Navigating Students' Mental Health in The Wake of Covid-19

The Mental Health and Well-being of Children and Adolescents
NAVIGATING STUDENTS’
MENTAL HEALTH IN THE
WAKE OF COVID-19
USING PUBLIC HEALTH CRISES TO
INFORM RESEARCH AND PRACTICE
Edited by
James M. Kauffman and Jeanmarie Badar
NAVIGATING STUDENTS’
MENTAL HEALTH IN THE WAKE
OF COVID-19
This book highlights the effects of the COVID-19 pandemic on the mental health
needs of children and adolescents in order to shed light on future practice and
reform needed to better deal with the aftermath of such devastating events.
The book identifies the conditions during any public health crisis that heighten the
mental health needs of children and adolescents and suggests the reforms of mental
health services needed to better meet the needs of children and youths during and
following pandemics and other public health crises. Importance is placed not only on
addressing the effects of COVID-19 but on anticipating and preparing for other public
health disruptions to the lives of those who have not reached adulthood. Although
mental health services in all settings are considered, special attention is given to the role
of schools in providing for the mental health of children and adolescents and preparing
for the mental health implications of future public health disruptions.
The book will be of equal use to both students and researchers in the fields of
mental health, well-being, and education as well as teachers, educational psychologists,
social workers, and practitioners working in schools and communities to address
students’ mental health needs. It will help readers better understand how and why
COVID-19 was a negative influence on students’ mental health, and unpack how best
to deal with the aftermath of the pandemic.
James M. Kauffman, Ed.D., Professor Emeritus, University of Virginia, USA.

Dr. Kauffman taught both special and general education and retired from the
University of Virginia after teaching there for 36 years. He is the author or co-
author of numerous publications.
Jeanmarie Badar, Ph.D., Independent Scholar, Afton, Virginia, USA. Dr.

Badar taught special education in public schools for 25 years and is now an in
dependent scholar, tutor, and consultant for children and adults with and without
disabilities. She is the co-author of numerous publications.
The Mental Health and Well-being
of Children and Adolescents
Series Editor: Garry Hornby
University of Plymouth
Mental health disorders in children and young people are increasing, with one in
four under-16s experiencing mental health difficulties which will disrupt re
lationships, education and work. In addition to this, one in ten under-16s suffers
from a diagnosed disorder. Access to up-to-date research and appropriate inter
ventions minimises the mental health challenges these children and adolescents
face and reduces their potentially lifelong impact.
It has been internationally recognised that the scale of mental health research is
low in relation to the burden of the disorder. This research-focused series will
consist of titles that consider key issues affecting young people’s mental health and
well-being, exploring preventative measures, promoting positive behaviour, and
sharing research to develop effective and efficient treatment.
Aimed primarily at researchers and postgraduate students, this series will also be
of interest to practitioners in the mental health field, such as psychologists, and
some in the field of education, such as counsellors, who would like to implement
research-based findings in their clinical practice.
Books in the series include:

Mental Health and Academic Learning in Schools
Approaches for Facilitating the Wellbeing of Children and Young People.
Andrea Reupert
Navigating Students’ Mental Health in the Wake of COVID-19
Using Public Health Crises to Inform Research and Practice
Edited by James M. Kauffman and Jeanmarie Badar
Please visit www.routledge.com/The-Mental-Health-and-Well-being-of-Children-
and-Adolescents/book-series/MHWCA
NAVIGATING
STUDENTS’ MENTAL
HEALTH IN THE
WAKE OF COVID-19
Using Public Health Crises to
Inform Research and Practice
Edited by James M. Kauffman and

Jeanmarie Badar
First published 2023
by Routledge
4 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
605 Third Avenue, New York, NY 10158
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2023 selection and editorial matter, James M. Kauffman and Jeanmarie
Badar; individual chapters, the contributors
The right of James M. Kauffman and Jeanmarie Badar to be identified as the
authors of the editorial material, and of the authors for their individual
chapters, has been asserted in accordance with sections 77 and 78 of the
Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or
utilised in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in
any information storage or retrieval system, without permission in writing
from the publishers.
Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and explanation
without intent to infringe.
British Library Cataloguing-in-Publication Data

A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data

A catalog record has been requested for this book
ISBN: 978-1-032-20528-1 (hbk)

ISBN: 978-1-032-20531-1 (pbk)
ISBN: 978-1-003-26403-3 (ebk)
DOI: 10.4324/9781003264033
Typeset in Bembo
by MPS Limited, Dehradun
CONTENTS
List of Figures vii

List of Tables viii
Series Editor’s Foreword ix
Preface xi
Acknowledgments xiii
List of Contributors xiv
1 A Sketch of the Problem 1

Hannah M. Mathews, Shanna E. Hirsch, Martha Hernandez,
and James M. Kauffman
2 Addressing the Need for Research into the Effects of

COVID-19 on Teachers and Students 20
Jeanmarie Badar, Lindsay Lowdon, and Emma C. Kauffman
3 Virtual and Personal Academic Instruction and Behavior

Management 34
Justin T. Cooper, Timothy J. Landrum, Todd Whitney, and
Heather M. Heather M. Baltodano-Van Ness
4 How COVID-19 Worsened the Mental Health Problems of

Incarcerated Youth 57
Theresa A. Ochoa, Yanúa Ovares-Fernández,
Nicole Maki Weller, Claire de Mezerville-López,
Viria Ureña-Salazar, Emilia Guillén-Ulate, and
Berenice Pérez-Ramírez
vi Contents
5 School and Community Reforms that Help Navigate the

COVID-19 Crisis 75
Sarup R. Mathur, Wendy Peia Oakes, Heather Griller Clark, and
Germaine Koziarski
6 Students’ Mental Health Issues in Europe and Other

Countries 98
Marion Felder, Bernd Ahrbeck, Dimitris Anastasiou,
Soraia Araújo, Carmen Leon-Himmelstine, João Lopes,
Célia R.Oliveira, Fiona Samuels, Katrin Schneiders,
and Philip Veerman
7 Preparing for Future Pandemics: A Science-Backed,

Human-Centered Framework 128
Marcia L. Rock, Veronnie Faye Jones, and Lisa Hooper
8 Summing Up What We Know—And What We Don’t 155

James M. Kauffman, Jeanmarie Badar, Daniel P. Hallahan, and
Paige C. Pullen
Index 161
FIGURES
1.1 Ecological Systems Theory and COVID-19 Pandemic 8

7.1 Preparing for Future Pandemics: A Science-Backed, Human-
Centered Framework 132
7.2 Planning Blueprint: Comprehensive, Coordinated School-Based
Mental Health 138
7.3 Mental Health Planning and Preparedness Recommendations 142
TABLES
1.1 Social, Emotional, Behavioral, and Mental Health Needs 3

5.1 Agencies and Organizations with Resources for Schools to
Support Students’ Mental Health 79
6.1 Government Response Stringency Index, Vaccination Rate,
and Mortality and Economic Consequences of the Pandemic
COVID-19 104
6.2 Pre-Pandemic Studies on the Mental Health of Children and
Adolescents in Portugal 114
6.3 Pandemic Studies on the Mental Health of Children and
Adolescents in Portugal 115
6.4 Pandemics Services and Programs for Children and Youth 116
SERIES EDITOR’S FOREWORD
This important book was written at a time when the whole of humanity has been
under the influence of the coronavirus pandemic. The impact of this global crisis
has increased stress and anxiety levels for everyone, but especially for children and
their families, which has highlighted the importance of supporting and facilitating
the mental health and well-being of children and adolescents. Although the
pandemic has led to increased awareness of children’s mental health needs, this was
already an issue of great concern.
The mental health and well-being of children and young people had become of
increasing concern in recent years. For example, the UK government recently
reported that 10% of young people aged between 5 and 16 years had a clinically
significant mental health problem, whilst only 25% of those were receiving
appropriate support and treatment (Cooper & Hornby, 2018). This situation has
been referred to as one of “scandalous neglect” by the editors of this book
(Kauffman & Badar, 2018). It is an important issue because, for 50% of those who
go on to develop mental illness, the symptoms are clearly evident before the age of
14. This highlights the critical role of early identification of children’s mental
health problems and the provision of safe environments for the development of
their well-being.
It is now 20 years since the need for an increased focus on children’s mental
health, particularly in schools, was acknowledged by the publication of the first of
several books on the topic, which provides information on a wide range of mental
health concerns (Atkinson & Hornby, 2002). One response to these publications
has been the creation of this series of books which is dedicated to addressing the
mental health and well-being of children and young people. The key focus of
books in this series is on evaluating the latest research and disseminating evidence-
based interventions and programs. This book is the fifth in that series. The first
book focused on bullying in schools (Cowie & Myers, 2018), the second book
x Series Editor’s Foreword
examined various approaches for promoting the mental health of children in

schools (Reupert, 2020), the third book focused specifically on the use of
mindfulness meditation for facilitating the mental health and well-being of
children and young people in schools and community settings (Singh & Singh
Joy, 2021), and the fourth book addressed bullying in schools from multiple
perspectives (Rigby, 2022).
The current book focuses on the effects of the pandemic on the mental health of
young people. Children and adolescents have been particularly affected by the
closure of schools, disruption of their routines, restriction of their social
relationships with peers, limitation of movement about the community and
attendance at social functions, the sudden transition to virtual learning, the illness
and possible death of loved ones, fear for their own physical health, and
uncertainty about their future.
The authors of chapters in this book help us better understand the effects of the
pandemic on the mental health of children and adolescents, the nature and
international scope of the problem, what can be done to mitigate the pandemic’s
negative effects, what we need to know more about, and how we might best
prepare for similar public health crises in the future.
Emeritus Professor Garry Hornby
University of Plymouth
References
Atkinson, M., & Hornby, G. (2002). Mental health handbook for schools. RoutledgeFalmer.
Cooper, P., & Hornby, G. (2018). Facing the challenges to mental health and wellbeing in
schools. Pastoral Care in Education, 36(3), 173–175.
Cowie, H., & Myers, C-A. (Eds.) (2018). School bullying and mental health: Risks, intervention
and prevention. Routledge.
Kauffman, J. M., & Badar, J. (2018). The scandalous neglect of children’s mental health: What
schools can do. Taylor & Francis.
Reupert, A. (2020). Mental health and academic learning in schools: Approaches for facilitating the
wellbeing of children and young people. Routledge.
Rigby, K. (2022). Multiperspectivity on school bullying: One pair of eyes is not enough.
Routledge.
Singh, N. N., & Singh Joy, S. D. (2021). Mindfulness-based interventions with children and
adolescents: Research and practice. Routledge.
PREFACE
The COVID-19 pandemic has been a disaster in many ways, not only in its
monstrous effects on the mental health of youngsters. It has been a disaster for the
mental health of people of all ages. Children and adolescents, the focus of this book,
have been particularly affected by the closure of schools, disruption of the routines,
restriction of their social relationships with peers, limitation of movement about the
community and attendance at social functions, sudden transition to virtual learning,
death of loved ones, fear for their own physical health, uncertainty about the future,
and other unfortunate events. This is not to deny that these same things have caused
adults trauma as well, but we concentrate our attention in this book on the trauma and
mental health problems of younger people.
COVID-19 has not been an unmitigated disaster for people of any age, although
it has changed the world in many disastrous ways (Helmuth, 2022). A few children
and adolescents, even some with disabilities, have thrived with the introduction of
virtual learning. The disaster of the pandemic has some “silver linings,” too,
including not only potentially positive future changes but immediate benefits for a
few individuals. Nevertheless, those with fewer economic resources, special
sensitivities, and risks such as incarceration or disabilities (or both), have been
disproportionately harmed, including children and adolescents with already-
existing mental health needs—and their families as well.
The poorest will also suffer the most from the pandemic’s economic
aftermath—in particular from the loss of job, disproportionately
concentrated low-wage service sectors. Just as worrisome, poorer
children have experienced terrible educational setbacks as schools moved
online, presaging a potentially long-term aggravation of inequality and
deprivation (Stiglitz, 2022, p. 52).
xii Preface
Not only are the poorest in any nation at the highest risk when it comes to
COVID but they are at the highest risk for negative consequences in any
humanitarian crisis, natural or manmade. For example, the humanitarian crisis
created by Vladimir Putin’s brutal invasion of Ukraine in 2022 will undoubtedly
increase the mental health needs of children and adolescents from Ukraine (e.g.,
Khurshudyan et al., 2022; Raghavan, 2022; see also related websites). However, it
is predictable that the greatest needs of all will be among those with the fewest
financial resources and those with disabilities.
One potential benefit of the COVID-19 pandemic is a better understanding of
how public health crises affect children and adolescents and what is required in
preparing for future crises. Certainly, future pandemics are likely to occur, but so are
other public health crises precipitated by such preventable things as gun violence,
war, and famine but also by natural disasters including less preventable or totally
unpreventable events such as hurricanes, cyclones, floods, wildfires, earthquakes, and
tsunamis. These may be more local than nation- or worldwide, but they are events
and conditions that will affect the mental health of children and adolescents around
the world. About 100 years elapsed between the worldwide flu pandemic of the
early 20th century and the COVID-19 pandemic. It will be very surprising, indeed,
if the world’s next pandemic is a century or more in the future.
The authors of chapters in this book help us better understand the effects of
COVID-19 on the mental health of children and adolescents, the nature and
international scope of the problem, what can be done to mitigate the pandemic’s
ill effects, what we need to know more about, and how we might best prepare for
future crises in public health.
References
Helmuth, L. (Ed.). (2022, March). Special issue: How COVID changed the world. Scientific
American, 326(3). Entire Issue.
Khurshudyan, I., Demirjian, K., Raghavan, S., & Slater, J. (2022, March 8). Ukraine’s
humanitarian crisis grows: Few safe escape routes from besiegfed cities; talks remain
inconclusive. Washington Post A1, A17.
Raghavan, S. (2022, March 8). With little more than their clothes and pets, panicked
residents flee. Washington Post, A1, A12.
Stiglitz, J. E. (2022). Inequality got much worse: The poor, no matter where they live, will
suffer the greatest lasting toll. Scientific American, 326(3), 52–53.
ACKNOWLEDGMENTS
We are indebted to many for the creation of this book. Garry Hornby helped us
shape the idea, provided encouragement for us to prepare a book proposal,
provided invaluable editorial assistance, and wrote a splendid foreword. Swapnil
Joshi gave us excellent guidance and expertly steered the project through its early
stages. We are deeply grateful for her attention to the project and her kind
assistance. A second editor, AnnaMary Goodall, seamlessly took over the project
during its development. She and her team gently and expertly saw it through to
the conclusion. The authors of the chapters completed their work in a timely
fashion and with great care and knowledge of the latest developments of our
knowledge of the pandemic (and lack thereof).
JMK & JB
Afton, VA
March, 2022
CONTRIBUTORS
Bernd Ahrbeck, Ph.D., is a Professor of Psychoanalytic Paedagogy at the

International Psychoanalytical University (IPU-Berlin). He previously taught at
Humboldt University Berlin with a focus on children and youth with behavior
disorders.
Dimitris Anastasiou, Ph.D., is an Associate Professor of Special Education at
Southern Illinois University, Carbondale. His publications and research include
disability rights and policy, comparative special education, and education
interventions in reading and writing.
Soraia Araújo is a Ph.D. student in Applied Psychology at the University of
Minho, Braga. Her research interests include literacy learning and instruction,
developmental disabilities, and teachers’ professional development.
Jeanmarie Badar, Ph.D., Independent Scholar, Afton, Virginia, USA. Dr. Badar
taught special education in public schools for 25 years and now is an independent
scholar, tutor, and consultant for children and adults with and without disabilities.
She is co-author of numerous publications.
Heather Baltodano-VanNess, Ph.D., BCBA-D, is an Assistant Professor in
Residence in the Department of Early Childhood, Multilingual, and Special
Education at the University of Nevada, Las Vegas. She is a licensed school
psychologist and Board Certified Behavior Analyst with expertise in applied
behavior analysis, emotional/behavioral disorders, and autism spectrum disorders.
Heather Griller Clark, Ph.D., Principal Research Specialist, Arizona State
University. Dr. Griller Clark’s teaching, research, and funded projects focus on
youth with disabilities in the juvenile justice system. She has authored or co-
Contributors xv
authored numerous publications and directs the annual Teacher Educators for
Children with Behavioral Disorders (TECBD) conference.
Justin T. Cooper, Ed.D., Associate Professor and Chair, Department of Special
Education, Early Childhood, and Prevention Science, University of Louisville.
Dr. Cooper taught special education in the area of learning and behavioral
disorders and conducts research on effective practices with that population of
students.
Claire de Mézerville López is a licensed psychologist, lecturer, and researcher at
Universidad de Costa Rica. She has been a therapist and consultant. She holds a
Master’s in Education with an emphasis on cognitive development from Instituto
Tecnológico de Estudios Superiores de Monterrey and another in Science in
Restorative Practices.
V. Faye Jones, MD, Ph.D., MSPH, Interim Senior Associate Vice President for
Diversity and Equity, Associate Vice President for Health Affairs/Diversity
Initiatives, Professor of Pediatrics, Vice-Chair, Department of Pediatrics,
University of Louisville. Dr. Jones has been a physician, university
administrator, professor, and author for 32 years.
Marion Felder, Ph.D., is a Professor in the Department of Social Sciences at the
University of Applied Sciences, Koblenz. Her teaching and research focus lies in
the area of rehabilitation, and special and inclusive education.
Emilia Guillén-Ulate is a licensed instructor with an emphasis on regular
education, educational administration, and adult education. She has 27 years of
experience as a teacher and was the chair of the education program in Correctional
Facilities. She works for the Ministerio de Justicia in Costa Rica and is part of the
Social Insertion Unit for reentry.
Daniel P. Hallahan, Ph.D., Professor Emeritus, University of Virginia, recipient of
numerous accolades, including State of Virginia’s Outstanding Faculty Award and
Council for Exceptional Children’s Research Award, has taught thousands of pre-
service teachers and dozens of doctoral students. His scholarship spans books to
articles and applied to basic research.
Martha L. Hernández is a doctoral student at Florida International University.
Her research seeks to improve the education of culturally and linguistically diverse
learners with disabilities using qualitative inquiry to attract, prepare, and support
Latina special education teachers.
Shanna E. Hirsch, Ph.D., BCBA-D, is an Associate Professor of Special Education
at Clemson University. Her current research focuses on implementing positive
behavior interventions and supports; supporting teachers with classroom
management; and implementing evidence-based practices to support students
with and at risk for emotional and behavioral disorders.
xvi Contributors
Lisa M. Hooper, Ph.D., Professor and Richard O. Jacobson Endowed Chair for
Research, Director Center for Educational Transformation, University of
Northern Iowa, USA. For 22 years, Dr. Hooper has served as a researcher,
mentor, and leader. She is the author or co-author of over 140 peer-reviewed
articles.
Emma Kauffman, B.A., is a high school social studies teacher at Rolesville High
School, Rolesville, North Carolina. She holds a Bachelor of Science in History
Education and a Bachelor of Arts in History. She primarily teaches 11th-grade
American History.
James M. Kauffman, Ed.D., Professor Emeritus, University of Virginia, USA. Dr.
Kauffman taught both special and general education and retired from the
University of Virginia after teaching there for 36 years. He is the author or co-
author of numerous publications.
Germaine Koziarski, M.Ed., Doctoral Student, Arizona State University, USA.
Ms. Koziarski previously taught special education in public elementary schools.
She is pursuing a doctorate with a focus on how students with and without
disabilities experience discipline in inclusive classrooms.
Timothy J. Landrum, Ph.D., Professor, University of Louisville, USA. Dr.
Landrum taught students with emotional and behavioral disorders in public
schools before moving into higher education. He is the author or co-author of
numerous publications, most around issues of challenging behavior, classroom
management, or translating research into practice.
Carmen Leon-Himmelstine, Ph.D., International Development, is a Research
Fellow at Overseas Development Institute (ODI, London, UK). She has extensive
research experience on mental health and its linkages with gender, migration,
social protection, adolescence, and intersectionality in Latin America and the
Caribbean, East Africa, and East Asia.
João Lopes, Ph.D., is an Associate Professor of Psychology at the University of
Minho, Braga. His research interests include childrens’ learning and behavior
problems, classroom discipline, literacy learning and instruction, and teachers’
professional development.
Lindsay Lowdon has taught for 33 years. She earned a B.A. in English Literature at
Kenyon College and an M.A. in Learning Disabilities at Northwestern University.
She has taught Kindergarten through 12th grade and now teaches literature to
middle school students in a private school in Charlottesville, VA.
Hannah Mathews, Ph.D., is an Assistant Professor of Special Education at the
University of Florida. Her research examines special educators’ professional
socialization and the ways that this interacts with other organizational factors to
shape the quality of services provided to students with disabilities.
Contributors xvii
Sarup R. Mathur, Ph.D., is Ryan C. Harris Memorial Professor in Special

Education, Arizona State University. Dr. Mathur has authored and co-authored
numerous publications on professional development, children with emotional and
behavioral disorders, equitable environments for learning and mental health, and
re-entry of juvenile offenders.
Wendy Peia Oakes, Ph.D., Associate Professor, Arizona State University. Dr.
Oakes’ research, teaching, and service focus on strengthening educational systems
and practices to support the development and educational attainment of students
with and at risk for emotional and behavioral disorders. She is a member of the
Comprehensive, Integrated, Three-tiered (Ci3T) model of prevention Strategic
Leadership Team.
Theresa A. Ochoa, Ph.D., is an Associate Professor of Special Education at Indiana
University. Dr. Ochoa specializes in emotional and behavioral disorders and is the
Founder and Co-Director of the Helping Offenders Prosper through Employment
mentoring program and the Global Consortium for Juvenile Delinquency and
Prevention.
Célia Oliveira, Ph.D., is an Assistant Professor of Cognition and Educational
Psychology at Lusófona University of Porto. Her research interests include
learning and memory, classroom discipline, and elementary education.
Yanúa Ovares Fernández is an instructor in Educational Services with an
emphasis on Special Education from Universidad de Costa Rica. She is an
instructor and researcher specializing in adolescents with emotional and behavioral
disorders. She coordinates different projects to support deaf teachers and people
with disabilities.
Paige Pullen, Ph.D., Chief Academic Officer, University of Florida Lastinger
Center. Pullen’s work focuses on high-quality professional development in
reading instruction and intervention. She has conducted research and presented
internationally on learning disabilities and reading intervention across the USA,
Europe, and Africa, and is the author of numerous publications.
Berenice Pérez Ramírez, Ph.D., is a Professor of Social Work at the Universidad
Autonoma de México (UNAM). She is the Co-coordinator of the Critical
Disability Studies Working Group. Dr. Pérez’s research focuses on the Mexican
prison system, disability, and social work.
Marcia L. Rock, Ph.D., Professor, University of North Carolina Greensboro,
USA. Dr. Rock has taught special education in public schools from kindergarten
through 12th grade. For over two decades, she has been a researcher and teacher
educator. She is the author and co-author of journal articles, books, chapters, and
other publications.
Fiona Samuels, Ph.D., is an anthropologist and Senior Research Fellow at
Overseas Development Institute (ODI, London) and an Honorary Associate
xviii Contributors
Professor at the London School of Hygiene and Tropical Medicine (LSHTM),

University of London.
Katrin Schneiders, PhD., is a Professor in the Department of Social Sciences at the
University of Applied Sciences, Koblenz. Her teaching and research foci are social
economics, welfare corporatism, and organizational and financial structures of
social work and education.
Emilia Guillén Ulate is a licensed instructor emphasizing regular education,
educational administration, and adult education. She was a teacher for 27 years and
chaired the education program in Correctional Facilities. She works for the
Ministerio de Justicia in Costa Rica and is part of the Social Insertion Unit for
reentry.
Viria Ureña Salazar is an instructor in Educational Sciences with an emphasis on
Counseling from the Universidad de Costa Rica. She is an instructor, researcher,
and supporter of thesis track and capstone projects for graduation in the vocational
field.
Philip Veerman, Ph.D., is a psychologist, specializing in health and forensic
psychology, children’s rights, childhood, child protection, (child) trafficking,
international human rights, and international cooperation. He has worked with
children, adults, and families within a variety of different services and
multidisciplinary teams.
Nicole Maki Weller, Ph.D., is an Associate Professor of Sociology, Indiana
University Kokomo, USA. Dr. Weller studies the sociodemographic predictors
for risky health behaviors among adolescents and young adults, including sexual
health and drug use behaviors.
Todd Whitney, Ph.D., Assistant Professor of Special Education, University of
Louisville. Dr. Whitney previously taught students with learning and behavior
disorders as a special education teacher. He is co-author of numerous publications.
1
A SKETCH OF THE PROBLEM
Hannah M. Mathews, Shanna E. Hirsch,
Martha Hernandez, and James M. Kauffman
In 2019, the world changed in significant ways. The emergence and spread of the
virus SARS-CoV-2, more commonly known as COVID-19 to note the year of its
development into a pandemic, altered social and economic conditions everywhere.
Its effects on individuals of school age have been profound. Dooley et al. (2022)
wrote, “The toll of school closures and social isolation on children’s mental health
cannot be overstated and will require both immediate- and long-term investigation
and action to fully assess and address the impact.”
All nations of the world had to contend with the virus and its effects. The
changes in education were particularly dramatic. By April 2020, United Nations
Educational, Scientific, and Cultural Organization (UNESCO) reported that 93%
of counties across the globe closed their schools fully or partially to stop the spread
of COVID-19 (2021b). These closures impacted 1.6 billion learners (The World
Bank, 2021). Educators shifted overnight to emergency remote instruction (Murphy
et al., 2020; UNESCO, 2022). During the emergency remote instruction phase
(Spring of 2020), educators may have communicated with students on the phone
(Nadworny, 2020) or on virtual platforms such as Zoom (Bruhn et al., 2022). At
the same time, some districts elected to close completely, not providing any in-
struction or communications (Hirsch et al., 2022). To decrease the physical harm
inflicted by the virus, school sites were closed. Without a doubt, this transition
disrupted the lives of children and adolescents. In addition to missing academic
support, more holistic, systematic support that many young people depend upon was
not available (e.g., meals, mental health services, behavioral support; UNESCO,
2021a). At the same time, many children and adolescents experienced the direct
impact of the virus, as they were confined to their homes, separated from their
extended families and friends, and unable to engage in opportunities for socializa-
tion. With this isolation, they also experienced a lack of structure, and an increase in
uncertainty and fear (Asbury et al., 2021).
DOI: 10.4324/9781003264033-1
2 Hannah M. Mathews et al.
The school site closures related to the COVID-19 pandemic’s negative effects
underscore that educational leaders in research, policy, and practice must consider the
interrelated components of student well-being related to mental health. Chafouleas
(2020) described mental health in schools as including three interrelated components:
social (how we relate to others), emotional (how we feel), and behavioral (how we act).
These interrelated components—social, emotional, and behavioral (SEB)—are parti-
cularly crucial to address with children, given the importance of mental health and
well-being for long-term success. Table 1.1 provides an overview of the ways the
pandemic shaped children’s SEB needs, revealed in the research to date.
The 2021 US Department of Education’s report provides an overview of a national
plan to address students’ SEB needs and overall well-being in the context of the
COVID-19 pandemic; many other nations are seeking to enact similar efforts. Yet,
these needs are not merely a product of the COVID-19 pandemic. Prior to the onset
of the virus, children and adolescents presented increased social, emotional, and be-
havioral needs and struggled with their overall mental health. Surveillance data from
the Centers for Disease Control and Prevention (CDC) indicated up to 20% of
school-aged children in the United States experienced a mental health disorder be-
tween 1994 and 2011. These data also indicate the percentage is increasing (Perou
et al., 2013). In a separate CDC study using data collected prior to the pandemic,
parents and teachers reported approximately one in six students (17%) experienced
symptoms of emotional or behavioral need and met criteria for one or more mental
health disorders (Danielson, 2021). Similar trends are seen in other nations, prior to
the pandemic. For example, in the United Kingdom, in a 2017 survey, 12.7% of
children and young people aged 5–19 experienced a mental health disorder (National
Health Services, 2018). Key findings from this report also noted an increase in
emotional and behavioral disorders for children of ages 5–15. In response to this
international need, in 2018 the United Nations General Assembly expanded their
focus to integrate and promote mental health with other non-communicable diseases
(Stein et al., 2019).
The COVID-19 pandemic likely added fuel to this fire. Available data from the
World Health Organization and other health agencies indicate that COVID-19
negatively affected the mental health of people, including children (U. S. Surgeon
General, 2021). For example, a meta-analysis of research regarding changes in
mental health, globally, the changes in anxiety and depression for children and
adolescents during the first year of the pandemic. This study drew on data from 29
studies which, in sum, included 80,879 children and adolescents (Racine et al.,
2021). The findings indicated depression and anxiety symptoms doubled com-
pared to pre-COVID-19 estimates, the highest rates being among adolescents in
Europe and North America. Further analysis indicated higher rates of depression
and anxiety in older adolescents and girls (Racine et al., 2021). In a separate meta-
analysis, Jones et al. (2021) evaluated the 16 quantitative studies including 40,076
adolescents from Canada (2), China (7), Denmark (1), Germany (1), Japan (1),
Philippines (1), United Kingdom (1), and United States (2). The findings indicate
TABLE 1.1 Social, Emotional, Behavioral, and Mental Health Needs
Impact of COVID-19 Pandemic Citation
Social Needs Survey conducted from May 2020 to June 2020 in the United States (N = 20, 437) found YouthTruth, (2020)
How we relate to others that only one in three students felt like part of their school community (30%) or felt
connected to school (31%).
Study conducted in March 2020 in Ireland (N = 94) found children reported experiencing O’Sullivan et al. (2021)
loneliness and prolonged social isolation.
Survey administered in the Fall of 2020 in the United States (N > 10,000 high school Challenge Success (2021)
students) found students feel less connected with both teachers and peers. Fifty percent
of students reported the strength of their relationships with teachers has decreased and
47% say the strength of their relationships with peers has decreased.
Emotional Needs Study conducted in the United Kingdom in March 2020 (N = 241 parents) found that Asbury et al. (2021)
How we feel 25% of parents of children with disabilities report that children are experiencing
increased anxiety associated with the pandemic and 5% experience increased stress.
Data from 12 longitudinal studies from three countries (10 US, 1 Netherlands, and 1 Peru) Barendse et al. (2021)
with 1,339 adolescents were analyzed. Results indicate adolescents experiencing
increased symptoms of depression during the first six months of the COVID-19
pandemic, compared to data collected prior to the COVID-19 pandemic; however, the
authors did not find statistically significant symptoms of anxiety.
In addition, the strongest increase in depression symptoms was found among biracial/
multiracial adolescents.
Meta-analysis of 136 articles published using data collected during COVID-19, found that Racine et al. (2021)
during the pandemic, adolescents reported experiencing increased symptoms of
depression, compared to data collected prior to the COVID-19 pandemic; however, the
authors did not find statistically significant symptoms of anxiety
(Continued)
A Sketch of the Problem 3
TABLE 1.1 (Continued)
Impact of COVID-19 Pandemic Citation
Behavioral Needs In a survey conducted during the Fall 2020 semester from six school districts in Tennessee, Patrick et al. (2021)
How we act more than half of responding middle school students— and more than two-thirds of
responding high school students—reported that worries, stress, and lack of motivation
made it hard for them to do their best in the 2020–2021 school year.
In a study conducted in Shanghai in February of 2020 during the first few weeks of Jiao et al. (2020)
lockdown, parents reported their children (ages 3 to 18 years) experienced behavioral
manifestations of anxiety, including clinginess, inattention, irritability, and obsessive

