Children need age-appropriate conversations to help them understand emotional events in their lives, whether it’s a death or global crisis.

By Nilagia McCoy

The COVID-19 pandemic has caused uncertainty and disruption for nearly everyone, not the least of whom are children. Children thrive on routine, but have been pulled from school and other structured activities. While adults may think kids aren’t as impacted or don’t need to understand the current situation, experts agree that kids are astute, and they may feel just as much distress about the changes to daily life as anyone. This destabilization is significant and can take an emotional toll. Add in a loss — such as a family separation or death — and the effect is compounded.

“Children will benefit most from age-appropriate conversations with people they trust to help them understand things, whether it’s a death or what’s happening in the world now,” says Maureen Patterson-Fede, LICSW, program manager for Boston Medical Center’s (BMC) Good Grief Program, which has helped children and families process grief from death, divorce, and traumatic separation since 1996. Now, the program has turned its focus to helping families cope with traumas from COVID-19, for which there is an overwhelming need — provider referrals to Good Grief’s services have increased 92% compared to 2019.

The team is working with families to address the complexities unique to the COVID-19 pandemic, such as how to find closure in the absence of being able to attend a funeral.

The program is a wraparound service to support medical care at the hospital, and is led with a social work approach, which considers the social, economic, and systemic injustices a patient may experience. The team’s social workers and mental health professionals provide consultations to pediatric patients’ parents or caregivers, who are typically referred by healthcare providers in pediatrics, behavioral health, and community health clinics. They provide guidance on how to have conversations so a child can begin their grieving process, and offer ongoing counseling for children who may need more support moving through their grief.

“Children will benefit most from age-appropriate conversations with people they trust to help them understand things, whether it’s a death or what’s happening in the world now.”

When it comes to processing grief, it’s best to hold the patient holistically and meet them where they are, says Patterson-Fede.

“There are many lenses that intersect with grief when working with a family,” she says. “There’s a developmental lens, because children grieve differently depending on their age. There’s the lens of understanding a family’s cultural and spiritual beliefs, so you can effectively communicate with the family and child.” Unmet social needs, which have seen an uptick during stay-at-home orders, also play a role. “If you’re not eating, if your home isn’t safe, you can’t move though the grief process,” says Patterson-Fede.

Each piece is essential and underscores the value of integrating a multidisciplinary approach into the medical home. Throughout the pandemic, as front-line medical providers have garnered well-earned headlines, other staff such as social workers have been critical in meeting health needs like food access and end-of-life decisions during the pandemic. Patterson-Fede hopes the emerging lessons from the coronavirus pandemic will encourage the healthcare sector to continue to put greater emphasis on social needs and mental health — where social work is particularly valuable — as part of better care.

“The acknowledgement of mental health and the importance of social work teams has been elevated because of coronavirus, and I think there is more of a platform to think about how those pieces are integrated into healthcare,” says Patterson-Fede.

That includes moving beyond the hospital walls to form partnerships within the community. Good Grief also collaborates with schools, childhood mental health providers, and other Boston-area organizations to provide training. Currently, Good Grief is working with early childhood providers to determine how to best support very young children, and strategizing on how to meet the needs of school systems while they cannot physically bring people together for coping and healing.

The COVID-19 pandemic and its impact will be long-lasting, requiring ongoing support for children. Whether it be grief for a loss of stability, loss of a loved one, or other difficult changes, an integrated approach across hospital departments, and with outside community organizations can help address the healthcare and social needs of families. “Many of the problems facing patients are too big for just one person to solve, and need to be thought about holistically,” says Patterson-Fede.

Schools and other organizations interested in Good Grief’s trainings can contact Patterson-Fede at [email protected] for more information.

This article is part of a series from the Boston University Center for Innovation in Social Work & Health (CISWH) for Boston Medical Center’s HealthCity that highlights social workers working in healthcare and public health to address the nonmedical factors that impact health, known as social determinants of health. Know of a healthcare team that’s doing innovative work involving social workers? Contact us — we want to hear your story.

BUSSW’s Professor Hahm and Dr. Liu of Brigham & Women’s Hospital seek 1,000 young adults to participate in study

BUSSW professor Hyeouk Chris Hahm is launching a new research project documenting the physical and emotional experiences of young adults during the Covid-19 pandemic. CARES: The Covid-19 Adult Resilience Experiences Study will use survey results from 1,000 young adults in the United States to assess well-being and identify needs.

Hahm, associate professor and chair of social research at BUSSW, is an expert in young adult health and health disparities with a focus on Asian American populations. Hahm leads the AWARE Lab, a culturally-grounded intervention program used in colleges and high schools, and co-leads Epi-AWARE, a study on stress and health outcomes among Asian American women.

