Stepping up to meet behavioral health needs “I love what I do!”

Before the COVID-19 outbreak, Sam Ciarocco was the Clinical Operations Manager for our Office-Based Addiction Treatment (OBAT) program.

As a licensed clinical social worker with a strong background in trauma and substance use disorders, Sam quickly shifted her focus from setting up telehealth services to creating a behavioral health infrastructure for BHCHP’s COVID positive patients at Boston Hope: the 1,000-bed field hospital at the Boston Convention and Exhibition Center. Patients come to Boston Hope from the shelters if they have tested positive for the COVID-19 virus and do not need to be hospitalized.

Boston Hope is a remarkable place, but for many of our patients experiencing homelessness and trauma, the unfamiliar, highly structured setting can be challenging. For many of us, a new environment can be difficult to adapt to, but it is even more daunting for those with behavioral health issues. Seeing medical providers wearing PPE, donned in what look like spacesuits—with masks and face shields, can be unsettling. On top of that, our patients have been told they have a highly contagious and potentially deadly virus, triggering fear and anxiety.

“COVID itself is a trauma,” says Sam, “Many of our patients have anxiety, depression, and PTSD and when you introduce a pandemic to those diagnoses, it can trigger or exacerbate the already devastating symptoms of those disorders.”

She tells the story of a Boston Hope patient who tested positive for COVID, and as a result had to miss a scheduled appointment with her OBAT nurse, “She was really anxious about losing that connection,” says Sam, “It wasn’t about the medication, it was about that relationship. So I found her an iPad and set her up with a Zoom meeting with her nurse. When I did that, she was able to calm down, and her anxiety eased.”

Using her innate compassion and experience in trauma-informed care, Sam saw a gap in the behavioral health care needs of our Boston Hope patients. She then assembled a behavioral health program starting with a welcoming and informative orientation for new patients modeled after the orientation our respite patients receive when they enter our Barbara McInnis House.

“Sam created the behavioral health infrastructure at Boston Hope from the ground up,” says Dr. Katie Koh, a psychiatrist with BHCHP. “It has been beautiful to watch her work and think so thoughtfully about our patients, who have been pulled out of their normal routines and shuttled into a new environment. She’s thinking creatively on behalf of our patients.”

Sam also launched therapy groups for addiction recovery, anxiety, depression and PTSD. She enlisted volunteers to lead yoga classes, painting, journaling and other activities to foster community and help patients through this difficult time. She saw the way patients reacted to clinicians donning masks, so she asked clinicians to wear a large badge with a smiling photo, helping to connect the patient with a friendly face who would be caring for them.

In addition, for those patients struggling with substance use disorder, the presence of staff from AHOPE—a harm reduction program within the Boston Public Health Commission—has been critical at Boston Hope. “AHOPE has been amazing,” Sam said, “It’s been invaluable having their expertise here.” 

In addition to receiving care at Boston Hope, Sam sees her COVID positive patients giving back by isolating themselves from the community.

“Our patients really are doing a public service by remaining here at Boston Hope, especially the asymptomatic ones. They aren’t required to stay here, but we want to make sure they understand how important it is that they do to stem the spread of COVID-19. Almost everyone has respected that, so I want to do everything I can for them.” When asked how she’s doing, Sam answers, “OK.” She is close to her team, and checks in regularly, which she says is really helpful. “We take care of each other and let each other know when we’re taking on too much and need a break.”

She says the work can be exhausting, but, “I love what I do.”