Social worker Liza Sanchez held this balloon release for her cousin, who died of COVID-19, and suggested holding a similar memorial might help a client who was also grieving a loved one. Photo courtesy of Liza Sanchez
The siblings – a teen and a pre-teen – waited for good news that never came. Their mother was sick, and doctors suspected it was COVID-19, the potentially deadly disease barreling through New York.
They couldn’t visit her as she lay in the hospital, even as days stretched into weeks. With no other relatives stepping forward to care for them, the pair lingered in a city building meant to house children entering the foster care system for only a couple of days at a time.
After countless long nights on unfamiliar cots, the news they had dreaded arrived: Their mother was gone. And now they were headed to a foster home with strangers.
“They didn’t get to say goodbye,” said Georgia Boothe, vice president at Children’s Aid, the agency that arranged the siblings’ foster placement. Instead, she added, “we tried to help them memorialize her.”
Across New York state – where the coronavirus has stolen nearly 30,000 lives in less than three months – children have been forced to reckon with sudden loss in a scary world that even adults barely recognize. Processing grief can be even more complex for young people in foster care and residential facilities, who are already reckoning with other heavy losses – of family, of home, of a world where they are safe and loved.
Waves of sadness
Grief is a “natural, automatic, full-body response” to loss, Dr. Katherine Shear, the founding director of the Center for Complicated Grief at the Columbia University School of Social Work, described in a webcast on the coronavirus pandemic in April. Death of a loved one is the loss that eclipses all others, enveloping a survivor in sadness, longing, anxiety, guilt and anger. Yet many other types of loss can also trigger grief, including the loss of routines, milestones and face-to-face interactions that have been wiped out by stay-at-home orders and social distancing restrictions.
So too can secondary trauma from events like the killing of George Floyd, the unarmed black man choked to death by a white police officer two weeks ago, captured in a widely shared video that has enraged the nation and sparked historic protests against police brutality.
Amid the parallel crises, foster care providers have rushed to adapt their mental health services to virtual sessions to serve children, nearly all from poor communities of color, now grappling with the disproportionate impact of family disruption, the pandemic and systemic racism.
In Staten Island, a bereavement support group for teens at Curtis High School, begun after the death of a student in fall 2018, is now meeting over video chat. In the last few months, a teacher and several students’ relatives have all died from exposure to the coronavirus.
Jose Desiderio, the counselor who runs the high school group, said coping with grief can be even more difficult when daily life changes after the loss of a loved one – a shakeup young people in foster care already know too well.
“Having to do those transitions over and over again, whether it’s moving or dealing with different family dynamics, can make their overall grief process more complicated,” Desiderio said. “It can co-exist with anxiety and depression and even a fear factor, like ‘Am I ever going to have a stable place like I did when my mom was alive?’”
Children who lose a parent are at higher risk of developing depression within two years, particularly when they are 12 or younger at the time of the loss, according to a study by psychiatrists at the University of Pittsburgh and the University of Cincinnati.
Trauma Work Before Grief Work
The wide range of children’s responses to grief can be thought of as a pyramid with four groups, where those in the largest group at the base have a lot of support and generally cope well, said Dr. Robin Goodman, assistant director of Public Education and Bereavement at the Child HELP Partnership. Children in the next-largest group are also fairly resilient, but can benefit from developing coping skills through group activities and extra support.
However, the children in the two smaller groups at the top of the pyramid experience traumatic grief compounded by a lack of support. Those at the peak are often already facing serious challenges – like a history of trauma or longstanding mental health or substance abuse issues – to which foster youth are particularly vulnerable. Youth in foster care placements are also less likely to have the family support and stability that promote a healthy grieving process.
A traumatic grief response often impacts a young person’s functioning for an extended period of time, Goodman said. They may be unable to talk about the person who died or express their feelings. Focusing on school or other activities may become extremely difficult. Some show signs of depression, like withdrawing from others. Some may act out or get into fights, while others can become self-destructive or overly anxious.
In some cases, children may avoid activities or places they used to enjoy because the reminder of what happened to the person they lost is too intrusive and upsetting. For example, she said, a child who used to play baseball with their late father may suddenly quit the game, because just thinking about the game prompts frightening memories of the ambulance that took him to the hospital.
“It’s attached to all the scary things that take over and trigger these intense, overwhelming reactions – they may shut down or freeze or feel numb,” Goodman said.
When a person is unable to move forward after a loss, experts recognize a disorder called prolonged grief, sometimes called “complicated grief.” The condition is relatively rare among those ages 8 to 18, affecting 12.4% of youth when defined as persisting six months after a loss, or 3.4% of youth when defined after a year, according to a 2019 study by Dutch psychologists.
Goodman says children suffering from a traumatic grief response or prolonged grieving can benefit from professional counseling in order to help them through what she calls the “tasks of bereavement” – managing emotions, talking about what happened and developing new relationships.
“You have to do the trauma work before you can do the grief work,” Goodman said. “Those scary things get in the way of talking about the sad things or remembering the happy things.”
‘Unexpected and uncontrollable’
The cruel nature of the coronavirus itself has also added to the strain of a loss. The virus strikes suddenly and seemingly randomly, and because infection is transmitted easily between people who spend the most time together, Shear called current circumstances a “set-up” for survivor’s guilt. In New York City, 5,630 people ages 18 to 64 have been killed by the virus, leaving behind countless young people now grieving the friends, family members and caregivers who had helped raise them and guide them through difficult times.
“Grief is determined primarily by the relationship with the person you lost, but it’s also affected by other people and other things that happen around us,” Shear said. “Right now, a lot of that is unexpected and uncontrollable.”
Foster youth who lose a parent or relative from whom they are estranged or have been separated, may be further buffeted by conflicting emotions.
“Youth in foster care might have an ambivalent relationship with a parent. They may have a lot of anger or haven’t spoken in years,”said Aaron Newman, deputy director of behavioral health at Children’s Aid, “and then that person dies, leaving no chance for closure.”
Another way to say goodbye
The restrictions of social distancing make it even more difficult for foster youth to approach any sense of closure. There are no community gatherings, no masses, no shivas or memorial celebrations. No hugs, even.
Instead, the pandemic has forced frontline workers in the child welfare field to get creative in finding ways to help the nation’s most vulnerable children and families experience loss with as much ceremony and dignity as is possible.
Liza Sanchez, a social worker at University Settlement Services, said strengthening families in the foster care system also means helping them find a meaningful way to honor their lost loved ones and stick together in the darkest of moments.
One mother Sanchez works with recently lost her brother to the coronavirus, not long after losing her mother – a key member of her support system – to a different ailment. The woman was devastated. She was also wracked with guilt that all she could do to honor her brother, who had lived in Florida, was attend an online funeral – a far cry from the big, proper service she’d recently held for their mother.
To help them cope, Sanchez suggested the woman and her four children hold their own special memorial at home, to give them a chance to remember the good times and say their own goodbyes. Her approach came from personal experience – she too had recently lost a dear cousin to the same virus.
“Give him something from your heart, that no one else can give him,” Sanchez suggested, thinking of how her own family had coped. “It helps to make a card, let some balloons go, say a prayer with a candle.”
For the siblings who entered foster care after losing their mother, Children’s Aid staff helped plan a memorial to offer a chance for closure. The children struggled through the emotional service, supported by their foster parents and a handful of others who attended – a teacher, a classmate, a couple of neighbors.
Before they closed the casket, they placed a few family photos and hand-drawn pictures inside, small tokens of the first love they ever knew – one they will never forget.
Megan Conn can be reached at [email protected].
