More than 40,000 children have lost a parent due to COVID-19. Black children, who constitute 14% of children in the US, are 20% of those who have lost a parent.
Chances are good, then, that some of your patients have been through one of the most significant losses they will experience in their whole lives.
The support they receive now to grieve in a healthy way can make the difference between their ability to thrive and their descent into adverse outcomes ranging from school failure to death by suicide.
Ways to support children who have lost a caregiver to COVID-19 was the subject of a May 19 webinar sponsored by The REACH Institute, Rady Children’s Hospital San Diego, and Children’s Primary Care Medical Group San Diego. We followed up with one of the panelists: Alyssa Label, a licensed marriage and family therapist who is program manager for the SmartCare Behavioral Health Consultation Services at Vista Hill Foundation in San Diego. She offered the following suggestions.
Find a local partner. “Build a partnership with a one-stop shop for case management,” said Ms. Label. “You don’t have to know all the community services. Just find that one partner and let them figure it out.”
Find your tribe. Build a support system of other providers with whom you talk regularly. “It can be really hard to see patients struggle,” Ms. Label noted. “We need to debrief. You’ll be more open and more helpful if you take care of yourself first.”
Ask open-ended questions. Families may not disclose immediately that a death has occurred. You can ask something like, “What’s been happening? Is there anything going on that makes you worried or sad?” You may get a direct response: “Well, my dad died.” Or it might be less direct: “I’m worried about putting food on the table because I’ve had to stay home with the kids after their dad died.” Either way, now you’ve got something to go on.
Attend to immediate needs first. “People can benefit from grief counseling only after their basic needs are met,” noted Ms. Label. She recommends having flyers about financial resources to hand to the remaining caregiver–starting with Social Security death benefits (see Resources).
Compensate for possible inattention. Grief, like other emotional struggles, can make it hard for people to listen. Ms. Label recommends not only handing out flyers but also putting important notes in writing, such as “Call us if things get worse.”
Normalize the grief. As with any mental health issue, patients and families can be comforted by knowing that their struggle is a common one. You can say, “People don’t always talk about their grief, so you might not know how many people have a really hard time after someone dies.” Normalizing grief may help families overcome any stigma they attach to seeking help.
Build on existing coping strategies. Ask patients and families what they are already doing to get through each day. If they don’t have ideas, ask what they used to do for fun or relaxation before the death. Can they try one of those things? “The family leaves feeling a little better,” said Ms. Label, “and so do you! You’ve taken a little step toward a treatment plan.”
Be patient, and build in follow-up. Knowing how dire the consequences of the death of a parent can be, you may feel pressure to solve the family’s problems immediately. But you have only a few minutes–and the family may not be ready for help. If you’re concerned that a family may not follow up with your referral, said Ms. Label, “Find a reason to bring them in again within a month or two.”
Let families know that you care. Distrust of the medical system runs high in some communities and families. “People might not be open to talking with you,” noted Ms. Label. “It’s not a reflection on you; it’s something that has been ingrained in them.” Through your openness and lack of judgment, let them know that your practice is a supportive space. Trust can build over time.
Know that you’re making a difference. “Even if all you’ve done is ask how they are doing, it might be more than they’ve gotten anywhere else,” said Ms. Label. “Remember how important it is simply to be seen and heard. People may not remember your words, but they’ll remember how they felt when they talked to you.”
The REACH Institute webinar Grief & Loss: Supporting a Child Who Has Lost a Parent to COVID-19 offers background on bereavement during the pandemic as well as practical suggestions for helping families cope.
Alyssa Label, LMFT, recommended the following resources.
Websites for grieving families
“I came into the course as a general pediatrician with no training or experience in pediatric mental health management Following the course, I now feel empowered, equipped and most importantly, supported to go back home and implement meaningful change in my practice.”