The Immediate and Lasting Impacts of COVID-19 on Children

August 4, 2020

COVID-19 has unique implications for child populations regarding physical health, mental development, and social well-being. Although evidence indicates that children are less susceptible to the more severe physical symptoms of COVID-19 that are reported in adults, emerging evidence points to new short- and long-term impacts that will affect children’s health long after the pandemic is adequately controlled. The CDC has identified an alarming emergence of multisystem inflammatory syndrome (MIS-C) cases — a potentially deadly condition that is more prevalent among children who have been diagnosed with or exposed to COVID-19. In addition to the direct effects of the virus, there have also been calls to recognize the impacts of social distancing measures on the long-term physical and mental health of children, including drops in vaccination levels and delayed critical well-child visits. Children are at risk of toxic stress, as well as other adverse childhood experiences (ACEs) during the COVID-19 outbreak that carry downstream implications for sustained mental health. Furthermore, the controversy surrounding schools reopening in the fall has generated elevated concern about ensuring that children, as well as their teachers and other school support staff, will be able to stay safe in the classroom and protected against COVID-19 transmission. This webinar addressed the specific impacts posed by COVID-19 to children in the short- and long-term and provide policy options that may support children’s physical and mental health.


  • Tamera Coyne-Beasley, past president Society for Adolescent Health and Medicine, Derrol Dawkins, MD Endowed Chair in Adolescent Medicine, Children’s of Alabama, University of Alabama Birmingham
  • Gary Blau, Ph.D., Executive Director, The Hackett Center for Mental Health, a Regional Center for Meadows Mental Health Policy Institute
  • David Rubin, M.D., MSCE, Director of PolicyLab, Director of Population Health, The Children’s Hospital of Philadelphia
  • Wendy L. Price, Psy.D., NCSP, President, National Association of School Psychologists
This briefing was made possible with support from the Children’s Hospital Association.

Presentation: Blau Presentation

Presentation: Coyne-Beasley Presentation

Presentation: Price Presentation

Presentation: Rubin Presentation

Event Resources

Key Resources

“Reopening Primary Schools during the Pandemic.” Levinson, M., Cevik, M., and Lipsitch, M. The New England Journal of Medicine. July 29, 2020. Available at

“What Do We Know About Children and Coronavirus Transmission?” Michaud, J., and Kates, J. Kaiser Family Foundation. July 29, 2020. Available at

“Coronavirus Pandemic: How Can We Reduce Long-Term Impact on Children’s Mental Health?” Gleason, M. Children’s Hospital of The King’s Daughters. June 1, 2020. Available at

“For Parents: MIS-C.” Centers for Disease Control and Prevention. May 20, 2020. Available at

“Preventing Adverse Childhood Experiences During COVID-19.” Association of State and Territorial Health Officials. April 8, 2020. Available at

Additional Resources

“Young Kids Could Spread COVID-19 As Much As Older Children and Adults.” Ann & Robert H. Lurie Children’s Hospital of Chicago. July 30, 2020. Available at

“Study: Middle, High Schoolers Can Spread Coronavirus As Well As Adults.” Knutson, J. Axios. July 18, 2020. Available at

“Millions of Seniors Live in Households With School-Age Children.” Rae, M., Neuman, T., Kates, J., et al. Kaiser Family Foundation. July 16, 2020. Available at

“Medical Vulnerability of Young Adults to Severe COVID-19 Illness – Data From the National Health Interview Survey.” Adams, S., Park, M., Schaub, J., et al. Journal of Adolescent Health. July 13, 2020. Available at

“1 in 3 Young Adults May Face Severe COVID-19, UCSF Study Shows.” Leigh, S. University of California San Francisco. July 12, 2020. Available at

“Researchers Report Nearly 300 Cases of Inflammatory Syndrome Tied to Covid-19 in Kids.” Branswell, H. STAT News. June 29, 2020. Available at

“Teens & COVID-19: Challenges and Opportunities During the Outbreak.” American Academy of Pediatrics. June 5, 2020. Available at

“Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration – United States, 2020.” Santoli, J., Lindley, M., DeSilva, M., et al. Morbidity and Mortality Weekly Report (MMWR). Centers for Disease Control and Prevention. May 15, 2020. Available at

“Coronavirus in Babies and Kids.” Milstone, A. Johns Hopkins Medicine. May 13, 2020. Available at

“COVID-19 in Children and the Dynamics of Infection in Families.” Posfay-Barbe, K., Wagner, N., Gauthey, M., et al. Pediatrics. May 12, 2020. Available at

“The Impact of the COVID-19 Pandemic on Adolescents.” Volkin, S. The Hub. May 11, 2020. Available at

“Adolescents’ Motivations to Engage in Social Distancing During the COVID-19 Pandemic: Associations with Mental and Social Health.” Oosterhoff, B., Palmer, C., Wilson, J., et al. The Journal of Adolescent Health. May 8, 2020. Available at

“Changes in Income and Health Coverage Eligibility After Job Loss Due to COVID-19.” Pollitz, K. and Claxton, G. Kaiser Family Foundation. April 14, 2020. Available at



Tamera Coyne-Beasley
Derrol Dawkins, MD Endowed Chair in Adolescent Medicine, Children’s of Alabama, University of Alabama Birmingham

Gary Blau
Executive Director of The Hackett Center for Mental Health

Wendy Price
President, National Association of School Psychologists

David Rubin
Director of PolicyLab and Director of Population Health, The Children’s Hospital of Philadelphia

Experts and Analysts:

Joan Alker
Georgetown University Center for Children and Families, Executive Director

Ken Duckworth
National Alliance on Mental Illness, Chief Medical Officer, Information, Support and Education

Dolores Acevedo-Garcia
Brandeis University Institute for Child, Youth, and Family Policy, Director

Jeffrey L. Goldhagen
University of Florida College of Medicine-Jacksonville, Chief of the Division of Community and Societal Pediatrics

Patricia Johnston
National Association for Children’s Behavioral Health, Director of Public Policy

Aimee Ossman
Children’s Hospital Association, Vice President of Policy Analysis and Implementation

Edward Schor
Lucile Packard Foundation for Children’s Health, Senior Vice President of Programs and Partnerships

Kelly Whitener
Georgetown University Center for Children and Families, Associate Professor of the Practice


(This is an unedited transcript. For accurate quotes and presentations, please refer to the full-event video.)

