June 25, 2021

Coming Out of Our COVID Caves: An Expert’s Guide to Re-Entry

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Cindy Lopez:
Welcome to Voices of Compassion, CHC’s podcast series providing courage, connection and compassion, highlighting topics that matter to our community, our parents, families, educators and other professionals. My name is Cindy Lopez, we’re talking about how we can reemerge from our COVID caves. Recently I read an article that noted over half of Americans say they’ve actually gone out to eat. And almost 60% say that they have recently visited friends and relatives in person. And as a result, some people are reporting that their emotional wellbeing has improved and others are reporting a little bit of a decline. So everyone’s experience is different. What are some strategies that you might consider as you plan for your family’s journey back into the world? Listen in to hear our conversation with Dr. Vivian Keil, Neuropsychologist and Director of Clinical Services at CHC. So Dr. Keil, before we get started I’m just wondering if there’s anything you’d like to share with our listeners?

[00:01:09] Dr. Vivien Keil:
This topic is so timely and so challenging and in some ways I wish I had some magical answers. What I can say is that I’m right there with you. I have two school-aged children and this past year has been quite a whirlwind and quite a challenge trying to juggle life and jobs and school and the like, and so when I chat with you today, you’re going to hear both advice as a clinician and in some ways you also are just going to hear advice from another mother.

[00:01:42] Cindy Lopez:
Some of the articles that I was reading as I was thinking about this podcast topic, people were talking about COVID caves, coming out of your COVID cave, and so that’s kind of stuck with me. So as we’re trying to figure out how to reemerge from COVID, what are you seeing as you talk with families and parents around mental health and what we’re experiencing right now?

[00:02:06] Dr. Vivien Keil:
I think the most common sort of sentiments that I keep hearing from families is just utter exhaustion at this point in terms of the chronic stress and the constant barrage of stressors that have basically been introduced into our lives and families are impacted in such tremendous ways because of the ongoing uncertainty and instability around schooling in particular. None of us know exactly how our schooling situations are going to evolve for our kids, what’s the fall going to look like now that we’re at the end of yet another school year and how are my kids going to catch up and adjust. And then because of all of that stress, I think parents just feel like they’re in a fog of sorts. I don’t think any of us feel like we are as rested or as able or as motivated as we were pre pandemic.

[00:03:01] Cindy Lopez:
We have data from the CDC around what people are reporting about mental health. So 75% of parents say they could have used more emotional support than they received during this time. Parents also said that 32 of them, so about a third have received treatment from a mental health professional. Um about 24% of parents were diagnosed with a mental health disorder since the pandemic started. So our parents are really experiencing a lot of stress and anxiety, right. And our kids are also experiencing similar kinds of issues. So what would the family journey look like as they plan to re-emerge and what are some strategies that parents can use?

[00:03:47] Dr. Vivien Keil:
The new CDC guidelines around basically vaccinated people can be mask free, indoors and outdoors, that’s a big development and what if you have a teenager who is vaccinated and then you have more of a school aged child who is not vaccinated. The parents might be vaccinated, but at the end of the day you still have an unvaccinated child in the home, and so your family decisions need to take into consideration ultimately your family and kind of what you’re comfortable with.

I would encourage parents to essentially reflect and take notice of their own anxiety level. That is such a big piece of this puzzle because anxiety, unlike some of our other childhood disorders that you may have heard of like autism or attention deficit disorder, those disorders are not contagious. You can’t catch them. Anxiety is very much a different beast, it is a very contagious presentation, and so if parents are quite anxious when they are talking to their kids or just in the way that they’re responding to the world around them and what this re-emergence looks like, their kids are going to pick up on that, and unfortunately they will also manifest their own anxiety that they’re picking up from their environment. So before talking about strategies for kids and families, I think it really needs to start at that level.

I think the next discussion becomes essentially what are our family rules. And actually putting language to that and making it clear what your family’s rules are around safety and mask wearing and making it clear to your kids that this is like a whole other culture; it’s a COVID culture, and every family has a different culture around their adjustment to COVID. So if your family rules are, we continue to wear masks and we continue to only have play dates outside then that is the rule that you’re going to create your sort of system and your plans around. I think it is important to make sure that when you’re having these discussions having them as different families have different rules, as opposed to there are good and bad choices, for example. There needs to be sort of a respect for different family’s rules because they’re going to need to navigate different peers’ rules around how they’ve adjusted to COVID and everything like that. So, if they’re playing on the playground and your child is more comfortable keeping a little bit of distance, they can explain that to their peer who might continue coming into their personal space and making them uncomfortable. So the more you talk about it, the more you are empowering your children to also talk about those same things as just these are my family rules.

