- No question that during the COVID pandemic, families had been under extreme amounts of stress. There have been behavior changes in kids. Parents have said that their children are more clingy, they're not sleeping as well. So a question we get all the time is what are some of the red flags? How will I know if I should be seeking therapy for my child? And here are some things to keep in mind. One, how much stress? How much distress does this child show when they are upset? How severe are the tantrums? How tearful are they? So how upset do they get? That's one part. The second is how long does it last? What's the duration? When they get upset, does it last the whole day? Does it ruin the whole day? Or do they get upset, and then they come down and are able to adjust after having been upset. And then one of the most important factors when trying to determine a red flag is, does it mess up their functioning? Does it get in the way of doing what they have to do? So when they had school, was getting in the way of them being able to pay attention, or get their schoolwork done, or sit through some of the Zoom classes and whatnot. Is getting in the way of their friendships? Their ability to socially connect, even though connection is such a difficult thing during these times. Do they want to connect? Are they wanting to reach out to friends? Is it getting in the way of family functioning and your ability to get together as a family? Or does it feel like you're maybe really over accommodating when your child does get upset? And then the other factor is, is it messing them up themselves? Are they unhappy? Are they seeming more unhappy than they typically had been with significant mood changes and whatnot? Some of the other things to look out for, sleep, appetite. Are they sleeping more than usual? Sleeping a lot less than usual? Are they eating a lot more than usual? Are they eating a lot less than usual? Are they isolating themselves more? Now, we know teenagers may naturally isolate a bit more. But this is more extreme. So if they're isolating and not really engaging with even family members, that's a red flag to look out for. Do they have physical symptoms? So are they reporting a lot more stomach aches, things like that. Headaches, physical complaints that don't go away or that are repeating more over the course of time. And then of course, if they ever express any thoughts of harming themselves or harming others, that's a definite red flag that parents should seek help for. If parents are concerned about their child's anxiety, distress, sadness during the COVID pandemic, they may want to consider seeking mental health treatment. Parents often ask well, how do I even talk about seeking mental health treatment with my kids? Here are some suggestions. First of all, talking always starts with listening. Talk to them about their feelings. Create an atmosphere where you speak openly about stress, anxiety, sadness. Normalize those feelings, especially during a pandemic, and especially during now, this next phase as we move into the summer. Parents can talk about how they cope and how they seek help. Do they seek out social support? Have they gone to treatment themselves? Creating an atmosphere where we talk about when we are stressed out or upset about something, and normalizing the act of reaching out for help. Whether to a friend or whether to a mental health expert. Another way to listen is to ask kids, Well, what do they know about mental health treatment? What have they heard? Have they heard the term psychologists social worker? What do they associate with the word therapy? What have they heard at school or on television? So listening and correcting any information? There are experts who specialize in dealing with feelings and mental health, and helping demystifying and destigmatize that can be helpful to children. Just like there are coaches that can help you with soccer or basketball, there are therapists who are experts in feelings and helping you deal with feelings. There are instructors and tutors that can help you with these types of things. One of the nice parts about these times is that there are many celebrities, famous people who are talking openly about their anxiety, depression. Who are seeking out treatment or speaking positively about seeking out treatment. Cognitive behavioral therapy, dialectical behavioral therapy. We have Michael Phelps, Lady Gaga, Prince Harry, Kevin Love, we have athletes talking about seeking out help. This might be helpful in speaking to children, and normalizing, destigmatizing seeking mental health treatment. Another option is to perhaps identify someone in the child's own world or life that they may know who has sought out therapy. Especially if it's a same age, whether it's a cousin or a neighbor. And explaining that that person sought out help and it's good to seek out help. Another model to think about is, going to the pediatrician or going to the dentist. Sometimes we go for checkups, sometimes we go to check in and see how we're doing. Sometimes we go when we need something. And so just like that, just like the dental health, we have to take care of our mental health. So that might be an analogy that's useful for parents and children. So what does child therapy look like during COVID-19. During non-pandemic non-lockdown times, going to a therapist usually involves a parent or caregiver taking their child to a physical office space. It looks like another doctor's visit, typically. Where you fill out a lot of forms, you answer a bunch of questions. The provider may ask to meet with the child individually depending on their age. They may meet with parents separately, to ask additional questions. And the goal is really to gather as much information as possible about the main concerns that the child and family are experiencing to come up with a plan. In a treatment like cognitive behavioral therapy, for example, for anxiety, you would set goals and work with the provider to set goals for treatment. Early on, the therapist will sort of explain what therapy looks like. How often is it going to be weekly, more than weekly. How long will the sessions last. 30 minutes, 45 minutes an hour. How will the therapist meet with the family. Will the therapist meet with the child individually, with the parents alone, with the caregivers with the child all together. To get a sense of how the meetings will work moving forward. And it's an opportunity to ask questions as well. And these may change depending on whether it's a younger child or an older child, and what the particulars of the concerns are. In general, anytime working with a child, it's working with the family, it's working with the unit in some way, and the therapist would really explain that. COVID-19 really changed how we deliver much of our care including mental health care. And what happened, was a lot of this had to move to telehealth. Fortunately, technology has afforded us the ability to keep providing services to kids, teenagers and their families during these times. A lot of what I described before applies to the telehealth sessions too. Having an understanding of what therapy looks like, an understanding of how frequently you're going to meet. Who's going to be a part of the sessions. What's changed is the format. So usually either over the phone or via telehealth platform. You may be familiar with FaceTime and Zoom, but there are platforms that are specific to delivery of healthcare. And these platforms are important, because they ensure that the information that's exchanged, the private information that's exchanged is kept secure. And that's something that's very important when it comes to healthcare delivery. Another issue that comes up during telehealth that may be different than usual therapy, is where's the therapy going to happen? Is there a private space in the home where the child or teen has access to be able to talk to his or her provider. Will the parents be present? Will the caregivers be around? How far off will they be? Will they be joining the session? That's something that the therapist and the family would want to work on ahead of time, so that there's an understanding of privacy and how that's going to work. So where the location is, is as important. What's gonna happen in an emergency. That's something that the therapist will also want to talk through with the family, with the child and their parents. What's going to happen in case of an emergency? Where will the parents be? How can we access them? And another important issue is technology glitches happen all the time. So what happens if the session gets disrupted, internet goes down, something. What's the backup plan? So telehealth while it can be similar and can be very valuable in delivering mental health care, also has unique challenges that need to be discussed, in addition to the regular aspects of therapy. The important thing to know is that telehealth delivery is doable, and if parents have concerns about their child, they should not wait in seeking treatment. As we move into this new phase, some areas may be going back to having mental health delivered in person, and there may be differences there too. There'll be more attention to asking questions about symptoms before being able to meet in person. There may be temperature checks at the door. Your provider may be wearing a mask. You may have to wear a mask. Parents, child, caregivers may have to wear a mask, and maintain social distance. So making sure that there's an office space that has at least six or more feet for the delivery of care. But again, the most important aspect is to know that whether the delivery of care is in person, on the phone via telehealth. If you have a concern about your child's care, you can get care for them. And we encourage you to reach out and seek out these types of services.