Why Louisiana counseling centers are seeing a rise in kids with grief

NEW ORLEANS AND LAFAYETTE, La. – As the number of COVID deaths reach another grim milestone, mental health experts are concerned for the tens of thousands of young people struggling through a growing wave of grief, many of them without the services they need.

Dr. Julie Kaplow, executive director at the Trauma and Grief Center at Children’s Hospital New Orleans, warns that the country is now facing an epidemic of “psychological long COVID.” Kids are struggling to cope with their grief and trauma, experiencing effects like depression to suicidal thoughts. Many more also experience guilt, she added.

In Louisiana, though, the crisis may be more profound for a generation of kids experiencing poverty, a lack of resources, and trauma stemming from destructive hurricanes.

Before the pandemic, Louisiana ranked near last – 48th – in well-being overall for children, according to a Kids Count Data Book report based on 2019 data. In New Orleans, some state mental health experts say we’re already seeing what untreated grief looks like. Young people and their families have already been under incredible levels of stress, not just from the pandemic losses, but also from previous adversities and traumas that date back to Hurricane Katrina and, more recently, Hurricane Ida making landfall last year.

The Trauma and Grief Center in New Orleans opened during the pandemic. It’s currently one of the only trauma and grief outpatient facilities in Louisiana, where there’s a lack of mental health resources for kids. As COVID and deaths persist, the need for stronger support for grieving children has grown and prompted several organizations to reassess how they’re offering services, especially in low-income and rural areas.

Kaplow recalled when a 9-year-old girl who was receiving treatment at the center said, “I killed my mommy.” The girl’s mother died from COVID shortly after she had likely contracted the virus from school.

“Unfortunately, because of our society, shame and guilt are embedded in what we’re seeing,” Kaplow said. She pointed to the stigma around COVID-related deaths, with some kids being told that their late parent should have been vaccinated or worn their mask more. The added blame and judgment “only compounds the effect of death on children,” she said.

Across the nation, at least 1 million lives have been lost to COVID, with more than 215,000 children experiencing the death of at least one parent or caregiver to COVID, including 3,371 youth in Louisiana, according to April 2022 numbers from the COVID Collaborative, a team of education, economic and health experts who have been calling on President Joe Biden to take urgent action to better support grieving children — the “hidden victims of the pandemic.” The collaborative is also co-chaired by two former governors – one Republican, one Democrat – and Kaplow is on the group’s scientific advisory board.

Roughly one in 450 children in the U.S. have lost at least one of their caretakers to COVID, according to a December report from the collaborative titled “Hidden Pain.” And 70 percent of caregiver loss – accounting for 151,982 children – was among those aged 13 and younger.

WATCH: How unresolved grief could haunt children who lost a parent or caregiver to COVID

This data builds on the growing body of research around how COVID has hurt the mental health of young people. In April, new data from the Centers for Disease Control and Prevention showed that from January to June 2021, more than a third, 37 percent, of high school students in the U.S. experienced poor mental health during the pandemic. About 44 percent of those who responded to the survey said they consistently felt sad or hopeless in the previous year. U.S. Surgeon General Vivek Murthy echoed this concern in a statement in December, saying the mental health crisis among young people predated the pandemic, but the effects of the virus made it worse.

“The future wellbeing of our country depends on how we support and invest in the next generation,” he said.

In a column published in The Advocate at the start of the year, Kaplow wrote that research has indicated that the “sudden death of a loved one is the strongest predictor of poor school outcomes, above and beyond any other form of trauma, including physical abuse or sexual abuse.”

She said most of the referrals to the center for grief counseling come from schools and pediatricians. Kaplow said there’s an urgent need to identify at-risk bereaved youth as quickly as possible.

At this moment, “we are behind the mark,” she added.

Doctors are seeing kids with unexplained headaches, stomach aches, and heart palpitations, among other sources of pain, Kaplow said. But upon closer inspection, doctors are finding how the children’s grief is manifesting through these physical complaints.

The center, too, has seen a significant increase in the last six months in the number of bereaved children due to COVID, Kaplow said. As a resource, she often refers caregivers to a virtual learning library, which offers a series of handouts called “Power of Parenting” on how to help children cope with trauma and loss.

For kids, it’s tough to recognize the permanence of losing a caregiver, especially when confronted with reminders of their grief.

“We had a young boy come in who had applications to fill out for Boy Scouts, but he lost his dad. It was tough,” she said. “Dad was gone and now, and he was harming himself because he just wanted to get rid of the pain of that loss. Those potent reminders are what trigger kids to want to seek help.”

The challenges of grieving in rural areas

Counselors at a grief support center in the rural Acadiana region, two hours west of New Orleans, have seen what happens when bereaved children are left alone in their grief in an already isolating experience throughout the pandemic.

“Children were not given the chance to say goodbye to their loved ones. Many had no idea who was actually in the coffin at their loved one’s burial,” said Jenee Broussard, executive director of Healing House, a nonprofit in Lafayette that provides support for grieving children. “They weren’t able to see them in the hospital. For some of them, the last time they saw their loved ones was when they dropped them off at the emergency room.”

That lack of closure prolongs the grieving process, she said. And with fewer access to support systems, the challenges can become steeper.

“For those [rural] families who are already physically isolated, if they experience the death of someone close to them, it might extend that isolation even more,” Broussard said.

