Boston grief support program for kids sees big increase in families seeking help

Tens of thousands of children in the U.S. are going through the holidays having lost a primary family member to COVID-19.

A recent study found that between April 1, 2020 and June 30 of this year, 140,000 American kids experienced the death of a parent — or a grandparent who took care of them — from COVID. The number was said to have risen to 170,000 children by October.

Some grief support programs for children have seen more kids and their families seeking help. The Good Grief Program at Boston Medical Center has experienced a 50% increase in families requesting services in 2021, over last year. Clinicians who run the program say about 10% of the new families they're seeing are grieving a loss from COVID — the rest from other causes, including drug use, violence and disease.

Maureen Patterson-Fede, a clinical social worker who oversees the Good Grief Program, and Minelia Rodriguez, a licensed mental health clinician there, spoke with WBUR's All Things Considered host Lisa Mullins.

On the complexity of children's grief:

Patterson-Fede: "A loss is so many pieces. And for some of our kids and families, they've experienced a death loss that's led to so many other types of losses — like, maybe a housing loss, kids who have had to change schools, families that ... may have lost their breadwinner, and they're not really sure where their next meal is coming from."

"A loss is so many pieces. And for some of our kids and families, they've experienced a death loss that's led to so many other types of losses."

Maureen Patterson-Fede

On how clinicians reach out to communities and kids who need grief support:

Rodriguez: "Those families are all identified within their primary care team. So we're often having nurse practitioners and pediatricians and social workers send those families to us. Kids are presenting with lots of different symptoms that are appropriate for ongoing counseling, but also we're just seeing really unstable ... environments for kids to be grieving in."

Patterson-Fede: "We're not necessarily focused right on the loss right away, because we're thinking about, 'How do we get this family somewhere where they can sleep tonight? How do we connect them with food resources,' so we can meet that need first before we're thinking about the ways that they're talking about their deceased. And so with that, we're often working with caregivers who are saying, 'Hey, I had losses happen when I was a kid, and no one ever helped me through it. I want something different for my kid, and I don't know how to do that.' So sometimes the work really takes on a whole life with the caregivers to talk about losses, talk about emotion, because those conversations may not have ever happened in their home beforehand."

On how children express grief:

Rodriguez: "There's a lot of misconceptions about childhood bereavement. ... A lot of the times, if we have an infant or a baby coming into the program, we're seeing things like they're not sleeping well or they're not eating well, or they're crying a lot more. ... We know that babies do grieve. And of course they don't have the cognitive capacity to understand what a death is, right? But, for example, if there's a baby who has lost their primary caregiver, then that baby is going to know that that person's not there anymore. They're very, very attuned to their emotional environment.

"Once kids have more of a cognitive capacity, once they're a bit more verbal, they'll have changes in their moods. They might be impacted socially. They might present with some behavioral issues at school or at home — symptoms of anxiety, for example. Separation anxiety is really, really common in little kids. And then when we get to adolescence, then we start kind of wondering about complex bereavement symptoms or depression."

On the scale of loss for children and any concerns about the amount of support that's in place to respond:

Patterson-Fede: "I think we're all holding our breath. We're feeling like we're just seeing the tip of the iceberg about what's going to play out for kids — thinking about not only these kids who have lost someone who is so important and centralizing to their life. You know, we think about the small moments, right? 'Who's going to cut my sandwich? Who's going to do my hair, who's my person that helps me with my math homework?' But on top of all of that, we just have kids who have been living in a state of uncertainty for the past two years. So we're really kind of hoping that because so many folks have been focused on children's mental health, that there can be this influx of support to the system because we're going to need so much more than we have access to."

"I think we're all holding our breath. We're feeling like we're just seeing the tip of the iceberg about what's going to play out for kids."

Maureen Patterson-Fede

On how the pandemic has exacerbated children's difficulties with grieving:

Rodriguez: "I think COVID has exacerbated all of the things that our families are going through. And so, I think for lack of a better word, the interesting piece about COVID is that kids have lost their sense of safety in the community. I have kids that did not leave their homes for months, because they were too afraid to step outside, their caregivers were too afraid to step outside. So COVID has exacerbated all of the symptoms that you can think of. And I think it's been a really significant barrier for kids to grieve in a normal way."