ABehavioralHealthToolboxforFamilies:

SupportingChildrenandAdolescentsDuringtheCOVID-19Pandemic

Thissummaryguideisaquickreferencedocumentfortipsonhowtonavigatesomeofthecriticalbehavioralhealthissuesthatfamiliesmayencounterindealingwitha

pandemic.Thepurposeofthistoolboxistoprovidegeneralinformationaboutwheretostartaddressingsomeoftheseissues,andwhattheknown,evidencebasedbestpracticesaretopromoteresiliencyandsupporthealthyfamilies.Ifyouwouldlikemoredetail,morereferencematerial,orinformationaboutanyspecificcontentarea,pleaseseelinkstotheresourcesandadditionalhandoutsonthefinalpageorcontacttheBehavioralHealthStrikeTeamviaemailatDOH-BHST@doh.wa.gov.TableofContents

1. PsychologicalImpactsofCOVID-19onChildrenandAdolescents2. SymptomsofTraumainYoungChildrenandWaystoHelpThemHealandGrow3. SymptomsofTraumainSchool-AgedChildrenandWaystoHelpThemHealand

Grow4. SymptomsofTraumainAdolescentsandWaystoHelpThemHealandGrow5. TheImpactofTraumaonEducation6. TheImportanceofSelf-CareforParentsandCaregivers7. LinksandHandoutsforAdditionalDetailedResources8. References9. AppendixA:STRONGKidsModelinEnglish10. AppendixB:STRONGKidsModelenEspañol

Thisdocumentwasauthoredby: StacyCecchet,Ph.D.,A.B.P.P.Forensic&ClinicalPsychologistBoardCertifiedinCouple&FamilyPsychologyObsidianForensics&SnohomishPsychologyAssociates

TonaMcGuire,Ph.D.ClinicalPsychologistCo-FounderEastsidePsychologicalAssociates

KiraMauseth,Ph.D.ClinicalPsychologistSnohomishPsychologyAssociatesSeniorInstructor,PsychologySeattleUniversity

PsychologicalImpactsofCOVID-19onChildrenandAdolescentsTheexperienceofchildren,adolescents,andfamiliesamidsttheCODIV-19pandemiciscomplicatedandfraughtwithchallenges.Parentsandchildrenmaybecomeill.Somefamilieswillexperiencejoblossesandfinancialworriesabouthousingandbasicexpenseslikefoodandinsurance.Parents,children,andteenslosecontactwithfriendsandfamilyduetosocialisolation.Theymayworryaboutolderadultsorotherfamilymemberswhoareatincreasedriskofseriousillnessanddeath.TeensmaywonderabouthowtheirfuturewillbeimpactedsincetheyaremissingimportanteducationinHighSchool,andbigeventssuchasgraduation.Divorcedparentsmustco-parentinthetimesofsocialisolationandtravelrestrictions.Familiesmayhavememberswithmentalhealthorsubstanceabuseproblems,whichmaygetworseduetothestressofCOVID.Theexperiencethatweareallnavigatingistraumatizing.TraumaChildrenoftenresponddifferentlythanadultstoatraumaticevent.Youmightnoticethosedifferencesinthewaystheyspeakabouttheevent,andalsointhewaystheybehave.Children’sbrainsdonotprocessinformationandeventslikeadultbrainsandinaddition,theydon’thavethelifeexperienceandjudgmenttofullyunderstandsomeevents.Forexample,mostfour-year-oldsdonotunderstandthatdeathispermanent.Teensmaynotunderstandtheirvulnerabilitytoharmanddeath,andmaytakerisksafterexperiencingtrauma.Themostcommonsymptomsoftraumainchildrenandteensarechangesineating,sleeping,behavior,andabilitytoprocessinformation.Itisalsoverycommonforchildrenandyouthofallagestoexperiencesomeregression,actingliketheydidasayoungerchild.Forexample,athree-year-oldwhohasnotbreast-fedinayearmightsuddenlywanttobreastfeed;aseven-year-oldmightstartwettingthebedatnightafteratrauma;ateenwhohadbeenatastagewherefriendswereofgreatimportancemightsuddenlywanttostayhomewithfamily;orastudentwhousedtodoallofhis/herhomeworkwithoutanyremindersmaysuddenlyneedremindingorcoaxinginordertocompletethattask.GriefandLossGriefcantakemanyforms.Besideslosingapersontodeath,wegrievechangesinourlivesandlossofour“normal”life.Childrenexperiencinggriefandlosscanhavereactionssimilartoadults.Outwardsignsofgriefmaylookjustlikethoseoftrauma.Childrenmayalsogrieveinwaysthatcanseemoddorunusualtoadults.Forexample,itisnotuncommonforchildrentohearaboutaterribleeventsuchasthelossofagrandparent,andthentorespondasthoughtheyhadn’theardanythingatall.Thechildmightsaysomethinglike“Okay,canIgoplaynow?”Childrentendtoprocessgriefovertime,returningoftentoatrustedadulttoaskthesamequestionoverandover.Childrenwhoareveryyoungmayask

whenthepersonwhodiediscomingback.Justaswithadults,childrenmayhavean“anniversaryresponse”tothelossoftheperson,becomingunexpectedlyangry,withdrawnorsadaroundthetimeofthedeath,atholidaysandbirthdayswhenthepersonwouldhavebeenpresent,andevenduringweathereventsorseasonsthatremindthechildofthepersontheylost.Itbecomesmoredifficultwhenparentsorcaregiversarealsogrievingandmaynothaveenergyforagrievingchild.HealingInordertoheal,childrenandadolescentsneed:

