USING RELATIONAL HEALTH DURING THE PANDEMIC TO HELP PREVENT TOXIC STRESS IN YOUR CHILD PATIENTS AND CLIENTS
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"...RESEARCH HAS SHOWN THAT WHEN WE DON’T CONNECT WITH OTHERS, OUR BRAINS CAN’T DEVELOP OPTIMALLY, OR FUNCTION WELL. THAT MAKES US MORE LIKELY TO HAVE CONFLICT, BEHAVIORAL PROBLEMS, ANXIETY AND DEPRESSION. BUT THERE ARE THINGS WE CAN DO TO ESTABLISH AND MAINTAIN EMOTIONAL CONNECTION DURING THIS DIFFICULT TIME."
- COLUMBIA NURTURE SCIENCE PROGRAM
- COLUMBIA NURTURE SCIENCE PROGRAM
The science of relational health and strategies to improve social support and connections can be used to offset the stress from the current pandemic and the corresponding reduction in many protective factors caused by physical distancing.
RISK OF TOXIC STRESS AS A RESULT OF THE PANDEMICThe fear and social isolation associated with COVID-19 are likely to worsen existing chronic stresses, as well as create new ones. Mental health problems, anxiety, partner violence, substance use, depression, suicidality, child abuse, are all increasing. (1) (2) (4) At the same time, families’ ability to maintain strong bonds and social networks could be disrupted by financial hardships, while at the same having less emotional support than they did prior to the pandemic because of isolation. (3) Isolation also increases the likelihood that children may witness and experience the impact of these hardships more. (4)
Although everyone is at risk of stress from the hardships of the pandemic, some people are more at risk than others, including children from low income families, those with few resources before COVID-19, those who have been disproportionately impacted by the virus, and racial and ethnic minority populations (5). And, families who’ve never experienced violence before are experiencing increased rates of domestic violence and child abuse. (1) |
Relational Health Check
Consider asking your families 3 simple questions: 1. How is physical distancing affecting your ability (or your child’s) to get emotional support now? 2. Have you been able to create a way for you and your children to stay in regular touch with supportive family members or friends? 3. Have you been able to replace your or your child’s pre-COVID ways of connecting with supportive adults with new ones? 4. Is there anything I can do to help you with this issue, such as provide you with resources? |
SOCIAL SUPPORT REDUCES THE NEGATIVE IMPACT OF STRESS
Relationships and connections can lessen the impact of the pandemic on children and families.
Social support has a greater impact on health than smoking, drinking and exercise – and those are really important. (6) People with adequate social relationships have a 50% greater likelihood of survival than people who don’t have them. (6)
Relationships have been shown to:
1. Calm the threat response. Interventions that promote responsive parenting have been shown to improve cortisol patterns and mitigate some of the negative effects of ACEs. (7)
2. Support the cardiovascular systems. Social support has been shown to lower resting blood pressure, and improve the cardiovascular system. (7)
3. Improve the immune system. More social connections has been associated with less susceptibility to the common cold, (7) and perceived support and hugging have been found to protect against viral infection and decrease symptoms. (8)
Social support has a greater impact on health than smoking, drinking and exercise – and those are really important. (6) People with adequate social relationships have a 50% greater likelihood of survival than people who don’t have them. (6)
Relationships have been shown to:
1. Calm the threat response. Interventions that promote responsive parenting have been shown to improve cortisol patterns and mitigate some of the negative effects of ACEs. (7)
2. Support the cardiovascular systems. Social support has been shown to lower resting blood pressure, and improve the cardiovascular system. (7)
3. Improve the immune system. More social connections has been associated with less susceptibility to the common cold, (7) and perceived support and hugging have been found to protect against viral infection and decrease symptoms. (8)
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Resources for Your Families on Connections Now
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SUPPORTING FAMILIES TO CREATE AND MAINTAIN RELATIONSHIPS DURING PHYSICAL DISTANCINGAs a professional who works with children and families, you can actively support them to build, maintain and access the social connections they have or need. You can administer a protective factors survey, use a connections assessment, or just begin a conversation (see panel). COVID-19 and physical distancing can negatively interfere with making or maintaining connections, but you can adapt your conversation to consider the impact of isolation, mask-wearing, and virtual contact on children’s connections with family members, teachers, and new friends.