Good afternoon, everybody. I’m president and CEO of the Alliance for Health Policy and I want to welcome you to our webinar on the immediate and Lasting impact of covert 19 on Children.

For those who are not familiar with the Alliant Welcome, We’re a non partisan resource for the policy community, dedicated to advancing knowledge and understanding of health policy issues.

The Alliance for Health Policy, gratefully acknowledge the Children’s Hospital Association for their support program. You can join our conversation on Twitter using the hashtag …, and follow us at All Health Policy.

We want you to be active participants. So please, get your questions ready.

You should see a dashboard on the right side of your web browser, with a speech bubble icon that has a question mark on it. Please use that chat, any questions that you may have throughout the broadcast, and we’ll address as many as we possibly can. Additionally, you can use that if you’re having any technical issues.

Check out our website on health policy dot org or background materials, including the panelists. A recording of today’s webinar will be made available there.

According to the Children’s Hospital Association and American Academy of Pediatrics, as of last Thursday, July 30th, children represented nearly 339,000 cases of Total Reporting coven. And children are at the intersection of, so many of the question here, grappling with.

From understanding the science of the direct to the social, and psychological impact, of various questions about the safest way to re-open cool, And the underlying question about health equity.

I’m so pleased today, to be joined by any panelist can affect the specific impact post 19 for children, physical, mental, and emotional health in the short and long term. Let me introduce them now. First, we will hear from doctor David Reuben, the Director of the Policy Lab, and Director of Population Health at the Children’s Hospital of Philadelphia.

Doctor Reuben, leading children and family advocate, and be practicing primary care pediatrician, and a Professor of Pediatrics at the University of Pennsylvania. Next, we’ll hear from doctor Camera Coin, Deeply. Past president of the Society for Adolescent Health and Medicine, and currently a narrow Balkin MD endowed chair in adolescent medicine at Children’s and Alabama. To outfit their Division Director for Adolescent Medicine, Vice Chair of Pediatrics for Community Engagement and Professor of Pediatrics and Internal Medicine at the University of Alabama, Birmingham, Alabama.

Next, we’ll hear from doctor Gary Webb, the Executive Director of the Center for Mental Health, a Regional Center for Mental Health Policy Institute. Doctor. Bob previously served as Chief of the Child Adolescent and Family branch for 15 years.

And, finally, we’re pleased to be joined by doctor Wendy, President of the National Association of School Psychologists, doctor, over 20 years experience as a psychologist, serving students through counseling and consultation and provide the full psychology intern as well as providing mentorship.

Panelists, thank you so much for joining us today. We’ll hear from each of you, and then we’ll get into our audience Q&A. Money. Now turn it over to doctor David Rubin.

Yeah, thanks for having me everyone. I’m just gonna make a couple of comments during this period, just so we can leave time for Q and A So it can promote my distinguished colleagues and our colleagues on this call. But, you know, just to just Eric …, back in March and April began modeling the forecasts, or what has now grown, to over about 750 counties as United States, representing about 80% of the US population. And we started this endeavor doing level forecasting, because while we were all prepared for the sheer mass to the book was about to happen through national models.

We also knew that we needed to re-open communities as quickly as possible and safely as possible, including schools, getting people back to work, et cetera.

And that, in order to do that, we would need to inform that response by by much more locally crafted models. That has now led to this modeling that we’re doing, if you go to the next slide. For those of you want to visit these models, go to policy lab dot chop dot edu. You can see a nice map of all our counties, and you can click on your individual counties, But the projected cases tab is really what can allow you in your state or your old counties, particularly more populated counties, to be able to see what’s going on. We are now up in all 50 states and the District of Columbia. And so we have we have a fair representation of what’s going on around the country. But if you go to the next slide.

These are what the projections look like. And I just wanted to describe a little bit about why our projections have been so valuable. Not just to my own state, into our region, but too many other states. It’s grown to virus test scores. When you look at our projections tab, we have cases and then we also have what’s called the our estimation, which I’m not showing you, but that’s your transmission rate over time. Models look about their updated every week. There’ll be a new model update out tomorrow. But what you’ll see in our, in our models, is that the actual rate of growth in cases. Where the transmission rates is the number one contributor to the models. If you’re growing, you’re likely going to have a growing forecasts. Now we alter your forecast based on the amount of social distancing people were doing the measured. What’s called the visits to notice that businesses and restaurants and retail stores. In our model, we also look at your, whether we look at your testing positivity rates.

We look at the size of your retiree population, have crowded your living conditions are, within your counties, had what the population density is there.

Real county to grow along the trajectory that they’ve established over time. We don’t assume Philadelphia is going to be New York, or it’s going to be like Sacramento, California, or another, or Indianapolis, Indiana, for example.

And because of that, you know, because we’re updating every week, I can see things that are very subtle, and we see the way this has been shifting. And our overall assessment right now of the epidemic is, we’re fortunate to see. Finally, after it has been a very difficult, somewhat, some evidence of siphoning in Arizona, California, maybe even areas of Texas and Florida, South is very much still having a very difficult time controlling the widespread transmission that we’re seeing throughout that area.

But, as those areas begin to subside, there can be this false sense that things are getting a little bit better, but but we’re seeing continued risk. Now, really moving, I would think of this is Wave. And the wave has not been moving over the heartland into the upper mid-west up through the mid atlantic. And now, I’m concerned that as we try to get some schools re-open here in the next few weeks, we’re gonna see increasing case counts in many areas of the north-east region. This is Philadelphia’s curve and we’re clearly seeing it there, most metro areas, now gone. Online learning, particularly the city areas, which is a huge tragedy, I think we missed a real opportunity to talk about the sacrifices that were not just of preventing hospitalizations and deaths, but assuring the safety opening up of our schools. When we think about and I’ll just close with saying, you know, when I think about school re-opening plans, we know fairly confidently. now that symptomatic children are going to transmit the virus, Fewer kids will be symptomatic. There are less susceptible, particularly the youngest children, than adults.