• Torecovertheirtrustinothers• Torecoverasenseofsafetyandstability• Toregainasenseofcontrol

CommonResponsesThatChildrenandTeensHavetoDisasters3Somaticcomplaints:

Changesinbehavior:

Changesinmood:

Changesinthinking:

Changesininterpersonalandsocialrelationships:

Headaches Substanceabuse

Increasedconcernsregardingthesafetyoflovedones

Decreasedconcentration

Socialwithdrawal

Stomachaches Flightintopleasure-seekingactivities

Feelingsofunfairness

Lossoftrustinadults’abilitytoprotectchildren

Increasedimmersionintopeer-relatedactivities

Feelingsofaforeshortenedfuture

Irritability

Lossoftrustinthesafetyandsecurityoftheworld

Regressivebehaviors

Feelingsofinsecurity,anxiety,fear,anger,sadness

Child’sdistortedbeliefthatheorshehascausedthedisaster

Avoidantandphobicsymptoms

Specificfearsthatthedisasterwillrecur

Clinginganddependentbehaviors

SleepandappetitedisturbancesHyperactivityDisruptivebehaviors

ThingsThatCanHelpChildrenRecoverandGrowStronger3Individualprotectivefactors

Familyprotectivefactors

Communityprotectivefactors

Factorswhichhelpbuildfamilystrengthinclude:

Recognizingthattherecanbeopportunitiesinthemidstoftroubles

Positivefamilyenvironment

Strongsocialsupportnetworks

Openandhonestcommunication

Problem-solvingandemotionalcopingskills

Goodparent-childrelationships

Supportiveextendedfamily

Teachingproblem-solving

Goodsocialskillswithpeersandadults

Parentalharmony

Acloserelationshipwithothercaringadultsliketeachers

Havingasenseoffamilyhistory

Knowingstrengthsandlimitations

Avaluedroleinthehousehold;helpingsiblingsordoinghouseholdchores

Goodpeerrelationships Havingasenseofhumor

Feelingsofempathyforothers

Beingaroundotherswhoofferpositiverolemodels

Developingcaringsocialnetworks

Believingthatone’seffortscanmakeadifference

Positiveschoolexperiences

Cooperativestyleofworkingwithothers

Senseofhumor

Valuedsocialrolesuchasajob,volunteering,orhelpingneighbors

Havingasenseofspirituality

Positivefeelingsaboutwhotheyare

Extracurricularactivities

Sharingcommonvalues

Self-reliance

Membershipinareligiousorfaithcommunity

Abilitytothink”outsidethebox”

Positiveemotions(optimism,senseofhumor,interests,joy)AbilitytointeractpositivelywithothersActivecopingPhysicalexerciseReligion

SymptomsofTraumainYoungChildrenandWaystoHelpThemHealandGrow

TypicalResponsestodisastersinPre-schoolers3

• Difficultysleeping,fearofthedark,nightmares• Eatingtoolittleorovereating• Unabletoseparatefromparentsandcaregivers• Actinglikeamuchyoungerchild• Beingjumpyandnervous• Playaboutthedisaster

Childrenunderagefiveyearsmaynotbeabletoexpresstheirthoughtsandfeelingsinwords,butwilloftenletyouknowwhatisbotheringthemthroughtheirplayanddrawings.Youngchildrenmayshutdownandrefusetotalk,orstoptalkingandchangethesubjectwhenasensitivetopicisraisedwiththem.Thatisalsoawaytheyaretellingyousomethingmaybebotheringthem.HelpingYourChildCommunicateAgreatwaytofosterconnectionandcommunicationwithyoungchildrenisChildDirectedPlay(CDI).ChildDirectedPlayhasbeenshowntohelpdecreasenegativebehaviorliketantrums,andincreasepositivebehavior.Hereishowitgoes:Pickatimetoplaywithyourchildfor5-10minutesina1:1setting.Itworksbestifyoucandothisdaily,butevenonceperweekwillstillbewonderfulforyourchild.Therulesareprettysimplebuthardertodothanyoumightthink.Justwatchthechildwithyourfullattention,andwatchwhatyousay.Sonogivingdirections(e.g.putthecaroverhere),noteaching(e.g.whatdoyoucallthatshape?),andnoquestions(e.g.whyisthatdoggyoverthere?).Theonlycommentsshouldbe:

• Tosaywhatthechildisdoingthatyoulike(e.g.,“Greatjobplayingsogently!”“Ilovethatyousharedwithme!”)

• Torepeatbackwhatthechildhadsaidtoshowyouwerelistening(e.g.,ifthechildsays,“I’mmakingatower!”youcansay,“Wow!You’remakingthetallesttower!”

• Todescribewhatthechildisdoing.Thisiskindoflikethe“playbyplay”announcere.g.“Nowthecarcrashedintotheblocks…whoathewholethingfellover.”

Thepointofthisistocreatealittleblockoftimewhenthechildgetsintensive1:1time,butitisstructuredsuchthatitishardforthemtobenegativeordefiant.Ifyouarenotaskingquestions,thechildcannotrefusetoanswerthem.Ifyouarenotteaching,thechildcannotignoreyou.Youarenotmakinganydemandsofthemandsothechilddoesnotgetmuch

chancetoengageinnegativebehavior.Itisonetimewhenheorshecanbeincontrolbutinaprettysafeway.Mostkidslovethisplaytime.Ifthechildbecomesdemandingoroutofcontrolordoessomethinginappropriate,justtellthemthatspecialplaytimeisoveruntilthenextday.IncreaseResiliencyandHealing:4,5

• GivehonestandclearinformationChildrennearlyalwaysknowaboutany“badnews”atsomelevel.

o Whenchildrenknowthatsomethingbadhashappened,butnoonetellsthemthetruth,theysometimescreateastorythatisworsethanthetruth.Forexample,thattheirgrandmotherdidnotlovethemandleftthemwithouttellingthemvs.theirgrandmotherbecameillanddied.

o Speak/explainsimplyandinlanguagethatisappropriatetotheage.o Reassurechildrenthatwhathappenedwasnottheirfault.o Oncenewsisgiven,domorelisteningthantalking.

