Facebook Live 7/15- Answers

Hi everybody, thank you for being here. We’re going to talk about mental health and COVID today, we’re going to specifically focus on our kids. We’re still talking about schools, getting back to school, and what it means for our kids. We’re going to talk about why the American Academy of Pediatrics came out and said it’s more risky for our kids to stay home than to go back to school. With the surveillance our teachers and social workers do with our kids at school is a big part of safety, but also being able to get them services is big.

To do a brief overview of COVID and where we are, Virginia still remains well below the threshold for percent positive. We’re doing a good job. I know the Governor came out and said there will be greater penalties for not wearing masks. I think there is something really important in our data, which is how we live with COVID side by side going forward, and how we protect ourselves. The important part of the data that I cannot find is the age group of the people that are now becoming positive with these spikes.

Here’s the scientific fact: as people mingle and interact more, we are going to see more positive results. But if those positives are in the age group that have significantly lower risk, we can say that is not necessarily a bad thing, as long as we’re protecting the at risk groups. In fact, it may even be a means to get closer to herd immunity.

Some other important data that’s come out in the last week: the idea that we had no immunity in the population for this SARS-COVID 19 virus is mistaken. We do have cross-reactivity with previous SARS and COVID viruses, which is why people aren’t getting symptoms even though they have the virus. That is now thought to be attributed to those who have cross immunity. As we look at some of the other states, the best I can tell you from the statistics coming out of other states is that none of them are nowhere near hospital capacity. As we go forward and look at living with COVID, we’ll have to determine which data points matter. This includes the age group, who’s getting this, are more people dying from this? There are some areas that have had spikes in deaths, but we need more demographic data on that as well. We need to evolve the way we’re looking at this, so we can make more substantive decisions for who can be out in public, and what’s at risk for them, which brings us back to schools.

We’ve seen a lot going on in the last few weeks about schools making decisions. The Richmond School District has decided to go fully virtual, which is to say I cannot get over the fact that the evidence is so strong that children need schools. I’m going to read you a few statistics that came from a Wall Street Journal article, looking at relative risk for having COVID. In a typical year, 190 kids die from the flu. We don’t shut down schools for the flu. In a typical year, 436 die from suicide, and 625 from homicide, which can be related to violence in the home, 4,114 die from unintentional deaths such as drowning. In fact, more kids have died from shootings in Chicago than have died from COVID. When you do a relative risk model on COVID for children, the risk is incredibly small. They should be in schools so we can focus on other things that may be detrimental to their health, including falling behind on education and not being able to read on a school level.

Today, we’re lucky to have Kristin Lennox from ChildSavers. She’s part of the immediate response program, she’s one of their supervisors, and a licensed clinical social worker. We also have Sean Blair who is the COO for one of the providers for our kids who are getting services through our schools. They’ve had to make that transition to do that more in the home. His organization is NCGCare, which is coordinated, appropriate, responsive and effective.

We’ll start with Kristin. I just talked a little bit about the risks for kids, that supersede any risk they may have from COVID. I’d like for you to tell us a little bit about what you’re seeing, and what your concerns are.

Kristin: Thanks Siobhan. You mentioned some of the challenges that families are encountering right now. One of the biggest stressors right now is the loss of routine, and the loss of emotional engagement and support for kids. We’ve switched all of our mental health services to telehealth, which means therapy through the phone or Zoom. There are some challenges there including scheduling, or lack of confidentiality due to lack of space. But we’ve also seen many strengths and strides. This includes physical safety, no travel so we can reach more difficult areas, and there are many more parents who are involved in the services. Normally parents may not be able to participate as much because they’re in school, or working.

Senator Dunnavant: Are you able to reach everybody with challenges of broadband and access? How are you dealing with screen fatigue?

Kristin: We tailor the treatments to what the families need at the time. We recognize that may just be a phone call to keep them connected to mental health services. We give support and advice to parents who are doing a lot of the work that we’d be doing, or that teachers would be doing. We also make sure to know what to look out for in terms of symptoms of depression or anxiety, and how to manage those.

Senator Dunnavant: Tell us a little bit about how the kids are? How are their levels of anxiety? How are they responding to COVID? I know, as a physician in my office, that we are seeing more people come in who are anxious and irritable, and they are actually starting medication because they are not themselves. Here are some more statistics from that Wall Street Journal article: 45% of people with COVID are feeling isolated within their homes, and they are having more emotional responses to that, and needing treatment.

Kristin: I would say that at the initial outset of the pandemic there was a lot of concern that the crisis would spike right away. A lot of us were focusing at the beginning of this pandemic on physical safety and resources. Now that we are months into the pandemic, resources aren’t being given the way they were, and experiences of stress and anxiety are pieces of a larger puzzle. This raises questions of whether families are really getting what they need to survive to mitigate stressors at home.