[00:06:51] Cindy Lopez:
So Dr. Keil, do you have other ideas about strategies in different settings?

[00:06:57] Dr. Vivien Keil:
So kids kind of live in three worlds, most of their time is spent within the family, within the peer group and then within schools. I would encourage you to think about kind of what are some specific goals you have in mind outside of the family as well. So for example with peers many of us have had very small worlds with our kids in the past year, oftentimes with only our nuclear family and perhaps your pod or your bubble. But I think now is the time to expand that bubble if you haven’t already started doing so. So coming up with a goal, making it a small goal. We don’t want to go from a pod that only included a sibling to, oh, now we have to start necessarily doing like summer camps with tons of kids. It doesn’t need to be that drastic if that’s not where your comfort level is, but really making a commitment to expand this bubble. And for example, we’re going to add play dates with one more kid in June and one more kid in July. Depending upon where you fall on the comfort continuum, you could, for example, only do play dates outside at like parks or beaches. And if you would rather not have your child playing on public play structures, you could choose a park or a beach that doesn’t have those things available, So just make a plan, and have a conversation with your child about what the plan is. And a lot of the times it can help to give your child choices within what your larger requirement or desire is as a parent. So if your goal is we’re going to add one more kid to our pod and do play dates with them regularly, then let your child pick. Like, do you want it to be with Emmy or do you want it to be with Susan? If you need to use incentives, so if it’s significantly anxiety provoking for them, and it is really hard, if you need to use an incentive after they successfully complete a play date, go ahead and do that because ultimately it’s getting them closer to where they need to be which is more comfortable in peer settings.

For the school setting in particular, I would say again, make a plan. If you can use the playground on the weekends. Like if it’s a campus where you can actually access the playground or just the grounds and the neighborhood on the weekends, just kind of getting them used to being close to campus and on campus again. I think those are all really small steps that you can take now in order to help prepare them for what the fall may look like.

[00:09:39] Cindy Lopez:
Thank you for tuning in! Just a note, before we continue on with today’s episode, we hope you’re following us on social media, so you don’t need to wait a whole week between episodes to get engaging, inspiring and educational content from CHC.  Our social handles are linked on our podcast webpage at podcasts.chconline.org.

So I’m wondering what if a parent even with all that in place is seeing things in their kids, that might be cause for concern as they kind of start this re-entry journey?

[00:10:16] Dr. Vivien Keil:
What I always encourage parents to do is trust their instincts. And if they have concerns, reach out, get a consultation with a mental health professional, and see where that conversation takes you because there is no harm in reaching out too early.

You’ll hear clinicians sometimes talk about either a change or decline in functioning or an impairment in daily activities. In some ways, it’s a fancy way of saying trust your gut because you know sort of what your knowledge is of your child in normal times, or in less stressed times. You know their likes, you know their sleeping patterns, you know their eating, you know what activities they love to do.  So any significant change in those domains really is cause for concern because you’re noticing a shift in your child. So I would absolutely encourage families to take notice and really reach out if they’ve noticed those sorts of shifts.

The other kind of threshold that we use is that sort of impairment in daily activities. So you can think of that as things like wiping down groceries, that was actually quite adapted and totally recommended by the professionals, right. The good news is we’ve learned a lot since then, and so for example, if you have a child who still insists upon wiping down the groceries and without doing that they feel really really anxious and worried about whether it be you getting sick or them getting sick that’s cause for concern because they haven’t adjusted to sort of our new understanding of COVID and they’re continuing to get stuck in those habits from about a year ago. So, think about how those worries or habits that we’ve created in the past year, if they’re now getting in the way of re-entry and whatever that looks like for your family, those would be what I would consider red flags.

Things that you can do in the interim as you are working on your re-entry plan and perhaps doing more activities, I think one thing to keep in mind always is that talking out loud and modeling problem solving and coping, that is one of our biggest tools as parents, because that’s how we’re teaching our kids basically how to respond to stress. And so if you haven’t already done so, start talking about you know what happens when mommy gets stressed. You might notice that’s usually when I go sit outside, I take a quick walk, like those are the things that are specific to my coping strategies and being clear with them that when I do those things, you probably noticed I’m in a better mood after, right.

