Field Trip: Caring for Students’ Mental Health During Virtual Learning

EPISODE 62 | 3/3/2021

The last year has been… difficult.

DR. ROSEANN: Kids are not tolerating stress. We’re moving to a really highly stressed society as families, with little downtime and our nervous systems are really activated.

That’s true for everyone. But it’s not always easy to see.

DR. ROSEANN: Often it’s through somatic complaints, it’s stomach aches, it’s headaches, it’s sleep issues. And that’s across all ages. And guess what? It’s not just teenagers and college aged kids. This is adults too.

And providing the kind of help that kids need, providing the kind of support that teachers and staff need, has never been more important.

DR. ROSEANN: A strong teacher who’s highly trained is so valuable. But we’ve got to support their mental health by not just talking about it, we need to give them things that will help alleviate it.

From Frontline Education, this is Field Trip.

Dr. Roseann Capanna-Hodge has spent 30 years working in integrative and pediatric mental health. She founded the Global Institute of Childen’s Mental Health, advocating for holistic treatment in mental health. She’s the author of The Teletherapy Toolkit: Therapist Handbook for Treating Children and Teens.

She joined us to talk about the kind of impact this year is having on students’ mental health, and how schools now and in the future can work to support kids who are struggling — especially if they’re operating virtually.

RYAN ESTES: We’re really glad to have you today here on Field Trip. We’re having this conversation in February of 2021. As we speak, the pandemic is still raging, although there is hopefully hope on the horizon as vaccines get out to the population. Could you talk to me about the impact that you’ve seen the past year have on students?

DR. ROSEANN: Yeah. I mean, it’s been so hard on students in so many ways because their education has been disrupted. Their lives have been disrupted, their social functioning, everything is. sort of a disappointment and about a half an hour ago, I was sitting with my clinical team here at Dr. Rosanne and Associates and we were talking about what’s happening to kids here local to the Connecticut/New York area, but we work with people all over, and we were talking about how kids right now in the middle of winter… kids right now are struggling with motivation and why. So everywhere in America, most kids are either fully virtual learning or hybrid. And why is their motivation being zapped? Well, they’re sitting. you know, I’m not talking to a kid who doesn’t feel like it’s hard to learn right now. They’re missing their connections, they’re missing structure and routine, and it’s really long at this point – we’re almost at about a year of this pandemic. We’re in month 11, and no end in sight.

So we were really talking about, how do you get motivation in with kids? And for me it’s about movement and structure and routine. I think that’s the best we can do right now and try to be creative in those kinds of things. That’s really what I’m seeing. I’m seeing kids with issues for the first time, whether it’s focus problems, getting their work done. My friend and colleague was talking about her younger daughter who, the teacher let her know her daughter’s behind at school and she’s never been behind in school. She’s one of those self-motivated kids. And I don’t think that’s very unusual. I think kids are finding it hard to be engaged with the way education is going on right now, but way more than that, no blame on the school systems. They’re doing the best they can. It’s really about, there’s not a lot of stimulation or excitement in their lives.

RYAN ESTES: Absolutely. And we know that, of course, this is not just impacting kids. As I’ve talked with a lot of people, adults are feeling this as well. So what impact have you seen this have on adults in schools, whether they’re teachers, administrators, other employees? I know that you do a lot of work with school districts.

DR. ROSEANN: Yeah. So, you know, I definitely do consulting with schools on social-emotional curriculum and working with kids with special needs, so there’s sort of a mix, but I think the thing that I see mostly is a lot of overwhelm, and so the personal overwhelm with just managing the disappointment and the hopes and the expectations of everybody around them. And I think that’s hard, of course, and they’re really stepping up and really being these leaders. That is there.

But the other part of this is, I’m seeing traumatized teachers. I’m seeing teachers that are afraid because they don’t want to get COVID. They may or may not have had their own history with trauma, right, and I’ll talk about that, but they’re struggling because everybody else seems like they’re treading water and they’re grabbing onto the adults around them. And it’s hard. So there’s the fear part of it. And then there’s everybody else. They’re the absorbers of everybody’s worries.

