Project TEACH/NYS AAP October 2020 Newsletter
October 31, 2020
Project TEACH E-Newsletter
Schooling in the Time of COVID
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
Routine and Predictability
- Pick out some basic and essential routines that will be the same regardless of remote or in-person learning. An example would be a morning routine – no matter the time that the child wakes up, have them go through the same schedule: get out of bed, brush their teeth, change out of pajamas, have breakfast (or whatever variation of this your household may have).5 It may be as short as 5 or 10 minutes but starting out the day with even that small amount of predictability can alleviate a great deal of anxiety that a child might otherwise have if they are laying in bed trying to figure out what the day holds for them.
- Another basic way to tackle routine and predictability is with a physical and/or digital calendar.5 This can be useful for mapping out in-person vs remote learning days, how they match up with the adult schedules in the home and especially marking down fun and enjoyable activities – such as family game nights, virtual play-dates or a physically distanced family outing.
- This can be as simple as a specifically colored placemat at the table. When in households with multiple children, physical dividers may be helpful to limit distractions if each child is struggling to focus.5 In that space, it is important to set expectations as clearly as possible for what work will need to be completed. This can be done by writing a to-do list, or laying out only the work that will need to be completed in the space. Sometimes having timers or clocks around to help divide up the child’s time in completing these tasks can assist with breaking up the day more.
- Speaking of timers and timing, setting limits on screen time and social media can be incredibly helpful in maintaining your child’s mental health.5 The transition away from screens and social media tends to be one of the more difficult times of day. Visual timers can be helpful for this, especially with younger children or children with developmental delays. If you are not sure exactly how much time will be needed (if say, an adult is on a work call), you can use a timer such as numbers (5,4,3,2,1) written on post-it notes one of which the adult removes every so often in a way that allows for the end of the time to correlate with a time that functions within the whole family’s need but still does so in a predictable way.5
- If you work a family board game or outdoor activity into your routine, letting the child choose the game or the outdoor activity (or the route of the outdoor activity if it is a walk, bike or drive) can increase the child’s sense of control in their environment.
- Another example could be allowing the child to have design choice of calendars or to-do lists so that they are associated with a fun crafting activity in lieu of an added stressor or school assignment.
- Lastly, with routine and predictability, make it work with your whole family’s schedule. Each family is navigating their own school, work and childcare requirements. Identify and acknowledge the challenges and barriers you face, and then communicate with your child’s school and teachers so that they can provide you with support in overcoming them.7,8
Discussion and Checking in
- When providing explanations or updates to children, it is helpful to do so in a developmentally appropriate way – sharing information that is clear and understandable will be essential to addressing their anxieties. Visual aids may be especially helpful, particularly when discussing day to day routines, handwashing expectations, mask wearing expectations and physical distancing.1
- Speaking of mask wearing, that is certainly a new task that children are taking to at varying levels. Some tips to keep in mind include: making it fun with colors, characters or themes, ensuring that it is as comfortable as possible with headbands or ear savers, giving choices in what type or which mask to wear, modeling wearing a mask during fun or enjoyable activities, explaining why it is important to wear a mask, involving the child’s favorite toy in wearing a mask, graded exposure (look at the mask, touch the mask with your hands, touch the mask to your face without putting it on, putting the mask on for gradually longer periods of time) and then when you do go out, utilizing rules, breaks and rewards to incentivize proper mask wearing.10
- Regarding worries, children, adolescents and adults will have many worries around this time. It is helpful to determine which are productive and should therefore be addressed and which are unproductive and should therefore be encouraged to be discarded.6 It is important to do this in a validating way that shows appreciation for the worry, while reassuring the child that focusing on this worry will not serve to change or decrease the worry.
- Feelings associated with any type of worry may translate to periods of increased distress and dysregulation and while those shouldn’t be ignored and safety is most important to consider, they should also be taken with the expectation that it is appropriate to have big reactions (to a degree) during this time.7,8 Lastly, know your resources. It is important to be familiar with what supports you can call on, whether they be family, friends, community supports, school supports, physical health professionals or mental health professionals.
