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Whether in Person or Virtual, Schools Can Focus on Mental Health

Whether in Person or Virtual, Schools Can Focus on Mental Health

The past 18 months have been challenging for kids. They’ve navigated months to a year or more of virtual learning, including live and self-guided instruction. Many have experienced isolation, loneliness, and unsurprisingly, since kids were at home day after day with family members for a good chunk of the Covid pandemic, family issues. However, kids haven’t just reported concern for themselves but also their parents’ well-being. Many parents are stressed, and their children have noticed. 

However, clumping together the past 1.5 years isn’t fully reflective of the Covid experience for anyone, let alone kids. The end of the 2020-2021 school year came as close to a return to normalcy since the start of the Covid emergency—cases fell to the lowest infection rate since June 2020, hospitalizations and deaths were also steadily dropping, vaccinations were on the rise, and the FDA expanded emergency use authorization of the Pfizer-BioNTech vaccine to include ages 12 to 15. Suddenly, family members who hadn’t seen each other for more than a year reunited and hugged, and not through a plastic shield. Kids started to talk about sleepovers and going to the movies.

Students are now returning to the classroom and starting the 2021-2022 school year amidst the United States’ fourth Covid wave. It’s the same pandemic, but unlike previous strains, kids are far more susceptible to the hyperinfectious Delta variant. The strain, says Dr. Sharon Hoover, has thrown everyone a curveball, including education leaders. Hoover is co-director of the National Center for School Mental Health at the University of Maryland School of Medicine.

Many education leaders across the nation had planned to leave remote learning behind, but in Covid-stricken communities, some school districts began the new school year virtually. Others doubled down on returning in-person to school without a distance learning option, even for immunocompromised children, and quickly grappled with thousands of students in quarantine. They had to provide virtual learning anyhow and weren’t adequately prepared.

The desire for schools to return fully in person is understandable. Not having students physically in the classroom has contributed to decreased identification of students experiencing behavioral health challenges, overall slower learning gains, and widened pre-existing chasms, making marginalized students even more so. 

“Schools are often a primary referrer to behavioral health services,” says Dr. Hoover. The closing of in-person schooling to halt the spread of Covid came along with unintended consequences. Identifying kids in need of services plummeted. According to McKinsey’s Center for Societal Benefit through Healthcare, in 2020, kids ages 0 to 14 experienced the largest decrease in behavioral health services use. 

“There was such significant school disruption and inequity in students’ access to education and healthcare,” says Dr. Hoover. Some communities, and the children within them, faced far greater vulnerability to the virus and economic challenges resulting from physical distancing mandates. 

The pandemic and corresponding physical distancing requirements have disproportionately affected Black and Hispanic families, making it more likely that they become ill and die of the virus, experience food insufficiency, are unable or have difficulty paying for housing and household expenses, and face higher unemployment. Dr. Rochelle Head-Dunham told us in October that structural racism is to blame. “Vulnerabilities to the virus aren’t inherent to a person’s race but because of the disadvantages U.S. systems have created,” she said. Dr. Head-Dunham is the executive and medical director for the Metropolitan Human Services District in New Orleans.

Andrea Rifkind is the program director of an in-home stabilization program in Maryland called Care and Connection for Families. The majority of the program’s clients are Hispanic or Black. She told #CrisisTalk in June that the program went from 82 clients in 2019 to 62 in 2020, with 85% of the latter referrals having taken place before the pandemic even began. Then, as schools reopened in the county in March 2021, the program went back up to full capacity.

Kids, points out Dr. Hoover, were likely exposed to much more harm during the pandemic than prior. “When we see family stress go up, the risk for kids—exposure to abuse and neglect—heightens,” she says. “So, the fact that we’re back in school does open up the opportunity for early identification systems to work better.” 

Deciphering the educational impacts of students not being physically in the classroom is a bit trickier. By the end of the 2020-2021 school year, standardized testing showed that students were behind in reading and math, with American Indian, Hispanic, and Black students experiencing larger gaps. There was also a rise in chronically absent students, especially in the higher grades. However, not all education experts believe in the learning loss narrative. For example, Wayne Au, a professor in the School of Education Studies at the University of Washington at Bothwell, told the Washington Post that standardized tests are better indicators of housing and food security and access to healthcare than learning. 

Dr. Hoover says the lack of in-person school also disrupted students’ peer networks. For middle and high schoolers, this has been particularly challenging. Adolescence is a time marked by self-discovery and increased interdependence on friends and peers. Unfortunately, during the pandemic, many preteens and teens were in their homes and experiencing isolation at a time when they’d often be achieving adolescent developmental and social milestones. 