Senator Dunnavant: Are you seeing more depressed teens?

Kristin: I would say that everyone’s anxiety and depression levels come in waves. We all experience that the longer this drags on. The warning signs to look for are isolation, separation anxiety, defiance and opposition, and agitation. These are some things we’re seeing in children, and in parents as well.

Senator Dunnavant: Sean, tell us what you’re seeing, and how your services are going, and what you’re seeing in your world.

Sean: Thanks Senator Dunnavant. We’re seeing some positives and some challenges when it comes to telehealth. Some of those positives that Kristin mentioned are real like speed and staff having greater access with flexibility. There are also challenges with broadband and with individuals not having access to the internet or to computers, or access to platforms that make telehealth easier. These things are more difficult on phones and small screens versus computer monitors with broadband. I think we’re all trying to navigate our way through, and one thing I am pleased to see is that providers have really come together in this time. Legislators have come together, and the state has come together to see how creatively we can come together for individuals. For example, in the past there have been regulations against telephonic and telehealth services, and some of those regulations have been opened up in terms of flexibility which is nice to be able to deliver that service. Hopefully that trend will continue past this pandemic. I also want to highlight some of the challenges, individuals in the school environment is how mental health issues have been identified in the past, with school counselors and a variety of professionals interacting with kids on a daily basis who have been trained to look for the signals and signs to get them help sooner. We’ve been able to see those individuals walking through the hallways with their head down. It is a challenge as individuals don’t go back to school to get them the help they need because their symptoms are not being identified by professionals.

One very real thing we are seeing is the number of calls to child protective agencies has decreased. On the surface that is a good thing and hopefully that is the case, but the question comes from professionals that those issues aren’t being identified because professionals are not around kids to identify those symptoms. Those are some of the biggest challenges that we are running into going forward, and especially if children aren’t going back to school.

Kristin: I’m glad you mentioned that Sean, I think that is definitely something that helping professionals have leaned on the schools to report on because they are mandatory reporters. But I am also curious to build a culture and community of care, so what if other folks are trained or more knowledgeable about what to look out for. Everyone goes to the grocery store, what if there was a table at the grocery store with training about mental health so folks can learn about the symptoms to look out for with regard to abuse and neglect. There are lots of other avenues for opportunity to learn more and engage the community. What if it wasn’t just on the schools but instead this is an invitation for society at large to be more aware of what to look out for.

Sean: That is very well said and I agree with that. With mental health, it takes a village. Opportunities for parent education is also so important, and opportunities to reach individuals in the community is so powerful to be able to have a forum for people to come together. Maybe teachers and parents don’t have the proper experience and training necessary, but they want the best for their kids and families. If there are some creative ways to get education to parents, that would be great, and forums like this are a great way of getting there.

Senator Dunnavant: I agree completely, I think there will have to be compensatory mechanisms to make up for not being in school. I hope that we’re going to find that a lot of schools go back. Most good whole person care stems from relationships, and that is why the doctor/patient relationship is so important, by the teacher/student, and counselor/student relationship is so important to pick up on those signs. I am concerned about the mental health of our kids, and about their overall development. When the American Academy of Pediatrics talks about why kids need to be in school, it’s not just about mental health and safety, it’s also about food security, having a safe place to be, and many have parents that can’t help them with online virtual learning. Many of them are going to be exposed to lots of different people for childcare instead of their individualized cohorts. So I think that even if we had never had COVID, we have to better educate parents, and learn what the warning signs are, because every time something bad happens you hear people say that they thought about it, and they weren’t sure if they should’ve spoken up.

I’ll weigh in on telemedicine. We’ve talked about this before, but I’m a big advocate for that as we go forward. I think it’s going to be a really important tool for all of Virginia, including the number of mental health providers because they don’t have to travel as much. This can be great for crisis intervention and for ongoing management.

Sean: Absolutely. There really are a lot of positives to it. It may not be as ideal as face to face, but it beats a lot of alternatives. We’re also seeing some more engagement because people hadn’t been receptive to mental health services in the past, and now we’re seeing more receptivity with telehealth because it’s a little bit less threatening than going to an office. We’ve seen a positive uptick in engagement with teenagers with telehealth. We need these platforms to have a method of choice.

Kristin: I agree, we’re fully on board with continuing. It breaks down a lot of barriers, and it opens people up to mental health services that may not otherwise have been open to it. It helps match individuals who have had closer lived experiences, so black, indigenous, and people of color who want to work with someone who has a more similar experience than they do can really break down barriers, especially in a field that is predominantly white.

Senator Dunnavant: How many new patients have you all gotten since we’ve started this versus maintaining the patients you’ve had?

