Children's Hospital associates provide mental, spiritual care to Uvalde hospital staff

July 1, 2022

Uvalde Memorial Hospital sought the support in wake of school shooting


The mass shooting at Robb Elementary School in Uvalde, Texas, has devastated the close-knit town of more than 15,000. The killer took the lives of 19 children and two teachers May 24.

Among those reeling in the immediate aftermath of the carnage were clinicians and other staff at Uvalde Memorial Hospital. The critical access hospital is about 2 miles from the school. Staff cared for critically injured people — most of them children.

A state trooper places a tiara on a cross honoring Ellie Garcia, one of the victims killed in the May 24 elementary school shooting in Uvalde, Texas.
Jae C. Hong/Associated Press

Many hospital staff had children who went to the school, or spouses who worked at the school, and so they feared for the safety of their loved ones as they focused on care of the wounded, said Elena Mikalsen, chief of pediatric psychology at The Children's Hospital of San Antonio, which is part of CHRISTUS Health.

"It's a very small community and everybody at the hospital had some relationship to someone at the school that day," Mikalsen said. A team from CHRISTUS Health was dispatched to help traumatized hospital staff and their family members in the immediate aftermath of the shooting.

She said Uvalde Memorial reached out to CHRISTUS Health, asking that system to provide counseling and support for staff. A dozen CHRISTUS mental health and spiritual care providers made the 80-mile trip from San Antonio to Uvalde May 27 to spend the day offering Uvalde Memorial staff comfort, resources and emotional support.


The CHRISTUS team — which included pediatric psychologists, social workers, chaplains and child life specialists — provided group therapy, individual therapy, support for children of staff processing fresh grief, referrals to long-term support and prayer.

"This is a very traumatized community, and while we were there, we just kept thinking of the long-term impacts," said Mikalsen. "This community will be hurting for many years. They won't be OK for a very long time," and CHRISTUS is looking at how to be part of recovery efforts over the long term.

Mikalsen said Uvalde Memorial admitted more than a dozen critically injured victims from the shooting, including many children with "gruesome, horrific" injuries. Some children were pronounced dead on arrival. All Uvalde Memorial staff were called in to respond to the mass casualty incident, Mikalsen said.

Call for help
Uvalde Memorial contacted CHRISTUS because it did not have mental health and spiritual care providers on its staff, and the town has few mental health resources, said Mikalsen.

Together with three other psychologists from Children's Hospital, Mikalsen provided mental health first aid in the form of individual and group therapy to hospital staff members. Three CHRISTUS child life specialists set up an area where they offered art therapy and play therapy to children of hospital staff. And three CHRISTUS chaplains and a priest offered prayer and comfort in every department at Uvalde Memorial throughout the day.

Mikalsen said the mass shooting at the elementary school "was absolutely horrific (for hospital employees). These medical professionals had never seen anything like this before. We were the first mental health providers many of them had talked to."

The Uvalde Memorial providers talked to the team of mental health providers about the trauma they'd experienced, Mikalsen said. People spoke of multiple layers of trauma and feeling so distressed they couldn't eat, sleep or work.

Staff of Uvalde Memorial Hospital in Uvalde, Texas, take part in a prayer service held by visiting chaplains from CHRISTUS Health's Children's Hospital of San Antonio. The service focused on the staff's spiritual recovery following the May 24 school shooting in Uvalde.

She said the CHRISTUS psychologists let every individual they counseled know how to reach them for follow-up in-person or telehealth counseling.

The team of psychologists plan to return to the Uvalde hospital June 27. The chaplain team also plans to return as a group to the Uvalde hospital.

Mikalsen said CHRISTUS is in talks with Uvalde Memorial and several foundations to explore how to establish more permanent mental health services in Uvalde. This could include individual and group trauma-based psychotherapy for children and families and in time a wellness center for the community.

No timeline for grief
Alyssa Maldonado, a pediatric chaplain for Children's Hospital of San Antonio, was one of three chaplains who went to Uvalde Memorial. She said they visited every department of the hospital, listening as hospital staff related their sorrow and shock. The chaplains prayed with staff. They stood by in silence for staff who did not wish to talk but who still wanted the chaplains' support.


For those able to talk about their pain, "we just let them pour out whatever was on their heart, whatever was in their spirit," Maldonado said. They offered all staff their phone numbers. "We reminded them there is no timeline for grief," and that they could seek help any time.

Divine hour
The chaplains held their prayer service for Uvalde Memorial staff at 3 p.m. that Friday, the hour that Christian tradition teaches Christ died on the cross. Maldonado calls it the "divine hour." She said the group brought teddy bears, rosaries, candles, blankets and pamphlets on grieving with them for their prayer service. They set up a small altar and invited the Uvalde Memorial staff to form a circle around it.

Maldonado said that the evening before the prayer service she sat at her kitchen table to plan out the gathering, and the Holy Spirit inspired her in the words she wrote. At the service, she centered her message around the concept of the peace that Jesus promises in scripture. Citing the scripture verse, "Jesus wept," she told the assembled mourners they were joined with Jesus in their sorrow. She prayed that everyone would feel God's presence in their trauma and grief.

Maldonado said the hospital employees asked that they be remembered in prayer. "There is sorrow and grief there. But the people I talked to have their faith, and that is what they are leaning on."

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