• Returntoroutine

o Reunitechildrenwithfamily,friends,andcommunityiftheyhaveexperiencedaseparation,andifthiscanbeaccomplishedsafely.

o Trytohaveaconsistentbedtimeandfamilymealsatregulartimes.o Attendanceatschoolontimeandregularly.Ifhomeschooling,providea

regularschoolingtime.o Providea“quietplace”wheretheycanescapefromthevisualchaos.Thiscan

beevenjustascreenedoffareaoraquietcornerofaroom.o Includechildreninritualssuchasfuneralsandwakes:Excludingchildren

fromtheseimportanteventsisolatesthemandmakesitmoredifficultforthemtoacceptwhathashappened.Furthermore,excludingchildrenmeanstheydonotseemodelsforhowadultsgrieve,andmaygivethemthemessagethatitisnotokaytoexpresstheirsadness.

o Assignsomeonetobewithachildandtomonitorhowthechildiscopingifthefamilyisabletohaveafuneralormemorialonlinegathering.Thisperson,ifpossible,shouldbesomeonewhoisnotsogrief-strickenthatheorshecannotfocusonthechild.

• Payattentiontothegoodstuff.Childrenlove,andneed,attention.Often,iftheydonotreceiveenoughpositiveattentionforgoodbehavior,theymightstartdoingthingstoget"negative"attention.Give lotsofattentionandpraise forbehaviorsthatyouwanttoencourage(i.e.,usingmanners,followingdirections),andignorebehaviorsthatyoudonotwanttosee.

o The bestway to give positive attention is through the use of labeled praise.Examples of labeled praise include: “Thank you for following directions!” or“Greatjobsharing!”or“I’mproudofyouforbrushingyourteeth!”

o Otherformsofpositiveattentionincludeanytypeofverbalpraise,hugs,kisses,

smiles,andrewards(i.e.,anextrabookbeforebed,extracuddletime,afavoritesnack,alaterbedtime,etc.).

o Whengivingpositiveattention,makesureto:• Makeeyecontactandspeakenthusiastically,butgenuinely.Childrenare

verygoodatspottingphonyresponses.• Be specific about the behavior that you liked, even if it is a small

improvement.Forexample,"Ilikehowquietyouarebeing"or"thatwasnicepickingupyourtoys."

• Giveattentionimmediatelyfollowingthebehaviorthatyouliked.o Forbehaviorthatisnotaggressiveordangerous,ignoringitcanbethebest

approach.However,whenyoufirstbeginignoring,thebehaviorwillgetworse.Thisisnormal.Iftheignoringcontinuesthenegativebehaviorwilldecreaseanddisappear.

o Givethetypeofattentionthatyourchildenjoys.Ifyourchilddoesnotlikekisses,giveahugorahighfiveinstead.

• Managenegativebehaviors.Childrenneedboundariestohelpthemfeelsafe.Whileit is good tounderstand that stressand traumaare things that can lead tonegativebehavior,allowingchildrentobecomeaggressiveanddestructivewithoutinterveningcanincreaseachild’sanxiety.Forbehaviorsthatarenotaggressiveordestructive(e.g.,whiningorarguing)ignoringisthebestresponse.Ifyourchildhitsordestroysthings,he/she may need a “time out.” Time out works well, if done correctly. Below areguidelinesfortimeout:

• Whenthechilddoessomethingaggressiveordestructive,giveONEwarningonly.For

example,“Youtoreupyoursister’sdrawing.Ifyoucan’tcalmdownandstop,you’llneedatimeout.”

• Ifthenegativebehaviorstops,praisethechild“Goodjobgettingcalmeddown.Iknow

youwereupset.”

• Ifthechildcontinuestomisbehave,donothaveanymorediscussion.Say,“Youdidn’tstopandsonowyouneedtohaveatimeout.”

• Takethechildtoyourdesignatedtimeoutarea.Thiscanbeachairinanotherroom,

steps, or simply another part of your home such as the child’s room. There is noevidencethathavingachildgototheirroomtocalmdownmakesthemfeelnegativeabouttheirroom.

• Donothaveaconversationorrespondtothechild’syellingorarguing.

• Timeoutdoesnotbeginuntilthechildisquietandinthetimeoutspot. Ifthechild

leavesthetimeoutarea,takethechildbackandsay“timeoutcan’tstartuntilyou’rein

thechairandquiet.” Repeatthiseachtime. Donotgetdrawnintoconversationsorarguments.

• Oncethechildisquiet,setatimerforaboutoneminuteperyearofage.

• Whenthetimergoesoff,yougoandletthechildoutoftimeout.Theparentdecides

when time out is over, not the child. Give the child a hug and praise for gettingthemselvescalmeddown.“Iknowyouwerereallymad,butgreatjobgettingcalmeddown.”