requests for updates.
Mental Health In the fall of 2020, 54% of school districts in the United States mention “mental health DeArmond et al. (2021)
Children’s psychological support” as part of their COVID-19 plan (Authors describe mental health support as
well-being; their ability to those associated with acute conditions such as depression, anxiety disorders, or bipolar
cope with the normal stresses disorder.)
of life, work productively, Compared with 2019, using surveillance data from the Centers for Disease Control and Leeb et al. (2020); Ridout
and make a contribution to Prevention, researchers found that the proportion of mental health–related visits for et al. (2021)
their community children aged 5–11 and 12–17 years increased by approximately 24% in April 2020 and
31% in October 2020.
that, globally, adolescents during 2019–2021 experienced higher levels of stress,

anxiety, and depression compared to prior years.
As another illustration, in the United States, researchers found that beginning in
April 2020 emergency departments saw an increase in mental health-related visits
(Leeb et al., 2020); the authors noted that adolescents (ages 12–17) represented the
highest proportion of those seeking mental health support in emergency depart-
ments. This increase continued throughout 2020 and is significantly more than
mental health visits during the same period in 2019. Many of these emergency
department visits were related to suicidal thoughts and behaviors (Ridout et al.,
2021). Compared to the same period in 2019, researchers indicate that suicide-
related concerns for children (ages 5–12) and adolescents (ages 13–17) increased
significantly, 133.5% and 69.4%, respectively (Ridout et al., 2021).
While the impact of the pandemic on children and adolescents, broadly, is con-
cerning, children and adolescents who experience marginalization with respect to
their race, ethnicity, socioeconomic status, and/or disability have been particularly
vulnerable. An August–September 2021 nationally representative survey of 3,616
households with children gauged family experiences during the Delta variant outbreak
(National Public Radio, Robert Wood Johnson Foundation, & Harvard T. H. Chan
School of Public Health, 2021). The survey asked respondents a wide variety of
questions related to their experiences. While the report indicated that 36% of re-
spondents reported that children in their households experienced depression, anxiety,
stress, or sleep issues within the past few months, the authors emphasized how the
COVID-19 pandemic has disproportionately impacted the most vulnerable popula-
tions. For example, 59% of respondents reported serious financial problems (e.g.,
serious problems paying rent/mortgage, utilities, affording medical care, affording
food). The majority (69%) of respondents with children in K-12 last year say their
children fell behind. The same report also examined household’s personal experiences
and fears of being threatened or attacked during this time period. Findings under-
scored that, against the backdrop of the pandemic, marginalized communities ex-
perienced continued strain and stress; Asian, Native American, and Black respondents
expressed a fear of being threatened or attacked because of their race/ethnicity, 25%,
22%, and 21%, respectively (National Public Radio, Robert Wood Johnson
Foundation, & Harvard T. H. Chan School of Public Health, 2021). Not only did the
United States experience an increase in race-related hate crimes during the pandemic
(Federal Bureau of Investigations, 2021), but there is evidence that school site closures
and the shift to online learning disproportionately disrupted the education of students
of Black and Latino Americans (Strada Education Network, 2020), children from
households earning less than $25,000 per year, and students with disabilities
(Kamenetz, 2020). A parent advocacy group conducted a survey of 1,500 United
States respondents from geographically, racially, and socioeconomically diverse
backgrounds during the first phase of the pandemic (Kamenetz, 2020). The findings
indicate that many families making less than $25,000 per year (38%) reported their
children are doing little or no remote learning compared to families making over
$100,000 per year (3.7%).
With regard to students with disabilities, multiple studies and briefs report the ways
that COVID-19 school closures shaped the educational experiences provided to
children and adolescents with disabilities (Bruhn et al., 2022, Hirsch et al., 2022,
Kamenetz, 2020; Pier et al., 2021). Specifically, school site closures restricted access to
the supports and services outlined in students’ Individualized Education Programs
(IEPs). For example, in one survey 40% of respondents of children who receive special
education services or other additional support indicated the child is not receiving any
support (Kamenetz, 2020). In addition to disrupting current services, the pandemic also
impacted the ability of IEP teams to test and determine whether students were eligible
for special education services (Cummings & Turner, 2020), delaying the start of in-
terventions. This is not only a problem for service delivery; young people with dis-
abilities and their families experienced unique and more intensified mental health needs
during this time (Asbury et al., 2021). A survey of 241 parents in the United Kingdom
reported the effect of the COVID-19 pandemic on their own mental health and the
mental health of their children (Asbury et al., 2021). The authors of the study em-
phasized the role of the COVID-19 pandemic on the mental health of these vulnerable
families and go on to discuss the supports that could be implemented to support them.
Though the pandemic likely shaped the mental health of families and children gen-
erally, research suggests the impact might have been more severe for young people
with disabilities and their families. Parents of students with disabilities indicated they
were more concerned about their child’s mental health compared to parents of children
without special needs, 40% and 23%, respectively (Kamenetz, 2020).
Taken together, these studies highlight how the children and families who have
previously experienced marginalization were, thus, made more vulnerable during
the pandemic. Due to a confluence of factors that are both a result of the COVID-19
pandemic and longstanding systemic oppression and inequity, they have likely ex-
perienced intensified social, emotional, behavioral, and mental health support needs
during this time.
Although seemingly intuitive, the aforementioned studies underscore that in-
creased attention to the well-being of children and adolescents is important, espe-
cially in the context of the COVID-19 pandemic (U. S. Department of Education,
2021). Policy is already following suit. For example, in August 2021, the United
States Health Resources and Services Administration allocated $10.7 million dollars
toward pediatric mental health services, and the Substance Abuse and Mental Health
Services Administration announced that they will invest $74.1 million to enhance
mental health services for school-age youth (U. S. White House, 2021). These are
just a few of the many initiatives the US government has taken up to address the
complex challenges related to providing K-12 mental health and wellness support
(U. S. Department of Education, 2021). Yet, initiatives isolated in individual systems
(e.g., initiatives addressing school or family or community) are insufficient. To
adequately and powerfully address the intensifying social, emotional, behavioral, and
mental health needs of children and youth, we must consider the ways in which
each of these systems interacts, and then reform the ways in which we have le-
veraged these various systems as week seek to mitigate the impact of the pandemic
on an already intensified need.
Purpose of The Remaining Pages of the Chapter

Protecting student well-being should be our priority—our first concern, our first
goal. The U. S. Surgeon General (2021) highlights essential “recommendations for the
institutions that surround young people and shape their day-to-day lives—schools,
community organizations, health care systems, technology companies, media, funders
and foundations, employers, and government. They all have an important role to play
in supporting the mental health of children and youth” (p. 5). To address this call, in
this chapter we draw on ecological systems theory (Bronfenbrenner, 1979) to high-
light the ways in which various systems were able to/unable to address children and
adolescents’ social, emotional, behavioral, and mental health needs during the pan-
demic. First, we lay out the assumptions that underlie ecological systems theory, a
developmental theory that explores human development as the result of interacting
and intertwined ecological contexts (Bronfenbrenner, 1979). Then, we provide an
illustration of how the social, emotional, behavioral, and mental health needs of
children and adolescents have been and continue to be shaped by interactions across
these various ecological contexts. Finally, we consider next steps and outline how
research, policy, and practice might take up ecological systems theory in seeking to
address the persistent and pervasive problems of children and adolescents’ well-being
in the context of intertwined and overlapping systems.
Applying Concepts of Ecological Systems Theory

Bronfenbrenner’s (1979) ecological systems theory (EST) is a theory of human
development that emphasizes how individuals’ development is bounded by con-
text, culture, and history (Bronfenbrenner, 2005; Darling, 2007). Using EST to
explore the impact of COVID-19 prompts us to consider three assertions. First, in
the context of the pandemic, children’s and adolescents’ experiences are em-
bedded in multiple, overlapping systems (e.g., families, peer groups, schools,
community organizations, health care systems, governmental policy, and decision
making). Second, these systems do not exist in isolation; the interactions between
these systems shape children’s development (U.S. Surgeon General, 2021). Third,
what we have learned and continue to learn from the COVID-19 crisis presents an
opportunity for researchers, policy-makers, and educators to reform these systems
as well as the ways these systems interact, and to reprioritize the social, emotional,
behavioral, and mental health needs of children and adolescents.
EST centers the individual’s experience in a series of nested, environmental
levels: the microsystem, the mesosystem, the exosystem, the macrosystem, and the
chronosystem (Bronfenbrenner, 1979) Each of these systems has been shaped
differently by the COVID-19 pandemic. We introduce these systems below,
starting with those in which children and adolescents are directly involved.
Figure 1.1 provides a model of EST and indicates the disruption of COVID-19
across these nested systems.
FIGURE 1.1 Ecological Systems Theory and COVID-19 Pandemic

The developing child or adolescent (herein referred to as a child) is directly in-

volved in the first two levels of EST: the microsystem and the mesosystem. The
microsystem includes the various systems in which the individual child directly
engages. This includes, for example, a child’s family, friend/peer group, their class-
room, neighborhood, faith community, and local recreation centers. The quantity and
quality of children’s engagement in each of these settings have been and continues to
be directly influenced by changes in policy and, subsequently, practice over the course
of the COVID-19 pandemic. The second layer of EST, the mesosystem, references
the interrelations among those settings in which the child is a direct and active par-
ticipant; across settings, others interact through the child. For example, the mesosystem
highlights the connections between a child’s experiences in their family and their
school or their experiences in their peer group and their community center. Ongoing
changes in these individual settings have altered the boundaries between these systems;
some boundaries have become more porous (e.g., those between school and home),
and some have likely felt so impenetrable or have changed so drastically that the very
nature of the relationship is redefined (e.g., those between family and neighbors).
In the remaining levels of EST, the developing child is not a direct participant.
The third level, the exosystem, refers to systems and settings that affect the child’s
development, even though they are not an active participant. For example, though
a child is not an active participant in their parent’s employment, stress that caregivers
experience in the workplace due to the COVID-19 pandemic (e.g., job loss, ex-
pectation of continued productivity in the move to remote work, navigating decisions
about returning to work in roles carrying increased risk) affects the child’s experience
in the family system (Dooley et al., 2022). Subsequently, their parents’ experiences of
employment shape children and adolescents’ social, emotional, behavioral, and mental
health needs. The macrosystem is the fourth level. This encompasses the broader
cultural context that surrounds the child and the systems and settings in which they
develop. This includes the beliefs, attitudes, norms, and ideologies circulating in
broader society; as is shown in Figure 1.1, the macrosystem does not represent only
one set of beliefs, etc.; instead, the conflict between belief systems is also a factor that
could shape a child’s development. It includes the shared identities, values, and his-
tories embraced by the broader culture; importantly, the influence of elements of the
macrosystem varies according to an individual’s position in society (e.g., race/ethni-
city, experience of poverty). For example, as reports from 2020–2022 suggest (e.g.,
Kamenetz, 2020; Racine et al., 2021), children and adolescents from historically
marginalized communities have experienced profound and disproportionate strain
during this time, as—while their world was redefined by the COVID-19
pandemic—their experiences are embedded in longstanding systems and structures
which uphold racism and ableism (Crenshaw, 1991). Finally, these nested systems
unfold in the context of the chronosystem, or how the systems surrounding an
individual change over time. The chronosystem includes all environmental
changes—major life transitions and historical events—that occur over an individual’s
lifetime. It should go without saying that the COVID-19 pandemic has not been the
only element in the chronosystem during this period of time (2020–2022). Children
and adolescents’ development is set against the backdrop of war and violence (e.g., the
ongoing Israeli-Palestinian conflict, crime, and violence in Nothern Triangle, the
insurgency in the United States Capitol), environmental disasters (e.g., wildfires,
tsunamis, floods), and other society-altering events.
Importantly, in drawing on EST, we must understand that children and adolescents
are not passive participants in the COVID-19 pandemic, nor are they passive parti-
cipants in their own development (Darling, 2007; Dooley et al., 2022). Instead, they
are an active part of the systems in which they have been living, learning, and growing
prior to and over the course of the COVID-19 pandemic. Furthermore, children’s
subjective experiences of the pandemic are a crucial aspect of understanding (a) how
the pandemic has shaped their social, emotional, and behavioral development; (b) the
ways the pandemic has shaped the systems and interactions between those systems that
influence their lived experience; and (c) the strategies and interventions that will
support their development going forward (Balsitis et al., 2022).
COVID-19 as an Ecological Disruptor: An Illustration of

Disruption
The impact of COVID-19 on children and adolescents must be understood as a
systems problem that occurs at all levels of their ecology; the change introduced to
the chronosystem has impacted all levels of EST. Working from the chronosystem
to the microsystem helps to illustrate this influence. This is shown in Figure 1.1.
The COVID-19 pandemic represents an immense societal change in the
chronosystem that cuts through all levels of EST. Importantly, these
changes—and children and adolescents’ development in the context of these
changes— cannot be considered as a monolith. The COVID-19 pandemic is
not a single historical event, Instead, the various phases of the pandemic in-
clude, for example, at least the following:
• lockdown (March 2020)

• reopening of school sites with a variety of layers of protection including social
distancing and masking (August 2020)
• COVID-19 vaccine receives emergency use authorization (December 2020)
• vaccine-approved individuals 16 years of age and older (May 2021)
• vaccine approved for individuals ages 5–11 (November 2021)
• Delta variant (July 2021)
• Omicron variant (December 2021).
Through these stages of the pandemic, adolescents have responded and adapted dif-
ferently. For example, as expected, there was a significant drop in what students
reported learning every day and in their sense of belonging in their schools in the
spring of 2020 (from 57% to 39% and 43% to 30%, respectively), yet by fall 2020
students’ reported learning and sense of belonging rose to an even higher percentage
than pre-pandemic (61% and 49%, respectively; YouthTruth, 2021). In spring 2021,
the numbers dropped back to pre-COVID numbers (YouthTruth, 2021).
Additionally, at this time (January 2022) there is no vaccine available for in-
dividuals ages 2–5. Many of these children have had limited social interactions
with other children, adults, or settings outside of their home/community. There
are just a few ways in which the systems surrounding children and adolescents have
responded to each of these phases that continue to add complexity to these
ecological systems and the ways they shape young people’s development.
Each of the various phases of the pandemic has acted on long-standing societal and
cultural values, the defining markers of the macrosystem. These phases have also
unearthed attitudes that have disrupted the structures and systems on which children
and adolescents rely. For example, as schools in the United States negotiated the
return to brick-and-mortar schools in the fall of 2020, there were frequent clashes
between dominant cultural norms regarding individual freedom and new norms re-
garding collective responsibility (Hineman, 2021). The clashes between these norms
were communicated, negotiated, and regulated through various actors in the exo-
system, including parent advocacy groups (Balsitis et al., 2022), policy-makers in
public health (Centers for Disease Control and Prevention, 2020), teachers’ unions
and other actors in educational policy (Goldstein & Steiber, 2022), and journalists and
others who produce mass media messaging (Strauss, 2021). Importantly, the influence
of the macrosystem was (and continues to be) complicated by the ways in which these
norms and resultant policies, practices, and procedures are communicated across
various forms of media. These changes in the macrosystem likely impacted every
environment in which children and adolescents are directly involved, the micro-
system. Because the very nature of the environments in which children and ado-
lescents engage was shifted to account for the COVID-19 pandemic and these shifts
were negotiated against the backdrop of conflicting norms and values, the connections
between these environments (or the mesosystem) also changed. What is the result of
this massive change and ongoing conflict? We argue that children and adolescents
have experienced heightened levels of disequilibrium and uncertainty, which has led
to an intensification of the social, emotional, behavioral, and mental health needs that
were a prominent concern, even before the onset of the COVID-19 pandemic.
Although much has been written about the conditions prior to the COVID-19
pandemic as well as the impact on the child during the pandemic, little is known
about what will happen to children after the pandemic. However, we can look
at research conducted following natural disasters to consider the long-term ef-
fects of the present pandemic on children and adolescents. For example,
McLaughlin et al. (2009) conducted a study with parents of 797 children (ages
4–17 years) with emotional and behavioral disorders (EBD) or EBD-like risk
(e.g., severe disruptive behaviors, mental health issues). Their findings high-
lighted how the students with EBD experienced a high amount of stress (20.3%)
and families earning lower incomes were at the greatest risk for long-term
psychiatric impairment.
Where Do We Go From Here?

It is important that we not report the changes in children’s ecological systems
without hope for reform and renewal. As noted previously, the trauma of the
COVID-19 pandemic presents an opportunity to reorient our society—and the
way it supports the systems that most powerfully affect the development of
children and adolescents at all levels of their developmental ecology—toward
well-being. By leveraging the unique skills and expertise of researchers, policy-
makers, and practitioners, we can not only mitigate the effects of the COVID-19
pandemic on our societal well-being but we can also correct the sins of our past by
rethinking and reimagining what it means to proactively support young people’s
well-being. In this final section of the chapter, we consider how we might begin
this reform through research, policy, and practice, and link our work to the rest of
this book.
Practitioner-Partnership Models
Highly complex problems, such as the ones described in this chapter, require
organizations and entities to collectively work together. Through various part-
nership models, resources and expertise are merged together to support students,
families, and teachers. Furthermore, partnerships help various entities understand
the needs of the student, community, culture, and social systems. For example, the
Community Engagement Continuum framework (McCloskey et al., 2011), builds
collaborations between community members, health professionals, educators, and
researchers. This framework emphasizes how coalitions evolve from time-limited
projects to long-term partnerships. District-university partnerships connect school
leadership with university faculty members (Hirsch et al., 2022). In these part-
nerships, both parties (a) work together to implement research-based practices and
(b) share a commitment to take responsibility for the education and outcomes of
students (Wepner, 2014). In family-professional partnerships “families (not just
parents) and professionals agree to build on each other’s expertise and resources, as
appropriate, for the purpose of making and implementing decisions that will di-
rectly benefit students and indirectly benefit other family members and profes-
sionals” (Turnbull et al., 2015, p. 161).
Researchers
Research regarding the ways in which COVID-19 has shaped the well-being of
children and adolescents is ongoing, yet there is so much more we need to know.
Though we need research that describes the experiences of young people, their
families, and the teachers and other professionals who have worked with children
and adolescents during the pandemic (e.g., Asbury et al., 2021; Hirsch et al., 2022;
Ma et al., 2021), there is a need for rigorous research drawing on quantitative,
qualitative, and mixed methods approaches to understand how to move forward.
Researchers need to draw on rigorous designs that will allow us to understand

how certain policies (exosystem), such as Stay at Home Orders (Viner et al., 2022),
shaped the social, emotional, behavioral, and mental health needs of children and
adolescents. This could include quasi-experimental research designs (e.g., regres-
sion discontinuity) in order to make causal claims about the impact of certain types
of policies. This will require interdisciplinary work and would be enhanced by
connecting data sets in (for example) education, healthcare, and social services.
This research could also include mixed methods designs that use survey data to
understand the extent to which youth had access to certain supports over the
course of the pandemic, and interview data to understand (a) how they took up
these supports and (b) how they connected these supports to their own well-being.
These types of research could build our knowledge regarding the ways that po-
licies act on children and adolescents and could inform planning for future pan-
demics and other events that might shift the settings (microsystems) in which
young people are most directly involved.
Additionally, researchers should strive to understand the ways that decision
making shapes the developmental experiences of children. For example, to un-
derstand the impact of political polarization in school board meetings in the
United States in response to mask mandates (macrosystem and exosystem), re-
searchers could draw on Discourse Analysis. This could help us to consider how
shifts in social and cultural values have acted and continue to act on educational
policy-makers at all levels. This could lead to the development of improved sys-
tems and processes in educational decision making under duress, especially as they
concern the well-being of young people.
Researchers must also take up the call to understand the variability in young
people’s experiences of this time in history (e.g., Balsitis et al., 2022; Ma et al., 2021;
Racine et al., 2021). Using qualitative methods which are designed to gain a deep,
contextualized understanding of experience (e.g., Narrative Inquiry) could help to
explore the “storied lives” (Connelly & Clandinin, 1990, p. 2) of young people.
These particular methods could highlight the ways their narratives have/have not
been understood by individuals up the power chain whose decisions indirectly affect
children and adolescents’ lived experiences. Given the importance of storytelling for
affecting public policy makers, this type of research could be particularly powerful as
we seek to reform the ways our society supports young people’s well-being.
Finally, research will need to provide interventions to address the surge in the
social, emotional, behavioral, and mental health needs of children and adolescents.
This should include developing and testing interventions with children and ado-
lescents to address this increased need. It should also include developing and testing
innovative systems through which parents, educators, and other professionals are
able to collaborate through professional learning and development. Throughout the
COVID-19 pandemic, schools shifted to provide remote professional learning and
development. Emerging programs such as ECHO (Extension for Community
Health Outcomes) in Education, offer synchronous tele-mentoring for stakeholders
including but not limited to administrators, teachers, parents, and counselors. Initial
research indicates participants increase their knowledge and skills for participating in
the networks (Root-Elledge et al., 2018).
Though research organizations, such as the Spencer Foundation (2020) and the
Institute for Education Sciences (Institute of Education Sciences, 2021), have
made specific efforts to fund and disseminate research associated with the COVID-
19 pandemic, there is certainly more work to be done. Creating continued op-
portunities for diverse and rigorous research is necessary.
Public Policy and Policy-Makers

Policy-makers include not only local education authorities (LEAs) but govern-
ment officials at local, state, and federal levels. All have the responsibility of basing
their statements and policy decisions on scientific evidence and truth as de-
termined by what (Rauch 2021) calls “the reality-based community,” which fa-
vors realities or facts determined by thinking in the Enlightenment tradition.
Unfortunately, some (perhaps many) do not accept this responsibility but flout it
in ways that put additional students and teachers at risk.
A problem of great significance is disinformation, reliance on “alternative
facts,” and government policy based purely on the calculation of political ad-
vantage rather than “reality-based” safety of students and teachers. Craven pan-
dering to political pressures and resistance to measures known by scientists to
lessen the chances of illness and death are common. These are often expressed as a
desire to resist government “control.” Also common are ostensible efforts to
preserve “freedom” and/or disinformation about vaccines or masks. The wide-
spread misinformation (wrong information seriously believed) and disinformation
(wrong information knowingly spread) make fighting the COVID-19 pandemic
and its worsening of physical and mental health more challenging.
Indeed, the era of the COVID-19 biological-virus pandemic seems to be also an
era of a mental pandemic, one in which infections of the mind—what some consider
mental parasites (e.g., Norman, 2021)—have invaded millions of minds in the United
States alone, perhaps billions worldwide. Some of these are spread by political parties,
religions, and anti-social individuals, typically using electronic social media to promote
misinformation and disinformation. Usually, the terrible ideas about these mental
infections involve an anti-scientific mindset, which may include misinterpretation or
abuse of scientific evidence (e.g., using evidence of break-through infections of
COVID-19 to argue that vaccinations against the virus do not work; suggesting that
vaccinations are dangerous because in some cases children die after being vaccinated).
Denial of and distrust of science and irrational thinking are common in the early 21st
century and perhaps always will be (Oreskes, 2021; Specter, 2009).
Conclusion
The mental health of children and youth was badly neglected before the
COVID-19 pandemic and is now of even more concern. Brofenbrenner’s
(1979) theory of ecological systems (EST) is a useful way of conceptualizing how the
mental health needs of individuals are affected by the pandemic. Much additional
research is needed, particularly on the long-term effects of the pandemic.
We have provided the broad outlines of the nature of the mental health pro-
blems exacerbated by COVID-19. The remaining chapters provide more evi-
dence and detail of the challenge and need for research on this scourge.
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2
ADDRESSING THE NEED FOR
RESEARCH INTO THE EFFECTS OF
COVID-19 ON TEACHERS AND
STUDENTS
Jeanmarie Badar, Lindsay Lowdon, and Emma C. Kauffman
In early March 2020, as COVID-19 began its rapid assault in the United States
and other countries, many schools shut down as teachers and students quickly
shifted to a “distance learning” or “virtual learning” model. Currently, no de-
finitive end is in sight in any country for necessary changes in schooling.
Disinformation about vaccines, resistance to public health measures (e.g., vac-
cination, mask-wearing, social distancing, lock-downs), and the development
and spread of variants of the virus have complicated the picture for citizens of all
nations and added an overlay of uncertainty to all predictions of future condi-
tions and stress for students (Fortin & Heyward, 2022). Some state government
officials have attempted to ban or undermine efforts to keep students and tea-
chers safe, such as mask and vaccine mandates, arguing that rather than fear
COVID infections all citizens should learn to live with it—presumably, before
the pandemic ends (e.g., Portnoy, 2022). Others suggest this is not a good idea
(e.g., Barry, 2022).
The purposes of this chapter are two-fold. First, we report on-the-ground
observations of teaching in general and special education in the United States
during the pandemic. These observations are intended to indicate some of the
practical problems faced by general and special education teachers, not only
in the United States. Second, we offer suggestions for needed research re-
garding the details—the “nitty-gritty” of instruction and behavior management
and how these might be different for in-person and virtual teaching. Our
observations and suggestions are intended to spur research of the problems we
describe and help researchers think of other issues or difficulties they might
address.
The neglect of children’s mental health was scandalous even before the
COVID-19 pandemic (e.g., Kauffman & Badar, 2018; Kauffman & Landrum,
2018). Dooley et al. (2022) indicate how the pandemic has made the mental health
of children and youths worse, and increased inequities in treatment is a concern
that cannot be over-emphasized and should prompt extensive research.
DOI: 10.4324/9781003264033-2
COVID-19 Pandemic Effects on Teachers and Students 21
General Effects of the Pandemic

More than two years after the COVID-19 pandemic began, many schools in the
United States were completely or partially closed for in-person learning. Some
teachers and school personnel in all nations have not yet been vaccinated (as of
February 2022). Changes in school policies (e.g., mask-wearing, social distancing,
vaccinations, virtual learning options, and school closure) appear to be necessary in
many nations’ plans to minimize illness and death resulting from the spread of
disease (see Lewis, 2021). An urgent need now is for research on how teaching and
learning have been affected by the public health crisis and on what is needed going
forward once the current pandemic is over.
Many publications have addressed the immediate effects of the pandemic on
education. These publications have been mostly recommendations for teachers
and observations of problems and potential solutions. Much of the literature in-
volves higher education, the spread of the disease, public health measures, and
virus-related matters of teaching, learning, and schooling.
Relatively little is known about just how the pandemic and school closures have
affected and will affect K-12 students’ learning, especially in the long run. The
pandemic and its effects on education at every level were relatively sudden and
unexpected, so it is understandable that two or three years later there would be little
actual research about its immediate effects and none regarding its long-term con-
sequences. The long-term effects are particularly important but obviously cannot be
assessed immediately. For example, a 10-year assessment of effects on the higher
education, employment, mental health, and social adjustment of students graduating
from the high school class of 2020 (or completing any grade) cannot be completed
before 2030. Furthermore, large-scale quantitative studies of even the one-year-later
effects on the learning of children who entered Kindergarten (or any other grade) in
2019 are unlikely to be published until 2023. Furthermore, we see considerable
uncertainty in early 2022 about what the next school years will bring.
In most wealthy nations, many adults and many school-age children have been
vaccinated, and it appears that many schools in these nations will be able to resume
their usual in-person education in the coming school years. Nevertheless, mask-
wearing, social distancing, and other safety measures may still be necessary for
many years. Moreover, vaccines for the youngest schoolchildren have only re-
cently been approved. It also appears that some schools will continue to offer a
virtual learning option, even if in-person classes are offered. Thus, there is much to
sort out about the immediate and long-term effects of the COVID-19 pandemic,
and this applies to all nations.
Many schools, if not most, have failed to provide appropriate instruction for
many students with disabilities during the pandemic. Clearly, the best way forward
for inclusive and special education following the pandemic depends on accurate
stock-taking and research of problems past, present, and future.
The pandemic has called attention to problems in many schools, among them: (a)
crumbling and inadequate buildings with lack of space, proper ventilation, and clean
22 Jeanmarie Badar et al.
air, (b) low achievement and lack of academic progress, (c) schedules and school
years rooted in the long-past conditions, (d) inequities in funding and recruitment
and retention of teachers. Special education has become extremely uncertain for
many students with disabilities placed in general education, sometimes leaving them
“in limbo,” as some have put it (Bamberger et al., 2020). Furthermore, the pandemic
has had a disproportionate impact on students with disabilities, who are also the least
likely to benefit from a distance or virtual learning (Natanson et al., 2021;
UNESCO, 2021).
Discussion of the more specific issues for inclusive and special education is or-
ganized around six aspects of support for learning: (a) instructional, (b) emotional/
behavioral, (c) logistical/practical, (d) students’ views, (e) collaboration with others,
and (6) personal issues for teachers.
Instructional Issues
Many of the instructional changes and adjustments that were needed when the
pandemic hit are obvious, even to non-educators. Early on, schools either closed
completely for a transition period or switched to “virtual learning” almost over-
night. Many teachers were forced by circumstances to work around-the-clock to
prepare weeks’ worth of lessons and gather materials to send home. Technologies
that might have been used to complement teaching suddenly became the primary
drivers of instruction. Already overwhelmed, new teachers found their more-
experienced counterparts and mentors at a loss for advice and guidance because
they, too, were exploring uncharted territory.
Admittedly, change and adaptation come with the job of teaching, but what
teachers seldom seem to be afforded—and definitely were not in the case of the
pandemic—is the necessary time to learn new things and practice new technologies
before having to apply and use them “under the gun.” Moreover, teacher pre-
paration programs, unable to anticipate the pandemic, were caught “flat-footed”
and unprepared to address its effects on teaching. Preparing and delivering virtual
lessons and assignments requires a different kind of thinking, planning, presenting,
and evaluating than in-person teaching. A good teacher does not simply take an
in-person lesson and post it on the internet, especially teachers of non-readers (or
poor readers) and students who may have little experience using a notebook
computer or tablet. In many ways, the pandemic made teachers feel they were
buried deep in a hole from the very start—but given neither the time nor the
proper tools to dig themselves out.
Research is needed to explicate the differences between instructional skills that
are needed for effective in-person instruction and those for effective virtual in-
struction. Specifically, is almost the same skill-set required, or is a completely
different set of skills needed? If different skills are required for effective virtual
instruction, then how are teachers best prepared, and should these instructional
methods become a standard part of teacher preparation? The very nature of some
of the pandemic-related practices, such as social distancing, presents barriers to
effective teaching, and research is needed to indicate how such barriers can be
mitigated.
Instructional Issues in Special Education