However, re-entering the classroom during a Covid surge with a variant young people are far more susceptible to presents its own challenges, especially for those children not yet eligible for the vaccine, those partially vaccinated, and those eligible but not vaccinated. The American Academy of Pediatrics and the Children’s Hospital Association, which collaborate to collect and publicly share data on child Covid cases from states, revealed that on the week of September 2, there were roughly 252,000 new cases of kids with Covid. That’s the largest number of child cases in a week since the start of the pandemic.

Families, notes Dr. Hoover, are experiencing vacillating shifts in concerns. “Many families are incredibly nervous about their children returning to school, but they’re also anxious, perhaps even more so, about their children not going back to school.”

Mental health experts have long been concerned about what would happen if Covid persisted, or even worse, resurged. In January, Dr. Robert Roca, chair of the American Psychiatric Association’s Council on Geriatric Psychiatry, told us that this would be a real test of people’s resilience. “When people’s confidence in the future wavers is when the most dire psychiatric events happen,” he said. Amidst the Delta variant, Dr. Hoover says students are facing layers of anxiety and uncertainty over what will happen next and fear for themselves and others; not just because of the stress and worries of contracting Covid itself but also concern that in-person school might soon shut down again.

In August, Amina Castronovo, a high school student in New York City, told Teen Vogue she worried about the mental health of her peers after 17 months of off-and-on quarantine and isolation. She pointed out that school administrators need to focus on mental health, not just on catching kids up academically.

Many schools are doing just that, notes Dr. Hoover, hoping that having kids return to the classroom will increase the identification of students who need support. “As schools have geared up to reopen for the 2021-2022 school year, we have witnessed many put into place screening to determine the impact of Covid on the well-being of children,” she says. This isn’t just a result of teachers being mandatory reports, she notes, which existed pre-Covid, but because of an increased understanding that schools play a role in early identification. “Screening is not only for mental health concerns but also basic quality of life factors like food, housing, and family functioning.”

States are also turning to Covid stimulus funding to support and expand their school-based services. For example, in June, California released a spending plan to expand its home- and community-based services, including $75 million in enhanced federal funds toward Mental Health First Aid for Schools and a back-to-school toolkit. The state is focusing on early intervention and helping schools support students who experience a crisis or mental health challenges as they return to the classroom for the 2021-2022 school year.

Schools that previously experienced a crisis like a mass shooting or natural disaster already knew that mental health crisis leadership is essential to community healing. Leora Wolf-Prusan, EdD, told us in September 2020 that “grief is the gateway conversation to crisis.” She’s the school mental health lead for the Pacific Southwest MHTTC. To help guide education leaders during disasters like Covid, she created a school mental health crisis leadership guide that includes thoughts from leaders who use curricula and instruction as the framework to discuss life, loss, grief, crisis, renewal, recovery, and growth. 

Dr. Hoover witnessed a similar shift among education leaders during the Covid disaster. They’ve leaned into examining how they can help students and staff as they navigate the ongoing pandemic, even during school closures. “I think a lot of folks thought with schools physically shut down, kids weren’t going to be able to get services through them anymore,” she says, “but actually what schools did, both for academics and student support, was leverage technology.” 

She says that throughout the pandemic, schools have become even more prominent as a place for kids to get mental health services through telehealth. Now that schools are restarting in person, they’re able to leverage the technology they already have in place to engage parents and provide distance learning for quarantining students and those with medical exemption to in-person learning. “They don’t have to reinvent the wheel,” she says. 

Superintendents have also worked with family advocacy organizations during the pandemic and understand that distance learning can actually be a better learning format for some kids. “That includes kids who have significant anxiety, some on the autism spectrum, or those who are bullied,” says Dr. Hoover. 

To help with early identification, schools are also putting into place technology they can use regardless of whether students are in-person or virtual, like Closegap, a free platform for daily well-being check-ins for K-12 students. “Students do it at the beginning of the day,” says Dr. Hoover. She says it provides teachers a dashboard with their students’ daily emotional health and gives kids an opportunity to say, “I need extra help from my teacher or counselor today.”

“We know that mental well-being is not a constant,” she says. “This is a quick pulse check that teachers can use to understand how their students are doing and intervene early.”

Dr. Hoover shares that the benefit of having been in a physically distanced world and leveraging telehealth for the last year and a half is that schools better understand how to navigate numerous learning landscapes. “They can quickly toggle from one to the other,” she says, “and tell students, ‘Okay, if you’re in the classroom or at home, here’s how you’re going to get academic and mental health support.’”