And we know kids are so affected. It’s really interesting, Ryan, the fifth largest school district in the United States, Las Vegas, they had, this academic year, they chose to go back to school and pull their kids from virtual learning and put them back in school, because they had 3000 reports of kids who either attempted suicide, had suicidal thoughts, or self harm. And they made a decision to put the mental health above the possibility of getting infection. And I thought that was very telling, you know, what is happening when the fifth largest district in the United States says, “We’re bringing our kids back because they’re struggling.”

RYAN ESTES: Not everyone listening is a psychologist, so tell me, what are some of the signs to watch out for that kids who may be struggling with anxiety or other mental health concerns may exhibit.

DR. ROSEANN: Yeah, what a wonderful question, because these kids show us what they’re feeling. Most kids don’t have the ability to say, “Hey mom, I’m feeling a little stressed out today.” Or, “I’d like to talk to a therapist,” right? And so they’re going to show us through their behaviors. And so often it’s through somatic complaints, it’s stomach aches, it’s headaches, it’s sleep issues. And that’s across all ages. And guess what? It’s not just teenagers and college aged kids. This is adults too.

Then you’re going to look for signs of excessive fatigue, difficulty waking up in the morning, but just a general lack of motivation, which again can overlap with the lack of movement and the kind of instruction kids are getting. And we don’t want to dismiss the importance of movement, because movement does a lot of things for our brain and body, and it releases these beautiful feel-good endorphins in our brain and nervous system. And it helps to have lymphatic drainage. It gets oxygen to the brain. So there’s a lot of things– and I’ve seen a lot of kids, particularly kids that have ADHD or some level of more on the mild side kind of issue, who were doing amazing in school because they had so much movement and they would do sports and activities. And they’ve really fallen apart because of that.

You next want to look for things like any change in behavior. So all of a sudden, your kid is a chatty Cathy, and they’re hiding in their room . Now, we want to think about normal development, most teenagers want to have autonomy and this is what they do, but this is more extreme. Like they’re just not talking to you, where last week they were.

So changes in behavior, tearfulness, rage, and I want to really state this to parents, because the world thinks that you can be functional, doing pretty good in life, and not have anxiety, depression, OCD, or a mental health issue. I’m here to tell you that is wrong. When we think about celebrities in 2019 who really struggled with mental health and committed suicide, Anthony Bourdain, Kate Spade, they had everything in life. And so a lot of times parents will say, “Well, they have a great school. They’re fed well, they’re loved. How could they be anxious or depressed or sad?” And I think this is a time when we’re really seeing that stuff doesn’t really matter, they can still be struggling because they’re disappointed or lack of connection.

So, look for signs, don’t dismiss those signs. A startling statistic, it takes 11 years, according to NAMI, it takes 11 years from the onset of a mental health problem before somebody gets appropriate help.

RYAN ESTES: Eleven years?

DR. ROSEANN: Eleven years. It really does. I’m going to tell you that I see people all the time. I see people trying to get help in their 11 years, but it’s not uncommon for me to see somebody who is a teenager or college age individual, or even somebody in their twenties who they knew there was something, they knew there was anxiety, they knew there was a low level of autism or a low level of OCD, but their grades were great. And so people base the mental health on their grades, or they said, “I talked to the school and the school said their grades are great,” or “I talked to the pediatrician and the pediatrician said their grades are great.” And then life happens and they try to launch, and they struggle.

And so it’s not unusual for me for somebody to look back, we can only connect the pieces looking backwards. So when you look back to say, “Oh, that was a sign. He vomited every night,” and I say that because gastrointestinal symptoms of anxiety in particular, which is the number one thing I see across all ages and everyone’s very anxious right now, and some people are depressed. But stomach aches is one of the most common issues that I see in this group of kids that are academically successful, but really still have clinical anxiety. With any level of gastrointestinal distress that doesn’t have a medical source, you always need to consider stress and anxiety.

One of the things that has become clear over the past year is that, while some kids are checking in online and appear to be doing fine in school, that’s not the case everywhere. Not everyone has the same level of parental care. A surprising percentage of kids have simply fallen off the radar. And that makes monitoring signs of mental health issues difficult or impossible in many cases. Dr. Roseann says that schools need to have a plan, because we don’t know exactly how long this situation will last.

DR. ROSEANN: So what can school districts do? I’m seeing different school districts, everybody’s handling everything differently. We don’t have a unified platform and support from our federal government for school districts to support education or mental health. And I’m going to tell you that every school district in America needs to make a long-term mental health plan for their students and their employees, and they’re doing a disservice to both, and they’re going to be constantly doing reactive triage care, which is what I’m hearing from educators, instead of trying to be proactive.

So what can we do with students that are disconnected? I think what I’m seeing work is boots on the ground, people really trying to actually get out and connect with these kids. There needs to be a plan, whether that’s starting with a group email that’s private, or trying to text people. We have to get caregivers that are involved with these students somehow connected. And in the larger infrastructures, is there a support person that can do family care? Is there a school-based health clinic associated with it? Is there a local agency? In the past having worked in schools when somebody didn’t connect with me, this is what we did. But on a case by case basis it becomes very hard. They’re going to have to put infrastructure in place to address this because I know in my state, one of the larger school districts had I think almost 20% of their students not checking in more than 40% of the time. So that’s a problem, right?

There has to be a system in place for them to address it. I think there need to be mental health components. There needs to be psycho-education involved in it, what’s going on with those families, right, that they’re not able to get their own children to school because maybe they don’t know their kids aren’t logging in, maybe their kid is lying, but it’s gotta be communication. And as much as I want it to be an individual social worker calling each person, I don’t know if that’s feasible in every district. And if it’s not, we need to find more care providers and the federal government needs to provide school districts for that.

When kids really fully come back, Ryan, it’s going to be tough. You have very maxed out staff trying to meet the emotional needs of students. There’s going to have to be daily curriculum in every single school district, private and public, in America going forward, or we’re going to have a whole grouping of traumatized children moving through our educational system.

RYAN ESTES: Let me ask you, you’ve written a book on teletherapy called The Teletherapy Toolkit. What prompted you to create that?

DR. ROSEANN: What prompted me to create that was truly the realization that there was no other book written for therapists, whether you’re a school counselor or working in private practice, on teletherapy. And so therapists, in the early days of this pandemic, just like educators, were completely thrown. Therapists were telling me they felt inadequate and I was really worried about the quality of therapy being done, because if we don’t have training for staff, some people are creative, other people aren’t. And guess what? They were asked to step up and do new things when we’re all hurting. And it just makes it hard. So in 31 days I wrote a 420 page book that has over 180 strategies and different techniques, it’s really easy to use. And I just wanted something that was like a cookbook. And that’s what this is. And it’s a great way, whatever you’re doing, I have parents actually using this, special ed teachers, to just engage with kids. And these kids are struggling to stay engaged in our platforms, whether it’s in the classroom or working with a specialist, like a speech and language teacher or a psychologist, and it has lots and lots of information, psycho-education, for parents. Because like I said, we know through research that when we educate parents about whatever we’re doing in treatment, whether it’s the type of treatment or the clinical condition, treatment outcomes are a lot better.

We really need to do, as therapists, a better job of helping parents to understand the why’s behind the different actions we’re taking to for therapy in school and out of school for parents. And I have always found it to be that it’s just a much better process and treatment outcome.

RYAN ESTES: You’ve touched on this a little bit already, Dr. Rosanne, but what can we learn about how to work with kids remotely? How can teachers, principals, mental health professionals, and others who work for schools or for school districts, support kids when those kids aren’t necessarily able to sit down across the table from you?

DR. ROSEANN: I think the most important part is engagement. And what do we know about kids and their learning? We need to have a highly visual and as much of a kinesthetic approach in a regular classroom, but way more so in these virtual settings, as well as, you have to have structure, you have to have routine. This is what our classrooms did. Right? How many times did I walk into a classroom when I was doing an observation and a teacher did that tapping hand movement? And then the kids knew exactly what to do because there was a structure and a routine around it. And so we need to modify that and do that.

It’s disappointing to me to see that some teachers are doing things like once-a-week check-ins on Google Meet and the rest of the time is just a list of things or little videos that they’re doing. Kids need live instruction. Does it have to be five or six hours? I think that just varies on the type of student and the type of teacher and the skills they have, but we need concrete strategies. We need structure, we need routine, and you got to get kids up and moving. So, having those regular breaks. Everybody up and moving. It’s great for the adult, it’s great for the kid. We can’t have this expectation that they’re under these lights and sitting, you know, in front of a camera with little interaction and movement. It’s not based on neuroscience. We know what stimulates the brain and body. Movement, structure, highly visual, and really trying to have live engagement with students, I think is really important.

