal services and case management. The agency was immediately contacted, and important information regarding his mental health care was obtained. After speaking to his lawyer, Brett Stark, Esq., the clinical team also learned that Jorge had the “UAC” designation. The team wondered how many other children like Jorge they had seen yet never asked whether they met the criteria for this designation or had legal representation. Drs. Shapiro and Muñiz also learned that this pro bono legal agency was seeing an increasing number of unaccompanied immigrant children and was looking for sites to send their clients for medical and mental health services. A series of strategic discussions led to the founding of Terra Firma (TF), just before the media's intense coverage of arriving unaccompanied children in 2014.