Current “inclusive” models of special education service delivery have most stu-
dents with disabilities receiving all or most of their instruction alongside non-
disabled peers in the general education classroom. Advantages and disadvantages of
inclusion in general education have been and continue to be studied and discussed
elsewhere (e.g., Kauffman et al., 2022, in press). Regardless of one’s opinions
about inclusion under ordinary circumstances, most people concede that the task
of providing a “free, appropriate public education” (FAPE, required by US law) to
all students with disabilities virtually is formidable, and this is especially the case for
students with multiple and severe disabilities. Students needing special education
present a quandary in every nation.
Students with multiple and severe disabilities often require instruction that is
not needed by students in general education (Kauffman et al., 2020). Such students
often need instruction and services that simply cannot be provided virtually (e.g.,
instruction in dressing or eating, physical therapy). At best, parents or others caring
for the student with disabilities might be instructed about teaching these things or
providing therapies as best they can themselves—therapies that require someone’s
physical presence and actual physical contact.
Granted, many students with mild learning difficulties may adjust to online
instruction relatively easily. However, the population of students with disabilities
ranges from individuals with mild impairments to those with multiple, profound,
life-threatening conditions that affect every aspect of their lives. Schools are fre-
quently the central agency for the provision of a wide range of services (e.g.,
speech/language therapy, physical and occupational therapy, services for non-
native-English speakers, behavioral therapies, and interventions).
Many students in low-income areas of even wealthy nations still do not have
access to a reliable electronic device or access to the Internet and are not able to
participate in virtual learning alongside their peers. Instead, paper packets in-
cluding worksheets and readings are given to students to complete every few
weeks. These already disadvantaged students are continuing to fall further behind
as schools and districts lack adequate funding and resources to provide them with a
reliable Internet connection and usable devices. This applies especially to students
with disabilities who are placed in general education classes. They not only have
the disadvantages experienced by students without disabilities but are additionally
disadvantaged by teachers’ difficulties in managing individualized provisions
remotely.
As more schools move to hybrid learning, with only a certain percentage of
students allowed in the school building per day, many secondary students choose
to stay home permanently rather than switch between at-home virtual learning
and in-person learning in school. Because there are fewer freedoms afforded to
students in hybrid learning than normally exist in a secondary school environment,

students are choosing to stay home instead of attending in-person learning even
when it is their turn to be taught in person. Teachers are then faced with the
challenge of providing a productive in-person learning environment to only a few
students in the building and a virtual lesson simultaneously. Although having only
a few students in the classroom at a time can be beneficial in providing additional
instruction to struggling students, many of the students who would most benefit
from this additional help are not returning to in-person learning. Secondary stu-
dents thrive on the social interaction they receive while at school during class
changes and lunchtime, but COVID-19 restrictions have taken most of these
social opportunities away, leaving students feeling isolated at school.
Research is needed to determine the special instructional strategies required for
meeting the needs of students with disabilities that can be used online and those
that simply cannot be. Furthermore, when persons other than teachers must
provide instruction, how are those persons best taught or coached to provide the
needed instruction to students with disabilities? Special educators especially need
to know how services that can be delivered only in-person to students with more
severe disabilities can be delivered safely in-person.
Social/Emotional/Behavioral Issues
Any teacher will attest to the fact that good instruction and good behavior man-
agement go hand-in-hand (Kauffman et al., 2011). Without the former, the like-
lihood that students will engage in inappropriate and disruptive behaviors increases
dramatically. Without the latter, well-intentioned instruction “falls on deaf ears”
because students are too distracted, inattentive, unmotivated, or disorganized to
benefit from it. Good teachers will admit that a huge part of their job is finding ways
to create a safe, orderly, focused, appealing, and supportive classroom environment.
Doing this in a virtual setting appears to require very different skills from what is
required in-person. It may even be safe to say that teachers who are best at exuding
warmth, encouragement, sensitivity, and caring in the classroom might have the
hardest time creating the same effect on a screen. Research is needed to find out
whether this is the case. If it is, then a key question is, how are teachers best taught to
encourage students and show warmth, sensitivity, and caring online?
Although some secondary students thrive in a virtual environment and enjoy
the ability to create their own schedule and manage their own time, many students
experience substantially increased stress levels with the use of remote and hybrid
learning. It seems that most students will have experienced elevated stress about
school and learning during the pandemic and female students and students of color
will have been impacted more substantially than their male and white counter-
parts. Schools have been working fervently to increase students’ social/emotional
well-being, but students are still left with high levels of stress and anxiety, nega-
tively affecting their success in school. Therefore, research is needed to determine
how stress and anxiety can best be reduced during virtual instruction.
Social/Emotional/Behavioral Issues in Special Education

Students who receive special education services for social/emotional/behavioral
needs present an enormous challenge when they cannot attend school in-person
(Hirsch et al., 2021). As mentioned, numerous behavioral supports and related
therapies are in place for them in schools. Many of these cannot be replicated online
or delivered by family members. Children who thrive on consistent schedules and
predictable routines may experience increased anxiety when these are disrupted.
Increased anxiety may lead to more frequent and/or intense acting-out behaviors or
exacerbate the tendency to disengage and withdraw. Teachers who may have de-
voted years to building respectful, trusting relationships with students find them-
selves struggling to explain why everything has changed. Many of the best practices
used to prevent problem behavior—e.g., physical proximity, non-verbal cues, con-
tingent attention, and immediate reinforcement—are often not available in virtual
environments and may not be feasible, even with in-person teaching, during a
pandemic because of social distancing, mask-wearing, and other safety protocols.
Social distancing is exactly the opposite of what many students with emotional and
behavioral disorders need. Many such children need a close-knit, strong community
of people who support their complex needs. Case-by-case analyses are required, but
especially during times of crisis, it is important not to impose blanket policies that do
not accommodate individual differences.
The extent to which special relationship-building and behavior management
techniques can be adapted to online learning is not known. Research on such
adaptations and their limitations are needed, as is research on the most effective
ways of preparing teachers to use them.
Logistical/Practical Issues in Virtual and In-Person

Teaching
Distance learning presents an obvious set of logistical issues, such as home Internet
connectivity (for students and teachers), access to a functional electronic device
(notebook or computer), creation of appropriate learning spaces at home, and
supervision of student’s online activities, not to mention the almost impossible
situation faced by parents who must go to work or try to juggle working from
home with their new roles as teachers. In-person teaching during a pandemic also
has its peculiar challenges. The logistical and practical challenges of in-person
schooling in the midst of a pandemic are poorly understood and much too easily
dismissed by the general public. School personnel need to think carefully about
seemingly mundane factors that actually play a vital role in creating an orderly
environment that is conducive to learning.
For example, consider (especially young) students’ personal effects (coats, hats,
backpacks, lunches, etc.) and school supplies (books, pencils, erasers, crayons,
notebooks, scissors, glue, etc.). Lockers or “cubbies” are not allowed for children
during the pandemic for fear of cross-contamination; many elementary classrooms
use desks or tables without storage spaces because supplies are normally shared by
small groups of students, and movement around the classroom is necessarily re-
stricted as per safety procedures. The result is an overflowing crate or bin next to
each student’s chair. Imagine trying to teach a class of 5-year-olds to focus on a
reading or math lesson rather than explore the exceedingly interesting “fidgets”
(including snacks) sitting right beside them! In one elementary classroom in which
we worked no fewer than six wasps were circling overhead—what a distraction for
students, never mind the teacher!
Other seemingly simple routines have been complicated by COVID-19 re-
strictions. Enforcing a no-jacket rule in the classroom is difficult or impossible
when jackets are routinely hung on the backs of chairs. Older students, in parti-
cular, have been known to disappear into their hooded jackets for hours, or use
large coats to conceal phones or other devices. Schools are notoriously poorly
ventilated, many with ancient heating/cooling systems and windows that either do
not open or have no screens to keep insects out.
Another problem of in-person teaching with COVID-19 restrictions involves
restroom breaks. Most classrooms do not have bathrooms and, with or without a
pandemic, students typically use a common restroom in the hallway. With no adult
assigned to supervise bathroom activity during a pandemic, students need to be trusted
to maintain social distancing and mask-wearing on their own. At one of our schools,
teachers devised a system whereby every student had a bathroom pass that he/she
would hang on the bathroom door before entering. Spots on the floor were desig-
nated for waiting outside the bathroom. In essence, this system would ensure that only
one student at a time would be in the bathroom (where he/she cannot be seen),
thereby maintaining proper physical distancing. The result of in-person teaching
during COVID-19 is long lines of students waiting in the hallway because the four-
person capacity restrooms can only accommodate one at a time. Whole-class bath-
room breaks are also problematic because of difficulties scheduling all 10 classrooms on
a given wing or area of the building for evenly spaced breaks throughout the day.
Many more examples of logistical nightmares created by COVID-19 could be
given, from frequent hand-washing to proper mask-wearing to eating safely in
classrooms to ensuring teachers have bathroom breaks and a chance to eat lunch.
The point is, however, to draw attention to the complexities of the school day and
all the ways in which school buildings, materials, and staffing policies need to be
altered in order for schools to re-open safely.
The tasks of cleaning classrooms and equipment have typically fallen on tea-
chers. For example, teachers may be required to sanitize all desks and all equip-
ment used during the class and to do this between class changes. This allows only a
few minutes to sanitize desks, chairs, and computers, resulting in students standing
in a crowded hallway waiting for teachers to finish sanitizing and taking away
valuable minutes of instructional time.
Research is needed to tell us just how a pandemic is likely to alter classroom and
school routines and the effects of such alterations. What changes are necessary and
predictable, and how are they best explained to students, parents, and teachers?
Logistical/Practical Issues in Inclusive and Special Education

Without belaboring this point, we do want to add that all of the above challenges are
made far more significant when dealing with children whose physical, emotional, or
cognitive issues require special attention and/or increased guidance and supervision.
Students of all ages can need assistance with toileting, washing hands, eating, and
even walking down the hallway safely—this was pre-COVID-19 and is complicated
by the pandemic. Most schools’ structures are not currently well-equipped to handle
these activities while following COVID-19 health guidelines. Research must address
these and related logistical and practical issues for students with disabilities.
Students’ Views
The views of students with disabilities, especially if their disabilities are relatively
mild and they are included in general education, are relatively seldom solicited.
For example, in interviews of 17 K-12 students, only a third-grader mentioned a
disability—her ADHD (Cogan, 2021). This might be expected, as students with
disabilities are a minority of those affected by COVID-19. This student spoke of
technology problems—like some pupils not having computers—but saw some
advantages of virtual teaching for herself. Because of her ADHD, she said, she
sometimes needed to do something else and could do that and then go back to the
screen and the task. And when the virtual session ended, she could dance, which
she probably couldn’t do or would find awkward in school.
Nearly all of the students interviewed by Cogan (2021) described how much
they missed personal, in-person relationships with peers. The social isolation and
restriction that students in both general and special education experience as part of
the pandemic is pervasive in students’ commentary on the effects of the disease.
Boredom, feelings of restriction, and depression are common themes in students’
reports. Research will be needed for years to come to address the lingering effects
of these feelings and how students are best helped to deal with them.
Our own students described physical, emotional, and mental challenges asso-
ciated with the pandemic. Some experienced considerably more stress than others.
Among the problems they mentioned are these:
• Limited opportunity for group work in class because of social distancing

• Online learning is very difficult, distracting, unmotivating, and provides no
opportunity for social interaction.
• Change of schools because families do not think students are adequately
protected
• Inability to visit grandparents who are sick with the virus.
• Inability to attend funeral ceremonies of extended family members
• Inability to hug anyone at funeral ceremonies, or comfort family members
• Kids/parents becoming sad about world problems, including depressing news
about the progress of the pandemic, many tragedies, and deaths
• Ups and downs of the pandemic, breakthrough infections, especially with

Omicron and new variants
• Strained family relations, siblings fighting, stressed parents
• Those who work in healthcare, being very worried about the health and
safety of all family members
• Lost years of school that can’t be gotten back
• Lost special events, including sports competitions and other special school
events
• Cancellation of many TV sports events
• Monotonous days
• Fear of vaccination
• Immune-compromised people living in the house prevent socializing
• Being on computers for so long that motivation to go outside or be active is
lost
• Canceled trips
• Feelings of unfulfillment
• Feeling isolated, alone, losing contact with friends
• Loss of trust in others
• Replacement of other activities with video games
• Weight gain resulting from inactivity
• Development of short temper
• Sleep problems
• Anxiety and worsening psychiatric symptoms
• Lower grades
• Loss of identity
Collaboration with Others

Collaboration among professionals has been complicated by COVID-19. The
social distancing and virtual environment often require multiple phone calls to
coordinate services that formerly involved person-to-person communication in
a non-virtual environment. Many suggestions have been made about how to
involve parents and families in education during COVID-19. However, the
involvement of parents may be seen as adding more duties or expectations to
their roles as well as interfering with their employment or job-seeking.
In short, working with a variety of service providers is often more com-
plicated when multiple services are provided virtually. Furthermore, parents
and families may feel resentful about being pressed into roles and duties for
which they have not been trained, adding to their stress in dealing with the
pandemic. This is especially likely to be a problem for students with multiple
and severe disabilities, regardless of their placement in general or special
education environments.
Research on how collaboration succeeded and failed during the COVID-19
pandemic will be important. Such research could be useful in discovering factors
that heighten or lower success in collaboration and help agencies and individuals
become better prepared for future disruptive events.
Personal Issues for Teachers

Many teachers’ reluctance to begin in-person classes during the pandemic attracted a
lot of attention in the press. Teachers’ unions are often blamed for encouraging
teachers to resist school openings unless their demands are met: to be fully vaccinated
and/or to teach only vaccinated students in-person; to make structural and procedural
changes to buildings, cleaning protocols, distribution of materials, technological
equipment, schedules, and staffing that reflect current health and safety guidelines.
Older teachers and those with pre-existing conditions (or who go home to family
members whose risk of getting COVID-19 is elevated) understandably feel especially
concerned about contracting or transmitting the virus. To some, these concerns are
unwarranted, and teachers are accused of being selfish.
Teachers have myriad reasons for their skepticism: most teachers are ac-
customed to having decisions made for and about them without meaningful input.
Often teachers are vilified for expressing their own needs, even when they have
spent most of their lives thinking only of their students and giving of themselves to
the point of feeling depleted. Unless fundamental changes occur over time in the
ways teachers are viewed, respected, valued, and consulted about their profession,
many will harbor resentment and anger.
The COVID-19 pandemic’s influences on the lives of teachers should be the
topic of research in future years. We need to know not only how it affected their
feelings about students, families, and instruction but also its role in their aspirations
and attitudes toward the teaching profession.
Lessons Learned and Hope for the Future

Not all that has happened as a result of the COVID-19 pandemic is negative.
Besides lessons learned, teachers and students see some other benefits and hope for
the future. We consider not only the comments of students but our own hopes
that the future will be better for teachers as well as students.
Students’ Perceptions of Positive Outcomes

Here are some things students have told us on the positive side of the pandemic:
• Some families grew closer; for example, they played more games together
• When parents stayed home to work, they became more accessible to their kids
• Some families got new pets, like Guinea pigs, cats, or dogs, to the delight of
the kids
• More practice of some skills (e.g., in basketball or soccer) leads to improvement
• Sports teams that did continue competitive play found it easier to win
• Some children developed new hobbies

• Some students liked online learning, and some used it to learn new languages
• Some learned not to be so afraid of the virus
Other Possible Positive Outcomes

In spite of the massive changes that schools are being forced to make, there is hope
that some of the new practices may actually be better than older ways of doing
things. For example, the increased levels of cleanliness and proper ventilation in
school buildings are long overdue (as long as the bulk of responsibility for extra
cleaning does not fall on teachers themselves, as is often the case). Most teachers
can attest to the fact that viruses and other ills spread very quickly in schools, and
most schools receive very superficial daily cleaning. Cleaner environments will
benefit both special and general education students.
Besides having a cleaner environment, a lesson we hope is learned is that virtual
learning has its advantages and disadvantages. The advantages include freedom from
some of the most highly questionable teachers’ meetings and administratively-imposed
duties of teachers. Disadvantages include lack of human in-person contact, which is
especially important in the case of students with emotional and behavioral disorders as
well as students with many other disabilities.
Another “silver lining” from the pandemic may be the benefits of smaller class
sizes and less crowded classrooms. The first author taught at a private school that
had to cut class size in half during the pandemic to allow for social distancing.
Although this change requires a great deal more classroom space and more staff,
the advantages of a smaller class are remarkable. Three benefits of smaller classes
are (a) students with and without disabilities feel seen and heard; (b) students are
afforded more opportunities to participate in activities and contribute their
thoughts; (c) teachers are better able to discern subtle differences in students’
learning and target instruction more specifically to individuals.
Technology can simplify and shorten meetings, in-service training, and parent
conferences, which is encouraging. The ability to do more from home or other
remote locations has the potential to relax teachers’ jam-packed schedules a bit, cut
down on daily commutes, and allow spaces to be used on a rotating basis. These
are all welcome changes for most educators and may prove more effective than
current practices, as long as teachers are adequately trained and given time to
practice and be trained in the most useful technologies.
COVID-19 has created many special challenges for inclusive and special education,
and many of these challenges apply whether teaching is in-person or virtual. Although
both students and teachers have been traumatized by the changes required by the
pandemic, some of the changes will likely result in the improvement of both virtual
and in-person teaching and the educational environment.
Within the next few years, one might expect to see far more quantitative
studies involving the safety of students and teachers during and after the pandemic
as in-person teaching resumes. Future quantitative and qualitative studies are also
needed on the effects on academic achievement and mental health problems of

children and adults, such as depression and suicide.
The longer-term effects of COVID-19 should be measured, with comparisons
being made for students placed in general education and other, alternative en-
vironments such as special classes and schools. The varied effects of placement on
academic and social skills should be assessed, and both immediate and long-term
effects should be measured.
Measurement of losses of academic skills attributable to the COVID-19 pandemic
and the effects of virtual teaching have become controversial issues. Although the
recognition and measurement of such losses are essential to remediating them, some
educators are concerned about the stigma that may accompany documentation of
them. Students with disabilities placed in general education are not exempt from this
problem and may, in fact, be especially likely to suffer disproportionate loss of skills,
regardless of their placement during the pandemic.
Also needed is research on the best ways of responding to lapses in learning
attributed to COVID-19. Tutoring, summer school, and extended school days or
school years are among the alternative ways of addressing learning losses. Among
the controversies spawned by learning losses is the matter of identifying or
“separating out” students who need some sort of remedial education from those
who do not. However, requiring the participation of all students in such services
suggests other problems. Stigma is likely to accompany any designation of need for
remediation, but objection of students and parents to forced inclusion in remedial
work for those who do not need it is both predictable and understandable.
Particularly important for students with disabilities is a determination of the services
that can be delivered remotely but effectively by a special educator. Also needed is
research identifying special education services that can be delivered effectively by a
general educator using virtual teaching, special services that can be delivered effec-
tively by family members with consultation and guidance provided by a special
educator or other service providers (perhaps with remote consultation), and those
services that can be delivered effectively only in-person by a trained professional.
Hope for the future depends on descriptions and personal observations of those
involved in education, but more objective, quantitative, scientific evidence is needed
as well. We need rigorous scientific evidence of best practices in both special and
inclusive education to guide the most effective instruction of all students during
traumatic events, such as future pandemics, violence, or other public health crises. In
these ways, the research could contribute to children with disabilities suffering fewer
negative effects from future pandemics, than they did from COVID-19.
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3
VIRTUAL AND PERSONAL ACADEMIC
INSTRUCTION AND BEHAVIOR
MANAGEMENT
Justin T. Cooper, Timothy J. Landrum, Todd Whitney,
and Heather M. Heather M. Baltodano-Van Ness
Beginning in March of 2020, like the entire world around it, the educational
landscape began changing due to the arrival of COVID-19 in our communities
and schools. Schools were faced with limited options on how to best continue
the teaching and learning process for millions of students. Within weeks, the in-
structional environment for over 50 million public school students began to change
(Education Week, 2020). Although the timing of the changes varied to some degree
across schools, districts, and from state to state, the inevitable outcome included a
rapid shift in the learning environment for millions of students and the teaching
environment for millions of teachers. Students were asked to shift to a learning
model that consisted primarily of them receiving instruction remotely in their
homes. Teachers were asked to begin providing instruction in a distance learning
format for which most educators and students were grossly ill-prepared. As one
might imagine, the rapid rollout of what would soon be referred to as the “new
normal” led to numerous challenges for educators and students alike. While it is
important to acknowledge the tremendous and often heroic efforts of the education
community to adjust and adapt to the new educational realities brought on by the
pandemic, it may be equally important to acknowledge and learn from some of the
problems that have been highlighted during the pandemic in relation to delivering
effective instruction, promoting effective behavior management, and the overall
mental health of school-age students.
Within weeks of schools moving to online education, disparities in resources
among families and communities became painfully obvious, and systemic educa-
tional inequities were amplified. Not everyone had equal access to the internet or
the hardware necessary for effective online instruction. In fact, those students in rural
areas and students from lower-income families experienced limited access to online
learning environments (Dorn et al., 2020). To be clear, as Fisher et al. (2021) noted,
the instruction that students were receiving and that schools were delivering in the
early stages of the pandemic was not what educators would consider to be traditional
distance learning. Rather, it was crisis mode teaching; educators doing anything they
DOI: 10.4324/9781003264033-3
Impact of COVID-19 on Academic Instruction and Behavior Management 35
could, regardless of training and expertise, to continue the teaching and learning
process during an unprecedented global health emergency. Again, educators and
administrators did their absolute best when faced with overwhelming logistical
difficulties, but the lack of training for both educators and students would soon
manifest itself in multiple ways including challenges in how teachers delivered in-
struction, how students participated in learning, and how both of these might impact
student outcomes.
We are just now beginning to learn the effects of the pandemic on short-term
student outcomes, and some projections about long-term outcomes are nothing
short of dire. Common sense and science tell us that when educators are unable to
deliver effective instruction in a reliable and effective manner with procedural fi-
delity, student outcomes will suffer. To compound this, there was great variability in
what instructional practices were implemented at the beginning of the pandemic,
especially in areas where larger low-income populations resided. An Education Week
(2020) survey indicated that in lower-income areas of the country, there was far less
actual instruction occurring during the early months of the pandemic. This is in-
dicative of the disparity that had persisted even before the pandemic in the lack of
access to technology, including both hardware and internet access, for some po-
pulations. When a large number of students and their families have limited access to
the technology required for virtual instruction, it is difficult for schools to deliver
instruction in that format in a meaningful and effective way. Additionally, in many
cases, parents or caregivers were left with the task of managing their child’s edu-
cational experience at home (Kuhfeld et al., 2020). Taken together, the lack of
training and preparedness for virtual instruction among both students and educators,
disparate access to technology, and parents and caregivers taking on new and ex-
traordinary levels of responsibility for managing their children’s virtual schooling set
the conditions for extraordinary potential impact on student outcomes.
As researchers begin to analyze the effects of the pandemic on student academic
performance, we are just scratching the surface of what will surely be a long-term
analysis of multiple areas of academic achievement. Early in the pandemic, Kuhfeld
et al. (2020) made numerous projections about the potential impact of Covid-19 on
student academic achievement. These projections were based on an analysis of
existing literature on absenteeism and learning patterns of students. Among the
projections, it was hypothesized that students would return to school in the fall of
2020 (i.e., the beginning of the first school year since the beginning of the pandemic)
with approximately 63–68% of the typical gains in reading and 37–50% of the
gains in mathematics when compared to the beginning of a typical school year.
Ascertaining the exact gains that students returned with to start the 2020–2021 year,
Lewis et al. (2021) found that students in grades 3–8 on average did make gains in
reading and mathematics. However, those gains were made at lower rates than what
was typically seen during years prior to the pandemic. More importantly, Black,
Latinx, American Indian, and Alaska Native students were disproportionately im-
pacted in their academic achievement when compared to their White peers. This is
also true for students from high-poverty schools.
36 Justin T. Cooper et al.
Another area of the teaching and learning process that changed dramatically
during the pandemic is the behavior management practices of educators. Students
with troublesome or particularly difficult behavior have long been a source of
frustration for many educators simply because these students arguably require the
most intensive effort and effective instructional practices in order for them to
succeed (Kauffman & Landrum, 2018). In many cases, educators do not have
the necessary background and skills to effectively teach students exhibiting such
behaviors. The pandemic brought on a new set of challenges for educators who
were trying to teach virtually to students who have a history of exhibiting trou-
blesome behaviors. One of the first things that happened as the pandemic started
was a virtual stoppage of the identification and eligibility determination process.
Without students in classroom settings, many teachers turned their focus to
learning how to teach in the new virtual environment. Teachers anecdotally have
reported having fewer behavior issues with certain virtual instruction, especially
with students who had been identified as exhibiting difficult behaviors in the
traditional classroom setting. While there may be multiple reasons for this, one
thing that we know may contribute more than anything. Many of these students
were simply not present for virtual instruction. In fact, many school districts are
reporting that they lost contact with many students who had been identified, or
were in the middle of the eligibility determination process for special education
services due to their behavior. In some cases, schools reported that only 50% of
special education students attended virtual instructional lessons on a consistent
basis (Stein & Strauss, 2020). Other teachers reported challenges with student
behavior during virtual instruction including failure to turn cameras on, failure to
engage in lessons when requested, and failure to complete assigned tasks (Dorn
et al., 2020; Herold, 2020). The challenges that educators faced in the areas of
academic instruction and behavior management of students during the pandemic
are part of a perfect storm of sorts. Unfortunately, our students with disabilities are
paying a particularly high price in terms of outcomes. More importantly, and
possibly more difficult to quantify, is the effects of the pandemic on the overall
mental health of our students.
In addition to the obvious academic interruption for children, COVID-19 has
had an equal, if not greater, impact on the overall mental health of school-age
children. The abrupt school closure and subsequent quarantine have served as a
sobering reminder that schools are more than institutions of academic knowledge,
but they also play an integral role in all areas of child development (Panchal et al.,
2021). In addition to the academic lessons presented throughout the day are op-
portunities for emotional, psychological, and social development. The pandemic has
heightened concerns for child mental health, and there had been a groundswell of
concern preceding 2019 that must be acknowledged.
Perou and colleagues (2013) reported that mental health was the greatest barrier
to positive outcomes for children and teens in the United States, noting ap-
proximately 1 in 5 individuals between the ages of 3 and 17 were reported to have
a mental health disorder. Additionally, Kalb et al. (2019) found a 28% increase in
emergency room visits for mental health-related concerns between 2011 and
2015, and Curtin (2020) reported that suicide rates for youth 10–24 increased by
57% in the United States between 2007 and 2018. Furthermore, the Centers for
Disease Control and Prevention (2020) reported a 40% increase in high school
students’ feelings of sadness and hopelessness from 2009 to 2019 and noted suicide
rates increased 57% during that same time frame for individuals between the ages
of 10 and 24. It would seem as though the feelings of sadness and anxiety are
overwhelming many of our youth. More staggering than the prevalence rates is
the limited access to treatment. In fact, Whitney and Peterson (2019) estimate that
half of the eight million children with an identified mental health disorder in 2016
did not receive appropriate care.
In order to begin developing a pathway forward, it is critical to understand the
depth and breadth of the current mental health crisis (Panda et al., 2021). Although
not surprising, Campione-Barr et al. (2021) suggest that the multitude of stressors
associated with the pandemic are negatively impacting the social and emotional well-
being of children. Given that issues of youth mental health were on the rise prior to
COVID-19 it comes as no surprise that anxiety, depression, and other mental health
disorders have increased at alarming rates from the onset of the pandemic and con-
tinue to increase. As a result of abrupt school closures, students have missed regular
opportunities to interact with trusted teachers, school staff, peers, and friends, and have
experienced a number of direct and indirect stressors (Panchal et al., 2021). The
structure and routine provided by schools serve as a constant upon which many
children with mental health concerns rely (Lee, 2020).
Beyond school closures, the severity of the COVID-19 pandemic has directly
impacted the lives of many of our children. The increased social isolation secondary
to the quarantine and educational disruption is likely to result in significant mental
health challenges for a group who was already in crisis (Benton et al., 2021, Dorn
et al., n.d., Panchal et al., 2021, Schaffer et al., 2021). In fact, Sharma et al. (2021)
found that behaviors such as impulsivity and irritability have increased, and Panda
et al. (2021) found that at least 70–90% of children in their study demonstrated a
decline in behavioral skills. Recent research of 80,000 youth globally found that
depressive and anxiety symptoms doubled during the pandemic, with 25% of youth
experiencing depressive symptoms and 20% experiencing symptoms of anxiety
(Racine et al, 2021). Studies have also found increases in sadness, loneliness, irrit-
ability, fear, anxiety, anger, stress, and sleep disturbances in children during the
pandemic when compared to pre-pandemic rates (Panchal et al., 2021; Panda et al.,
2021; Sharma et al 2021). The impact is also evident when considering that pediatric
emergency room visits for issues related to mental health increased 69% from 2019 to
2020 (Panchal et al., 2021). In their study of over 80,000 children worldwide,
Racine et al. (2021) found that symptoms of anxiety and depression doubled during
the pandemic. In the absence of available mental health treatment, there are increases
in suicide attempts and completions as well. It is reported that suicide attempts were
51% higher for adolescent girls and 4% higher for adolescent boys in the United
States early in 2020 as compared to the year prior (Yard et al., 2021). Additionally,
National Center for Health Statistics data for 2020 indicate that the number of deaths
resulting from suicide for young people between the ages of 10 and 24 is approaching
7,000 (Curtin et al., 2021).
There is overwhelming evidence of an existing mental health crisis for children;
however, the impact is more profound for those most vulnerable. We would be
remiss were we not to address the disproportionate impact of illness and loss ex-
perienced by minority groups. According to June 2020 figures from the Centers for
Disease Control and Prevention (CDC), despite the fact that African Americans
represent 13% of the United States population they account for 22% of COVID-19
cases and 34% of cases were Latinx although they represent 15% of the population (in
Tai et al., 2021). As a result, already vulnerable communities are experiencing
greater stress, loss, and greater mental health needs. There is certainly a unique
impact for students who have directly experienced the loss of a loved one to
COVID-19. Hillis et al. (2021) estimate that as of June 2021 the number of children
who have lost a primary caregiver to COVID-19 exceeds 140,000 in the United
States alone. This figure is staggering and speaks to the grief with which children are
returning to the classroom. As a result, it is essential to attend to the differential
impact and mental health needs experienced by ethnic minority communities with a
particular focus on the impact on the children (Benton et al., 2021).
It also appears that females and adolescents are experiencing greater levels of stress
and sadness resulting from the pandemic (Benton et al., 2021; Campione-Barr et al.,
2021). An additional consideration is the mental health needs subsequent to child
abuse and neglect that have gone undocumented. In the absence of a structured
school day filled with caring adults, there are fewer eyes on students to potentially
report concerns. Although economic and familial stress is a risk factor for child abuse
and neglect, it appears that abuse has largely gone unrecognized or underreported
given the decrease in reports to child protective service departments in comparison
to other years (Almeida et al., n.d., Lee, 2020; Panchal et al., 2021). Additionally,
access to mental health support was an issue for some students during periods of
quarantine. For example, telehealth was not a viable option for students without
internet access or for students in rural areas that experienced limited internet despite
the increased mental health need for this at-risk population (Almeida et al., n.d.). It
would appear, based on early research, that the impact of COVID-19 on mental
health and access to services is often moderated by variables such as income, gender,
race, and age.
It is safe to say that essentially no educators saw the pandemic coming. Nor
could they possibly foresee the ramifications for instruction, behavior manage-
ment, and overall student achievement and mental health. However, they quickly
found themselves on the front line of the new virtual instruction environment,
attempting to learn how to teach while also learning how to best facilitate the
learning process for their students. They faced a difficult battle at the beginning of
the pandemic as teaching and learning moved online. They may face an even
larger battle as students come back to in-person instruction. They will encounter
students who have regressed in their academic achievement, who have not found
themselves in a traditional classroom in some cases for over a year, and who have
found themselves navigating the “new normal” of school under conditions that
have been difficult at best. More importantly, these students and the changing
environment at home and school that they have been subjected to due to the
pandemic have changed the mental health landscape for countless children and
adolescents. As students return to in-person learning, it is more important than
ever that educators use effective instructional practices in the areas of academic
instruction and behavior management as we work to help ensure student success
for all students. This chapter explores effective instructional and behavior man-
agement practices, and their role in creating an environment that promotes student
success and student mental well-being.
Effective Instructional Practices

Before we can discuss how COVID-19 has affected teachers’ ability to implement
effective instructional practices, it is important to discuss what effective instruction
is. We view effective instruction as a teacher bringing about intended outcomes that
give students the highest probability for academic success. It is a “process-product”
approach whereas overt teacher behaviors (i.e., process) affect student achievement
(i.e., product). For example, if a teacher’s intended outcome is for their students to
learn to read, they will implement those instructional practices that have been
identified by research to be the most effective for teaching reading. Fortunately,
over 35 years of educational research has consistently identified a set of in-
structional methods, protocols, and strategies that provide students with the
highest probability for academic success (e.g., Brophy & Good, 1986; Hattie,
2009; Rosenshine & Stevens, 1986). Most recently, the Collaboration for
Effective Educator Development, Accountability, and Reform (CEEDAR)
Center, in collaboration with the Council of Exceptional Children (CEC),
developed a set of high leverage practices (HLP) to be used by special educators.
These practices were identified because research supports their positive impact on
student achievement across content areas and grade levels (McLeskey et al., 2017).
These practices include using explicit instruction, using strategies to promote student
engagement, and providing positive and constructive feedback.
Explicit Instruction
The instructional approach known as explicit instruction has been oversimplified by
some as referring only to a model-lead-test approach. Explicit instruction is a com-
bination of effective teaching practices that have consistently shown to have a positive
impact on student achievement (Archer & Hughes, 2011; Hughes et al., 2017;
McLeskey et al., 2017). Hughes and colleagues (2017) define explicit instruction as:
A group of research-supported instructional behaviors used to design and

deliver instruction that provides needed supports for successful learning
through clarity of language and purpose, and reduction of cognitive load. It

promotes active student engagement by requiring frequent and varied
responses followed by appropriate affirmative and corrective feedback, and
assists long-term retention through use of purposeful practice strategies.
(Hughes et al., 2017, p. 143)
Ellis and Worthington (1994) conducted a research synthesis on teacher effectiveness

that can be viewed as the “underpinnings of effective, explicit instruction” (Archer
& Hughes, 2011, p. 4). Their analysis identified the following 10 underlying
principles that are highly correlated with student achievement.
1. Students learn more when they are engaged actively during an instructional
task.
2. High and moderate success rates are correlated positively with student
learning outcomes, and low success rates are correlated negatively with stu-
dent learning outcomes.
3. Increased opportunity to learn content is correlated positively with increased
student achievement. Therefore, the more content covered, the greater the
potential for student learning.
4. Students achieve more in classes in which they spend much of their time
being directly taught or supervised by their teacher.
5. Students can become independent, self-regulated learners through instruction
that is deliberately and carefully scaffolded.
6. The critical forms of knowledge associated with strategic learning are declarative
knowledge, procedural knowledge, and conditional knowledge. Each of these
must be addressed if students are to become independent learners.
7. Learning is increased when teaching is presented in a manner that assists
students in organizing, storing, and retrieving knowledge.
8. Students can become more independent, self-regulated learners through
strategic instruction.
9. Students can become independent, self-regulated learners through instruction
that is explicit.
10. By teaching sameness both within and across subjects, teachers promote the
ability of students to access potentially relevant knowledge in novel problem-
solving situations (Ellis et al., 1994, p. 8).
In addition to the underlying principles above, Archer and Hughes (2011) de-
scribed a range of 16 instructional behaviors or elements that have been identified
by educational researchers as characteristic of an explicit instructional approach.
The 16 elements, listed below, can be viewed as the methods to ensure that the
principles of instruction are addressed when designing and delivering instruction.
1. Focus instruction on critical content.

2. Sequence skills logically.
3. Break down complex skills and strategies into smaller instructional units.
4. Design organized and focused lessons.
5. Begin lessons with a clear statement of the lesson’s goal and your expectations.
6. Review prior skills and knowledge before beginning instruction.
7. Provide step-by-step demonstrations.
8. Use clear and concise language.
9. Provide an adequate range of examples and non-examples.
10. Provide guided and supported practice.
11. Require frequent responses.
12. Monitor student performance closely.
13. Provide immediate affirmative and corrective feedback.
14. Deliver the lesson at a brisk pace.
15. Help students organize knowledge.
16. Provide distributed and cumulative practice (Archer & Hughes, 2011, p. 2–3).
The elements of explicit instruction are not novel approaches to instruction.

They are merely a set of instructional practices that research has consistently
shown to maximize the probability of student success. Additionally, the ele-
ments should not be viewed as a set of rigid steps that need to be followed
exactly as presented because not all are necessary for all instructional scenarios
(Archer & Hughes, 2011). However, explicit instruction must embrace and
encourage both active student engagement and positive and constructive
feedback to be effective.
Active Student Engagement

Active student engagement is critical for the learning and success of all students.
Students who are engaged in the learning process are less likely to exhibit in-
appropriate behaviors and more likely to achieve academic success (Simonsen
et al., 2008; Sutherland & Wehby, 2001). Conversely, if students are not actively
engaged, the likelihood of negative behavioral outcomes and the chances of
falling behind academically increase. One manner of engaging students is for the
teacher to provide sufficient opportunities for students to respond (OTR) during
instruction. An OTR is an interaction between a teacher’s academic prompt and
a student’s response (Sprick et al., 2006). Research indicates that teachers who
provide a sufficient number of OTR can increase student engagement, increase
student correct responses, and decrease disruptive behavior for a variety of
students (e.g., students with and without disabilities) across a variety of settings
(e.g., general and special education classrooms; MacSuga-Gage & Simonsen,
2015; Sutherland & Wehby, 2001). Additionally, OTR rates of at least three per
minute during instruction are associated with significantly higher rates of student
active engagement and significantly lower rates of student disruption (Gage et al.,
2018; Sutherland et al., 2003).
Feedback
Effective feedback involves providing information to improve or maintain student
performance, and increasing student motivation, engagement, and independence
(McLeskey et al., 2017). This includes statements that confirm understanding, im-
prove understanding, or clarify a misunderstanding (Oakes et al., 2018). More than
40 years of research has consistently demonstrated that effective feedback has had a
significant positive impact on student academic and behavioral outcomes (e.g.,
Hattie & Timperley, 2007; Royer et al., 2019). John Hattie’s synthesis of over
800 meta-analyses revealed feedback has a significant effect (d = .70) on student
achievement (Hattie, 2009).
Although there are many ways a teacher can provide feedback to students, it is
important to note that all feedback is not equal. To have the greatest effect,
McLeskey and colleagues suggest the following
Effective feedback must be strategically delivered and goal directed;

feedback is most effective when the learner has a goal and the feedback
informs the learner regarding areas of improvement and ways to improve
performance. Feedback … should be timely, contingent, genuine, mean-
ingful, age appropriate, and at rates commensurate with task and phase of
learning (i.e., acquisition, fluency, maintenance). Teachers should provide
ongoing feedback until learners reach their established goals.
(McLeskey et al., 2017, p. 57)
Hattie and Timperley (2007) provide a model of feedback to enhance learning. In

this model, they suggest effective feedback must answer three questions for the
student: (a) Where am I going? (i.e., goals); (b) How am I going? (i.e., progress
toward goals); and (c) Where to next? (i.e., what activities/strategies are needed
to improve progress; Hattie & Timperley, 2007). Additionally, each question
will work at four levels: (a) task level; (b) process level; (c) self-regulated level; and
(d) self-level. Hattie argues that the task level is the least effective, self-regulation and
process level are effective for deep processing and mastery of tasks; and self-level is
effective when used for improving strategy processing (Hattie & Timperley, 2007).
Impact of COVID-19 on Effective Instruction

The implementation of effective instructional practices has been an issue long before
the onset of COVID-19. For example, research has shown that teachers provide
OTRs at rates far below the recommended level of three per minute (elementary =
.97/minute, middle school = .69/minute, high school = .53/minute; Scott et al.,
2017) and few teachers approach the optimal 4:1 ratio of positive feedback to ne-
gative feedback (Scott et al., 2011). This issue was exacerbated with the arrival of
COVID-19 as instructional design, delivery, and assessment transformed into pri-
marily an online environment. In 2020, the American Institutes for Research (AIR)
conducted a national survey asking k-12 school district leaders across the country to
describe the persistent challenges they were facing during COVID-19. Three major
themes emerged from the district leader’s responses: (a) learning and instruction;
(b) infrastructure and staffing; and (c) social-emotional support and engagement
(Pitluck & Jacques, 2021).
Learning and Instruction

Meeting students’ learning needs and virtual instruction were two themes that
emerged regarding challenges related to learning and instruction during the pan-
demic (Pitluck & Jacques, 2021). As previously discussed, when schools were forced
to transition to distance learning, many teachers felt they did not have the knowledge
or skills necessary to provide effective instruction in an online environment.
Effective teaching practices such as explicit instruction, using strategies to promote
student engagement, and providing positive and constructive feedback look different
when delivered virtually and teachers were learning how to adapt their instruction
with very little time to prepare. Additionally, teachers had to spend time teaching
rules and expectations for this new environment which took away from valuable
academic learning time. And in many instances, “live” instruction was limited in
order to accommodate students and families which led to students being asked
to be passively engaged while viewing recorded lessons or videos and com-
pleting online assignments that were the equivalent of worksheets. This does not
even account for the students who were unable to attend live instruction or
complete assignments due to technology issues (e.g., lack of computer, lack of or
limited internet connection).
As the transition to in-person learning began, schools were faced with addi-
tional challenges that impeded successful teaching and learning. Teachers needed
to spend extra time teaching school and classroom rules and expectations to stu-
dents who had not been in a classroom for a year or more. Because of health and
safety regulations related to COVID-19, the rules and expectations were modified
to include how to be socially distanced from peers and mask-wearing etiquette.
Additionally, students who tested positive or were exposed to someone who tested
positive for COVID-19 would be absent from school for up to 10 days.
Infrastructure and Staffing

The AIR survey identified student access to technology and finding qualified
teaching staff as themes related to infrastructure and staffing (Pitluck & Jacques,
2021). Although online platforms enabled educational services to continue while
the school was closed, there were concerns that inequities in access to technology
contributed to increasing the academic gap that already existed before the pan-
demic (Irwin et al., 2021). For example, at the beginning of the 2020–2021 school
year, 96–97% of adults with income at or above $75,000 reported that internet
access was always or usually available to their children for educational purposes
compared to only 83–93% of adults with income levels below $75,000 (US Dept.
of Commerce, 2020).
One of the most critical infrastructure challenges involves the recruitment and
retention of qualified teachers. The COVID-19 pandemic has exacerbated a
teacher shortage issue that existed before the pandemic began. For example, a
survey from the RAND corporation found that 23% of k-12 teachers reported
they were likely to leave the teaching profession by the end of the 2020–2021
school year, compared to 16% of teachers who were likely to leave pre-pandemic
(Steiner & Woo, 2021). The fact that there is also a national substitute teacher
shortage makes the situation more acute. As short-term fixes, some states are re-
laxing the requirements for being a substitute teacher. For example, the Kansas
State Board of Education recently approved an emergency declaration that would
replace the requirement that a substitute teacher needs 60 hours of college credits
with just a high school diploma (Kansas State Department of Education, 2022).
Engagement and Social-Emotional support

Student and family engagement as well as social-emotional needs among students
were two themes that emerged regarding challenges related to social-emotional
support and engagement during the pandemic (Pitluck & Jacques, 2021). As pre-
viously discussed, teachers were forced to abruptly change their mode of instruction
when the school doors closed at the beginning of the pandemic. The virtual en-
vironment provided many additional challenges, including how to effectively pro-
mote active student engagement. Due to limitations of some technology platforms,
teachers could not rely on traditional active engagement strategies such as choral
response or turn and talk during live instruction. Additionally, unison responding
through the use of response cards and/or response slates required incorporating
technology applications or delivering physical materials to each student’s home.
These challenges made it more likely for teachers to rely on less effective practices
such as calling on individual students or posing a question to the whole class and
calling on a volunteer to answer (McLeskey, 2019).
Likewise, students and their families were asked to abruptly change when, how,
and where they learn. Due to circumstances beyond their control (e.g., no internet
access, parent’s work schedule), a student may not have been available during the
scheduled live online teaching sessions. Although they may have access to the
recorded lesson to view at a later time, this would require passive engagement at
best. And even if a student could join a live online teaching session, they may not
be in an environment conducive to learning. Furthermore, parents were asked to
take on a greater responsibility for their child’s learning and some may have not
been able to adequately do so.
In addition to navigating a global pandemic and reconceptualizing the current
responsibilities of their employment, many parents also became educational
liaisons for their child(ren). Their roles and responsibilities were often blurred,
they were experiencing increased levels of stress, and they were overwhelmed
(Kerr et al., 2021; Petts et al., 2021). There is an interactive dynamic to stress
within the family and as a result, children have been impacted. The roles,
routines, and expectations for children have also shifted dramatically thereby
increasing their stress level which often manifests as maladaptive behaviors in
children. Unfortunately, resources and coping mechanisms that are typically
available to children were no longer options. Students could not access social
support with their peers in the same way (Campione-Barr et al., 2021), they
could not participate in sports, and they had limited access to mental health
support within the school (Schaffer et al., 2021).
Addressing the Problem

Although we are still learning about the ramifications of the COVID-19 pandemic
on students’ academic learning and social-emotional well-being, there are logical
steps that can be taken to address these problems as we go back to a more tra-
ditional style of learning.
Short-Term
As schools go back to in-person learning, educators will most likely encounter
students with more variability in their academic skills than pre-pandemic years
(Kuhfeld et al., 2020). They will need to find ways to (a) assess student learning both
informally and formally in order to understand exactly where each student is, aca-
demically; (b) determine where instruction needs to begin for all students; (c) es-
tablish supplemental supports for those students that are behind. As for instruction,
we are at a time when efficiency and effectiveness are of the utmost importance. It
will be critical for teachers to implement those instructional methods, protocols, and
strategies that provide students with the highest probability for academic success. In
order to do so, there needs to be a concerted effort made by school district leaders,
school administrators, and instructional coaches to provide teachers with the on-
going training and support to be successful in implementing these strategies.
It is understandable, but unreasonable, to desire a “return to normal” Students
have returned to school with a range of experiences and trauma resulting from
COVID-19, and it is time to explicitly increase the scope of educational services to
include the mental health of students, particularly those most vulnerable (Dorn
et al., 2020; Mann et al., 2021).
Given the existing data on youth mental health, the number of children who
will experience difficulties in returning to school will be significant (Lee, 2020). It
is important to identify particularly vulnerable populations, identify students ex-
hibiting symptoms of distress, and intervene early to provide support. Students will
require explicit instruction in social-emotional learning to include both inter-
personal and coping skills as these critical skills have been shown to positively
impact all areas of student development (Matlin et al., 2019; Mann et al., 2021).
Having said that, teachers cannot bear the brunt of this responsibility. They are
overwhelmed and have not been adequately trained to support the extent of
childhood mental health and social-emotional needs with which they will be
faced. This will require extensive training for all school staff as well as additional
support personnel on campus to address the mental health needs of the students
and to support teachers.
Long-Term
As for long-term approaches to addressing the impact of COVID-19, it needs to
start with providing adequate teacher training. Because there has been limited
success in increasing effective teaching practices of in-service teachers, more focus
needs to be placed on the preparation of pre-service teachers in delivering these
practices. Scholars in general and special education (Ball & Forzani, 2009;
McLeskey & Brownell, 2015) have argued that teacher educators need to identify
a critical set of practices that are essential to improving student learning and be-
havior and can be learned in coursework and deliberately practiced in field ex-
periences. Unfortunately, it has been reported that teacher education has not
focused on the critical components of effective instruction (Leko et al., 2012).
The ability to deliver instruction and positively engage all students in the
content becomes an overwhelming challenge when teachers do not have the basic
skills to maintain an orderly learning environment (Cameron et al., 2008).
Paradoxically, while teachers continually report classroom management to be one
of the areas in which they feel least prepared (Melnick & Meister, 2008), it
continues to be an area in which teacher education fails to provide adequate focus
(Baker, 2005, Oliver & Reschly, 2010).
Behavior Management
Classroom and behavior management have long been identified as areas of con-
cern for teachers. This includes consistent identification of behavior management
as an area in which teachers report they are underprepared (Stough et al., 2015), as
well as a frequently cited reason in analyses of the causes of teacher burnout, which
in turn may predict teachers’ intent to leave the profession altogether (Aloe et al.,
2014; Gilmour et al., 2021). Public sentiment toward challenging behavior in
schools shows equal levels of concern, and attitudes toward stricter discipline and
zero-tolerance policies remain strong. Despite these perceptions, there is in fact a
rich literature base supporting a number of positive, preventive classroom and
behavior management strategies, as well as specific interventions for challenging
behavior that have proven effective in supporting positive student outcomes.
Moreover, research supports that many of the same principles underlying explicit
instruction are central to effective classroom management.
Drawing from decades of research on classroom applications of principles of
applied behavior analysis (Alberto & Troutman, 2013; Kazdin, 2013), most re-
cently applied in the context of tiered supports (i.e., PBIS; Horner & Sugai, 2015),
a few key fundamentals underlie most positive and effective classroom management
approaches. These have been summarized in a variety of outlets (e.g., Kern &
Clemens, 2007), including practice guides from the Institute of Education Sciences
(IES) (Epstein et al., 2008), and the Center on Positive Behavior Interventions and
Supports (Center on PBIS, 2022). In the next sections, we first provide a brief
overview of three such fundamentals. These include that management approaches
should be (a) positive, rather than emphasizing punitive responses; (b) embedded in
clear structures and predictable routines; and (c) proactive, emphasizing antecedent
strategies to the greatest extent possible. We follow this with a brief analysis of why
these fundamentals may be more important than ever as we emerge from the worst
of the pandemic, and children both return to structures and routines that may be
new to them, and recover from both instructional loss and the mental health toll the
pandemic has surely had on all children, families, and teachers.
Positive Management Strategies

A hallmark of the earliest applications of applied behavior analysis to classroom
contexts was the efficacy and benefits of a positive, rather than a punitive approach.
Indeed the very first paper published in the Journal of Applied Behavior Analysis de-
scribed the positive effects of contingent teacher attention on the study behavior of
elementary-aged students (Hall et al., 1968). In this study teachers attended to students
following periods of appropriate study behavior, and, importantly, simply ignored
(i.e., used extinction on) their disruptive behavior, which had been occurring at high
rates. Using a reversal design, Hall et al. demonstrated that teachers’ positive attention
was systematically associated with increased rates of study behavior (and, to the extent
to which it was measured, with decreased rates of disruptive behavior). This simple
concept has been validated, replicated, and extended in scores of classroom-based
studies across decades, and effects are observed across age and ability levels as well.
While a variety of reinforcers can be used to increase desired behavior (e.g., tangible,
edible, sensory, activity reinforcers) (Alberto & Troutman, 2013), perhaps the most
efficient and practical reinforcement approach involves teacher praise.
Although the efficacy of praise as an intervention was well established decades
ago, the use of praise has not been without critics (e.g., Kohn). Nonetheless, even
when reviews of this literature highlight the need for more evidence meeting
current standards for methodological rigor (e.g., Moore et al., 2019), the volume
and breadth of evidence remain compelling. As Moore et al. noted:
“researchers demonstrated the effectiveness of teacher praise in lower and

upper grade levels, for whole classes and individual students, for male and
female students, in general and special education classrooms, and to increase
appropriate behavior (e.g., on-task) as well as decrease disruptive behavior.
Results indicated teacher praise was effective for almost 70% of the 32 cases
summarized in this review, and average effect sizes indicate teacher praise is
an effective intervention option” (pp. 12–13).
More recently, researchers have validated that behavior-specific praise may be espe-
cially effective (see review by Royer et al., 2019). In short, generic praise (e.g.,
“good job”) is not as effective as praise statements that include information about
the specific behavior and context (e.g., “Nice job lining up; you remembered to
push in your chair and walk”). Moreover, within a PBIS context, researchers
suggest tying praise statements to expectations (e.g., “Good job raising your hand
and waiting, Carlos; that showed respect”) (Myers et al., 2017).
Another parallel between explicit instruction in academics and effective classroom
management involves the benefits of structure and routine in helping students be
successful. Consider the critical features of positive classroom management highlighted
by the authors of OSEP’s practice guide on responding to and supporting students’
social, emotional, and behavior needs (Center on PBIS, 2022). Noting that “Research
continues to demonstrate the link between positive and proactive classroom practices
and desired student outcomes” (Center on PBIS, 2022), the authors suggest the
following steps toward developing predictable routines:
1. Establish a predictable schedule and clear procedures for each teaching and
learning activity and transitions between activities
2. Post steps for specific routines to promote independence
3. Teach routines and procedures explicitly (in combination with expectations,
using classroom matrix see section 1.4)
4. Practice regularly and reteach throughout the year
5. Provide specific feedback for students’ use of routines and procedures
6. Promote self-managed or student-guided schedules and routines, (Center on
PBIS, 2022)
Note especially a number of key imperatives in these six steps. First, a predictable
routine and procedure are established for every instructional and non-instructional
(e.g., transition) activity. Second, although the steps are posted with the goal of
promoting independence, it is recognized that merely posting rules or procedures
is insufficient. Teachers are encouraged to actively and explicitly teach these
routines. Such explicit teaching includes not just learning what the routines are,
but learning what they look like and how to engage in them appropriately (i.e., via
modeling, guided practice, independent practice, and feedback). Here it may be
especially important that teachers avoid assumptions that children ‘should already
know’ how to navigate basic routines, and do not need specific instruction or
reinforcement. It is also important that developing and teaching routines is not
viewed strictly as a beginning-of-the-year activity—routines must be practiced and
re-taught as needed, throughout the school year.
Antecedent Approaches
A final imperative in establishing effective classroom and behavior management is
not only supported by an extensive research base but addresses the simple practical
reality that it is better to prevent problem behavior than to deal with its aftermath.
Antecedent strategies—those that establish the conditions that increase the prob-
ability of success—are particularly important for several reasons. First, because they
increase the odds of increased prosocial behavior, opportunities for positive teacher
attention and reinforcement also naturally increase. Second, teachers can target
antecedent strategies toward the specific contexts and settings in which problem
behavior has been observed to be more likely to occur. Indeed this is the very
point of the broad strategy known as pre-correction (Colvin et al., 1993). In their
classic description of pre-correction, Colvin et al. listed the following steps in using
precorrection to address predictable problem behavior:
1. Identify the context and the predictable behavior

2. Specify the expected behavior
3. Modify the context
4. Conduct behavior rehearsals
5. Provide strong reinforcement for expected behaviors
6. Prompt expected behaviors
7. Monitor the plan
We emphasize again how the framework for effective behavior management par-
allels that of explicit academic instruction. Similar elements include being clear with
expectations, guiding practice in appropriate responding, prompting responses in
context, and of course, providing reinforcement when desired or expected behaviors
are observed.
Finally, an antecedent strategy that capitalizes on similar concepts and has gained
considerable empirical support is Positive Greetings at the Door (Allday et al., 2011;
Cook et al., 2018). This formal procedure includes a number of critical, yet simple
elements, which Cook et al., described as (a) standing at the door; (b) greeting students
(verbally or nonverbally); (c) providing a specific prompt or precorrection, based on
expectations for upcoming instruction or on anticipated problem behavior; and
(d) reinforcing students for on-time arrival or attendance. Researchers have pointed
not only to the efficacy of this strategy in improving engagement and reducing be-
havioral concerns but to its fundamental focus on establishing positive relationships
with students (Collins & Landrum, 2022).
Behavior Management as We Emerge From the Pandemic

The true toll of the pandemic on students, families, and educators remains to be
seen, but experts seem to agree that in addition to the practical matters of in-
structional loss, which will surely be significant for many learners, there are certain
to be social, emotional, and behavioral impacts. Indeed there is already evidence
that mental health concerns for children and youth have increased significantly
(Meade, 2021). The combined stressors associated with the pandemic (e.g., iso-
lation and quarantine, financial impacts and food insecurity for many families, and
the direct experience of illness and even loss of loved ones to the pandemic) are
clearly traumatic, and undoubtedly even more so for already vulnerable popula-
tions. Although our purpose in this chapter is to focus on academic instruction and
behavior management, we nonetheless think it may be useful to consider how the
evidence-based approaches we might recommend mesh with guidance for
working with children and youth impacted by trauma.
The Centers for Disease Control (CDC) and the Substance Abuse and Mental
Health Services Administration (SAMSHA) recommend six guiding principles for
trauma-informed care: (s) safety; (b) trustworthiness and transparency; (c) peer
support; (d) collaboration and mutuality; (e) empowerment and choice; and
(f) cultural, historical, and gender issues (CDC, nd). While we certainly endorse
all of these elements, with reference to behavior management specifically there may
be particular relevance in the first two principles: safety, transparency, and trust-
worthiness. We see remarkable parallels between many of the behavior management
concepts (e.g., structure and predictable routines) and specific practices (e.g., positive
greetings at the door) researchers recommend and the principles experts have
recommended for children and youth impacted by trauma. Indeed, if we think of
the combined effects and classroom climate that might be created by the strategies
and concepts we have reviewed, we believe that the conditions may be set wherein
children stressed by the pandemic and its impacts have the best chance to feel safe and
cared for, and ultimately to be successful.
Concluding Thoughts
As we think about emerging from the pandemic and how educators might best
meet the needs of children and families, there is scarce empirical guidance spe-
cifically on “post-pandemic education.” That said, as we have also highlighted,
there is extensive research literature supporting effective instruction and classroom
management approaches. We have long known what works in terms of effective
academic instruction (Brophy & Good, 1986). Additionally, as a field, we have a
broad scientific understanding of effective behavior and classroom management
practices (Kauffman & Landrum, 2018). Unfortunately, we also know that many
of the identified effective practices in both academic instruction and behavior
management are not implemented in classrooms at acceptable rates (Scott et al.,
2017). We think a logical and critical starting point for educators in the moment
would be to re-double efforts toward the concepts emphasized in this chapter; in
both academic instruction and behavior management practices.
This will be neither simple nor fast. But it is imperative that we face this
unprecedented challenge with what we do best; relentless and rigorous im-
plementation of scientifically-proven educational practices. The academic and
behavioral success of our students, as well as their overall mental health, is de-
pendent on what educators do as we begin to come out of the pandemic. However,
in order to do this, it is critical that we provide teachers with the support they need.
The pandemic has exacerbated the challenges that teachers face as students return to
the physical classroom. In many cases, there has been a regression in both academic
and social-behavioral skills. As we begin to re-double our efforts to address the sig-
nificant needs of our students, we must work to develop and reinforce the skills
necessary for teachers to intervene effectively with both academic instruction and
behavior management. This will require educator preparation programs to adapt to
the changing educational landscape and better-prepare future educators to be pre-
pared to teach in both virtual and in-person settings. Additionally, both educator
preparation programs and school districts must face the reality of the effects of the
pandemic on our students’ populations and re-tool our inservice educators with the
skills needed to address the instructional and behavioral needs of our students, as well
as the wide-ranging mental health needs that we will be seeing as a result of this
pandemic for years to come. While no one may have seen the COVID-19 pandemic
coming, or wanted it to occur, in hindsight, it can be viewed as an opportunity for
educators to take what we know and improve on our service delivery efforts.
Rigorous implementation of academic instruction and behavior management prac-
tices potentially holds the key to improving both outcomes and overall mental health
for countless students.
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4
HOW COVID-19 WORSENED THE
MENTAL HEALTH PROBLEMS OF
INCARCERATED YOUTH
Theresa A. Ochoa, Yanúa Ovares-Fernández,
Nicole Maki Weller, Claire de Mezerville-López,
Viria Ureña-Salazar, Emilia Guillén-Ulate, and
Berenice Pérez-Ramírez
The COVID-19 pandemic of 2020 transformed daily life worldwide. To minimize

the spread of the virus, many governments imposed a lockdown and physical dis-
tancing measures (Buchanan et al., 2020). Schools, universities, restaurants, shops,
and businesses all closed. Government mandates in different countries forced
everyone but the most essential workers to stay at home (Buchanan et al., 2020).
For many people, the initial few weeks, and perhaps the first few months, of the
sudden stay-at-home orders might have felt like a forced, but pleasant, vacation
from work and school. However, the prolonged disruption to daily life caused
by the COVID-19 pandemic has given way to questions about how social roles,
interactions, and responsibilities in our current systems have impacted mental
health for all members of societies (Brooks et al., 2020).
Parents worldwide experienced elevated stress and anxiety during the pan-
demic, in part because they were required to meet their job responsibilities, care
for their children’s health and well-being, and on top of that, provide educational
oversight given that in-person instruction at schools transformed abruptly to on-
line instruction all at the same time (Sengupta et al., 2021). Also, parents worried
about not contracting the virus, worried about the possibility of hospitalization
and dying if they did contract the virus, feared the sickness and death of loved
ones, and had to navigate misinformation about the risks of the COVID-19
vaccines. Additional stressors like worrying about the security of their jobs and
general ambiguity about the future of their children and families contributed even
further to increased levels of anxiety (Brooks et al., 2020). Not only adults but
children and adolescents experienced increased stress and anxiety due to the
COVID-19 pandemic. Separation from peers and teachers at school, the break in
the daily routine at home, and seeing heightened levels of anxiety in their parents
have negatively impacted the mental and emotional health of children and ado-
lescents (Brooks et al., 2020; Evans, 2021).
DOI: 10.4324/9781003264033-4
58 Theresa A. Ochoa et al.
Research has shown that the mandatory stay-at-home orders associated with the
COVID-19 pandemic adversely affected the mental health of parents, children, and
youth. But less is known about how the COVID-19 virus has affected an already
vulnerable population, that is, incarcerated youth (Nelson & Segil, 2021). The focus
of this chapter is to consider how the COVID-19 pandemic has affected the mental
health of youth behind bars in the United States and in other countries.
Mental Health Needs Among Incarcerated Youth

