D Ed > , >d, /DW d^ K& Ks/ r í õ KE · W ZdD Ed E D & } µ } v u ] v ] v ] v P ] v o µ ] À ] Ç...

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DEPARTMENT NAME MENTAL HEALTH IMPACTS OF COVID-19 ON CHILDREN IN THE SCHOOL SETTING Ginger Depp Cline, Ph.D., ABPP Licensed Psychologist Board Certified in Clinical Child & Adolescent Psychology BCM - Pediatrics - Psychology Section TCH - Psychology Service Pediatric Health Psychology Program (PHPP)

Transcript of D Ed > , >d, /DW d^ K& Ks/ r í õ KE · W ZdD Ed E D & } µ } v u ] v ] v ] v P ] v o µ ] À ] Ç...

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DEPARTMENT NAME

MENTAL HEALTH IMPACTS OF COVID-19 ON CHILDREN IN THE SCHOOL SETTING

Ginger Depp Cline, Ph.D., ABPPLicensed PsychologistBoard Certified in Clinical Child & Adolescent PsychologyBCM - Pediatrics - Psychology SectionTCH - Psychology ServicePediatric Health Psychology Program (PHPP)

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DEPARTMENT NAME

1. Identifying students at risk

2. Providing brief interventions

3. Coordinating referrals to mental health providers in the school and community

4. Continuity of care

REMEMBER: SCHOOL NURSES & MENTAL HEALTH

PSYCHOLOGY

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Preparing for System, Family, and Individual Supports

2. INTERVENTION

PSYCHOLOGY

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DEPARTMENT NAME

PLAN FOR RETURNING TO SCHOOL

PSYCHOLOGY

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DEPARTMENT NAME

TRAUMA INFORMED SCHOOLS

http://psychlearningcurve.org/psychology-trauma-schools/

PSYCHOLOGY

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DEPARTMENT NAME

MASLOW’S HIERARCHY OF NEEDS

https://www.simplypsychology.org/maslow.html

PSYCHOLOGY

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TRAUMA INFORMED SCHOOLS

• Safe/welcoming environment for all students/families

• Increase cultural responsiveness (implicit/explicit bias, representativeness)

• Structured/predictable environment

• Increase trauma literacy (students, families, and staff)

• Minimize triggers

• Assess for trauma

• School discipline -restorative justice and safe spaces when needed

• Anti-bullying and suicide prevention

• Emergency plans (preparation for students)

• Staff self-care and wellness (resources)

Creating, Supporting, and Sustaining Trauma-Informed Schools: A System Framework (NCTSN)

PSYCHOLOGY

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TRAUMA INFORMED CARE

NCTSN Child Trauma Toolkit for EducatorsA Trauma-Informed Approach to Teaching Through Coronavirus (www.tolerance.org/magazine.a-trauma-informed-approach-to-teaching-through-coronavirus (2020)

Explain reasons for changesGive choices when possible

Be sensitive to possible triggers

1. Maintain routines and warn children when changes will occur

PSYCHOLOGY

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Focus on maintaining inclusivity and creating feelings of being valued

(not all about academics)

2. Anticipate difficult times and provide additional support

https://static1.squarespace.com/static/5b7c56e255b02c683659fe43/t/5e87546013dcc5026661f52b/1585927269609/SAMPLE+COVID-19+check+in+survey.pdf

PSYCHOLOGY

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DEPARTMENT NAME

BREATHING & MINDFULNESS

Mindful eating practice

https://www.bing.com/videos/search?q=stop+think+breathe+you+tube&&view=detail&mid=C819F1E3B69DE3407025C819F1E3B69DE3407025&&FORM=VRDGAR&ru=%2Fvideos%2Fsearch%3Fq%3Dstop%2Bthink%2Bbreathe%2Byou%2Btube%26FORM%3DHDRSC4

http://mindfulnessforteens.com/guided-meditations/

3. Increase support/encouragementReview normal emotions and teach

regulation skills (mindfulness, breathing, gratitude practice, soothing activities)

PSYCHOLOGY

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DEPARTMENT NAME

https://www.search-institute.org/wp-content/uploads/2020/03/Coronavirus-checklist-Search-Institute.pdf

PSYCHOLOGY

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TRAUMA INFORMED CARE

NCTSN Child Trauma Toolkit for EducatorsA Trauma-Informed Approach to Teaching Through Coronavirus (www.tolerance.org/magazine.a-trauma-informed-approach-to-teaching-through-coronavirus (2020)