Relational Health Practice Steps
1. Ask your families about their connections now, and how they are handling the stress of the pandemic. If they are missing connections and resources, connect them to community services that specialize in resourcing families. (See panel.) 2. Explain why the connections their children have with them and others matter. 3. Provide your families with a handout with links to tools and information that will help them practice making creative, new connections and sustain existing ones. |
ADVICE FOR YOU
Your connection as a professional with your patients or clients in itself can help mitigate their stress. Here are some ways to maintain your connection with them during the pandemic.
1. Reflective practice, being emotionally present in the face of physical absence or distance, is key to connecting with your children and families.
2. Take advantage of some of the benefits of TeleHealth and virtual meetings including:
3. Schedule follow-up visits and make an extra effort to maintain contact between visits with families you’re concerned about by using electronic check-ins via email, texts, (9) or messages in electronic records.
1. Reflective practice, being emotionally present in the face of physical absence or distance, is key to connecting with your children and families.
- Starts with self-care for the provider (it will be more difficult to be emotionally present for your clients if you yourself are overtired and stressed) (9)
- Requires active listening including:
- Ask if your understanding of what was said is correct
- Reflect what you heard (such as by paraphrasing, “It sounds like…”)
- Ask questions that cannot be answered with a “yes” or “no"
- Listen for signs of frustration, anger or fear (9)
- Ask how you can help. Be specific about how your practice can be a resource
- Acknowledge feelings of frustration, anger or fear
2. Take advantage of some of the benefits of TeleHealth and virtual meetings including:
- You have an opportunity to look into the home environment;
- You are able to see children, their play and interactions at home;
- You may be able to “see” and speak with other family members. (9)
3. Schedule follow-up visits and make an extra effort to maintain contact between visits with families you’re concerned about by using electronic check-ins via email, texts, (9) or messages in electronic records.
ADVICE FOR YOUR FAMILIES
As a provider, you can be a lifeline for that parent and recognize their stress, help them normalize their feelings, and provide them with information and resources. For many parents, they are experiencing new challenges that may take them by surprise and overwhelm them.
You as a provider can:
1. Inform parents about what changes they might see in their children now as a result of isolation and the pandemic. Explain what kind of stress they themselves might be experiencing, and how it might manifest.
2. Ask caregivers what they do to manage their own stress, and what their ideas are for helping with their children’s.
3. Share with families that self-care is critical for everyone in the household, including eating healthy, exercising (especially exercising outdoors together) (10), getting enough sleep, and maintaining social connections by phone, video, email or other ways (11); avoiding smoking and drinking too much alcohol. (10)
4. Encourage routines since predictable (but not rigid) practices promote a sense of safety (10) and reduce stress.
5. Promote and praise family strengths, such as having a sense of humor, being good at caring for things like pets, and maintaining family traditions.
7. Encourage use of health, education and social service resources, and make sure parents know where to go to connect to them.
You as a provider can:
1. Inform parents about what changes they might see in their children now as a result of isolation and the pandemic. Explain what kind of stress they themselves might be experiencing, and how it might manifest.
2. Ask caregivers what they do to manage their own stress, and what their ideas are for helping with their children’s.
3. Share with families that self-care is critical for everyone in the household, including eating healthy, exercising (especially exercising outdoors together) (10), getting enough sleep, and maintaining social connections by phone, video, email or other ways (11); avoiding smoking and drinking too much alcohol. (10)
4. Encourage routines since predictable (but not rigid) practices promote a sense of safety (10) and reduce stress.
5. Promote and praise family strengths, such as having a sense of humor, being good at caring for things like pets, and maintaining family traditions.
