A Roadmap to Recovery – Putting Children First
With the accelerated vaccination of millions of Americans, we can at last begin to contemplate life after Covid-19, despite the variants that continue to pose significant challenges to medical professionals here in the U.S. and abroad. At the same time, the enactment of the American Recovery Act offers local economies a once-in-a-generation investment of federal funding, levels of which haven’t been seen since the days of Franklin D. Roosevelt.
Indeed, recovery is on everyone’s mind and the prospect of resuming something resembling “normal” seems finally within our grasp.
But what effective vaccines and an infusion of federal funding cannot remedy are the learning and socialization gaps that our young children and teenagers now experience due to their protracted displacement from their learning environments after more than a year of social isolation. At a critical stage, our young people have been deprived of essential interaction with adults and other children, and the stimulation that is so critical to their intellectual and emotional health and maturity.
According to the National Institutes of Health, “90% of the world’s student population – over 1.5 billion learners in 165 countries – have had their learning experiences disrupted by precautions and policies implemented to quell the spread of the disease.” The United States – much like the rest of the world – faces a second global health pandemic, one defined by the severe mental and emotional distress experienced by young children and teenagers that, if not addressed, will certainly stay with us long after Covid-19 has been vanquished.
During the protracted quarantine, most children and teens had fewer school responsibilities, and limited opportunities for social interactions or extracurricular activities. Many parents had the added responsibility of supervising their children and taking on the roles of teachers while also having to balance their work and daily responsibilities. Some students and families experienced serious economic impacts (the loss of employment and in some cases displacement from homes) which further led to family conflicts and increased exposure to domestic discord and even violence. Many experienced the loss of loved ones, in addition to uncertainties due to prolonged hospitalization and the isolation of family members in recovery. Those affected disproportionately by these stressors are primarily those children and teens with developmental disabilities, children with pre-existing mental health conditions, racial minorities and those from lower socio-economic backgrounds. The inevitable result is that mental health conditions have been unmasked and, in many cases, worsened due to the factors of grief and trauma, the loss of structure, and diminished peer support and limited special education services resulting from school closures.
If we hope to mitigate the mental and emotional fall-out, we must be in a position first to identify the symptoms that indicate the need for professional intervention. These include:
- Increase in depression and the contemplation of suicide
- Increased anxiety about reintegration back in school after protracted absence and the possibility of contracting the virus
- Increased academic challenges- lack of motivation, decline in school performance, shame about lack of academic competence
- Increased sleep disturbances specifically sleep cycle reversals which further affected motivation, energy and willingness to participate in school during the day.
- Increase in screen time/ solitary gaming that trumped child /teen’s priorities such as schoolwork, family time and physical exercise
- Weight gain as a result of lack of exercise- further affecting self-esteem and compounding mood/anxiety symptoms.
And then, of course, teachers and school administrators need to be tuned-in to those indicators that evidence personal struggle and the need for professional intervention. Typical indicators include:
- Increased difficulty paying attention, lack of willingness to participate in schooling, difficulty comprehending schoolwork;
- Demoralization due to inability to do schoolwork;
- Anxiety resulting from separating from parents or loved ones;
- Increase in aggressive behaviors – temper tantrums, anger outbursts, verbal threats to self or others;
- Withdrawal from family and friends – “isolating in their rooms”;
- Poor or failing grades;
- Excessive solitary gaming.
The long-term effects of learning displacement in children and teenagers cannot yet be measured. Parents and teachers face the daunting challenge of recognizing signs of emotional and learning distress and must be equipped to not only deal with its manifestation but have recourse to effective mitigation methods that offer the strongest prospects for closing the gaps created by Covid.
While the inclination is merely to resume life as we once knew it, we parents, care-givers and teachers need to be much more intentional in confronting these effects and supporting children as they transition back to school after summer. It’s important to recognize that children are resilient and are able to recover even in the face of severe stress or trauma. Re-establishing a routine and a structure is one of the essential pillars of recovery. Parents shouldn’t wait till September. Even in the summer months, it’s highly advisable that parents enforce a schedule that involves consistent sleep/wake-up and mealtimes, specific periods for family dialogue and interaction, chores and activities, as well as developmentally appropriate screen activities in moderation.
Re-establishing school as a positive and safe environment with proper emphasis on social emotional learning (SEL) will be a key factor in successfully transitioning students back to in-classroom learning. Because the student-teacher-coach relationship represents a very powerful predictor of a student’s emotional well-being, those teachers, coaches and mentors have a unique advantage in their ability to help re-establish and restore constructive relationships aimed at helping students regain ground lost to the pandemic. Mentors should pay special attention to empathic listening; making time to talk with each student individually; addressing the concerns of those students who may have fallen behind academically, de-stigmatizing and normalizing mental health concerns that some students may be experiencing; providing a safe classroom climate where students will feel empowered to talk about their challenges without shame; helping students identify and articulate their emotions and teaching them to modulate their emotions in an appropriate way; and providing resources/referrals for higher levels of care when there ‘red flags’ are observed.
Teachers would also do well to survey parents for any trauma that their children faced during their prolonged classroom absence, as well as any resulting academic challenges. This approach to open and candid dialogue is critical to mitigating potential effects that at-risk children and adolescents, in particular, face.
School districts should consider a consistent approach for screening for emotional/ behavioral difficulties, employing psychometric tools that can further identify students who are struggling and may need additional support. Those students identified for special attention can be referred to the school guidance counselor or school-based mental health clinicians contracted by the school, or referred to local community clinics.
Reintegrating students in sports activities and extracurricular school activities offers a way to shore-up the self-esteem of those students struggling academically but who possess athletic prowess. Moreover, those same students can act as ‘junior’ coaches or mentors for younger students, creating a sense of purpose and opportunities for validation that the past year disabled. The same goes for students with musical and artistic talent. Educators must seize every opportunity to enable students to re-establish confidence and thrive.
Without question, we will eventually enter the post-Covid reality. It would be a serious mistake, however, to assume that a “return to normal” is, in fact, just that. We can only hope to define the new normal by first acknowledging all that has been lost and then working collaboratively and intentionally to close the gaps that the Covid pandemic has caused among those who offer our best hope for true and lasting recovery.
Neethu Koshy MD Richard O. Huffman
MedStar Medical Group Celebree School