Helping Children Deal With Isolation And Uncertainty During Unrest And A Pandemic | New Hampshire Public Radio

Helping Children Deal With Isolation And Uncertainty During Unrest And A Pandemic

Jun 1, 2020

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Children are facing not only the stress of remote learning and social isolation as a result of the coronavirus pandemic, but also a week of social unrest across the country. In the midst of all this uncertainty and loss, how are they handling the turmoil? We discuss childrens' mental health, how we can address their concerns and what the long-term impacts might be. 

Air date: Tuesday, June 2, 2020. 


GUESTS:

This show was produced by fellow Jane Vaughan. 

Resources

The phone number for the National Suicide Prevention Lifeline is 1-800-273-8255. 

Transcript

  This is a computer-generated transcript and may contain errors. 

Laura Knoy:
From New Hampshire Public Radio, I'm Laura Knoy, and this is The Exchange. Today we ask, how are the kids doing? Child health experts are worried about the mental health of young Americans and it's easy to see why. Almost three months of restrictions and isolation, uncertainty about the summer and fall. And now a week of social unrest and violence erupting in our cities. It's a lot for children to process. And this hour, we look closer at that and at strategies for adults in children's lives to help, even to build resilience. Exchange listeners, tell us how your kids or grandkids are doing. And if you're a young person yourself, tell us how you're feeling these days. Our guests are Dr. Steve Chapman, pediatrician at Dartmouth Hitchcock Medical Center in Lebanon and president of the New Hampshire chapter of the American Academy of Pediatrics. Also, Brian Hawkins, director of Children and Youth Programs at the National Alliance on Mental Illness, New Hampshire, and Jodie Lubarsky, Child, Adolescent and Family Services director at Seacoast Mental Health Center and a licensed clinical mental health counselor. Welcome, everybody. And Dr. Chapman, I want to start with you. What are you hearing from kids these days, almost three months into this era?

Dr. Steve Chapman:
Well, you know, kids are, as always, kids are remarkably resilient and they have a lot to teach adults who pay attention about curiosity, about making adjustments, and about finding fun and engaging. But this has been really hard on kids without the safety of school structure, the routines, the community that kids count on, having lunch with friends, sports, and just the connection with teachers and the other fellow kids that they count on. It's really been a collective trauma that kids have experienced individually. I've been doing a fair amount of telehealth and visits with kids, and I think anxiety, depression and loneliness have been things that a lot of New Hampshire kids have been wrestling with and trying to find their ways through this challenge of the pandemic. And then, of course, the social unrest and racism that we've been seeing over the last week or so.

Laura Knoy:
That just adds more anxiety to the picture. So, Dr. Chapman, you are hearing about anxiety and depression among the kids that you see. That was certainly the prediction when this whole thing began. Also, an increase in suicides was predicted. Have you seen that, Dr. Chapman?

Dr. Steve Chapman:
So we've seen quite a few kids who felt a loss of connection, the loss of motivation and looking for how they fit in to the world, having lost the usual school connections and connection with friends. I've heard from kids that they're really questioning how things fit together. It's hard sometimes for kids to have the same perspective that older folks can have and to understand that something might be temporary and absolutely, we've seen kids reach high levels of despair. You know, honestly, we've in our practice here and I think most likely statewide, though, I don't have the data. We've admitted more kids for suicidal ideation than we have actually for the virus itself. Trends and suicide ideation and depression in teenagers has been trending up for the last decade or so. And so what's happening now has been overlaid on top of a trend that we've been seeing. But there's absolutely no question that the experience that kids are having is really hitting them at a vulnerable time.

Laura Knoy:
Wow, that's really profound what you just said, Dr. Chapman. So I want to make sure I got it right. You, in your practice, have admitted more kids for suicidal ideation, admitted meaning to the hospital, I'm assuming, than for the coronavirus.

Dr. Steve Chapman:
Yes, that's right. State wide, there have been about a half dozen kids, and by kids, I mean under the age of 19, admitted for the coronavirus. And they've all done relatively well. Fortunately, the virus does not seem to be affecting kids to the same degree that it's affecting older adults. Of course, we wish it were affecting nobody. But kids seem to be doing fairly well with the virus itself. And perhaps that's something to do with the social distancing that's been happening and the care that families have been taking with their kids. But really, in terms of the health issues that we're seeing, the volume of anxiety, depression visits, and that admission for psychiatric conditions and suicidality has been much greater in terms of the effect on kids right now.

Laura Knoy:
Jodie, how about you? You see a case load of children in addition to, you know, your other functions. What are they telling you about what they're struggling with?