Parents sometimes haveworries that placing a child in time outwill lead to them feeling“abandoned”oris“traumatizing”insomewaybecausethechildisdistressedandcrying.ThereisNOevidencethatthisistrue. Childrenwhohavefirmboundaries,deliveredinapositiveparenting environment (i.e., high warmth, high praise, high physical affection) tend to behappier,calmerandlessanxious.7,8HelpYourChildRelax(i.e.,decreaseanxiety)

o Bubble Breathing: Buy bubbleswhich comewith awand. Have your childpracticeblowingthebiggestbubblestheycan.Thisneedsslow,soft,steadybreaths…whichinducescalm.

o Scrunches:Have thechild liedownon theirback. Theyshouldcurlupandmakeallmusclesscrunchupastightaspossible,holdforaslowcountto3andthenrelaxthem.Repeatthisseveraltimesandthenhavethechildchecktomakesurealltheirmusclesare“looseandfloppy.”Thisisagreatexercisetodorightbeforebed.

SymptomsofTraumainSchool-AgedChildrenandWaystoHelpThemHealand

GrowTypicalResponsestodisastersinSchoolAgedChildren3

• Disorganizedorconfusedbehaviors• Somaticcomplaintsliketummyachesorheadaches• Actinghyper• Tantrumsandbeingdestructive• Anxietysymptomslikebeingafraidtobealoneoraskinglotsofquestionsoverand

over• Notdoingwellinschoolorhavingtroublelearning

Childrenages5andoldermaybeabletotalkaboutwhathappened,buttheymightnotwanttotalkaboutthem,orhavetroubletalkingabouttheirfeelings.Childrenofallagesmaynotexpresstheirsadnessorfearoutofasenseofprotectingtheirfamily,thinkingthattheirparentsorcaregiverscannotcopewithyetanotherproblem,suchastheirchild’ssadness.Ortheymightnottalkabouthowtheyfeelbecausetheyassumethateveryonealreadyknowswhattheyarethinkingandfeelingwithoutthemneedingtosayit.Noticeyourchild’sbehaviorandhowtheyarecommunicatinginordertounderstandiftheyareexperiencingtraumasymptoms.Doyourchild’sexpressionsandbodylanguagematchwhattheyaresaying?Achildsays,“I’mfine”buttheyactuallyappeartobesad,angry,orconfused.Doesyourchildchangetopicsoftenandquickly?Forexample,eachtimeatopicmightmeanthinkingaboutthepast,thechildsuddenlybringsupsomethingelsetotalkabout,ormighteveninterruptwith,“Let’splayagame,”or“Ihavetogopee.”HelpCommunicationandProblemSolvingWaituntilyouandyourchildarebothcalmbeforetryingtotalkaboutsomethingdifficult.Tryingtotalkandreasonwithanangrychildisliketryingtoteachsomeonewhoisdrowninghowtoswim.Whenangry,thechild’sabilitytoreasonisimpaired.Mostchildrenbecomemoreangrywhensomeoneistryingtotalktothem.Thisisatimewhentheirbrainsarein“fightorflight”modeandthisisnotagoodtimefor“teachablemoments”.

• First,simplylistenandusebodylanguagethatindicatesyouarepayingattention.• Summarizewhatyouthinkthechildistryingtoconvey.Forexample,“Itsoundslike

you’reprettyfrustratedwiththewaythingsaregoingwithyourbrother.”• Donottrytoprovideasolutionorlecturethechildaboutwhatyouthinktheydid

wrong.Rather,becuriousabouthowthechildthinkstheymightsolvetheproblem.Forexample,“Whatwouldyouliketodotosolvetheproblem?”

• Askforseveralsolutions.Explorewiththechildwhatmighthappenwitheach

solution.Forexample,“Ifyouhityourbrother,whatdoyouthinkwillhappenthen?”Continuethediscussiontohelpthechildchooseanapproachandmakeaplan.

• Listenwithoutinterruptingiftheywanttotalkaboutwhathappenedtothemorhowtheyarefeeling.

• Sometimesa“thirdperson”approachtoconversationsmayhelpthemopenup.Forexample,anadultmightguesswhatisgoingonbysaying“I’veheardfromotherkidsthatwhentheirmomanddadgotadivorcetheyweresomadandsad”or,“Iwasthinkingthatif_____happenedtome,I’dbefeelingreallyscared.”Thisapproachallowsthechildtobegintoshare.Also,itallowsthechildtorespondthatthat’snothowtheyfeel.

IncreaseResiliencyandHealing:4,5

• Trytokeeparegularscheduleofwaking,eating,activities,andsleep.

• Alternatescreentimewithphysicalactivities.

• Buildinsomefunactivitiesduringtheday,suchasboardgames,crafts,andimaginativeplay.

• TalktochildrenatadevelopmentallyappropriatelevelaboutCOVID-19andwhytheymaynotbeinschoolorhavingplaydates.Givehonestanswersandexplanations.Itisokaytosay,“Idon’tknowbutIwilltrytofindout.”

• Helpyourchildtobegintothinkforward.Askthemquestionssuchas“Whatdoyouwanttobewhenyougetolder?”Thenhelpthemseethethingstheydonowthatwillconnecttothatfuture.Example:Ifachildsaysthattheywanttobeaveterinarian,youcanpraisethemforalwaysbeinggentleandkindtoanimals,andhowthatskillisveryimportantforveterinarians.

• Encouragechildrentoexpressfeelingsviadrawing,orkeepingadiarythattheycanwrite,draw,orcollagein.

• Helpyourchildnoticethepositives.Focusonanypositivethingsthathappenedandpositivethingstheydid,evenifsmall.Youmightask,“Whatwasthebestthingthathappenedtoday?”or“Whatwassomethingyoudidtodayeventhoughitwasalittlescary?”