The longstanding impression of prisons is that the people in custody are violent,
dangerous, and deserve to be incarcerated (Nelson & Segil, 2021). Even incarcerated
youth are viewed by many in society as super-predators (DiIulio, 1995). The reality
is far from this negative view of incarcerated youth. Most incarcerated youth have
significant mental health needs (Leone & Fink, 2017). About 70% of incarcerated
youth meet the criteria for a mental health diagnosis (Kumm et al., 2019; Swank &
Gagnon, 2016). Incarcerated youth often suffer from a variety of mental health
conditions including anxiety, depression, Post Traumatic Stress Disorder (PTSD),
substance abuse, and suicidal ideation (Ford et al., 2008; Kumm et al., 2019). In
addition, research has consistently shown that youth with disabilities make up about
37% of the incarcerated population (Office of Juvenile Justice and Delinquency
Prevention 2019). Ochoa et al. (2021) reported that emotional and behavioral
disorders (47%) and learning disabilities (38%) were the most common disability
categories among incarcerated youth with disabilities. The fact that the majority of
incarcerated youth have mental health problems is not intended to justify or excuse
the crimes they committed but rather it serves to suggest that incarceration in and of
itself, will not likely result in rehabilitation (Ochoa et al., 2021). The stress process
paradigm posits that for most youth, incarceration will exacerbate mental health
disorders. Incarceration and its vicissitudes (e.g., isolation, confinement, fear, and
danger of the prison environment) can result in negative mental health consequences
for incarcerated youth (Turney et al., 2012).
Common barriers impact juvenile correctional facilities’ ability to provide mental
health services to incarcerated youth in general and youth with disabilities in par-
ticular. Access to sufficient funding to hire trained and licensed mental health pro-
fessionals is extremely limited (Skowyra & Cocozza, 2007). In addition, adequate
training and professional development opportunities, particularly in the area of
treatment to youth with disabilities, are seldom available to staff who are treating the
youth (Swank & Gagnon, 2016). If a staff member is unaware that conditions such as
anxiety and depression among youth can cause them to act out, the staff member is
more likely to respond in a punitive way to the acting out behavior, thus exacer-
bating the behavior the youth is exhibiting. Although organizations that can provide
accreditation opportunities for staff in juvenile correctional facilities exist, most often
these organizations can only serve in an advisory role and, because of the lack of
federal laws surrounding mental health treatment, juvenile correctional facilities are
not obliged to meet the accreditation standards (Kumm et al., 2019).
COVID-19 Behind Bars 59
Incarceration is an inherently isolating experience in which youth are removed

from their homes and communities, confined to a locked facility, forced to adhere to
very restrictive regulations and schedules, and are under constant supervision.
Readers unfamiliar with juvenile correctional facilities might think that youth are
housed in individual cells the same way adult prisoners are portrayed in many
movies. Contrary to this assumption, incarcerated youth typically live in communal-
style units, like school dormitories, and surveillance technology incessantly monitors
a youth’s every move (Ravi et al., 2020). Youth follow strict schedules: wake and
sleep hours are prescribed; they go to school, attend treatment, relinquish their
personal garments, and are forced to wear an assigned uniform. The loss of au-
tonomy, self-identity, and personal freedom can exacerbate existing mental health
disorders and/or trigger new disorders (Brooks et al., 2020).
COVID-19 Quarantine Mimics Solitary Confinement

When incarcerated youth show symptoms of COVID-19 or are diagnosed with it,
juvenile correctional facilities are faced with few options for quarantine that do not
resemble solitary confinement (Buchanan et al., 2020). It should be noted that while
juvenile correctional facilities do isolate youth for a variety of reasons, the psycho-
logical trauma known to result from solitary confinement, a specific type of isolation
of one person in a single cell with limited meaningful contact with other people, has
made its use less frequent for incarcerated youth (Stickrath & Blessinger, 2016).
The United Nations considers solitary confinement a form of torture. A survey
conducted in the United States by Hockenberry and Sladky (2020) found that the
facilities reporting that they locked youth in a cell did so mainly on two occasions:
87% of the facilities that locked youth in their cell did so only at night, and 80%
locked youth in their cells when they were out of control (Hockenberry & Sladky,
2020). Solitary confinement, a specific type of isolation used in prisons as a form of
punishment when inmates are disruptive and fail to meet expected behavior, is less
common (Hockenberry & Sladky, 2020). Prolonged isolation can lead to heightened
levels of anger, anxiety, depression, and suicide (Brooks et al., 2020). The quarantine
instituted as a precaution to prevent the spread of the COVID virus has worsened
existing mental health and behavioral problems common in incarcerated youth
(Evans, 2021).
Juvenile Correctional Facilities Are Breeding Ground for the

Spread of COVID-19
Experts say that the coronavirus spreads through person-to-person contact pri-
marily through respiratory droplets produced when an infected person coughs or
sneezes (Nelson & Segil, 2021). Although lockdown measures such as temporarily
terminating family visitations help to reduce the risk of the virus entering the
facility, the infrastructure of prisons are breeding ground for the spread of diseases
(Nelson & Segil, 2021). Communal living spaces, overcrowding, and antiquated
infrastructure like poor air circulation, which are common in prisons, increase the
probability of transmission of the COVID-19 virus (Ravi et al., 2020). As such,
prison conditions make it difficult to follow public health guidelines for social dis-
tancing (Buchanan et al., 2020). Short of locking youth in their cells, juvenile
correctional facilities are limited in how they can respond to reduce the risk of
spreading COVID-19 within their facilities. Although solitary confinement is used
less in juvenile correctional facilities because it is known to cause significant trauma
to the person in solitary confinement, most prisons still have spaces or rooms for use
in the extreme cases in which individuals need to be separated when the health and
safety of that individual, or others, is at risk. If a youth needs to be quarantined,
besides the fact that they already feel the pain of separation from their family and
friends and have mental health issues, the isolation brought on to prevent the spread
of the COVID-19 virus may feel like solitary confinement because their movements
are restricted, and they cannot interact with their peers or personnel.
Closures and Restrictions on Visitations to Prevent Spread

of COVID-19
Because of concern regarding the high transmissibility of COVID-19 in juvenile
prisons, most prison administrators suspend visitors or greatly restrict the number
of people entering the facilities. For example, to minimize the spread of the virus
among incarcerated youth, correctional facilities have had to employ lockdown
measures, such as temporarily terminating family visitations to reduce possible
transmission. That restriction has led to an increased sense of isolation, which is
inherent to the correctional confinement. For example, as indicated in Appendices
A and B, the United States and Costa Rica suspended all visits from families and
volunteers to inmates. In Mexico, as indicated in Appendix C, visits to inmates
were reduced to 50%. Although such restrictions are warranted to reduce the risk
of a COVID outbreak in a juvenile correctional facility, such measures further
deprive youth in custody from contact with family and friends (Segule, 2021).
Such isolation has had devastating consequences on the mental health of in-
carcerated youth (Segule, 2021). Research has shown that staying in touch with
the outside world, primarily family and friends, is positively correlated with
treatment outcomes among incarcerated youth (Buchanan et al., 2020). Theories
like social bonds and general strain note the maintenance of social ties, especially
family supports, are required for treatment success. Parents and guardians who
want to visit their incarcerated youth have gone without seeing them for extended
periods of time because visitations have been suspended. Volunteer programs have
also been suspended to minimize the spread of the virus. Volunteers are an integral
part of juvenile facilities, as they add to the treatment plan offered by facility
personnel. They provide youth activities like sports, games, faith-based and secular
mentoring, and academic tutoring support. The suspension of volunteers who
work in juvenile facilities has meant fewer interactions with the outside world and
fewer opportunities to stay meaningfully occupied while incarcerated.
Restrictions of visits from family and volunteers are justified, but the outcome
is further isolation for a group of youth already suffering from loss of contact with
people they know. The closure of juvenile correctional facilities has meant that
family, loved ones, mentors, and advocates for incarcerated youth have not been
allowed into the facilities (Buchanan et al., 2020). Loss of in-person visitation
almost certainly has resulted in added fear and anxiety among incarcerated youth
already feeling anxious and alone from being imprisoned.
COVID-19 Quarantine: Necessary but Harmful to

Incarcerated Youth
Quarantine because of exposure to the virus adds to the isolation associated with
incarceration. Quarantine involves separating and/or restricting the movement of
people who have been potentially exposed to an infectious disease to see if they
become unwell and to minimize the possibility that they will contaminate other
people (Brooks et al., 2020). For youth already isolated from their family and the
outside world, the quarantine of the COVID-19 pandemic has added yet more
isolation because now, even contact with others who are in the facility is limited,
increasing the sense of isolation to higher levels.
Despite these added isolation efforts used as preventive measures, the COVID-19
virus is infecting and killing incarcerated people (Nelson & Segil, 2021). A prison
reform expert, Phillip Meissner from the United Nations Office on Crime and
Drugs, estimated there are more than 527,000 prisoners in the world who
have become infected with the COVID-19 virus in 122 countries, with more than
3,800 fatalities in 47 countries. It is difficult to ascertain the exact number of youths
infected by the coronavirus because many facilities that have youth in custody do not
report COVID-19 infection data (Segule, 2021).
Once the quarantine period has ended for someone who is not incarcerated, they
can return to their normal interactions but for incarcerated youth, after quarantine
from infection, the isolation that comes from incarceration continues. As the pan-
demic has extended for two or more years, there has been increased concern about
how the COVID-19 pandemic has affected individuals’ mental health (Brooks et al.,
2020). With increased lockdown measures employed within correctional facilities
due to the COVID-19 pandemic, it has become even more difficult to assess the
emotional and psychological conditions of incarcerated youth because interventions
with these youth have become even more limited and restricted.
Fear of Becoming Infected with COVID-19

The increases in anxiety and fear associated with the COVID-19 pandemic and the
lack of mental health services during the COVID-19 pandemic have led to higher
levels of stress among incarcerated youth (Buchanan et al., 2020). Often, incarcerated
youth express their emotions and frustrations behaviorally, and as anxiety from fears of
not being in contact with their families and of contracting COVID increase, youth are
likely to act out. Although some incarcerated youth will act out their anxiety and
stressor by striking out at external targets through fighting and oppositional behavior,
some youth will direct their distress at themselves through self-harm, such as cutting,
(Deskalo & Fontaine, 2021). In some facilities, youth have been observed acting out
their frustration related to not being able to see or talk to their family and being cut off
from the few contacts from the outside world they had previous to COVID-19. Riots
of incarcerated youth are extreme forms of acting out behavior that causes greater
problems for all individuals involved. Youth involved in riots may be placed in more
isolation or transferred to another facility (Mason & McDowell, 2020). As mentioned
before, isolation (i.e., solitary confinement) for any reason, has adverse effects on
youth (Hockenberry & Sladky, 2020). For youth who are transferred, finding
themselves in a new environment away from staff and peers they knew increases
distress and anxiety. Youth who do not participate in rioting but are witness to
violence are likely to become more fearful, both because of the riot itself and because
of the response by the facility’s staff to control the violence. Incarcerated youth may
also experience elevated anxiety when they encounter youth from another, different
facility who rioted and now sharing their living space. Finally, staff also experience
heightened stress levels when a youth is transferred from another facility to theirs; they
worry about the possibility that the transferred youth may act out. They also fear the
transmission of the virus when someone new enters from another facility (Mason &
McDowell, 2020).
Suspension of Educational Programs

Education is considered a human right, but the COVID-19 pandemic has forced
many juvenile correctional facilities to suspend or greatly reduce educational
programing (Buchanan et al., 2020). The majority of youths entering correctional
confinement have significant academic deficits, and many also have learning dis-
abilities (Ochoa et al., 2021). For many youths with and without disabilities,
academic knowledge and skills may worsen because they do not have access to a
rigorous academic curriculum while incarcerated (Leone & Fink, 2017). Prior to
the COVID-19 virus, juvenile correctional facilities offered in-person learning
during which youth had an opportunity to interact one-on-one with their in-
structor, receiving individualized instruction and special education support (Ochoa
et al., 2021). Importantly, going to school also serves as a way of breaking up the
monotony and stress of daily living while incarcerated (Leone & Fink, 2017). The
COVID-19 pandemic, which required a physical distancing of a minimum of
six feet between people, made this problematic. If juvenile correctional facilities
have space to maintain a safe distance, in-person schooling continues. For ex-
ample, in Appendix A, a warden in a small juvenile facility for girls indicated that
the school remained open and girls could continue to go to school in person
because the size of the incarcerated population was small and could adhere to
the required physical distancing of six feet (J. Smiley, personal communication,
April 27, 2020). However, for many other juvenile correctional facilities around
the world, the physical distancing requirement has posed new challenges. For
example, in Costa Rica (see Appendix B), in-person schooling was suspended.
Teachers were not considered essential workers, so they could not enter the ju-
venile facility to teach their courses.
In response to the physical distancing mandate to minimize the spread of
COVID-19, many juvenile correctional facilities suspended in-person learning, and
incarcerated youth received “in-cell” instructional packets that were often not in-
dividualized to meet the needs of the students and provided little feedback on the
youths’ academic progress (Barnert, 2020). The suspension of educational programs
was due only in part to attempts to curtail the spread of the virus. Another factor
impacting the educational programming of incarcerated youth was due to personnel
shortages. As the virus spread outside of juvenile correctional facilities, staff shortages
resulted as some staff contracted the virus. Due to staff shortages at juvenile cor-
rectional facilities, there have not been enough teachers to provide in-person
educational programming to incarcerated youth. Buchanan et al. (2020) have noted
that many juvenile correctional facilities have returned to a worksheet approach to
teaching in which assignments are passed out to students for them to complete on
their own, then the work is collected, graded, and returned to students on a rotating
basis. The suspension of in-person learning in juvenile correctional facilities is of
concern because it is likely to aggravate the long-term psychological and educational
outcomes for incarcerated youth.
The shift away from in-person instruction in many juvenile correctional fa-
cilities is more likely to negatively impact youth with learning disabilities, who, as
reported by Ochoa et al. (2021), account for 37% of the population of incarcerated
youths. Students with disabilities continue to be under the protection of the
Department of Education in the United States and the Department of Education
has made clear that all provisions of the Individuals with Disabilities Education
Improvement Act (IDEA) remain in effect during the COVID-19 pandemic (U.S.
Department of Education, 2021). Even if it is unintentional and beyond the
control of the juvenile correctional facility, youth with disabilities are not only
being denied the educational support they need to overcome their learning and
behavioral challenges, but they may also be experiencing elevated levels of distress
during isolation which could be mitigated by having the support of a teacher had
they been receiving in-person instructional support. The continuation of educa-
tion while incarcerated reduces the risks of a youth recidivating, improves their
odds of securing employment after release, and can enhance overall morale and
mental health (Ochoa et al., 2021; Leone & Fink, 2017). Disruptions in school and
learning caused by COVID-19 will likely exacerbate the mental health morbidity
of an already vulnerable population.
Technology Use in Juvenile Correctional Facilities

Until the COVID-19 pandemic, technology in prisons was used primarily for sur-
veillance purposes (Ravi et al., 2020). For example, in the largest juvenile correctional
facility in the United States, there are a total of 700 digital video cameras; the
facility holds about 180 youth and the video cameras functioned as surveillance
tools (Unruh, et al., 2021). Before COVID-19 forced prisons to close to visitors,
most juvenile correctional facilities did not use video technology to keep youth
connected to their families (Buchanan et al., 2020). The common reluctance to
use video technology was due to security and privacy concerns (Buchanan et al.,
2020; U.S. Department of Education, 2021). If a correctional facility had not
already adopted technologies prior to the pandemic, it was almost impossible to
drastically alter that facility’s infrastructure without compromising the safety of
the youth population and staff (Buchanan et al., 2020).
Since correctional facilities suspended visits as a measure to reduce outbreaks of
the COVID-19 virus, access to some technology has increased. If there is a silver
lining to the COVID-19 pandemic, it is that it has forced facilities to begin to
adopt video technology to keep youth and their families connected. In the three
countries featured in this chapter, personnel in Costa Rica, Mexico, and the
United States have turned to video conferencing to bridge the physical distance
between families and their incarcerated youth. As indicated by a warden of a
juvenile correctional facility in the United States (J. Smiley, personal commu-
nication, April 27, 2020), they plan to keep using video conferencing even after
the pandemic subsides. As indicated in Appendix B, when the government in
Costa Rica suspended in-person schooling, it brought to light the differences in
technological access among its student population (Gonzales, 2016).
Although some students have access to devices and the internet, others do not.
Costa Rica implemented a national reclassification system based on access to
technological devices and the internet (see Appendix B). Of note, the juvenile
correctional facility for minors in Costa Rica repurposed all of their existing
technology devices and shifted their use to provide individualized instruction to
incarcerated youth. Under this arrangement, incarcerated minors had both elec-
tronic devices and access to the internet. This innovative arrangement allowed for
the teachers who could not enter the juvenile facility (because of the suspension of
in-person instruction) to connect from home to teach individual students, who in
turn connected with them from another device in the juvenile correctional fa-
cility. Although the facility had limited computer stations, the administrators
implemented a rotation schedule to allow each incarcerated youth some in-
dividualized time with a teacher, connected virtually.
In the United States, a warden of a correctional facility for girls indicated that
he has witnessed an increase in family visits with their children who are in custody
because now, he can offer parents an option to connect electronically (J. Smiley,
personal communication, April 27, 2020). Therefore, although youth in custody
remain physically isolated from their family, it appears that the COVID-19 pan-
demic has eased some of the restrictions on the use of communication technol-
ogies within correctional facilities. Human connections are an invaluable and
important psychological factor to help youths cope with the stressful aspects of
incarceration (Buchanan et al., 2020), and the pandemic has severely heightened
the need for communication technologies in correctional facilities.
A major obstacle to the adoption of technology to keep families and in-
carcerated youth connected is the digital disparity and unequal access to tech-
nology related to socioeconomic, sociocultural, and political factors (Vogels,
2021; Gonzales, 2016; Ragnedds & Muschert, 2013). This disparity is known as
the digital divide, and it impacts the most marginalized populations who are
excluded from the digital world (Gonzales, 2016; Ragnedds & Muschert, 2013;
Vogels, 2021). Nowhere is the digital divide more evident than in juvenile
correctional facilities, where access to learning technologies, pre- and post-
COVID-19, are limited (Moreira & Dias-Trindade, 2020). In-person schooling
and in-person visits pre-COVID-19 made technology a desirable resource, but
COVID-19 transformed this reality in such a way that access to technology
became a necessary condition to remain in contact with the youths’ loved ones,
as well as to continue their education.
Not only is the digital divide present within the correctional facilities, but it is
also a reality facing the families and communities of the incarcerated youth. It is
important to keep in mind that many youths in correctional confinement come
from families with limited financial means. As such, these families have less access to
technology and experience significant limitations in establishing electronic con-
nections with their children because they do not have the technological agility to
learn how to download applications such as WhatsApp, Zoom, or Microsoft Teams,
as well as the internet bandwidth to make use of these technologies to connect with
their children. Even as part of their confinement process, greater access to learning,
information, and communication technologies while incarcerated may be the key to
empowering youth to prepare for re-entry into the outside society and to plan for
their futures, and improve their chances for success. It is also an important condition
to keep the bonds with family and community outside of the confined facility: a key
element for mental health.
Conclusion
The COVID-19 pandemic has had a negative impact on everyone, and it is far
from over. The two years (so far) of disruption to daily routines caused by the virus
and its new variants will continue to pose challenges. Monitoring how the
COVID-19 pandemic is affecting all people and youth is important. The mental
health of incarcerated youth, in particular, must be a priority because they are
already vulnerable and the pandemic has impacted them disproportionately. More
specifically, we recommend that incarcerated youth:
• Maintain or increase contact with family. Incarcerated youth need to be

connected to people who love them. They need reassurance that they are not
alone and that their family and friends are healthy. Although video con-
ferencing with families is not the same as physical touch, it has proven to be a
viable alternative and it is preferable to no contact with family. Limiting fa-

mily visits to reduce the risk of spreading the virus may be important, but it
may also be beneficial to examine how the process of reducing family visits by
50% has worked in some countries (e.g., in Mexico, where family visits were
not eliminated completely).
• Return to instruction provided by teachers. Although worksheets with aca-
demic content may suffice for some students, worksheets for incarcerated youth
are less optimal because of the academic deficits of many of these youths. Many
require teacher-directed instruction. In particular, incarcerated youth with
disabilities need direction from teachers in order to learn.
• Receive direct services from mental health professionals who can help them
manage their increased anxiety and stress in adaptive ways. In this regard, the
way Costa Rica provided distance education to each student shows other
countries how they can use technology in a similar way to provide telehealth
to each youth. Until mental health professionals are allowed to return to the
juvenile correctional facilities in person, they can connect from their homes
or offices to provide each youth with mental health services on a rotation basis
so that each youth gets individualized mental health treatment to help them
cope with the added stress of the COVID-19 pandemic.
• Are the focus of research to examine how the COVID-19 pandemic affected
them and the treatments they will need to be able to adjust while incarcerated
and when they return home to a new world changed by the COVID-19
pandemic.
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Appendix A: Feature Box: A look into juvenile correctional

facilities in the United States
The Juvenile Residential Facility Census (JRFC) is sponsored by the Office of
Juvenile Delinquency and Prevention (OJJDP) two times per year in each of the
50 states in the United States. Data from 2018 indicated that 73% of the 37,529
incarcerated youth under the age of 21 years were held in the 1,510 correctional
facilities for youth. Small facilities held 20 or fewer residents, medium-size facilities
held between 21 and 100 residents, and large facilities hold 100 to 200 residents.
Only 1% of juvenile correctional facilities operated over capacity in 2018. Each
correctional facility in the United States was required to offer educational pro-
gramming for youth in their custody, including special education services for
youth with disabilities. About 95% of juvenile correctional facilities screened all
youth for suicide risk and 88% screened all youth for educational needs
(Hockenberry & Sladky, 2020).
The COVID-19 pandemic altered daily routines in juvenile correctional fa-
cilities in the United States. Facilities that lacked sufficient space to adhere to the 6
feet distancing protocol, suspended in-person schooling and returned to a
worksheet approach. However, some smaller juvenile correctional facilities were
able to continue providing educational, treatment, and recreational activities to
youth while maintaining distance. These are the responses during a phone in-
terview on May 27, 2020, with one warden in a facility for girls.
How has COVID-19 affected youth and staff?

At first, there was a great deal of concern among the girls. There was a lot of fear
because no one knew what was going on. The Department of Correction was
quick to act. We started restricting visits and volunteers and started doing hand
washing. Ultimately, the girls felt a sense of relief. They’re here, in a bubble, and
they don’t have to worry about getting it. Because we didn’t know what it meant
for kids, they felt safe, because they knew that if they were going to get it, they’d
get it from us, and we were in the bubble with them.
What did COVID-19 alter in the daily routine as you had to

shelter in place?
The biggest difference is, when you walk in, everybody has a mask on. Everybody
washes their hands before entering, each time they come in. There’s hand sanitizer
everywhere. We’ve doubled our cleaning. We’re doing it twice per shift and
cleaning high touch points multiple times. If you don’t see a girl or a crew
member cleaning, you’re not looking hard enough.
What programs run differently? How?

We’ve been lucky as far as school. We’re so small, we can continue running our
school without disruptions. The kids are still going to school for half the day. Our
class sizes are three to four kids per room, so we can do that and stay socially dis-
tanced at the same time. With the visitors not being allowed to come in, we’ve
stepped up our facetime with relatives. Which I think has helped. We will probably
continue using facetime even after the pandemic has calmed down a little bit.
What has surprised you? Inspired you?

How close the facility staff has come together throughout this entire pandemic. We
haven’t had a lot of call-offs. Staff wanted to come to work every day. They felt if
they weren’t here, they were letting down their team. It was great to watch how
close they worked together. The dedication of the staff has inspired me. The girls
have been super good during this time. They’ve been understanding. A lot of times,
when you get in situations like these, where everything gets crazy and we’re taking
away visits from family and you may expect them to have bad behavior. They’ve
taken it in stride and it’s definitely helped our facility handle the pandemic.
I heard the girls sewing masks?

When the pandemic started, we had a couple of sewing machines that staff
brought in and two girls who were pretty good at sewing made about 40 masks
that we passed out to our girls. They’re not making masks anymore; we had
such a huge donation that we have so many masks. We haven’t had to keep
making them.
Greatest challenges related to COVID-19

Not knowing what to do. Fighting something we can’t see and all the changing
information that we’re getting and using to try and help the facility.
What do you want the outside community to know about the

correctional staff?
I would say that in general correctional officers are still here, doing our job, we’re
not often looked at as front-line heroes like police, firefighters, and nurses are, but
we’re still here, doing our jobs like we have every day. They’re being professional
and doing an outstanding job.
Appendix B: Feature Box: A look into a prison for minors in

Costa Rica
Costa Rica has 13 prisons nationwide. Ten of the prisons hold male inmates over
the age of 25 years old. One of the prisons holds female inmates over the age of 18.
One prison is for young male inmates ages 18–25 years old. One prison is for male
and female minors from ages 12–18 years old (Ministerio de Justicia y Paz, 2018).
The prison for minors can have people over the age of 18 up to 25 if the sentence
was given while the inmate was a minor. Data provided by the State of the Nation
Program (Programa Estado de la Nación, 2017) indicated that there was a total of
13,983 prisoners in 2017: 13,438 were men (96%) and 545 were women (4%).
The total size of the juvenile population ages 12 to 25 was 937: 877 (94%) were
boys and 60 were girls (6%).
When the COVID-19 pandemic was declared, the Costa Rican government
passed three measures to reduce the risk of an outbreak in prisons. First, the
Ministry of Justice and Peace allowed the release from prison or relocation of those
who: (a) were non-violent and close to completing their sentence; (b) had health
conditions; (c) were pregnant women or with children; or (d) were over 65 years
of age (Ministry of Justice and Peace, 2020; Miranda, 2020; Romero et al., 2021).
In addition, the Ministry of Justice and Peace acknowledged the pandemic in-
creased the importance of providing transition support when inmates were re-
leased from prison (Romero et al., 2021). Towards this effort, the Social Insertion
Unit within the Ministry of Justice and Peace assumed the responsibility to seek
community organizations that could provide temporary housing and government
institution or could provide educational support to people released from prison
who were over the age of 18.
Finally, the Costa Rican Ministry of Public Education suspended all in-person
teaching and changed to a new model of education: distance learning. Since this
change occurred in April of 2020, four levels of instructional support have been
provided in the new model. The first level is for students who have access to the
internet and an electronic device at home. In this scenario, the teacher uses
technology available in the student’s home to provide synchronous instruction.
The second level is for students who have a device but have limited access to the
internet. In this scenario, teaching is asynchronous with weekly assignments that
the students complete as access to the internet is available. In level three, students
may have a technological device but no access to the internet. In this scenario, the
teacher provides printed material (e.g., worksheets) and may send digital material,
such as video with instructions to complement the printed material. In level four,
students have neither device nor access to the internet. In this scenario, instruction
is completely autonomous through printed worksheets that are handed out to the
student on a periodic basis (Ministerio de Educación Pública, 2020).
What are the implications of these three measures for

incarcerated youth?
Since the pandemic existed in the section in the prison for minors, the minors
were treated as a social exception to keep their sections separate. The technology
that existed in the juvenile facility was repurposed and made available to provide
individualized instruction to youths, which in turn classified them into level 1
according to the new model of distance instruction. Therefore, the COVID-19
pandemic provided incarcerated youth in Costa Rica, not only access to tech-
nology and internet connection but also to 1–1 instruction, albeit on a rotation
basis. Furthermore, directors, teachers, and security staff ensured that youth had
artistic, cultural, and sports activities to minimize the risk of feelings of greater
isolation because of the loss of visitation from relatives (E. Viales, personal com-
munication, November 11, 2021). The facility staff converted large recreational
spaces, such as soccer fields and basketball courts, to hold activities while main-
taining the required 6 feet of physical distance. They used specific recreational
spaces such as soccer or basketball fields to develop different activities and structure
a schedule in such a way that the social groups did not mix.
Appendix C: Feature Box: A look into juvenile correctional

facilities in Mexico
The National Human Rights Commission (Comisión Nacional de los Derechos
Humanos, CNDH) of Mexico required all Federal and State Penitentiary System
administrators to carry out measures to prevent the spread of COVID-19 in
prisons and in Specialized Centers for Adolescents (Mexico’s term for juvenile
correctional facilities). The purpose of these measures was protecting the health
and life of inmates, visitors, prison staff, and service providers (Núñez, 2020).
Cleaning supplies were delivered to prisons, and information about sanitation was
provided to inmates, visitors, and prison staff. In addition, all areas of the centers
and mobile units underwent deep cleaning. Finally, all prisons were instructed to
reduce visits by 50% to avoid the spread of the virus. The adoption of these
measures looks different across states in Mexico. Following are two examples.
In response to the reduction of in-person visits to inmates, one center for youths
in Mexico City implemented a video call program to provide communication be-
tween the youth and their families (López, 2020). Of note, they obtained support for
the video conferencing program from families, presumably for their buy-in. In
addition, three cell phones were purchased to make it easier for the 55 youths in the
facility to make phone calls to their families. The same three phones served the 65
youths detained in the preventive section of the juvenile facility. The preventive
section houses youth who are detained straight from the street or who are removed
from a dangerous home environment but are not processed for any crime, this
detention is preventive. The centers minimize the probability that the COVID-19
virus will spread by using antibacterial gel, requiring the use of face masks for staff,
and taking daily temperature of everyone in the facility. Isolation is not mandatory,
but activities are monitored, and if any symptoms are detected among youths, they
are removed from the general population as a control measure against the spread of
the COVID-19 virus. If any of the youths’ health worsens, they are treated in a
specialized clinic, different from the clinic for adults (López 2020).
Quintana Roo
In the State of Quintana Roo, there is only one center for youth involved in the
juvenile justice system (Center for the Execution of Measures for Adolescents).
The center holds 23 boys: 17 are serving time for a serious crime, and 6 of them
are detained as precautionary measures. In 2020, the center suspended in-person
hearings and moved to real-time video conferencing. In addition, all activities,
such as religious support groups, English workshops, gardening, and guitar lessons
were suspended to avoid the spread of the virus. All youth and staff were vacci-
nated as part of a campaign to reduce the risk of influenza, hepatitis, and measles.
In addition, the facility offered educational, recreational, and sports activities as
well as psychological and social work support and treatment to minimize panic,
stress, and depression (López, 2020).
Girls incarcerated
It is difficult to know how the COVID-19 virus has affected incarcerated girls
because even prior to the COVID-19 pandemic prison data are not disaggregated
by gender. As such, it is unclear how many of the 3,268 reported deaths due to
COVID-19 were females. The only instance in which it is known that one in-
carcerated female died from COVID in a prison in Tijuana, Mexico and that was
revealed through a media announcement (Observatory of Gender and COVID-19
in Mexico, 2021). What is known about incarcerated females is that compared to
males they receive fewer visits and consequently have less access to food, hygiene
items, and clothing as a consequence of not having visitors. The closure of visits
attributed to the COVID-19 pandemic has further exacerbated these conditions
for incarcerated females. Families of incarcerated females claim that prison au-
thorities do not provide information about the health condition of incarcerated
women. Relatives of some of the female prisoners have stated that if a female
presents symptoms of COVID-19, then they are isolated without confirmation
from a test that they in fact have COVID-19 (Observatory of Gender and
COVID-19 in Mexico, 2021). Finally, misinformation within the facilities has
increased fears among the girls about medical services in the facilities.
5
SCHOOL AND COMMUNITY REFORMS
THAT HELP NAVIGATE THE COVID-19
CRISIS
Sarup R. Mathur, Wendy Peia Oakes, Heather Griller Clark,
and Germaine Koziarski
Good mental health and well-being are not only associated with the positive out-
comes discussed in the previous chapters, such as employment (Lee et al., 2019), and
effective social functioning (Aro et al., 2019), but also with school success. At any
given time, 20% of children and adolescents are likely to experience a mental health
concern during their school years (CDC, 2020; Danielson et al., 2020). Poor grades,
absenteeism, disciplinary problems, and school dropout, are a few of the school-related
performance indicators that serve as early signs of emerging mental health concerns
(Porche et al., 2016).
In 2019, the Substance Abuse and Mental Health Services Administration
(SAMHSA) reported that 3.8 million students, ranging in age from 12 to 17,
experienced a major depressive episode, but less than half received mental health
treatment. Unfortunately, many of those who did not avail themselves of treat-
ment were from low-income communities. Of the students who did get help,
nearly two-thirds did so only in school. A recent cross-sectional study (Finkelhor
et al., 2021) from three US national surveys found that 41–63% of children ex-
perienced a high number of adverse childhood experiences (ACEs) or a high level
of distress symptoms (i.e., high symptoms) and did not receive mental or beha-
vioral health services. In addition, they found that young Black children received
services less than any other group. It is very concerning that large proportions of
the high-risk youth population remain untreated and do not access mental health
services that could improve their developmental outcomes. The findings imply a
strong need for early screening of mental health problems in children in order to
design and implement early intervention efforts.
Pandemic and Mental Health in Schools