Jodie Lubarsky:
Well Laura, I think it's been interesting because as we move through this pandemic and really to echo some of what Dr. Chapman said, when we move to kind of remote learning, remote work environment, social distancing. It happened at a time when we generally see an increase in suicide rates. April tends to be one of the months through the calendar year where we see the highest number of incidents of death by suicide or are folks having thoughts of suicide. So then we put everybody in this place of isolation to only potentially increase those feelings for individuals. We've seen as we've been working here at our center, my colleagues across the other 10 mental health centers in the state and even in our work with schools as we've been in this remote world, that we all have the spectrum of kids. You know, we talk about the kids who were maybe already struggling at school, who really had a lot of social anxiety about being present in their school environments, had some resistance going to school because maybe the academics were too challenging. They may have been encountering some bullying or some social challenges with their school environment. And what we saw was a significant shift for those kids who started to actually more thrive and do well in the home environment, allow those pressures and stressors that were increasing their anxiety and depression had been removed from them. And then similar to what Dr. Chapman was saying. We then have a cohort of kids who were, you know, you may describe as the social butterflies who were very involved in athletics, who maybe relied upon adult mentors in their school environments, whether it was coach, teachers, other mentors, who then really struggled because being separated from their peers, being separated from those adults started to increase their anxiety and depression. It was interesting that I remember talking to a young lady recently who reflected how weird it was because when this began, she was still wearing a winter coat. And then when she went outdoors recently, she was wearing shorts and a tank top. She goes, I feel like I missed an entire season.

Laura Knoy:
And she kind of did.

Jodie Lubarsky:
Right. We all did. And when we start to think about, you know, for kids especially, this becomes a core memory for them. And this is something now for the rest of their lives, they'll remember and each of them, depending on where they're at developmentally and their age, kind of carry that memory in a different way. And I really love that idea of the fact that kids are generally really resilient and that's how we, as the adults in their lives, really support them as we move through this pandemic.

Laura Knoy:
Yeah, I really like what Dr. Chapman said about that, Jodie. And just to ask you to pick up on that a little bit more. For sure, the concerns are there and it's so easy to see why, as we've all said. How do you encourage the innate adaptability and creativity of kids to help them work through this, Jodie?

Jodie Lubarsky:
Absolutely. You know, and I think every child is unique. So there's not going to be necessarily one cookie cutter approach. But when we start to think about how do we support them during this time, I think it can start very basic with routines and schedules, making sure that our children are still going to bed at a good time, waking up in the morning, that they're practicing good sleep hygiene. You some of the kids who we're hearing that they're having some challenges with sleeping, but then hearing that they're awake until 2:30 in the morning on devices connecting with friends, which that connection to friends through their devices and through social media is important, but probably needing to set some limits. So they're getting still a restful night's sleep. You know, making sure that they're still eating or have access to nutritional foods. With so many of our kids not in school, we know that some of our children in our communities might be struggling with access to healthy meals. And so making sure that families have the resources they need to provide the nutrition and the meals that the children need. And then really that idea of self care, you know, making sure that kids are getting outside, that families can, that they're taking walks together, that they're, you know, removing themselves from the devices because we all know, as we've been on devices for multiple hours a day now for weeks. Everybody's talking about eyestrain and headaches and different muscle pains from being on devices. The importance of just really walking away, getting outdoors, having some good set routines. But I think also looking at those conversations and how do parents and caregivers and the adults in children's lives have really good, solid conversations with them, talk to them about how they're doing, checking in and then finding creative ways to go about doing it. I recently saw a friend's post on social media and his daughter's teacher had asked them to write the word that best describes what this pandemic has meant to them. And then within those words, you draw images that relate to it. And she had wrote the word confusing. And the letter N was the Netflix symbol, which is funny. But, you know, I think it's really like tapping into how kids express themselves, whether it's through art, whether it's through music, whether it's through their play and the adults in their lives know them best. And really monitoring, observing those things and recognizing when maybe they're not doing well anymore. And then what additional supports do they need outside the family or household system to support them.

Laura Knoy:
Brian, a slightly different question for you. You know, obviously, this is hard for everyone, no matter what age. But is there an age group in particular among this sort of, you know, age zero to 19 group that we're looking at, is there one slice of this demographic in particular, Brian, that you think deserves special consideration?

Brian Huckins:
I don't know that there is one particular slice, but I think we have concerns from birth all the way up through graduation age. I think that we have lots of concerns and at the same time, lots of successes going on too at the same time through this pandemic time. I do want to bring up one stat that is very important that probably most people don't even realize is that death by suicide is the second leading cause of death in the United States. And it's actually 50 percent higher in New Hampshire. Well, this is something that is a large concern for us and us in New Hampshire. And something we're monitoring very closely. I can say that for the families that we support, in other words, the caregivers and parents that are raising these children, that we do a lot of family peer support. We're seeing a pretty significant increase in the amount of interaction that we're providing for families. It's actually up 35 percent before over time. So, you know, it's constantly seeing that families need an increased amount of support during this time to help one initially deal with what's going on between school and the concerns around COVID. And then now we're getting the point where this is really settled in that this has become a little bit of more of a norm, that we're not just going back to school now. And we're seeing families once again, you know, asking for more structure ideas and how to get their children their day, that their day set where they have a lot of downtime, where school filled those structured time in the past.

