Friends,

I thought I’d make it easy on you as many of your patients with children, or patients who are children, have questions about returning to school this fall. Delta variants of COVID cases are rising, mask mandates are in effect, parents still linger with vaccine questions – all of this creates a bit of angst as the calendar turns and school plans begin.

Feel free to use this as a handout for parents as you navigate questions during visits about returning to school this fall. Sign this with your name, you clinic’s name – just make it easy. Or print it and hand it out, or use it as a script. You’re going to have to give this speech a thousand times!

With kindness and compassion,

Dr. Amy

Some of you are already sending your kids back to school – in person and online. Every fall, I’m delighted to see kids in excited anticipation heading back to school. Plus, and I’m sure this makes you happy too, I love seeing all of my friends and their kids grow a year older, declare dreams, and smile brightly as they welcome a new teacher or friend. And this year, I’m sad at the same time. I see kids in masks and overburdened teachers welcoming children who feel overcome and uncertain. Five year-olds starting kindergarten on Google classrooms is not what we’d hope to see this fall.

So, that said, I want to provide all of you a few straightforward reminders as we all head back to school in any capacity. 

Most importantly – we are all doing the best we can. Teachers, parents and students. 

Teachers did not sign up for teaching during a pandemic. Whether they’re in person or online, each one is figuring out how to do this for the first time. If a teacher is in-person, they are worried about their health, your kids’ health and their own family’s health. And if they are online, they are faced with trying to teach distracted, overwhelmed kids in meaningful ways. Please give our teachers grace and understanding. Several teachers have reached out to me in tears saying that this way of teaching feels like being a first year teacher all over again and they’re trying to figure everything out that’s new. Thank a teacher. 

Parents did not sign up for this either. Parents are working, we are homeschooling, and we are worried about exposure. We’re trying to be medical educators for our kids, social directors for lonely, isolated kids and athletic trainers for kids with no sports. Parents – be kind to each other. If your friends are choosing a different path – be encouraging vs. discouraging or judgmental. Reach out to another mom and see if she’s ok. Wrap in another child to your online learning program. Just be there for each other. 

Children look to us as to whether or not they are ok. And by this, I’m not saying you have to have your stuff together all the time. I get it – none of us are totally “ok” right now and there is a great deal of uncertainty. But, please understand that if we model to kids that things are uncertain, but that we’re doing our best in uncertainty, they will observe our ability to face adversity. If teachers embrace whatever circumstance they are in with positivity and guidance, children will pick up on their efforts. If parents model encouragement and support for school and teachers, children will know to trust educators. If we all acknowledge for our kids that this is “absolutely crazy and not what we expected but we’re going to make the best of it,” they WILL BE OK. We can show them how to face hard stuff and work through it. Facing adversity as a challenge versus a hardship builds resilience. 

That’s what I mean when I say “kids will be ok if we’re ok.” What I mean is that kids will be ok if we model that, despite these uncertain times, we’re making the best of it. 

Just the other day, I talked with a teacher about social distancing and mask wearing and all the things. She said that in her classroom, they are decorating masks and using lily pads to hop about the classroom for breaks. “If we’re ‘two lily pads apart,’ we’re safe.” And you know what? The kids hopped all over the room with their decorated masks – they did it and showed incredible resilience because the adults in their lives showed them how. 

So, be kind to each other. Show grace. Know that we are all doing our best this fall. And no, I am not quite sure what we are going to do about Halloween yet, because we are simply going to tackle one next moment when it comes. Just one day, one week, one momentous occasion, one holiday at a time.

With kindness and compassion,

Dr. Amy
 

Well, given the response to last week’s post,  it appears to have met a need that we all have – guidance. My hope (and that of my guest contributor, Dr. Kristin Valerius) was to offer guidance and perspective in a way that allowed all of you to focus on comprehensive information without as much fear. Don’t get me wrong, I’m overwhelmed with these decisions too. Often, fear overrides my rationality and I just want to keep my kids at home and pretend none of this is happening. But I cannot. And neither can you.
 
