Key Learnings: Crisis & Trauma Resource Institute – Supporting Children During Covid-19

Today I watched the supporting children during Covid-19 webinar hosted by the Crisis and Trauma Resource Institute (Fadol, 2020).  The trainer, Marwa Fadol, brought up a series of useful considerations that could be applied to families and more specifically, the interactions caregivers have with children.  One of the key points brought up throughout the webinar was the impact of changes to routine, socialization, and activity.  This is reminiscent of information from Santrock on child development and the importance of routine along with domains such as sleep and activity (2014).  It should also be noted that routines are different based on the life stage of the child, so looking at age-appropriate changes and maintenance of routines can have pro-social impacts.  As indicated by Santrock (2014), good family management practices have a positive relation to good school grades, responsibility, and have a reduction in school-related problems.   Fadol (2020) notes that it is the change in routines that is significant, arguably keeping in mind temperament styles of children as to not further pathologize children under the circumstances of the pandemic.  Keeping in mind temperaments and changes in temperaments is an important consideration when providing education to families who have undergone a rapid change in their lives.

Fadol (2020) makes note that the current environment increases the likelihood of an increase in the potential for conflict, irritability, and anxiety (which can be contagious), along with financial stress and social isolation (as supports are not as readily available).  Social workers can consider Maslow’s hierarchy of needs, systems theory, ecological theory, and ecomaps as constructs and tools to explore the client’s reality and develop supports in these circumstances.

Fadol (2020) brings up the concepts of healthy, tolerable, and toxic stress in her discussion.  Stress is first defined as one’s experience of a situation, and that normal stress can be healthy, overcome, and promote positive growth.  The main characteristic of healthy stress is that it promotes positive growth – allowing the body to return to its baseline after the stress-inducing event has passed.  This means the stress is adaptive.  An alternative to healthy stress is tolerable stress.  In these situations, stress has a longer duration.  It can be buffered, but coping is more taxing on the individual.  Fadol suggests that a healthy attachment style and figures can buffer the impacts of the stressor.  The last form of stress, toxic stress, is conceptualized as a period of long-term adversity.  In these situations, there is minimal caregiver support and neurological impacts on the developing brain.  Illnesses related to the physiological impacts of stress can form.

Fadol (2020) suggests that each age-range of children have a series of recently-changed characteristics that may indicate stress.  They are as follows:

• Young Children
  • Sleep disruptions
  • Regressions in behaviour
  • Becoming more emotionally sensitive
  • Increased  bids for proximity/closeness (attachment need-based)
  • An increase or formation of disruptive behaviour (s)
•  School-aged Children (6-12)
  • Difficulties in sustaining or focusing attention
  • Sleep disruptions
  • withdrawal from friends and/or family
  • An increase in emotion dysregulation (there is room to expand emotional management)
• Adolescents
  • Decreased energy
  • A change in sleep patterns
  • Isolation from family and/or friends
  • Irritability and agitation

*Fadol (2020) stresses that it is the change in behaviours from their “normal” baseline that we want to look for.

Resilience is also something we want to consider in the Covid-19 pandemic.  Some of the examples of resilience include

• Adapting well in the face of an adversity
• Positive adaptation to adversity despite its threats towards wellness and/or adaptation.

Fadol (2020) discusses several ways to foster resilience in children.  First is the presence or development of supportive and responsive relationships.  Second is the prioritizing of physical and emotional health (thinking again back to Maslow’s hierarchy of needs).  The third component is the strengthening of regulation skills.  Fourth is a safe exposure to the manageable stress that builds capacity (having the supports as necessary to grow the capacity to manage stress).  Finally, the fifth component is developing a sense of purpose and fostering hope.  From these components, attachment theory, existentialism/logotherapy, and the work of Michael Unger (2015) on parent-child relationships would appear to be relevant concepts/theories to explore further.  For the hope component, interventions that build on the attitude of gratitude that has been studied in positive psychology may be useful (Snyder & Lopez, 2007).

Fadol (2020) also makes mention of suggestions in what supportive and responsive relationships may look like.  One of the first components outlined is that there is consistent time made for points of connection.  Pointed out here is that it is not just a physical presence, but an interactional presence.  There can be a planning process for the time that will be set for time together for interaction.  Fadol refers to this as “collecting” time.  A note of physical distance is also made.  Technology-mediated connections such as video conferencing can be used, or less technical options like letter-writing that are personalized with images can be sent or dropped off to others who are significant in one’s life.  Another important concept that can be integrated here is “bridging separation.”  When we are faced with separation, bridging separation has the individual(s) look for the next point of contact and connection.  This is inherently forward-looking so that we can focus on the next time we will be able to interact.

