Primary care physicians and medical staff are part of the frontline response to the COVID-19 pandemic. In addition to providing primary care during COVID-19, they provide reassurance and guidance to concerned families. These families are worried about their risk of becoming ill, but they are also facing unprecedented challenges to their overall stability, with changes in employment and income, and increased family demands. Many providers are adapting their care practices to better meet the emotional needs of their pediatric patients and families.
Mental health screening during COVID-19
Now more than ever, completing a mental health screening in every provider visit, regardless of the presenting problem, is important for supporting a patient’s total well-being. This can be informal and may include asking general questions about emotional distress, physical distress, social distress and financial stressors, which can be common during times like this. Some clinics may have behavioral health staff who are trained to identify and provide care for patients with common and severe mental health conditions. However, it is imperative that all clinical staff who have contact with patients be aware of the risks and warning signs of deteriorating mental health and suicidal thoughts.
It can be crucial to screen for the following:
- History of mood disorder
- Alcohol or drug abuse
- Family history of trauma, suicide or violence
- Feeling alone
- Events or recent losses leading to humiliation, shame or despair
- Irritability, agitation or aggression
- Chronic pain, major physical illness or recent life-threatening diagnosis
- Brain injury
- Perceived burden on others
- Exposure to suicide in the community, social circles or the media.
If concerns arise, care providers may need to begin a more formal mental health screening. Free options include PHQ-9, GAD, PSC-17 and the SDQ. If suicidal thoughts are a concern, free options include asQ and Columbia.
Referrals for mental health consultations
Primary care physicians often provide support to youth and their families and act as a referral source for additional assessment or treatment for a variety of conditions. Providing primary care during pandemic times also means anticipating that baseline levels of anxiety, depression and stress will increase. Because of this, it can be helpful to regularly consider when it is appropriate to refer a patient for additional mental health support or consultation. Pre-existing conditions may be exacerbated during periods of increased stress or new conditions may arise, such as adjustment disorders, which develop in the context of a stressor. When evaluating whether to refer for increased mental health support, consider the following:
- Is the youth demonstrating significant behavioral or emotional changes?
- Are current relationships or roles impacted (such as ability to complete schoolwork)?
- Does the youth have a history of mental health challenges and DSM-V diagnoses?
- Is the youth concerned about their level of distress? What are their thoughts regarding the need for increased support?
Research indicates that early referral and treatment can be particularly beneficial because it can provide families with the skills and support necessary to manage ongoing stressors and challenging life events. When referring for services, it’s helpful to reiterate this point and instill a sense of hope in youth and their families.
Tips providers can share with parents
A child’s ability to adapt and cope during this stressful time depends heavily on the well-being of the adults who care for them. It is important to remember that parents’ lives have been disrupted too. Some mental health tips you can share with parents include:
- Practice self-care. In order to create space to care for the needs of others, we need to care for our own needs. Prioritizing good sleeping habits, healthy meals, exercise time and time outside are ways to practice self-care. Families may want to consider seeking support from friends, family and neighbors who are likely experiencing similar stressors right now.
- Spend time together as a family. Fun time together can be reassuring to children, especially during times of stress. Families should plan how they want to spend time together. Examples include movie nights, time connecting with friends and family over technology, playing outside or going on a walk, engaging in family crafts and cooking dinner together.
- Provide developmentally appropriate information to children. Children are likely experiencing fear, anxiety and sadness right now because their lives have changed, and they understand the seriousness of these times. It’s helpful for parents to take some time to listen to what their child is feeling and talk about current events using language they can understand. They can provide reassurance by sharing all their family is doing to protect themselves against the virus. This is also a good time to limit their child’s access to news and media coverage.
- Find a routine that works for the family. Many of us do better with a consistent routine, especially kids. Parents should consider ways to maintain the routine their child is used to. If they are in school, they can think of ways to mimic their school routine, such as providing recess time. Building in regular daily practices including learning, play, time outdoors and connecting to others may also be helpful.
- Be prepared for possible changes in children’s behavior. The disruptions kids are facing will likely impact their behavior at home, but there are a few things parents can do that might help. Parents can carve out time to give children their undivided, positive attention and provide needed reassurance. They should also consider ignoring behavior that is annoying, but not dangerous, to decrease its occurrence. It’s also helpful to give each other space when things get heated. This can prevent behaviors and tempers from escalating. And, most importantly, parents can generously share praise for what their child is doing well right now to adapt to these circumstances.
- Take time to listen to older children. Constant change is likely to leave many teens feeling anxious, scared, angry or sad. Parents should listen with respect to the stresses and losses their child is experiencing right now. Being heard can help teens with the loss of control they may be feeling. When possible, parents can include teens in decision-making so they can have an increased sense of control. It is also important to reinforce messages about social distancing by being a good role model and abiding by current directives. Parents’ actions may be the biggest influence on how seriously teens take current directives and recommendations.
- Use humor and practice gratitude. This is a time of adjustment for everyone and feelings of anxiety and discomfort are likely to continue. That’s why it’s even more important to engage in healthy coping behaviors as a family. Families should try to find gratitude, humor and fun wherever you can. Some ideas include creating a gratitude jar as a family, watching online entertainment provided by national aquariums and zoos, dancing and writing letters to friends and family members.