RYAN ESTES: Let me ask a related question. How do you think schools can promote good coping skills and resilience in kids as it’s so desperately needed right now?

DR. ROSEANN: Yeah, coping skills and resilience, before the pandemic, Ryan, were already, for me, being in this mental health space for, it’s my 30th year, we’re on the decline. Kids are not tolerating stress. We’re moving to a really highly stressed society as families, with little downtime and our nervous systems are really activated.

So, talking about building coping skills and resilience, the first part of that is getting our nervous system to calm down. And whether that comes from breath work, meditation, yoga, biofeedback, we have to intentionally try to create space 10 minutes a day. You can do this with your kids or help your kids of all ages. To do that is really important because if not, with an activated nervous system, we react.

So educators can take that time during the day — and schools are doing this, right? We’re talking a lot about mindfulness in schools and that’s a great practice and there’s a lot of clinical things, but it’s got to be a daily thing. But what educators and parents can do is we can reframe how we’re talking to kids. So instead of saying to a child, you know, I’m so upset, you know, I can’t do this homework. It’s terrible. You can say, “Well, you did it yesterday. What was different about yesterday? How did you get through it?” And get the kid to problem solve, but also to recognize their accomplishments. We’ve come to a point where we’re helicoptering our kids, particularly parents, and they’re well-meaning and they’re doing the best they can. But they don’t want their kids to go through the mud. And going through the mud, getting your boot stuck in there, is a lesson. It’s like when you’re a kid and you experiment and you play outside and you realize, “Oh my gosh, I shouldn’t be walking through that deep mud because I’m going to lose my boot.” And so you realize, “Okay. Well, I can walk in it when it’s an inch, but I can’t walk in it when it’s five.”

So you learn to problem solve and experiment on your own. And you don’t get upset, you figure it out. Well, what happens today is kids, their fuses are so short. Everybody’s so stressed out and more so than ever during this pandemic for obvious reasons. But when we give kids accolades for managing things, coping, it’s the shifting in our dialogues that gets them to concentrate on coping and problem-solving and their accomplishments without constantly being like, “Let me run and get your boot for you.” No, you go, “Wow, that’s pretty cool. How are you going to get your boot?” And getting them to shift, so I focus a lot on coping and resiliency mindset, and I have a bonus for coping statements to help individuals help the kids that they’re either working with or they’re parenting. And they can go to a teletherapytoolkitbonus.com and there’s over a hundred statements. It’s really important. We often think in parenting and mental health and teaching that sometimes we want to rush in with these giant things and we think that’s going to fix it. And I’m going to tell you, it’s the little things on the daily that move the dial.

And teachers know this because they’re doing structure and routine, and parents need to know this too. We get our kids to be more autonomous, right? I’m a big fan of autonomy-supportive parenting. It’s a combination of positive parenting, authoritative parenting, it’s a little mix of everything. It’s really about establishing loving limits, giving a lot of love, but really empowering your child to cope and problem solve. It’s putting bumpers in place, saying like, “Here are the limits.”

A great example is we think about young kids and they want to do things like wear their slippers to school. And it’s a foot of snow out and you say, “Okay. So you want to wear your slippers to school and there’s a foot of snow out? What do you think? What do you think’s going to happen?” And you let them talk to you about it. It’s a lot of communication, right? It’s a lot of front-loading, but it makes parenting a lot easier later.

RYAN ESTES: I’m filing this away as a parent, good stuff.

DR. ROSEANN: And then your kid’s like, “I’m going to wear those slippers to school.” And this is where you say, “Hey, guess what? You’re not, because you’re going to get frostbite. But how could you have your slippers at school?” And the kid’s like, “Well, I can bring them to school.” Great idea. And you let them kind of fail a little bit instead of being like, well, the kids are going to say something too, because you wore your slippers. They really get a lot of, they get to know themselves. They get a lot of self-confidence. They feel comfortable saying no, which I love. Parents, authoritarian parents don’t like to have their kids say no, but kids need to know themselves. And that means sometimes saying no.

So building resiliency and coping starts with those little moments. We don’t want to rescue the kids. Whether we’re working with them or parenting them, we want them to learn and problem solve on their own because that, resiliency, is the key to good mental health throughout their life.

RYAN ESTES: Let me turn away from mental health for a quick second, and ask you about an issue that is absolutely on everybody’s mind in education right now. And that’s the idea of virtual learning, the effects of not being able to gather in person in a classroom, obviously a ton of thought and work has gone into this issue, but perhaps you can provide some helpful insight from a different angle. What are things that you think schools could be doing right now to make virtual learning more effective? Whether that’s better differentiation of instruction, how can we address this huge thing that we’ve been trying to solve for the past 11 months?

DR. ROSEANN: Yeah. I mean, such a powerful question. So again, I think that you start with the basis of structure, routine, movement, highly visual. Start with that. And it’s got to be live and I think that’s important. But I also think that if we’re going to continue this another year, they need to staff it more. And you need to have breakouts, right? Just like in a classroom, we had small group instruction and we need to have an adult supervising these little groups. So I think that’s a really important feature because we can differentiate, we can move kids to where they need to be. They need to think about virtual learning just like when we go to our conferences now, they’re stepping up their game, they’re making it exciting. They’re putting fun stuff in there. Make sure they’re not just saying, “Sit. Do your work for this amount of time.” We have to make it engaging. And that means allowing kids to have fun.

When I would work in schools and I would have different ages of teachers, my older teachers would do things like put up paper on their window at their door and let the kids play, because she’s like, “We’re not allowed to, it’s only academic,” and I’m saying right now we need to prioritize mental health.

So I think that’s really important for people that are structuring, learning to make it engaging, make it visual. And there’s lots of ways to do that. I think some  teachers embraced what was there and found great YouTube videos and engaging, but passive learning like videos is not as stimulating as a live person who can interact with you. And I think people need to know that, too, video is a supplementary component and we need to modify what we’re doing in a class, but think about what was working in a classroom setting. And kids are suffering because they’re not engaging with their peers. In a classroom of 30 kids they’re not going to be able to engage. So think about breakouts and doing small groups. I think that is a piece that is really missing right now and they can easily do that.

RYAN ESTES: One of the things that we think and talk a lot about is the idea that helping kids learn, as an administrator or a superintendent or a principal helping kids learn, the way that you do that is by working through your people, by getting the right people into the classrooms, by training them. So my question here is really how can schools help staff during this time? A lot of teachers and other school employees are just exhausted by this point. And as we’ve seen and talked about earlier, adults aren’t immune to mental health struggles. What, from your perspective, can schools do to support their staff throughout all this?

DR. ROSEANN: I don’t just work with schools. I work with corporations and organization. And I’m going to say the same thing that I say to them: we need to focus on building connection with our employees. We need to give them flexibility, which I know a lot of school districts absolutely are doing. We need to help them with stress management by providing direct support and helping them build their own coping skills. And there’s no one model for that, but there are things that we know that work. Connection and communication and stress managing, coping skills. That can be done. I know that means it might be another Zoom meeting, but we need that. They need a place where they have a safe space. But I think that when we have meetings, we need to be careful. We need to give our staff strategies and support without it just being a venting place, right?

Just like I don’t believe in starting out therapy with just talk therapy, because often that becomes a venting place instead of a place for action. So maybe providing exercise class for their staff virtually, those kinds of things, and it can build connection. It could be family exercise. We need to think about this. I mean, these teachers and educators and leaders, they are at max capacity, and we’re asking them to step up.

We also need to think about as leaders, we’ve got to retain our employees. They said 1.4 million women left the workforce last year. I know a lot of teachers retired. A strong teacher who’s highly trained is so valuable. So even from an employee retention component, that’s important, but we’ve got to support their mental health by not just talking about it, we need to give them things that will help alleviate it.

And again, that can be done through exercise, meditation, whatever works in your culture of your education. I think it’s really important. I think these teachers need to be trained in the science behind stress. What happens to the brain and body and techniques. And it will not only benefit them, but every teacher needs to know this, and be bringing it into her classroom, because it’s going to have reciprocal benefits. So I think that’s a critical, critical thing that needs to happen immediately, but going forward as we continue to deal with this for the long term.

I asked Dr. Roseann to think back to last March, when the pandemic began, when schools closed down across much of the country. What did she expect to see with regard to mental health, and how did that compare with what actually happened?

DR. ROSEANN: I expected for people to be stressed. I expected the isolation and loneliness, once we knew this was really going to go on, I think most of us thought — they said two weeks, I knew it had to be at least four to eight weeks. I mean, I was like, “This is going to be at least four to eight weeks.” But once that point happened, then I said, “Oh, this is at least next year and the year after.” And I think people were having a hard time.

I’m going to tell you that I was so surprised that certain people, in my life — which is why I coined the term ‘re-entry panic syndrome’ — who essentially had these great lives, nothing was changed in terms of financial or their job, but they were so reactive to the infection. They were reactive to the isolation and I saw people just struggle in a way that was very much… some people were sad, but I’ve just seen people sort of flash. They’re turning their anger from this pandemic at people around them. I think that was very surprising to me. I expect that when people already are struggling… I don’t want to say I expect that, but it’s not outside the realm of the possibilities. But I saw people just be so frustrated and angry and start just lashing out and be incredibly panicked.

That was surprising to me. For me, I know exactly what it’s about. Even though I think people were doing well, these same people were caught up in their distress and weren’t dialing back and using techniques that may have worked for them in the past, but worked for everybody else, breathing techniques, grounding, staying connected, taking yoga classes with their friends online and then texting while you’re there ’cause it’s funny. We’re all sort of in the middle of winter, we are bummed, right? I have a big birthday coming up. I’m turning 50 and you know, we were going to have a gala, for any big event, I like to host something and turn it into a place where people can donate money. In the past, they’ve donated to Lyme Connection. I was going to do something. So, you know, we get to have a little family party. That’s sort of it, we have a pandemic pod. Grammy’s in our pod, that’s it, and cousin Erica. It means I’m not really that disappointed cause we’re still going to have grilled octopus, sushi, and gluten-free cupcakes. So. But, it’s long in the winter, Ryan, everyone is like, really? I think we felt a lift in the springtime because of movement. So, I have been surprised.

Yet on the positive side, Ryan, silver lining, people are more interested in self care and personal development and wellness than ever. And I love that. So that is not necessarily a surprise to me, but I’m super happy about that.

Last of all, I asked Dr. Roseann, what is the number one thing she would want to communicate to people in schools as we think about caring for mental health. She said, it’s simple. Every teacher, every educator, needs to be trained in what stress is, what it does to the nervous system, and simple techniques they can integrate into their classroom. She suggested a 15 minute period every day — whether schools are operating virtually, hybrid, or in-person, to use those stress alleviation techniques.

DR. ROSEANN: Simple, simple things. It needs to be done every day because the nervous system needs 10 minutes a day, seven days a week, to power down. And we’re going to have absolutely based on clinical research, we’re going to have better mental health as a result. And our mental health needs to be the number one priority: 1A. 1B is education, but education isn’t going to happen, and you’ll be seeing all these kids struggling, when mental health is not prioritized.

RYAN ESTES: Dr. Rosanne Capanna-Hodge is a pediatric mental health expert and founder and director of the Global Institute of Children’s Mental Health and Dr. Rosanne & Associates. Thank you so much for taking time to talk to us today. It’s been great speaking with you.

DR. ROSEANN: Oh, it’s been great speaking to you and, you know, kudos to all the educators out there who are doing a beautiful job and, you know, just lots of positive thoughts because they really are our heroes.

Field Trip is a podcast from Frontline Education. Frontline is the leading provider of school administrative software. That includes Frontline School Health Management, an electronic health records system with tools to help you keep track of health data for all students. It also includes tools to support mental and behavioral health management, as well as COVID-19 functionality to help you easily collect and track health data for students and staff, and keep your school community safe.

For more information, visit FrontlineEducation.com/FieldTripPodcast. For Frontline Education, I’m Ryan Estes. Thanks for listening, and have a great day.