Kristin: We’ve gotten a lot. We’re able to see a lot more clients than we were even able to see this time last year.

Sean: It’s a mixed bag, on one hand we’re seeing a lot more clients through telehealth. But on the other hand with professionals, as students aren’t in school, the identification of individuals has been less. Not just schools, as we’ve seen other industries scale back on in person services, they’re not able to identify mental health challenges in the same way they used to. On the one hand we’ve seen a decrease in more traditional referral services, but on the other hand for other services it’s been an increase. This speaks to our discussion before about the whole community being engaged and helping the community.

Kristin: We did initially see a slow in mental health referrals in our work group. That goes back to the primary focus on physical needs, and not being able to focus on mental health. Until all that is established, other things fall on the backburner.

Sean: You’re so right. Some of those needs can be met in creative ways. We, as a community, need to look at what needs need to be met, and how those needs can be met without the school environment.

Senator Dunnavant: When looking to solve mental health problems, it’s not a simple solution. You need to appropriately identify individuals who need those services, which we’re not getting with schools closed. We also need to connect them with services, and those services need to be working. COVID has created a situation where we can adapt some of the ways we connect with patients, that are making us more efficient, but the absence of schools is creating a situation where we aren’t identifying those who need care. Decisions need to be predicated on an appropriate analysis of risk. In this case, people are going to get COVID as we go forward and there will be tragic losses. But if you do a risk analysis, we don’t close schools for the flu, which has taken the lives of many more children, but we aren’t helping the kids who need support at home, or the social determinants of health. When you put that on a scale, looking at the kids who are going to suffer the most from not having school services holistically, I’m really concerned and upset that we’re even having a conversation about not opening at all.

I’d love for you to be able to give us some pointers for parents to look for warning signs, and some of the warning signs for substance use and abuse because we think that’s on the rise too.

Kristin: Some signs to look out for include social isolation, agitation and defiance, behaviors people typically call “attention seeking”, but I’d like to reframe that as “connection seeking”. What is the goal of the child you’re concerned about, in order to call attention to their needs. Other signs may be anger or unexplained anger, changes in sleeping, either sleeping too much or not sleeping enough, and appetite disturbance, all are things to look for. Also, some people internalize a lot of things, so keeping an eye out for opening conversations and building a culture of community care and talking about mental health.

Sean: From a substance abuse standpoint, the most noteworthy signs people are used to like slurred speech and blurry eyes. There are also a lot of subtle signs including withdrawn behavior, if individuals are withdrawn, or lack of appetite or loss of sleep. Without professionals being around to help identify those signs, it can be difficult for parents to connect with children about these issues. It’s challenging for adolescents to be engaged in substance abuse if they’re frequently engaging with their parents. One strategy that people can use at home is engagement, as much as you can engage with your kids, the better you can do to prevent substance abuse challenges. There is also a correlation with depression, anxiety and substance abuse. Substance use is often used as an opportunity to escape or to self medicate. For a lot of teenagers, this is the go to fix.

Senator Dunnavant: Who should parents reach out to if they’re worried about their kids?

Sean: There are provider associations, like ChildSavers, or National Counseling Group. There are also online opportunities and local community boards. We are offering 3 free 30 minute telehealth sessions for anyone that has any questions. They can go to ncgenvision.com and sign up. There are a lot of resources out there if they are willing and interested and we can certainly help out as a community and as a provider organization.

Senator Dunnavant: We’re going to post those on Facebook and on our website.

Kristin: As a final comment, a lot of what this conversation means to me is to see a world where we don’t have to lean so much on schools and teachers to do a vast variety of things, and finding other ways to fill those gaps.

Sean: I wanted to thank Senator Dunnavant and all the participants, it’s great to hear mental health being an important topic. There are a number of ramifications if individuals in our community are struggling with mental health, there are far reaching effects. One thing we’ve seen over the last 10 years or so is greater communication and I hope that continues. Let’s get things out in the open and let’s talk about it.

Senator Dunnavant: When I look at applying what I learned in medicine to fixing problems in government there’s a concept in medicine that every time you touch a patient, you want to make sure you don’t lose the opportunity to identify or solve a problem. That is why every time you go to the doctor they do a little mental health analysis. This applies to abuse in the home, we’re always inquiring to draw out those relationships. That is why schools are so important for kids, and looking at things that we’re failing to identify over time when we have so many touches is the school. My solution is that teachers need to change, but we need to have centers at every school that can provide those touches, help identify those kids, and improve their trajectory of their outcome. We’ve been working on legislation for that for years, and I will continue working on that in this session, but we need to make sure we don’t lose that opportunity to help make sure they don’t struggle in silence.

That is why I am advocating for being back in school 5 days a week, because depriving kids of the opportunity to be in school is a big mistake.