Coronavirus #1: Maintaining the lifeline for children receiving treatment
In a new series of expert blogs, the Anna Freud Centre shines a spotlight on those children who are particularly vulnerable during the coronavirus crisis. As leading specialists in their fields, they call on colleagues and wider society to keep in mind these children and young people - and to act on the opportunities which exist to support them in these uncertain times.
Dr Eia Asen from the Anna Freud Centre explores the impact of coronavirus on children and young people receiving psychological treatment and therapeutic interventions. Even from the distance forced upon us by lockdown, he sets out ways in which the profession can continue to support those most in need.
Many children and young people with existing mental health issues will find the current uncertainties around the coronavirus outbreak difficult. Parents and carers are themselves facing increased stress, prompted by worries about their own and grandparents’ health, as well as about job security and finances.
For children, their mental health needs may become more severe, with increases in irritability, clingy-ness, withdrawal, emotional outbursts, depression, aggressiveness, as well as problems with sleeping and eating. Meanwhile, young people will feel the considerable impact of the crisis through the sudden loss of routines, school closures, perceived loss of freedom, and possibly rising family tensions. Children and young people with learning disabilities are particularly prone to experiencing a loss of control in times of uncertainty, and they may require extra words of reassurance and understanding.
What opportunities exist to continue to provide support?
Children and families who had been receiving psychological treatment and therapeutic interventions prior to the coronavirus outbreak may feel that their lifeline has suddenly been removed, and we should not underestimate the impact of this. Appointments may have been cancelled or postponed. Many across the profession are now looking to alternative means, enabling them to continue to provide essential support.
- Providing therapy digitally: Many young people are now accessing therapy digitally, be that via telephone or video. There is good evidence that therapeutic work which is usually acceptable to the client (or clients) can be delivered competently via different media, and that it is possible to build up therapeutic relationships that are as strong as those formed in traditional face-to-face therapy.
- Checking in on the young person: Telephone or online webcam check-ins can also be alternatives to full therapy hours. These can be brief, supportive, and focused on wellbeing and on enhancing coping mechanisms. This work can be offered to individual children, as well as to whole families - though therapeutic work with primary school aged children is clearly quite different to that of secondary school age children.
- Giving indirect support: However, therapeutic intervention online or via telephone may not be suitable for all children and young people. This will be the case especially if they cannot access a safe, confidential space to talk to their therapist - even if headphones are worn to make the consultation more confidential. In such cases, we may need to find ways to pause formal therapy and consider a temporary break until face-to-face sessions can resume. When unable to support a child directly, parents can be helped to support their child themselves via remote consultations.
- Valuing their own support network: Above all, it is important that the child or young person is not left alone, but is helped to connect to their support network. Being able to talk about emotional experiences enables children and young people to share these, and it helps them to feel less alone. They may feel less anxious if they are able to express and communicate their feelings in a safe and supportive environment. Children and young people benefit from continuing to relate to the people who matter to them - both inside and outside the home.
- Not becoming isolated: The networks of social connections which individuals develop through childhood and adolescence can significantly help to protect against mental disorder. Social distancing is quite different from social isolation. (Indeed, coronavirus-related ‘social distancing’ is sometimes now referred to as ‘physical distancing’ to counter the idea that we should lose social contact in any form.) Social media can significantly help overcome a sense of isolation in this period - if used for connecting with others in meaningful ways, rather than merely for entertainment or passing time.
- Maintaining routines: Routine gives children an increased feeling of safety in the context of uncertainty. When daily routines are disrupted, this can aggravate the consequences of the current coronavirus situation. Therapists and parents alike can assist children and young people to develop new routines, focusing on making clear plans for each day and for the week ahead to allow equal time for learning, playing, exercising, relaxing and sleeping. This introduces continuity and predictability, and perhaps even a sense of some control.
As we move through this period of uncertainty for the children, young people and families we support, there is much we can do to play a part. Even from a distance. We all need to be helped not to become obsessed with looking into an unknown future, and worrying excessively about what can or may happen. We need to guard against this, for the mental health of us all – and particularly those children and young people who may need our reassurance more than ever.
Dr Eia Asen is a Consultant Child, Adolescent and Adult Psychiatrist and Family Therapist at the Anna Freud Centre. He also holds the position of Visiting Professor at University College London.
