CSHE Bulletin

The CSHE Bulletin is a platform for the Center for School, Health and Education and partners to explore issues at the intersection of health, education and equity. Check back monthly for new insights and sign up for our newsletter to hear more from our team about each topic.

Past issues:

The Impact of COVID on Child & Adolescent Mental Health

As part of APHA's 150th anniversary programming for May — Mental Health Awareness Month — Melissa Brymer, PhD, PsyD, of the National Child Traumatic Stress Network joined the Association for a webinar on the mental health impacts of COVID-19 on children and families.

Funded by the Substance Abuse and Mental Health Services Administration, and jointly coordinated by the University of California-Los Angeles and Duke University, the network improves standards of care and access to services for traumatized children, their families and communities throughout the U.S. During the pandemic, the network has focused on supporting the needs of children and youth impacted by COVID and addressing the effects of additional stressors on families, including financial insecurity and social isolation. To support professionals working on behalf of these populations — as well as the children, youth and families themselves — the network offers more than 400 e-learning courses alongside webinars, training curricula and other educational resources.

Access a free recording of "The Impact of COVID on Child and Adolescent Mental Health" on APHA Now — our digital library of events, continuing education offerings and more — and keep reading for key takeaways and resource highlights.

Bereavement & Prolonged Grief

A study released in October 2021 found that more than 140,000 U.S. children lost a primary or secondary caregiver to COVID by the end of June 2021. At the time, the U.S. had lost approximately 600,000 people to COVID; as of June 2022, pandemic-related deaths are estimated at just over 1 million with a disproportionate impact on Black, Hispanic and Native communities. Already overwhelming, this staggering number does not include losses related to reduced access to medical care or overdoses related to the heightened opioid crisis.

While grief is never simple, grief during the pandemic has been especially complicated. End-of-life rituals have often been disrupted or absent as a result of COVID restrictions, with many funerals, memorials and celebrations of life moved from in-person to virtual spaces. Some family members have been unable to say goodbye to loved ones dying in the hospital, while others have grappled with sudden losses. In instances where children were the first ones in their families to get sick, their grief is sometimes heightened by fears that they might have caused the death of their loved ones. For those dealing with prolonged grief &mdash a condition added to the Diagnostic and Statistical Manual of Mental Disorders in 2021 — bereavement can be marked by significant distress most of the day, nearly every day, for months on end.

To help support children and youth experiencing grief during the pandemic:

Collective & Compounding Traumas

In addition to substantial loss of life, the pandemic has also led to an uptick in risk factors for suicidal ideation and substance use among youth. COVID and approaches to COVID response have reduced social connection, increased anxiety, deepened economic hardships, limited access to care, and compounded the effects of political and civil unrest — all of which disproportionately impact communities of color and LGBTQ+ youth. Emergency department visits for suspected suicide attempts have increased substantially, especially among adolescent girls, and the U.S. has seen an overall rise in substance use and overdoses since 2019.

Estimates of interpersonal violence have also increased during COVID. There are more reports of abuse from youth, increased severity in reports from emergency rooms, fewer survivors able to relocate to safe and stable housing because of increased financial insecurity, and fears that disruptions in mandated reporting — prompted by the switch to distance learning — allowed many instances of child abuse to go undetected. The child welfare and juvenile justice systems also experienced major disruptions, with family reunifications delayed and contact between children in placements and their families either reduced or suspended.

For youth supporting their peers through traumatic experiences:

For schools and educators interested in multitiered interventions:

  • Classroom WISE (Well-Being Information and Strategies for Educators) is a three-part training package that offers K-12 educators evidence-based strategies and skills aimed at engaging and supporting students with mental health concerns in the classroom.
  • Psychological First Aid for Schools is a webinar aimed at reducing the distress that school communities can experience after a disaster or violent event. This resource helps teachers, support staff and administrators prepare for and respond to such events with the whole school community in mind, including students, staff and families.
  • Bounce Back: An Elementary School Intervention for Childhood Trauma is a cognitive-behavioral and skills-based group intervention to help children in grades K-5 navigate traumatic events. Children get tools to cope with and recover from community, family, or school violence, natural disasters, or traumatic separation from a loved one due to death, incarceration, deportation, or child welfare placement.
  • Cognitive Behavioral Intervention for Trauma in Schools, or CBITS, is a skills-based group intervention aimed at relieving symptoms of post-traumatic stress disorder, depression and general anxiety among children in grades 5-12 exposed to multiple forms of trauma.

For other professionals working with children who have experienced traumatic stress:

  • A Toolkit to Help Young People Heal and Thrive During and After Natural Disasters — designed separately for child welfare and juvenile justice agencies — provides staff, supervisors and administrators with evidence- and trauma-informed guidance for promoting positive outcomes for children and youth facing emergencies.
  • Pause-Reset-Nourish to Promote Wellbeing is a fact sheet designed to help professionals acknowledge the levels of stress they may be experiencing and offer ways to reset and rebalance their nervous system.

Secondary Traumatic Stress

The increase in pandemic-related traumatic stress has led to a subsequent increase in secondary traumatic stress from indirect trauma exposure. Like post-traumatic stress disorder, secondary traumatic stress can lead to fear, hopelessness, hypervigilance, chronic exhaustion and even physical pain. While the COVID-related stress and burnout confronting frontline emergency workers has received some attention, the ongoing pandemic has placed all child-serving professionals — including other medical professionals, social workers and educators — at heightened risk for secondary traumatic stress.

In order to effectively support children and youth experiencing traumatic stress, professionals and caregivers alike need to first take care of themselves by recognizing and responding to the signs and symptoms of secondary traumatic stress. To help with this work, the National Child Traumatic Stress Network and its partners offer a series of resources geared toward specific audiences and available in a variety of formats:

To hear more from Brymer — including a Q&A addressing social connections and skills for children born during the pandemic, bullying prevention in the COVID era and both hot- and warmlines for youth dealing with pandemic stressors — watch the full webinar on APHA Now and check out the accompanying list of COVID-19 resources. For other APHA 150th anniversary celebration programming, bookmark the 150th events page.

C. Pluff is the program manager for the Center for School, Health and Education at APHA.