Laura Knoy:
Yeah, a little bit. Even the online school, which, you know, for some kids wasn't as extensive as regular school, that at least provided some structure. And you're right, Brian, a lot of schools are either closing out this week or next week. So lots of empty spaces to fill, which we'll definitely talk about a little bit later. Since suicide has come up, I do want to give the National Suicide Prevention Lifeline. It's 1-800-273-8255. I'm wondering, Brian, about teenagers. They are at a time in their lives where they're supposed to be making their own decisions. They're supposed to be stretching away from mom and dad. They're supposed to be learning how to be independent and on their own. And they want to be independent and on their own. So I'm wondering, Brian, what you're hearing about the teenagers that your organization keeps an eye on?

Brian Huckins:
Just like you said, they're constantly looking for that independence and raising a couple of teenagers myself, it's a constant battle, if you will, of trying to make sure that they're healthy and do make the right decision and at the same time being able to provide that level of independence that they need. And during this time where we're in the stay at home phase, it's even more challenging, especially for those students who are having school ending. And like I said, losing that structured time where we get into concerns around the amount of reduced time is also that there are less day camps that are available. There are probably gonna be less amount of opportunities for summer jobs, summer employment. So these kids are going to really have, you know, a bit of a challenge in filling their days in the summer. And right now, and, you know, like Jodie said, that some kids are really flourishing during this time and doing great at home. And then we are seeing others having a real challenge completing their school work during each day and really keeping up. And I can say that, you know, we're hearing that some school districts are actually extending their opportunities to allow children to catch up, even even after technically school ends and continue into the summer. And, you know, they're providing those opportunities. And that's great to hear.

Laura Knoy:
If you're a young person yourself, tell us how you're feeling emotionally these days. How has this all affected you? And of course, parents, grandparents. Tell us how your kids are doing. Again, we're looking at the mental health of Granite State children today on The Exchange. Jack in Berlin sent us an e-mail. He says, I'm a clinician in the north country. Are there any changes or new initiatives statewide to address the needs of child and adolescent mental health in this COVID-19 pandemic? Jack says, I work with children myself now entirely by telehealth and find creative ways to provide counseling services. Jodie, I'd love to throw that to you. And Jack, thank you for writing in.

Jodie Lubarsky:
Well, I think that the biggest thing that we have an opportunity to look at Laura and Jack and it's a great question is how we use telehealth moving forward. I think for most of us as providers, both mental health and in any health care setting, we went into this very quickly and I think very successfully in a lot of ways. And it's been demonstrated to remove a lot of barriers for families who maybe would have struggled coming into the office previously or just with the multiple, you know, the multiple appointments that they have to manage to get to the office. So I think moving forward, telehealth isn't going away. And we've had some conversations around the state and looking at mobile crisis and how that's done for children across our state. And I think, you know, I would imagine moving forward as we look at the delivery of any mental health service, we're looking at not only how that's done in person, face to face, safely moving forward, but also how we continue to use telehealth, make it accessible to reduce those barriers. We've seen some really creative ways that our staff have been able to use it during this time. We had a staff person as an example who was working with a young person struggling with anxiety where in a face to face world, they would have done some exposure work. And instead they were able to bring up different applications during their telehealth sessions. They did a virtual tour of Disneyworld and rode the rides as a way to do some exposure work to reduce anxiety. So I think it really demonstrates that it allows us to kind of change our thinking about how we've done our work before and those very creative ways, like Jack said, of how we apply the work moving forward in a telehealth and televideo environment.

Laura Knoy:
It's interesting, Jodie, one of the few bright spots that I have heard is from people like you who work in mental health and have found that in many instances, telehealth actually helps people keep up with their appointments. Some of them feel more comfortable not being in office. A lot of young people especially don't want to sit in the waiting room, you know, of a mental health provider.So I have heard that there has been some success with telehealth, especially with young patients. And that sounds like what you're saying, Jodie, right?

Jodie Lubarsky:
I would totally agree. I think we definitely have a population of kids who really enjoy the use of telehealth. When I talk to my staff and the opportunities that they've had in their work, as far as maybe having more family members be present. We've had some really nice experiences with separated or divorced parents where we've now been able to do co parenting work where they're both able to be present during those sessions and really focus on the co parenting of their children and how they establish, again, those structures, those routines and work together as co parents. So the kids really enjoy it. We know that we're raising a generation of kids who really use and thrive with technology, and sometimes they're teaching us how to use it as well. But again, you're right. I think for so many kids, sometimes just walking into a building that says mental health on the outside can be a barrier to coming inside. And so this is another way that we can reduce those barriers to make sure that the children, the families and the adults within our state are accessing the care that they need. And I think this is a great opportunity for us to do that.

Laura Knoy:
Well that's really interesting to think about families where, you know, the parents don't live together, but they can both participate in their child's mental health visit because of the technology instead of saying, well, I can't go because I have this or I can't get there because of this, that's super interesting. And Dorthy's calling in from Lebanon. Hi, Dorothy. You're on the air. Welcome.