The same is true for all of our kids. So when they’re having those moments talk them through like I can see that you’re having an off day or you seem a little bit more cranky than usual today, what can you do to help you feel better. And that conversation you’re essentially teaching them that a) it’s okay to have these feelings, I have them too and b) you can do something about these feelings, and depending upon the age and the sort of  language capacity of your child, You might have to provide examples for your child. You might have to say, I’ve noticed that when you play Legos, you seem to be in a really great space or when you listen to your favorite music, it seems to really brighten your day. Versus you might have an older child or just a linguistically gifted child who is very much willing to engage in that conversation and they can come up with those strategies themselves. And then your job is really just to reinforce like, yeah, why don’t you try that, that sounds like a a great option. So by doing all of those things, while you are  doing these activities for your family to help your re-entry and adjustment to our new lives, you’re teaching them coping strategies. Parents are in an incredibly powerful position to be able to provide those therapeutic skills to their own children.

[00:14:43] Cindy Lopez:
If I see these behaviors and we’ve talked through coping strategies and the coping strategies aren’t working or the child’s not using them, when would they need to reach out for more help?

[00:14:55] Dr. Vivien Keil:
Honestly the moment that you start having those concerns as a parent, that wondering and that feeling in your gut that says, gosh, I wonder if I need to talk to someone, that’s your cue to go ahead and talk to someone and reach out. Talk to trusted confidants, this could be someone within your faith-based organization, this could be your pediatrician, this could be a mental health counselor or a place like CHC. These are allies that are out there, and so reach out to them sooner rather than later, especially because we know right now, all mental health clinics and behavioral health providers are quite busy. So there is often a wait time associated with even potentially getting a consultation or certainly a first appointment or things like that. So now would be the time to get connected.

[00:15:48] Cindy Lopez:
And a reminder to our listeners that CHC is here for you. You can find out more at chconline.org. If you select clinical services on the website, then you can make appointments there. Another option would be to find out about a free 30-minute parent consultation. So that’s just an opportunity for you to talk with one of our clinicians. And talk to them about your concerns and what you see going on, and then they can provide some guidance and advice regarding next steps. So there’s lots of options, we also have free parents support groups. We have, obviously, podcasts like this and other parent ed sessions. So please reach out. Dr. Keil, if there was one thing that you hope our listeners would take away from this episode, what would that be?

[00:16:41] Dr. Vivien Keil:
So we do have a lot of research about trauma and what it does to the brain. When something is truly traumatic it shuts down the left side of our brain. And the left side of our brain is very much sort of the language center and the side of the brain that’s associated with more logical thinking, organized thinking. And so what you have is oftentimes just a right hemisphere activation, which means that’s the emotional part of our brain. We experienced trauma and stress and anxiety very heavily in the right part of our brain. And so when the language centers get shut down, you get these sort of disorganized, stressful memories. And so, so many of the interventions and the strategies that therapists use for individuals who have experienced trauma, it is all around language and the narrative of the experience.

And so what I would really love to see for all of our families is that there is some sort of pandemic narrative, if you will, that really captures our lives in 2020 and as it continues on in 2021. Part of this narrative is absolutely it’s heartbreak, it’s grief, it’s loss, it’s incredibly heavy, but part of this narrative also has to be our small victories, our silver linings, our fun moments as a family as well. Because if you can’t paint that whole picture and your family’s narrative is only one or the other, that’s not a reflection of reality, right. We also don’t want to paint this rosy picture for our kids that is just not reality. So the more you can have this coherent narrative of what your family has experienced in the past year or two that’s what’s going to be their protective factor moving forward. So five years from now, they have a  really balanced picture of what that was and it’s part of their identity, but it is not what defines them. So that the story ultimately years from now is one of resiliency, as opposed to you know, those years were awful and I just don’t want to talk about it anymore. That’s not healthy for our families or our children.

Embrace your power as a parent, our impact has been I would argue even greater on our kids in the pandemic because our worlds have shrunk so much. There have been so many fewer influences in our kid’s life as we’ve become like the teacher and the chef and the mother and the, you know, insert role here. So remember that you’re an incredibly powerful agent of change, even though there are times where you feel totally helpless and powerless, those are fleeting moments. Ultimately you really can support your kids through these stressful times.

[00:19:50] Cindy Lopez:
Thank you, Dr. Keil for sharing your expertise and insights with us today and also to our listeners thank you for joining us and we hope you’ll join us again next week.

[00:20:03] Cindy Lopez:
Find us online at  podcasts.chconline.org. Also, please follow us on our socials.  Find us on Facebook at chc.paloalto and Twitter and Instagram at CHC_paloalto.  You can also visit our YouTube channel at chconlinepaloalto. And we are on LinkedIn. Subscribe to Voices of Compassion on Apple podcasts, Spotify and other podcast apps, and sign up for a virtual village email list so you never miss an update or an episode. I always love to hear from you so send me an email or a voice memo at podcasts@chconline.org or leave us a rating and review.  We look forward to you tuning in each week. After all we are in this together. See you next week.

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