Pandemic Exacerbated Health Challenges in Communities of Color

“While we are not yet on the other side of COVID-19, we know that this pandemic—which is likely the largest public health crisis we will see in our lifetimes—has been nothing short of a collective trauma,” said Ross, who spearheaded the grant effort and is the principal investigator. “It has disproportionately affected communities of color and has placed New York City’s youngest residents at risk of a host of adverse health and behavioral health outcomes. To mitigate these challenges, there is a dire need for a well-prepared behavioral health social work workforce equipped with skills in prevention, interprofessional practice, and health equity that mirrors the population most affected.”

Addressing Need for Social Workers from Diverse Backgrounds

The project, which is part of HRSA’s Behavioral Health Workforce Education and Training Program for Professionals, sets out to address workforce shortages in social work and lack of diversity in the profession while equipping workers with skills designed to address the potential impact of adverse childhood experiences, said Debra McPhee, Ph.D., dean of the Graduate School of Social Work.

“The overarching goal of PIPELINE for Youth Health is to create a sustainable pipeline of racially and ethnically diverse behavioral health practitioners equipped with the skills needed to work effectively with youth,” said McPhee.

Each year, a total of 27 student fellows—26 MSW students and one doctoral candidate—will be supported with stipends to offset the cost of tuition while they participate in a specialized training program that prioritizes prevention, integrated care, and health equity for underserved young people. The project has been funded for five years; 75% of the student fellowship slots are reserved for students of color.

The PIPELINE for Youth Health team is led by Ross and includes Binta Alleyne-Green, Ph.D., associate professor, Larry Farmer, Ph.D., associate professor, Janna Heyman, Ph.D., professor and Henry C. Ravazzin Chair; Christie Hunnicut, director of field education; Liz Matthews, Ph.D., assistant professor; Yvette Sealy, Ph.D., associate professor; Linda White-Ryan, Ph.D., associate dean of students; and Anne Williams-Isom, D.Min., professor and Dumpson Chair in Child Welfare.

Ross said the new training program will prioritize prevention, integrated care and interprofessional practice, and health equity in the youth behavioral health workforce. The program begins this fall, when students will participate in required coursework; a PIPELINE Integrative Seminar; and a special speaker series featuring innovations in prevention-oriented practice with children, youth, and their families.

“We were already facing a major shortage of youth behavioral health practitioners here in New York City even before COVID-19 emerged. The need is now greater than ever,” said Ross. “I am very excited to work with the PIPELINE for Youth Health team to develop and implement a specialized behavioral health training program that will greatly enhance the social work workforce dedicated to serving the children, youth, and families of New York City.”

In a conversation on Zoom, author Amy Dresner and clinical social worker Joe Schrank, hosts of the podcast “Rehab Confidential,” held a conversation on addiction, the uptick in substance use during the pandemic, and how social workers can help—now and in the future. The exchange, held on Nov. 5, was sponsored by the Graduate School of Social Service with several GSS students tuning in. Assistant Professor Sameena Azhar, Ph.D., moderated the dialogue in conjunction with a class she teaches on substance abuse treatment—a subject she has researched extensively.

“The true fallout to whatever this pandemic has done remains to be seen, but we do know that substance abuse and suicidal ideation have increased,” said Azhar. “We’re self-isolating for longer periods of time and it’s a lot easier to hide your substance misuse, because nobody is looking and everybody is in the same boat of working online.”

Dresner, a former comedian and author of My Fair Junkie: A Memoir of Getting Dirty and Staying Clean (Hachette, 2017), grew up in tony Beverly Hills only to find herself homeless and sweeping up used syringes on Hollywood Boulevard as part of a court-ordered punishment for a domestic violence violation spurred on by her addiction. She has been clean and sober for eight years. Schrank is a Jesuit-educated social worker based out of Los Angeles who liberally peppers his speech with Latin whenever the opportunity presents itself, in particular, cura personalis. He’s been sober for more than 20 years. The two podcasters helped promote the event, which was open to all.

A Growing Online Recovery Community

Azhar noted that most recovery meetings have had to move online to a virtual space. But well before the pandemic there was already a growing digital recovery community, including a thriving scene of bloggers, social media influencers, and podcasters like Dresner and Schrank.

As people continue to cope with the stress of being cooped up at home, there has been a well-documented uptick in substance abuse, making the digital community all the more important because it’s accessible to anyone with a smartphone or computer, Azhar said. She organized the event because she wanted to familiarize GSS students with the burgeoning digital scene.