Caller:
Oh, hello. Thank you. I just wanted to make two points. I work in a school system and I'm a school psychologist. So I have been doing a lot of Zoom meetings with kids. One of the things that I see a lot of is the anxiety around children not having any structure. You know, it would be like we go to work in the morning and the day we arrive because kids can't foresee the future. We can say this is going to happen. They don't really experience it until it happens. We go into work and there's no secretaries, there's no printer, there's no technology person to help us. We have only our computer and our desk. Our files are gone, our pencils are gone, everything is gone. And then they say, OK, now do your job. It would be incredibly stressful. And I think that's what kids experience. And the point I want to make, is that so many children have problems with executive functioning. That means that prefrontal lobe that helps us plan and organize, get started on things, track things, monitor things. The classroom and the teacher provide all that for kids who are at different places developmentally as far as that goes.And without that, their parents have to write it and it's not possible. The people I have talked to, the teachers I've talked to themselves, they're having a terrible time trying to keep organized. They're teaching. They're taking care of their children. They're also teaching their children. So it's a very stressful environment for everybody.

Laura Knoy:
Well Dorothy, I'm so glad you called cause you're with the schools. And as Brian alluded to earlier, this lack of structure could only get worse as the summer approaches. I hate to be so negative, but what do you think, Dorothy? What would you like to see in your community? I mean, schools are closing down quite early in some communities. Some communities aren't offering day camps. Some communities are closing down basketball courts, pools. You know, what would you like to see communities do? Because parents in many cases are working and they just can't be, you know, camp mom or dad.

Caller:
Well, if I had an answer, I'd probably be very rich. I don't know. I don't know that there is one answer. But I think the main thing is to provide connection. And one of the things our school did is we had a couple of very talented teachers who set up a friendship club for after school hours where teachers, we would take turns monitoring. And kids could just check in and talk to each other and just be together. And what I found in the days I monitored is that there would be six or eight kids and they would come on in for five minutes. They'd have a lot of this that and the other to talk about. And then there was nothing to talk about. It was like they just simply wanted to be together. And there was a five year old who started to cry because she didn't want to see her friends on TV anymore. She wanted to her friends for real, you know, and those connections are all lost in this process. And anything we can do in our communities to provide those connections, even if it's Zoom meetings and clubs. I don't know what you can do if you can't be with each other. It's a human need. And these kids are telling us loud and clear. I think the kids who have resiliency will probably come through fine and they'll be OK and maybe we'll find some new ways of doing things for us. But a lot of kids are in real, real emotional trouble.

Laura Knoy:
Dorothy, I'm really glad you called. Good to hear from you, especially given your role as a school psychologist. And I feel the way that five year old feels. I don't want to see my friends on Zoom anymore. I want to see them for real. Coming up after a short break, we'll talk more about what Dorothy mentioned, building resilience. We'll also ask how some kids may be feeling about the protests sweeping American cities. They're on their devices. They see what's going on if they're not experiencing it personally. So we'll talk about that, too, after a short break. Stay with us. This is The Exchange on NHPR.

Laura Knoy:
This is The Exchange. I'm Laura Knoy. Today, kids' mental health. We're asking how children are faring emotionally these days. After three months of restrictions and uncertainty now about the summer and fall. We're also looking at strategies for how adults might help kids get through this, even build resilience and adaptability. We're talking with Dr. Steve Chapman, pediatrician at Dartmouth Hitchcock Medical Center in Lebanon and president of the New Hampshire chapter of the American Academy of Pediatrics. Also, Brian Hawkins, director of Children and Youth Programs at the National Alliance on Mental Illness, New Hampshire, and Jodie Lubarsky, Child and Adolescent and Family Services director at Seacoast Mental Health Center and a licensed clinical mental health counselor. Brian, I want to ask you and maybe you, too, Dr. Chapman, on top of the pandemic, kids may be processing the unrest that we've seen erupt in our cities, over police violence towards African-Americans. Even if kids aren't directly affected, we've all said, you know, kids are on screens a lot more now and there are dramatic images on screens going around You first, Brian. How do you see this affecting kids' mental health, whether they're dealing with this directly or not?

Brian Huckins:
Nothing more is going to exasperate what's already going on for them, this is a very challenging time, not only for our children, but it's also a challenging time for everybody in America, if you will, and especially for parents who are probably watching this maybe more than what their children are having to the challenge of how to explain what's going on in a rational way to the children. And it's more than likely going to affect the mental health of parents, too, and which in turn will then affect how they are supporting their children. The mental health of a parents impacts their child's well-being for sure. So this is something that we have to closely monitor on top of everything we're monitoring now and just continue to provide more and more support to family members and children. But this is just piling on, if you will, what's already going on to the mental health concerns in New Hampshire and in the United States.

Laura Knoy:
Well, Dr. Chapman, I'd like your thoughts too, you know, especially after the anxiety that we've all been living through for three months now, children, especially minority children who really may be feeling extra vulnerable. Dr. Chapman, how can people who care about these kids and their families, you know, lend a hand?

Dr. Steve Chapman:
Yep, well, what's always been true and is even more true now, I think, is that kids want to be heard and we can't hide our children from the world. We just couldn't possibly do that. And so checking in with your child I think is really important. Ask what they've seen. Ask what they know. Ask how they're feeling. No doubt they're aware of what's going on and the upsetting violence that is in so many communities and the racism that really is everywhere. But I think by engaging in a conversation and listening to kids, we can connect. And if we can extract in this that what this is going on in addition to the conflict, is a call for justice. It's a call for community. It's a call for us to connect with each other. And kids can understand those kinds of issues. Of course, the age of the child makes an enormous difference. A conversation with a six year old or a five year old will be quite different from a teenager. But those issues of how do we treat each other fairly? How do we listen to each other? And what kind of community do we want to be is something that we can engage with kids and maybe help provide some connection.

Laura Knoy:
Let's take a call again. This is Michelle. Good morning, Michelle. You're on the air. Thanks for being with us today on The Exchange.

Caller:
Hi. Thank you for taking my call. I just wanted to mention that, you know, my my son is going through pretty much almost everything that your callers, your speakers have talked about from depression and isolation and dealing with challenges with schoolwork. And my husband and I are both essential workers. I work in healthcare and he works for a Department of Defense company. And we have been unable to be home with him. We are both working 12 hours a day and the situation has been very difficult for him. And we've been working on getting him in counseling, but we've started to look ahead to the fall. And the reality is that if this continues into the fall with any type of remote learning, we can't put him in that situation long term. So we've made a very difficult decision that I will ultimately be leaving my job, which on the one hand, we are fortunate that we can afford to do that. And, you know, if anything, this week has shown us that there are plenty of people who aren't and that that level of injustice permeates our society. But it also will impact my ability to re enter the workforce at some point and, you know, continue to perpetuate the situation that happens with women where we can't get ahead. And so I think that, you know, the COVID pandemic has really just exposed a lot of the inequities and injustice that continue in our society. And I'll leave it at that.

Laura Knoy:
Michelle, I'm so glad you called. Can you tell us how old your son is, please?

Caller:
Oh, yeah. He's 14, which is especially challenging because he's too old for any day camp. Even if there were any. He's young to really get a job at this point, even if he could find one. And there aren't many places that are taking volunteers. So we're also facing a summer where he will be relatively alone. A lot of his friends are older and have gotten some jobs. And so I really don't know what we're going to be doing in the next couple of months. It will depend a little bit on whether or not I can manage some work from home option.

Laura Knoy:
And when are you leaving your job, Michelle?

Caller:
I don't know, I haven't quite had that conversation yet with my employer. I'm hoping to see how things go with some of the counseling sessions that we will be starting hopefully this week with him.

Laura Knoy:
Well, and hopefully the telehealth will help, as we've heard and I'm so glad you called Michelle, because it was a very compelling article in The Washington Post recently about more women leaving the workforce because of all this remote learning. And these women saying, you know, when people talk about a flexible fall, you know, kids returning in small groups and being home some and being in school some, you know, that kind of strikes fear in the hearts of these usually women because they usually make less than men. So they're the ones like you, Michelle, who choose to stay home and how this is having a real impact on women and their careers. So I'm really glad you called. That's a whole other topic for a whole other show, I think, because that's a real trend that we've been hearing about. But Brian, more to her son. I do want to talk about her case. You know, some parents are home too much. Some are not home at all. She's working 12 hour days because of the pandemic. Her husband's working long days because of the pandemic. How is your organization giving support to families like these where, you know, they hear you guys saying, have a conversation, take the time. But some families like Michelle's probably don't have time to have conversations. They're just like barely getting dinner on the table. What do you think, Brian?

Brian Huckins:
Exactly. And, you know, first, thank you, Michelle, for being an essential worker. And back to our earlier caller, Dorothy, who talked about executive functioning that a lot of parents are providing right now for these children who are at home because the teachers aren't available as much to provide the executive functioning for their school work. We have several families just like Michelle, who are essential workers and have to work every day. And their children are unfortunately either with other siblings or left alone during the day to kind of navigate what they're going through each day. And a very challenging situation for sure, especially when, you know, after a long day of work probably one of the last things they have time for or energy for is to come home and and support all the needs that child probably has after being alone for the day or even to catch up with whatever homework they have or schoolwork they have because they need their parents to be available during those times. I think we know we're doing a lot of work with schools to make sure that they're aware of those those families, to make sure that they're getting the proper support that they need from schools, whether it's through a 504 plan or IEP or just general education, ensure that the child's getting what they need. I can say that, you know, one of the things that we're seeing for families, though, is because of being stuck at home, if you will, during tis situation, there are some positives that are coming out of it. For instance, like families eating together more than ever, they're sitting down to dinner table. They're having more home cooked meals, if you will. There's more planning around those types of things and to involve their children and the whole family to be part of those, you know, meal preps and those types of things. This is one thing to look at, you know, think that we're encouraging families to get out and go for a walk every day. On the opposite end, too, for the families that are together all day, we're encouraging them to take space from each other even if they have to separate room to room, you know, take fifteen minutes to refresh and go get a break from each other in a situation where we're not able to actually leave the home to go somewhere to take a break from each other.

Laura Knoy:
A lot of people can relate to that. I think a lot of people can relate to that for sure. So some mental health challenges as we've been talking about. Dr. Chapman, for sure. What do you think, Dr. Chapman, about what Brian is saying, though, there may be some mental health benefits in all this that parents can find? What you think, Dr. Chapman?

Dr. Steve Chapman:
Well, sure. And that's the key. I think it's looking for those opportunities to make connection and to do things that otherwise they wouldn't have the opportunity to. So cooking is a terrific one. And, you know, I've heard from some of my kids in and some of the visits is that they've taken up baking and they've been making cupcakes nonstop and and making things for the rest of their family. And that's a really good idea for families to think about is to think about how to cook together and eat together. Outside and going outside. I think we've been a little hesitant to get together in any respect. But I've heard from some teenagers and parents that they've built a fire in the backyard and they've set chairs 6 feet apart and put the marshmallows on the stick and they've had you know, small gatherings to make s'mores. And, you know, that's another really good idea. You know, we know that being outside and exercising is good anyway. And so building a walk into the routine, you know, a family walk, I've heard from some families that have been doing that and where they hadn't been doing that before. And that's another really good opportunity. And so I think thinking about looking for those things to do with your kids or asking for their help and doing some chores like cooking or preparing some things for the family to help out with a really busy working parents are really, really good opportunities. I think asking kids for their thoughts about what the family can do together. You know, what would you like to do or what what are some of your ideas? Is another just a conversation that parents can engage in in their kids. And so, you know, I think that's the big challenge, is to take you know this difficult situation and look to what we can do together to make it a better situation.

Laura Knoy:
Well, on what you just said about the importance of getting out, Dr. Chapman relates to an e-mail we got from Sarah. And this is a conversation that I'm sure you're having with a lot of your families, Dr. Chapman. Sarah says, My family has made the decision to allow our tween and teen kids to ride bikes and go for walks with friends. They are old enough to know what six feet is. And it was becoming too much for them to be stuck at home. Sarah says, I think it's a delicate balance between what is healthy for them physically and what is good for their mental health. And Dr. Chapman, I hear so much of this from families. I've got teenagers in that age range. So this is a conversation I'm having with a lot of friends. You know, they do need to get out. They do need to see their friends. They do need to move around and be active. But we're all worried about virus transmission. So I just wonder how you're talking to your patients about the importance of kids' mental health, especially teenagers. Teenagers don't really want to go for a walk with mom and dad. I mean, maybe some of them do. You know what I'm saying? So there's a lot of sort of really tough decision making and everybody's making slightly different decisions. So there's also, I think, a lot of judgment, like, oh, you let your kids do that. I wouldn't let my kids do that. You know what I mean? So I'm hearing a lot of this going on. What you think, Dr. Chapman?

Dr. Steve Chapman:
Well, you know, it's changing and it's evolving. You know, we're in a very different place now from where we were a month ago, and hopefully we'll be in a different place a month from now. But I encourage kids and parents not to think of it as an either or. It's not a choice between being home and safe inside and going out and being unsafe. I think it's important to go out and and be outside and to be safe. So if you're making s'mores, if you're kicking a soccer ball. Be careful about how close you're getting. Try not to touch and share. Try not to have direct contact. Try to space a little bit and be six feet apart or more. If you're kicking a soccer ball, you can be plenty far apart. But we know that being outside is safer than being inside. And we know that being cooped up is not good for anybody. And so I think having that conversation about how to be outside and to be safe is a really important one. And kids need to get outdoors.

Laura Knoy:
Well, Sarah, I'm really glad you wrote and Michelle, who called earlier, my best luck to you, Michelle, as you work through these decisions. It is not easy. We're going to take a very quick break. And when we come back, we'll look more about what to watch out for, for kids' mental health, especially as the summer approaches. We've touched on that. But we'll talk about that a little bit more. More in a moment.

Laura Knoy:
This is The Exchange. I'm Laura Knoy. This hour, we're checking in on children's mental health. How they're processing the past three months of restrictions and facing an uncertain summer. We're also looking at how adults can help with strategies and conversations. Our guests are Dr. Steve Chapman. He's a pediatrician and president of the New Hampshire chapter of the American Academy of Pediatrics. Brian Huckins is with us. Director of Children and Youth Programs at the National Alliance on Mental Illness, New Hampshire, along with Jodie Lubarsky, Child Adolescent and Family Services director at Seacoast Mental Health Center and a licensed clinical mental health counselor herself. And here's an email that I think I'll throw to you, Jodie. This is Amy in Hudson who says, I've got two daughters ages eight and five. They're both in a very difficult time with the situation. Their birthdays were canceled in April. Parties were canceled, disappointment all around. They miss their friends and teachers so much and have done everything virtually: classes, piano lessons, brownie meetings, ballet class. My husband and I have let them feel as much as they can, express their emotions, their feelings, their anger. We've kept communication open and answered their questions as best we can. It's been a rough road and I hope they can resume their normal lives someday soon. And of course, Amy, nobody knows when normal life will resume. But I hear what you're saying. And Jodie, what do you think about the situation? These little girls are eight and five. It's hard.

