The Long Shadow: Collateral Impact and Finding Resilience Amidst a Global Pandemic Pediatric Palliative Care Social Work During COVID-19

The impact of COVID-19 on palliative care social work: An online survey by a European Association of Palliative Care Task Force

BACKGROUND

The SARS-Cov-2 (COVID-19) pandemic affected the delivery of health and social care services globally. However, little is known about how palliative care social work services were impacted.

AIM

The aim of this study was to capture and analyse data from palliative care social workers who provided professional support in a range of settings across 21 countries during the COVID-19 pandemic.

DESIGN

A cross-sectional survey-based design was used for this empirical study and this paper primarily focuses on the quantitative responses.

SETTING/PARTICIPANTS

Participants, palliative care social workers, were drawn internationally via members of the EAPC Social Work Task Force and the World Hospice Palliative Care Social Work network.

RESULTS

We received 362 survey responses from 21 countries. Most (79%) respondents worked with adults in in-patient units or hospitals. The number of referrals during COVID-19 increased more in non-European countries, compared to European countries. The full range of social work services could no longer be delivered, existing services changed and 65.3% of participants reported higher levels of pressure during the pandemic, which was linked to higher levels of staff absence and additional duties. For many respondents (40.8%), this included facilitating online communication between patients and their families.

CONCLUSIONS

Our findings indicate that restrictions to limit the spread of COVID-19 resulted in adaptations to service delivery, increased pressure on staff and moral distress, like other health and social care professions. All members of the palliative team need support and supervision to ensure effective interdisciplinary working and team cohesion.

Les effets de la pandémie de COVID-19 sur la santé mentale des enfants atteints de problèmes de santé physique ou d’incapacités, des familles et des professionnels de la santé

Objectifs

La pandémie de COVID-19 a influé sur la santé mentale de la population. Les familles des enfants qui ont des vulnérabilités en matière de santé ont été démesurément touchées par les politiques liées à la pandémie et les perturbations aux services, car elles s’appuient beaucoup sur le système de soins de santé et de services sociaux. Les chercheurs ont établi les répercussions de la pandémie de COVID-19 sur les enfants ayant des vulnérabilités en matière de santé physique et des incapacités, les familles et les professionnels de la santé.

Méthodologie

Des enfants ayant diverses vulnérabilités en matière de santé (transplantation cardiaque, affections respiratoires, anémie falciforme, trouble du spectre de l’autisme, troubles de santé mentale et approche de la fin de vie en raison d’une série de causes sous-jacentes), leurs parents et leurs professionnels de la santé ont participé à des entrevues semi-structurées. Les chercheurs ont utilisé des méthodes d’analyse qualitative et en ont extrait les thèmes liés aux effets et les recommandations en vue d’améliorer la pratique.

Résultats

Au total, 262 participants (30 enfants, 76 parents, 156 professionnels de la santé) ont été interviewés. Les enfants ont décrit leur solitude et leur isolement, les parents, leur épuisement, et les professionnels de la santé, la pression ressentie et un sentiment de détresse morale. Les thèmes reflétaient les effets de la pandémie sur la santé mentale des enfants, des familles et des professionnels de la santé, de même que les ressources insuffisantes pour soutenir la santé mentale, les influences organisationnelles et politiques qui ont façonné la prestation des services et les recommandations pour améliorer la prestation de ces services.

Conclusion

Les restrictions sanitaires imposées par la pandémie et les modifications aux soins ont eu de profondes répercussions sur la santé mentale des enfants qui ont des vulnérabilités en matière de santé, les familles et les professionnels de la santé. Les recommandations incluent la rédaction et l’adoption d’information ciblée sur la pandémie et la mise en œuvre de services de soutien en santé mentale. Ces résultats amplifient la nécessité de renforcer les capacités, y compris des stratégies proactives et la planification de mesures d’atténuation du risque dans l’éventualité d’une future pandémie.

Mental health impacts of the COVID-19 pandemic on children with underlying health and disability issues, and their families and health care providers

Objectives

The COVID-19 pandemic has impacted mental health at a population level. Families of children with health vulnerabilities have been disproportionately affected by pandemic-related policies and service disruptions as they substantially rely on the health and social care system. We elicited the impact of the COVID-19 pandemic on children with health and disability-related vulnerabilities, their families, and their health care providers (HCPs).

Methods

Children with diverse health vulnerabilities (cardiac transplantation, respiratory conditions, sickle cell disease, autism spectrum disorder, mental health issues, and nearing the end of life due to a range of underlying causes), as well as their parents and HCPs, participated in semi-structured interviews. Data were analyzed using qualitative content analysis in determining themes related to impact and recommendations for practice improvement.

Results

A total of 262 participants (30 children, 76 parents, 156 HCPs) were interviewed. Children described loneliness and isolation; parents described feeling burnt out; and HCPs described strain and a sense of moral distress. Themes reflected mental health impacts on children, families, and HCPs, with insufficient resources to support mental health; organizational and policy influences that shaped service delivery; and recommendations to enhance service delivery.

Conclusion

Children with health vulnerabilities, their families and HCPs incurred profound mental health impacts due to pandemic-imposed public health restrictions and care shifts. Recommendations include the development and application of targeted pandemic information and mental health supports. These findings amplify the need for capacity building, including proactive strategies and mitigative planning in the event of a future pandemic.

Parent and Adolescent Perspectives on the Impact of COVID on the Care of Seriously Ill Children

CONTEXT

Few studies have explored the impact of the Coronavirus Pandemic (COVID-19) on the care of seriously ill children which may be especially affected due to the child's vulnerability, complexity of care, and high reliance on hospital-based care.

OBJECTIVE

To explore parental and adolescent perspectives on the impact of COVID-19 on care of seriously children.

METHODS

We recruited a convenience sample of families of seriously ill children between September and December 2020. The study involved a semi-structured interview through Zoom followed by an online sociodemographic survey. Interviews were transcribed and coded using the constant comparison method. The sample intended to represent diversity in child age and diagnoses, and family sociodemographic characteristics.

RESULTS

Sixty-four families were approached; 29 enrolled (response rate 45%), including 30 parents and three AYAs. Most parents and AYAs identified as white (62%). Some families reported new financial hardships, with 17.2% having difficulty paying bills after March 2020 compared to 6.9% before. Emerging themes from interviews included additional roles parents managed due to cancelled services or shifting to telehealth, increased isolation, high emotional distress due increased in-home demands, uncertainty, and visitor restrictions in medical facilities, and benefits and challenges to telehealth. One positive outcome was the use of a hybrid care model whereby families choose telehealth appointments and in-person services, when necessary.

CONCLUSION

Families caring for seriously ill children during COVID-19 face increased challenges. Health systems should consider long-term telehealth/in-person hybrid care models that have potential to improve access to and satisfaction with care.