- Physicians should ask parents and patients about any immediate changes and stressors to the family because this pandemic can look very different for each child and each family
- Normalize and validate caregiving efforts. Parents and providers are trying to do the best they can, and we are all going through this difficult process of adapting to new and rapidly changing information about the COVID-19 outbreak
- Talk to children and families about the goals that they had established before these changes and reevaluate whether those same goals make sense
COVID-19 has created a tremendous amount of stress and anxiety for families and increased the need for pediatric mental health care. In this Q&A, Archana Basu, PhD, clinical psychologist at the MassGeneral Hospital for Children, explains how providers can offer mental health care for pediatric patients and parents during this trying time.
Q: How should physicians change how they evaluate children during this time?
Basu: In addition to the typical assessment questions, asking parents and patients about the immediate changes and stressors for the family related to the pandemic is helpful. These changes can look very different for each child and each family. Asking about access to resources can also be valuable. For instance, loss of a parent’s employment is not directly about the child but would certainly affect parental stress and could impact the availability of material resources for a family.
During virtual or phone visits, asking about confidentiality and the availability of private space to talk is also very important. For example, before getting started, ask your patient if this is a good time to talk or if they are in a place where they can talk to you. This can be particularly important when working with adolescents. Younger children often don't have the same expectations of privacy. And certainly, for visits with adolescents and parents, physicians should talk about ways to maintain confidentiality at the outset, and discussing any concerns they may have about this.
Q: How should physicians speak to their patients about how they're feeling and their general level of stress at this time?
Basu: First, the impact of the pandemic can look very different for each family and each child. Ask kids the things that they're most worried about. "What are the biggest changes that have been harder to manage?" Each child, depending on their age, personality, family and community context, will have a different perspective on how the changes are affecting them. Some will worry more about school work, others may worry more about stress at home, etc.
Physicians can also help children reframe some of their concerns (e.g., I can’t see my friends). They can validate their feelings and help them understand that they are doing their part by following public health guidelines (e.g., My friends and I are helping each other stay safe and healthy).
Finally, asking children and/or parents about the impact on the family as a whole and not just what affects kids is key. What affects one family member affects others. For this reason, also asking parents about their plans for their own self-care and stress management is important.
Q: Should providers work with patients on established goals or consider new ones?
Basu: I would recommend reassessing the established goals. This is a period of tremendous change and transition in circumstances and the way that we live our daily lives. So providers can talk to children and families about the goals that they had established before these changes and reevaluate whether those same goals still make sense. For instance, there may be some goals that are more time-sensitive or may be related to safety issues. Working on those goals is most important.
But there might be other goals that in the grand scheme of things are not as useful or relevant right now. For example, if they have a goal related to addressing some specific peer related problems, it may not be something they can really work on right now since children are not in school, or it may not be the most important thing to focus on.
Q: How can physicians best speak to parents about their child's behavioral and developmental health during this time?
Basu: Talking to parents or caregivers is actually a really valuable opportunity to normalize and validate their caregiving efforts. I emphasize that everyone is trying to do the best they can and that we are all going through this difficult and ongoing process of adapting to new information about the outbreak that is rapidly changing.
I would also stress that providing psychoeducation or information from prior research about children’s reactions to mass disasters, including infectious disease outbreaks, as well as children’s general resilience, can help parents understand and anticipate the ways in which their children may respond or need additional support. How this plays out with each child and family will be different.
Q: How can mental health providers effectively use virtual visits and telehealth with pediatric patients?
Basu: Telehealth communication has been in use for some time but using them exclusively without in person visits is certainly new to us. To ensure that we are providing care that is as seamless and as effective as possible, there are at least two key things to consider.
First, as providers we can try to be more flexible. For example, this could mean more frequent check-ins for some families that need additional help, relative to a typical once a week or every other week format. Another creative solution that has been proposed by some providers is to use a multidisciplinary approach to telehealth visits by having more than one type of provider join a virtual visit or call with a family, if that is appropriate and helpful. Because providers do not connect as we typically might in the hospital, it can be helpful to communicate more closely as a team.
Second, although a majority of parents are likely to have smartphones, families can vary in terms of digital access and reliable internet. It is important for us to be mindful about asking about this issue. Governor Charlie Baker has signed an executive order that has made telemedicine, including mental health services, more available. Asking families about which platform works for them, including phone calls, is key.
Q: How can providers consider their own mental health?
Basu: There is evidence that providing frontline clinical care for severe stress or trauma also affects providers. This is called indirect trauma, vicarious trauma or secondary trauma or compassion fatigue. Supporting ourselves and each other as we cope with the pandemic ourselves, and continue to provide care to patients in coping with this severe stress, is crucial.
Q: Are there any particular resources that you recommend for providers around this topic?
Basu: There are many reputable organizations with tremendous resources, including tips from the Mass General Hospital for Children on how to talk your kid about coronavirus and a comprehensive guide to related mental health resources from the Department of Psychiatry at Mass General.
Some other notable, child-friendly COVID-19 resources for providers and parents include: