COVID-19 Vaccine Hesitancy: How Social Workers Can Support Children and Families

by Miste Hower, MSSW, LCSW

     In many areas of practice, social workers are viewed as trusted messengers, both by interdisciplinary colleagues and clients. Because of this, we are uniquely positioned to assist certain populations at high risk of severe illness to navigate hesitancy around whether to receive a COVID-19 vaccine. Fewer than 70% of Americans are fully vaccinated, and fewer than 18% of those people have received the recommended, updated booster that was approved in September 2022. 1.1 million people have died of COVID-19 infection. Most were unvaccinated, even though the vaccines were widely available. A new, updated COVID vaccine is available as of September 2023.

    For some, the barrier may be access or convenience, whereas others experience complacency, perhaps a false sense of security, or lack of confidence in the healthcare system. Whatever the concern, social workers frequently work with individuals who are part of groups with lower vaccination rates: pregnant women, children, adolescents, young adults, incarcerated people, unhoused people, those living in historically underserved populations, people living in rural areas, and others. 

     Returning to emergency room social work in 2021, a year into the pandemic, I witnessed first hand the devastation COVID-19 inflicted on the unvaccinated and their families. Proximity to the greater Austin community through emergency healthcare offered an opportunity for me to explore the perceptions and beliefs our patients hold around COVID-19 vaccinations. Incorporating Motivational Interviewing (MI) and Screening, Brief Intervention, and Referral to Treatment (SBIRT) techniques helped me approach the subject of vaccine hesitation with our patients in a non-threatening way. Curiosity shown by using open-ended questions respects and honors any likely resistance and ambivalence a client might be experiencing around the subject. 

     The CDC lists all individuals older than six months as eligible to receive the COVID vaccination, yet vaccination coverage among children and adolescents is lower than in older groups. According to Austin Public Health, children ages six months to four years are at high risk for developing severe symptoms. The need exists for social workers to explore a parent's or guardian’s current perceptions and beliefs as they relate to vaccinating their children for COVID-19. By exploring thoughts around vaccine ambivalence and social barriers, then offering education when appropriate, social workers can help parents make informed healthcare decisions for their children.

     Connect to End COVID-19 is a hub of resources social workers may utilize to enhance their knowledge and skills when approaching vaccine hesitancy discussions. The National Association of Social Workers and the NASW Foundation are partnering with the Health Behavior Research and Training Institute (HBRT) at The University of Texas at Austin Steve Hicks School of Social Work in a $3.3 million Center for Disease Control and Prevention-funded (CDC) initiative to support social workers and their clients in informed vaccine decision-making. Here you will find virtual professional education, skills trainings in MI and SBIRT techniques, and a deep dive into barriers to vaccinations, including myths and facts, logistical challenges, and more. You will find tools that can be applied during your sessions with clients. Following is just a sampling of open-ended questions and potential responses. Refer to Connect to End COVID-19 for an in-depth experience for adding this to your tool box.

Questions To Ask

     When considering where to start, engage with a question similar to: Part of my job is to help families make informed healthcare decisions that they think are best for them. Would it be okay if we discuss the COVID vaccine?

     A reassuring follow-up comment could be: Please know that I am not here to tell you what to do. Any decisions you make around the vaccine are entirely up to you.

     When eliciting concerns and beliefs during this conversation, it is important to be aware of countertransference and the empathy blocking righting reflex. This could happen when a client expresses concerns that reflect misinformation. Responding to misinformation might look more reflective: You have heard the COVID vaccine will make you sick and that it was developed too quickly. That is a real concern for you because you need to stay healthy to care for your family.

     What should I do if my client does not want to talk about the COVID-19 vaccine? That’s okay! Use this response: Thank you for considering it. Feel free to come back if you change your mind or would like more information.

Resources

CDC https://covid.cdc.gov/covid-data-tracker/#pediatric-data

Connect to End COVID-19 Resources https://www.socialworkers.org/Practice/Infectious-Diseases/COVID-19-Vaccine-Confidence

Vaccines.gov https://www.vaccines.gov/

Miste Hower, MSSW, LCSW, lives and works in Austin, TX. She earned her MSSW from The University of Texas at Austin and is currently employed as an ER social worker.