Project TEACH/NYS AAP April 2020 Newsletter
Project TEACH E-Newsletter
Project TEACH has been working with pediatric practices in New York State since 2010. The project, funded by the New York State Office of Mental Health, has supported and strengthened the critical role that New York State pediatric primary care providers (PCP’s) can play in the early identification and treatment of mild-to-moderate mental health concerns for children ranging in age from 0 to 21.
One component of the Project TEACH /NYS American Academy of Pediatrics partnership in 2020 is a series of monthly newsletters touching on topics of concern to pediatricians and to parents.
And now to our topic of this Project TEACH Pediatric Newsletter:
Resources for Parents During COVID-19
By Amber Parden, M.D. and David Kaye, M.D.
PART 1: GENERAL RECOMMENDATIONS
- Convey a sense of safety. Questions of safety are big questions for children and adolescents, especially so for younger children. Reassuring kids that they are safe physically and emotionally, and that their parents and loved ones are safe is essential. This is why it is so important for parents to keep their own emotions in check as much as possible. Emotions can be contagious and creating a calm, safe environment starts with the adults. Although social distancing outside the family is paramount, hugging and touching does not need to stop inside the home. Physical contact between parents and children helps to maintain a safe and supportive environment.
- Maintain “good enough” child and family routines. Keep routines in place as much as possible and encourage healthy habits. This will contribute to a sense of safety. Good elements of a family routine include getting adequate sleep, eating regular meals together, and making time for exercise. A routine makes the day more predictable. This predictability is helpful for all kids, and crucial for younger or anxious children. Most children will have ongoing school responsibilities and time for these school activities should be scheduled and maintained. Creating written (or pictorial) schedules may be helpful for children and adolescents. Visual prompts, verbal reminders, and timers can be very useful for times of transition for those children who find this challenging.
- Get outside. Going outdoors is essential physically and emotionally for parents and children. This can be a good opportunity for talking and listening as well. Ideally children should get outside every day for at least 30 minutes. Indoor physical activity on rainy days can also be helpful.
- Sleep is crucial. Maintain regular bedtime routines and habits. For many children and families this will mean continuing to use the same bedtime as before, while other families may find it helpful to shift bedtimes and wake times to accommodate the needs of the entire family (e.g. to allow parents enough sleep). Total sleep time should remain the same and getting up should be about the same as during the regular school year. Flexibility on the timing for some (e.g. adolescents) may be appropriate but all with the understanding that everyone in the house needs as much (or more sleep) during the COVID crisis.
- Make “rest time” for kids and adults. Everyone needs down time and some of this should occur ideally during the day. Designating a time for this (e.g. 3-4 PM) will work for many families. This can also be a time to encourage children to occupy themselves and be more independent.
- Create opportunities for new shared activities. This time may be ripe for adding activities to the routine. If family dinners are not already a regular routine this is a great time to start. Family games, arts and crafts, cooking, baking, or yoga are great options to keep your child occupied. These activities can also limit the amount of screen time children are exposed to. Family time can be a time where children can plan for things that they can look forward to and shift their quarantine to a positive mindset while looking forward to new activities each day. Each family member may have a role to play to be sure one individual does not get overwhelmed.
- Limit the news for yourself and your children. Information overload is rampant and it is not advisable to keep the news on while children are in earshot as this can provoke anxiety in both parents and children. Social media is also a place requiring parental monitoring as there can be posts that feed anxiety with panic inducing or even false information. Using the provided resources below to control the narrative surrounding the pandemic and to explain what is going on in a developmentally appropriate way is useful so that children know what to expect, but do not expect the worst.
- Listen and talk with your children and adolescents. It is especially important during this crisis to remain engaged with your kids and to ask how they are feeling. The National Child Traumatic Stress Network has a helpful chart to identify how different aged children may react to overwhelming feelings amid this pandemic. Project TEACH and the MGH Clay Center for Young Healthy Minds also have good guidance on approaching this with your children.
- Stay in touch. Keep in touch with friends, family and loved ones. Facetime, skype, and other similar video chatting apps may be the only way for children and adolescents to keep up with their friends. Staying in touch with grandparents and other extended family in some manner is crucial for children and families, and promotes a sense of safety and continuity.
