PART 1: GENERAL RECOMMENDATIONS

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/wp/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/app/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/app/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/app/uploads/2019/06/Depression.pdf

Resources:

• Project TEACH Parent and Family Resources https://projectteachny.org/wp/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/wp/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/wp/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.