Recognizing and Responding to Student Distress During the Pandemic: A Guide for Making Mental Health Referrals

By Gerard Barone, LCSW, Chief Clinical Officer and Lisa Ciappi, LCSW, Executive Director

It is certainly an understatement to say that school professionals have had to adapt to a multitude of changes since the beginning of the COVID-19 quarantine in March, 2020. Despite time spent during the summer to re-group and prepare for the beginning of a new school year in September, educators are finding that even deep into the fall semester they still feel unsettled. As districts adapt to changing infection rates and the loosening or tightening of state restrictions that result, teachers, students and parents have needed to phase in and out of remote, hybrid and in-school instruction models, and adjust to changing rules and protocols.

With the necessary emphasis on achieving general academic standards as well as special education mandates during this challenging time, it is perhaps predictable that teachers have less time and bandwidth available to devote to the many other roles that they play. These roles include the identification of students’ mental health and learning problems, and being the community’s eyes and ears when it comes to spotting potential child abuse and neglect, or identifying those with food insecurity and other critical concerns.

There are many reasons for this, of course, none of which suggests a lack of dedication or caring. First, it is much harder to spot problems when students are literally not under direct observation as they are in the classroom. Second, with the bulk of the population seemingly moved into the virtual world, there are technological and connectivity issues that can make interactions both inconsistent and frustrating. And thirdly, teachers themselves are juggling their own upended home schedules, and trying to manage their own grief, loss, anxiety, and exhaustion.

Signs That a Child or Adolescent Needs Help

The American Academy of Pediatrics has outlined several indicators that might alert educators and parents that a child or adolescent needs more support. Infants, toddlers and young children may slow down or have setbacks in reaching developmental milestones​. Educators and parents may also see increased problems with irritability and emotion regulation, sleep and/or eating changes, increased clinginess and separation issues, more behavioral issues such as tantrums and aggressive behaviors, and increased talk or play that includes themes of illness, injury, or death.

Older children and adolescents might show unusual changes in mood; changes in behavior such as increased conflict with friends and family, or a backing away altogether from typical interactions with peers (such as texting, video games, social media, etc.); a loss of interest in things typically valued or enjoyed; sleep and/or eating changes; problems with memory or concentration; increased school avoidance and/or changes in academic interest or effort; significant changes in appearance or personal hygiene; an increase in risky or reckless behaviors, including drug and alcohol use; increased thoughts or verbalizations about death, suicide, or life no longer being worth living. And, regardless of whether a student’s family has directly experienced illness or death, he or she may express more worry about the health and well-being of family or friends.

Public health organizations both global and national (e.g., WHO and the CDC) are citing dramatic increases in the number of individuals who are reporting mental health symptoms such as anxiety and depression because of the pandemic. A November 2020 article published online in Psychiatry Research by Singh, et al. reports that “compared to adults, this pandemic may continue to have increased long-term adverse consequences on children and adolescents (Shen et al., 2020). The nature and extent of impact on this age group depend on many vulnerability factors such as the developmental age, current educational status, having special needs, pre-existing mental health condition, being economically under privileged and child/ parent being quarantined due to infection or fear of infection.” The possibility that long-term damage is being done to children’s health and academic achievement around the world is daunting, so it is important that both school professionals and parents remain vigilant and proactive in addressing students’ mental health needs.

What Educators Can Do to Help

So, what can already overwhelmed teachers and administrators do to mitigate the effects of this global health crisis on students?

Classroom teachers who notice changes in a student’s mood or behavior can gently (and privately) comment on the change, and ask the student “What’s going on? Do you want to talk about anything?” This conveys both interest and an openness to provide support beyond academics. Despite the different challenges posed by hybrid or fully remote learning environments, teachers can create classroom routines that can help students maintain a sense of predictability and calm during uncertain times. Opportunities to support social-emotional learning can be included in classroom routines, such as mindfulness practices that encourage the recognition and expression of emotions. Teachers can also explicitly teach the signs and symptoms of stress that we are all to some degree experiencing during the COVID crisis (e.g. grief, anxiety, sadness, a sense of loss, loneliness, etc.), and invite students to share their experiences and have their feelings validated and normalized.

It is, of course, important that teachers help students understand that it is common to experience fears and anxieties related to the pandemic. But during this time of social and political unrest, it is also critical to acknowledge for students that the surge of racial tension and related violence, along with the effects of poverty and healthcare and educational disparities, can cause one to feel unsafe in one’s own community. In line with this, educators must be aware that minority students, as well as immigrants, might not feel safe enough to share their struggles with anyone outside of their immediate families.

In those districts where students continue to work virtually, either for part of each week or completely, it is important for teachers to schedule regular check-ins with students and with their parents. Ask parents what they are noticing about their children at home and agree to mutually track behaviors and emotions across multiple dimensions. Make sure to inquire about family illness and deaths, as well as financial hardships that might contribute to parental stress and children’s worries. Reduce barriers for communication by being flexible with the methods parents can use to convey information or ask questions, e.g. email, text, school portals, etc.

During this time of physical distancing, collateral sources of information, such as your students’ former teachers, become even more important. Chat with their former teachers re: learning styles and academic achievement, as well as typical, baseline behaviors. In line with this “it takes a village” educational approach, take time to re-acquaint yourself with the full array of mental health resources available within your district. It is also advisable to lower your threshold for referring for a mental health assessment for the duration of the public health crisis.

Self-Care is Critical!

At the risk of sounding like a self-help broken record, the staff of Effective School Solutions also wants to emphasize that it is extremely important for school professionals to decide upon, and carry out, a plan of self-care. Attend to food choices, get enough sleep, exercise, seek support from family and friends, and develop a toolbox of mindfulness and distress tolerance techniques. Make time for activities that you enjoy and that boost positive emotions, and do not resist asking for help.

On a district level, the American Psychological Association has recommended that additional mental health and trauma supports be put in place to support teachers. Returning to work while the COVID-19 pandemic is still raging, and when individuals might feel unsafe due to racial injustice and discrimination, can cause extreme distress, and make it difficult to devote attention to vulnerable students. ESS hopes, for us and our colleagues, that we all emerge from this pandemic with an enhanced technical and social/emotional skill set, and with increased resilience and gratitude for the blessings in our lives.

Resources:

https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/Signs-your-Teen-May-Need-More-Support.aspx

https://www.apa.org/topics/covid-19/teachers-supporting-students

https://www.psychiatrictimes.com/view/new-findings-children-mental-health-covid-19

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444649/#:~:text=The%20children%20may%20develop%20feelings,et%20al.%2C%202020).

Singh, S., Roy, D., Krittika Sinha, K., Sheeba, Parveen, S., Sharma, G., and Joshi, G. (November, 2020). Impact of COVID-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations. Psychiatry Research Volume 293, November 2020, 113429. https://doi.org/10.1016/j.psychres.2020.113429

Reinventing K-12 Mental Health Care. Effective School Solution partners with school districts to help develop K-12 whole-school mental health programs.