Twenty-five percent of high school students have reported emotional and
mental health issues during the pandemic (Mansfield et al., 2021). Many students
have had to face illness, loss, food insecurity, and economic hardship resulting
from the pandemic. They have experienced anxiety, fear, and depression
DOI: 10.4324/9781003264033-5
76 Sarup R. Mathur et al.
attributable to long-term school closures, isolation, quarantines, and stay-at-home

orders (Margolius, 2020). Parents have reported an increase in their own stress
because of loss of employment, increase in household expenses, and constant bal-
ancing of work and childcare (Kalluri et al., 2021). Of those who already were at risk
for mental health difficulties, their issues have been further exacerbated, warranting
immediate and intensive attention (Mansfield et al., 2021).
Schools have experienced difficulty providing students with a sense of con-
nectedness, belongingness, and development of positive relationships with peers and
teachers, as many had to adopt virtual modes of learning. It is imperative that
educators have the tools needed to identify children who have gone through such
trauma and that they link children to local support systems and care. School-based
mental health (SMH) can be viewed as an emerging need in response to this in-
creasing national health crisis (CDC, 2020; Office of the Surgeon General, 2021). In
this chapter, we discuss the importance of SMH services for children in schools,
highlight the use of tiered systems to prevent and respond to mental health concerns
of students and provide specific considerations for school and community for
creating integrated systems (Ormiston et al., 2021).
School-Based Mental Health

Schools have been viewed as a pivotal agency in providing more than academic
and vocational preparation to their students, including the promotion of mental
health and well-being. Studies have indicated that developing comprehensive
mental health programs in schools can help students achieve not only academi-
cally, but also add to having experiences that build self-awareness and successful
connections with the community (McCray & Rosenberg, 2021). Several federal
agencies, such as the President’s New Freedom Commission on Mental Health,
the Department of Health and Human Services, SAMHSA, and the Institute of
Medicine have called on schools to assume a significant role in enhancing early
identification and connecting students with mental health supports (Green et al.,
2013). One of the reasons for having SMH is that schools have a strategic ability to
reach children and families in surrounding communities (NASP, 2021). School
professionals have knowledge about their students and families, and they have
developed effective communication mechanisms and strategies, which can become
instrumental in increasing the availability and accessibility of services (Kern et al.,
2021; Mathur et al., 2017). School personnel, such as school psychologists,
counselors, social workers, and nurses are trained in understanding the relationship
between child development, mental health needs, and learning, and can help shape
schoolwide and individual interventions to promote the overall well-being of
students who have targeted or intensive, ongoing needs. Schools also show ca-
pacity for conducting screening, providing preventive measures, and promoting
positive social and emotional development. By recognizing soft signs and early
warning symptoms of risk, schools can assist in initiating intervention in a timely
and appropriate manner. As small communities, schools provide many elements
School and Community Reforms 77
that are critical to mental health, such as belongingness, support, and purpose
(Office of the Surgeon General, 2021). When students feel they are part of the
community, they feel accepted for their attributes and values. Those who do not
feel appreciated, seen, and accepted may become disengaged and disconnected,
and are at heightened risk for poor mental health.
Guidance from the field indicates that programs that fit the needs of the
community and are based on the active involvement of the community and
schools produce more positive results than programs operating in isolation
(Hoover et al., 2019). Comprehensive mental health systems (CMHS) are based
on the premise that there are complex inter-relationships among students’ mental
health, learning outcomes, and the roles of families, school, and community en-
vironments (Hoover et al., 2019). CMHS are established using a strategic part-
nership with students and their families, as well as community health and mental
health agencies. The drive toward CMHS has experienced momentum, as it has
the potential for addressing a full array of services and supports starting from
awareness to prevention and early identification to comprehensive treatment.
Since schools and community agencies work in different environments and in
multiple systems, CMHS needs to be grounded in a set of core principles that
promote collaboration of all partners. The US Department of Health and Human
Services in collaboration with the Health Resources and Services Administration
(HRSA), SAMHSA, and the Bainum Family Foundation, brought in experts and
held three national convenings, in which they identified eight core features for
CMHS: (1) well-trained personnel in social and emotional learning and mental
health literacy; (2) family-school-community partnerships to coordinate resources
and strategies; (3) needs assessment and resource mapping to provide a compre-
hensive view of services; (4) multi-tiered system to provide supports in varying
intensities; (5) early mental health screening and assessment of the social de-
terminants of mental health (6) evidence-based practices that are culturally re-
levant; (7) data sharing to develop a common understanding of concern(s) and
informed decision making; and (8) funding resources to support a full continuum
of services. Although there is no standard set of rules or guidelines for an optimal
program, these features are critical for advancing high-quality CMHS at the state
and local levels (Hoover et al., 2019).
To address the full continuum of student needs, schools and community
agencies need to collaborate and coordinate to deliver services in schools, as well as
to provide supplementary or intensive services through community agencies.
Although multisystemic support and some individual program components exist in
many schools, there is still a significant lack of comprehensive and integrated
programs (Kauffman & Badar, 2018). It is important for school personnel to de-
velop and create memoranda of understanding (MOUs) to provide clear identi-
fication of contributions of each partner toward more seamless and comprehensive
service delivery, and to coordinate partnerships with community mental health
service providers. Both school and community agencies need to rely on practices
that are evidence-based.
Evidence-Based Practices
Evidence-based practices (EBPs) have a strong scientific basis for their use, as they
are supported by high-quality research that offers empirical demonstrations of
effectiveness (Kern et al., 2017). A practice is considered to be evidence-based
when a body of research finds an adequate number of studies meeting quality
indicators and producing desirable student outcomes (Council for Exceptional
Children, 2014). For successfully implementing EBPs to support mental health, it
is critical that there are sufficient resources, adequate training, and commitment to
implementing the program with fidelity (Kern et al., 2017). EBPs should be the
first-choice option, as they have been supported by research and have accumulated
evidence (see Table 5.1).
Current statistics and implications for the mental health of children and youth are
a call to action. While schools and other agencies are making gains in promoting
awareness and EBPs to support students’ mental health, the Office of the Surgeon
General (2021) calls for an “all-of-society effort” to respond to the current mental
health crisis, with schools playing a critical role in the prevention and response (p. 4).
The implications for learning are clear; students’ behavior, social skills, and mental
health play an important role in their academic achievement (Durlak et al., 2011;
O’Connor et al., 2019). As a response, schools across the United States are adopting
tiered systems of support, consisting of EBPs, to address systematically the growing
diversity of students’ needs, particularly in light of Covid-19’s effects on students’
academic, behavioral, and social-emotional well-being.
The Role of a Tiered Systems as a Prevention Framework

for Schools
Schools are an important institution for promoting the mental health of children
and youth, particularly given the dearth of available mental health services in many
communities (Tobin Tyler et al., 2017). In addition, systemic barriers, which
disproportionately affect Black children and youth, may prevent families from
accessing care. These barriers include lack of information; limited availability of
appointments, causing extended wait times and delays; insurance coverage and
limits; a disconnect between primary care and mental health services; adminis-
trative complexities (Anderson et al., 2017); and cultural perceptions of stigma
related to mental health (Finkelhor et al., 2021; Weist et al., 2019).
Tiered systems provide the framework for coordination of services within
schools and across community resources to prevent, reverse, or minimize harm
(Lane et al., 2020) and promote academic achievement, behavioral performance,
and strong mental health. Examples of tiered systems, that include components
to address students’ behavioral and social-emotional development are (a) the
Comprehensive, Integrated Three-tiered (Ci3T) model of prevention (Lane et al.,
2020) addressing academic, behavior, and social-emotional well-being domains,
(b) Positive Behavioral Interventions and Supports (PBIS; Sugai & Horner, 2002)
TABLE 5.1 Agencies and Organizations with Resources for Schools to Support Students’ Mental Health
Agency/Organization Where to Find Resources
Collaborative for Academic, Social, and Emotional • Program Guide > Identify Your Goals
Learning (CASEL) Program Guides ◦ Use this tool to identify the goals you wish to achieve in implementing an SEL
www.pg.casel.org curriculum. Downloadable versions are available
• Program Guide > View All Programs
◦ A list of SEL programs evaluated by CASEL. Compare programs, filter by grade
or even evaluation outcomes
Comprehensive, Integrated Three-Tiered Model • Professional Learning > Tiered Library
of Prevention (Ci3T) ◦ Professional learning and implementation resources for evidence-based strategies
www.ci3t.org (e.g., precorrection) and interventions (e.g., functional assessment-based
interventions)
• Building your Ci3T Model
◦ Resources to support schools in designing their own Ci3T model of prevention
Institute of Education Sciences (IES) • Intervention Reports
What Works Clearinghouse (WWC) ◦ Research supporting the interventions that WWC promotes (e.g., Social
www.ies.ed.gov/ncee/wwc Belonging)
Institute of Education Sciences (IES) • Access to guides designed to help teachers address challenges within their schools
Practice Guides using research- and evidence-based practices
www.ies.ed.gov/ncee/wwc/practiceguides
National Center on Intensive Intervention (NCII) • Tools/Charts > Behavioral Intervention Chart
www.intensiveintervention.org ◦ Compare research on various behavioral intervention tools (e.g., Check &
Connect, token economy)
• Implementation & Intervention > Behavior Strategies
◦ NCII’s list of behavioral strategies: Antecedent Modification, Self-Management,
and Reinforcement. Resources and guides available for each
School and Community Reforms
79
addressing behavior and social skills (e.g., bullying prevention), and (c) the
Interconnected Systems Framework (ISF; Barrett et al., 2013) integrating mental
health services within a PBIS framework (see Table 5.1).
The Surgeon General’s Advisory provided recommendations for supporting
students’ mental health as part of an integrated system that includes: (a) a con-
tinuum of prevention and interventions efforts, (b) systematic universal screening
procedures, and (c) schoolwide and targeted social and emotional learning pro-
grams (Office of the Surgeon General, 2021).
Provision of a Continuum of Prevention and Interventions Efforts

Prevention-focused systems most often have three tiers offering a continuum of
prevention and intervention efforts that increase in intensity as students demon-
strate need. Tier 1 is primary prevention and encompasses programs and practices
to prevent difficulties from occurring (Lane et al., 2020). Tier 1 is for all students
enrolled in the school and includes a school-wide research-based social-emotional
curriculum, such as Connect with Kids (Connect with Kids Network, 2017) or
Second Step (Committee for Children, 2021) implemented with fidelity. School-
based social/emotional learning (SEL) programs have been found to be effective
not only in promoting healthy social and emotional development of students but
also in improving productive engagement in academic learning (Collaborative for
Academic Social and Emotional Learning (CASEL) 2012; Durlak et al., 2011).
To support students’ behavioral development and mental health, all the named
frameworks include PBIS practices—identifying 3–5 social expectations (e.g., Be
respectful, Be responsible, Give best effort) with clearly defined behavioral de-
scriptions for how to demonstrate these expectations in each school setting,
providing opportunities to practice, and using a schoolwide reinforcement system
to acknowledge students and promote meeting the expectations (Horner & Sugai,
2015). Of importance, each school’s expectations and behavioral descriptions are
determined by the school community. Ideally, families’ voices contribute to the
determination of the expected behaviors. Teachers use effective and efficient low-
intensity strategies to promote students’ academic engagement and meeting of the
schools’ social expectations—moving away from reactive systems and reductive
strategies and toward proactive strategies such as pre-correction (Ennis et al.,
2017), opportunities to respond (Common et al., 2020), and active supervision
(Allen et al., 2020). Collectively, these practices provide for safe, positive, and
predictable school environments for students, instrumental at a time of especially
great unpredictability for children and youth.
For students with identified targeted needs, Tier 2 interventions are selected
and implemented, ideally in an integrated fashion. Tier 2 interventions are for
some students (~15%) and do not replace but complement Tier 1. For example, a
student may demonstrate moderate risk for externalizing behaviors, detected
through the school’s screening process, and be performing below the grade-level
benchmark in mathematics. In this case, the teacher may elect to teach a specific
prosocial skill or emotional regulation. Ideally, teachers use Tier 1 curricular

materials or their supplemental materials for this additional instruction so that skills
will more likely generalize across school social settings (e.g., classroom, cafeteria,
playground). Tier 2 interventions or supports are likely to be sufficient for meeting
most students’ targeted social and emotional well-being needs. However, about
5% of students may require Tier 3 interventions.
Tier 3 interventions are designed for students with multiple risk factors such as
traumatic experiences, older students with persistent concerns, or those for whom
Tier 2 was insufficient to meet their needs (Lane et al., 2020). Tier 3 supports are
individualized, although they may be implemented in small groups or in the class-
room, such as functional assessment-based interventions (Umbreit et al., 2007), or
cognitive-behavioral interventions (Schoenfeld & Mathur, 2009; Zaheer et al., 2019).
Systematic Universal Screening Procedures

By recognizing soft signs and early warning symptoms of risk, schools can initiate
intervention in a timely and appropriate manner. For example, integrated three-
tiered (Ci3T) model schools use a validated screening tool such as the Student Risk
Screening Scale for Internalizing and Externalizing behaviors (SRSS-IE; Drummond,
1994; Lane & Menzies, 2009), Social, Academic, and Emotional Behavior Risk
Screener (SAEBRS; Fastbridge/Illuminate Education, 2013), or the Social Skills
Improvement System-Social Emotional Learning (SSiS-SEL; Gresham & Elliott,
2015). While these screeners are not mental health screening specifically, the SRSS-
IE detects students with behavioral manifestations of poor mental health by detecting
students experiencing two major childhood disorders—externalizing behaviors (e.g.,
tantrums, disruption, non-compliance) and internalizing behaviors (e.g., anxiety,
depression), again, affecting about 20% of all school-age students (Forness et al.,
2012). Alarming increases in internalizing symptoms since the start of the pandemic
(Racine et al., 2021) highlight the urgency for the use of screening tools that assess
internalizing disorders, specifically. Other screeners use the CASEL framework to
examine students’ social and emotional learning skills (e.g., SSiS-SEL).
Regardless of the tool selected, teachers and other educators conduct screenings
three times per year for all students. These are most often teacher-completed tools,
however, schools may select a screener with student- and parent-completed
versions (e.g., BASC-3, Behavioral and Emotional Screening System; Reynolds &
Kamphaus, 2015). It is important to plan for additional parent permission for
student-completed screeners, and a swift review of data and response to in-
formation from students and parents (Lane et al., 2021). Additional information on
these resources are included in Table 5.1.
Educators, in teams or independently, review systematic screening data in
conjunction with additional sources of student-level data such as attendance, office
discipline referrals (ODRs), and academic progress data, to select the most ap-
propriate Tier 2 or 3 interventions, as needed. All schools using tiered models rely
on data to make the most informed instructional decisions and swift connections
for students with appropriate interventions, including the provision of mental

health supports.
Targeted Social and Emotional Learning Programs

Central to integrated, tiered models is the provision of SEL programs to promote
students’ school outcomes. Although there are demonstrated benefits of both PBIS
and SEL independently, the integration of PBIS and SEL yields significantly
greater improvements in students’ internalizing and externalizing behavior patterns
(Cook et al., 2015). Schools implementing PBIS well have demonstrated sig-
nificant reductions in students’ aggressive behavior, concentration difficulties,
ODRs, and improvements in emotional regulation and prosocial behavior, and
contributed to safe, predictable learning environments (Bradshaw et al., 2009;
Bradshaw et al., 2012). Resources for designing and implementing PBIS are
available from the National Center on PBIS.
Reviews of the research evidence to support the use of specific SEL programs
are available from What Works Clearinghouse (Institute of Education Sciences
[IES]) and the Collaborative for Academic, Social, and Emotional Learning
(CASEL; see Table 5.1). Together, tiered systems addressing behavioral and social-
emotional well-being hold promise for improved mental health as well as aca-
demic outcomes and provide a systems effort to respond to students’ increased
pandemic-related educational needs. The following illustrations represent ways in
which educators have strengthened students’ mental health across all three tiers of
prevention and intervention.
Illustration at Tier 1 for Supporting Students’ Mental Health

Jackson Elementary School implements an integrated three-tiered (Ci3T) model of
prevention. During their year-long design process, they identified research-based
curricula and evidence-based instructional practices for reading and mathematics,
selected an SEL program (e.g., Merrell’s Strong Kids; Carrizales-Engelmann et al.,
2016), and created a PBIS expectation matrix (i.e., Show kindness, Show respect,
Take responsibility) and universal reinforcement system (Jazz Cash). They reviewed
their assessment system and selected a universal behavior screener for the early de-
tection of students with externalizing and internalizing behavior concerns (i.e.,
SRSS-IE). They screened all enrolled students three times each year making data
available to teachers immediately after screening. They established a leadership team
with academic instructional coaches, a school-based mental health team member,
and school counselor, in addition to general and special education teachers and
school administrators (Lane et al., 2020).
The school was fortunate to have a mental health provider in their local
community. School personnel reached out to establish a partnership with the
provider and invited them to join the school’s leadership team (Barrett et al.,
2013). The school leaders established and consistently communicated to all school
staff and families a clear vision focused on academic achievement, behavioral

expectations, and social and emotional well-being for all students. Further, teams
planned for focused professional development throughout the school year to
empower teachers with the knowledge, skills, and resources to positively affect the
learning and development of their students.
Having research- and evidence-based programs, practices, and strategies at
Tier 1 provided a strong foundation of prevention for all students. At Jackson
Elementary School, all students participated in the core academic curricula (e.g.,
90 minutes daily of uninterrupted reading instruction, 60 minutes of mathematics
instruction), SEL instruction (e.g., 30 minutes twice per week of explicit in-
struction with the skills learned embedded across the curriculum), and instruction
on the behavioral expectations with opportunities to practice and receive re-
inforcement. The community mental health provider, SMH team member, and
school counselor provided the team with expertise on the SEL curriculum se-
lection, implementation, and monitoring of implementation (e.g., is it being used
as intended and are all lessons being taught) as well as student outcomes across all
three learning domains. They also supported teachers in teaching the SEL lessons,
such as co-teaching a lesson when a teacher felt they or their students may need
additional guidance or support related to the lesson content.

Jackson Elementary School educators used schoolwide data (e.g., academic
screening, attendance, ODRs, behavior screening, referrals to the counselor and
mental health team) to determine if a student may need a Tier 2 intervention and
selected the available intervention to best fit their needs. As part of their Ci3T
model, educators built in transparencies as to the available Tier 2 interventions
using the intervention grids that detail the name of the support, a description, data-
based criteria for students who may benefit from the intervention, as well as
progress monitoring procedures, and exit criteria. Teachers and the school lea-
dership teams reviewed the available data to determine which students may need
Tier 2 support. Teachers selected strategies they could quickly implement in their
classrooms or they met with the leadership team to discuss an appropriate inter-
vention. Either way, the goal was to provide students swift access to intervention.
While the community mental health provider did not provide a Tier 2 inter-
vention, it was helpful when they understood the range of supports available and
supported decision making.
After winter academic and behavior screenings were conducted, Mr. Jones
received the data for his class. The data showed that about 10% of students were in
need of Tier 2 support for moderate levels of internalizing concerns. The students
also had lower than desired scores on reading or mathematics screenings. Since
students were already participating in Tier 2 small group instruction for mathe-
matics or reading, Mr. Jones decided to teach them some relaxation techniques
and a private way to signal when they needed his help. After just a few lessons, the
students were proficient with relaxation and signaling so he introduced a self-

monitoring form to help students self-assess and record their use of the relaxation
and signaling strategies during the whole class and small group reading or
mathematics instruction. He met with students daily to review their self-
monitoring sheets and debrief on their use of the strategies. He also closely
monitored their progress in reading or mathematics and shared the progress during
debriefing sessions. Most of his students made improvements in engagement in the
instruction, use of the strategies, and academic outcomes. One student continued
to struggle, therefore, Mr. Jones met with the leadership team to review the
student’s data and select a Tier 3 support.

The Jackson Elementary leadership team and Mr. Jones met with the student’s
parents to determine the best intervention. They determined that the student’s
experiences with the loss of his grandparents to Covid-19, his parents’ work and
financial stress, and the fear of becoming sick or losing another member of his
family were negatively impacting his ability to concentrate on school work. They
also noticed that he had withdrawn from his normal peer group. His SRSS-IE
scores reflected this concern; his spring screening score on the internalizing scale
fell into the high-risk category and his grades continued to be lower than ex-
pected. Given the level of concern, they selected a multi-pronged approach. Mr.
Jones would provide individualized reading instruction during the intervention
time, Ms. Francis, the reading instructional coach, would provide additional
reading instruction five days per week using the Wilson Reading System®
(Wilson Language Training, 2021), and the counselor would see the student
during lunchtime with a small group of peers. As well, parents expressed an in-
terest in counseling services for the student and family. The community mental
health provider guided the parents through the process to schedule regular sessions
outside of school for the student and family.
By working together, the school was able to quickly respond to the students’
identified needs; the parents were able to access support to navigate the mental
health system, eliminating some of the identified barriers. In addition, as a member
of the school team, the mental health provider was privy to the student’s data, the
school-based interventions that were previously and currently in place, and had an
open line of communication with the school and family. Certainly, access to a
community health provider is not possible for many school districts, particularly
those in urban (Anderson et al., 2017) and rural areas (Morales et al., 2020). The
call to action by the Surgeon General’s Advisory, efforts to increase the number of
mental health professionals (The White House, 2021), primary care doctors
working as partners (Tobin Tyler et al., 2017), and new telehealth procedures, will
increase access to mental health care for our children, youth, and families.
Working collaboratively with schools with tiered models in place, therefore, may
be an effective way for families to access mental health care for their children.
Considerations for Schools for the Successful

Implementation of SMH Supports
The following considerations relate to the previous section on the use of tiered
systems within schools to provide safe, positive, learning environments promoting
academic, behavioral, and social-emotional well-being outcomes.
Partnerships with Policymakers, Medical Professionals, and

Community Agencies
Child psychiatrists and other mental health providers are in critically short supply
across the United States, with severe shortages in 43 states (Tobin Tyler et al.,
2017). While efforts are being invested to increase the number of qualified mental
health providers (The White House, 2021), schools and communities may be
better served by joining efforts to create partnerships across institutions that serve
children and youth, taking steps to break down traditional silos of care (Hoover
et al., 2019; Ormiston et al., 2021).
This collaboration across disciplines to strengthen SMH has a strong literature
base supporting it. For example, Waxman and colleagues (1999) proposed
schools take the lead through expanded school mental health programs to fill the
void in available community providers, however, the authors cited tensions
between education and mental health professions that acted as barriers to rea-
lizing an integrated approach. The ISF (Barrett et al., 2013) is an example of a
successful approach based on promoting collaboration and minimizing tradi-
tional barriers such as language systems, feelings of ownership or “turf ” con-
cerns, concerns with confidentiality, and understanding of various service
contexts (Waxman et al., 1999). By having members of the medical profession
and community agencies sit on school or district leadership teams, there is an
opportunity for all partners to build common language systems, examine uni-
versal screening approaches and data to identify school- and student-level needs,
better understand the interventions and support available for students at the
school site, and plan for a coordinated approach of community support for
students, when needed.
Another benefit of these partnerships is having a collective voice with pol-
icymakers. With a shared agenda for promoting the mental health of children and
youth, such as increasing school and community mental health funding for pro-
fessionals, programs, and assessments; advocating for policies that promote uni-
versal screening in schools; increasing access to mental health services in urban and
rural areas; removing systemic barriers to community-based mental health care;
adopting policies that support strengthening families; attending to needs of pro-
fessionals involved in this effort; increasing research funding to continue to de-
velop and rigorously test interventions, stories can be shared and recommendations
made to keep the focus on EBPs to help address this public health crisis (Office of
the Surgeon General, 2021).
Conduct Universal Screening Procedures

There are calls for universal screening to detect early mental health concerns and
adverse child events (ACEs) across disciplines such as primary care (Finkelhor et al.,
2021; Tobin Tyler, 2017) and education (U.S. Department of Education [USDOE],
2021). With compulsory education in place, schools are uniquely positioned to
conduct universal behavior screening for larger numbers of children and youth than
any other agency. Further, teachers spend more time with students than any other
professional and have opportunities to work as partners with families. Teachers see
students in situations where they are challenged in their learning, as well as when
they are navigating new and diverse social spaces with peers and adults. School-based
universal screening should be in place that can detect both major disorders of
childhood (Oakes et al., 2017; Sprague & Walker, 2000) and provide educators with
the information needed to select and implement evidence-based intervention.
Schools may consider gathering information from multiple informants (e.g., family,
student) if they have systems in place to respond swiftly to concerns. Because tea-
chers are mandatory reporters, they would have already taken concerns through the
appropriate reporting channels, however, family and student screeners would in-
troduce potentially new information to the school system that would need to be
addressed immediately, if the information learned may bring harm to the child or
others (Lane et al., 2020). With a school or district leadership team in place, ideally,
with members from the mental health community, they could conduct due dili-
gence in the selection of a screening tool and procedures for responding to in-
formation learned (Lane et al., 2020; USDOE, 2021).
Communicate with Families

Despite increased mental health awareness, due to fear of stigma, stereotypes, and
prejudices, many students and families avoid seeking help, demonstrating negative
self-esteem, hopelessness, and reduced possibility of recovery (Yanos et al., 2020).
Schools need to create a welcoming environment for all families, including those
from various cultural and linguistic backgrounds, and treat them as meaningful
partners and decision-makers (Astor et al., 2017). Schools need to engage in
training to become aware of and responsive to various cultural health beliefs and
practices and develop the capacity in addressing health literacy and communication
needs in preferred languages (Bass, 2021).
Professional Learning
Working in partnership allows community-based professionals an access point for
contributing their expertise by leading professional learning communities (Weist
et al., 2012). Professional learning may increase educators’ knowledge and skills in
the use of EBPs for supporting students with mental health concerns, such as SEL,
child development, ACEs, trauma-informed approaches, recognizing early signs of
emotional distress, supportive approaches that de-escalate difficult situations, and

diversity and equity training. Professional learning on how to use data to ensure
students with increased risk of poor mental health have access to bias-free
screening procedures and appropriate, equitable care would be beneficial
(Finkelhor et al., 2021; USDOE, 2021). Professional learning communities and
coaching supports are recommended along with strengthening pre-service edu-
cator preparation (detailed in the next section; USDOE, 2021).
Community-based Factors that Contribute to Successful

Implementation of SMH Supports
This section broadly encompasses community-based factors that contribute to the
successful implementation of SMH practices. As each school and community have its
own unique needs, services, and supports, the following suggestions should be
modified to best meet the needs of individual communities and make access to ser-
vices and supports that are available easier and more efficient. Optimally, community-
based mental health services and supports are woven into SMH services and integrated
into a multi-tiered system to provide a coordinated and inclusive system of care
(Ormiston et al., 2021). To accomplish this, the following recommendations can be
used in conjunction with the USDOE’s recent report, Supporting Child and Student
Social, Emotional, Behavioral, and Mental Health Needs (2021) and The Surgeon
General’s Advisory on Protecting Youth Mental Health (2021).
Collaboration and Integration

The siloed approach that schools, medical professions, and community agencies
have traditionally taken to providing mental health services and support for young
people does not allow for real collaboration, integration, or leveraging of resources
(Hoover et al., 2019). To move toward true collaboration and integration, systems
can take a number of different actions beginning by focusing on community
awareness and education that reduces stigma and enhances mental health literacy
(USDOE, 2021).
Mental Health Literacy and Community Awareness

Perceived public stigma has been one of the major reasons people do not seek mental
health care (Weist et al., 2019). In contrast, mental health literacy is associated with
increased help-seeking intentions and treatment utilization. When communities offer
a range of mental health literacy interventions and training programs, schools and
families are more likely to engage in opportunities and gain the skills necessary to
recognize and assist youth or make more appropriate referrals (USDOE, 2021).
Community awareness, anti-stigma, and mental health promotion campaigns, recently
launched in the United States and several other countries (McGorry et al., 2022) also
aid in the promotion of mental health literacy. For example, the Hopeful Futures
Campaign is a collaboration among leading mental health organizations to advocate for

comprehensive mental health services in schools across the country. The Reach Out
program in Australia focuses on early intervention and prevention services and aims to
improve young people’s mental health literacy, resilience, social connectedness, and
help-seeking behaviors through self-help information, peer support forums, and re-
ferral tools (McGorry et al., 2022). There are many other worldwide examples of
awareness campaigns.
Consistent Language
Equally important to promoting mental health literacy, is the use of consistent or
universal language when defining and identifying student mental health issues
(Ormiston et al., 2021) and providing culturally and linguistically relevant services
(USDOE, 2021). Concrete guidance about how best to serve English language
learners, students with disabilities, and others with complex needs, like those in the
juvenile justice system, in challenging times is still emerging (Reich et al., 2020;
USDOE, 2021).
Integrated Networks
To achieve greater collaboration and integration, communities should combine efforts
of mental health providers, schools, and other child-serving systems (e.g., child welfare
and juvenile justice), to develop networks to efficiently apply resources and provide a
continuum of support. As previously mentioned, an example of a movement toward
integrating education and mental health systems is the Interconnected Systems
Framework (ISF). Another example that can be used to support the needs of youth
across settings is the Integrated Care for Kids (InCK) Model, which strives to reduce
expenditures and streamline delivery of services for those covered by Medicaid and
the Children’s Health Insurance Program (Office of the Surgeon General, 2021). The
move to integrating health care in a “one-stop-shop” model also holds promise, as a
single community-based location mobilizes providers and enables better multi-
disciplinary care, which helps streamline services for youth and families, and protects
against the risk of defunding single providers (McGorry et al., 2022).
Resource Mapping
Resource mapping identifies school and community assets, existing partnerships,
resource allocations, and policies, which help inform decision-making around
needed supports and services (Hoover et al., 2019). They can also identify how
needs are currently being addressed, and provide a visual display of the location and
type of services available. Resource maps can “support the creation of a strategic
plan to improve the alignment, coordination, and, ultimately, delivery of services.
When combined with community information, resource maps can provide a
comprehensive picture of a community’s vision, goals, projects, and infrastructure”
(Crane & Mooney, 2005, p. 3). Resource maps can highlight strengths and illu-
minate gaps in mental health systems to inform action plans, avoid duplication of
services, and ensure that all youth have access to the resources they need (Crane &
Mooney, 2005; Hoover et al., 2019). After mapping resources, models of care can
be deployed based on the availability of resources in the community (McGorry
et al., 2022).
Data Sharing
Collaborative networks and approaches to treatment require data-sharing me-
chanisms (Hoover et al., 2019). Regularly collecting, analyzing, and using data are
critical not only to support the mental health and academic needs of children and
youth, but also to inform decision making for system planning, service im-
plementation, and youth care (USDOE, 2021). The Surgeon General’s Advisory
points out that much more work is needed to improve the efficiency of mental
health data collection and timeliness of analysis. The Advisory calls for “[strength-
ening] the integration of data across governments, health systems, and community
organizations, to ensure regular, longitudinal surveillance of national mental health
trends across the age continuum” (Office of the Surgeon General, 2021, p. 38). The
report notes linkages should be improved and disaggregation is needed that enables
analysis of trends by age, gender, race, ethnicity, disability status, etc. Public-private
research partnerships to evaluate risk and protective factors for youth mental health
are also encouraged, as is prioritizing research on at-risk or marginalized populations,
including youth with disabilities and those involved in the juvenile justice system
(Office of the Surgeon General, 2021).
Recommendations from this Advisory extend to social media and technology
companies, calling for these groups to prioritize user mental health by, (a) mea-
suring the impact of their products on user health and well-being, (b) creating
dedicated metrics for user health and well-being, (c) collecting behavioral data, (d)
allowing independent researchers to request data and to study the impact of
products on user health and well-being, (e) providing researchers with data to
enable understanding of subgroups of users most at risk of harm, (f) providing
researchers with data to enable understanding of the algorithmic design and op-
eration, (g) allowing a broad range of researchers to access data and previous re-
search instead of providing access to a privileged few, (h) allowing users to provide
data about their experiences to independent researchers, (i) being transparent and
making their results publicly available, and (j) taking corrective action to address
harms (Office of the Surgeon General, 2021).
Digital Services
The integration of digital services within systems of care, like Telemental health
(mental health care delivered via an electronic device), can have advantages, in-
cluding improved service efficiency and access to potentially reduce treatment
gaps, especially in rural or low-resource settings (McGorry et al., 2022).

