Resources

Clinical child psychologist with expertise in pediatric mood and anxiety disorders. amywest@usc.edu

There is a tremendous amount of anxiety swirling around in our family systems currently. Especially in isolated home environments without as much interaction with the outside world, it is likely harder for parents to contain their own anxiety, frustration, fear, etc. Children are very sensitive to their parents’ emotional states and are likely picking up on emotional states regardless of parents’ attempts to hide them. Thus, it is a good idea to have open conversations with children about what is going on and make sure they feel they have space to express their feelings and ask questions. They do not need to hear a lot of details and certainly do not need to be exposed to media coverage, but it is also not necessary (or useful) to try to completely shield them from what is happening in the outside world. Depending on their developmental level, parents can communicate information to explain why lives and routines have changed, but offer reassurance, love, and support. Parents can also communicate their own feelings. It is good for children to see that their parents experience negative emotion, but can navigate these emotions and use coping strategies to help manage them. Also, children may experience an increase in fear and anxiety during this period. It can be difficult to balance offering children reassurance and support, but also not engaging in accommodation behavior. Accommodation is when parents engage in reassurance behaviors that actually reinforce fear and avoidance rather than helping children to experience their emotions and effectively cope with them.

Expert on infant and family mental health. mwilliams@chla.usc.edu

I work in our mental health program, which has close to 200 staff (interdisciplinary including psychologists. social work, developmental behavioral pediatricians, occupational therapists, speech-language pathologists), and trainees in all of those disciplines.  We provide mental health services outpatient, home visiting, and in the inpatient and outpatient medical clinics. I'm so proud of our team because in one week we have transformed our entire program to telehealth. As one of our faculty said "I've been trying to get telehealth going for 5 years and we just did it in one week."  We were in a good position because we had just gotten a Graduate Psychology Education grant from HRSA (the PI on that is our Training Director, Sara Sherer, PhD), which was partly focused on developing telehealth. We've now set up all our staff and trainees with the WebEx technology, partnered with the Innovations Studio at CHLA who developed a brief training for doing telehealth that was rolled out to all our staff, and we're launching more and more each day.

I have set up a daily WebEx drop-in meeting for my staff, who are the therapists who work in our infant and early childhood mental health program (serving families ages 0 - 5).  I must admit I was a skeptic only a month ago about the idea of using telehealth with our population of young children. But I'm so impressed. The families we work with are beyond grateful when they get a call from their therapist offering to continue providing therapy via telehealth or telephone.  These are families who are all on MediCal and living close to the edge financially. Now they have their children at home from school and often they live several families to one apartment so we're talking tight quarters. In my daily call with the staff, we all share inspiring stories of our day, and it's keeping us going.  We also share the pain our families experience and share resources with one another about how to help them find basic services. Here are a few examples:

