Staff in group homes for vulnerable youth have faced pandemic trials like few others in America’s low-paid frontline workforce.
Last spring brought a sudden halt to all the activities that set a daily rhythm for youth in need of structure. Employees who act as surrogate parents had to keep their distance and don the impersonal protective garb of an emergency room — if they were lucky enough to even find masks, gowns and gloves.
When COVID-19 surged again in the summer, the workers supervised sick youth in “quarantine cottages” and called around in a desperate search for tests. Fall brought long days struggling to keep bored, isolated youth engaged with remote learning, stuck in a shrunken world that froze around them.
When December came — and with it new hope to crush the deadly virus with vaccines — there was more fear and disappointment. Many states did not prioritize the tens of thousands of frontline staff who care for foster youth and teens on probation in densely populated housing, and agencies and workers have spent weeks scrambling to find shots on their own.
Now, a new problem is roiling the residential care industry: Large numbers of staff are skeptical of the new vaccine’s safety and don’t want to take the shot. This widespread wariness has many providers discussing whether they may need to require the injections at some point in the future.
In a Jan. 26 survey of providers in 19 states conducted for The Imprint by the Association of Children’s Residential Centers, a significant level of coronavirus vaccine skepticism emerged. Among those that responded anonymously to a question about their workers’ willingness to take the vaccine, most reported that at least one-third of employees — and as many as one half at some agencies — did not currently want to get a shot.
“Primary concern is obviously uncertainty about the safety of the vaccine in the politicized/distrust of government space we are in right now,” one Northeast agency director explained in the survey. “Have been surprised by the number of people refusing or saying they would rather wait a while. Not the people I would have predicted in many cases.”
Group home workers’ reluctance mirrors larger nationwide trends.
According to a January survey by the Kaiser Family Foundation, more than half of all Americans aren’t yet comfortable taking the new vaccines — including 7% who will get the shot only if required and 13% who will refuse it no matter what. In this environment, group home workers are no exception.
A director in Michigan was sympathetic to the apprehension expressed by their employees, many of whom lost loved ones to the virus early on as the federal government floundered in its messaging and management of the pandemic, failing to deliver on everything from adequate protective gear to available testing.
“There’s understandable mistrust in a Government that downplayed the pandemic significantly,” the Northeast agency director wrote of the Trump administration.
Despite the risks of spending time in close quarters with often large and ever-shifting groups of children, workers in group homes and residential treatment centers are hardly alone in their apprehension about the vaccine’s safety and efficacy. In a December survey by the Kaiser Family Foundation, 29% of frontline healthcare workers said they “probably” or “definitely” would not take a coronavirus vaccine.
When the shots were first rolled out to staff in nursing homes — a low-paid workforce of mostly women and people of color — large numbers declined to get vaccinated, including more than half of workers in Ohio and Maryland, according to figures released by Ohio Gov. Mike DeWine (R) and a union representative for Maryland nursing home workers.
In phone interviews with The Imprint, several directors of youth care facilities in New York said, in addition to general distrust of the government and the vaccine development process, some female employees had expressed fear that the vaccine could cause infertility — an unfounded rumor that has circulated widely on social media in recent months. There is no evidence that the vaccines have any effect on fertility, and in some cases, even women in vaccine trials have gotten pregnant, according to reports the companies submitted to the Food and Drug Administration.
A survey by the Wisconsin-based Association of Children’s Residential Centers found evidence that in some instances, Black employees are particularly hesitant to receive a new vaccine, a position borne of personal experiences confronting racism in the health care system and the long history of unethical medical experiments on people of color.
“African American staff (a large pool of my staff) are very distrustful due to very real historical events,” one agency head in California wrote in response to the survey. In the Michigan agency, 75% of Black employees said they did not plan to get vaccinated, compared to just 20% of white employees.
