By Will Gordillo, Senior Associate

Since late February and early March of 2020, due to the COVID-19 emergency, school districts across the nation have experienced school closures, which have impacted the delivery of instructional continuity. Many have managed to shift instructional practices to distance learning with varying degrees of success. 

Across the world, countries are beginning to gradually come out of self-isolation, and they are targeting the opening of specific aspects of work and life deemed necessary and essential. One of the first actions recognized in many communities is the need for children to be able to leave their homes, go outside to play, or go for walks with adult supervision.

How Isolation Impacts Children’s Social Emotional Well-Being

Social relationships are widely considered crucial to emotional well-being; however, the possibility that social connections may be a biological need, vital to physical well-being and even survival, is commonly unrecognized. Because of stay-at-home and social-distancing orders, parents/guardians have been tasked with the following for their children:

• Providing food, shelter, and financial and social emotional support.
• Creating a nurturing environment at home that promotes a sense of connectedness, safety, and security, 24/7.
• Planning, supporting, and/or supervising appropriate learning and leisure activities at home.

Stay-at-home and social-distancing measures have been in place now for extended periods, and many individuals, including children and teens, are showing signs of stress, anxiety, depression, or other mental health concerns.

Need for Trauma-Informed Care

The publication, “Trauma Informed Care in Behavioral Health Services,” provides information on evidence-based practices for behavioral health services. It is a useful resource for providers and administrators who want to work more effectively with people who have been exposed to acute and chronic traumas, and/or are at risk of developing traumatic stress reactions resulting from lived experiences due to the COVID-19 emergency.[1] Using trauma-informed principles is key to addressing trauma-related prevention, intervention, and treatment issues and strategies. The American Psychological Association compiled a resourceful collection of trauma, grief, and resilience research studies with real-world applications, designed to help individuals find constructive ways to managing their emotions when dealing with a traumatic event.[2]

According to the recent guidance, recommendations, and resources provided by child trauma experts at Child Trends and the Child Trauma Training Center at the University of Massachusetts, the COVID-19 emergency has changed everyday life and will continue to do so for many people around the world. Children who are often more vulnerable will struggle with significant adjustments to their routines brought on by the disruptions created by the COVID-19 emergency, such as:[3] schools and childcare closures, social distancing, and home confinement. These struggles and adjustments may interfere with their sense of structure, predictability, and sense of security, and will surely follow them upon return to school.  This will create a domino effect of new trauma-related challenges for children identified as needing these types of behavioral and mental health services and supports in our schools and communities.

The stressors brought on by the events children have experienced as a result of the COVID-19 emergency can affect how children feel, think, and act. In a blog post by Dr. Ralph Lewis in Psychology Today entitled, “Why Do Bad Things Happen to Good People?,” Lewis said, “bad things happen for the same reason anything happens.”[4] The same perspective can be applied when parents/guardians are thinking about their children and are doubly conscious that bad things can have a strong consequential effect on these children. When bad things happen:

• Children might have many different thoughts and feelings.
• Bad things can affect how children cope with the stressors of lived experiences.
• Children might experience feelings in their bodies; they might have unusual thoughts; and they might act differently.

According to the National Child Traumatic Stress Network, complexly traumatized children are more likely to engage in high-risk behaviors, such as self-harm.[5] Therefore, it is of utmost importance that we to listen to children, observe their behavior, assess risk levels, and begin to address signs that we recognize as their call for help.

Strategies for Addressing a Child’s Call for Help

1. Monitor Warning Signs. Take note of any children who show signs of trauma, depression, or other social, emotional, and behavioral concerns, that do not resolve quickly. Be conscious of signs that may include suicide ideation or self-harm. Signs to look for might include nightmares, anxiety, aggression, regression, threats to self or self-harm, and threats to others that persist and are not resolved, or discovered to be unfounded.
2. Implement Suicide Prevention Strategies. According to the Centers for Disease Control, suicide is a serious and preventable public health issue. Prevention requires a comprehensive approach that supports the implementation of effective strategies to: [6]
• Strengthen access and delivery of suicide care
• Create protective environments, and promote connectedness
• Teach coping and problem-solving skills
• Identify and support those at risk (using suicide screenings or risk assessments), decrease risks of harm, and prevent future risk (postvention).