They’re less likely to have severe infection, but they will, but that, but they will have, some infections, were, and when there’s high community burden, you’re gonna see more infections in kids. In the symptomatic kids, there are the likelihood of spreading events in school environments, is there. We’ve seen major outbreaks in camp, and Missouri, and a camp at Georgia, over the summer, that confirms that, when the disease burden is, how we’re going to see outbreak. So the safest way to re-open schools is, to get case counts down, and you’re gonna be hearing a lot about testing positivity, being much lower in order to do that. And once testing positivity, you can get it down below five, below 3%. depending on what your state leaders in your Departments of Health are telling you.

Then you have an opportunity to kind of use your mitigation plan, and the foundation for a good mitigation plan and schools is really number one, assuring that you keep sick kids and teachers at school. But by symptom checks, and looking for exposures, fewer symptomatic kids there on the school year, the less likely you are going to have a square root of N. And then once they’re in the school, assuring that there’s a fair amount of physical distancing, You know, we have stood at Paul’s behind the recommendation of six feet between desks. I know a lot of districts don’t have that facility, but that’s six feet is based on knowledge about the respiratory viruses like the coronavirus that spread through respiratory droplets. The further you distance kids, the less likely to spread. You’re going to have, and then using a masking effectively, particularly with your teachers and particularly with the kids and transition between classes that you achieve a good bubble for kids? And your transmission rates are down in communities when they sit at their desk. That’s nice distance from other kids.

There may be opportunities when transmission rates are low mass, but unfortunately in our country that it’s very hard to identify any use right now. That would meet those criteria of focus on hygiene. And disinfection is going to be critically important as well. And then supporting efforts to improve ventilation. Depopulate in the classroom and assuring that you know that you’ve kinda thought through the different permutations and what I call the moments of transmission, that the teacher’s lounge, and the teachers are spread out. So they’re not all congregate in a small lounge because of the likelihood of them spreading amongst themselves. And so we can go into a lot more during the Q&A period. But I lead my comments there to say we’re in a very difficult position. We’ve lost a moment here to try to get our schools as open as we could. But I hope that we’re going to regain some opportunity with some of the restrictions per the task force recommendations, and would be limited travel that people might do after Labor Day to try to get some case counts down here, mid september. Maybe revisit some discussions about opening some school safely.

Great. Thank, David. We did have a question from our audience already, and a quick clarifying question. I’m gonna ask you the data that you were showing with that total or pediatric forecasting own land.

Yeah, those are total daily case transmission within these counties, and so they’re not just aggregating pediatric versus adult in in that data.

OK, great, thank you, David. So, now, to turn it over to doctor Hamra point deeply.

Tamara, take it away.

All right, well, let’s go ahead and go to the first slide.

I’m going to talk about adolescence, which is actually a party and the childhood childhood transitions into adolescence. And it’s important to talk about adolescence because they make up about 25% of the populations. And we look at all age groups in the United States, adolescents, and children are the most racially and ethnically diverse among all groups.

It’s also important when we think about, understand that most people consider that to be the age range between 11 and 24, but it is a critical developmental stage as young people transition into adulthood.

There were several important developmental tasks that must be completed, such as developing and applying abstract thinking, adjusting to a new sense in physical sense of self and developing stable and productive peer relationships while also striving for independence and autonomy from one’s parents.

It is also during adolescence when young people adopt a personal value system and develop their own racial, ethnic, social, sexual identity might provide conflicting and also non affirming messages.

Adolescence is also important because it’s a period of brain plasticity and growth.

It’s because of brain plasticity and the chemical and physical changes that adolescents are particularly susceptible to stress. And you’ll hear about this more from other presenters. They’re also very susceptible to the environment.

During adolescence, people will also develop habits and have experiences that impact their physical, psychological, and social health and well-being, and these experiences as well as the outcome so these experiences can be transmitted into adulthood and can even be transmitted inter generationally.

So, the next slide allows us to actually look at a framework for how some of these experiences, which can be positive or negative, can impact individuals, called the social determinants of health, which are the conditions in which people are born, live work and age. They are shaped by the distribution of money, power, and resources, estimated 60% of health related outcomes, and are largely responsible for health inequities.

So, let’s consider, an adolescent and family have negative experiences such as unemployment, inadequate housing, or transportation or safety. Low educational attainment, poor access to food, particularly healthy food if they experience discrimination, stressful, or low access to quality care, outcomes are negatively impacted, and can result in increased morbidity and mortality, as well as decreased life expectancy and health status. So, let’s take a look at the next slide, which gives us another opportunity to describe how people characterized childhood experiences. Adverse childhood experiences, or aces, I will just talk about briefly because another panelist will talk about them more in depth.

I want to call your attention to the second to last category, which is Adverse Community environments. Notice that you have systemic racism listed here among the other variables.

Remember, that one of the things that I told you is that the developmental task of adolescence is to actually help them develop their social, racial, ethnic, gender, sexual, and religious identities. So when you look at the other adverse childhood experiences that they they expect experience through as exemplified in the adverse cultural exposures, you can see that these exposures have an opportunity to deleterious impact young people. And so these include things like homophobia, racism, ageism, ableism, sexism, and classism. So let’s go to the next slide.

Racial injustice and disparities highlighting an exacerbated by the 19 pandemic. I thought it would be important to discuss the impact of racism as an example of the immediate and long lasting impact of children and adolescents. You can see here, we talked about one manifestation of racism, which is discrimination. We can see it can have multiple impacts, however, will talk about the goods and services, as well, a psychological stress and assault.

And, as you can see by the bidirectional arrows, that these things can go in multiple directions.

Denial of goods and services can lead to poor living conditions, as well as decreased quality. Not only health care, but also schools, as you’ve heard, already mentioned.