HelpYourChildCalmRelaxationScript

• Hereisarelaxationscriptthatacaregivercanreadtotheirchild.Trytohaveacalm,eventone,andspeakslightlyslowerthanusual.

• Say:“Findacomfortableplacetoliedown.Keepingallthemusclesofyourbodylooseandrelaxed,tightenuponlyyourfeet.Countslowlyto3andthenrelax.Then,keepingallthemusclesinyourbodyrelaxedandloose,tightenuponlythemusclesinyourlegs.Countslowlyto3andrelax.”

• Dothiswitharms/handsandthenwithface/head.

• Onceyouhavegonethroughallthemusclegroups,checkandmakesuretherearenotightmusclesanywhere.

• Putonehandonyourbellyandoneonyourchest.Breatheinthroughyournoseandoutwithyourmouth,softly,slowly.Asyoubreathe,makethebellyhandriseupanddownandtrytokeepthechesthandstill.

• Closingyoureyes,imagineasetofstepsgoingdown.Trytoseethemasclearlyasyoucan.Aretheywood?Painted?Whatcolorarethey?

• Imaginewalkingslowlydownthestepsandateachstepimagineyoubecomeevenmorerelaxed.Whenyougettothebottomstep, imagineadoor.Whatdoesit looklike?

• Gothroughthedoortoabeautifulbeach.Theskyisblueandyouhavethispartofthebeachalltoyourself. Pictureyourswimsuitandtowel.Imaginelyingdownonthetowel.Feelthewarmsunonyourface,yourchestandbelly,thetopsofyourlegs.Feelthewarmsandbeneathyourtowel,warmingthebackofyourlegsandback.

• Imaginethewarmsunraysmeltinganypain,anyfeelingsofnervousnessoutofyourstomach.Youcanimaginethefearsanduncomfortablefeelingsjustmeltingoutanddownintothesand.Stayonthebeachaslongasyoulike.

• Onceyouarefinished,imaginegoingthroughthedoor,andupthestairs.Onceyouareatthetop,openyoureyes,takeabigbreathandstretch.

• Trytopracticetwiceaday,onceatbedtime.

SymptomsofTraumainAdolescentsandWaystoHelpThemHealandGrow

TypicalResponsestoDisasterOfAdolescents3

• Anxiety• Depression• Guilt,anger,fear,disillusionment• Fearsthatthereisnofutureforthem• Changesinsocialbehaviorslikenotseeingfriendsorchangingfriends• Stayingbusywithactivitiestoavoidfeelings• Substanceabuse

Teenagersaregenerallyresilient,buttheyalsomayexperienceamoreintensesetofreactionstotraumaticsituationsthanadultsbecausetheirbrainsarestilldevelopingandbecausetheydonothavealotoflifeexperiencesyet.Teensmayrespondinacoupleofways: Acting“out”:Ononepoleisthetendencyfor“actingout,”whichmayincludethingssuchastryingsubstancesorusingsubstancesatagreaterrate,actingaggressivelyorfighting,swearing,risk-taking(morethanusual),andengaginginrulebreakingorillegalbehaviors. Acting“in”:Theotherpoleistheoppositetypeofbehavior,withwithdrawalandsocialisolation..beingquietandnotexpressingemotions,lookingvisiblylessexpressive(flat),andphysicallylessactive.Theyseeminterestedonlyinbeingalone.Both“actingout”and“actingin”canbecommonresponsestotraumaticeventsforteens,butinterventionsarethesameforboth.Connection.Connectioncanbeenhancedthroughthedevelopmentofrelationshipswithfamilymembers,friends(whoarestableinfluences),groupsorclubs,andpets.IncreasingResiliencyandHealing:4

• Encourageteenstoexpresstheirthoughtsandfeelingsbybeinganactivelistener.

• Educatethemincommonresponsestotraumaandwaystopracticeself-care.

• Discuss(withoutlecturing)thepitfallsofunhealthywaysofcopingsuchasalcoholordruguse,violence,andlawlessness,unhealthyrelationships.

• Provideinformationonhealthycoping.

• Discusschoosingpeerswhohelpwithgooddecisionsratherthanleadthemintonegativepatterns.

• Allowthemtoassistinsupportingyoungerchildrenandothercommunitymembers.

• Encouragethemtobecomeanactivepartofthecommunityrecoveryprocessintangibleways(e.g.,startingagarden,pickinguptrashandrubble,organizingactivitiesforyoungerchildrenandpeers,helpingneighborswithgroceryshopping).

• Aimconversationstowardthefuture(e.g.,whatdotheywanttobedoinginthenext

year?5years?Whatishappeningnowthatactuallyishelpingthemreachthatgoal?).

• Encouragerelationshipbuildingwiththeirfamiliesandpeers.

• Encourageactivitiesthatbringthemasenseof“flow”:athletics,thearts,academicsubjectswheretheyexcel,etc.

