There have been many challenges impacting children and adolescents during the pandemic. Consider that children may have had their schooling completely altered, possibly numerous times. Some may have engaged in schooling completely remote when COVID-19 cases rose, then switched to a hybrid model, then to in person schooling with restrictions, and back to completely remote again, whereas others may not have had the means or ability to engage in remote schooling at all. For children who are able to attend school in person, activities such as lunch may now be isolated disrupting the normal banter at the lunch table, gym may be less integrated, and recess may be structured without physical contact. Typical facial cues such as a smile, a frown, or a scowl, are often not seen as faces are most often being concealed with masks, limiting non-verbal communication.

Children may also not have typical off hours interaction such as sleepovers or play dates.  Consider children who may not have had the financial means to access remote schooling for reasons such as a lack of computer, tablet, or WIFI. Additionally, consider children who may have received their meals at school and now are hungry, or the children who are living in homes where they could be abused or neglected. Teachers were often the frontline person where a child could disclose issues occurring in their home, may have observed signs of abuse or neglect, and took steps to ensure that a child was receiving services and was protected.

Mental health issues, specifically, are increasing due to the pandemic. According to a Kaiser Family Foundation poll, nearly half of Americans report that the coronavirus pandemic is harming their mental health.^[1] A federal emergency hotline administered by Substance Abuse and Mental Health Services Administration (SAMHSA), for people in emotional distress, registered a more than 1,000 percent increase in April 2020 as compared with the same time last year.^[2]

It is important for Allied Healthcare Professionals to remain aware of risk factors when treating children and adolescents. This includes treatment either via telehealth or in person. Minors who were struggling before the pandemic are at higher risk.  Although data is limited to date, a study recently found that children are experiencing mental health issues as a result of the pandemic. In one study, out of China, published in JAMA Pediatrics, researchers in Hubei province, where the pandemic originated, examined a sample group of 2,330 schoolchildren for signs of emotional distress. The children had been locked down for what, to quarantine-weary people may seem to be a relatively short period–an average of 33.7 days. Even after that single month, 22.6% of the children reported depressive symptoms and 18.9% were experiencing anxiety. Additionally, they indicated that reduction of outdoor activities and social interaction may have been associated.^[3]

It is also important to keep in mind that suicide rates for young people were already rising before the pandemic. According to the Centers for Disease Control, between 2007 and 2017, suicides increased 56% among people between the ages of 10 and 24.^[4] With minors being isolated, it is important to be vigilant for any suicidal ideation.

There are many stressors that minors may be experiencing. Allied Healthcare Professionals who treat minors should be aware of risks as well as know how to obtain resources for their patients. Although this is not an exhaustive list, it is important to keep a few considerations in mind:

• Know how to access and obtain services in your patient’s area.
• When indicated, and provided there are no restrictions on consent, involve the minor’s parent/guardian in treatment.
• Be aware if you need to take immediate steps to obtain assistance. 
• If engaging in telehealth, know the patient’s location ahead of time.  You may not be in a session at the time you become aware of an issue, however, you may need to attempt to find out the patient’s location. 
• Know when you may need to quickly take action by contacting the relevant authorities.  Safety is of the utmost importance.
• Know if you are a mandated reporter and what the requirements are in your state.
• Be aware if you have a duty to warn/protect and steps you may need to take.  Specific to mental health, the National Conference of State Legislatures has a complete list of each states’ laws, and it is important you know the rules in your particular state.
• If you are an Allied Healthcare Professional not providing mental health treatment, check your board of licensure’s website, your professional organization’s website, and your state website for applicable laws.  As regulations change, it is important to be up to date on the laws in your state pertaining to duty to warn/protect.^[5]
• If you have time, i.e., the situation does not put the patient or others at imminent risk, seek advice from a risk management professional or an attorney.

It is important to know your local and state resources. For additional support, the below programs and hotlines, may be helpful.

• Child help National Child Abuse Hotline — 1800-4ACHILD, https://www.childhelp.org/hotline

• SAMHSA distress helpline — 1-800-985-5990 or text “talk with us” to 66746, https://www.samhsa.gov
• National Alliance of Mental Illness — 1-800-950-6264 (Monday-Friday, 10 a.m. to 6 p.m. EST) http://www.nami.org

• 211 — National Suicide Hotline
• National Suicide Prevention Lifeline – 1-800-273-TALK (8255)

• Crisis Textline — Text Connect to 741741

Kristen Lambert, JD, MSW, LICSW, CPHRM, FASHRM Healthcare Practice and Risk Management Innovation Officer Trust Risk Management Services, Inc. email: contact@trustrms.com

NOTE: This information is provided as a risk management resource and is not legal advice or an individualized personal consultation.  At the time this resource was prepared, all information was as current and accurate as possible; however, regulations, laws, or prevailing professional practice standards may have changed since the posting or recording of this resource. Accordingly, it is your responsibility to confirm whether regulatory or legal issues that are relevant to you have since been updated and/or to consult with your professional advisors or legal counsel for timely guidance specific to your situation. As with all professional use of material, please explicitly cite The Trust as the source if you reproduce or distribute any portion of these resources.  Reproduction or distribution of this resource without the express written permission of The Trust is strictly prohibited.