Also, lead to psychological stress, which can provide psychological symptoms. It can also lead to negative coping behaviors and psychological stress responses, and those of us who are in the medical profession may describe this as an Alice static load. Taken together, all of these things can have significant mental health, as well as psychological or physical outcomes, including anxiety, depression, substance use of post-traumatic Stress Disorder, but even cardiovascular disease, diabetes. And decrease both ways in blood squash and physical injury, can also occur.

Next slide.

But, I want you to know that the disparities that we see during cold, they are not new, and that history actually shows that. Severe illness and death rates tend to be higher for people of color at all times. But, in particular, during public health emergencies, this is related to longstanding systemic health and social inequities, and people of color coded have had higher rates of hospitalization and death. What are the long term complications? are? implications for a long lasting impact for our children? And adolescents, particularly those of color. They also are disproportionately having the first childhood experience of losing a parent A grandparent. A loved one, or community member.

Next slide, please.

Why do racial health disparities exist for many adolescents and their families during coded? Some of the things are listed on this slide and can be characterized into living conditions, work circumstances and health circumstances.

To list a few many people who are of color live in densely populated areas where it’s racial housing segregation, as you heard, Our last panelist talk about. And this racial segregation can lead to health conditions that actually exacerbate during, such as asthma. When we think about homes on reservations, where our Native American populations live, our homes in the black belt that may lack incomplete, plumbing, and inability to wash their hands and have proper hygiene, they may also live in multi-generational in multi-family household, making it hard to quarantine. And we also know that they are overrepresented in jails prisons, shelters, in detention centers, and that in all of these facilities, there are higher rates of colon infection and death compared with the general population.

What about working circumstances? They’re more likely to be an essential worker could be incompetent. But they can also be low wage workers such as meat plant, meat packing plants, grocery stores, cleaning service, cities and factories. And they may need to continue working in their jobs even when they’re sick because of their dire economic circumstances. And they may not have the luxury of sick leave or childcare.

On average, people of color by less than whites have less accumulated wealth, and have higher rates of joblessness clearly leads into some of the health circumstances. When they may be more likely to be uninsured, may not receive health care because of language barriers or distress may actually experience higher rates of comorbid conditions like diabetes or cardiovascular disease which can lead to high death rates when they do contract call it. And then, of course, is the racism, stigma, stigma, and systemic inequities that undermine not only prevention efforts, but increased levels of chronic stress and toxic stress that leave the body body vulnerable. Next slide.

So when we think about potential on public policy, ideas for consideration, I actually have listed a few here. And things like the Affordable Care Act ensures that people can try to get health care, that actually addresses some of those issues related to social determinants, of health, such as protections against evictions, and enhanced unemployment benefits. You can see a variety of things here, including social, criminal, justice, and police reform. But, one way to summarize the types of policies are needed, are policies that promote a living wage to equity as well is eliminate disparate, living, working in health conditions.

When we think about developing policy is important for us to look at it from a socio ecological model, we need policies that are not just directed at an individual, but at an interpersonal level. Policies that impact communities and schools, as well as organization. And then the last thing, which is orange reflects society.

So the next slide, please, final slide, actually participate in a legislative and policy for, without honoring. What I feel is one of our greatest legislators, Congressman, John Lewis. Pulse, Humorous essay published in The New York Times, last Thursday. He reflected on his own adolescence and roads.

Emmett till story. He was masa, Sandra Bland, and we want to tailor.

Till was 14, when he was killed and I was only 15 at the time. I’ll never forget, the moment when he became so clear that he could easily have been me in those days, via constrained us, like an imaginary prison. And troubling thoughts, potential brutality committed for understandable reasons were on the bars.

So called the 19 pandemic. And the racial disparities in highlights is a crisis within a crisis.

Not only does it give us the opportunity to provide input events and heal our country and its children and adolescents from the immediate and lasting impacts of …, but also heal our nation and prevent its children and adolescents future from the immediate and long lasting impacts of the ravages of racism and other ISMS that separate us.

Thank you.

Thank you so much, doctor … deeply presentation. We really appreciate it. And we’re now going to turn to doctor Gary Blau. You’re listening and you have a question. Don’t hesitate to send that and we’re already getting some questions from our audience. Go ahead.

Great. Thank you so much, And thank you all so much for joining this webinar today. First, let me start off by saying that I hope that you and your families, your co-workers, and your friends, are are, Well, I’m honored to have the opportunity to speak with you today. And I think that what we’re trying to do is to take sort of policy issues and then like to Tamara, was saying, you know, to distill that into some very specific issues that are happening.

And my role for today really is, and you can advance the slide, please, is to, to talk about the relationship for cauvery, specifically around the mental health issues, for, for children. And I’m going to talk about the traumatic reactions that we’re experiencing and some of these underlying factors. And then I will talk a little further about the aces study and the impact that this has potentially long term. I will share, I, today, I represent, the hack at Center for Mental Health, where I’m the Executive Director. We are, a regional center. Next slide, please of the Meadows, Mental Health Policy Institute. Not too long established, where we are. And I’m located in Houston, Texas. And my agency really does envision Texas to become a national leader in treating people with mental health leads through our work as an independent, non partisan, data driven policy organization. So, thank you for this opportunity. Next slide.

Prior to this, I was actually 15 years with 25 years in government, 10 with the state of Connecticut, in the Department of Children and Families, and 15 with the Federal Substance Abuse and Mental Health Services Administration, and so talking about kovats effect on children’s mental health. Please, next slide.

I think it’s important that we take a trauma focused lens when discussing this. And, and importantly, of course, trauma, and as it has been defined by my former agency, SAMHSA, is is really about the events that occur, or a series of events that create a set of circumstances that is experienced by the person as either physically or emotionally harmful, or threatening. And that can have lasting adverse effects on the person’s functioning, and that is across a whole realm. You know, Children in many ways I learned this in graduate school children, can be thought of as pi, P I Yes. Physical, intellectual, emotional, and social slash spiritual type of beings and, And that that is sort of the what’s happened to children in the course of Cove. It is not unlike other kind of adverse experiences that you know, that we’ve been discussing.

