Some children and youth who had pre-existing mental health issues are not doing well because of the added strain and stress and the uncertainty that has been a feature of the pandemic.  Signs of mental health struggles are also appearing in children and youth who had not had previous mental health issues.  A recent Ontario Centre of Excellence for Child & Youth Mental Health CYMH webinar explored the situation.

Based on a survey conducted in collaboration with Infant and Early Mental Health Promotion, Children First and Kids Brain Health Network, the webinar explores the first wave pandemic experiences of Canadian families with children under the age of 6 and the types of services they did or did not have access to, and makes recommendations to make sure that families have access to the practical and mental health supports they need to ensure positive social-emotional development in the children both during and post-pandemic. 

A mother of a newborn talked about her personal experience of isolation from peer supports during the pandemic and the anxiety that created around whether her child was meeting developmental milestones, and whether this year of isolation will have long-term impacts for her child’s social development.

The webinar noted that the ways in which mental health issues are working out during the pandemic are distinctive within different age groups. 

Dr. Chaya Kulkami, Director of Infant and Early Mental Health Promotion at Sick Kids, reported on a COVID-19 parental survey they undertook.  She noted that parents of under-5s were enthusiastic about being consulted on their experience. Relationships are a key aspect to child development, and the positive aspect is that parents have spent a lot of time with their children this past year, but stress and exhaustion has been a significant factor for parents.  Sick Kids is partnering with the University of Calgary, who are doing a much deeper analysis of the responses.

One of the biggest concerns of parents is the effect on their children of being isolated from interaction with other children.  The concern is how we can effectively support children who have been isolated from peer interaction as they re-integrate socially.

Post-partum depression counselling has been adversely impacted by the pandemic, and parents dealing with significant mental health issues may not be receiving adequate support as they continue to care for their infant, particularly parents in rural communities.  Untreated post-partum depression has long-term effects on children’s development, including:

·       Delayed cognitive and language development

·       Insecure attachment

·       Higher rates of behavioural problems

·       Lower grades

·       Higher rates of depression in teenage years

Children First in Essex County, Ontario, provides individualized services to families with children from birth to six year of age who are at risk for or who are experiencing developmental or mental health challenges.   They compared the initial stage of the pandemic for the organization as trying to fly a plane while you are building it.  Common to experiences of other agencies, at the same time as trying to create safe working conditions for their staff, they were attempting to deal with referrals of families in need of support.  They made the decision not to shut down, even temporarily, but senior staff managed referrals and reached out to families by phone contact, encouraging parents to decrease screen time and to focus on direct interaction and play with their child, especially in terms of speech development and meeting developmental goalposts.

As the pandemic continued, the agency staff, who were used to meeting with families in their home, switched to video-conferencing with parents.  They also had to switch from working directly with the individual child to working with the child in the context of the full family dynamic.

While agency-based referrals decreased from normal levels during the pandemic, due to operational impacts on the referring agencies, Children First became aware of the significance of infant development needs in the present situation, requiring sustained contact with parents needing support and re-assurance as they coped with parenting their infants in isolation.

To cope with the logistical issues of offering support to families through the pandemic, they implemented the following strategies:

·       Culture, communication, contact and collaboration

·       Filling the travel void (they had previously offered in-home consultations to families for some of their services)

·       Social media & website (created a uTube channel and posted videos/webinars on key issues)

·       Virtual platform

·       Waitlist response (they contacted every family on their waitlist)

·       Prioritization and triage

·       Brief service (responding to parents’ stress levels by offering each family who contacted them 3 support sessions with a social worker as a starting point; this met the needs of many families, while those who needed additional supports were then able to be routed effectively to meet their specific requirements)

·       Responding to specific clinical needs (segments)

·       Flexibility and adaptability in roles to meet service needs

·       System development – phone coverage, parent portal, voicemail to email

·       Wider system collaboration (staff were willing to be re-deployed as necessary in-house, and within the wider community there has been development of collaboration between the support agencies for adult mental health and children’s mental health to widen the spectrum of support to families)

Two trends that have arisen are the specific support requirements of grandparents raising grandchildren due to mental health/addiction issues of the children’s parent(s) and support needs of foster parents, especially those caring for several high-need children during lockdown.  Partner abuse has also arisen as a source of referrals, along with family conflict situations, where access to children has been impacted by concerns around limiting COVID-19 exposure and maintaining safety ‘bubbles’.

The agency also draws attention to the significance of social interactions to speech and language development during the period of infancy.  Parental mental health issues increased by isolation and stress, and parents trying to work at home, can make it hard to sustain the regular, interactive interplay between parent and child that builds on speech/language development.

The Children First team had to develop new skills to deliver care through virtual means.  They tried to standardize those practices, so staff had a framework for service provision.  It was a shift to move intervention and coaching to a virtual environment.  They worked on maintaining privacy, creating a conducive environment, having a plan for what to do if you are disconnected during the video call, and addressing reliability of technology.   Families have often found it less stressful when they don’t have to travel to an appointment and bring or find care for their children in order to attend. CYMH will be offering further webinars on offering virtual support to families with unsafe family environments.

The agency has addressed staff supports by increasing break time, in acknowledgement that online meetings are more tiring than in-person work.  They have been supportive to staff by being more flexible around scheduling vacation time, when staff see potential windows in their caseload.  There is access to emergency child care for staff for their own children if required, health resources and therapy support for staff, webinars on coaching through a virtual platform, and collaborating with other agencies on sharing staff-support strategies.  The team participated in a 30-day gratitude journal exercise to align and sustain their own focus on what is good for them, even during this difficult time.

Children First have concerns about developing issues during the pandemic, such as increased exposure to substance use in utero, as evidence arises that alcohol and substance use has increased as the pandemic has continued.  The agency is focusing on a family-systems approach to therapy and increasing capacity and training for staff on fetal-alcohol syndrome.  They are mindful of staff needs in terms of exhaustion, vicarious trauma, and the conflicting needs of sustaining work and family demands.  In terms of infant mental health, there will be a sustained need to reach new parents and look at the increased support needs there may be post-pandemic as families and communities attempt to re-normalize.

The City of Hamilton, Ontario, has provided a useful page on Child and Youth Mental Health During COVID-19 on their website at:  https://www.hamilton.ca/coronavirus/child-and-youth-mental-health-during-covid-19  with practical suggestions and resources for families who are concerned that their child or youth may be experience a mental health concern. 

The page offers a number of simple, practical tips and resources for families with babies, toddlers and preschoolers, grouped around six key messages:

·       LISTEN to your child and pay attention to their cues.

·       VALIDATE and SUPPORT your child in a calm manner and with an age-appropriate answer.

·       BE PATIENT with yourself and your child.  Know that it is normal to have many emotions.

·       Help your child to FOCUS ON WHAT IS IN THEIR CONTROL.

·       HAVE A ROUTINE at home that includes time for fun while following public health measures.

·       STAY CONNECTED with important people in your child’s life.