7. Encourage use of health, education and social service resources, and make sure parents know where to go to connect to them.
ADDITIONAL RESOURCES ON RELATIONAL HEALTH
PARENTS
Talking to Children About Wearing Masks
Supporting Young Children Isolated Due to COVID-19
Staying Connected: Zero to Three COVID resources-
Tips to Make the Most of Video Chats
Young Children at Home during the COVID-19 Outbreak: The Importance of Self-Care (Also in Spanish)
CDC Coping with Stress - (Also in Spanish)
Young Children at Home during the COVID-19 Outbreak: The Importance of Self-Care (Available in Spanish)
Supporting Young Children Isolated Due to COVID-19
Staying Connected: Zero to Three COVID resources-
Tips to Make the Most of Video Chats
Young Children at Home during the COVID-19 Outbreak: The Importance of Self-Care (Also in Spanish)
CDC Coping with Stress - (Also in Spanish)
Young Children at Home during the COVID-19 Outbreak: The Importance of Self-Care (Available in Spanish)
pROVIDERS
Safe, Stable and Nurturing Relationships Framework
Protective Factors Framework
HOPE: Healthy Outcomes from Positive Experiences
Protective Factors Framework
HOPE: Healthy Outcomes from Positive Experiences
REFERENCES
1. Bullinger, Lindsey, et al. “The Neglected Ones: Time at Home During COVID-19 and Child Maltreatment.” SSRN Electronic Journal, 2020, doi:10.2139/ssrn.3674064, https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3674064.
2. Schmidt, Samantha, and Hannah Natanson. “With Kids Stuck at Home, ER Doctors See More Severe Cases of Child Abuse.” The Washington Post, 30 Apr. 2020, www.washingtonpost.com/education/2020/04/30/child-abuse-reports-coronavirus/.
3. CTN, UOregon. “How Long Can the Levee Hold? The Role of Caregiver Emotional Support in Buffering Children from the Stress of Material Hardship.” Medium, RAPID-EC Project, 10 Sept. 2020, medium.com/rapid-ec-project/how-long-can-the-levee-hold-2a2cd0779914.
4. Campbell, Andrew M. “An Increasing Risk of Family Violence during the Covid-19 Pandemic: Strengthening Community Collaborations to Save Lives.” Forensic Science International: Reports, vol. 2, 2020, p. 100089., doi:10.1016/j.fsir.2020.100089, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152912/?report=reader.
5. Vásquez, Elizabeth, et al. “Racial and Ethnic Disparities in the Association Between Adverse Childhood Experience, Perceived Discrimination and Body Mass Index in a National Sample of U.S. Older Adults.” Journal of Nutrition in Gerontology and Geriatrics, vol. 38, no. 1, 27 Feb. 2019, 6-17. doi:10.1080/21551197.2019.1572569, https://pubmed.ncbi.nlm.nih.gov/30810507
6. Holt-Lunstad, Julianne, et al. “Social Relationships and Mortality Risk: A Meta-Analytic Review.” Plos Medicine, 27 July 2010, doi:10.4016/19865.01, https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000316.
7. Uchino, Bert N. “Social Support and Health: A Review of Physiological Processes Potentially Underlying Links to Disease Outcomes.” Journal of Behavioral Medicine, vol. 29, no. 4, 7 June 2006, pp. 377–387., doi:10.1007/s10865-006-9056-5 https://pubmed.ncbi.nlm.nih.gov/16758315/.
8. Cohen, Sheldon, et al. “Does Hugging Provide Stress-Buffering Social Support? A Study of Susceptibility to Upper Respiratory Infection and Illness.” Psychological Science, vol. 26, no. 2, 19 June 2014, pp. 135–147., doi:10.1177/0956797614559284, https://pubmed.ncbi.nlm.nih.gov/25526910/.
