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Project TEACH/NYS AAP November 2020 Newsletter

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Schooling in the Time of COVID
Part 2

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:

“Schooling in the Time of COVID, Part 2”

COVID-19 has led students, teachers, and parents to face an unprecedented challenge: how to educate and learn during a pandemic. Teachers suddenly had to adjust to teaching online, students of all ages were forced to learn on a computer, tablet or phone, and parents had to learn how to balance assisting their children while keeping up with the household and their own job. With the return of school came uncertainty in how schools would open and provide education while preventing the resurgence of COVID-19 cases. Schools continue to have the unenviably difficult job of planning for multiple possible scenarios for re-opening and reclosing: virtual online learning, a fully in-person education, or a hybrid model where part of the week students go into school. The plans continue to vary across the state, and even across school districts depending on schools’ size, spaces, ventilation, and resources. And now with many schools having re-opened, there is the constant risk of classrooms or entire schools re-closing if COVID-19 cases increase. Currently the NYC schools are closed due to an uptick of cases in the five boroughs.

The following are some educational challenges and ways to manage them depending on the school re-opening/reclosing scenarios:

Challenges for K-12 children who are attending school solely remotely based on age ranges and different developmental needs:

Elementary School-aged Students: Limitations for many include less outdoor and physical activities, less opportunity for social skill development and interactions. For the younger child, virtual learning is particularly challenging because of more limited attention spans. Teachers must be even more animated and creative in engaging students than when in person. Furthermore, parents of younger children have more responsibility for their children’s participation in online learning. This becomes a great challenge for those parents who have demanding jobs – whether they are out of the home or not.

Children with Developmental Disabilities: Online learning can be particularly challenging for those who receive support from schools and outside agencies. In fact, the AAP and AACAP advised this group of students to have priority in terms of returning to schools in-person. Depending on the schools’ ability and/or the family’s risk vulnerability, these students may have to continue to learn virtually from home. Challenges may include a need for highly structured schedules, behavior reward plans, and various types of therapies. In these cases, keeping in touch with school staff personnel with expertise is essential.

Middle and High School Students: The preadolescent and adolescent stage of development is a time where peer social life dominates. Developmentally, teens are practicing becoming more independent and less reliant on their parents. The peer interaction and connection to friends provides a way to cope with many issues during these years– missing the socialization is a big loss for this age group. And for all those students who are attending school remotely, staying focused on virtual platforms in settings with many distractions can be quite difficult. Virtual learning requires more self-pacing, and a reliance on their own executive functioning, meaning the ability to plan, structure and organize schoolwork. And lastly, for many students in this age range, sleep has been greatly affected, impacting their ability to sign on to morning classes.

Some ways to manage challenges for children attending school solely remotely include:

  • Developing and maintaining a routine. Keep bedtime and wake times about the same time each day. For kids who require a parent’s presence, parents should work out a schedule of who can be available to assist with classwork, which may mean balancing multiple parents’ and other caregivers’ schedules.
  • For children who are learning from home, keep their morning and bedtime routines the same as if they were going to school in-person, making sure to change out of pajamas in the morning, get dressed, and make the bed.
  • Maintain a separate space for schoolwork – even if there is limited space in the home, having a corner or a small space dedicated only to schoolwork to help with establishing a school-focused mindset. Try to avoid children doing schoolwork in bed as bed that should be devoted to sleep. Try to keep area for schoolwork clutter-free, and have books, papers and pens/pencils necessary for school close by.
  • The great thing about schooling from home is that methods for learning can be more flexible in certain respects. For example, parents can arrange for their child to have a standing desk if that helps with attention.
  • To prevent distraction, parents can either take away cell phones and other electronic distractions, or download an app that locks the phone during class time, such as the forest app
  • Implementing exercise during breaks can help with increasing energy and sharpening attention.
  • Encourage teens to maintain their social connections safely during outdoor activities, or set up fun virtual interactions.

 

Challenges for K-12 children who are attending school on a mixed schedule of in-person and remote learning:

One clear challenge is keeping up with which days students go to school and which days they are at home. Keep a calendar available, reviewing it at the beginning of the week to ensure it is accurate since many schools switch days biweekly. For older kids, have a shared calendar among all family members.

Some students may express initial anxiety about being divided from their friends in the hybrid plan. Empathize with the disappointment, but also remind them of the opportunity to meet new people.

Challenges for K-12 children who are attending school solely in-person:

Many children have been, and continue to be, excited about being back at school. What I have been hearing from school staff is that the students’ energy is palpable through the hallways—but nonetheless, it is different. Many students are waiting in long lines to get screened before entering school. Many are eating lunch in the classroom. By the end of the school day, many students return home as extracurricular activities have been canceled in several school districts, and it feels much different than the busy active time it was pre-COVID when students stayed behind for afterschool activities and sports.
How parents and PCPs can help children overcome fears of contagion, and the possible disruption of the in-person model:
  • PCPs can continue alleviating parents’ and children’s’ fear of contagion by educating them on the ways to prevent spread of infection: wearing masks, staying safely distanced, washing hands, and staying home if they have symptoms. PCPs can also encourage parents to think through who would be with their children when they are at home, which may include having a discussion with an employer and/ or other people to see how their schedule may have to change.
  • It is frustrating for parents and children to become accustomed to a plan and then have it be changed, such sudden school re-closings due to COVID-19. For parents some planning ahead can ease their children’s anxiety and help manage expectations. Parents should have a back-up plan in case school do close. Parents can talk through with their children where they would do schoolwork, and what their expectations might be on a school reclosing or if they continue to learn remotely at home.

The decision to have children return to school in person, learn on a hybrid model, or learn on a fully remote model, is a personal one and unique to each family’s circumstances. To stay centered during this challenging time, families may have already, or want to going forward, incorporate a ritual at the end of the day, such as to listing three things each family member is grateful for. Alternatively, family members could share things that went well, that were funny, or made them feel good during the day.

This continues to be a challenging time for many, and in particular for some populations which have been impacted more than others. What is important to know is that you are not alone, and that there are many community organizations there to support you, including Project TEACH.


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.

Project TEACH direct services to pediatricians include:

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.