3. Identify the Risk Factors for Students of Concern. Students of concern might demonstrate risk factors which are direct or indirect characteristics that might be associated with suicide. A combination of individual, relationship, community, and societal factors, contribute to the risk of suicide. Risk factors may include but are not be limited to:

4. Enable a Child’s Protective Factors. Help enable the protective factors that buffer children from suicidal thoughts and behaviors, such as:
• Effective clinical care for mental, physical, and substance use disorders
• Easy access to a variety of clinical interventions, and support for seeking help
• Family and community support (connection)
• Support from ongoing medical and mental health care relationships
• Skills in problem solving, conflict resolution, and nonviolent ways of handling disputes
• Cultural and religious beliefs that discourage suicide and support instincts for self-preservation

5. Adopt Evidence-Based Suicide Risk Assessment (SRA) Tools. Consider adopting evidenced-based suicide risk assessment tools for implementation. The following are some examples of tools that the Florida Department Education’s Office of Safe Schools approved for schools to use in order to attain the Suicide Prevention Certified School designation:[7]
   
   
• Columbia – Suicide Severity Rating Scale (C-SSRS)
• Lifetime/Recent
• Columbia – Suicide Severity Rating Scale (C-SSRS) – Risk Assessment Page
• Suicide Assessment Five-Step Evaluation and Triage (SAFE-T)
• The SAFE-T Pocket Card that assists clinicians with conducting suicide assessments using a five-step evaluation is available at https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432. A Suicide Safe mobile app is available in the Apple App Store.
• SAFE-T with C-SSRS
  
  

6. Integrate Technology Solutions. Consider using technology solutions that will help you consistently implement and track suicide prevention and risk assessment practices; connect students with interventions; align supports; and create safety plans with fluidity from the beginning to the end of the process.
   
   

7. Identify and Use Suicide Prevention Resources to Help Broaden Understanding and Share Information. The Suicide Prevention Resource Center (SPRC) has compiled a selection of web pages and information sheets on mental health, and coping with the effects of the COVID-19 emergency. These resources are a selection from key organizations in the field.[8]

How PCG Can Help

COVID-19 is creating significant challenges for school districts. Public Consulting Group, Inc. (PCG) is always looking for ways to support school districts and students.

Behavioral Threat Assessment. Our behavioral threat assessments (BTA) are a proven method of early intervention that can help prevent acts of targeted violence in school environments. This practice is recommended by the Federal Bureau of Investigation (FBI), the U.S. Department of Education, and the U.S. Secret Service. Our platform manages all threats, such as behavioral threats, suicide risk, sexual threats, and fire-setting incidents. We manage your risks through EDPlan’s case management platform, used by 3,600 school districts across the U.S.

Suicide Risk Assessment. Our newly-released suicide risk assessment pathway allows school districts to implement a standardized procedure to assess a student’s suicide risk. Using this tool, staff are able to use the same language, which is understood by all, to discuss a student’s status, and make plans for appropriate care.

Professional Development – Our subject matter experts can provide much-needed guidance, training, and support, to help you establish/enhance your school safety framework, in order to implement integrated, evidenced-based practices for behavioral threat assessments, suicide risk assessments, sexual threats, and fire-setting incidents.

About the Author

Will Gordillo, a Senior Associate at PCG, provides thought leadership and consulting services in the areas of special education and behavioral threat assessment policies, practices, and solutions, to support project implementation in Florida and nationally. Prior to joining PCG, Mr. Gordillo taught students receiving special education services, and English language learners in the K–12 settings. These experiences allowed him to develop extensive expertise in the provision of programs and services for students, with a specialization in emotional behavioral disabilities, autism spectrum disorders, and other learning differences. Mr. Gordillo further honed his skills and experiences, working as a school site assistant principal and principal, and he headed exceptional student education, psychological services, and behavioral, mental health, and crisis supports, in two urban school districts. He is currently supporting the implementation of integrated solutions for behavioral threat assessment, suicide risk assessment, sexual threats, and fire-setting incidents, to help manage and address the behavioral, mental health, and wellness of students with school safety in mind.

[1]  Treatment Improvement Protocol (TIP) Series, No. 57, Center for Substance Abuse Treatment (US). Rockville (MD) 2014 https://www.ncbi.nlm.nih.gov/books/NBK207201/

[2] Trauma, Grief and Resilience, American Psychological Association (APA) https://www.apa.org/research/action/trauma

[3] Child Trends https://www.childtrends.org/publications/resources-for-supporting-childrens-emotional-well-being-during-the-covid-19-pandemic

[4] When Bad Things Happen to Good People, Psychology Today, October 16, 2019 https://www.psychologytoday.com/us/blog/finding-purpose/201910/why-do-bad-things-happen-good-people

[5]  National Child Traumatic Stress Network https://www.nctsn.org/what-is-child-trauma/trauma-types/complex-trauma/effects

[6] Center for Disease Control, Preventing Suicide: A Technical Package of Policies, Programs and Practices https://www.cdc.gov/violenceprevention/pdf/suicideTechnicalPackage.pdf

[7] Suicide Prevention , Florida Department of Education Office of Safe Schools http://www.fldoe.org/safe-schools/suicide-prevent.stml

[8] COVID-19 Resources from the Suicide Prevention Resource Center (SPRC)  https://www.sprc.org/covid19