9. “Clinicians’ Attending To Risks for Abuse and Neglect During COVID-19: A Guided Reflection.” ZERO TO THREE, 15 Apr. 2020, www.zerotothree.org/resources/3379-clinicians-attending-to-risks-for-abuse-and-neglect-during-covid-19-a-guided-reflection.
10. Kraft, Chris. “How to Keep Your Relationship Healthy During the Coronavirus Pandemic.” How to Keep Your Relationship Healthy During the Coronavirus Pandemic | Johns Hopkins Medicine, John Hopkins Medicine, 1 May 2020, www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/keep-healthy-relationship-during-pandemic.
11. “Child Abuse and Neglect: Prevention.” American Academy of Pediatrics , 2020, www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Child-Abuse-and-Neglect/Pages/Prevention.aspx
2. Schmidt, Samantha, and Hannah Natanson. “With Kids Stuck at Home, ER Doctors See More Severe Cases of Child Abuse.” The Washington Post, 30 Apr. 2020, www.washingtonpost.com/education/2020/04/30/child-abuse-reports-coronavirus/.
3. CTN, UOregon. “How Long Can the Levee Hold? The Role of Caregiver Emotional Support in Buffering Children from the Stress of Material Hardship.” Medium, RAPID-EC Project, 10 Sept. 2020, medium.com/rapid-ec-project/how-long-can-the-levee-hold-2a2cd0779914.
4. Campbell, Andrew M. “An Increasing Risk of Family Violence during the Covid-19 Pandemic: Strengthening Community Collaborations to Save Lives.” Forensic Science International: Reports, vol. 2, 2020, p. 100089., doi:10.1016/j.fsir.2020.100089, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152912/?report=reader.
5. Vásquez, Elizabeth, et al. “Racial and Ethnic Disparities in the Association Between Adverse Childhood Experience, Perceived Discrimination and Body Mass Index in a National Sample of U.S. Older Adults.” Journal of Nutrition in Gerontology and Geriatrics, vol. 38, no. 1, 27 Feb. 2019, 6-17. doi:10.1080/21551197.2019.1572569, https://pubmed.ncbi.nlm.nih.gov/30810507
6. Holt-Lunstad, Julianne, et al. “Social Relationships and Mortality Risk: A Meta-Analytic Review.” Plos Medicine, 27 July 2010, doi:10.4016/19865.01, https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000316.
7. Uchino, Bert N. “Social Support and Health: A Review of Physiological Processes Potentially Underlying Links to Disease Outcomes.” Journal of Behavioral Medicine, vol. 29, no. 4, 7 June 2006, pp. 377–387., doi:10.1007/s10865-006-9056-5 https://pubmed.ncbi.nlm.nih.gov/16758315/.
8. Cohen, Sheldon, et al. “Does Hugging Provide Stress-Buffering Social Support? A Study of Susceptibility to Upper Respiratory Infection and Illness.” Psychological Science, vol. 26, no. 2, 19 June 2014, pp. 135–147., doi:10.1177/0956797614559284, https://pubmed.ncbi.nlm.nih.gov/25526910/.
9. “Clinicians’ Attending To Risks for Abuse and Neglect During COVID-19: A Guided Reflection.” ZERO TO THREE, 15 Apr. 2020, www.zerotothree.org/resources/3379-clinicians-attending-to-risks-for-abuse-and-neglect-during-covid-19-a-guided-reflection.
10. Kraft, Chris. “How to Keep Your Relationship Healthy During the Coronavirus Pandemic.” How to Keep Your Relationship Healthy During the Coronavirus Pandemic | Johns Hopkins Medicine, John Hopkins Medicine, 1 May 2020, www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/keep-healthy-relationship-during-pandemic.
11. “Child Abuse and Neglect: Prevention.” American Academy of Pediatrics , 2020, www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Child-Abuse-and-Neglect/Pages/Prevention.aspx