And this one, however, in contrast to say in where I’m living in Houston a mix of effects of Hurricane Harvey. Or the terrible tragedy in the shooting at Santa Fe High School that have a defined or finite period. This things that have, you know, goes on and on and on, and particularly around quarantining and stuff. And in trauma, it’s really important to, to not talk to young people about what’s the matter with you. It really is about this idea of what happened to you. And that the, the behaviors that we’re often seeing that can occur in children are the result of adaptations to trauma. And that it’s not just that, you know, kids are bad or anything like that, that they’re actually experiencing traumatic events. And then that affects them both physically and emotionally.

And in fact, as we know, traumatic experience has actually changed the way that your brain functions and so through things like MRIs and stuff that you can tell the difference in a child’s brain as a result of trauma. And that healing ultimately happens in the relationships that are developed. So next slide, please.

And I talk about this. And SAMHSA has historically talk to these three E’s. And the events that cause trauma and these, and how you experience it. So the same event may not be experienced by children, or adolescents in the same way. I mean, it really is a personal understanding of this. And, and I think it’s important and continues to be important for all of us to recognize that. It, children that are having to be quarantined. That are missing school, that are struggling with the loss of activities, the loss of being involved with Friends. Sometimes, even the loss of family members, as a result of co big can, this can be incredible, adverse experiences that result in trauma kinds of reactions. And, again, those reactions can be across the gamut of childhood experiences, be that social emotional, or physical. So, next slide, please.

It’s also important that there can be, and this is really developmentally different across the different stages, and we can talk further about that. But in a general sense, you can look at children’s responses, their behaviors, their emotional reactions. Some of their physical things as as is the things that are manifested because of the trauma reactions. So, so, we have different ages that are, you know, young children that may have no trouble sleeping or looking at sort of destructive kinds of things, are older kids that might use drugs, or blow up or start fighting. And these are things that happen across the developmental stages, and it’s really important that our, our, whether kids are going back to school or counselors and take this kind of a lens, because really, we need to understand these trauma responses. Again, not not about what’s the matter with you, but what’s happened to you.

What are these kinds of events that really resonate to the point where a child is acting out? And is having some kind of difficulty may baby, you know, challenges with their bellies, or trouble concentrating, or fears that are manifesting themselves. So this slide really does help us to understand that these are behaviors that are the result of traumatic experiences. So next slide.

It was mentioned before, and I think it’s important for us to focus on this idea of adverse childhood experiences. There can be many kinds of adverse experiences, whether it’s things like significant abuse or neglect, or terrible experiences with child victimization of some sort. And I also, you know, I think that what we’ve done at the Hackett Center and the work we’ve done around Hurricane Harvey and Santa Fe is to understand that specific Events and and Covert is certainly one of them, can really be identified as this kind of an adverse experience that gives rise to trauma. And then, in the Kaiser studies, where you got to understand that, they looked at 17,000 members and talked about their experiences that they were having now and looked at their varying experiences in childhood as far as their traumatic. We responses are concern.

And …, really, what was found in Kaiser to their credit, is actually doing a new study around this, to see if the same kind of things are happening, but multiple adverse experiences, sort of, are cumulative, and give rise to negative outcome. So, the more adverse experiences you have, and the more intensity that is, experience, the more negative outcomes you’re going to have. So, for example, you can see on this particular slide, that if you have four or more adverse experiences, you’re gonna have a higher likelihood for depression, higher likelihood for using drugs or smoking. The real key to this is that you can also have higher likelihood of many physical kinds of issues as well.

Cardiovascular disease is a great example, so young people had many and multiple adverse childhood experiences have, later, in their adulthood, have higher rates of things like cardiovascular disease, diabetes, lung disease, and of course, other things like suicide.

So these are just framing it around, the good news is that we can mitigate these impacts, but it’s important to understand where these impacts are coming from. Next slide, please.

So right now, our children are experiencing these effects. Short-term, certainly, irritability, anxiety, isolation, the issues that are being happening because of school and our next speaker is going to talk about the issues related to school functioning. We also know that there’s pent up demand without children being seen in various forums. We don’t know that that that they may be having issues that we need to address around child abuse or other kinds of victimization. And in the long term impacts that we know are widening this education gap between folks that have resources versus those that don’t in terms of poverty issues and that we’re then going to see increases in diagnoses related to trauma like post-traumatic stress disorder, like significant depression and significant anxiety. Next slide, please.

The bottom line here, come from a former colleague and good friend, doctor Larke, wrong at SAMHSA, who said that really the bottom line is that kids that are too sad or too mad, can’t add. And that that is really a phrase that we’d like to talk about, that it’s important to address the mental health of youngsters in order for them to do well, to perform well, to do better in school. And that. we also know that the young people, that aces are more prevalent for children of color. Children living in poverty and young people that have LGBT issue status. You know, that, that, that, we just know, that, obviously, you’re having more potential for adverse experiences, and final slide, please.

So, our policy options that we are focused on, when we’re talking about getting kids health, we’re talking about expanding and continuing telehealth, because that helps us with capacity and access. It involves engaging our pediatricians and our pediatric providers in terms of collaborative care of integrating physical and mental health care, and that’s where kids go. Families. 75% of families take their kids to their pediatrician when they’re concerned about a mental health issue. We know we need to do more around evidence based practices and measure care more, and, as Tamara said, we need to address health equity kinds of issues. So that’s sort of a nutshell about what’s happening with the mental health of our children today, and some ideas for the future for how we can impact it in a positive way. So thank you very much.

Great, thank you, Gary. And I could just quickly ask you to clarify something that came in from the audience to ask what Pi four, if you could just clarify that, for sure pies. It’s just an acronym that I used as a is an easy way to understand the importance that we think of a whole pie. And then we cut it into these segments for children.

It’s physical, intellectual, emotional, and social spiritual. And that really frames out the various spheres of development and sphere of functioning that children have.

Great. Thank you so much. Great. So taking up now to the level of schools and psychologists, Wendy Prey. Thank you. Thank you. So I’m representing 25,000 school psychologists across the country, and then 28 different countries. And the President of the National Association of School Psychologists. And for those of you that don’t know what or who was school psychologist is. Next slide, please.