Healing House counselors say now that COVID protections are being lifted, the staggering loss for this rural area, home to nine parishes around Lafayette, is coming into focus. Even as the group has created 10 times as many support groups in recent months, kids have much higher needs than staff has ever seen. Last fall, Healing House conducted a grief survey in Lafayette public schools. Though not every school provided results — the survey did not include one of the area’s largest high schools — the survey showed more than 1,700 students were grieving the death of a loved one. The results in a city with a population of 126,000 people left many counselors in disbelief.

“Many school counselors were shocked. They had no idea because it wasn’t being talked about,” said Healing House’s in-school program director, Mandy McCoy. The situation isn’t helped if counselors have an already high caseload, she added. At first, the survey’s results were a “little bit overwhelming” in seeing how many schools and children needed grief services, McCoy said. But once caseloads are factored in, as well as the demands of school counselors, “it is easy to see how some kids are getting overlooked.”

Following that survey, Healing House, which has 12 staff members, increased services at its Lafayette facility and in schools, launching nearly 40 new in-school support groups that are helping more than 400 kids.

In a rural area where nearly one in five people lives in poverty and access to services is limited, grief around losing those who provided stability, confidence, and care is amplified by anxiety about the future.

“For many, it’s a single-income household. Now, the caregiver may have to take on another job to support the family, and it could trickle down to the other kids having to take on more responsibilities in the home,” said Brad Gros, the program director for Healing House. “They may have to become a young adult and take care of the needs of the family. Kids have a great deal of distress relating to their own grief, as well as watching the surviving parent deal with their distress.”

Grief experts say there are multiple ways surviving caregivers can help a child deal with loss. The recommendations include acknowledging the child’s grief, being honest, listening, and finding creative outlets that allow them to express their grief.

Grief can come out in different ways, through different emotions, including a lot of anger. Gros said connecting with in-person support groups with other kids has relieved some of the pressure. During the beginning of the pandemic, some programs were discontinued, while others were virtual-only.

“It’s not difficult for kids to show emotion; they show emotions quite easily. It’s difficult for them to vocalize what they’re feeling,” Gros said. It’s why support groups, like those administered at Healing House, use many methods of facilitating healthy expression. Some kids get their emotions out in the art room by drawing. Others express themselves through play by dressing up or using puppets. Healing House, in particular, has a “hurricane room,” which has reinforced walls for kids to express themselves physically, using a punching bag and bean bag chairs. Sometimes, Gros said, “they just need a hug.”

Some support groups at Healing House in Lafayette use the “Hurricane Room” for kids grieving the loss of a loved one. It has reinforced walls for kids to use a punching bag and bean bag chairs to express themselves with physicality. Photo by Travis Gauthier/Zoom Photo Studio

“There were some nights when I brought in a giant teddy bear. That poor teddy bear, I don’t know how he is still put together. He took the brunt of a lot of kids’ frustration,” Gros said.

The vast majority of these bereaved children do not require treatment in a clinical setting, the COVID Collaborative said in its 2021 report, “but all of them require loving people in their lives who understand the depth of their loss and are dedicated to their well-being.”

The collaborative estimated that about 5 to 10 percent of the children will “experience traumatic prolonged grief that requires clinical intervention.”

Kaplow, who has been a researcher for multiple studies on parental loss, said children without the appropriate supports – caregivers, mentors, grief camps, family bereavement programs, social and emotional learning, and deeper mental health supports in childhood, among others – may experience a wide range of problems later in adulthood, including relationship difficulties, substance use, depression, and risk of suicide.

‘Society is not meeting their needs’

Dr. Denese Shervington, a clinical professor of psychiatry at Tulane University’s School of Medicine, said her fear “is that children’s sadness will look like badness,” and they won’t get the kind of support they need, Shervington said. “Unfortunately, for Black and brown children, that puts them at higher risk for being in the juvenile justice system. Unfortunately, we misdiagnose those kids and mislabel these grieving kids as having a conduct disorder.”

Nationwide, the majority of these losses have taken place among Black and Hispanic families, many of whom were facing health disparities and higher death rates prior to the pandemic, making them even more vulnerable to mental and behavioral health issues, according to data from the COVID Collaborative, the CDC, among other organizations tracking COVID’s impact. In Louisiana, more than half – 1,744 total – of the children who have lost a caregiver are Black, according to the collaborative.

“Society is not meeting their needs, and children and teens don’t have the developmental capacity to understand consequences of behavior,” said Shervington, the founder and CEO of the Institute of Women and Ethnic Studies.

Dr. Denese Shervington, founder and CEO of the Institute of Women and Ethnic Studies, testified at the first-ever congressional hearing to address childhood trauma as a public health crisis in July 2019. Video by IWES NOLA

Shervington, who has extensively studied the psychological impacts of Katrina, said grieving children, especially the most vulnerable groups, know that adults aren’t doing enough to support them after they lose a caregiver.

“We have to understand; these are the young people who we didn’t care about during the pandemic. We didn’t care about whether they had access to food, could their families pay their rent, and how much exposure they had to COVID. We didn’t care about them. We didn’t do anything extra for them. We didn’t make them feel that their lives mattered. Now we expect them to think that our lives matter after we show them that we didn’t care about them,” she said.

Shervington also warned that if grief goes unhealed, over time, long-term effects can start to develop.

Shervington said she’d like to see resources shared more equitably, so that it’s not just the “people at the top who have access to everything at the expense of the people at the bottom who can’t crawl their way out of the daily grind of poverty and poor health.”

Overall, she’d like to see a greater acknowledgment on how everyone can help kids manage the stress of the pandemic.

“We need a public showing for young people that we care for them.”

If you are having thoughts of suicide, go to SpeakingOfSuicide.com/resources or call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK).