Children and Youth Need Trauma-Informed Care More Than Ever

The COVID-19 pandemic continues to take a toll on individuals and groups around the world, from frontline health care professionals to service workers to the elderly to entire families decimated by the virus. However, there is a large, traumatized cohort that requires more attention: our youth. How do we help young people cope with the upheaval in their lives due to the coronavirus, on top of the many other traumas they experience? This is a challenge we must address sooner rather than later with trauma-informed care.

According to the Center for Health Care Strategies, trauma-informed care (TIC) “shifts the focus from ‘What’s wrong with you?’ to ‘What happened to you?’” TIC enables caregivers to understand an individual’s entire life situation as a foundation to offer that person the most beneficial services. For many, it is the first time that someone else recognizes that they have suffered from trauma—or continue to do so.

The mental and physical impact of COVID

UNICEF has concluded that the pandemic is affecting the mental health and well-being of children and youth not only in the present but in ways that will affect them long-term. COVID-19 has exacerbated the mental health issues that many of these young people experienced before the pandemic began. UNICEF’s statistics present a grim picture:

• Globally, at least 1 in 7 adolescents aged 10-19 live with a diagnosed mental disorder.
• Some 46,000 adolescents die from suicide annually.
• Worldwide, only 2 percent of government health budgets are allocated for mental health.
• In a UNICEF/Gallup survey of people in 21 countries, 20 percent of youth aged 15-24 said they often feel depressed or have little interest in doing things.

COVID-19 has altered activity levels that may have long-term physical health implications, too. BMC Public Health reported that short-term changes in both physical activity and sedentary behavior could become permanent, resulting in higher threats of diabetes, obesity, and cardiovascular disease in children. It is calling for programs and policies that would reduce sedentary behavior and promote physical activity—easier said than done as the pandemic drags into its third year. The current surge in the Omicron variant of COVID has led to a rise in pediatric hospital admissions, also increasing uncertainty and fear about short and long-term health implications.

Think about all the things that children and adolescents have lost, just as their minds and bodies are in full growth mode, starting with social isolation from their peers and months of inadequate education, to the deaths of parents, grandparents, and friends and their own battles with COVID-19, these young people have experienced more trauma in their short lives than many of us will ever know.

Now the majority of them are back in school, and those aged 5 and older can receive a vaccine. But the mental stress remains: Will I get COVID playing sports or singing in the school chorus? Will I infect my family and friends? Will something happen to my parents or caregivers? Will we lose our home because my parents lost their jobs? Will we have even less to eat than usual? It’s obvious they need the help of trained professionals to address both their health care and social services needs.

Shortages are compromising trauma-informed care

Besides the dearth of funding for mental health care, our efforts toward trauma-informed care for young people are stymied by other factors. In 2018, the American Academy of Child & Adolescent Psychiatry reported a “severe national shortage of child and adolescent psychiatrists.” Last year, many media outlets pointed to the worsening of that situation due to COVID. The president of the American Psychiatric Association estimated that 15 million children and adolescents needed mental health therapy, yet the country had only between 8,000 and 9,000 psychiatrists treating those age groups. The National Association of School Psychologists noted that despite having between 38,000 and 40,000 school psychologists in the U.S., the ratio of child to practitioner was 1,400-to-1. Like many other health-care professionals, numerous child psychiatrists, psychologists, and therapists have stopped practicing during the pandemic, do not take private insurance, or have full practices and nowhere to refer desperate families.

While children and youth have sat on indefinite waiting lists for psychological help, acting on their mental state has sent them to the next source of shortages: hospitals. Starting in mid-2020, one small teaching hospital in North Carolina admitted an average of five children per week due to medication overdoses; previously, that rate was five per month. The hospital had no available beds for children in emotional crisis and wound up caring for them in the emergency department until they could be transferred to another hospital.

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Finally, what about the services and interventions that children and adolescents need once they leave the ER? Besides the lack of mental health care providers, communities have lost professionals who create and administer community-based programs. Budget reallocations and cuts have also affected policies and initiatives designed to help at-risk children and adolescents. Many young people are returning to homes where they face chronic domestic violence and/or alcohol or drug dependence. Any headway that was made in reducing these circumstances has been erased by the pandemic.

Educate, take action, and remain hopeful

We need to approach care with the assumption that young people have experienced trauma because of COVID-19 and that it may not be the only trauma that has touched their lives. The CDC has developed six guiding principles to trauma-informed care:

1. Safety
2. Trustworthiness and transparency
3. Peer support
4. Collaboration and mutuality
5. Empowerment and choice
6. Cultural, historical, and gender issues

This approach helps increase awareness and sensitivity and makes it easier to engage with stakeholders in the community.

How else can we expand the use of TIC?

• Encourage students to pursue careers in pediatric or adolescent psychiatry, psychology, and social work, to refill the pipeline of behavioral health professionals.
• Educate caregivers to ask young patients the right questions and listen carefully to their answers to identify symptoms of trauma more quickly.
• Find a therapist near you who is experienced in trauma-informed care on Psychology Today’s Therapist Directory.
• Access the referral and support resources of organizations such as the Substance Abuse and Mental Health Services Administration (SAMHSA), part of the Interagency Task Force on Trauma-Informed Care.
• Connect children and youth to community resources such as churches, Boys and Girls Clubs, and Job Corps, giving them outlets for physical activity, peer interaction, and service to others.

COVID-19 has hit our children and youth harder than we ever imagined. Yes, they are resilient, but most will carry some memory of this trauma into adulthood. Let us work with them now to keep it from translating into issues such as unemployment, housing problems, food insecurity, and chronic mental illness. We owe it to them, and to our future.