We are school workers who are uniquely qualified members of school teams, and we have a broad range of skill sets, and we really have expertise in mental health learning behavior. And we try and help children succeed academically, socially, behaviorally, and emotionally, so that’s a wide range of things that a school psychologists can do, and we tend to work in concert with other mental and behavioral health professionals in the schools, such as school counselors, school adjustment counselors, school social workers, school nurses, and we really partner with families, teachers, and administrators, to create supportive and healthy, safe learning environments for students. And a school Psychologist Role could also include assessment for learning disabilities, So, doing testing through the IEP process. We do crisis work, individual and group counseling, and consultation.

So, for those of you that don’t know what a school psychologist does, I urge you to reach out to your child’s school because they likely have one, maybe not full-time, and I’ll talk about ratios in a second. Next slide.

So, what we know, and the thing that I I believe that parents are the most concerned about in terms of coming back to school, is the known effects of what Calvin has done to our students, our children. And, number one is, you know, perhaps, loss of learning because everybody was doing virtual.

The kind of academic work from March on, and it was new territory. Nobody really knew how to deliver the same sort of academic and social emotional supports to children via tele telehealth. So they weren’t getting the same 1 to 1 instruction from teachers that they had been getting previously. So people are concerned about loss of learning. There’s an increase in level of stress. Stress, as some of my colleagues have alluded to before me. Mental health risks, risks, including trauma, and that’s for students and staff.

There’s a higher risk for students with disabilities. Are ingrid’s English language learners are LGBTQ one to S, children and youth and there’s also increased family stress and instability that comes with the financial fragility. As mentioned, previously, there might be some grief and loss of family members or close friends who have died of …. And there really is glaring inequities on the impact of communities of color. So the compounded trauma of systemic racism and violence against black communities and other people of color.

So, we clearly need federal guidance for schools, regarding how we’re going to meet this, the student’s needs, particularly with regard to Special Education, our kids in the substantially separate classrooms. Kids with intellectual impairments, Down’s syndrome kids that may tend to go to school year round and have an extended school year. And the other impact is inadequate funding and staff resources. So, for school psychologists, we’re being asked to do more and more with less and less, and that also goes for our teachers and our administrators. Next slide, please.

So, addressing the social, emotional learning and mental health needs of students and staff. Schools.

Operate within multi-tiered systems of support, MTSS. And anybody that’s worked in a school would probably recognize this triangle. It’s a response to intervention, MTSS model. And I’m gonna be talking a little bit about the Tier one, which is all students. And it’s a universal core curriculum that every student has access to. And tier one is the level that everyone participates in.

So, there may be a screening for reading at the beginning of the year in the middle of the year, and at the end of the year to make sure that kids are reaching benchmark opportunities and levels. And, you know, this may include evidenced based classroom lessons, morning meetings, to check in, see how students are doing, check in, check out. There may be advisory periods where a school counselor may check in with the student to make sure that they’re in line to continue on the right path, scholastically, in terms of the way that their curriculum is made, and it may include peer buddies.

I’m a school psychologist at a regional high school on the South Shore of Massachusetts.

And we try to do as much tier one preventative and proactive interventions as we can, so that we’re able to hit more students, educationally speaking with proactive and preventative supports so that they don’t have to be kicked up to tier two, which is individual and small group counseling.

You know, we, we tend to look to help a specified number of people that are not able to reach potential in Tier one, so they need additional supports. Next slide, please.

So, access to school mental health professionals. I’ve got some recommended ratios here. The school psychologist ratio comes from NASS, my organization, the other ratios were found in other areas of expertise of school mental health professionals work. So School Psychologists, The recommended ratio from NASA is one school psychologist for every 500 students.

In my particular building, I’m very, very fortunate, at Whitman Hansen to have to school psychologist for 1200 students. So we’re a little bit over the ratio of 1 to 500, and we have 1 to 600. However, we also have many, many other school based, mental health professionals, such as school counselors, social worker and school. Nurses who help with our behavioral and mental health supports school counselors, the recommended ratio is 1 for 250 students. And that’s the same as school social workers, and school nurses. It’s 1 to 750 students. However, the lack of funding and budget cuts to schools and education means that many schools have much higher ratios. For example, in some districts, they might have one school psychologist helping 5000 students.

And this is all tied to funding. This is all tied to grant writing and this is all tied to budget’s. Next slide.

So, our return to school will not be a return to the school norm. And, you know, right now school districts are hammering out 1 of 3 different type of educational platforms that they may be accessing. one is going to back, going back to school full-time, in person. And what does that mean for meeting the social emotional needs of students and their, their safety? There could be a hybrid model, that is, you go a few days, and then you do the rest online, learning at home, and, and different teams are rotated in and out, or it may be completely virtual. And so, what does that do to the impact of our social emotional needs of students when they’re not able to see their friends. And so, I’ve included next slide.

Some resources I encourage you to go to the … website and download some of these excellent resources. Because we certainly can’t tackle everything in the 5 to 7 minutes that we are allotted, but I encourage you to look at and ask for additional resources. Thank you.

Great. Thank you, Wendy, and hello. And I’m gonna ask our panelists to turn on their cameras, have an obsession. Right, Thank you all for that session. We’re going to go to 1 of 5, We’re gonna take about 15 minutes for some questions, So, let me kind of app on. A lot of people’s minds. I mean, David, you know, going back to your presentation. You talked about Yes, can can spread the virus. There’s also strange. New PubMed.

That Maybe you could spend a minute talking about, I mean, people, Are people kind of afraid, for their kids live, the life that the teachers or teachers may come into contact with?

Let’s just talk about the physical health and epidemiology for a second. And we got a question from the audience about sort of age ranges. There are difference, in terms of the spread between kids who are under three years or older. Give us a little bit of event, David.

Well, we know that the kids can carry the virus.

You know, I think younger, the younger the child is, the less susceptible they appear to become to becoming symptomatic with the loads, which likely makes them less contagions. Contagious. This is this is not absolute.

I do think that adolescents, both because of behavior and because of the fact that they appear to carry this virus and become symptomatic and similar rates to adults, it places them at some higher risk for symptomatic transmission.

