Psycho-social Teams Make New Care Connections During COVID-19 Pandemic
By Kate Setter
When the reality of COVID-19 began to unfold in mid-March, house-wide measures to conserve personal protective equipment (PPE) came fast and cut deep. Those changes impacted many teams across the medical center, but perhaps none more profoundly than the teams that assess and support the psychological, social, spiritual and emotional well-being of our patients and families. Colleagues in Child Life and Integrative Care, Pastoral Care, Education Services, Social Services and Clinical Psychology found themselves on the outside figuring out how to get in.
The whole medical center started thinking in degrees of essentiality. Many people who typically provide care in patient rooms were asked to consider how to provide care from outside the room, or more often, provide care while working from home. “There was so much intensity the first seven to 10 days,” shared Eileen Clark, director of Child Life and Integrative Care. “We knew what needed to be done, but we had to figure out how to achieve it.” Child life specialists, chaplains and social workers maintained a modified presence in the hospital, but face-to-face access to patients was limited. They were suddenly questioning whether donning PPE to go into a patient room was worth the risk that the PPE wouldn’t be available in a critical situation later. In many cases, they made hard decisions to stay out of patient rooms, even when their professional judgment shouted, “Get in there!”
Megan Elam’s Education Services team began shifting and evolving their work when Governor DeWine ordered school closures. They coined the term “degrees of essentiality” and referenced it daily as they evaluated
patient needs and adjusted their onsite and remote presence. By late March they had switched to all virtual instruction. “There was heartache in the moment when we realized that this is our new reality,” said Elam. “It’s hard not to be at the bedside, and we feel guilty for not being there.” “My last face-to-face patient interaction was Monday, March 16,” said Wendi Lopez, PsyD, a clinical psychologist who specializes in inpatient consultation. Lopez and her team have also been working full-time from home since the middle of March. “This is definitely not an ideal set-up for psycho-social care.” But they are doing their best to provide for patients’ needs. Portions of the Pastoral Care, Social Services and Child Life and Integrative Care teams have also transitioned to work-from-home, some with on-call shift rotations and most using technology to provide care in these unprecedented times.
The Conduit to Care
Technology has been the savior of interpersonal connections in this new normal and allowed remote care providers to stay connected to patient families and their onsite colleagues. “It was a baptism by fire, learning Skype and Zoom,” said Marc Zumhagen, overnight staff chaplain. “There has also been more intentionality and openness to innovation because old structures aren’t there.” Indeed, the Pastoral Care team members have been remarkably creative as they have supported families and staff in crisis and grief. Chaplains Cate Desjardins and Maija Mikkelsen organized a baptism by Skype for a patient who was nearing the end of life. “While a “Skype baptism” wasn’t something we’d ever thought of doing before—and at first seemed to be a compromise—we were able to facilitate a deeply powerful ritual that gave the parents the unique role of actively participating in the baptism of their child that perhaps may not have been the case had we been there in person,” shared Mikkelsen. Chaplain Cindy Jones created an online happy hour to support her team in the Heart Institute. “As all of us were exploring an unknown dynamic of teamwork, I hoped that time together to process thoughts and feelings might be cathartic for some of us on the team,” said Jones.
“What is compassion in a pandemic?” asked Judy Ragsdale, senior director, Pastoral Care. “We have to let go of thinking there is a right answer.” So many of her peer leaders echo her sentiment that they are figuring this all out one day at a time, one step at a time, solving the next problem with as little compromise to patient experience as possible. Among the problem-solving, creativity and inevitable compromises, there have been bright spots of realization that the technology can enable connections that are more powerful than just the conversations. Lopez is conducting her consultations via video from her home office. “During a consult with a 3-year-old inpatient and her mom, Mom shared with me that I was the only member of the care team her daughter had spoken to since her admission,” said Lopez. “She said it was because mine was the only face she had been able to see.” Lopez and her colleagues have always visited families wearing regular clothes—no white coats or scrubs—to separate themselves visually from someone whom the child may associate with pain. In this time of head-to-toe PPE for everyone, Lopez’s unobstructed, friendly face on the iPad screen was a great comfort to the young patient she met that day.