- American Academy of Child and Adolescent Psychiatry. Talking to Children About Coronavirus (COVID-19). https://www.aacap.org/App_Themes/AACAP/Docs/latest_news/2020/Coronavirus_COVID19__Children.pdf
- American Academy of Child and Adolescent Psychiatry. Helping Kids Cope While Sheltering in Place. https://www.aacap.org/App_Themes/AACAP/Docs/latest_news/2020/Helping-Kids-Cope-While-Sheltering-in-Place.pdf
- AAP healthychildren.org has a CORONA virus page for parents and families with multiple articles on a variety of topics. https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/2019-Novel-Coronavirus.aspx
- Association of Child Life Professionals. COVID 19 Resources for Children and Families https://www.childlife.org/resources/covid-19-resources
- BrainPOP: Coronavirus for children. (4 minute video for elementary or middle school) https://www.brainpop.com/health/diseasesinjuriesandconditions/coronavirus/
- Child Mind institute. Supporting Kids During the Coronavirus Crisis. https://childmind.org/article/supporting-kids-during-the-covid-19-crisis/
- Child Mind Institute. Supporting Teenagers and Young Adults During the Coronavirus Crisis. Tips for Parents with Older Children At Home. https://childmind.org/article/supporting-teenagers-and-young-adults-during-the-coronavirus-crisis/
- ChildTrends.org. Resources for Supporting children’s Emotional Well-Being during the COVID-19 Pandemic. March 19, 2020. https://www.childtrends.org/publications/resources-for-supporting-childrens-emotional-well-being-during-the-covid-19-pandemic
- MGH Clay Center for Young Healthy Minds. Coronavirus and Family Mental Health https://www.mghclaycenter.org/coronavirus-and-family-mental-health/
- The National Child Traumatic Stress Network. Parent/ Caregiver guide to helping Families Cope with the Coronavirus Disease 2019 (COVID-19). Revised March 1, 2020. https://www.nctsn.org/sites/default/files/resources/fact-sheet/outbreak_factsheet_1.pdf
- NPR Just For Kids: A Comic Exploring The New Coronavirus. February 28, 2020. https://www.npr.org/sections/goatsandsoda/2020/02/28/809580453/just-for-kids-a-comic-exploring-the-new-coronavirus
- PBSS.org How to Talk to Your Kids about CORONA Virus https://www.pbs.org/parents/thrive/how-to-talk-to-your-kids-about-coronavirus
- Understood.org My 5 Parenting Rules for Letting Go and Getting Through the Coronavirus Crisis https://www.understood.org/en/family/coronavirus-parenting-rules
- American Psychological Association: Five Ways to View Coverage of the Coronavirus https://www.apa.org/helpcenter/pandemics
PART 2: RECOMMENDATIONS FOR PARENTS OF CHILDREN WITH DEVELOPMENTAL DISABILITIES AND/OR MENTAL HEALTH CONCERNS
For parents of children with developmental disabilities and/or mental health concerns, this time of sheltering at home presents additional challenges. One change that often follows treatment disruption is that patients return to their Pediatric Primary Care Provider to rebuild the care team and create an effective treatment plan. Project TEACH provides free phone consultation warm lines, remote telepsychiatry evaluations, and referral to community resources to assist Pediatric Primary Care Providers to assess and manage both new and well-known patients during the COVID-19 pandemic: https://projectteachny.org/contact-us/
Guidance for parents of children with common conditions is as follows:
For the Child with Developmental Disorder
These are extremely challenging times for families with children with Autism Spectrum Disorder or other developmental disorders. Routines are disrupted and the usual community supports and resources are less available and generally only accessible by phone or online. Finding new ways to establish routines and permitting parents to have “rest times” is essential. Support is available through the Office of People with Developmental Disabilities (OPWDD) and parents should stay in close touch with their care coordinators and mental health providers that they are already linked with. Tips for parents include:
- Have an emergency plan in place outlining provisions for childcare if a primary caregiver is hospitalized or otherwise ill or quarantined.
- Develop a daily schedule for the child. Contact the child’s teacher and obtain the school schedule to incorporate into the family daily routine. The familiarity of elements of the school schedule may help the child to adjust. Parents may need to make adjustments based on the child’s response as well as their own needs.
- Use visual prompts to maintain routines. Again contact the school teacher to obtain any successful visual prompts they have already developed.
- Incorporate physical breaks at regular intervals.
- Include the child in joint activities as they are able (e.g. cooking, cleaning chores).
- Be flexible about screen time. Allowing for more screen time than usual is going to happen for many, if not most, families. At the same time be cautious about allowing too much time on screens and developing habits that will be difficult to change later.
- Telehealth appointments with pediatricians are strongly encouraged. These appointments allow for ongoing monitoring and promote a sense of continuity and stability for developmentally disabled children and adolescents. Because telehealth appointments are generally well accepted by children and much easier on the adults who need to transition and transport the child to the doctor’s office, this modality may become the standard for many appointments with developmentally disabled children after the COVID crisis resolves.
- Set up reminders to refill medications and maintain regular schedules of medication administration. A discussion with the pediatrician about troubleshooting the details of medication adherence and management can be very helpful in finding practical solutions to these issues.
For the Child with ADHD
- Maintain usual school routines and schedules.
- Utilize behavioral approaches successful at school (these can be obtained by contacting child’s school).
- Stay in touch with your pediatrician; this is a great time for telehealth appointments.
- Continue the same medication regimen your child has been using unless discussed otherwise with your pediatrician.
- Incorporate lots of physical breaks into the daily routine.
