Children’s Grief, Disruption, and the Social Work Skills Hospitals Should Lean On
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.
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.
This article is part of a series from the Boston University Center for Innovation in Social Work & Health (CISWH) 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.