- One of these ways is an emotional “temperature check” at the beginning, middle or end of the day during which the child tells you how they are feeling through a chart, feeling word or number demonstrating the intensity of their feeling.1
- It is then helpful to discuss the physical sensations that pair with the emotion being experienced to help facilitate a stronger mind-body connection. Another way to foster socioemotional learning includes promoting journaling or group discussion with peers or siblings, which can give your child opportunities to process their emotional reactions and receive validation and normalization of their experience.
- Berman, G., & Dubinski, A. (n.d.). Supporting Students’ Mental Health During COVID. Child Mind Institute. Retrieved October 5, 2020, from https://childmind.org/
article/supporting-students- mental-health/?utm_source= newsletter&utm_medium=email& utm_content=Supporting% 20Students%E2%80%99%20Mental% 20Health%20During%20COVID&utm_ campaign=Public-Ed-Newsletter
- Brown, R. (2020, September 25). URMC partners with schools to help parents navigate remote learning. WHEC News10NBC. https://www.whec.
com/back-to-school-rochester/ urmc-partners-with-schools-to- help-parents-navigate-remote- learning/5874369/
- Fairyington, S. (2020, September 18). How to adapt meditation for little kids? It looks a lot like play. Washington Post. https://www.
washingtonpost.com/gdpr- consent/?next_url=https%3a%2f% 2fwww.washingtonpost.com% 2flifestyle%2f2020%2f09%2f18% 2fchild-mindfulness- meditation-pandemic%2f
- Gleeson, S. (2020, August 4). The revised meaning of self-care in the wake of COVID-19. Counseling Today. https://ct.counseling.
org/2020/08/the-revised- meaning-of-self-care-in-the- wake-of-covid-19/?utm_source= counselinginsider&utm_medium= email&utm_campaign=ct_online& utm_term=article&utm_content= selfcare
- Hume, K., Waters, V., Sam, A., Steinbrenner, J., Perkins, Y., Dees, B., Tomaszewski, B., Rentschler, L., Szendrey, S., McIntyre, N., White, M., Nowell, S., & Odom, S. (2020). Supporting Individuals with Autism through Uncertain Times. Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill. https://afirm.fpg.unc.
edu/sites/afirm.fpg.unc.edu/ files/covid-resources/ Supporting%20Individuals% 20with%20Autism%20through% 20Uncertian%20Times%20Full% 20Packet.pdf
- Mental Health America B4Stage4. (2020). Back to School 2020 – Coping During COVID – Outreach Toolkit. Mental Health America. https://mhanational.
org/sites/default/files/Full% 202020%20Back%20to%20School% 20Toolkit%20-%20Images% 20Separate_08.28.20.pdf
- SPCC, Whole Child Connection, & UR Medicine, Golisano Children’s Hospital. (2020a). Returning to Middle and High School Education during the COVID-19 Pandemic. The Society for the Protection and Care of Children.
- SPCC, Whole Child Connection, & UR Medicine, Golisano Children’s Hospital. (2020b). Returning to Pre-K and Elementary Education during the COVID-19 Pandemic. The Society for the Protection and Care of Children.
- Strauss, V. (2020, October 5). How much learning is really “lost” when children aren’t in school buildings? Washington Post. https://www.
washingtonpost.com/gdpr- consent/?next_url=https%3a%2f% 2fwww.washingtonpost.com% 2feducation%2f2020%2f10%2f05% 2fhow-much-learning-is-really- lost-when-children-arent- school-buildings%2f
- Strong Center for Developmental Disabilities in the Division of Developmental and Behavioral Pediatrics. (2020, August). A toolkit for helping your child wear a mask during COVID-19. University of Rochester Medical Center. https://www.urmc.
rochester.edu/MediaLibraries/ URMCMedia/strong-center- developmental-disabilities/ documents/Mask-Wearing- Toolkit.pdf
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.
- 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.