Building Resilience Sala specialists help patients and families process distressing feelings and learn new coping skills.

Soccer is Jake’s favorite sport.

The active eight-year-old loves playing on his local team alongside his friends.

But when Jake started feeling sick for long periods of time, playing soccer—and many activities he enjoyed—grew harder. Tests done at Hassenfeld Children’s Hospital revealed his diagnosis of type 1 diabetes. With this condition, the pancreas doesn’t make enough insulin, a hormone that helps blood sugar enter cells to be used as energy. The resulting high blood sugar can cause blurry vision, numb hands or feet, fatigue, weight loss, and other debilitating symptoms.

The chronic, lifelong condition requires permanent adjustments for kids and families alike. Changes like strict diets, insulin injections, and regular finger pricks can cause discomfort and require parents’ round-the-clock help.

“Type 1 diabetes is all-encompassing,” explains Becky Lois, PhD, a Sala Institute child and adolescent psychologist. “It creates a massive life shift for the whole family.”

Jake quickly became concerned with what diabetes would mean for him. He wanted to know: Would he die early because of his diabetes? Could he still play soccer?

“Naturally, many parents and providers want to reassure a child who’s received a new medical diagnosis that they’ll be OK,” Dr. Lois says. “Although Jake’s care team told him it was safe to play soccer, things weren’t sitting right with him. Deep down, he truly didn’t believe he was OK.”

Jake’s anxiety played out on the field through panic attacks. That’s when his care team at the Robert I. Grossman, MD, and Elisabeth J. Cohen, MD, Pediatric Diabetes Center asked integrative behavioral health specialists from Sala Institute to help Jake and his family process his incredibly common yet distressing feelings about his diabetes diagnosis.

Identifying Medical Trauma

Medical trauma can result from a person’s difficult health experiences. It can stem from a single significant event, such as being rushed to the hospital for a medical emergency, or from many different experiences that accumulate over time, such as frequent hospital appointments or repeated blood draws. Vicarious medical trauma can also occur after witnessing or hearing about what happened to a loved one, friend, or peer.

“Medical and vicarious trauma can come on immediately following a diagnosis, or surface only after a child or family member has had time to process their experiences,” explains Bethany Watson, PhD, a child and adolescent psychology fellow in Sala Institute.

Signs of medical trauma are diverse and include panic attacks like those Jake had on the soccer field, acting out and testing limits in extreme ways, developmental regression, or certain statements, such as “I can’t sleep” or “I can’t stop thinking about what happened to me.”

Compassionate Support Rooted in Research

To help children and their families work through medical and vicarious trauma, Sala Institute’s team of psychologists, child life specialists, and social workers receive referrals from clinical teams or through a system of built-in behavioral health screenings across Hassenfeld Children’s Hospital.

“We’ve created universal touchpoints at the hospital and ambulatory care centers where we know it’s common to find individuals struggling with what we call little-T traumas that accumulate over time, and big-T traumas that can take the form of life-threatening or scary health events,” says Dr. Watson.

From there, the road to recovery differs for every child and family member—but it always begins with education about the nature of trauma and helping the person to understand that every feeling is normal when it comes to processing stressful health experiences.

“We’ve been helping Jake and his family understand that Jake’s fear is a very appropriate reaction to a diabetes diagnosis,” Dr. Lois explains. “When he expresses distress, his parents’ impulse is to save him from those feelings in the moment. In our sessions together, we’re giving space to listen to and validate Jake’s emotions.”

The KiDS of NYU Integrative Behavioral Health team within Sala then helps the child and family make sense of their situation. They often teach new coping skills—for example, offering ways to navigate a panic attack—and help reframe their thinking. “Everything we do focuses on helping them take charge of their situation,” says Dr. Liaw, Director of Sala’s Child-Family Services and Resilience Programs.

Sala Institute also provides diverse supports depending on what’s needed, such as nutritionists, creative arts therapists, physical therapists, and education for teachers in how best to support their students’ medical or behavioral needs.

“A pillar of trauma-informed care is to teach kids to actively resist re-traumatization,” notes Dr. Watson. “We want to support kids to have affirming medical experiences, so in addition to helping them process past trauma, we proactively work to ensure their future medical experiences will be better.”

Mentionable and Manageable

Sala Institute’s specialists have helped Jake improve his outlook on life. He and his family are equipped with new coping skills, a deeper understanding of their feelings, and the courage to hold space for Jake’s difficult emotions. His family asked diabetes educators to meet with Jake’s soccer coach and teammates to share how they can help their son.

“I always like to say, ‘If it’s mentionable, it’s manageable,’” shares Dr. Watson. “We can’t take the pain or the trauma away; we cannot erase what happened. But we can help them to carry their experiences forward with new skills, agency, and a sense of validation.”

We also seek out children who are internalizing their trauma and are quiet about it—not acting out in ways that command attention and prompt intervention, but who are still suffering.

Ron-Li Liaw, MD

Director of Sala’s Child-Family Services and Resilience Programs

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