Children are amazing and resilient. Yes, children and adolescents can often handle more than we care to realize. However, 2020 and the beginnings of 2021 have been more than any of us could have ever imagined. Even the leaders running the world had no idea how much, how long, and how impactful the events of this past year would be to our country and our children. If someone had said a year ago that some children would be out of school for a full year, we would have said that there is absolutely no way that can happen. And yet, here we are.
Fortunately, there is finally a glimmer of hope on the horizon.
What often makes children’s resilience possible is the involvement of at least one caring and available adult. That caring adult can be a caregiver in the family, a family friend, a teacher, a youth group leader, a healthcare provider/therapist, or coach. This past year, as children watched for clues on how to handle all of the changes that were happening, the adults they normally turned to were likely trying to manage the chaos themselves. These adults, despite their best efforts, could very well have been emotionally unavailable due to their own stress, and quite possibly physically unavailable. We will not know the long-term impacts that this period of time has had on our children for a while; however, we do know that as the fog clears, it will be everyone’s responsibility to help ensure that resources are available for healing and recovery.
There is not a single sector of our society that can handle all of the needs of our children on its own. We cannot expect families to manage on their own. We cannot expect school systems to jump in and miraculously fill the entire gap. We cannot expect that regular visits to the pediatrician for sore throats and stomach aches will not be tangled up with the emotional turmoil that trauma can bring. We cannot expect to return to the status quo of how we have previously taken care of children in North Carolina.
The well-child exam is a natural place to provide an additional layer of support to children/adolescents and their families. For years now, this exam has been valuable in catching developmental warning signs, providing vaccinations, and addressing parental concerns. The concerns are often behavioral in nature, such as temper tantrums, developmental progress, attention deficit, and sleep hygiene, to name just a few. As childhood moves into adolescence, age-appropriate screeners transition into more adult questions focusing on substance use and sexual activity.
It is in these appointments that there is space and some time for patients and their caregivers to ask questions about mood, substance use, stress management, and coping with overall worries about life. It is in these appointments that we can be even more purposeful around our conversation with patients (and each other) around mental health and relational health to help nurture the whole child. Now is the time to capitalize on those valuable patient interactions in primary care offices to help provide additional support to these kids who have been through so much.
At the Center of Excellence for Integrated Care, we have been exploring system and policy changes that can integrate even more behavioral health support for children and adolescents than is already offered. Integrating behavioral health into practices not only helps provide a more robust offering of whole person care, but it also has been shown to help providers feel supported and improve their overall satisfaction with their work. It is time that our protocols and policies provide the support both our providers and our pediatric patients need in the aftermath of this past year. It was needed before now, but now it is undeniable. We look forward to sharing more as our partnerships around this idea evolve!