‘Mommy Drinking’ and More

Azhar asked the hosts what they were seeing on the ground in Los Angeles. In particular, she wanted to know whether people who did not have a prior substance issue are prone to developing one in response to the trauma of the pandemic, social unrest, and the continuous onslaught of negative news.

“Among my friends that are normies [i.e. sober] we know that people are eating more, we know that people are drinking more, we know that they’re drinking during the day, that there’s ‘mommy drinking.’ Drug use has gone up. Porn has gone up,” said Dresner. “Whether these people will come out of the pandemic and have an addiction, I don’t know. Can you drink yourself into having alcoholism? Sure. Just like you can get addicted to pain pills if you take them for too long. You’ll have a physical addiction, whether or not you have a psychological addiction.”

Schrank said that there are few absolutes when it comes to addiction, except for the dangers of being idle and alone.

“We know those are absolutes for any mental health issues, like anxiety, depression, substance misuse,” said Schrank. “So, do something,” he advised, “and do it with somebody—even if online.”

He recalled a recent incident at the supermarket that he feared was becoming all too common. He observed a young person in line with a jar of peanut butter, a loaf of bread, and a bottle of vodka.

“I said, ‘Are those your groceries?’ And he was like, ‘I know.’”

Schrank concurred with Azhar that the mental health issues related to the pandemic are only beginning to surface.

“I think that a lot of people are hiding out. So, if you just have to get on Zoom for 15 minutes with your boss a day, and then back to the couch in your jammies with your peanut butter and bottle of vodka, that’s not going to help,” he said.

Social Workers Can Make a Difference

Azhar said that there are many telehealth options that people could consider when seeking help for a growing problem, but she was also careful to underscore that in-person therapy will remain extremely important in the post-pandemic world. Whether online or in-person, the need for social workers will only grow in the coming years, she said.

Yet some social workers are feeling despondent, she noted, unsure if they can make a difference as the crisis grows. In the chat, one student questioned whether social workers could still have an impact as “lowly clinicians, nurses, counselors.”

Dresner cited her own experience as proof that they do make a difference.

“I’ve been in quite a few treatment centers and the way that you treat… I’m going to cry,” she said, collecting herself before continuing. “A lot of them were like, ‘Here’s your crazy pills.’ And I was like, ‘Okay, that’s not very cool.’ But there was one [nurse]who looked at me and treated me … with dignity and saw me like the person I could become. When I came out of that extraordinarily depressive, alcoholic, self-destructive place—I thanked him.”

But what if the trauma is not a one-time event? What if a person’s entire world is filled with adversity, flooding her with constant stress and anxiety and preventing her brain from ever recovering?

This the challenge that underlies the treatment of complex, or chronic, trauma, says Amelio D’Onofrio, Ph.D., a clinical professor and director of the Psychological Services Institute in the Graduate School of Education (GSE).

In general, a traumatic experience is one that is so distressing that it overwhelms the brain’s ability to process the event and triggers a set of survival-oriented physiological and psychological responses. Acute trauma refers to a singular event such as a car accident, an assault, or a natural disaster. Complex trauma, though, is more pervasive.

“For instance, if a parent chronically abuses substances and cannot meet a child’s basic needs, that is a traumatic environment for the child. Or if there is violence in the home or in the neighborhood and kids are constantly trying to protect themselves, that is traumatic,” said D’Onofrio, who is also a practicing psychotherapist.

“We expect kids to focus on doing schoolwork and solving complex problems, but they’re so worried about self-protection that their nervous systems have been activated to the point that they can’t focus.”

This year D’Onofrio received a $311,000 grant from the Department of Health and Human Services to design an intervention program for inner-city students who have experienced complex trauma and who otherwise would not be able to receive specialized psychological services.

The grant-funded program, which was implemented in two Bronx middle schools this fall, is divided into ten-week increments over the course of two years. For each set of ten weeks, doctoral students from GSE’s counseling and counseling psychology program run structured group treatment with at-risk students. The team also meets with each student individually at least twice and meets with parents to educate them on the effects of trauma and how it impacts their children.

The goal is to help students start to understand the impact of stressful and traumatic environments and to teach them healthy coping skills so that they will be less likely to turn to gangs or drugs.

“We worked closely with GSE’s Center for Educational Partnerships to select the two schools. One of the schools is serving many recent immigrants from all over the world, and the other school recently had a gang-related stabbing,” D’Onofrio said, referring to an incident this summer in which a 14-year-old student stabbed and killed another student outside their middle school.

D’Onofrio hopes to later develop internships and externships in the schools so that Fordham counseling students can continue working with the middle school students once their ten sessions come to an end.

“I think this a powerful interface between a Jesuit university and the community, a way of giving back and working toward social justice,” he said.