Telemental health may also provide a flexible way for community providers to
reach-in to schools with services, while also reducing stigma for those who may
otherwise be reluctant to receive support (USDOE, 2021). An ever-increasing
range of interventions is available, including games, online courses or chat groups,
and mobile apps like MoodMission, Sanvello, or Talkspace.
A recent systematic review (Zhou et al., 2021) of randomized controlled trials
found online mental health interventions to be effective in managing diverse
mental health needs of youth and young adults. The majority of studies used
online or mobile apps to deliver cognitive behavior therapy. Sixty-four percent of
the telehealth interventions were found to be effective in managing depression,
anxiety, stress, insomnia, and improving quality of life when compared with
control conditions (Zhou et al., 2021). Another recent systematic review
(Toombs et al., 2021) of online mental health interventions for Indigenous youth
generally indicated positive community or individual responses to interventions
despite minor technological barriers.
Training & Staffing

Another recommendation to promote the successful implementation of the SMH
practices pertains to training and staffing. First and foremost, training that focuses
on prevention at all levels and includes all stages of care is paramount. When
mental health is viewed as both an individual and public health condition, the
dialog changes and a full spectrum of prevention, early intervention, treatment,
strategies, and resources become available (Hoover et al., 2019). Furthermore, it is
essential for the full spectrum of service providers, clinicians, volunteers, em-
ployers, and parents, not just educators and specialized instructional support per-
sonnel, to be well trained and equipped with social and emotional skills and mental
health literacy (Office of the Surgeon General 2021; USDOE 2021). Included in
this is expanded training on culturally responsive practices and trauma-informed
care to support the mental health needs of all youth, including those who are
marginalized and system involved.
Countries throughout the world have documented increased mental health
needs of youth and inadequate staffing to meet these needs as a result of the
pandemic (USDOE, 2021). Even prior to the pandemic, the United States was
experiencing a mental health crisis in which the escalating needs of our youth
were largely unmet due, in part, to insufficient capacity (USDOE, 2021; Tobin
Tyler et al., 2017). To address this shortage the FY 2022 budget includes one
billion dollars for a new School-Based Health Professionals program to help
build a pipeline and support the hiring of school-based mental health providers
(The White House, 2021). The Office of the Surgeon General (2021) also calls
for accelerated training and loan repayment options to expand and support the
mental health workforce.
Guidance from the field also includes recommendations for state-level strategies
related to training and implementation of mental health supports. Examples of
these strategies include: (a) an annual state school mental health conference to raise
awareness and provide tools and resources that build capacity for comprehensive
school mental health systems, (b) a school mental health website, (c) technical
assistance in developing and implementing effective school mental health systems,
and (d) implementing cross-system provider training on key topics, including
implementation of EBP and guidance on leveraging funding (Hoover et al., 2019).
Institutions of Higher Education also have a significant role to play in pro-
moting mental health literacy and training teachers and mental health providers in
EBPs. While many youth receive mental health services and supports in schools,
teachers often report that they do not have adequate background knowledge or
skills to effectively support these students (Ormiston et al., 2021). In addition,
there is recognition that youth mental health difficulties impact providers’ mental
health, therefore, strategies to cope with this on the job should be infused into
preparation programs (Ormiston et al., 2021). Again, all training should include
culturally responsive practices that address the unique mental health needs of at-
risk and marginalized youth, including racial and ethnic minorities, LGBTQ+
youth, and youth with disabilities.
Engaging Youth
Engaging youth in community-based solutions to improve the implementation of
SMH supports is vital. Having voice, giving and receiving peer support, and
gaining knowledge and skills to pursue goals validates youth by allowing them to
use their experiences to make a difference in their schools and communities.
Furthermore, “Inclusion of the perspectives of the end-users—in this case, the
youth themselves—improves the science and strengthens the ethics of our sci-
entific work” (Fazel & Hoagwood, 2021, p. 3). For example, in Oregon, Youth
Advisory Councils that receive state funds must have a Youth Participatory Action
Research (YPAR) project in which youth are authentically engaged in a research
and decision-making process around a mental health topic of their choice
(USDOE, 2021).
Funding
The need to fiscally support community-based implementation of SMH practices
has never been greater, and national, state, and local governments are attempting
to answer the call. For example, the FY22 discretionary budget calls for more than
doubling funding to address mental health and substance use, stating that the
additional resources will be used to support youth with behavioral health needs
and their families, partner mental health providers with law enforcement, expand
suicide prevention, and support the hiring of school-based health professionals
(The White House, 2021). At the state level, Nevada’s “Collaboratory” integrates
various state grants and requires leaders to work together to develop a State
Integration Team to align work (USDOE, 2021). The Oklahoma State
Department of Education is creating the Oklahoma School Counselor Corps
grant program to provide funding for districts to hire counselors and other
school-based mental health professionals (The White House, 2021). Minnesota
concretely links education and mental health services, intentionally embeds
PBIS in comprehensive approaches to school mental health, and fosters re-
lationship building between school staff and mental health providers as part of
co-written grants by requiring potential partners to identify what they hope to
“give” and “get” in the relationship (USDOE, 2021). Local and district funds
are also being used to support these efforts. For example, Lake Washington
School District in Washington has removed certain eligibility requirements so
schools can mobilize supports and interventions earlier (USDOE, 2021).
Through a MOU, the community mental health partners also support pre-
vention and promotion efforts that enhance Tier 1 supports (USDOE, 2021).
Policy and Legislation

Policy and legislation are vital to the successful implementation of SMH supports.
The Surgeon General’s Advisory on protecting youth mental health is evidence of
the current state of the problem. State agencies are also reacting to this need. For
example, the Arizona state legislature recently passed a bill requiring health and
physical education to include mental health instruction and specified that mental
health instruction must incorporate the multiple dimensions of health. The new
rules align with state mental health and wellness priorities and include definitions,
recommendations for instruction, and resources to help evaluate potential curri-
cula (Arizona Department of Education, 2021).
Summary
This chapter highlights the urgency for schools and community agencies to col-
laborate with each other to meet the mental health needs of students and their
families. Schools are viewed as critical and best suited for identifying and sup-
porting students with mental health issues. Yet, many students identified with
mental health needs do not have access to these services or have not availed
themselves of them. Additionally, children and families residing in rural and re-
mote areas lack mental health services and qualified service providers. The pan-
demic has exacerbated the underlying mental health needs of students and
contributed to the declining mental health of those who have pre-existing mental
health conditions.
Early identification and comprehensive mental health systems have been related
to enhanced academic productivity, reduced disciplinary encounters, and in-
creased engagement and graduation. Including mental health professionals in
school leadership teams allows schools to provide universal support and implement
evidence-based mental health interventions in tiered systems that are guided by

data-based decision-making processes. The frequency and duration of interven-
tions are aligned to the needs of the students through screening procedures. Tier 2
supports are specifically designed for students who need to receive targeted in-
terventions related to their mental health symptoms. Students who require Tier 3
interventions receive individualized mental health support and interventions
through an integrated approach also supporting their academics, behavior, and
social-emotional well-being.
School leaders have a responsibility to ensure that students have access to the
services and care that they require. This chapter highlights multiple ways that
school leaders can leverage the resources of community professionals and families
to provide services to their students. The importance of these partnerships cannot
be overlooked. Collaboration and integration between schools and community-
based mental health providers are complex but possible. Silos must be removed,
while awareness, literacy, resources, and data sharing are enhanced. When SMH
and community-based services are integrated into a multi-tiered system to provide
a coordinated and inclusive system of care, it produces more positive outcomes.
The responsibility for student mental health is shared and must be prioritized.
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6
STUDENTS’ MENTAL HEALTH ISSUES
IN EUROPE AND OTHER COUNTRIES
Marion Felder, Bernd Ahrbeck, Dimitris Anastasiou,
Soraia Araújo, Carmen Leon-Himmelstine, João Lopes,
Célia R. Oliveira, Fiona Samuels, Katrin Schneiders,
and Philip Veerman
This chapter describes and analyzes how different countries dealt with children and
youth with mental health issues before and during the COVID-19 pandemic be-
ginning in March 2020. The pandemic and measures worldwide to control the spread
of the virus COVID-19, such as lockdowns, closures of schools and preschools, social
distancing rules, restrictions of movement, contact limits, and quarantine, changed
the daily life of millions of people, especially children and youth (Schlack et al., 2020).
The following countries are included, in alphabetical order: Germany, Greece,
Portugal, Tanzania/Vietnam, and the Netherlands. We analyze how fear of infection
and death, high uncertainty, and the containment measures that were implemented
on affected children and youth with mental health issues.
In the new reality created by COVID-19, the consequences of the measures we
mentioned (lockdowns, school closures, social distancing, restrictions of move-
ment, contact limits, quarantine) seem to vary according to respective countries’
political, economic, social, and educational systems. Whether in Germany, Greece,
Netherlands, Portugal, Tanzania, or Vietnam, the COVID-19 pandemic has impacted
children and adolescents’ socialization and mental health. Across countries, we high-
light the importance of in-person learning for students’ mental health and the need for
systemic and targeted interventions (e.g., improved prevention and intervention with
public health strategies) in high‑risk groups, including those with disabilities.
Germany
Impact of the COVID-19 Pandemic on Schools, Child, and

Youth Welfare
Germany has a well-developed range of school-based educational institutions
and a wide-ranging, comprehensive supply structure in child and youth welfare.
DOI: 10.4324/9781003264033-6
The COVID-19 Era 99
The latter offers a range from care services for preschool children, educational and
recreational services for children and adolescents, counseling services for children,
adolescents, and their parents to semi-inpatient and inpatient facilities for children
and adolescents with permanent or temporary special needs due to mental illness
or disabilities.
The majority of these services are publicly financed: the school-based services are
funded by the state budgets because of Germany’s federal structure, and the child and
youth services are supported by the municipal and state budgets as well as by federal
project funding. The public sector also provides most services in the school sector;
but private schools remain the exception despite their increasing importance
(Autorengruppe, 2020, p. 49). The situation is different in the area of child and
youth welfare. Here, most services are provided by so-called independent providers
commissioned by the public sector to provide services. The overwhelming majority
of independent providers are oriented toward the common good and therefore
enjoy tax privileges (non-profit) and integrate volunteers and full-time professionals.
This form of cooperation between the public sector and welfare associations is also
referred to as welfare corporatism (Schneiders, 2020, p. 36).
Because of the federal structure of school education, the impact on school settings
during the pandemic must also be considered in a differentiated manner. Different
measures were taken depending on the regional or local pandemic situation, which
was measured primarily in terms of incidence. In many federal states, all schools were
completely closed, at least temporarily, and at times children were taught in alter-
nating classes. During the closures, it became clear that Germany still has a lot of
catching up in terms of digital technical equipment, didactic skills, and compe-
tencies. Neither teachers nor students had enough devices suitable for digital in-
struction. Publicly financed procurement programs, but above all civil society
activities, were used to equip teachers and student groups from the underprivileged
population with the necessary digital devices. The German Government provided
500 million euros to procure digital resources for teachers and students through
an emergency program partially supplemented by the federal states. Initial studies
show that only some children had relatively good learning conditions during the
pandemic (Middendorf, 2021). Even if classes could not be held in full at times, the
financing of the schools or the payment of teaching staff was ensured at all times
because of public sponsorship.
The area of extracurricular education, care, and leisure services was also affected
by closures. This mainly concerned daycare, which is not part of the school sector
in Germany, low-threshold leisure services, and outpatient counseling services.
Inpatient facilities, where children and young people are cared for in a family-like
manner, remained open but were exposed to particular pressures because of the
loss of supplementary leisure activities offered by various clubs and other orga-
nizations. Partial or occasional attempts were made to switch face-to-face care to
online services; however, this only succeeded to some extent and in selected
settings suitable for this purpose (Mairhofer et al., 2020). Similar to the school
sector, many such ideas failed because of the lack of technical infrastructure in the
100 Marion Felder et al.
target groups. Despite the lockdown and the associated massive restriction or
elimination of numerous outpatient services, child and youth welfare organizations
in the narrower sense or their staff were not affected by any loss of income. At the
beginning of the pandemic on February 3, 2020, the German legislature had already
passed the Social Service Provider Deployment Act (SodEG), which promised to
continue the payment for social services by public payers even if offers/services
could not be provided due to the pandemic. In return, organizations had to agree to
use staff for tasks within the public health service (e.g., contact tracing) if necessary
(Section 1 SodEG).
Overall, it should be noted that the school-based and out-of-school child and
youth welfare services system remained financially stable. However, although in-
dividual areas were heavily burdened by additional tasks (school organization; in-
patient services; crisis intervention), others continued to be financed by the SodEG
despite the lack of service provision. As a result, even after the pandemic temporarily
subsided in the summer months of 2021, all social services could be provided in a
high quantity and quality. Despite all previously expressed criticism (Schneiders,
2020, p. 105), welfare corporatism proved to be a crisis-proof successful model
during the pandemic.
Impact on Children and Adolescents Including those with

Mental Health Issues
The true impact of measures to control the effects of COVID-19 on mental health
and on children and youth who had mental health issues before the pandemic can
only be fully assessed when the pandemic is over. During the pandemic, young
people’s ability to engage in developmentally appropriate activities such as school
and social activities with peers were significantly impacted (Beckmann et al., 2021).
There is some evidence that there has been a dramatic increase in mental health
issues in children and youth (Bujarda et al., 2021). In the Corona and Psyche Online
Study (COPSY) of the University Hospital (UKE) in Hamburg, Germany, from
May to June 2020, 1040 adolescents (11–17 years) and another 1586 parents (for
7–10-year-old children) participated. A key finding reported is that the risk for
mental health problems in children and adolescents increased from about 17.6%
before the onset of the COVID-19 pandemic to 30.4% during the crisis. Mental
disorders, symptoms of generalized anxiety disorder, hyperactivity, and problems
with peers also increased. The quality of life of children/adolescents and parents, in
general, is estimated to be worse than before the pandemic. Children whose parents
have low educational attainment or have an immigrant background are particularly
at risk. Concerning social relationships, 82% of children and adolescents in the
COPSY study reported a decrease in their social contacts, and 64.4% reported
feeling burdened by homeschooling. They also reported more fighting in their
families. Youth also reported increased media and candy consumption and less
exercise than before the pandemic (Ravens-Sieberer et al., 2021). However, some
families reported positive effects of the school closures, for example, being together
The COVID-19 Era 101
more as a family, less pressure from school, less competition, and more self-determined
time (Hahlweg et al., 2020).
It is not clear yet what consequences the pandemic has on existing mental
health issues, but some research indicates that it might worsen them (Hahlweg
et al., 2020). The University Hospital Essen, Germany, reported that, during the
second lockdown involving school closures from March 2021 to May 2021, the
suicide attempt rate of children and youth rose 400% from pre-pandemic times.
This was measured by the number of children in intensive care units in Germany
who had tried to take their own lives. Notably, children and youth who suffered
from depression and anxiety before the pandemic were the most affected. The
study is not published yet but has been widely publicized and discussed in German
news (Westfälische Rundschau, 2022).
Losses in social participation and increased experiences of loneliness particularly
affect children and adolescents who already had a mental disorder before the
pandemic. Symptoms of Attention-Deficit-Hyperactivity-Disorder (ADHD), for
example, may worsen as families lose daytime structure and activities outside the
home (Schlack et al., 2020). Various agencies in Germany have also reported
increased child protection cases. Experiences of violence pose one of the most
significant risk factors for mental health problems lasting into adulthood.
Internationally, crises and pandemics are known to promote child abuse, sexual
abuse, and neglect. Reliable figures for Germany are currently lacking, but it can
be assumed that children and adolescents with intellectual and physical impair-
ments, and children from vulnerable backgrounds in particular, form special risk
groups (Schlack et al., 2020).
In the particular focus area of intellectual and physical disabilities, initial re-
search results assume that special education practices could not be maintained in
remote education at home. Daily structures and routines have been eliminated for
many children and adolescents. Parents of children with special needs who require
a high level of physical care were especially taxed. Just getting through the day was
challenging because of the lack of support systems. Many parents were thus too
overwhelmed to also assist their children in remote learning (Goldan et al., 2020).
In principle, however, teachers indicated that appropriate digital learning for-
mats should be developed for teaching intellectually disabled students in the future.
However, this does not change the fact that especially this group of students is
dependent on contact and presence in learning (Siegemund et al., 2021). Students
with social, emotional, and learning problems also rely on close contact with
their teachers. These children often have low access to digital devices, little
space at home, and parents who cannot support them well. Some examples
show that strategies for inclusive learning that were implemented well before
the pandemic could also be used digitally during school closures. These include
maintaining close contact (including phone contact) with students, direct visits,
if possible, individualized instruction, learning on common topics, individualized
feedback, well-coordinated multi-disciplinary teams, and parent involvement.
However, these solutions cannot replace face-to-face teaching (Goldan et al., 2020).
Ahrbeck et al. (2021) found in a multi-year study of school-based inclusion in Berlin

that there is still a lack of resources to implement successful inclusion. Thus, there is
reason to believe that supporting children and adolescents with social-emotional
problems in remote education under pandemic conditions was even more
challenging for most schools than before. Interestingly, in one study, in which
296 students participated in a questionnaire study (45 of those students received
special education support), it was reported that children with special needs compared
to their peers did not miss school that much (the study took place in an inclusive
school). The reasons for this are not known yet, although it seems to be also related
to the well-being of the students in the school before the pandemic. In addition,
students with special needs also reported more social problems once they went back
to school. They also worried more about a COVID-19 infection, their ability to
concentrate back in school, and their achievement (Goldan et al., 2021).
During school closures, it was possible to obtain emergency care at school for
some children and youth. However, it is pointed out that this emergency care only
went well if it was oriented to the needs of the children and adolescents and offered
stable, reliable routines and arrangements, not changing care but with stable per-
sonnel. In addition, the so-called alternating instruction was offered, where classes
were divided and alternated between digital and in-person instruction. This had the
advantage of small classes, but teachers, parents, and students required a high degree
of organization (Wölfl, 2021).
Implications for the future

In Germany, the lack of digitalization in school and out-of-school settings and the
availability of tablets for all children and young people, in general, pose a particular
challenge. International studies show that teachers in Germany also receive less
training in digitalization compared to other countries (Eickelmann et al., 2019).
In general, remote learning could only replace in-person learning in school to a
limited extent, particularly for children and young people with special needs and
mental health problems. In the future, adequate digital materials must be devel-
oped in all areas, those for children with intellectual disabilities.
Many families in Germany seem to have succeeded in coping with the chal-
lenges of the pandemic despite all the difficulties, at least in the initial stages of the
pandemic (Schlack et al., 2020). However, it became clear that children and
adolescents with mental health problems and other vulnerable children and ado-
lescents (e.g., poor children, children with an immigrant background) and their
parents were particularly challenged during the pandemic. It is especially these at-
risk groups for whom special protection concepts and services must be developed,
especially concerning future pandemic situations (Schlack et al., 2020). Some
experts demand there should also be a children’s and youth council for all children,
in addition to a general ethics council, so that the interests of children and ado-
lescents are more strongly taken into account in the future (Bundesverband der
Vertragspsychotherapeuten, 2021).
Greece
On March 11, 2020, with 99 confirmed COVID-19 cases and no deaths, the
Greek government implemented school and university closures nationwide.
Subsequently, during the first wave of the pandemic, additional measures were
introduced every 2–3 days to mitigate the risk of virus transmission. On March 23,
2020, with 695 confirmed cases and 17 deaths, a nationwide lockdown was en-
forced, including restrictions on movement. Citizens could leave their houses only
for specific reasons and with a special permit (Giannopoulou et al., 2021).
In Greece, the Government Response Stringency Index (Stringency Index) of the
Oxford COVID-19 Government Response Tracker (OxCGRT), a composite measure
based on nine response indicators including school closures, workplace closures,
cancellation of public events, restrictions on public gatherings, closures of public
transport, stay-at-home requirements, public information campaigns, restrictions
on internal movements, and international travel bans, measured on a scale from
0 to 100 (100 = strictest; a higher score indicates a more stringent response), was
very high. From the beginning of the pandemic until October 10, 2022, the
Stringency Index varied between 72 and 89 for a total time of 396 days divided
into three intervals: March 21, 2020, to October 5, 2020, July 11, 2020, to
May 17, 2021, and October 8, 2021 , to October 1, 2022 (see Table 6.1). Quite
often and for long periods, Greece appeared to have one of the Top 5 strictest
governmental responses in the world (see Table 6.1). A glaring exception to the
stringency of the government response was the summertime in Greece.
In addition, the Greek government extensively implemented full school closures,
where all schools were closed at the national level during spring 2020 and the aca-
demic year 2020–2021. It had full school closures for 18 weeks, according to the UN
(2021) data, or 21 weeks according to a more reliable Greek educational resource
(Makris, 2021), except for special schools. Greece also had partial school closures,
referring to school closures in big regions of the country (Athens or Thessaloniki and
northern Greece) or with reduced in-person instruction for about 18–19 weeks.
Table 6.1 shows that Greece, along with Hungary, Poland, Serbia, and Bulgaria in
Europe, as well as Peru and Brazil in South America, was one of the countries that
“sacrificed” in-person teaching in order to control the pandemic. This alone was not
sufficient, as the data on deaths per million is also shown in the same table.
It is also shocking that the impact of containment measures was very significant
on the economy. According to Eurostat and the World Bank data, the Gross
Domestic Product (GDP) fell significantly in 2020 (9.0%), and Greece was the
third country in Europe, after Spain and Montenegro, which had a double-digit
fall in the GDP (see Table 6.1). As containment measures eased in late April 2021,
economic activity rebounded with a stronger-than-expected summer tourist
season in 2021. Greece’s GDP was projected to increase by 6.5% in 2021, ac-
cording to International Monetary Fund (IMF), or 8.5% according to national
organizations. However, it is doubtful that this increase will compensate for the
2020 GDP loss, and the economy still runs under pre-pandemic levels.
TABLE 6.1 Government Response Stringency Index, Vaccination Rate, and Mortality and
Economic Consequences of the Pandemic COVID-19
Country Number of Days Duration of Full % of the Deaths/1 % GDP

with a Stringency School Closures population million (Until growth
Index >70 in Weeks (Until vaccinated by January 18, 2020 5
(Until January November 30, at least one 2022) 4
10, 2022) 1 2021) 2 dose (Until
January 18,
2022) 3
Germany 250 14 75.1 1,385 −4.6

Greece 396 18 [21] 71.2 2,146 −9.0
Netherlands 204 12 76.6 1,231 −3.8
Portugal 158 12 92.5 1,909 −8.4
Tanzania 0 11 4.2 503 +2.0
Vietnam 261 7 80.7 364 +2.9
Australia 230 0 81.4 107 −0.0
Austria 238 15 75.2 1,534 −6.7
Brazil 213 38 79.0 2,899 −4.1
Bulgaria 49 18 29.0 4,695 −4.4
China 476 9 89.5 3 +2.3
France 207 7 82.1 1,949 −7.9
Hungary 198 20 64.7 4,219 −4.7
Italy 390 13 82.8 2,351 −8.9
Japan 0 3 80.4 146 −4.6
Poland 252 24 58.0 2,718 −2.5
Peru 486 34 74.0 6,044 −11.1
Russia 71 0 51.3 2,210 −3.0
Serbia 60 28 48.1 1,511 −0.9
Spain 188 10 85.8 1,951 −10.8
Sweden 0 0 75.2 1,522 −2.9
United 165 16 77.7 2,229 −2.4
Kingdom
United 229 0 74.2 2,621 −3.6
States
Notes
1 Data on the Stringency Index from the Oxford Coronavirus Government Response Tracker on January
16, 2022, at https://ourworldindata.org/metrics-explained-covid19-stringency-index
2 Full school closures refer to situations where all schools were closed nationwide due to COVID-19.
The data were drawn from UNESCO (2021). Global monitoring of school closures [Last update:
November 30, 2021] at https://en.unesco.org/covid19/educationresponse
3 Vaccine data from Bloomberg’s COVID-19 Tracker on January 16, 2022, at https://www.
bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/?sref=vAydZQ5n
4 Deaths per million data from the Worldometers Coronavirus on January 16, 2022, at https://www.
worldometers.info/coronavirus/
5 The World Bank is the source of GDP growth rate for all countries. https://data.worldbank.org/
indicator/NY.GDP.MKTP.KD.ZG The values for some countries are provisional (Last update
January 14, 2022).
Society faces a trade-off between safety versus well-being, including education

and mental health in a pandemic era. This issue is often viewed as an all-or-nothing
choice between complete lockdown versus zero restrictions. In reality, there is a
continuum in the stringency restrictions, such as the degree of lockdowns.
Looking around the world, different countries have imposed degrees of re-
strictions (e.g., in Table 6.1, compare Sweden with Greece, or Japan with
China), and even varying forms of restriction (Portugal’s accordion lockdown
vs. Greece’s three periods of stringent lockdown) (Quah et al., 2020). In a Pew
Research Center survey (2021), in 17 advanced economies, Greece was the only
country surveyed where a plurality of adults (43%) favored fewer restrictions vs.
25% of adults who wanted more restrictions. In comparison, only 26% of adults
in Germany and the United States favored fewer restrictions, whereas 56% and
37% in the two countries, respectively, wanted more restrictions (Pew Research
Center, 2021).
That said, very high mortality in Greece and relatively low vaccination rates
(see Table 6.1) as a result of people’s lack of trust in the government’s pandemic
strategy and science/biotechnology may indicate that the governmental response
has not achieved a golden ratio between economy/schools openings and closings
in Greece, or between public health and lost livelihoods. Prolonged and stringent
lockdowns applied between March 2020 and December 2021 also suggest con-
sequences for the mental health of children and adolescents.
Impact of the COVID-19 Pandemic on Greek schools

and students
Despite teachers’ efforts to adapt to remote learning, the disruption of academic
life was unprecedented for the Greek education system, unprepared to address
students’ learning needs in the pandemic crisis. According to the World Bank
(2020) data, only 78% of the individuals had access to the Internet in 2020,
defined as individuals who have used the Internet (from any location) in the last
three months, via a computer, mobile phone, personal digital assistant, games
machine, etc. The same data place Greece in the 2nd worst position, along with
Romania, Portugal, and Croatia, in the European Union of 27 country mem-
bers. In an extensive survey of 5,111 households, the Hellenic Statistical
Authority (the Hellenic Statistical Authority/ELSTAT, 2020) found that 8 out
of 10 (or 80.4%) households had access to the Internet from their residence in
2020. The Ministry of Education funded a voucher program of 112 million
euros, allocating 200 euros for a student from low-income families to buy a
tablet, laptop, or PC. Later, the Minister of Education announced that about
384,00 students would benefit from this program by December 2021 amid
complaints of increasing tablet prices on the market and questions about
transparency. In addition, about 90,000 devices subsidized by EU funds and
private donations were sent to schools. However, most of those devices were
given late to students.
Overall, learning was severely disrupted for many students from socio-
economically disadvantaged backgrounds and students with disabilities who did
not have access to remote teaching. Extremely vulnerable were students from low-
income families, students with disabilities, refugee and immigrant students, Roma
and Muslim minorities, and incarcerated students (Research and Documentation
Center of OLME [KEMETE], 2021). We should also note that remote learning
was not mandatory for the students during the first lockdown in spring 2020. A
Greek newspaper reported that 95% of Roma students did not have access to the
Internet and did not possess laptops, computers, tablets, or even cell phones to
attend their online class meetings (KEMETE, 2021). Incarcerated students, who
attend their Second Chance Schools, were not allowed access to the internet for
security reasons and, at best, were given worksheets distributed by prison officers
(KEMETE, 2021). In large families with three or more children, an additional
issue for students was to find physical space and necessary display devices (desktops,
laptops, tablets) to participate in an online classroom environment, primarily when
their parents worked from home.
Quality of access to the internet was also a huge issue. Several newspapers
reported students using a small café in a village to attend online classes. In a survey
with 3,182 elementary education students conducted in October-November 2020
by a teacher union in the metropolitan area of Athens, 9.9% of students could not
attend online classes, and 15% did that via a mobile phone. The average internet
speed for teachers who used the school facilities was low, 10.17 Mbps (Union of
elementary teachers Kallitheas–Moschatou, 2020), which is expected as Greece in
2020 was one of the countries with the slowest internet speed in Europe, that is,
7.3 Mbps, according to Fastmetrics (2022), far behind the Netherlands (17.0),
Germany (12.9), and Portugal (12.1), but above Tanzania (2.2) and Vietnam (3.8).
Another issue was the degree of governmental and teacher preparation to meet
the remote learning needs of their students. In a survey with 4,324 secondary
education teachers, a representative sample of all Greek regions, 86.3% of teachers
stated that they carried out remote teaching mainly or only from their residences,
7.1% primarily or only from school, 5.6% equally from their schools, and home, and
1.0% did not deliver remote teaching for a variety of reasons (KEMETE, 2021). Of
them, 57.9% of teachers encountered Internet connectivity issues, 50.1% reported
financing issues to buy technological means for remote teaching, 26.8% reported
problems of the unsuitability of space, and only 15.7% stated that they had no issues.
Overall, the delivery of remote instruction was a significant burden for the teachers,
who faced problems in the new digital educational process and their family life
(KEMETE, 2021).
In short, the pandemic crisis combined with the chosen policies for addressing
it challenged the right to education for about 20% of students. It added new
educational inequalities to the old inequalities and exacerbated existing learning
disparities (KEMETE, 2021). In the KEMETE survey, 81.6% of teachers stated
that distance education created new educational disparities.
Impact of the COVID-19 Pandemic on Students’ Mental Health

