Children, Schools and Social Risk

Children, Schools and Social Risk:

UNICEF reminded us, April 2020, “while our eyes are firmly focused on how to avoid or treat COVID-19, the serious consequences that will challenge us far beyond the current pandemic – the hidden impacts – are not yet front of mind. This must change. Not only are children and young people contracting COVID-19, they are also among its most severely impacted victims. Unless we act now to address the pandemic’s impacts on children, the echoes of COVID-19 will permanently damage our shared future. According to our analysis, 99 per cent of children and young people under 18 worldwide (2.34 billion) live in one of the 186 countries with some form of movement restrictions in place due to COVID-19. Sixty per cent of all children live in one of the 82 countries with a full (7%) or partial (53%) lockdown – accounting for 1.4 billion young lives. We know that, in any crisis, the young and the most vulnerable suffer disproportionately. This pandemic is no different. It is our responsibility to prevent suffering, save lives and protect the health of every child. We must also ensure that risk-informed decisions on COVID-19 control measures are made based on the best available evidence in order to minimise and prevent any collateral damage, and to provide mitigation measures so the damage is not lasting.” Most agree,18 months later, that we have not prioritised these goals.

Significant concerns have been raised in terms of increased statistics relating to child abuse, mental illness, developmental problems, general health and well-being for children due to indiscriminate mandatory initiatives not based on good clinical evidence. 

Many agree that child abuse and mental health statistics need to decrease significantly; early detection, prevention and access to appropriate services are essential steps to achieve these goals. We offer assistance and training in this regard, often pro bono. We have extensive experience in teaching and training, for example teaching medical students at the University of Cambridge, teaching medical doctors specialising in Child Psychiatry on the MRCPsych course in Cambridge and offering training to GPs, Paediatricians, Psychologists, Social Care, Police, Prisons and Youth Offending teams. Most of our training currently offered relates to identifying child abuse or mental health problems in complex presentations such as children with neurodevelopmental problems or hard to reach children. Please contact us for further details.

Recommendations to safeguard children – many colleagues recommend; 

• ending indiscriminate mandatory initiatives, not based on good clinical evidence, where evidence exists that harm is caused and risk is increased without delay.  “The benefits of wearing masks in children for COVID-19 control should be weighed against potential harm associated with wearing masks, including feasibility and discomfort, as well as social and communication concerns.”  WHO and,

• schools need to re-open and remain open, but with education (age appropriate and enjoyable approach) regarding evidence-based risk reduction and protective strategies for children and staff in the context of COVID-19 and general health; it is important that children’s anxiety levels remain low in the context of ‘germs’ or infections to prevent mental health morbidity, often common in certain age groups,

• daily healthy school meals with educational, enjoyable opportunities to learn skills to cultivate herbs, fruit and vegetables at home and prepare enjoyable, healthy meals,

• education in schools regarding important life skills such as managing finances, starting businesses, applying for work or conflict resolution,

• education in schools (staff and pupils) regarding general safety, child abuse and mental health (practical and age appropriate approach) – we offer pro bono question and answer sessions in schools where any individual can ask any question,

• normative activities for children – regular opportunities outside schools where children can engage in enjoyable, positive and meaningful activities, including group activities, in the community with responsible adults and peers with similar interests, where opportunities are offered to develop social support networks, learn new skills and experience a sense of achievement. Normative activities promote normal child development (physical, social, emotional, cognitive and language), general health, mental health, general well-being, and reduce risk. Good clinical outcomes and prognoses in general and mental health usually require a bio-psycho-social approach. Children described as ‘hopeless’ (never an accurate description) are often referred to us, and we have consistently observed that prognosis can change markedly with the introduction of a patient specific and appropriate bio-psycho-social treatment plan. It is our recommendation that electronic activities or tools be excluded during normative activities; electronic activities and tools can offer other benefits to children, but we recommend that this is considered separately, based on our experience.

• positive narratives; many children with a background of ongoing or past significant trauma often report the life event that precipitated sustained positive change in their lives eg “one message” by a teacher or other adult, “who believed I can do better and have better”, “I saw she saw me as good, so I thought ok I must have good in me”, or provided by a setting eg “Disney’s message that anything is possible if you work hard and believe changed my life”. We have written extensively regarding the importance of positive public messaging and narratives, and the direct effects on thoughts, beliefs, emotions, behaviour, physiology and clinical outcomes.

• access to general and mental health services and specialist consultation without delay for serious presentations, we have shared extensively details regarding our concerns relating to children waiting more than 5 years for consultant input or for comprehensive assessments to screen for medical, neurodevelopmental and serious mental health concerns, 

• formal and urgent review of A – child mental health teams (by individuals with experience in managing bio-psycho-social risk in clinical settings), B – regulations under the Mental Health Act relating to clinicians with clinical responsibility for children and adults detained under the mental health act. We have shared comments regarding the urgency of identifying medical concerns in patients with mental health problems, early and accurate mental health diagnoses, safe and user-friendly practices in CAMHS teams and in general health clinics. 

• formal and urgent review of current policies, processes and emergency legislation in the context of COVID-19 and the definition relating to ‘state of emergency’ and ‘covid deaths’ (definitions need to be consistent and need to make medical sense – medical and legal colleagues raised concerns that some nations finalised legislation in haste and omitted appeals processes to safeguard the public or allow for the inclusion of medical opinions),

• training regarding identifying mental health problems, risk or child abuse in complex and high risk clinical presentations – child abuse can sometimes present very similar to other mental health problems such as anxiety, or neurodevelopment disorders such as Attention Deficit Hyperactivity Disorder (ADHD) or Autism Spectrum Disorders (ASD),

• service development and training regarding engaging hard to reach children, such as children refusing to attend appointments or children in high risk contexts such as homeless children or young offenders,

• a greater emphasis on child protection by governments – child protection concerns and an awareness of child protection in general have been emphasised in many countries in 2020 and 2021 – for example questions have been asked about adult nudity on beaches or next to pools where children are present, or at homes when children are present or have peers visiting, which most agree is not acceptable and does not protect children or promote healthy child development. Concerns have also been raised regarding general settings or policies in communities or schools relating to various topics. We have extensive experience of working in child protection, looked after children, foster and adoption, unaccompanied minor, youth offending as well as children’s drug and alcohol teams. We know that the children’s views, or views of professionals with decades of experience in these fields, are not considered in many or most of these decisions, which will often increase risk to children and communities.

These recommendations include evidence-based protective factors relating to child development (physical, social, emotional, cognitive and language), general health, mental health, social risk and general well-being.  

Many agree that we should ask ourselves whether our decisions in the last 21 months contributed to harm or to protection for children and adults, based on evidence available, and that we need to focus on investing in or preparing for the future, knowing that the most logical place to start is with children’s welfare.

We asked children and young people in various countries where they would suggest the world starts to invest in a better future. Most replied that we should start with reviewing the definition of leadership and good leadership; “some things are as simple as building sand castles, but the focus is not on the problem and solution, the focus is on what is to gain from it”, young person in EU country.

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