Break directions into smaller parts and encourage questions

Restorative justice5. Support self- and community-

efficacy

4. Set clear, firm limits for behavior with logical consequences

PSYCHOLOGY

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DEPARTMENT NAME

PSYCHOEDUCATION/RESOURCES

PSYCHOLOGY

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DEPARTMENT NAME

PARENTING

PSYCHOLOGY

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DEPARTMENT NAME

TIER 1 UNIVERSAL SUPPORTS

Examples: • social-emotional learning goals/focus• Resilience Classroom Curriculum (built on Families Overcoming Under

Stress – FOCUS program)Listen, Protect, Connect (LPC)

PSYCHOLOGY

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• Be a role model (self care)

• Be aware of listening ears

• Clear communication about school safety process, information about when an outbreak is present, how families can help, when schools need to close

• Normalize feelings and reassure (“normal reaction to an abnormal situation”)

• Teach positive coping skills to help them self-regulate (deep breathing, mindfulness, focus on the positive)

• Establish and keep a daily routine (encourage at home; at school)

• Identify ways to help others

RECOMMENDATIONS FOR HELPING CHILDREN COPE WITH COVID-19

Helping Children Cope with Changes Resulting from COVID-19 – NASP (updated March 25, 2020)

PSYCHOLOGY

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• Monitor TV/Social media viewing (what have you heard)

• Invite youth to ask questions and answer honestly and in developmentally targeted way

• Teach ways to stay safe (social distancing, washing hands, covering sneeze)

• Be sensitive to blame/scapegoating related to others with illness/certain ethnic groups

• Appreciate grief

• Teach regulation skills

• Recognize resilience - How have you gotten this far with coping to date (strengths, sources of support, prior tough times you made it through)?

RECOMMENDATIONS FOR HELPING CHILDREN COPE WITH COVID-19

Helping Children Cope with Changes Resulting from COVID-19 – NASP (updated March 25, 2020)

PSYCHOLOGY

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DEPARTMENT NAME

DEVELOPMENTALLY TARGETED EXPLANATIONS

• Early elementary

• Brief, simple explanations

• Steps we take to stay safe

• Adults are working to keep them safe

• Encourage them to express thoughts/feelings

• Provide active listening

• Upper elementary and early middle school• Respond to their questions

• Inform them of national, state, and community focus on preventing germs from spreading

• Encourage them to express thoughts/feelings

• Provide active listening

Helping Children Cope with Changes Resulting from COVID-19 – NASP (updated March 25, 2020)

PSYCHOLOGY

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DEPARTMENT NAME

DEVELOPMENTALLY TARGETED EXPLANATIONS

• Upper middle and high school• Discuss more indepth

• Refer to scientifically vetted sources (CDC, etc)

• Engage in decision-making for how they can help

• Encourage them to express thoughts/feelings

• Provide active listening

Helping Children Cope with Changes Resulting from COVID-19 – NASP (updated March 25, 2020)

PSYCHOLOGY

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DEPARTMENT NAME

Helping Children Cope with Changes Resulting from COVID-19 – NASP (updated March 25, 2020)Eductor’s Guide to Supporting the Social and Emotional Needs of Students: COVID-19 Information and Resource

Materials (Michigan Department of Education and Michigan Department of Health & Human Services)PSYCHOLOGY

RECOMMENDATIONS FOR SUPPORT

Preschool PatienceProvide reassurance (physical and verbal)Encourage expression (play, art)Allow short-term changes in sleepMaintain routinesAvoid media exposure

School-aged PatienceAsk about worries and offer reassurance Play sessions/staying in contact with friendsRegular exerciseHelp around the house and complete workSet gentle but firm limitsEncourage expression (play, talk)Create family routines for safety and maintain typical routines/expectations (chores, sleep)Limit media and address any discrimination/stigmaHelping others activities

Adolescent Patience & reassuranceEncourage discussionsMaintain routinesMaintain social contact (friends, family)Participate in family routines (chores, caring for siblings, healthy routines)Maintain expectationsLimit media exposure and discussAddress discrimination/stigmaHelping others activitiesMaintaining hopeSupport self- and community-efficacy

*Educator’s Guide to Supporting the Social and Emotional Needs of Students: COVID-19 Information and Resource

Materials (Michigan Department of Education and Michigan Department of Health & Human Services)*Talking with Children: Tips for Caregivers, Parents, and Teachers during Infectious Disease Outbreaks (SAMHSA)

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DEPARTMENT NAME

PSYCHOLOGICAL FIRST AID??

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DEPARTMENT NAMEPSYCHOLOGY

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DEPARTMENT NAME

1. Contact/engagement – connection and noticing changes

2. Safety/comfort – Hard to focus on academics if this isn’t in place (“You are safe here with me. I know you’re overwhelmed, and I want you to feel safe and calm”)

3. Stabilization (if needed) – private calming area and active listening• “I don’t want to be at school – it’s safer at home.”