Directors at Children’s Village in New York say the first step in building trust is acknowledging that systemic racism affects Black Americans in a multitude of settings, including health care, and that some are less willing to trust the hastily produced vaccines because of negative personal experiences or historical trauma.
“The COVID pandemic has exposed uncomfortable truths within Black communities about systemic disparities and discrimination,” Medical Director Traci Gardner and CEO Jeremy Kohomban wrote in a December Psychology Today opinion piece titled “The Collective Trauma of the Black Community in 2020.”
“When this is coupled with the worst pandemic in a lifetime, then what results is people in the Black community being scared to die from the pandemic and also, in some cases, scared to take the vaccine,” they wrote.
To broadcast her confidence in the vaccine’s safety, Dr. Gardner shared a photo of her pulling up her sleeve for the shot and recorded an informational video explaining the science behind the vaccine. Gardner and Kohomban also invited staff with doubts about the vaccine to reach out for a one-on-one conversation.
Other leaders of agencies who care for troubled youth say they too are attempting to ease concerns and increase employee vaccination rates by providing information through email, video and Q&A sessions with medical experts and peers.
Some of those surveyed expressed hope that staff would be more open to a vaccine after seeing more of their colleagues receive shots.
“We are hearing here and from other providers around the state that there is a big number who want to see their peers get it first and then make a decision,” wrote one Midwest agency director.
A survey respondent in Arizona said they encourage staff to share their personal experiences after getting the vaccine so others know what to expect. While some people feel no discernible difference, but common side effects include fatigue, muscle aches or a low-grade fever.
In New York’s Hudson Valley, a survey of staff at the Children’s Home of Poughkeepsie found that while just 35% of employees wanted to get vaccinated as soon as possible, 70% said they would probably get a shot after three months — if people they knew who joined the first vaccination wave didn’t display any significant side effects.
Executive Director Walter Joseph speculated that employees spending long hours working side by side in close quarters will motivate each other.
“There’s going to be pretty interesting peer pressure too,” he said, “because I don’t think staff want unvaccinated staff to be working with them.”
It may yet be too soon to see the impact of providers’ efforts and peer pressure. While one respondent in the Northeast said some staff had already changed their minds about getting a vaccine, another nearby wrote, “Not clear that education is leading to more people taking it.”
Meanwhile, the surge in infections and deaths over the winter holidays has underscored the urgency of staff protecting themselves and others — particularly in areas that had not suffered a direct hit in the spring and summer waves.
“As time went on, the majority of people most likely knew someone who has either been COVID-positive or has died from the pandemic, so they’re seeing firsthand the destruction, and it hits closer to home,” said Kathy Perkins, chief program officer at House of the Good Shepherd in Utica, four hours north of the pandemic’s early epicenter in New York City. “That’s got more people saying, ‘Maybe I’m willing and able to do this.’”
For now, none of the agencies surveyed are requiring employees to get vaccinated or plan to do so in the near future. The coronavirus vaccines are now being offered under an emergency use authorization and are not yet licensed by the Food and Drug Administration, so virtually no American employers have begun mandating them yet — not even major hospital systems or the U.S. military.
Some group home providers said they are waiting before finalizing their policies to see if local health authorities or supervising state agencies will issue guidance, which could take the pressure off individual employers.
“We are very closely watching what our state agencies and our regulatory bodies are doing. If they make it required, the decision is out of our hands, so we don’t want to create a policy that then conflicts with that,” Perkins said.
Right now, many child welfare directors worry that pushing vaccines too aggressively could alienate critical staff members whom they rely on to keep 24-7 centers open under extraordinarily challenging conditions. But there are ongoing dangers to consider as well if too few accept the shots, and some of the directors surveyed for The Imprint reported they’ve already asked their legal and human resources departments about requiring vaccinations for employees.
“We are not mandating the vaccine but we’re thinking about it, and probably other people are as well,” said Joseph at the Children’s Home of Poughkeepsie. “I don’t see a way out of this until you get very high vaccination rates.”