Stuck on a Screen, Therapists Rush to Respond to Mental Health Crises Among Foster Youth

facetime mental health therapy virtual counseling youth therapists
Illustration by Christine Ongjoco

As New York enters its third month of sheltering at home, mental health counselors serving vulnerable children and families in the foster care system are racing to adapt their tried-and-true methods to a virtual connection. Under the coronavirus shutdown, treating emotional distress means relying on phones, laptops and video platforms that even experienced therapists may have never before used to treat young people.

They’ve had to come up with some unique approaches.

Clinician Stephanie Olaso of the foster agency Children’s Aid, invites one young client to play a quick game of “I Spy” to break up an otherwise lengthy virtual session. She has a teen and her mom call in from separate rooms, so that eye-rolling and other physical reactions don’t trigger even greater conflict. With a young woman diagnosed with post-traumatic stress disorder who is holed up alone, Olaso focuses on day-to-day life rather than dredging up painful memories that could overwhelm her client after they sign out of the session.

Just six weeks into the coronavirus, Americans ages 18 to 29 were 10 times more likely to report feeling serious mental distress than they were two years ago, according to early university research published this month. That stress and isolation can be even more acute for the 15,393 young people in foster care in hard-hit New York state, where over 343,000 people have fallen ill and 22,000 have died. While the heaviest disease toll has fallen on the city, statewide school shutdowns and social distancing have left virtually all foster youth isolated.

Even before social distancing orders cut them off from visits with parents, siblings and friends, they were already grappling with mental health challenges and traumatic histories.

“When you’re someone who suffers from depression, being stuck with your own thoughts is not conducive to your development,” said Melanie Thompson, 24, a social work student and and former foster youth who now advocates for others with the Foster Youth Success Alliance. Thompson, who lives alone, has continued to meet with her therapist each week. But she says that hour-long virtual sessions are different from meeting in person, and can be “draining” for her and her therapist.

What’s more, the children and teens in foster care – of whom, in New York City, 85 percent are black or Latino are among those most likely to have family members sick and dying during the pandemic. These young people now wrestle with the added emotional burden of fearing for loved ones’ health, on top of the agony the entire city is now suffering. 

Some are already in mourning. In a recent poll by the Siena College Research Institute, half of all black and Latino voters in the city knew someone who has died of coronavirus, compared to a quarter of white voters.

“Any pre-existing conditions have been tremendously exacerbated by this pandemic,” said Aaron Newman, deputy director of behavioral health at the foster care agency Children’s Aid. “Even youth who previously may not have sought mental health services really need them because of being thrust into social isolation, fear, anxiety and bereavement.”

For many young people in foster care, the chaos caused by coronavirus is all too familiar. 

“If you’ve had bad things happen to you, you know bad things can happen to you,” said Mary Adams, the associate executive director for mental health at University Settlement Society, which provides foster care and family support services.

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Melanie Thompson, a student advocate with the Fostering Youth Success Alliance, is riding out coronavirus on her own.

Rush to put therapy online

On March 11, four days after Gov. Andrew Cuomo (D) declared a state of emergency due to the COVID-19 pandemic, the state Office of Mental Health waived regulations so that nearly all types of counseling – individual, family and group – can be provided virtually. 

With just days to prepare, dozens of agencies caring for desperately needy populations scrambled to create an entirely new structure of service delivery. They had to quickly sift through new technology platforms, and weigh how to make counseling easy for patients to access while also protecting their privacy – a difficult challenge even for savvy health care providers with years of planning. 

Among the nonprofit agencies’ most vulnerable clients were the thousands of young people in foster care, a population whose needs, already significant, have only grown in these unimaginably chaotic and desperate times. Therapists had to refashion individual sessions with foster youth, as well as those held jointly with the parents attempting to reunite with them.

Some therapists quickly recognized a need to replace hour-long sessions with shorter, more frequent check-ins, particularly given that young people are already spending hours in online classes every day. Those adaptations are especially essential for the youngest children, said Olaso from Children’s Aid, who works with youth ages 9 to 19. With her youngest patients, Olaso uses games like “I Spy” to break up the sessions and keep kids engaged. 

For some teens and young adults, the shift to virtual therapy has been a welcome change to the sometimes-awkward face-to-face sessions they have grown used to over years in foster care. In phone interviews this month, several clinicians said young people have been more willing to open up when communicating by video call, phone, or even text.

“The intimacy of being one-on-one in the same room can be difficult for people, particularly for young adults, who are used to talking on FaceTime and Instagram,” said Adams. One colleague reported that her client – a withdrawn teen with a history of trauma, mental illness and family disruption – was immediately more comfortable talking over video chat.

There are also practical benefits to virtual sessions, clinicians said. They can be more accessible for families already juggling multiple social service appointments, who would otherwise have to cart young children across town. Teens attending virtual therapy sessions are spared any potential stigma from entering a brick-and-mortar mental health clinic and can avoid traveling through neighborhoods where they may be targeted by bullies or dangerous gangs. 