Helpyourteencalm:RelaxationandMindfulnessToolsandActiveCopingEncourageyourteentofindsomemethodsofreducingtheirfeelingsofstress.Forsome,thismaybelearningsomesimplebreathingandrelaxationtools.Forotherteens,doingsomethingactivemayhelpthemdealbetter.Thiscanberunning,liftingweightsorothermethodsofmovingtheirbodies.Therearemanyonlineormobileappstohelpteens(andparents)withstress,suchas:www.stopbreathethink.comwww.headspace.comwww.calm.com

TheImpactofTraumaonEducation

Childrennavigatingeducationinthemidstof,andafter,disasterwilloftenstrugglewiththeirbehavior,moodandlearning.Commonshorttermresponsesincludethefollowing:1,4,5

• Difficultypayingattentionandwithfocus• Difficultywithmemory• Retaininginformationandskills• Hyper-arousalandbeingwoundup• Fatigueanddifficultysleeping• Somaticsymptomssuchasstomachachesorheadaches• Irritabilityandbehavioraloutbursts• Troublemanagingimpulses

Thereareanumberofwaysthatparentsandcaregiverscansupporttheirstudentsinthecurrenteducationalenvironmentandwhileeducatingtheirchildrenfromhome:4,5Thefirst,istohavepatiencewithyourselfandwithyourchild.Reduceexpectations,andofferpraiseforevensmallaccomplishments.Ifthereareonlineclasseswhichyourstudentshouldbeattending,monitortomakesuretheyaredoingthat.Offerrewardsfor“showingup”suchasfoodtreats,payingforaninexpensivephoneapp(e.g.$1-$2)orfreepassforahomechore.Considerdoingaregular“feelingscheck-in”usingtheZonesofRegulationasaguideatthestartofthedaytohelpyourchildunderstandhowtheyarefeeling,andhelpyouandyourchildunderstandhowthosefeelingsmayimpacttheirabilitytolearnthatday.6InusingZonesofRegulation,everyoneusesthecolorsbluegreen,yellow,andredtoidentifytheir“zone”: Bluezoneisalowstateofalertness:bored,tired,sad,disappointed,sick,depressed, orshy. Thegreenzoneisanidealstateofalertness:happy,positive,thankful,proud,calm, content,readytolearn. Theyellowzoneisaheightenedstateofalertness:excited,silly,annoyed,worried, embarrassed,confused,ornervous. Theredzoneisanextremelyheightenedstateofalertness:upset,angry,aggressive, mad,elated,terrified,oroutofcontrol.

Eachmorning,haveeveryone(includingyou)sayoutloudoneatatimewhattheiremotionalzoneisatthattimeandtalkbrieflyabouthowitmayimpactmoodandlearning.GoalSettingAnotherwaytohelpyourchilddevelopself-awarenessistohaveyourchildsettheirownpersonalgoalfortheday(i.e.,stayontrackwhendoingmath,askaclarifyingquestioniftheydonotunderstandaninstruction,etc.).Attheendofthehome-basedschoolingtime,yourchildcandetermineiftheirgoalwas“achieved.”Ifitwasnot,thestudentcanexaminewhyorwhynot,anddeterminewithguidanceawaytoachievethegoalthenextday(i.e.,useacopingskilllikeplayingwithafidgettodecreasedistractibilityduringonlinelearning).

TheImportanceofSelf-CareforParentsandCaregivers

Parentsandcaregiversarethesinglemostimportantpeopleintheirchild’slife,andprioritizingtimetopracticeself-careandmeetyourownneedsisanessentialcomponentofbeinganeffectivecaregiver.5Parentscansometimesfeelguiltyiftheytaketimeforthemselvesandhaveboundaries.Butifyoudonottakecareofyourself,whatwillhappentoyourchildren?Youneedtobethereforthelonghaul.Herearesomethingsyoumightdotostayhealthy:

• Keepingthingspositive.

• Justlikegearsinanysystem,thoughts,feelingsandbehaviorswithinpeopleareallconnected.Bychangingone,youcanchangetheothertwo.Feelingsaretheeasiesttonotice,buthardertochangethanthoughts,sostartwiththoughts.

• Forexample,ifyoufindyourselfthinking,“I’msooverwhelmed,nothingisworking

outthewayitshould,”tryreplacingthatthoughtwithapositiveone,suchas“I’mfeelingoverwhelmedrightnow,butIamstrongandwillpersevere.IhaveresourcesthatIcanusetogetthroughthis.”

• Changingbehaviorscanchangeyourmood.

• Forexample,trydoingjustonesmallthing:

o Choosesomethingthatisnottoohard,liketakinga10minutewalkeachdayo Askyourselfwhatmightgetinthewayofdoingthato Askwhatmightbethebenefito Makeaplano Tryitouto Ifsomethingdoesnotwork,makesomechanges

ManagingGriefInadditiontonavigatingtheirowntraumarelatedtoCOVID-19,parentsandcaregiversarealsonavigatingsignificantgriefandloss.Itisimportanttonotethatthegriefandlossprocessdoesnotonlyapplytothedeathofalovedone.Manypeoplegothroughthisprocesswhenthereissomethingelse,besidesaperson,thathasbeenlost.4Examplesinclude:

• Thelossofidentity(suchaslosingajob)Thelossofameaningfulobject(suchasaproperty,home,orpet)Thelossofmeaning(suchasmighttakeplaceafteralifetransitionormove)Thelossofanideaorprinciple(thinkingthatsomethinglikethiswouldneverhappen)