Physical health is another important consideration during these times.  Fadol (2020) suggests making time for consistent periods to move around.  Other physical practices such as sleep hygiene – that incorporates limiting screen time, access to stressful news, and promoting relaxing activities – can be undertaken.  Another suggestion includes mindful eating.  From Fadol’s description, this sounds different from mindfulness practices such as the orange exercise (see The Mindfulness Clinic, 2011 ).  However, I think the orange exercise could still be relevant as an intervention that introduces mindfulness to a variety of ages and somatic awareness could bring awareness to.somatic sensations and bring awareness to boredom eating.

On the emotional dimension of health Fadol (2020) brings up the importance of routines and our ability to makes new ones if our old ones are disrupted.  Regular points of connection, such as family meals, may be useful considerations.  The key is to not have the routines so strict as to invoke anxiety if they are not fully adhered to.  The goal is to establish a sense of normalcy during change by providing some predictability.

Modelling healthy expressions of emotion to youth and children is another important consideration.  Adults have an important task of portraying that it is okay to have emotions while showing how emotions can be effectively expressed.  In trying circumstances, an opportunity is presented where emotional maturity can be developed and displayed through capacity building of self-regulation skills.  One of the components of self-regulation discussed is the development or capacity building on emotional literacy.  Using the concept of “to name it is to tame it,” an exchange can take place where a guess of the emotions a child may feel can unfold.  The child can then build off of that guess to further provide detail to its (in)accuracy.  Michael White does a similar process in his family work with children (2007).  Another component of the discussions can include going through and identifying cognitive distortions that may be taking place.  This provides social workers with the opportunity to educate individuals/families on the types of thought distortions that exist (such as all-or-nothing thinking, overgeneralization, mental filter, discounting positives, mind reading, fortune telling, emotional reasoning, “should” statements, labelling, and blame; see Burns, 1999) we can then provide alternative ways to move away from them.

One of the significant acknowledgements made in this webinar was that there may be some inevitable some grief that individuals may need to process.  Fadol (2020) discusses the need for there to be a space to express the grief – be it emotions such as anger, sadness, or anxiety.  What is important to consider is that grieving is a very individual response, so all individuals do it in their own way.  Recognizing that it comes in waves is also another essential consideration.  Fadol (2020) suggests that having opportunities to share stories of a loved one may be helpful and that these conversations should not be forced, but emerge at intuitive times when the opportunity presents itself.

The last piece that is discussed is parent/caregiver wellness.  Fadol (2020) highlights the significance of being kind to oneself, and the need to give ourselves a break.  Learning about positive self-talk and/or engaging in positive self-talk provides an opportunity to counter some of the negative messaging individuals may internalize under stress.  Fadol (2020) also makes mention of the need to keep the routines that are generated manageable and realistic to the individual’s circumstances (see SMART goals; DecisionSkills, 2014).  Knowing our own capacity and not trying to keep up with others is an important consideration here.  This fits with Fadol’s (2020) concept of keeping the goals realistic and not comparing oneself to others.  One of the considerations is to start small and move from there.

Another consideration that is discussed is one’s connection with their support network.  Finding time to connect with individuals who nurture you, rejuvenate, or create emotional safety to discuss thoughts/feelings/beliefs is a good consideration.  From a social work perspective, an ecomap and/or genogram may be a useful assessment tool to construct or review with clients, which supports may be useful to connect with as needed (Miley, O’Melia, & DuBois, 2017).  The last consideration is self-care time.  This time should not be stressful and comprise of things that replenish your energy.

Overall, this webinar contributed to the many considerations that a practitioner working within a family context may want to explore in helping families navigate a medical emergency or crisis.  This was a free and useful video that produces a 1 hour of continuing education certificate.  If you are interested in watching it you can find it here.

References

Burns, D. D. (1999). Ten days to self-esteem: Leader’s manual. New York, NY: HarperCollins.

DecisionSkills. (2014). S.M.A.R.T. goals – quick overview.  Retrieved from https://www.youtube.com/watch?v=1-SvuFIQjK8

Fadol, M. (2020). Crisis and trauma resource institute: Supporting children during Covid-19.  Retrieved from https://ca.ctrinstitute.com/covid-19-videos/supporting-children-during-covid-19/

Miley, K. K., O’Melia, M. W., & DuBois, B. L. (2017). Generalist social work practice: An empowering approach (8th ed.). Upper Saddle River, NJ: Pearson.

Santrock, J. W. (2014). Child development (14th ed.). New York, NY: McGraw-Hill Education.

The Mindfulness Clinic. (2011) Mindful eating exercise – how to eat mindfully.  Retrieved from https://www.youtube.com/watch?v=7CCr5w3ox_4

Ungar, M. (2015). I still love you: nine things troubled kids need from their parents. Toronto, ON: Dundurn.

White, M. (2007). Maps of narrative practice. New York, NY: W.W. Norton.