Look, the risk of severe infection is low in kids.

It’s also lower in kids with special needs. You know, it’s a little bit surprised when I saw the CDC list for parents talk about, does your child have an underlying health condition that makes them more prone to severe covert illness? Well, we haven’t seen that actually, you know, children’s hospitals.

Even our young kids with special needs, or asthma, or other types underlying chronic health conditions, kids with sickle cell disease, Kids with cancer, have not gotten really sick, disproportionately, like we see an influenza season, for example. But that said, some kids will get really sick and one of the syndromes we described this summer, it’s a rare syndrome, but consistent with this immune mediated response. And coronavirus, M I S C, is sort of a variant of … disease with very high fevers. Cardiac dysfunction, often coronary artery abnormalities others. Problems with blood pressure, shock, in a lot of our kids, it seems to be responsive to the medications we use for … disease. These kids are extremely sick. It’s just very rare.

So, you take advantage of the fact knowing that kids are at less risk for severe infection. It gives you some opportunities to open, but they transmit.

And so, you know, and kids don’t live in bubbles.

They rely on parents and grandparents every day. They rely on their teachers, the school personnel Wendy talked about today, you know, to know that are involved in their daily lives. And there’s such a sort of foundational sort of social network for a community.

That this isn’t simply about whether kids don’t get that SIQ.

This is about the risk to entire communities that are borne by placing kids in large groups in a school.

And so, that’s why I try to contextualize these comments. I don’t worry as much about the kids in terms of the energy will help. Although I qualify that, we don’t know the subtle chronic, made a mistake. This is still an evolving disease and whether there’ll be chronic health issues later on in life, coronary artery disease. Based on some of the things we see with an MIS, even in my older kids. But that said, I think we have to, we have to think of kids in this idea of a social network or prefer community. And we want to get, and it should have been a national priority to get these kids back to school safely so that the community could work. So that the so that people get back to their lives. And I see us has now having missed the mark. But still hoping that we begin to understand what we’ve lost here. It’s a real tragedy that schools are not re-opening right now. And it doesn’t matter what elected officials are going to do. Parents are not going to send their kids to schools if they don’t feel safe.

Teachers are not going to go into the classroom, building public confidence that our schools can be saved, is extremely important.

And I’ll leave you with one story, which is, we were terrified to go back to work in April, in March and April at Children’s Hospital. And it’s because of the, the mitigation plans and the safety plans we put into effect for our staff with our masking our distance, et cetera, that we have not seen any transmission to our staff, And I can tell you, we had nurses or physicians. We had office staff were, All terrified. They all share the same medical and psychosocial complexity that our communities have. We all feel safer now when we go to work. When we’re walking around on the streets, and that’s what we want our teachers and our parents to fuel. When kids go to school. and until we can achieve that, you’re not going to be able to successfully open schools.

Level of public trust. And, confidence, And actually, super quick, follow up. Very, Very quickly.

David, We had a question about, you know, someone from the audience has heard about doctors to say, there had been no case of transmission reported from child to adult, like, how do you get that trust if there’s still so much? Is that true? That’s not, that’s not true.

OK, right. Thank you for confirming that.

But let me let me, you know, just one more kind of cool, I mean, Wendy kind of laid out three different scenarios, kind of a full-time return to call a virtual and then sort of an in-between. You know, I mean, from the standpoint, when you start with you and then and then we can kind of go to the panel from the standpoint of the vector and well-being of care.

Whether we’re talking about the risks of transmission to each other or to the adults in their household or their social and emotional, is there any one?

Sort of three general categories right now that it seems like it’s going be the best or the most optimal in terms of balancing those tradeoffs.

I mean, it really depends where you are in the country and what your levels of covert are around you, We have colleagues in Montana that, you know, are very small and very rural districts, and they haven’t had a single case of covert and they’re ready to go back.

Whereas, maybe, you know, Boston Public Schools with, you know, thousands and thousands of students is certainly not ready, and, there’s going to be challenges for any of the, type of going back to school plans that you look at. For in person, You have to look at, the safety. As David was saying, The, you know, six feet, you have to have adequate space in-between student desks.

Kids are going to have to wear masks, We’re going to have to look at scheduling of students and supporting the higher risk students and staff. So, for example, a student who may have leukemia, who would be very susceptible. We have to be thinking about some of these higher risk people have to think about the psychological safety, As as Gary was saying, we have to reinforce this stability and security, we have to allow for healthy social interactions. Positive communication between home and school. And, we have to identify students who are in more risk of intensive academic and social emotional needs. And also, as Gary said, addressing trauma and other issues.

When we’re looking at the schools, virtual needs, there’s continued concerns regarding the inequities in the system. Does everybody have access to wireless or broadband Wi-Fi or do they have access to Chromebooks?

We’ll also have to be monitoring student well-being virtually. There’s the mental health and the family stability of kids being cooped up with.

They’re family for long periods of time.

We also have to think about reinforcing positive relationships between students and staff. I happened to be down in New Orleans when the pandemic hit. And I stayed for three months, but I was still checking in daily with the students in my high school that I provide emotional support to. And I was very, very concerned about them.

Um, so, I mean, there’s, there’s just a litany of things that schools are going to have to consider and it’s no one size fits all. It really isn’t. It’s, and that’s what I think is so cold. Because people are looking for the one answer to say, OK, you should do it this way, and it’s such a fluid and dynamic situation that what we’ve put into place in September, may not be appropriate in January. And we may have to roll back, and we’ll forward, and, and being flexible.

And really paying attention to, to the levels around us in our neighborhoods, and our, in our communities.

Funding areas around the social impact, and we got a great question from the audience. Gary, Hammer, you’re welcome to join, you know, can you see the reality that, not every childhood experiences, trauma and their impact? And I would add.

Can you start with that? I’d love to hear your thoughts.