• A single mom with four children (ages 9 months to 8 years) worked in a factory.  Now her preschooler and elementary school kid are home from school, and the neighbor who was caring for the babies is scared to have anyone in her house.  So the mom has to care for the children and can't go to work. She was told on Thursday that if she doesn't show up to work on Friday she's out of a job. So she's out of a job.  She has no idea what she's going to do. She's undocumented of course.
• One of our therapists took the stuffed animals and other figures that she uses in Child-Parent Psychotherapy (a relationship-based, evidence-based trauma therapy for children ages 0 -5) home with her, created "super hero capes" for each of them, and is now using them in video therapy with her preschool-aged clients to teach them how to be "super heros" by washing their hands and keeping their distance from others.
• Another therapist has been working with a family that has two deaf parents and a hearing 3-year-old child.  Prior to the crisis, she did family therapy with them using a live ASL interpreter so that everyone could talk to each other.  She spent many hours last week figuring out how she could do virtual therapy with them, pending our language and cultural support team coming up with a solution, which they said at best will be next week (b/c the usual interpretation is via phone but without video, which obviously won't work for ASL).  Meanwhile the parents were texting her urgently that their child was really struggling and they needed help, but were scared to come to the clinic for their therapy. Finally she came up with a solution of using an iPad with a "chat" function so that she could see the child and family and they could see her, and the parents could use the chat to communicate via text.  Meanwhile the child is carrying the iPad around through her home proudly showing her therapist her toys and pets, and was just delighted that her therapist had "come" to her home to visit while she was out of school.
• We have a psychologist who is based in the NICU and we weren't sure if she should go to the unit for fear of contamination.  We reached out to the medical director for the NICU and she said "I consider you an essential service. We need you. We'll figure it out."  We came up with a plan for minimizing contagion and making sure our psychologist does not have to waste any of the precious protective gear, and she was able to reach out to parents and offer them support via telehealth.  She's also been a source of support for nurses and medical social workers who are dealing with their own stress, being away from their own children, worrying about their own health, and still being there for the kids and families. 
• I have a team of 6 speakers who had scheduled to do a 6-hour training on Infant Mental Health Interventions for Medically Fragile Infants next Friday.  It's part of our training series for mental health professionals in the community, funded by the LA County Dept of Mental Health. We decided to try doing it via Zoom rather than cancel.  The participants were thrilled that we would do that, and DMH agreed to the plan. So I've spent the past week learning how to use Zoom (many thanks to the USC Center for Excellence in Teaching for their help!) and teaching the speakers how to use the breakout room function, polling, etc, to try to make it interesting.  If it goes well, we'll offer our April trainings (Brain Development and Implications for Attachment; Trauma in Infants; and Typical and Atypical Development in Young Children) the same way.  
• We also have reflective practice groups for supervisors from about 20 mental health agencies who have contracts with DMH.  We decided to make them all virtual and just started those last week. The supervisors were so grateful to have a place to come together with their peers from other agencies and talk about how they are managing this crisis for their staff and the families they work with. 
• One of my psychology fellows had planned to do her scholarly project on the use of tele mental health with young children and families (via a survey of clinician who work in 0 - 5 mental health).  That was before this happened! Now she will have the opportunity to do a really groundbreaking study as it all happens live. If anyone wants to partner on that project I'm sure she'd be interested in input!    

I could go on and on.  I'm so proud of our team, and so glad that we can be there for our families!  It feels good to share.   

Expert on health economics. bennetd@usc.edu 

At CESR, we are currently fielding a survey of perceptions and responses to COVID-19.  Wändi Bruine de Bruin and I led this effort. The survey is representative of US adults. Some findings that are relevant to families: 

• We find that 18% of all respondents have “worked or studied at home” as a response to coronavirus concerns.  This gives a sense of how many people have changed their work routines.  (This figure includes people who are not in the labor force.). 
• We find that for people with jobs, 59% say they that they would have difficulty working from home.  As schools close, these families face particular challenges with child care.  
• 33% of respondents include an adult over age 60, and 10% include an adult over age 80.  These families are particularly vulnerable to the health risks. 
• A significant fraction of people express concerns that they could lose their job or run out of money.  Obviously these sorts of things have profound impacts across the household.  

Expert on demography, global health, and family bereavement. smithgre@usc.edu

A growing number of Americans will be in isolation or distancing while simultaneously dealing with the direct stressors of this pandemic. Because we are at the very early stages of this, most distancing is being framed and encouraged as something for healthy, unaffected individuals to do to slow the spread of COVID19. However, due to the lack of testing and the stress the healthcare system is already facing, with each passing day more and more Americans will be isolating/distancing while they manage their own symptoms and concerns that they themselves could be infected. We can't underestimate the psychological toll this will take--especially given that nearly 30% of the U.S. population lives alone. Moreover, those with a family member hospitalized with COVID19 will simultaneously be coping with concerns about a loved one's health, and the health of exposed relatives, all while they navigate this new reality of being distanced from society. And sadly, this goes for the bereaved as well--families will have to navigate the initial days of their loss potentially separated from one another. So, it's important that as we navigate this new reality that we make an effort to make social connections--to check-in on one another, especially those living alone, and help family members and friends feel emotionally close even while physically separated.

