CMHO Guidelines: Impact of Pandemics on Child and Youth Mental Health
Children’s Mental Health Ontario (CMHO) have produced an interim guideline document sharing existing evidence about the impacts of pandemics on child and youth mental health to assist service providing agencies to better understand emerging needs and plan for service delivery post-pandemic.
The document comes with the note “The contents of this document were gathered through a rapid, non-systematic scan of the evidence with an intent to support Ontario’s child and youth mental health service providers in a timely fashion. This information reflects information available at the time of writing. As new knowledge emerges, this document may evolve.”
Potential Impacts of COVID-19 on Child and Youth Mental Health: Considerations for service planning during and post-pandemic has compiled:
· A summary of relevant findings from the peer-reviewed and gray literature on the potential impacts of pandemics on child and youth mental health
· Considerations for service capacity planning post-pandemic
· Information about a current research study aimed to identify child and youth mental health experiences and needs as a result of the COVID-19 pandemic
· Information about a current evaluation study aimed to understand agencies’ rapid transition to delivery of virtual mental health services in light of COVID-19, in effort to help plan for and improve virtual care through and post-pandemic.
The authors note that “a) evidence specific to the psychological impacts of pandemics is limited, (Morganstein et al., 2017); b) evidence specific to children and youth is sparse; and c) while proxies may provide us clues as to the potential volume, severity, type and duration of mental health needs service providers may be facing, we are experiencing a wholly unprecedented situation (the first global pandemic with physical distancing measures of this scale in the past 100 years) and real-time data will be our best guide.”
The document looks to existing and emerging literature for considerations on:
· Why the pandemic is expected to affect child and youth mental health (potential sources of distress)
· How it may affect child and youth mental health (presenting issues and concerns)
· Who may be at higher risk (vulnerable populations) of experiencing adverse mental health consequences as a result of COVID-19.
The document draws attention to the study by Whaley et al (2017) which “reported that while children and youth have demonstrated heightened resilience to the effects of pandemics and disasters when compared to adults, young people of all ages possess cognitive and psychological developmental characteristics that make them more vulnerable to the immediate and long-term impacts of crises.
Specifically, children’s limited understanding of dangers, how to remain safe or when/how to access help and limited problem-solving skills can make them vulnerable to increased stress, fear, anxieity, academic challenges, contact with dangerous situations or materials during or in the aftermath of a disaster (Whaley et al., 2017). Psychologically, children’s limited coping and emotion regulation skills place them at elevated risk of increased symptoms of posttraumatic stress, depression, anxiety and behavioural problems during or in the aftermath of a disaster (Whaley et al., 2017). Infants are impacted by their caregivers’ responses and can experience significant distress when these are insufficient or problematic. Because of their limited capacity to understand the crisis and their developing emotion regulation and coping skills, toddlers, preschoolers and some school-aged children are at risk of experiencing heightened levels of distress, fear and anxiety, and can be challenged to learn due to feelings of distraction, distress, anxiety and/or depression.”
The authors of the document have “adapted the work of Whaley et al. (2017, p. 219) and summarized factors potentially relevant to the COVID-19 pandemic in Table 1. These risk factors have not been validated in relation to the COVID-19 pandemic or previous pandemics but have been drawn from existing literature on various types of disasters and traumatic events.”
The document identifies sub-populations of children and youth vulnerable to the mental health impacts of the COVID-19 pandemic.
· Children, you or families/caregivers with pre-existing mental illness and substance use disorders
· Children, youth or families/caregivers who are members of marginalized communities, including Indigenous populations, migrants and refugees, and individuals who are homeless or precariously housed
· Children, youth or families/caregivers who have contracted the virus.
· Youth or young people whose family/caregivers provide essential services during the pandemic
The CMHO, together with the CHEO Research Institute, has launched a study to explore the impact of COVID-19 on Ontario’s children, youth and families, consisting of two online surveys: a survey for young people 12-25 year old and a survey for parents or caregivers with children 4-25 years old. The research group plans to use this information to forecast what changes in mental health services may be precipitated by the outbreak and provide suggestions to assist mental health services providers and agencies with their responses. So far, survey responses have been collected from 740 parents or caregivers. A high-level summary of study findings will be made available to the Lead Agency Consortium as soon as possible.
CMHO and sector partners are also launching an evaluation study to learn about the process of implementing virtual care during the COVID-19 pandemic, as well as the impacts on clients and services providers, in order to assist the sector, post-pandemic, to take planned, deliberate steps to adding virtual care options as a service tool on an ongoing basis.
The document also includes a list of Canadian and International Resources on the psychological impacts of the COVID-19 pandemic and a detailed list of references used in the preparation of the document.