Sure, I think that these are great questions. So, I mean, first of all, I think one of the issues that we have to grapple with is that there is no right answer when he was talking about that. And, you know, that we have to address these issues, and, and it will create a real problem with some of the equity, You know, kinds of pieces. People need. Their kids need to be in school. They need the socialization. Mean, I worry about my own, again, grandkids, and, you know, about how how they can get back safely and efficiently, And And so we’re, I think, the everyone is struggling with that, especially for parents who have to work. We know that unemployment is also a major contributor to challenges. My agency at the meadows Spinoff Policy Institute did a modeling study about for if you, if, for every increase in unemployment rates, for percentages that we can expect increases in deaths by despair, which include suicide and substance use.

And so all of these factors have to be taken into consideration. And at the same time, we have to protect our children and to address how they may be feeling that entire range. So, again, this is developmentally important that the child’s range of responses to this may be very impacted by, you know, their age. So, you have preschool children that, you know, may experience bedwetting or bad dreams or appetite changes in temperature, tantrums, you know, all the way through no adolescents who, who have significant issues with, you know, sort of, oppositional kinds of things. And, yes.

That, that, you know, those kinds of ranges are part of this my hope. And what I’m, you know, I think, as part of the process, is that we have to have our counselors, our guidance folks, our teachers, our pediatricians, everyone that touches on families, and children to better understand what those range of behaviors are so that we can intervene this whole idea of a multi-tiered system of supports. And, you know, for all of our children, we need to be thinking about how do we best help them with maintaining routines and, and following proper hygiene. But when they starting to demonstrate behavioral and emotional problems, then why do we do, how do we intervene to provide services, or when is it appropriate, to reach out and actually ask for specific kinds of counseling and therapeutic interventions? And, and that’s when I think that everyone is struggling with right now and what we need to address. So, that’s, sort of, again, a nutshell of things that we’re focused on and that we need to be concerned about.

Thank you.
There are even an adverse event being kind of cumulative and talk a little bit about that. And again, like what do you promote resilience as they move forward and hopefully one day we recover from the pandemic.

Sure, sure. And so when we talk about static load, it’s really related to the changes that actually come from a person’s body due to chronic stress. So that can be changes that happens in the brain. It can be something where people already audience might understand. It could be the flight or fight response, is that continue to read the body up. And those have long lasting impacts on different parts of the body, whether it be the heart, whether it be the lungs or even the brain. And I think the thing that’s really important when we think about the developmental tasks that young people have. Adolescence is also a time when people build resiliency. What campers, resiliency? What Canvas resiliency when people get negative messages about themselves When they’re in equities and this is actually something that all children struggle with, whether regardless of their race and ethnicity, because they’re trying to develop their skills and understand who they are, very vulnerable time period.

What helps build resiliency and young people is when they have supportive communities, that doesn’t just mean their families, school, psychologist, people in the school, people in their church. But it doesn’t really just begin when they’re actually adolescents or older children. Positive messaging and helping young people develop strong sense of self really begins at infancy. In fact, it actually begins when they’re being born. Even before conception, because what happens to a family, and particularly on my mother, actually can come transgender to the generations to her child and impacts chart.

So, in fact, we have a mother who is highly stressed, because the issue is the adverse childhood experiences She has. That can epigenetic lead even change the DNA of our child before is on. So, when we think about, kind of, how do we build resiliency, is about community resiliency, a community of acceptance, and really, a community that helps people to feel good about who they are, and to utilize their assets, their best of your ability, and to actually help them when they do face challenges. And so, it’s really about taking an approach. I will talk about first tier, second, Tier three tier. But it’s really about a comprehensive approach, realizing that all of these things are inter-connected with other community level, was an individual level society. And so, resiliency is something that every young person has the opportunity to develop, but they need the community supports through many different disciplines and in many avenues of their lives.

Unfortunately, we’re getting more. Questions. I could ask, Mary, very briefly. What is one practical that family and community?

The webinar, I’ll pick one right now. Actually, comment on that, and I’m going to. David. Cameron Gary, can you can you clarify what you’re talking about?

Clarified. What? 1, 1 practical in your world that you know, we’ve talked about parent, family, and Community in India 1 1 Magic Wand and make? It better.

What would happen?

I’ll start to saying that that in our manuscript that came out again, open Network in the last couple of weeks, people will be surprised by the amount of physical distance and in addition to masking that, is required to keep transmission that day. So, I can have one wish, it would be for people, to recognize to keep the size of their babies Small On, committed to just, you know, you call the pod. I call. just, you know, having a few friends that you spend, your level of, risk, and trying to spend time in smaller groups, until until we’re fortunate enough and I do have optimism.

I think we’re going to have hopefully a vaccine by later winter, but we’ve got another six months to go before we see any relief from hopefully a successful vaccines dartington market.

If we keep our gatherings small and we attend to these distancing, physical distancing recommendations, this virus won’t transmit as effectively.

Thank you.

So to add onto that, clearly, you’ve got to decrease the burden of the disease in the community and doing that outlines really well how that can happen. And so, the other thing that is really important, because I think it goes towards thinking about the lasting impacts of this disease. It goes to adolescence. Our future, in the majority, a large portion of our population is really dealing with the inequities that we have in our society that also perpetuate the disease because we’re not able to get an under control in the same way we which we would if we didn’t have these.

Thank you.

Gary, Unpractical thing, so, you know, I represent a policy institute. So, and from a policy perspective, it’s important that we get people services, when they need it, where they need it. And so, I would really encourage people to fight for the the ongoing payment and inclusion in a benefit package for telehealth services so that people can get help when they need it. So, I’ll leave it at that.

Thank you.

Wendy, you get the last word.

In terms of schools, I think we’d need to prioritize meeting the social emotional needs of our students first and foremost. Because, as was alluded to earlier, when a kid’s upset or dealing with some sort of issue up here, there’s no learning going on. So, we really need to prioritize that, you know, every kid has been out of school, we’re all in the same boat, but we really need to be paying attention to the social emotional needs of the kids and the staff, and the and the families we serve.

Great. Well, thank you all for joining us for a much longer conversation. We really appreciate you sharing your expertise with us today. Picture of Children’s health and the conversation. So, thank you for our audio recording available later this. Afternoon, And, again, Wendy, Gary, Camera. Thank you for joining us, and thank you for making that possible.