Expert on couple and family dynamics, family aggression, and intergenerational transmission of family risk and resilience. margolin@usc.edu 

I have conducted research about how children respond to natural disasters, specifically earthquakes.  Children take their cues from parents, so the more that parents can convey the spirit of being able to get through unsettling and scary times, the better for children. The more parents panic, the worse for children. That is, parents should not undermine the reality of the situation or be dismissive of children’s fears.  However, conveying specific information about how the family will cope can be reassuring.  

Children should not be inundated with constant news. However, their questions should be answered in a straightforward and honest fashion—addressing what the child is asking without going beyond what the child has asked and getting into unnecessary details. Information needs to be age-appropriate, of course. Children will learn from what the parents do--the attitudes they convey, and the resilience they display. And, importantly, children need routines and rituals, e.g., around meals, bedtime, and other daily rituals.

Second, and related to the idea of what children observe—the caring and concern that parents show for those around, particularly vulnerable persons, provides invaluable lessons for children. So if parents offer to buy groceries for an elderly neighbor or family member or share what they have or just reach out to others, e.g., while walking down the street, stopping to wave to an elderly person in a window, this can model kindness for their children.  

Thankfully children do not seem particularly physically vulnerable to this virus.  However, children are always eager consumers of the lessons that parents show their own actions. As has been observed by others, “We are all first responders during this health crisis.” 

Expert on stress contagion within families, parenting, division of household labor, and the transition to parenthood.dsaxbe@usc.edu 

Family members can influence each others’ emotions, behaviors, and even physiology. In my research, I have found that couples and parent-child pairs show interconnected levels of the stress hormone, cortisol. In fact, more strongly linked cortisol levels emerge in families that report more conflict and relationship dissatisfaction. In other words, stress can actually make us more reactive to each other and erode the quality of our relationships over time. 

For cohabiting families, “social distancing” actually means “enforced intimacy.” Many family members are spending more time together under the same roof, with fewer outlets for socializing and recreation. Social distancing requires separation from extended family and community members, including childcare service providers and teachers. In some ways, life under social distancing echoes a trend that has already been happening in modern industrialized societies: as household sizes shrink and the birth rate declines, and as families live geographically farther away from each other, more pressure gets put on the immediate family. Child-rearing becomes a private, individualized choice rather than a public, collective activity. Hopefully our experiences during COVID-19 can provide an opportunity to reflect on the value of the larger society’s importance to raising the next generation. It takes a village to raise a child…and we become especially aware of that when we lose access to our villages.  

Expert on physical activity and nutrition within families. dunton@usc.edu

As family schedules are completely upended during this challenging time, finding moments to be physically active and exercise can be difficult. However, maintaining adequate levels of physical activity (at least 60 min per day for children and 150 min per week for adults) is critical for physical and emotional health. Importantly, our immune system is better equipped to defend against exposures to Covid-19 when we are being physically active regularly. 

When social distancing and staying at home, we are not following our regular routines. Opportunities to be physically active while commuting to work, taking the kids to school, or even walking to our parked car no longer exist. Also, with the closure of fitness clubs and gyms, we no longer have access to group exercise classes and workout facilities. Children no longer have access to their school playground, recess, physical education, and organized sports. Therefore, it is critical now more than ever for families to look for opportunities to be physically active at home and in their neighborhoods.  

As they are working on distance learning and homeschooling, children need regular stretch and activity breaks throughout the day. For families with elementary school children, parents should encourage physical activity breaks that mirror the school schedule (with a minimum of morning and lunch recess) that last approximately the same amount of time as those periods normally would. Also, it is important for kids to also break up long bouts of sedentary behavior with opportunities to stand, stretch, and jump around.  Although parents are juggling many different things these days with potentially working from home and facilitating home schooling, finding opportunities to get in regular physical activity is also important for them. Youtube has many free exercise videos (as short as a few minutes) for quick activity breaks across the day. Parents should also strive to stand up at least once per hour to stretch their legs (walk around the house, get a drink of water, use the restroom). Families can be physically active together with afternoon or nightly walks, bike rides, or scootering around their neighborhoods (as long as they try to maintain at least 6 ft of separation from other people). Also, hiking in local parks or mountains is a great way to be physically active together as a family while maintaining social distancing. Overall, the most important take home message is to find a way to by physically active everyday. 