The Kids Know What They Need
As the pandemic has unfolded, it’s apparent that the largest impact of COVID-19 on children hasn’t been, and won’t be, the disease itself, but the negative impact of the care they aren’t receiving. The Child Life and Integrative Care team has felt this first-hand as they have grappled with the impossible choice between providing care and protecting patients.
“Children’s voices are loud,” said Clark. “They are looking for and, in many cases, demanding the care and support of our team. We are always looking for signs that we’ve hit the point that not going in is doing more harm than good. Kids with PTSD who are afraid of the hospital are
always at risk for trauma if they don’t have interventions. We won’t give COVID that!”
As the medical center carefully managed PPE supply, clinical care evolved for Clark’s team. “When PPE restrictions eased, that was GOLD! It brought our professional judgment back into play,” she said. The Education Services team has switched to virtual tutoring sessions, but the kids want to learn and need to continue their work with their teachers. “I am surprised how much patient care has been able to continue,” said Elam. “We take it one day, one step at a time as we learn more.”
In the Community
During this global pandemic, colleagues have shown incredible ingenuity and leadership to meet needs outside the walls of Cincinnati Children’s. Community health workers, who are part of the Social Services team, figured out how to adapt the support they provide and meet the most basic needs of families in the community. Through a collaboration with the Free Store Food Bank, they modified how they coordinate the pop-up events for Avondale residents to safely access fresh produce in their neighborhood. “Despite the pandemic, this team is doing everything they can to ensure basic needs are met,” said Laura Monhollen, MSW, LISW-S, clinical director, Social Services.
The new ways in which social workers are delivering care to families at home may potentially become a long-term part of their practice.
“It’s difficult for some families who don’t have resources to access healthcare at Cincinnati Children’s. We now know we can provide great care remotely and it is a benefit to many families to meet them where they are, removing some of the burden and barriers for them,” she said. “Social workers are connecting with families daily, providing support, resources, and connection to reassure families they are not alone and that we will get through this together.”
Prayers for NYC
Working farther outside our walls, Chaplain Karen Behm also helped ease a burden. On March 29, she received a call from a doctor in The Bronx, NY. Sarah Norris, MD, did her fellowship at Cincinnati Children’s and knew Behm personally from their work together during that time. Norris is a pediatric palliative care attending working at a children’s hospital that rose to the challenge of making room for adult COVID patients. She led the palliative team taking care of those patients. They hadn’t been able to find a chaplain to join them, so Norris asked Behm if she would write prayers that they could say with staff, patients and their families over the phone or FaceTime when they needed comfort. The patients would be without their families and faith support in their hospital rooms.
With the help of her Pastoral Care colleagues and Translation Services, Behm delivered 17 original and adapted prayers to Norris within 48 hours—in both English and Spanish. “We put ourselves in the shoes of the people who will be hearing them,” she said. “They were written so people of all different faiths can find meaning and comfort in them.” The prayers have since been shared with hospice and palliative care organizations around the country. Norris uses them every day as she continues her work in New York. “She called and said she’d only worked a half-day but had used one of the prayers three times already for dying patients,” shared Behm.
How Are You?
Our psycho-social teams are hard-wired to assess needs. Amazingly, but perhaps predictably, they’ve begun assessing each other as seamlessly as they assess patients and families. And they’re using their skills, talents and hearts to genuinely take care of each other and their colleagues. Clark likens the COVID-19 pandemic to a marathon. It’s going to take a long time to make it to what may—or may not—feel like a finish line. “There are water stations in marathons,” she said, “What is filling you up and keeping you going?” Call them water stations, call them bucket-fillers, they’re the critical recipe for resilience. Teams report they are staying connected more in their separation than they did when they saw each other every day. They’re gathering to socialize, share, grieve, commiserate and support each other and the care teams with whom they work closely.
Beth Bauer, a bereavement coordinator and social worker who works with the NICU, Fetal Center and Transitional Care Center, says our teams are experiencing what’s called anticipatory grief. “This is the grief response to the experiences we’re missing and the situation we find ourselves in. It is also closely connected to the struggle with the ambiguity of the situation,” she shared. “Right now, we can all make an effort to find joy and focus on what’s in front of us—stay centered in our space.” Staying connected and supporting each other in new, meaningful ways is a high priority and keeps the team going. “I hope after this, we continue to be really good to each other!” said Monhollen.