We spoke to Alex Friedman, MPH, Program Manager at Boston Medical Center in the Division of Developmental and Behavioral Pediatrics. He discusses his work supporting patients with autism and families who have experienced the unexpected death of their child. Alex also provides a view of how the programs work to fill gaps in the healthcare system and shape systemic change.

Would you mind telling us your name, your position, and where you work?

I am Alexander Friedman. I am a program manager in the Division of Developmental and Behavioral Pediatrics at Boston Medical Center, where I help to oversee two programs: the Autism Program at Boston Medical Center and the Massachusetts Center for Unexpected Infant and Child Death. 

That is really such interesting and important work. I think that we often just think about the event itself—the diagnosis or the death—but not the kind of wraparound support that people really need. Could you share a little bit about your background and how you got to where you are now? 

I arrived at college thinking that I wanted to work in healthcare, knowing that I wanted to create a healthier world. I understood at that time that my options for this were being a doctor or being a nurse. As such, I began as pre-med! I very quickly realized that was not going to be for me. I had a moment of reckoning and had to figure out what else was out there. I was fortunate to learn about a health sciences program offered at my university that was open to students who may not be interested in going to medical school. I wound up majoring in Health Sciences as well as American History, which was a really powerful combination in how I’m able to think about the world around me. 

Early on as part of this bachelor’s program, I got an internship at Boston Medical Center (BMC) in the Department of Pediatrics and essentially never left. For the last 15 years, I have been growing and strengthening my professional capacity through my work in the Division of Developmental and Behavioral Pediatrics. Upon graduating with my MPH, I really wanted to work full-time in my same division and was offered a position splitting my time between the hospital’s Child Protection Team, where I had already been working part-time, and the program that supports families after their child dies. At that point, I had never considered work in child fatality, but I was committed to being open and flexible and continuing to learn from my brilliant colleagues, so I said yes. I have immense gratitude for that opportunity. Without it,  I would have never seen my life going in this direction.

Lots of people, when we are kids, want to grow up and be a certain thing. Then many of us are, as you were, confronted with the fact that it actually is not what we want our life plan to be. How did you process that in your head and heart—to let go of what you thought was your dream?

This was a really challenging moment because we are conditioned over time that success looks one of a few specific ways, especially relying on using your undergraduate education to get into an esteemed program like medical school. To reckon with this not being my path and to hit that wall in such a strong way was really difficult. Ultimately, I felt serendipity that I had chosen the college I did, which had a lot of different undergraduate majors to choose from. If I had been at a different college that offered fewer avenues of exploration, I’m not sure where I would have landed. There is community here; I am not the only person that needed to pull out of pre-med.

I went to Boston University for undergrad, and we had an entire school devoted to the health sciences. I hadn't even considered that because I was focused on doing biology as leverage for medical school. To actually take time to research and see the dozens of options out there really planted a seed for me: there are infinite avenues to explore within the professional working world. Nothing is ever cut and dry relative to what your job must be. Landing at that mindset is what really set me up for success.

You mentioned that you work for two different programs at Boston Medical Center. Could you briefly describe the types of services the programs offer and the needs or gaps your work addresses?

There are many dimensions to both programs, but ultimately my mind goes to two places. First is that the structures we have created for our communities really end at what is otherwise the beginning of a family’s journey or next chapter. So many families who are given a diagnosis of autism can feel as though they are sent out the door, essentially told "best of luck" in whatever comes next. The same goes for families whose children die. In both of our programs, we think longitudinally for families that have experienced an enormous life stressor and everything that needs to come after that.

Secondly, both programs hold a mix of both individual and systems-level thinking. In our autism program, we support thousands of individuals and their families each year by connecting them with resources, guidance, and direction. But we also think about how we can change systems to better accommodate the needs of autistic individuals. The healthcare system is set up for a very specific type of patient that often is not aligned with the needs and challenges of those with autism. In my work with child fatality, we similarly support families in navigating their deep grief by connecting them with resources, offering commemorative events, and fostering a sense of community to demonstrate they are not alone. But we also think about the systems. We provide training to thousands of professionals—child welfare, law enforcement, healthcare, and childcare professionals—who are looked to as experts in navigating what comes next. We also think about how families can be better armed with the advocacy they need to confront these enormous power systems.

In public health, having to confront systems can bring about sadness, anger, frustration. Whether you are a community organizer or work in other ways to challenge and change systems or structures, the weight of the work can take an emotional toll. How do you navigate this aspect of your work?

This is an ongoing and forever process. I would say, first and foremost, it's important to have a team around you that you can lean on, that you can talk to and debrief with. I am immensely privileged to work with incredible, brilliant, kind, funny, empathetic, and loving people—to have grown in this space with them is a deep blessing in my life. 

I’ve also had to recalibrate how I think about impact. The families we serve are often navigating lifelong journeys; the emotions, complexity, and systemic barriers don’t just disappear. Instead of trying to figure out, “How do I fix this?” I now ask, “How can I make this family’s experience or trajectory even slightly better than it was before?” It’s about scaffolding and supporting—not controlling or insisting. Self-determination is important here. Even when we see someone in pain, we have to be thoughtful about when and how we intervene. Powerful systems—hospitals, child welfare, healthcare more broadly—have historically taken control away from families. Part of our responsibility is to return agency to them.

It’s an important point you make, how powerful these systems are and how they can really take everything away from a family…

Absolutely. Three years ago, I became a parent to a son with a rare genetic syndrome and have had to navigate the healthcare system in a completely different way than I do professionally. Even after over a decade of working in a pediatrics department, I still did not understand what the family experience was like. We felt the imbalance of power very acutely. You’re reduced to a medical record number. You get 15 minutes with someone who is overworked and overwhelmed. Implicit or explicit threats—like mentions of child welfare involvement or financial penalties by not complying with a physician—can deeply affect a family. Even when providers are trying their best, those dynamics can be harmful. That experience has changed me. It reinforced how important it is to design systems that treat families with dignity and humanity.

What advice would you offer students, early-career professionals or even seasoned professionals about taking care of yourself, especially when doing emotionally intense work?

It took me years to be able to end the day with unread emails and step away from a desk with work still on it. That alone was growth.

Self-care starts with self-awareness. Who are you? What experiences have shaped you? What do you actually need? Blanket advice, like meditate five minutes a day, drink more water, get sunshine, can sometimes feel like another task on an already overwhelming list. Instead, I ask: how can I reduce ambient stress in my life? What lowers tension in my body and day? For me, that includes spending time with my husband and son, being outdoors in the city, playing with my dogs, projects around my house.

It looks different for everyone. But if you’re doing emotionally heavy work, tending to yourself isn’t optional. Burnout serves no one—not you, not your colleagues, and certainly not the families you’re trying to support. Taking care of yourself is just as important as answering emails or meeting deadlines.

Thanks very much, Alex, for taking the time to speak with us!