COVID-19 has created a tremendous amount of stress and anxiety for families and increased the need for pediatric mental health care. In this Q&A, Archana Basu, PhD, clinical psychologist at the MassGeneral Hospital for Children, explains how providers can offer mental health care for pediatric patients and parents during this trying time.
Q: How should physicians change how they evaluate children during this time?
Basu: In addition to the typical assessments, I would recommend physicians ask parents and patients about any immediate changes and stressors to the family. This can look very different for each child and each family. Asking about access to resources can also be valuable. Resources for kids and families can be so variable.
During virtual visits, asking about confidentiality is also very important. For example, before getting started, ask your patient if this is a good time to talk or if they are in a place where they can talk to you. When we are working with adolescents, this can be particularly important. Younger children often don't have the same expectations of privacy. And certainly, for visits with adolescents and parents, physicians should talk about maintaining that same confidentiality at the outset.
Q: How should physicians speak to their patients about how they're feeling and their general level of stress at this time?
Basu: The number one thing is to ask and not to presume, as it can look very different for each family and each child. Ask kids the things that they're most worried about. "What are the biggest changes that have been harder to manage?"
Ask them what life looks like for them. You should also ask about family changes, and not just the kind of changes that affect the kids—also things that affect the parents. The third thing is to ask parents about their plans for their own self-care and stress management.
Q: Should providers work with patients on established goals or consider new ones?
Basu: I would recommend reassessing the established goals. This is a period of tremendous change and transition in circumstances and the way that we live our daily lives. So you can talk to children and families about the goals that they had established before these changes and reevaluate whether those same goals make sense. For instance, there may be some goals that are more time-sensitive or may be related to safety issues. Working on those goals is most important.
But there might be other goals in the grand scheme of things that are not as useful. For example, if they have a goal related to anxiety in public speaking, that's not something they can really practice right now, so it may not be the most important thing to focus on.
Q: How can physicians best speak to parents about their child's behavioral and developmental health during this time?
Basu: Talking to parents is actually a really valuable opportunity to start modeling. My number one goal when I speak to my patient caregivers is to normalize and validate their caregiving efforts. I stress that everyone is trying to do the best they can and that we are all going through this difficult and ongoing process of adapting to new information about the outbreak that's rapidly changing.
I would also stress to physicians that their own psychoeducation can help support patients and caregivers. There is a lot of prior research from mass disasters, including infectious disease outbreaks, that we can use to help parents understand and anticipate what ways their children may experience things. I think it's also important for physicians to understand that how it plays out with each particular child and family will be different.
Q: How can mental health providers effectively use virtual visits and telehealth with pediatric patients?
Basu: Telehealth communication has a very new role and physicians need to make sure that they are providing care that is seamless and as effective as possible, while maintaining communication with their care team.
The first thing I would say is for providers to try to be flexible. For example, that could mean for families that need more help, consider more frequent check-ins. Another thing that I think has been a very creative solution is a multidisciplinary approach. Teams made up of more than one type of provider can join a call with a family. I've noticed that it's been incredibly helpful to coordinate care even more closely as a team.
Another thing to remember is children and families really vary in terms of digital access and reliable internet, although a majority of parents are likely to have smartphones. Some families may not or don't have reliable internet access right now. It is important for providers to be mindful and to be flexible to that as well.
Governor Charlie Baker signed an executive order making mental health more available as telemedicine and not just internet-based services. But you also have the option of reaching out to people to make sure that whichever platform you use actually works for patients and families.
Q: How can providers consider their own mental health?
Basu: There's a lot of evidence already about how this kind of frontline clinical care in the context of severe stress also affects providers, whether it's indirect trauma, vicarious trauma or angry trauma. And similar to how we tell parents that their own health care is important to support kids, I would make a similar recommendation to providers. It is on us as providers to support each other and ourselves as we provide this in-home care to patients in the midst of this severe stress.
Q: Are there any particular resources that you recommend for providers around this topic?
Basu: There are many, many reputable organizations that are out there with tremendous resources, including from the Mass General Hospital for Children on how to talk your kid about coronavirus.