- Maintain sleep routines; although flexibility is important in many domains now is not the time for flexibility on sleep for kids with ADHD! Parents need to have time to recharge their batteries and if children stay up too late parents don’t get this opportunity.
- Project TEACH offers parents and families advice for children with ADHD: https://projectteachny.org/wp-content/uploads/2019/06/ADHD.pdf
For the Child with Anxiety/Depression
- Stay engaged with your child.
- Encourage active engagement with productive activities (school, homework, physical activity, hobbies, chores, etc).
- Minimize isolation and check in frequently enough with the child that they know the parent is engaged and paying attention, but not so much that the parent is seen as “bugging” their child.
- Maintain sleep routines used during the regular school year.
- Ensure the child is engaged in outdoor activities at least once per day.
- For teens, monitor alcohol in the home .
- Stay in touch with your child’s emotional pulse by asking and listening to how they are feeling each day. It’s more important that a child feel listened to than that the parent came up with the “right thing to say.”
- For anxious children, as always, encourage children to face their fears and avoid colluding with the child’s anxiety by making excessive accommodations. Because so many activities are restricted by the current crisis anxieties may manifest themselves in more subtle ways. Parents need to continue to challenge their children to “build their emotional muscles,” better tolerate their anxiety, and maintain their freedom to live their life fully.
- For depressed youth, parents should be monitoring for any signs of impulses for self-harm or suicide. Crisis services remain available in all counties. Mental health providers are available by phone or telehealth for new evaluations or ongoing treatment.
- If already linked for mental health treatment, parents should stay in close touch with the child’s mental health professionals.
- During the COVID pandemic, pediatricians should continue to monitor and provide support for the children in their practice with anxiety/depression. This may be an easier time to stay in touch with mental health professionals providing psychotherapy. A conversation between the pediatrician and mental health professional can be enormously helpful for all.
- Project TEACH offers parents and families advice on what to look for in children experiencing anxiety: https://projectteachny.org/wp-content/uploads/2019/06/Anxiety.pdf
- Project TEACH also offers parents and families advice on what to look for in children experiencing depression: https://projectteachny.org/wp-content/uploads/2019/06/Depression.pdf
- Project TEACH Parent and Family Resources https://projectteachny.org/parent-and-family-page/
- ADDiTude: I’ve Been Homeschooling My ADHD Brood for Years. Here’s what I Want You to Know. https://www.additudemag.com/homeschool-adhd-advice/
- Autism Speaks. COVID 19 Information and Resources for Families. https://www.autismspeaks.org/covid-19-information-and-resources-families
- Autism Speaks Autism Response Team is available for families Monday-Friday 9-5, 1-888-288-4762
- Child Mind Institute. Autism and the Coronavirus: Resources for Families. https://childmind.org/coping-during-covid-19-resources-for-parents/
- Child Mind Institute. Support for Kids with ADHD During the Coronavirus Crisis. https://childmind.org/article/giving-kids-with-adhd-support-and-structure-during-the-coronavirus-crisis/
- ECHO Autism: Practical Resources for Parents During COVID 19 https://echoautism.org/parent-resources-during-covid-19/
- Johns Hopkins Medicine Center for Autism: Handwashing and Corona virus Prevention for Children Infographic. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/handwashing-for-kids-infographic
- New York State Parent Network (for parents of any child with special needs) https://www.nysparentnetwork.org/about-the-network.html
- NY START (mobile support program of OPWDD) https://www.centerforstartservices.org/locations/new-york
- Parent to Parent of New York State (parent support for those with children enrolled in OPWDD) http://parenttoparentnys.org
Overview of Project TEACH Services
Current initiatives in Medicaid and Commercial insurance and the NYS PCMH incentive project, all create an environment that encourages pediatric practices to work toward integrating children’s behavioral healthcare into pediatric primary care. Behavioral health integration has the potential to enhance the value proposition for most practices.
Project TEACH Child and Adolescent Psychiatrists are available through the Project TEACH warm lines to provide guidance on assessment of a children’s and adolescents’ mental health symptoms and evidence-based treatment following traumatic events. You can also find the Child PTSD Symptom Scale (CPSS) on the Project TEACH website: https://projectteachny.org/rating-scales/
Project TEACH direct services to pediatricians include:
- Telephone consultations with Project TEACH child and adolescent psychiatrists (“Regional Providers”)
- Face-to-face evaluations provided by the Regional Providers as needed following phone consultations
- Linkages and referrals to key community mental health resources for children and families
- A selection of CME accredited educational opportunities
- Maternal Mental Health Initiative for linkages to care and other support for maternal depression and related anxiety and mood disorders – https://projectteachny.org/mmh/
Accessing the educational and supportive services of Project TEACH can help your practice contract for higher payments, while also supporting you and your team in providing more comprehensive higher quality care to your patients with mild-to-moderate mental health concerns.