Still, technical problems and competing demands still present barriers to remote counseling. Agencies across the state are having trouble serving families whose internet is unstable, or whose device is shared among multiple children studying and communicating with friends online. Some families are simply too overwhelmed – whether by day-to-day parenting or by the anxiety and grief wrought by COVID – to log in for therapy.

‘When does this end?’

Some agencies serving the mental health needs of children and families in the foster care system report growing numbers of referrals, as the extended period of social distancing has intensified stress and frozen family reunification plans. For almost two months, many in-person family visits have been cancelled and court proceedings have paused. That has left both children and parents increasingly anxious about when – or if – they will ever be able to resolve allegations of neglect or abuse and live together again.

“It goes right back to the original trauma of ‘What’s going to happen and when does this end?’” said Andrea Blumenthal, associate director of the Foster Care and Adoption Project at the Ackerman Institute for the Family.

At Children’s Aid, Olaso has seen her clients who are in foster care displaying more distress and acting out, unlike clients who are living with their parents, whose behaviors have generally improved, she said. 

One teen girl was unable to reach her biological family because her mother doesn’t have a phone, and began to rebel against her foster family. Her chosen method: Going out without a mask on.

“It’s another disruption in attachment – she always talks about how stressed out she is about not being able to see her biological family, especially her little brother, her mom, her dad,” Olaso  said. “She’s taking it out in a socially unacceptable manner, but it’s the only way she really knows how.”

As if that wasn’t enough, even as the teen grew more frustrated, her foster mother’s sister came down with COVID-19, exacerbating the tension in the home. When it became too much for her caregiver to handle, the teenager was moved to a 21-day respite care program to give them a break from each other and help the girl regulate her emotions, Olaso said.

For parents struggling to regain custody of their children, the prolonged disruption of visits may tip them over the edge, with devastating long-term consequences. The shutdown disrupted in-person visits between one 21-year-old mother and her two young children, who have been in foster care for more than 18 months, according to Liza Sanchez, a University Settlement social worker who supports primarily Spanish-speaking families. The young mother has struggled with homelessness, domestic violence and substance abuse, and if she does not complete her court-ordered mandates, her parental rights will be terminated – and she could also lose the child she is now carrying.

“I don’t know how much her kids understand their mom not physically being able to see them – and that’s something that she’s struggling with,” Sanchez said. “When she sees her kids on the video, I’m working with her on using it as motivation to work on her mandates, so that God forbid something should happen in the future, she would be able to be with her children.”

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Social worker Liza Sanchez works with high-risk families whose children are placed in foster care or were recently returned.

Strengthening Family Bonds

Many clinicians working with families with a history of disruption are trying to use their time stuck in close quarters to help strengthen family bonds, especially with teens, whose quest for independence often puts them in conflict with their parents. Liza Sanchez, believes that quarantine can be a unique opportunity for them to learn how to get along better.

“I can work with teenagers until they’re blue in the face, but I really need the partnership of the parents to make change,” Sanchez said. “Now that they’re both home, they’re both present, we’re trying to use this tele-health video to help them find each other. I want them to look back on this time and say, ‘I made it through with Mom.’”

Sanchez looks for simple ways that children and parents holed up together can connect. For one girl who loves to do make-up, Sanchez gave her “homework:” Do your mother’s make-up before their next counseling session. Another mother-daughter pair who were “constantly in conflict,” according to Sanchez, had a mini breakthrough when the daughter expressed appreciation to her mom – for cooking her favorite foods while in quarantine.

‘I’m not the only one’

For Thompson, the college student, one of the best sources of support for life as a young person alone in quarantine has been call-in forums with peers set up by the Fostering Youth Success Alliance. On the calls, many have shared similar feelings of loneliness and difficulty getting out of bed each day. For students, there’s the added stress of keeping up with online classes, paired with anxiety about losing financial aid if they can’t keep up.

The forums have given them a space to validate each others’ feelings and share simple activities that can bring joy – walking outside, listening to music, exercising, journaling, playing online games, singing.

Thompson said some of the most meaningful support she’s found throughout the pandemic has come from others who know firsthand how foster care affects well-being, even before COVID.

“Being on the webinar with other people, who are my age and look like me, helped me realize I’m not the only one who feels that way,” Thompson said. “What I loved is that as someone was talking live about their particular struggle, people were also dropping resources in the chat – ‘Here’s something that can help with that.’”

Megan Conn can be reached at mconn@chronicleofsocialchange.org.

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Megan Conn, New York Reporter, The Chronicle of Social Change
About Megan Conn, New York Reporter, The Chronicle of Social Change 21 Articles
Megan Conn is a reporter for The Chronicle of Social Change. Reach her at mconn@chronicleofsocialchange.org.