When your child has a brain injury, rehab is a confusing new world. Yael walks families through the process

Photo of Yael Diamond (left), social worker, with parent Jessica.

By Louise Kinross

When a child is hospitalized at Holland Bloorview after a brain injury caused by trauma or illness, it's a bewildering time for the whole family. Yael Diamond's role as a social worker is to listen to their story, provide coping strategies and counselling, and connect them with funding, peer support and other resources in the community. "These clients and families are in crisis mode when they come in, because this is usually a new disability," Yael says. We spoke about why Yael chose social work and the joys and challenges of her job.

BLOOM: How did you get into the field?

Yael Diamond: I always knew I wanted to be in the helping profession. I grew up in a home where my dad was a doctor, so I had a lot of medical conversations around me.

When I was a teenager I became a patient at SickKids. I had a major surgery and a recovery period and a follow-up surgery. I remember a lot of the doctors and nurses ended up talking to my parents, even though I was in the room. The first time anyone asked me a question, it was a social worker, and I remembered the feeling of it. Later, whether it was inpatient or outpatient clinics, it was always the social workers talking to me. I love hearing people's stories, and I loved the idea of a role where I could listen to people's stories all day. 

I did my undergrad here in social work at York University. Then I did my graduate schooling at Yeshiva University's Wurzweiler School of Social Work in New York City. I got my first job in a foster care agency there working in a health program for kids in foster care with complex medical needs. It was a really good learning opportunity, but I didn't want to stay in foster care and I knew I would come back to Toronto.

Before I left, I worked in acute-care with adults and decided I wanted to be in a job where I connected with patients over the long-term. In acute-care, people come in and out, and sometimes you don't see them again. When I was back in Toronto looking at health-care jobs there was a posting at Holland Bloorview in the brain injury unit. I applied and I've been here for eight years now.

BLOOM: What is a typical day like?

Yael Diamond: There is no typical day! Generally I see clients and families for one-hour sessions focused on counselling around coping with the diagnosis and the hospitalization. These clients and families are in crisis mode when they come in, because this is usually a new disability. Sometimes they're not ready for counselling, they need in-the-moment coping and self-care strategies.

I also focus at the beginning on getting practical supports in place. That could be applying for funding for new medical equipment or home modifications, finding brain injury resources and caregiver support in their community, and finding adapted recreation opportunities for the child. The counselling and adjustment usually comes later as I follow families over time as they move back into the community.

We work closely with our Bloorview School to make sure the kids get the supports they need when they return to school.

I also spend a lot of time in team meetings, being in touch with the whole team to talk about individual clients. We also have psychosocial rounds where we talk about supporting clients and families with social workers, child life specialists, psychologists, a life skills coach and our family therapist.  

BLOOM: What's the greatest challenge of your job?

Yael Diamond: There's not enough funding in place for what families need. We'll hear about agencies that are out of money or there will be a huge wait list—for example, for Special Services at Home Funding. 

Because this is an acquired disability, a family may not be eligible for funding because it's based on last year's income, not recognizing that parents may have suddenly had to stop working to care for their child. There's a lot of paperwork to get the funding and when it's denied it can be overwhelming.

Listening to a family's story—and their anxiety and stress—does weigh on me. I really need to practise self-reflection to stay calm and support the families in the challenges they face.

Now that I'm more than 10 years into my career, I'm much better at compartmentalizing. I can't carry these stories into my whole day. I need to put them in a box and process them afterwards. What I find most helpful is that I share an office with two social work colleagues, and we have an opportunity to debrief and support each other.

BLOOM: What's the greatest joy?

Yael Diamond: Watching the families draw on their resilience, and the motivation and perseverance of the kids. Families are hugely creative to make things work. They're their best problem-solvers. 

I remember a family wanted to get their kid home for the weekend, but they had a small vehicle and couldn't get the wheelchair in it. So they tied the chair with bungie cords to a small trailer attached to their car and brought it home that way. 

The joy is when despite systemic issues with funding, an application that we asked to be expedited gets approved. We're building relationships with government offices around our families' needs, so that we have a process for expediting support, for example, to support discharge.

BLOOM: What emotions come with the job?

Yael Diamond: Every emotion. There are definitely moments of sadness and moments of excitement. When something is successful or a child accomplishes a goal they've been working on you see that relief wash over the child and family. What's awesome about kids is they're resilient. They want to have fun. Things don't feel sad here on a day-to-day basis. 

BLOOM: How do you manage those emotions?

Yael Diamond: By speaking with my social work colleagues. I want to give a shout-out to Val Lusted, who is our supervisor we can go to with tough cases. Val retired but was rehired in a social work supervisor role and she comes back a few times a month. She's been in the trenches and gets it. She provides an opportunity for me to reflect and rethink a situation. Often I'm trying to wrap my head around next steps for a client or what to do emotionally, because I'm having a hard time. She's able to sit and help me process the impact on me and strategize on how to move forward emotionally. 

BLOOM: Are there other things you do to manage stress?

Yael Diamond: Social connections fill my bucket, so spending time with my family and friends. I love cooking and baking. I'm a religious person so my faith and community are a huge source of support for me. I also enjoy walking in the nicer weather. 

BLOOM: Acquired brain injury is such a life-changing event. What helps families adapt over time?

Yael Diamond: Understanding the brain injury and how it can affect different stages of a child's development, and knowing what to expect. One of my clients recently left our inpatient program and is transitioning back to school and it's challenging. We've talked about how it won't be this hard forever. He's going to adjust and adapt. Most kids will continue to improve and grow into the brain injury. At some point, as they're developing, you can't separate if something about them is due to the brain injury or the child's personality or it's unique to the child. They may have learning needs but most kids do pretty well.

BLOOM: If you could change one thing about rehab for children with brain injury, what would it be?

Yael Diamond: I think Holland Bloorview does a good job. I think the gaps lie in community supports. I'd like to see more intense community-based therapies, less wait lists and better mental health supports. A lot of the mental health services are for adults and we need more for kids.

BLOOM: Brain injury can be an invisible disability if a child recovers well physically. Why can that be difficult for children and families?

Yael Diamond: That's extremely common. For example, people they know and even people in the street may not expect them to have social communication challenges. I love doing role-modelling prep with kids before they return to school. We'll practise what they can say if a peer says: 'But you look the same!' The client may say 'I had a stroke or a brain tumour' and give a bit of an overview of what happened. There's no easy answer and we need a lot more education.

BLOOM: If you could give advice to a social worker here on their first day, what would it be?

Yael Diamond: Be open. For me, there wasn't a learning curve. It was a straight, deep, vertical climb. Getting used to the culture, the rehab, the language. I was new to pediatric rehab and I had worked in the American health care system, so it felt overwhelming.

Ask questions. Keep asking questions and no question is too many. I always felt like a burden interrupting someone with a question, but I put myself out there and asked everyone and everyone was welcoming and open to answering me. That's how I learned. 

Take time to shadow the different disciplines to see how everyone works collaboratively and to understand a day in the life of a child here. Ask a client 'Is it okay if I come to your physio today and watch?'  

I often join a client's speech sessions to understand their communication style so I can better support them in counselling. You can also learn a lot from our inpatient support groups for caregivers and teens.

Here's how a client recently described his counselling sessions with Yael in a Spotlight award: "It's so difficult to put into words how enjoyable our sessions were. Despite how boring and sad inducing I thought therapy sessions would be, it actually felt quite relieving and fun! You were also able to make me feel more happy and comfortable, which was a difficult feat."

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