Ifyourfamilyhassufferedadeath,rememberthatthereisnorightorwrongwayforpeopletoprocessgriefandloss.Itiscommonforpeopletogobackandforththroughmanyoftheaspectsofthegriefandlossprocessbeforearrivingataplaceofpeaceandacceptance.OnewaytothinkaboutnavigatingthegriefandlossprocessisthroughHEAL.H=Honorthelossbyparticipatinginrituals,ceremoniesorotherevents.Ratherthanavoidingmemories,andimportantpartofhealingistohonorthememoryofthepersonorideathatwassosignificant.Writeinajournal,sharestories,lookatpictures,andreflectonmemories.E=Expressemotion.Therearenowrongemotions.Beingangryisacommonemotionthatmanypeopleexperienceingrief.Inthecaseofthelossofalovedone,itisnotuncommonforpeopletofeelangrytowardsthatperson,andthenfeelguiltyforbeingangry.Thisisnormal,anditisOKtoexpressthesefeelings.A=Acknowledgetheobstaclesthatareblockingyoufromhealing.Mostpeopletellthemselvesthingsthatpreventthemfromreallyacceptingtheloss.Acknowledgingthoseobstaclestendstoremovethem,andhelpswithhealing.Commonobstaclesthatgetinthewayofacknowledgement(andthenaccepting)thelossinclude:

• Avoidingordenyingtheloss• Wishingthingsweredifferentthantheyare• Wonderingwhatcouldhavecausedadifferentoutcome

L=Live.Somedaysfollowingaloss,allsomeonecandoistomakeitthroughtheday.Overtime,asthehealingprocesscontinues,itbecomesimportanttofocusonlifeandactiveliving,ratherthanjustsurvivingorexisting.Focusonlivingbyengaging,learning,participating,doing,andfeeling.RemembertheCAREmodelforhealthyliving:BeConnected,Acceptingofchange,Reasonedwithyouractions,andEngaged!OtherWaystoIncreaseYourResiliencyandHealing:4,5

• Talkabouthowyouaredoingwithatrustedfriendorfamilymember

• Payattentiontoyourmoodandphysicalhealth

• Trytoavoidunhealthycopingsuchastoomuchalcoholorsmoking

• Takeabreakwhenyoucan

• Exercise

• Askquestionsandseekinformationthatisimportanttoyou

• Trytotakecareofyourself.Everyonesaysthistocaregivers,anditisoneofthe

hardestthingstodo!Littlewaystopracticeself-caremayinclude:o Showeringdailyand/orchangingintofreshclothes.o Trytogetasmuchsleepaspossible.o Askforhelparoundthehousefromyourpartner,olderchildren,andother

sourcesofsupport.Teamuptogetworkdone.o Scheduletime“away”togetabreakandrecharge,evenifItisonlyfor5

minutes.Sitoutsideanddrinktea,takeabathorshower,watchamovieorreadabook,orhaveacallwithafriend.

o Takethetimetoengageinahighpreferenceactivity.Itwillhelpyourbrainresetbyforgettingaboutstress/worryforalittlebit.

LinksandHandoutsforAdditionalDetailedResources

• STRONGKIDSModel:HelpingChildrenFeelSafeandRecoverfromDisaster• ParentandCaregiverGuidetoHelpingFamiliesCopewithCOVID-19(linkincluded

English,Chinese,andSpanish):https://www.nctsn.org/resources/parent-caregiver-guide-to-helping-families-cope-with-the-coronavirus-disease-2019

• HelpingFamiliesDealwiththeStressofRelocationAfteraDisaster:https://www.atsdr.cdc.gov/emes/health_professionals/documents/relocationstress_508.pdf

• CopingwithStressDuringInfectiousDiseaseOutbreaksEnglish:sma14-4885.pdf• CopingwithStressDuringInfectiousDiseaseOutbreaksSpanish:sma14-

4885spanish.pdf• TakingCareofYourBehavioralHealthDuringInfectiousDiseaseOutbreaksEnglish:

sma14-4894.pdf• TakingCareofYourBehavioralHealthDuringInfectiousDiseaseOutbreaksSpanish:

sma14-4894spanish.pdf

References

1. Cooper,N.S.,Feder,A.,Southwick,A.M.,&Charney,D.S.(2007).Resiliencyandvulnerabilitytotrauma:Psychobiologicalmechanisms.InD.Romer&E.F.Walker(Eds.),Adolescentpsychopathologyandthedevelopingbrain:Integratingbrainandpreventionscience.(pp.347-372).Oxford,UK:OxfordUniversityPress.

2. Newman,T.,&Blackburn,S.(2002,October25).Transitionsinthelivesofchildrenandyoungpeople:Resiliencefactors.Iriss.Availableat:https://lx.iriss.org.uk/content/transitions-lives-children-and-young-people-resilience-factors-full-report.AccessedAugust24,2011.

3. Shaw,J.A.,Espinel,Z.,&Shultz,J.M.(2012).Careofchildrenexposedtothetraumaticeffectsofdisaster.Arlington,VA:AmericanPsychiatricPublishing.

4. KiraMauseth,PhD.,TonaMcGuire,PhD.,KathrynAdams,EdD.,HealthSupportTeam;contactathealthsupportteam.org

5. StacyCecchet,PhD.,KiraMauseth,PhD.,PsychMedInternational;contactatpsychmedintl@gmail.com

6. Kuypers,L.M.(2011).Thezonesofregulation.ThinkSocialPublishing,Inc.Retrievedfrom:www.zonesofregulation.com

7. Martinelli,K.(n.d.).Aretimeoutsharmfultochildren?ChildMindInstitute.Retrievedfrom:www.childmind.org/article/are-time-outs-harmful-kids/

8. Dadds,M.R.,&Tully,L.A.(2019).Whatisittodisciplineachild:Whatshoulditbe?Areanalysisoftime-outfromtheperspectiveofchildmentalhealth,attachment,andtrauma.AmericanPsychologist,74(7),794–808.doi:10.1037/amp0000449

AppendixA:STRONGKidsModelinEnglish

STRONGKIDSModelHelpingChildrenFeelSafeandRecoverfromDisaster

TohaveSTRONGKIDSafteradisaster,itisimportantforprovidersandcaregiverstoworkon:

• S=Safetyintheirenvironment.Tellyourchildrenwhattodoifanotheremergencyhappens(i.e.,fire,earthquake,separationfromfamily).