To that end, we have created a tool to help you quantify these difficult decisions. I won’t belabor its content. Take the quiz yourself and find out! Dr. Kristin spent countless hours creating a tool that might guide you to your next best step. Please know that we recognize no decision is perfect. No decision is the “right” decision. We simply want parents to have access to tools and make informed decisions.
 
Know this: There is no shame in whatever decision you make for you and your family. Every decision (other than the stay-at-home 100% and go crazy, if you’re like me!) is difficult and involves some level of risk. You don’t have to justify your decision to other moms, teachers, friends on the internet – no one. We all make the best decisions we can at the time, with the information we have access to, at that time.
 
COVID Decision-Making Tool
 
Click below to download a questionnaire to help guide your decision about returning to school this fall. When creating this tool, we started with available adult supervision knowing that supervision for children is critical and was not available to all parents this spring. As well, engaging in homeschooling requires adult support and scaffolding, not simply supervision. Second, we considered underlying health conditions and overall adjustment to distance learning this past spring.
 
When answering questions about adjustment and next steps, don’t think about your worst or best days. In general, ask yourself, how did things go this spring? Were you able to meet the academic needs of your child, manage sibling relationships and have little conflict with your child? And, did your child fare well? Did he/she meet academic expectations, feel manageable and adjust well emotionally and behaviorally?  

Results
 
Recommendations for next steps fall into several categories based on your answers. If you had multiple columns with high scores, that indicates several competing challenges. We recommend you reach out to school professionals, your pediatrician and/or a mental health provider. In general, we want to encourage you to use the systems available to you – it’s what they are there for, including resources at your child’s school. We recommend having 2-3 meetings with professionals if your column D scores are heavily weighed.  

Socialization, regardless of choice, is critical. Reach out to other parents – we’re all facing enormous stress right now. Create some circles of support for you and your children so that you can all have socialization opportunities. For some parents, this may take a bit of preparation now. Many of the children we work with have found building strong friendships outside of school challenging. Maybe your child had good friends in school, but you haven’t really connected with those parents outside of school. It can feel a bit intimidating at times to try and make that connection with someone you don’t know well. But our world is so different now, and the truth is we are all hungry for connection. When we were busy with sports, jobs, and so many other events certain playdates may have been hard to fit in. But one of the silver-linings from COVID (please let there be some!) is that a simplified schedule leaves more opportunity and desire to meet up outdoors at the park and try and build that out-of-school connection. So take the chance to reach out to that family that you just don’t know well and build a bridge!

In addition, families may want to explore social-emotional learning resources. Small social groupings might be best for kids that struggle socially while older kids might consider alternate activities such as volunteering, a first job, joining a youth group, or seeking out a mentoring role—there will be many younger kids who just might do much better on a class assignment sitting next to a “cool big older kid” than they will with their parents. Given concerns about transmission, we recognize less social engagement might be necessary; but be aware of complete isolation. It’s simply not healthy for you or your children.

Finally, we’d love to hear from you. If you’re willing to submit your results, we want to compile them for decision-makers on local and state levels. To submit your results save the excel spreadsheet once you’ve entered all your answers. Attach it to an email and send it to ksvalerius@sundstromclinic.com. If you want to send your results encrypted simply start with an email to the above with “secure email” in the subject line. Dr. Kristin will respond to your email with a encrypted email. In your reply you can then attach your email and it will be all secured!!
 
We hope this assessment tool helps to guide informed decisions. I want to reiterate, no decision is the right decision – only the one that’s right for you. We are all doing the best we can during precarious times.
 
Let’s keep learning together!
 
Dr. Amy & Dr. Kristin
PS – thank goodness for friends! Dr. Kristin’s brain works so much differently than mine – while our philosophy and messaging is the same, her ability to use excel is STEALTH! Huge thanks to her!

Hello friends,

Just as I finished up writing how to reset summer, emails, DM’s and posts are flooding every inbox with a cry for help around how to answer the question – What about school this fall?  Some of you have to make decisions within weeks while others have a month or so. Regardless, the decisions surrounding school are complex and multi-layered. Add to that a lack of leadership around next steps and messaging that vacillates between terrifying and overwhelming to the point of paralyzing and one aspect becomes crystal clear: We need a way to make a thoughtful decision.
 
Even as I write this, I fear excoriation. Perhaps half of you will stop following me. Maybe you’ll love me more. But one observation I’ve made is that, while there is plenty of information (and misinformation), there is a paucity of professional opinion and guidance for next steps. Fear is flooding the news and social media. Teachers and parents are terrified. So, I feel compelled to offer some thoughts and direction.
 
To that end, I’ve partnered with a colleague, Dr. Kristin Valerius. Jointly, we have over 40 years’ experience working with children and families. We are also working in collaboration with medical experts to carefully digest ways to support children and families. What follows represents two psychologists’ (and moms of 5 kids between us) humble, but thoughtful and informed opinions, about next steps for our kids this fall.
 
First, let us engage in some level-setting:

1. Avoiding risk is a privilege. As we think about return to school, deciding “whether or not” we should go back and how that might look represents privilege. When our nation shut down in March, no one asked the Safeway stockers if they wanted to return to work. No one asked physicians and nurses if it felt “safe enough” for them. We expected our mail to be delivered, our garbage to be picked up, our homes to be safe in the event of fire or robbery, and our health to be our physicians’ number one priority.

To the mamas out there working second shift as an essential worker and the first responders who go to work without a second thought, we thank you. We recognize that you had no choice but to step into the burning house.

1. Any exposure to risk might be non-negotiable for you. Perhaps you or someone you live with has a disease or health condition that puts you/them at risk. Even for those essential workers, those who fell into a vulnerable health population were often given concession. If that’s you, we get that too. In no way are we encouraging parents, family members or children to gamble with their health.

2. Policy should be proximate to the pain. I wish we were so wise, but this quote is from Dr. Jeff Duncan-Andrade, professor at SFSU. What he was encouraging educators and leaders to consider was that we most focus on what is best for the most vulnerable people and that will help lead us to the best policy. We recognize that, for some families, being away from school – the structure, safety, nourishment and resources it provides – is deleterious to children’s health. When weighing risk and needs, our most vulnerable families – those with food insecurities, homelessness, physical safety concerns and lack of adult supervision – are in most need of systemic supports and resources from our schools. It is imperative for schools to creatively consider ways to support our most vulnerable students. And it is equally imperative that if you are a family with privilege that does not consider yourself vulnerable, it is upon you to look out for those families too. They are all of our children.

Second, let’s be sure our decisions are based on scientific, researched information.

1. Get informed. Much of the delirium and angst that parents, teachers and schools are facing are coming from opinion and others’ fears; and, unfortunately, not educated scientists who specialize in the areas of mental health, school, and medicine. Two websites that we have found quite helpful and informative are:

   1. COVID Explained. https://explaincovid.org/

   2. Don’t Forget the Bubbles. https://dontforgetthebubbles.com/evidence-summary-paediatric-covid-19-literature/

   3. ACES Connection. https://www.acesconnection.com/blog/a-better-normal-education-upended-the-return-to-school-episode

1. Guided recommendations.

   1. Infection and disease burden. A review of the research shows that kids are not getting infected with COVID-19 at the same as older populations. And when they do, their symptoms are mild and often asymptomatic.

OK, perhaps that’s not reassuring b/c you’re still worried about them being asymptomatic and getting teachers and staff sick, right?

1. Transmission. Increasingly, the available research suggests that kids are less likely to spread the virus to others, as well. Across multiple countries, children have rarely been the “index case” that started a cluster of infection (even though asymptomatic adults have frequently been identified as index cases)…nor have they been the first one in a family to be infected. Several studies from schools re-opening have shown that when COVID+ children or staff attended school, the people they came in contact with did not get COVID. There is still much work to do in replicating and reviewing this research, but there is good reason to believe that protecting children and teachers from transmission is possible.  

To note – it’s not helpful that there are hundreds of IG stories and funny FB satires on teachers’ expressing worry about kindergarteners picking each others’ noses, middle schoolers swapping spit, or teenagers being buffoons regarding social distancing. The research is clear – while kids spread a lot of other diseases (the flu, for instance) they’re not spreading COVID at the same rate! So, please stop watching these and terrifying yourselves!!

1. Mortality. As well, their mortality rate is less than 2% of the entire mortality rate of “all things that children die from each year.” Read that again, because many of you are listening to news that takes a student population (let’s say 2,000 kids in a high school) and saying that 40 kids (2% of 2000) are going to die. That’s simply not true! The CDC reports 42 deaths out of the 53 million school age children in our country (a rate of .0001%). Applied to our state of 583,000 school age children we would expect less than 1 student death! Indeed, out of the 1700 pediatric cases in Oregon we have had no deaths. The likelihood that our children are going to die from COVID is less likely that many other illnesses, natural disasters, or events such as a school shooting.

We’re all terrified of losing someone we love. We are not minimizing loss and grief at all and we recognize that many of you have experienced this loss first hand. At the same time, we don’t want parents inappropriately worried about their child dying because the research simply does not indicate that as a likely outcome.
 
What is clear is that adults are transmitting the virus at high rates. Although we’re not concerned about rates of transmission b/w kids based on a literature review, we remain concerned about teachers and other adults infecting each other. We highly recommend schools have systems in place for adult behavior. For instance, precautions in teacher lounges, offices, supply rooms, libraries and other common spaces. It’s likely not a good idea for teachers to share supplies, classrooms or other physical property whenever possible.
 
Finally, now that we have had some level-setting AND we’re guided by factual information, let’s dig into what many of you are overwhelmed by – the multiple decisions regarding how school might look this fall. We recognize, that we are faced with less-than ideal options and that there is no “right” answer. There are no absolute truths; and, decisions you make will be multi-layered. What we encourage you to ponder involves decisions that are genuine to you and your family. No one else’s circumstances are quite your own – so asking friends and neighbors might be validating and help you process; but those are simply opinions. Consider the following when deciding what is best for your family:

1. Consider your relationships. We truly believe that many parent-child relationships were strained this spring. Parents limped by for 6-8 weeks of schooling with threats, fatigue, lack of information, angry conversations and crying kids. Parents felt overwhelmed in balancing work demands and home demands in addition to creating learning plans at home. No one signed up for the crisis we faced and we all did the best we could for spring school. That said, it’s our professional opinion that utilizing the same model for the 2020 school year may be detrimental to your relationship with your child. If you or your child struggled to adjust to schooling this spring consider an alternate plan. The attachment and quality of relationship you have with your children is one of their most important wellness resources!!

2. Kids mental health has and continues to suffer. In May, we saw a huge rise in depression, helplessness, suicidal behavior, anger and withdrawal. We are seeing another rise this summer as uncertainty about the future, including but not limited to, the future of school and social isolation. From early childhood to teens, we are seeing a spike in sadness, anger and isolation. We witness similar symptoms in parents. Children require consistency, structure and predictability to thrive. As well, they are meant to be social. However that might look, it is important to begin to craft a “best practice” plan so that children may realize those themes.

3. Ask a medical and/or mental expert about your unique situation. Just because your friend’s child has asthma, does not mean that your child’s asthma will present the same way or have the same outcomes in a school environment. The same is true for mental health, chronic medical conditions, learning difficulties, or special needs. Reach out to your pediatrician and/or psychologist to glean information about what is best for your unique child. That professional can help you wade through the complexities of your child and family and help you come to a decision that is best for you and your child.

4. Children are resilient. There is a lot of information out there that returning to school for children will be traumatizing. That wearing masks, asking children to socially distance themselves, or not hug/touch each other will create acute fear and trauma. As an expert on trauma and resilience – I want you to consider the following:

   1. Kids will rise up to the expectations that adults set out for them. If we explain masks, hand-washing and social distancing to them in developmentally appropriate ways, they can and will understand. If I can explain executive functioning to kindergarteners, you bet we can explain mask-wearing and “sneaky germs” in a way that doesn’t escalate fear but builds compliance.

   2. Kids are born to be resilient. Working through crises and problem solving actually creates resilient children. Kids have now gone through active shooter drills in our schools. Kids face bullying, isolation, failure and peer pressure in schools. And yet, kids show us every day that they will rise up.

   3. Resilience can be taught, modeled and improved upon.

   4. Kids regulate their emotions based on relationships with healthy adults. We tend to agree that if teachers and administrators model angst and overwhelm this fall, kids will emulate those behaviors. But if teachers model best practice, regulating behaviors and have genuine talks about fears, concerns and overwhelm, kids will mirror us. Equally, parents set the tone for whether all of this is OK. Your children need to hear the calm consistent message that “This is hard and is really a bummer, but we can adjust and deal with hard things…our flexibility and making smart choices will get us through!”

5. Create a village of homeschool collaboration. We believe it’s critically important to begin to reach out to other parents right now. Whether you’re participating in a full-time homeschool option or some type of hybrid option, this next step is imperative.

   1. Find a small group of parents with whom you can homeschool and collaborate. 3-6 families total.

   2. Make an agreement about health and safety concerns and how you might handle kids behaviors consistently.

   3. Invite them to create a “collaborative” of sorts where each parent takes a turn being in charge of a day.

   4. When it’s “your day” – you’re in charge of creating structure, support, meals & snacks, physical outlets and inspiration. Then you get to be done!

   5. A collaborative allows structure, support and predictability as well as socialization with peers – critical ingredients to success! As well, it allows parents a chance to work and have breaks – another critical ingredient.

6. Wrap in another kid. Remember what we said before? There are kids whose parents may not be in a position to offer a full day of support. Wrap another child into your collaborate. Invite their parent to participate or contribute in a meaningful way. Perhaps that parent can make healthy snacks or lunches. Maybe he/she can review papers at night or provide an outing for the kids on the weekend? Don’t lose out on an opportunity to be inclusive. It is our hope that once the cohort groups are built in your child’s classroom that parents can review their cohort and see who may need an invitation to join their collaborative on the “off-days.”

7. Use numbers. To this end, Dr. Valerius has create a decision tree that might help you in your process. This tool will drive a decision that is filled with emotion to become more quantifiable. See, anxiety loves “what ifs” and “look over here.” It cringes at observable numbers and data. So, we thought a decision tree would be quite helpful for those of you that need help weighing pros and cons.

 
Stay tuned! The decision tree is coming! We’ll post it next week. Take time digesting this information first.
 
We hope this helps you find calm within chaos. We hope that you feel direction and support. Please know we are guiding families through these decisions every day and we are making decisions for our own children as well. None of these choices do we take lightly.
 
Please do not hesitate to comment below with thoughts and questions.
 
You can always reach me at awstoeber@hotmail.com and Dr. Valerius at ksvalerius@sundstromclinic.com.  
 
In the meantime, we stand with all of you as we walk through difficult times. We cherish your children and want only the best for our children, communities and schools.
 
With humility and kindness,
Dr. Amy & guest contributor, Dr. Kristin Valerius

P.S. Join our FB group here – see you soon!

Hello friends – welcome! For those of you who are new to our village, I’m Dr. Amy – I’m a licensed psychologist, consultant and trainer. I specialize in helping professionals and parents recognize stress and trauma in children and foster resilience-building skills to decrease long-term effects for children. 

And, before I get started today, let me be sure to invite you to my new, private FB group – you can find out all about it here. We’re creating a village of parents who want more than traditional parenting advice from a supportive community of parents and a realistic, practical expert. 

 

We are currently creating huge amounts of stress for children by not talking to them about COVID, mask-wearing, social distancing and other important health behaviors. So, hang in here with me as I half rant/half educate on what we should be doing to protect children right now. 

 

This past weekend was a holiday and we’re moving full-swing into summer months. I know that right now, our nation’s COVID rates are at a dramatic height. So, wear your masks! It’s not hard! It takes 2 seconds and can save lives. This, in no way, is an anti-mask message. At the same time, I think we can be responsible about COVID but not continue to stress out our kids and traumatize them – and when I say kids, I’m referring to little people under the age of 15. 

 

With sunny skies and BBQ’s for weeks to come, I wanted to message everyone about ways to be safe, but not hurt children. 