Expert on infant neuromuscular development.beth.smith@pt.usc.edu

If you’ve got an infant at home, do your best to balance interaction and engagement with your infant (reading to them, playing peek-a-boo, tummy time or other motor skill development practice) with placing them in a car seat or other constraining device while you do necessary things like use the bathroom, prepare food, etc. We are all under a lot of stress and trying to manage multiple priorities, so just think balance (and not perfection) is my best advice. 

Expert on telehealth and using videoconferencing technology to support families.traube@usc.edu 

Families need to continue to have social connection even when utilizing social distancing measures. The use of videoconferencing technology to interact with friends, family, teachers, and service providers is vital to the well-being of all families. In the absence of teachers and early childhood educators, parents need guidance on how to support their child’s learning. Without social interaction, children do not get to tap into the social modeling that is vital for their growth.  Virtual connection can bridge this gap.

Unfortunately, many do not have access to adequate computers or internet connections, and often service providers have not explored how to effectively provide virtual services. These resources need to be made available to families at low or no-cost, as they have now become a civil right. Federal and state intervention to ensure access for families is required for the health and safety of all citizens. Furthermore, providers have to include virtual services as a portion of their business cost and best practices. 

While much attention has been given to the dangers of excessive screen time with children, caregivers need to realize that quality screen time can be an important aid during this period of social isolation. There are numerous online learning tools, even for some of our littlest learners. Caregivers can also tap into virtual parent networks for support and feedback during this period.

Despite high quality evidence of the feasibility and acceptability of offering child development focused, home visitation services to families, federal and state entities have been reluctant to deviate from their on-the-ground services to families. Now that this is not feasible, home visitation programs are scrambling to figure out if their families have access to computers and internet and if their organization can quickly train home visitors in virtual home visitation techniques. With a bit of forward thinking, these services could have been in place prior to an international emergency, yet provincial thinking stymied innovative options to help vulnerable families.

Expert on parenting, health disparities, military families, teen parenting. jcederba@usc.edu

Children are naturally resilient, experiencing exceptional cognitive and social emotional growth is short periods of time. However, children are not immune to the distress of adults, and changes to their routines create strain as they also navigate the changes COVID-19 is making their daily lives. Remember that kids thrive on routine, particularly toddlers and school age children. Changes in schedules can be disruptive to children’s sense of normalcy and control. This may result in social-emotional changes in children not commonly experienced by families. There are a number of things parents can do to create a sense of security and stability for children during this uncertain time. 

• Remember kids are listening
  • Cautious about radio and tv stories that are constant (and which they can process)
  • Reduce talking about your own distress to children (rather focus that talk to other adults when children aren’t there to listen)
  • Be able to answer questions in age appropriate ways. Use great media resources to do this like https://www.brainpop.com/health/diseasesinjuriesandconditions/coronavirus/
  • Create a routine…and stick to it
    • Set a schedule for each day
    • Use praise and rewards for completion of tasks
    • Give breaks
    • Do some activities together
    • Get outside

Additionally, parents can hold space for their children’s need to mourn the disruptions and losses associated with the pandemic. With most of our adult efforts focused the practical needs of our families, many children are left without a space to process their feelings of loss. While our adult minds may not see these experiences in the same way as our children, not actively creating a space and really asking and listening to how this pandemic feels for our children fails to acknowledge their feelings of loss. 

We often think of loss as feelings associated with something concrete, like a death of a loved one. When this occurs, we, as adults, can respond very effectively to the feelings of loss experienced by children. However, in reality much of the loss that children experience has little to do with a biological death. This type of loss is called ambiguous loss and may include, but not limited to experiences of parental separation or divorce, the moving of a friend to another city, losing or the destruction of a favorite toy, among many others. Many children are currently experiencing ambiguous losses, such as:  

• Loss of access to friends
• Loss of access to teachers
• Loss of routine
• Loss of experiences, like school field trips, dances, and graduation events