Jodie Lubarsky:
Well, and when I listen to Amy and everything that she and her husband have done, you know, it sounds really spot on as far as in a difficult situation, really trying to support their daughters the best way they can. And I'm sure for, Brian's commented that he has two teenagers that he's raising. My daughter's almost nine years old. So, you know, I think we all can not only put our professional hats on when we're discussing this and thinking about the needs of children, but we're all putting our parent hats or our caregiver hats on as well. And it's hard not to be touched by these situations. You know, for Amy and her husband and for any of our listeners out there who are raising children or supporting other loved ones or adults in their lives, it's really about recognizing what we can do to support them during this time. You know, I don't want to minimize how difficult it is, but we also have to make that decision to not stay stuck in it as well. You know, how do we make sure that we, as the adults that are caring for these young people are trying to role model those good practices? So if I'm telling my child to stick to a routine and structure, I have to also live by that example, stick to a routine and structure. And I think for any parent and caregiver, we know our children best. We know those children best that we're caring for. And so looking for those things that we need to watch out for. If we're seeing any changes in their habits as far as eating their sleeping, they're starting to isolate even more so from family members. You know, when I think about the examples that Amy gave, if she starts to notice that her daughters no longer want to participate in those things, these are signs that our children may not be doing well, no matter how much we're trying to fill their buckets and support them. I mean, for any parent or caregiver out there listening right now, it's making sure that we know those signs. What's a good baseline for our children and how do we recognize when they're not doing so well anymore? Or maybe more covert signs versus overt signs of that. But having those conversations, talking, and I think also just recognizing those losses that they've had, when I hear that they both missed their birthdays and those parties and those celebrations that our kids should be allowed to have, recognizing that, talking about it and then, you know, hopefully finding those creative ways to still celebrate it. So we've seen so many families doing car parades. We are seeing numbers of them where families that we know will say if everybody wants to line up down the street and beginning at 2:00, everybody can drive by, honk their horns, asking folks to mail cards. We have family friends across the country that we made sure we mailed out cards to just as a special way to recognize that this was an important moment for their children and that they're thought about no matter what.

Laura Knoy:
Yeah. And again, those conversations that parents need to have and keeping an eye on stuff. But some parents, as you know, Jodie, are, you know, working less or have lost their jobs. But other parents like Michelle who called, you know, she's working twelve hours a day and her husband is working 12 hours a day. I just wonder, Jodie, what support is there for those families who are working harder than ever?

Jodie Lubarsky:
Well, when we were talking about Michelle's situation, when I listened to her when she called it a bit ago, I first want to recognize and think Michelle and her husband and all the essential workers out there for their tireless efforts during this time. And we wouldn't be where we are right now if it wasn't for our essential workers. And it is really difficult, you know, when you're wearing multiple hats, when I think about for our families, not only in our state, but across our country and our world. Within a few hour's notice, they went from life as they once knew it, to a change of life as they once knew it. And for many people, they went from being an employee to wearing multiple hats, even if for many people it's being in their house and being a parent, a spouse, a caregiver, an employee and a teacher now as well. And those are really difficult roles to manage. And I think Dr. Chapman was talking about it. And Brian, as well, as far as how much it's important for us to be connected to each other, but also recognize when we need to practice personal self care and take a break as well, because if you're in your house 24/7 and you're operating as an employee and as a spouse and as a parent and as a teacher, that's a heavy lift for a lot of people. And so sometimes we need to recognize when we need our alone time to recharge our batteries in order to go back and to wear all those roles. I think for any of our listeners, it's looking within your community to see what resources may be out there. So within your catchment regions of the community mental health centers, many of the centers are offering a variety of support groups and continue to offer the mental health services that they were in a live environment. Organizations like NAMI New Hampshire have support groups and other ways for families and those affected by mental illness to connect with others and to get support that way. But also talking to schools and pediatricians and teachers. They're those individuals who know our children best outside of us as our roles as parents and looking to them for resources and suggestions as well. And I think one of the things that we're so blessed with within our family is our daughter has an amazing teacher. And to quote her, she's always saying, use your resources. It's more important than ever for us to really use our resources in recognizing that our doctors, our neighbors, our human resource departments, many of our companies have employee assistance programs that we have to really be mindful of when we need to give ourselves a break, when we need to recharge your batteries, and how much we really need to extend patience to each other during this time.

Laura Knoy:
Well, it's interesting to hear you say that. And one of you mentioned earlier, you know, again, the importance of parental mental health. And then you can be in a better space for your kids. Here's an email from Michael, and I'll throw this to Dr. Chapman, please. Michael says, How can we essentially, quote, reverse the effects of the past 11 weeks of social isolation to put our children in a better mental space? Michael, thank you so much. Reverse the effects of the past eleven weeks. What do you think, Dr. Chapman?