 

None of the preventative measures we need to take for health and safety are developmentally appropriate for kids – that’s why older kids are balking at this – they don’t understand their role and we’ve used fear tactics vs. compassion and conversation to understand what’s going on. With younger kids, we’re scaring them without conversations and understanding. In Oregon, there was a commercial that highlighted “Don’t Kill Grandma” by hugging her. Can you imagine how that child must feel? What if grandma actually died? Geez! At the grocery store, I see moms (understandably frightened as COVID rates spike) yell at their kids at the grocery store “don’t touch that” “stay away from people” – kids look terrified. So, I’m going to talk about some ways to alleviate this stress. 

 

Get educated! Stop listening to your neighbor or your FB friend or your buddy from work about his/her opinion on COVID – masks save lives, being outdoors is better than being indoors and if you can’t keep socially distanced, then being with just the people you live with is the most safe. So, if you’re thinking about a get-togethers and BBQ’s this summer, think outdoors, think wide spaces. Or think about staying home. 

 

Begin to have tough conversations with people with whom you’re socializing. I’ve talked with families for months now about the intersection of risk and comfort. If you’re going places, getting together for small gatherings, etc, you’ve already accepted some risk. At that point, decide what would make you feel most comfortable while taking the risk. For example, at our family BBQ this past weekend, we had two families over for the holiday. This means accepting some risk. What we did to be most comfortable with the risk was to clearly communicate expectations.  

 

For example, it was ok with us for people to come over as long as they stayed outside. People brought their own chairs. Food was kept outside. Hand sanitizer was put out when shared utensils were being used. The only reason people entered our home (except for the people that live here) were to use the restroom. And then, the quickest route to the restroom was made and wipes were made available to wipe down the faucet, sink and door knobs on guests’ way out. 

 

While this might sound laborious, it allowed us to be clear and comfortable while taking some risk with the benefit of socialization and community. So, have the tough conversations. 

 

Include kids in conversations about the “why”. For younger kids, instead of terrifying them, talk to them about how germs spread and why we’re taking preventative measures. 

1. Let them know it keeps everyone safe. Allow them to make their own masks, decorate them, wear costume masks or sunglasses too. Know that some of these necessary procedures are embarrassing and strange for kids. 

2. Let them know it’s ok to ask questions and that we all look funny right now. 

3. Let your kids know what IS ok – it’s ok to hug mommy; but it’s not ok to hug grandma right now until we wash our hands; or we can talk to grammy through a window or in the backyard. We can send her love notes, poems, talk to her on facetime. We can make meals for her. 

 

Constantly focusing on what kids “can’t” do is not helping. Kids are supposed to be social. They’re supposed to hug, play next to, run in gaggles, and clump together – we’re asking them to do what is NOT developmentally appropriate. So, for goodness sake, instead of shaming them or terrifying them – none of which has a health policy history of working…..instead, have conversations with them. Let them know that we’re being extra cautious right now because these germs are sneaky and invisible. 

 

The same is true for older kids. For goodness sake, if you have an 18-25 year old who’s acting selfish and you’re judging them and shaming them; instead, try having a conversation with them: 

• “Talk to me about your behavior and why you feel like this is safe?”

• “Are you aware of the dangers?”

• “If you’re going to be out and about, how can you limit exposure to others?”

This  population of young people are supposed to be invincible and autonomous – it’s developmentally appropriate for them to be. So, instead of asking them to NOT do what is normal; instead, ask them thoughtful questions and encourage them to self-reflect. 

So, those thoughts come down to 5 practical strategies:

1. Know what’s developmentally appropriate for kids. If you’re not sure, ask someone like me, your pediatrician, or a teacher. But please, stop asking google and FB friends unless they’re a physician, educators or mental health expert.

2. Educate yourself about what’s appropriate right now to keep kids and families safe. We have to provide socialization without shame in ways that address needs for kids to be social, but still keep them safe.

3. Have conversations about the intersection of comfort and risk with anyone you’re going to spend time with – and if you can’t have that conversation, you probably shouldn’t spend time with them.

4. Include kids in conversations that focus on what they can do vs. what they can’t.

5. Encourage empowerment and socialization in healthy ways vs. shame and terror. 

 

That’s it. 

Wear your masks. Have conversations and STOP terrifying children.

Dr. Amy

 

PS – if you haven’t joined my free, private FB group, do it now! I can’t wait to have you join these discussions. Click here to join!