• T=Trust.Childrenneedtotrustthatadultswillcareforthemandkeepthemsafe.Holdyourchild’shandtoremindsthemthatyouarepresent.Giveyourchildatighthugandfrequentcuddlestoregulateyourchild’s“fightorflight”responsebycalmingtheirheartbeatandtheirbreathing.

• R=Routineisessentialforhelpingchildrentofeelsafeandadjustafteratrauma.Routinemeanshavingaconsistentbedtimeeverynight,havingmealsaroundthesametimeofday,andmaintainingschoolattendance.

• O=Orientationtowardsthefutureisimportant.Talkwithyourchildrenaboutgoingbacktoschool,seeingfriends,playing,ormakingfavoritemeals.

• N=Noticewhatyourchildrenaredoing.Makesureyouknowwhereyourchildrenareandwhomtheyarewith;decreaseunsupervisedtimeforchildrenunder12yearsofage.

• G=Givechildreninformation:Ageappropriatehonestyandexplanationsaboutwhat’shappeningandwhattoexpectareanimportantpartofhelpingchildrenfeelsafeandprocesstraumaticexperiences.

• K=Knowingyourchild’sstrengths.Talkwithyourchildrenabouttheskillsandbehaviorsthattheyaregoodatorenjoydoing.Praiseyourchildfortakingdeepbreathswhenworried,forsittingquietlyandplaying,forholdingyourhand,forusingmanners,forgoingtoschool,etc.

• I=InhalingandExhaling.Practicingcopingskillsisimportant,evenforlittleones.Coachingkidstopracticetakingdeepbreathsandtothinkgoodthoughtscangoalongwayinhelpingchildrenfeelcalm.

• D=Directiontowardshealthybehaviors.Encouragechildrentotalkwithyouabouthowtheyarefeelingandanyworriestheyhave.Helpthemeathealthyfoodandgetenoughsleepatnight.

• S=SpecificResponse.Childrenpickuponparent’semotions.Trytostaycalminfrontofyourchildtoincreasetheirfeelingsofsafety.It’sokaytocryandexpressemotion,wewanttoshowchildrenhowtogrieveandthatit’sokaytobesad,butyoudon’twanttobecomesoupsetthatyouchildbecomesscaredorhastocomfortyou.

AppendixB:STRONGKidsModelenEspanol

ModeloSTRONGKIDS

AyudandoaquelosNiñosseSientanSegurosyRecuperadosporDesastres

ParatenerSTRONGKIDS(niñosfuertes)despuésdeundesastre,esimportanteparalosproveedoresycuidadoresquetrabajenen:

• S=Seguridadensumedioambiente.Dígaleasusniñosquehacerencasodequepasaraotraemergencia(ej.,incendios,terremotos,separacióndefamilia).

• C=Confié.Niñosnecesitanestarconfiadosdequelosadultoslosvanacuidarymantenerseguros.Agárralelamanoatusniñospararecordarlesqueestaspresente.Daleunabrazofuerteyacarícielofrecuentementepararegularlaansiedadeintranquilidaddelniño,calmandosuritmocardiacoysurespiración.

• R=Rutinassonesencialesparaayudaraquelosniñossesientansegurosyparaqueasimilendespuésdeuntrauma.Lasrutinassignificanquevallanadormiralmismotiempotodaslasnoches,quetenganlascomidasenelmismotiempotodoslosdíasyquevallanalaescuela.

• O=Orientaciónparaelfuturoesimportante.Hableconsusniñosacercaderegresaralaescuela,verasusamigos,jugarohacersuscomidafavoritas.

• O=Observeloquesusniñosesténhaciendo.Asegúresedesaberdondeestánsushijosyconquienestán;disminuyatiemponosupervisadoparalosniñosmenoresde12años.

• P=Proveainformaciónasusniños:Honestidadapropiadaparalaedadyexplicacionesacercadequeestasucediendoydeloquesucederásonimportantesparaayudaraquelosniñossesientansegurosypuedanprocesarexperienciastraumáticas.

• S=Sepalasfortalezasdesusniños.Hableconsusniñosacercadehabilidadesycomportamientosqueellossonbuenosoquedisfrutenutilizándolos.Feliciteasusniñosportomarrespiracionesprofundascuandoestánpreocupados,porsentarsecalladosjugando,poragarrarsusmanos,porusarsusmodales,poriralaescuela,etc.

• I=InhalaryExhalar.Practicarhabilidadesdeafrontamientoesimportante,hastaparalosniñospequeños.Ensenaraquelosniñospractiquenrespiracionesprofundasyapensarenpensamientospositivos,puedensermuyvaliososenayudaraquelosniñossientancalma.

• D=Direcciónhaciacomportamientossanos.Alienteaquesusniñoshablenconustedacercadecómosesientenydealgunaspreocupacionesquetengan.Ayúdelosacomersanamenteyaqueobtengansuficientehorasdesueno.

• R=RespuestaEspecifica.Losniñossabenreconocerlasemocionesdelospadres.Tratedepermanecercalmadoenfrentedesusniñosparaincrementarlos

sentimientosdeseguridad.Estabienlloraryexpresaremociones,queremosmostrarlealosniñoscomosobrellevarunapenayqueestabiensentirsetriste,peronoqueremosllegarasertanmolestoquesusniñosseasustenoquelotenganqueconsolarausted.