Dr. Steve Chapman:
Well, I think that's a great question. I think the answer is in connection and in connection for our kids and it's in connection for all of us. And what that meaningful connection is will probably vary from child to child. And so talking with kids about, you know, what that means, what are you missing? And how do you wish that you could connect with your friends and your school and your teachers again? I think we all need to adjust our expectations of where we are right now and not put too much pressure on any of us. All of us as parents, you know, I have two teenage daughters as well. You know, we need to be forgiving of ourselves as parents. And I think we do need to get back to being connected. I don't know that we're ever going to go into reverse, though. This experience is changing all of us. And isn't something and is going to live with the kids, I think forever. And I think it's how do we move forward with this and how do we stay connected? How do we get together? I sure am hopeful that schools open up in the fall with safety accommodations and contingencies for sure. This virus is not gone and we can't be cavalier. But what we're doing now isn't safe. It's not safe for kids and it's not sustainable for parents. And we need to take the full measure of its effect on kids. So I think we have to move forward. And I think we need to think about ways that we can pull people, that we can allow people to get together because this collective trauma that we're all experiencing individually won't go away till we feel that we're supporting each other and that we're supported by each other.

Laura Knoy:
Well, that's a really important point, Dr. Chapman. And you probably hit the nail on the head for a lot of listeners, you know, worrying about this balance, again, of mental and physical health, trying to avoid the virus. So let's look ahead to fall in. I'll start with you, Dr. Chapman. What should schools be thinking about as they consider welcoming everybody back or doing a measured back to school, as is now being discussed? And, you know, as we talked earlier with Michel, that could be a nightmare for families. But what should schools be thinking about, Dr. Chapman?

Dr. Steve Chapman:
Well, no one can see the future, and so I certainly won't pretend about what will happen over the summer in regards to the virus and in regards to where we are from a public health standpoint. But I think I think we should start planning for the inevitable. And I hope it's next September, the opening up of schools and bringing kids in together. You know, obviously, we'll have to make some accommodations for screenings, how to limit large gatherings, and it won't be exactly the same. But I think communicating with parents about how to, you know, have kids say everyone stay home if you are sick. But thinking about how we can start to have classes, perhaps smaller classes, perhaps even rotating cohorts, you know, where we're limiting exposure but not having kids in isolation anymore. And I think we need to start thinking about how will that look and how will we open things up again in a way that's safe and that allows for kids to start interacting and getting back to the development that's so important to them in their lives.

Laura Knoy:
Brian, I've read several articles warning teachers and administrators to be prepared for some emotional fireworks in the fall. You know, again, after all the kids have been through, when they get back together, we don't know what form that's going to take, as Dr. Chapman just said. But what are those warnings about, Brian?

Brian Huckins:
I think that we don't exactly know what we're gonna have for coming back from this situation. And also we don't know what this is going to look like, similar to what Dr. Chapman said. But to prepare to have a school situation is probably going to look significantly different than what they left, if you will, in the spring. We're gonna have situations where probably we're to have parents refuse to have the children go back to school until they feel safer, if you will. And we're gonna have other children and parents want to have the children go back as soon as possible and in some of those situations too we have to be mindful of how do we support those children and families who have decided to stay home. And how do we support those families who decided to go back to school. So that way there's no people getting upset with each other and potential bullying opportunities there. So those is also concerns that we have to deal with. And when we come back to school, children are going to be faced with situations like Dr. Chapman said where they're going be six feet apart or have some sort of lower classrooms sizes. But we are looking at the good thing about that as we're looking at social opportunities to come back and school districts that have their hands full for sure. But I can say one thing about school districts and the Department of Education is they're doing a good job, for the most part, putting out surveys to families, asking their staff, asking the students, asking parents as to what is this going to look like when and if they come back to school in the fall. So asking you know for their input and not allowing just the school boards to make these decisions.

Laura Knoy:
Well, Brian, you get the last word today. And we really, really appreciate all of you being on. And maybe we'll check back with you, you know, as this school year gets closer and we can talk about some of the strategies that are being employed and the impact that you all might see. For now, though, I will say thank you. And Brian, it was really good to talk to you. Thanks for being with us today.

Brian Huckins:
Thank you.

Laura Knoy:
That's Brian Huckins, director of children and youth programs at the National Alliance on Mental Illness, New Hampshire. Jodie, very good to have you, too. Thanks for your time.

Jodie Lubarsky:
Thank you so much, Laura. Be well.

Laura Knoy:
Jodie Lubarsky, Child, Adolescent and Family Services director at Seacoast Mental Health Center. And last but not least, Dr. Chapman, thank you also so much for your time.

Dr. Steve Chapman:
Thank you so much, Laura.

Laura Knoy:
That's Dr. Steve Chapman, pediatrician at Dartmouth Hitchcock Medical Center in Lebanon. You've been listening to The Exchange on NHPR.