• Don’t feel that way – you’ll be fine

• It sounds like you’re really worried about what will happen.

• You’re scared that you’ll get sick.

• We won’t let anything happen to you.

PSYCHOLOGICAL FIRST AID

PSYCHOLOGY

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DEPARTMENT NAME

4. Information gathering

5. Practical assistance – let’s take 5 deep breaths, give a break/drink

• What would help you feel better right now?

6. Connection with social support

• Who has helped you in the past when you were upset/had a problem?

7. Information & praise for coping (brave & strong, wisdom for asking for help; what has helped in the past)

8. Linkage with services (parents, mental health provider at school, community resources for needs such as housing, food, clothing, electricity, etc., faith communities)

PSYCHOLOGICAL FIRST AID CONT…

PSYCHOLOGY

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DEPARTMENT NAME

LISTEN, PROTECT, CONNECT

LISTEN• Tell me how you’ve been

impacted by COVID.• What’s your schedule like

during the week?• How do you spend your

weekends?• I am ready to listen when

you’re reading to share

PROTECT

• Are you worried about your safety or others’?

• What are you most worried about right now?

https://traumaawareschools.org/pfa

PSYCHOLOGY

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DEPARTMENT NAME

LISTEN, PROTECT, CONNECT

CONNECT

• What can family do to help?

• What can your friends do to help?

• What can you do to make things better?

• What has been helpful to you in the past when facing a hard situation?

MODEL

• Thank you for how brave you’ve been and sharing your concerns

• Let’s talk about some things you can do to stay connected with others while staying healthy

• Let’s brainstorm ways others are coping

https://traumaawareschools.org/pfa

PSYCHOLOGY

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DEPARTMENT NAME

LISTEN, PROTECT, CONNECT -- TEACH

• “This is a health crisis that is very stressful. Sometimes people feel all types of emotions, and they may have a hard time keeping routines and managing emotions. Are these happening to you?”

• “We can create a new routine until things get back to closer to normal.”

• “I am here anytime you want to talk, and I really look forward to seeing you back at school soon. Take care of yourself and your family.”

• “Here are some resources that may be helpful…”

https://traumaawareschools.org/pfa

PSYCHOLOGY

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DEPARTMENT NAME

HTTPS://TWITTER.COM/PFAGELL/STATUS/1243968510176436224

PSYCHOLOGY

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DEPARTMENT NAME

• Providing information and scientifically supported resources and information

• Focus on what most families are doing – health promoting

• Debunk myths & help families think critically

• Finding sources of information that align with families (who they listen to) and their values (i.e., protecting others, wanting to be with the norm group)

• Be vigilant for outgroup thinking and discrimination/bullying & promote ways to collaborate

• Focus on stress growth

ROLE OF EDUCATION FROM NURSING STAFF

Van Bavel, Baicker, Boggio, Capraro, Cichocka, Cikara, et al., 2020

PSYCHOLOGY

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DEPARTMENT NAME

TIER 2 TARGETED SUPPORTS

PSYCHOLOGY

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• Prior traumatic experiences – 1 in 4 children has been exposed to a traumatic event• Which of the following could be a trigger for a child?

A. Fire alarm

B. Loud talking

C. Talking about pet dog

D. Rainy day

E. All of the above

RISK FACTORS

PSYCHOLOGY

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• Premorbid mental health/learning concerns

• Teens and limited social contact

• Families who may have lost jobs/income or those with health concerns

• Families with healthcare workers or other front-line workers

• Children with less supervision due to work demands

RISK FACTORS CONT.. .

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TIER 2 INTERVENTION EXAMPLES

• Cognitive Behavioral Intervention for Trauma in the Schools) –CBITS (middle and high school)

• Bounce Back (elementary)

• Support for Students Exposed to Trauma (for teachers/counselors/staff without mental health training to deliver a modified program)

https://cbitsprogram.org/https://bouncebackprogram.org/https://www.rand.org/pubs/technical_reports/TR675.html

PSYCHOLOGY

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DEPARTMENT NAME

• Relaxation:• Diaphragmatic Breathing

• Progressive Muscle Relaxation

• Distraction:• Mindful Visualization

• Game of 5

• Cognitive Coping:• Helpful thoughts/self-talk

BRIEF STRESS MANAGEMENT INTERVENTIONS

PSYCHOLOGY

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CHANGING THE CHANNEL ON NEGATIVE THOUGHTSWe’re going to We’re going to lose our house

because my parents lost their jobs

I am going to get very

sickI am taking I am taking

steps to stay

healthy

Everyone is Everyone is working to be sure families

have what they need

? ?

