COVID-19 has changed the way children experience the death of a loved one. Although difficult under any circumstance, bereavement is even harder when mourners can't gather. Barriers to comforting mourning rituals and supportive social communities can make it harder for children to grieve in healthy ways, while increasing the risk for maladaptive grief reactions. Without intervention, maladaptive grief reactions can lead to long-term problems including persistent difficulties with functioning at school, at home, with friends, and in romantic relationships. Over the long term, if not alleviated, these difficulties can cascade forward into more severe outcomes: failing grades, reduced likelihood of graduating from high school and of post-secondary school success, and reluctance to marry and form stable families.

"We have kids who come in here on three, four different medications," says Dr. Elizabeth Wallis, MD, "and we don't know why. We don't know what data were used to make those decisions." Dr. Wallis, director of the Foster Care Support Clinic (FCSC) of the Medical University of South Carolina and a REACH faculty member, was expressing just one of the challenges of treating children and youth in the foster care system.