Hahm co-leads CARES alongside Dr. Cindy Liu, director of the Developmental Risk and Cultural Resilience Laboratory at Brigham and Women’s Hospital and assistant professor of Pediatrics at Harvard Medical School.

Adults ages 18-30 living in the United States or receiving an education in the United States are encouraged to participate in the survey. For details, please visit cares2020.com.

What is involved?​

• 30-45 minute online survey that will take place in up to three time points over the course of six months (April – October 2020)
• 1 out of every 10 participants will earn a $25 Amazon gift card.

Contact CARES

Email [email protected] or contact the team via the CARES website.

On Tuesday, February 25, 2020, the Center for Innovation in Social Work & Health (CISWH) Social Work and Health Equity Speaker Series hosted a panel discussion called Stopping Sex Trafficking: The Role for Health and Social Services. This panel featured voices from key community perspectives to explore the impact of sex trafficking, how to identify victims, and ways to support survivors in their healing journey.

The panel was moderated by BU School of Social Work graduate student Erin Sheehan, and featured:

• Nikki Valila, Director of Training at My Life My Choice, Justice Resource Institute
• Jennifer Martin, LISCW, Staff Clinician at Project Reach, The Trauma Center, Justice Resource Institute
• Louise Sheehan, RN, Access Nurse at Mass General Hospital Freedom Clinic
• Oscar Delgado, Outreach Coordinator at New England Coalition Against Trafficking
• Madeline Pouw, BU MPH student and Co-Founder of Every Hand is a Hero

Framing up the discussion to follow, Madeline Pouw stressed that sex trafficking is not a “somewhere else” or “somebody else” issue. It happens everywhere, in all 50 states, and over 80% of victims are United States citizens. Many victims are involved in the welfare system and traffickers prey on their vulnerable position, typically recruiting victims online and building trust with seemingly helpful or romantic gestures. All too often, favors turn into debts that trap victims on the wrong end of a power dynamic that seems inescapable.

The discussion then turned to the panel, which examined sex trafficking from social work, health care, social justice, and mental health perspectives, and highlighted challenges and opportunities that could make progress in stopping sex trafficking.

Interdisciplinary solutions to a multi-faceted problem

First, panelists were asked to think about how their organization used cross-agency and professional collaborations to help prevent sex trafficking. Panelists agreed that successful intervention requires a cross-disciplinary approach, involving family, social work, law enforcement, education, and health care systems. For example, MGH’s Freedom Clinic created a trauma-informed specialty provider network to meet the complex and diverse needs of this population. They secured specialized medical billing codes that opened the door to mental health, housing, and unique recovery services such as removal of branding tattoos.

Oscar Delgado noted that a significant challenge is long-term economic development for survivors. Once they leave dysfunctional networks, survivors need skills training as well as transitional assistance to rebuild their lives. Shelters can be traumatic, yet there are few safe housing options. Agencies need to reach across traditional roles and work together for integrative, holistic approaches to supporting survivors. 

Creating a roadmap for survivors and providers

There’s no easy or clear path for survivors. Most of the time, victims simultaneously have contact with multiple systems that provide support in a specific area of expertise—but rarely is anyone coordinating the entire effort. The panelists suggested developing a scenario-based playbook like the ones used in medicine (e.g. if a patient’s blood pressure drops, follow these three steps) to think about protocols for treating survivors, including which systems and providers would need immediate, coordinated activation. 

Of primary concern, the panelists agreed, is to not re-traumatize victims through a piecemeal system. Nikki Valila of My Life My Choice noted that nearly 90% of victims reported contact with someone who could have helped—but they couldn’t bring themselves to ask. If providers knew what to look for and the right questions to ask, they could provide faster and better assistance. Humanizing the process and dialogue, collaborating across disciplines, and using technology can all be used to build trust with survivors and help guide them forward.

Shared networks expedite connection with resources

Broad networks among service providers create the most opportunities to help survivors access support systems when and where they need them. Panelists called for establishing cross-disciplinary pathways to facilitate access to services, including pro bono legal resources for survivors trafficked as undocumented immigrants. Knowing whom to contact for jobs, housing, legal resources, and food—the foundational supports for rebuilding a life—helps providers move swiftly, so victims aren’t further traumatized by navigating an intimidating system. 

Strategies for concerned parents and caregivers

Asked how to prevent recruitment, panelists noted that a good place to start is through conversations at home, with family and friends. Building trust within families and having honest dialogue with safe spaces for questions create an environment where adolescents feel like they belong and are less susceptible to online predators. “We can’t stay ahead of technology,” notes Delgado, “so we need to do a better job of building trust with our families.”

Article by Mariah LeStage, photo by Nilagia McCoy.