PSYCHOLOGY

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DEPARTMENT NAME

TIER 3 TARGETED SUPPORTS

Ex: Trauma-focused Cognitive-behavioral therapy (TF-CBT)

PSYCHOLOGY

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DEPARTMENT NAME

Networking, resources, & continuity

3. & 4. FOLLOW-UP & REFERRAL

PSYCHOLOGY

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• Symptoms last longer than 2-4 weeks or when they appear suddenly• Continued check-ins, screening for ongoing risk/symptoms

• Titrating off

• Referring out

• Establishing continuity• Did they follow up with referral? Are their symptoms improving? Do they

still have the appropriate resources?

HAVING A FOLLOW-UP PLAN

PSYCHOLOGY

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• Guidance counselor

• May help with: reducing course schedule overload, connecting to school services, transition to college with adequate supports

• School psychologist (LSSP)

• May help with: evaluation for services, individual therapy, group therapy, referral to evidence-based clinicians in the community

• IEP team

• May help with: supportive resources during school day (breaks, resource room, reduced workload), modifications or accommodations to reduce cognitive stress

• Community-based providers (private practices, PCP integration, specialty clinics)

• For targeted interventions

LOCATING APPROPRIATE REFERRALS: KNOWING WHO'S WHO

Helping Children Cope with Changes Resulting from COVID-19 – NASP (updated March 25, 2020)

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DEPARTMENT NAME

• Identifying Calming Strategies/Breaks for You & Your Child (www.makesociallearningstick.com

• Calming menu (i.e., draw/color, get a hug, go into Zen Den, hum/sing)

• Resources to Teach Your Child Mindfulness (including apps such as Stop, Breath and Think Kids, Calm, Headspace for kids, Smiling Mind, My Life) (www.makesociallearningstick.com)

• http://mindfulnessforteens.com/guided-meditations/

• https://www.youtube.com/watch?v=UMIU-Uo8cZU&feature=youtu.be (automatic thoughts video)

• https://www.autismspeaks.org/sites/default/files/flu_teaching_story_final%20%281%29.pdfhttps://www.apa.org/helpcenter/resilience

• https://www.autismspeaks.org/covid-19-information-and-resources-families#Teaching%20Stories

• https://www.apa.org/helpcenter/resilience

• School Safety and Crisis – Countering Coronavirus Stigma and Racism: Tips for Teachers and Other Educators (NASP)

RESOURCES

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PSYCHOLOGY

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DEPARTMENT NAME

• Preparing for a Pandemic Illness: Guidelines for School Administrators and Crisis Teams (NASP)

• Preparing for Infectious Disease Epidemics: Brief Tips for School Mental Health Professionals (NASP)

• BrainPOP: Coronavirus

• PBS Kids: How to talk to your kids about coronavirus

• Yale Center for Emotional Intelligence: Managing anxiety around COVID-19: Tips for you and your school community

• Traumaawareschools.org evaluation

• https://www.nctsn.org/sites/default/files/resources//pfa_schools.pdf (Psychological First Aid for Schools)

• https://www.air.org/resource/building-positive-conditions-learning-home-strategies-and-resources-families-and-caregivers

• https://casel.org/wp-content/uploads/2020/07/SEL-ROADMAP.pdf (Reunite, Renew, and Thrive: Social and Emotional Learning (SEL) Roadmap for Reopening School)

RESOURCES

PSYCHOLOGY

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DEPARTMENT NAME

• https://trailstowellness.org/materials/resources/covid-19-resources

• https://store.samhsa.gov/product/Talking-With-Children-Tips-for-Caregivers-Parents-and-Teachers-During-Infectious-Disease-Outbreaks/PEP20-01-01-006

• https://www.childtrends.org/publications/ways-to-promote-childrens-resilience-to-the-covid-19-pandemic

• https://www.tolerance.org/magazine/a-trauma-informed-approach-to-teaching-through-coronavirus

• https://www.nctsn.org/resources/child-trauma-toolkit-educators

• https://www.childtrends.org/publications/resources-for-supporting-childrens-emotional-well-being-during-the-covid-19-pandemic

• http://japconline.org/journal/article.php?code=54835 (Helping the Weeping, Worried, and Willful: Psychological First Aid for Primary and Secondary Students, 2017)

RESOURCES

PSYCHOLOGY

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DEPARTMENT NAME

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DEPARTMENT NAME

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COMMENTS/QUESTIONS?


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