School closures have had significant implications for students’ mental health across
countries, as schools are not only places where students develop and progress their
academic skills, but they are also a physical space to establish and develop social
relationships (OECD, 2021). In the KEMETE survey (2021), 73–88% of the
secondary education teachers stated that distance education created barriers to
interaction between teachers, barriers to the interaction of students with each
other, and obstacles to the normal socialization of children and adolescents.
Closures of educational institutions at all levels, except for special schools during
the prolonged second lockdown (fall 2020 to spring 2021), have weakened pro-
tective factors, such as social interactions that help students maintain good mental
health (OECD, 2021). Nevertheless, the potential effect of the pandemic, lock-
downs, and distance education on the mental health of children and adolescents
has not been extensively investigated in Greece. We review the existing literature
for typically developing students and students with disabilities until January 2022.
In Hatzichristou et al.’s (2021) study with a sample of 256 adolescents during
the first lockdown, more than two-thirds of the adolescents reported that during
the school closure they missed their classmates and friends but described helpful
coping practices, primarily related to social support. However, regarding distance
education, 37% of adolescents reported technical difficulties (e.g., poor internet
connection, interruption of sound, lack of knowledge about the use of technology
by some teachers), and 10% mentioned personal challenges (e.g., being bored,
difficulty concentrating, eyes hurt because of the long time sitting in front of the
computer). Also, 9% mentioned environmental factors (e.g., external noise), 4%
learning factors (e.g., difficulty in understanding the lesson via remote learning,
difficulty in attending several consecutive online lectures), while 5% reported non-
participation in the courses. Only 36% of adolescents reported experiencing no
problems in attending online classes (Hatzichristou et al., 2021, pp. 604–605).
Sentio Solutions (2020), a startup company, in collaboration with a department in
the National and Kapodistrian University of Athens, surveyed a sample of 180
adolescents and young people during October and November 2020, where more
negative feelings were predominant compared to spring 2020. Over 60% of parti-
cipants considered that their mental health was negatively affected by the pandemic
and reported negative emotions such as stress, monotony, depression, and lack of
motivation. About 88% of participants preferred traditional learning in the classroom
over remote learning, whereas 59% considered that their academic performance had
been adversely affected by the pandemic and distance education. About 42% said
they had felt the need for psychological support; however, 57% found that access to
psychological support services was difficult (Sentio Solutions, 2020).
Giannakopoulos et al. (2021) conducted a qualitative study with nine adolescent
psychiatric inpatients aged 12–17. The adolescents were treated in a psychiatric
intensive care unit of a hospital in Athens. They used individual in-depth interviews
to investigate the nine adolescents with mental health issues’ perceptions, emotional
reactions, and needs. They found that (a) almost all adolescents identified mostly
negative changes (vs. positive changes) due to the lockdowns, including restrictions
on both social life and personal freedom, (b) adolescents acknowledged anxiety
about self-harm and harming their loved ones; anxiety was also manifested about the
unknown and management of the pandemic, and (c) positive thinking was reported
as a constructive strategy for coping with challenging emotions (Giannakopoulos
et al., 2021, p. 1).
Triantafillou (2021), a journalist, recorded an impressive statement by a special
education teacher in an elementary school about the effects of remote teaching on
students with disabilities:
As far as the cognitive part is concerned, remote learning is more than

nothing. It is far from desirable. The teacher’s absence next to these
children [with disabilities] hinders us in many ways. How easy is teaching
phonological awareness through the microphone and with dubious quality
sound? We also cannot work on the fine motor skills of children. How
can we help them grasp the pencil correctly, organize their writing, put all
the letters [in a word] in the same order, keep spaces between words, just
to mention a few examples? How to do those through the screen?
Children with attention deficits, in particular, find it extremely difficult to
locate and process information in the limited visual space of the screen. The
screen is a wall between the teacher and the students, which rises higher by
connection problems. Children with intellectual disabilities are also terribly
confused by this system. It’s a massive setback for this student population.
Giannopoulou et al. (2021) conducted a well-designed study with 442 senior high
school students, who prepared for the national university entrance exam in Greece
in Spring 2020, concerning the lockdown’s impact on their mental health. This
exam/contest is emotionally one of the most trying periods in a young person’s
life. The baseline anxiety and depression rates were measured one month before
the lockdown, and the second measurement was conducted two weeks after the
lockdown. They found that depression rates measured with the Patient Health
Questionnaire-9 (PHQ-9) significantly increased from 48.5 to 63.8%. For those
who scored within the severe depression range, depression increased from 10 to
27% (Giannopoulou et al., 2021). In addition, anxiety rates measured with the
Generalized Anxiety Disorder-7 (GAD) significantly increased from 23.8 to
49.5%. For those scoring within the severe anxiety range, their severe anxiety rose
from 3.8 to 20.5% (Giannopoulou et al., 2021).
In the KEMETE (2021) survey, most secondary education teachers (61.4%)
reported that remote teaching negatively affected their psychology. In addition,
18% of teachers experienced at least an incident of verbal or moral harassment/
intimidation during their instruction, 32% of teachers reported such an incident
for another teacher at their school, and 12% of teachers reported such an incident
for a student at their school.
In a study of 271 parents that investigated parental involvement in the

homework of fifth and sixth graders with learning disabilities during distance
education, both mothers and fathers expressed a high fear of COVID‐19, a low
resilience, and stated that they were involved in their children’s homework mostly
in terms of parental control (Touloupis, 2021, p. 2345). Hatzichristou et al. (2021)
also found that parents and teachers showed a high propensity for anxiety but also
high levels of resilient coping.
Pandemic Lessons
The Greek education system dealt with the pandemic of COVID-19 under ad-
verse conditions, such as underfunding, lack of devices for students, lack of smooth
accessibility to online learning environments and slow connectivity problems,
inadequate teachers’ training in remote teaching, etc. In a few words, the country’s
digital infrastructure was found to have been underdeveloped. But it was revealed
that even the most advanced technological applications could not replace face-to-
face class sessions, a socialized dynamic system. This is likely because in-person
instruction includes social relationships, interactions, face emotional recognitions,
non-verbal communication, etc. Given digital infrastructure inequalities, remote
teaching created new disparities.
Our review of the published studies thus far made clear that uncertainty, fear,
and anxiety were dominant feelings for students with and without disabilities
during the pandemic. Students, like other people, feel threatened by the virus.
States of emotional deregulation under prolonged lockdowns prevailed. Some, the
most vulnerable, could not adapt immediately, and psychiatric symptoms (e.g.,
severe depression) appeared or increased (Giannopoulou et al., 2021). More stu-
dies and time are needed to study the pandemic’s impact on mental health and its
long-term consequences.
Finally, our review revealed the need for a national strategy for mental health
and suicide prevention, in which children, adolescents, and young people would
be key target groups. A government’s priority on students’ mental health should be
specified through specific initiatives targeting disadvantaged student populations
and students with disabilities by allocated funds to strengthen mental health ser-
vices and suicide prevention.
Netherlands
The Netherlands Institute of Human Rights expressed its concern in a Report
(2021) to the UN Committee on the Rights of the Child (the CRC Committee)
in Geneva:
There is a severe risk that the pandemic and the measures the Government is
taking to combat it will have a more detrimental effect on children in
vulnerable situations than others. The access to equal opportunities for
disadvantaged children will diminish dramatically because of this. The

burden of this pandemic should not be borne by the weakest shoulders, so
when the Government takes measures with impact on children, it should
always put their short and long term interests first.
In balancing different interests, children’s best interests did not weigh heavily.
A Dutch study by Luijten et al. (2021), for instance, concluded that “gov-
ernmental regulations regarding lockdown pose a serious mental/social health
threat on children and/or adolescents that should be brought to the forefront of
political decision-making and mental healthcare policy, intervention, and
prevention”.
Impact of School Lockdowns on Children’s Mental Health

To slow down the spread of the Omicron variant of the virus then Dutch
caretaker Prime Minister Mark Rutte (from January 10, 2022, again Prime
Minister) announced in an improvised press conference on December 18, 2021
(Reuters, 2021) a new hard lockdown of the country, including the closure of
schools from December 20. For many schoolchildren, this was an unfortunate
announcement. Already in the first lockdown, Dutch children and adolescents
between 8 and 18 years of age experienced, according to Luijten et al. (2021),
5% more problems with sleeping, 7% felt more anger, 10% were more de-
pressed, and 15% had more fears. This Dutch study showed that an increase in
fear and depression can be predicted when one of the parents suffers the loss of
a job and/or one of the family members or friends of the child catches
COVID-19. A study among adolescents and young adults found that this is a
time of loneliness among young people (Dutch Red Cross, 2020). The worry
about the virus affects all of us, and it most likely affects vulnerable groups
(parents with a mental disorder or an addiction, children with a learning
disability, for instance) the most.
At the end of December 2021, civil society mobilized, and 60 NGOs and
professional organizations (educators, psychologists, and psychiatrists) pub-
lished a joint letter (coordinated by UNICEF Nederlands) to the Government
and Parliament “to put the interests of children first and open the schools after the
Christmas holidays” (UNICEF Nederlands, 2021). And this is what happened
(although senior secondary vocational education, the Colleges, and Universities re-
mained closed).
The child psychiatrist Popma from the University Medical Center (UMC)
Amsterdam (UMC, 2020) reported that when children have to answer a question
like “how are the COVID measures for you?” only negative answers are uttered,
and in addition, they describe that the atmosphere at home is less pleasant now.
Moreover, especially in larger families, more frustration and anger can be found
when there are more children at home.
Impact on Vulnerable Groups of the Pandemic and Measures to

Control the Pandemic
As a result of the COVID-19 crisis, the differences in socioeconomic situations
became very visible, but they also grew more prominent. The Dutch Education
Council (2021) published, as a response to this, in December 2021 a report to
draw attention that currently, the public character of education is in danger. Many
parents who have the financial resources hire private teachers or older students to
give extra lessons to their children. The COVID-19 crisis increased these problems.
The housing situation of some children makes it harder for them to cope with the
difficult situation at home, where parents have to work on their laptops, and other
children are around as well (Bol, 2020). If you can afford a larger house, it is easier.
However, some situations are equally hard for all parents and children, for example, a
child with autism who can’t handle changes. The announcement by the Prime
Minister on December 18, 2021, that schools will be closed (in order to stop
spreading the Omicron variant of the virus) again was tough (Reuters, 2021). There
was no time to even prepare the children for this.
We now know that the number of victims of child abuse went up during the
first lockdown, compared with the period before the lockdown, according to
researchers from Leiden University (Vermeulen et al., 2021). Families about
which there were already concerns were even more vulnerable. There was also an
increase in the number of victims of emotional neglect (Vermeulen et al., 2021).
In addition, the Dutch Red Cross reported in February 2021 that many adoles-
cents and young adults feel lonely in the Corona crisis: 60% of young people
report feelings of loneliness sometimes, 23% report that they feel lonely all the
time (Dutch Red Cross, 2021). Compared with numbers several months earlier,
the numbers went up. Van Egmond & Blijker (2022) report that The Dutch
Association of Psychiatrists (NVvP) wrote a letter to the new government stating
that the lockdown is meant to prevent people from becoming sick but students of
senior secondary vocational education and colleges and universities (young adults)
get depressed, have fears and stress accumulates. This can lead (later) to a more
permanent mental illness. The psychiatrists’ pleaded for opening senior vocational
education and colleges and universities. Adolescents and adults are vulnerable and
need contact with peers, the psychiatrists wrote (Van Egmond & Blijker, 2022).
Deficits in the Dutch Mental Health System and Possible

Solutions
The increase in the number of children and adolescents who were abused or
neglected and had fears or depression comes on top of the malfunctioning youth
care and mental health system. From 2015 on, municipalities in the Netherlands
have been made responsible for youth care, but this coincided with budget cuts by
the national Government (Dibbets et al., 2021). What is possible in municipality A
is not possible in municipality B. Youth mental health services had already long
waiting lists (from the moment of referral to an actual intake, it can often take
eight months, even if a young person is very depressed). Many child psychiatrists
and other professionals left the youth mental health field because of the bureau-
cratic reporting obligations, which took away a lot of pleasure in the work. Due to
the COVID-19 crisis, the new cases were added to existing waiting lists. In
general, the whole care and education field (nurses, youth care workers, child
psychiatrists, psychologists, teachers) has a chronic shortage of personnel in ad-
dition to heavy levels of bureaucracy. In addition, the Ministry of Public Health,
Social Welfare, and Sport was also slow in organizing boosters (for counselors
working with youth, for instance), and the nurses and doctors in hospitals are ex-
hausted. Some are dropping out or reporting sick. In short, the Netherlands’ chil-
dren and youth mental health systems are not very well equipped to meet the needs
of children and youth with mental health problems. To change the way mental
health problems in children are addressed, significant changes have to occur, par-
ticularly financing, reduction of bureaucracy, and personnel recruitment. In addi-
tion, children’s resiliency should be improved at home and school, in sports, and
through youth work. Contact between young people and support systems must also
be sustained during a pandemic. This can happen through home visits, designated
meeting points, and digital solutions. In any case, it is essential to offer individualized
solutions (UMC, 2020). A new government (again headed by Mark Rutte) was
sworn in by King William Alexander on January 10, 2022. For the youth mental
health system, which also has to support new cases of children with fears, stress, and
depression due to COVID-19 and patients already in treatment where the symptoms
are aggravating, the signs are not promising. The Coalition agreement put forward
ideas like limiting the time of treatment or demanding a financial contribution of the
patients or their parents (which will no doubt lead to young people avoiding care
(Bureau Woordvoering Kabinetsformatie, 2021).
Portugal
Like many other countries worldwide, the COVID-19 pandemic was sig-
nificantly disruptive for children and adolescents in Portugal. Because of several
confinements, schools were locked, and peer relations were severely restricted.
Families became the only relational space during long and endless days
(Petretto et al., 2020).
On March 2, 2020, the first two cases of COVID-19 were reported in
Portugal, and on March 12, the Government decided that classroom teaching was
suspended till the end of the school year. Then, in September 2020, classroom
activities resumed. However, after several renewals of the state of emergency, new
total confinement was decreed from January 21, 2021. The extension of the
confinement periods, the prolonged closure of schools, and the uncertainty over
the return to classes necessarily affected millions of children and their families in
multiple ways. For example, Domingue et al. (2021) found that second and third
graders reading fluency was 30% lower than expected after school closure and that
the results were meager for poor children. Petretto et al. (2020) also emphasize that
school closure was particularly stressful for children with special needs and their
families.
Two recent meta-analyses (Chai et al., 2021; Ma et al., 2021) showed a high
prevalence of depression, anxiety, sleep disorders, and post-traumatic stress
symptoms among children and adolescents during the pandemic period. These and
other studies worldwide (e.g., Sinha et al., 2021; Tajane et al., 2021) confirm that
pandemic mental health levels were poorer than pre-pandemic levels.
Mental Health Problems of Children and Youth in Portugal:

Pre-pandemic Studies
It is not straightforward to have a reliable representation of the mental health
problems in children and youth in Portugal because data are scattered across
government departments. Therefore, the data might not reflect the magnitude of
the problem. Still, there is relevant information about the issue. Table 6.2 shows
some of the most relevant studies conducted in Portugal about mental health
problems in children and youth before COVID-19 pandemics.
Notably, one of the most solid studies conducted by Matos and Equipa
Aventura Social (2018) found that most participants (81.7% out of 6,997 adoles-
cents) report feeling happy. Only a minority face serious mental health problems.
Other studies (e.g., Gaspar, 2019) show that girls experience more problems than
boys, that anxiety and depression are the most common problems, and anxiolytics
are the most used drugs. Still, only a few subjects experience severe mental health
problems such as self-harm behaviors or suicide ideation.
Mental Health Problems of Children and Youth in Portugal:

Pandemic Studies and Interventions
During the pandemic period, many studies and interventions were designed to
understand and deal with the successive waves of confinement or semi-confinement.
Table 6.3 shows that anxiety, depression, loneliness, boredom, irritability, and
reduced physical activity are the most referred mental health problems. These
problems are not unexpected, because in Portugal students are expected to be in
school full-time. Schools have been the most crucial socialization context after
six years of age, and for a significant number of children, after age three. With
schools closing, that context was significantly reduced and hardly substituted by
social networks.
Upon students’ return to school, newspapers and TVs reported many inter-
ventions conducted by schools to deal with their students’ mental health and
learning problems. Most of these interventions were informal, not formal.
Therefore, it is not possible to mention them by name or designation.
The most essential services and large-scale interventions to deal with children
and youth mental health problems during the pandemic come from the National
114
TABLE 6.2 Pre-pandemic Studies on the Mental Health of Children and Adolescents in Portugal
Author Objectives Participants Findings

Marion Felder et al.
Matos and Equipa Aventura Study lifestyle of adolescents n = 6,997 students, from sixth Most adolescents consider themselves
Social (2018) (e.g., family support, school, (36%), eighth (39,5%) and happy (81.7%); 27.6% feel worried
friends, sleep, sexuality) tenth grade (24,5%), mean every day, several times a day;
age = 13.73 years 13.6% feel nervous, 12.6% feel
irritated, 9.2% feel sad, and 6.3%
experience some fears afraid.
Gaspar et al. (2019) Analyze the mental health and n = 8,215 Eight through Girls show more positive results than
quality of life of Portuguese twelfth grade boys; younger adolescents (eighth
adolescents grade) present more positive values
than older adolescents (tenth and
twelfth years of schooling);
adolescents refer to self-injury
behavior in the eighth grade.
UNICEF (October 2021) Describe the state of children n = 47.2 million children and Portuguese participants with mental
and adolescents’ mental health adolescents aged 10–19 health problems: 19.8%
years, and caregivers, in
116 countries
TABLE 6.3 Pandemic Studies on the Mental Health of Children and Adolescents in Portugal
Author Objectives Participants Findings
Costa et al. (2021) Assess mood, anxiety, and behavior n = 502 children and youth aged An overall increase in screen hours (81%),
changes – in a child psychiatric 5–18 years reduced physical activity (in 78.5% cases),
population during confinement and sleep (45%). More symptoms of sadness,
irritability, and anxiety. There was an
aggravation of sadness, irritability, anxiety
and, to a lesser extent, changes in behavior.
Salvaterra and Explore the resources and strategies n = 807 families of children aged Children and young people felt bored (54%),
Chora (2021) used by children and families to 4–18 years worried about grandparents (53.8%), parents
deal with pandemics (45.3%), other relatives (41.4%), and friends
(40.3%); 9.8% showed more symptoms of
anxiety than the national normative data;
levels of anxiety above functional, mainly in
children aged 8–12 years.
Francisco et al. Describe and compare the Parents of 1,480 children and More than 50% of children felt bored and 40%
(2020) psychological and behavioral adolescents aged 3–18 years. irritated; one in three felt lonely, nervous,
symptoms of children and worried, and anxious.
adolescents in quarantine (Italy,
Spain, and Portugal)
Branquinho et al. Understand the health condition of n = 304, age 16–24 years, Students did not find the “welcoming old
(2021) adolescents and young adults M = 18.4 years school” they expected. Instead, they
when returning to school, after referred to the school as “another school,”
confinement safe but cold and distant. However, they
were pleased to be out of the home.
The COVID-19 Era
115
TABLE 6.4 Pandemics Services and Programs for Children and Youth
Services and programs Objectives
NHS 24 (National Health a. Manage emotions (stress, anxiety, anxiety, fear);

System) b. Promote psychological resilience;
c. Reduce the probability of mental health problems
following COVID-19;
d. Increase feelings of security
University of Minho Identify mental health and educational children’s needs,
ProChild CoLAB promote positive parenting
The University of Minho Screen and assess mental health problems in children
CoAction Against Covid- attending schools (3 through 10 years)
19 Project
Health System (NHS) and the Universities (Table 6.4). These services, although
community-based, are fundamentally conducted in schools. In addition, contrary
to previous years, some of these programs are aimed at very young children.
Overall, it is not easy to have a clear picture of what is being done in the field
because most interventions are not formally registered or published. Still, with
about 90% of the population vaccinated and with seemingly mild pandemic
mental health problems (e.g., anxiety and loneliness), there are reasons for mod-
erate optimism in Portugal. The possibility of children getting back to school
safely, interacting with friends, and focusing on classroom learning are some
reasons for optimism. Moreover, the reopening of schools freed the parents from
the highly stressful demands of parenting coupled with income losses (Antunes
et al., 2021). It is now time for the country to prepare to deal with unknown
sequels and act accordingly whenever necessary.
Tanzania and Vietnam

COVID-19 has brought welcome attention to mental health issues globally. There
have also been laudable efforts even before the pandemic to raise the profile of
mental health, including from the WHO (WHO, nd). Despite this, more is
needed to raise awareness that mental ill-health is a pandemic in itself, and that
globally 10–20% of adolescents suffer from mental health conditions (WHO,
2021). This relative neglect is particularly evident in low- and middle-income
countries (LMICS) where mental ill-health is often not discussed, services are
limited and often non-existent and more generally where mental health is not
prioritized in government resource allocation.
This section of the chapter draws on a 30-month operations research program
in Tanzania and Vietnam which focuses on addressing the mental health needs of
adolescents (age 11–19) in four schools in two regions in Tanzania—Morogoro
and Mwanza—and in eight schools in two provinces in Vietnam—Nha Trang and
Vinh. Underpinning this study was the realization that while mental health issues
were a problem faced by adolescents in both countries, mental health service

provision for adolescents was limited if non-existent in both countries and con-
tinued to be so when the pandemic started (Chakraborty & Samuels, 2021).
The most recent and first nationally representative epidemiological survey on the
prevalence of mental health problems in children conducted in 2014 in Vietnam
found that overall levels of child mental health problems were about 12% of the non-
adult population. The study also found that overall rates of child mental health
problems varied significantly across the 10 provinces surveyed (Weiss et al., 2014). In
Tanzania, an epidemiological study of Tanzanians aged 15–59 in Dar es Salaam
found the prevalence of common mental disorders among those aged 16–24 to be
4.7% (Jenkins et al., 2010). A nationally representative survey of 700 Tanzanian
secondary school students showed that 41% reported an elevated level of mental
health problems in the previous 6 months, and 31% of parents reported observing an
elevated level of mental health problems in their children (Nkuba et al., 2018).
In Vietnam, the mental health system is heavily focused on the treatment of severe
mental disorders in hospitals in provincial capitals, tending to ignore more common
mental health problems (Lee et al., 2015; Niemi et al., 2010; ODI & UNICEF, 2018;
Vuong et al., 2011). There is also a lack of trained staff, service coverage is low beyond
the provincial capitals, and where services exist, uptake is limited due to stigma, lack of
awareness, and lack of age and gender-appropriate services (Lee et al., 2015; MoH &
Health Partnership Group, 2015; ODI & UNICEF, 2018). Findings from this and
other studies (Samuels et al., 2021) show that some schools have tried to institute
supportive services for students—these have included psychological counseling
units, mailboxes where students can raise issues anonymously, supportive telephone
“hotlines” and events such as information lectures and “talk shows”. However, these
have had limited degrees of success.
In Tanzania, several challenges limit rapid access to effective mental health care,
including poor mental health literacy, high levels of stigma, problematic insurance
coverage for mental health disorders, lack of drugs, and weak capacity at the
community level to address and access mental health care (Ambikile & Iseselo,
2017; Kutcher et al., 2016, 2019). Psychiatric nurses provide most mental health
services with a ratio of 2/100,000 but with limited training in youth mental health
(Kutcher et al., 2019). At the same time, most Tanzanians rely on traditional/
alternative medicine, while mental illness is the second most common condition
managed by practitioners of traditional medicine (Kutcher et al., 2017).
To contribute towards addressing this dearth of mental health services for
adolescents, this project aimed to firstly identify the drivers of mental ill-health
amongst adolescents through a mixed-method baseline study and then working
with them, to co-create an approach (to include digital and non-digital inter-
ventions) to address mental ill-health and support well-being which would then be
tested over a 10-month period. As part of the co-creation approach, findings from
the baseline study are being shared with a wide group of stakeholders, thus also
raising awareness about the drivers of mental ill-health amongst adolescents, a
critical component for changing attitudes around mental health.
While COVID-19 was not the focus, given that the project started during
the onset of the pandemic, we were able to incorporate some questions ex-
ploring the effect it was having on mental health into our qualitative baseline
study. Data were collected in March 2021 in Tanzania and between December
2020 and January 2021 in Vietnam. A total of 93 interactions took place in
Tanzania and 92 in Vietnam consisting of in-depth interviews (IDIs) with
adolescent girls and boys; intergenerational discussions (IGD) where different
members of one household were interviewed separately to explore intra-
household interactions and dynamics; focus group discussions (FGDs) with
parents and adolescents; and key informant interviews (KIIs) including those
with teachers. The quotes and narratives in the sections below are drawn from
these interactions. (For further details of the study and methodology, see Leon-
Himmelstine et al. for Tanzania and Samuels et al. for Vietnam.)
We use a socioecological framework to explore the effects of COVID-19
primarily on adolescents—thus, we explore the impact at the individual level,
within households, within schools, and at the broader community level. As will be
shown in our findings, the levels interact with each other, and the prominence of
the effects at different levels differ by country.
Effects of COVID-19 at the Individual Level

In Vietnam, boredom and sadness were the most frequently mentioned senti-
ments arising from adolescents not going to school, staying at home, usual
routines being disrupted, and not seeing friends. In Tanzania, feelings of un-
certainty were common, particularly at the onset of the pandemic with school
closures and government requests to students and young children to stay at
home. Girls in Vietnam also reported how some relationships broke down because
of COVID-19, and girls especially felt anxiety related to their body image
… I was scared of other people judging that I got fatter (because of the pandemic) or
sometimes there were boys who said things like… like … just unintentionally but
it… caused … bad impacts on … like I would have the thought that I was becoming
very fat …(FGD with 16-year-old girls, Vinh).
In both countries, COVID-19 restrictions (having to wear masks, social distan-

cing) and fears of becoming ill and even dying from COVID-19, caused stress and
anxiety. In Tanzania especially, uncertainties about the future and the reopening
of schools caused anxiety, which led adolescents to think that it was better to
pursue other endeavors.
Effects of COVID-19 at the Household Level

COVID-19 led to tensions and conflicts within the household which also affected
the mental health of adolescents. In both countries, intra-household tensions were
related to schooling and economic pressures, but responses/manifestations dif-

fered. For example, parents in Vietnam were concerned that children were
spending too much time online “playing games” rather than studying. Increasing
online activities also made some adolescents querulous, while at the same time,
they resented that their parents were not staying at home and looking after them.
The (on-line classes) enable children to play and (result in them) getting a grade below
the average. (FGD with parents of adolescents, living in Vinh)
In Tanzania, with schools closed and fearing they would remain closed for a long
time, faced with economic pressures of job losses, some parents “forced” their
daughters to marry early or join the labor market, which also exposed them to
potential dangers. While this may have eased economic pressures, it caused upset,
tensions and stress.
Corona has affected some people … Parents thought (that) ‘Corona will not end,’ it’s
better to get the children married or send them [off] for domestic work, so that they can
at least bring income. (mixed gender FGD with adolescent aged 15–19 years-
old, Mwanza)
In both countries, children were often left at home alone, unsupervised by parents.
In Vietnam, this led to falling academic performance as rather than learning online
children would resort to playing games. In Tanzania, this was seen to be one of the
causes of increases in early and unintended pregnancies and abortions amongst
adolescent girls.
Effects of COVID-19 at the School Level

One of the most visible, widely spoken about, and immediate effects of the
pandemic for adolescents, especially in Vietnam were school closures. Adolescents
missed their friends, felt socially isolated, and all learning went online. This online
learning, along with being distracted by constant news about the pandemic, led to
declines in academic performance. Some adolescents feared that they may have
lost the ability to concentrate and learn and would have difficulty getting used to it
again when they returned to school. In addition, some had connectivity problems
and internet delays, and some reported playing online games rather than studying.
This all caused anxiety and stress and affected relationships with parents.
R It was more troublesome to study on-line because it was harder to concentrate and
sometimes there were Internet lagging, so …
R Some turned off their cameras while studying so they could play games. (FGD
with 14-year-old boys, Vinh).
With the increasing usage of phones and other technology because of COVID-19,
concerns were raised about the dangers of addictive behaviors (related to e.g.
gaming), the potential increased exposure to harmful material and online abuse,
and the loss of in-person communication skills. All of which were also seen to
result in increased isolation and social anxiety.
In Tanzania, online education was not an option for most adolescents, so many
dropped out of school to marry or pursue jobs. When schools reopened, some
parents were reluctant to let their children attend since some schools had been
used to house COVID-19 patients. Boys mainly had also got accustomed to
spending time with friends and enjoying this freedom and were reluctant to return
to school. On the other hand, some girls were observed to have terminated their
pregnancies when they saw that schools were reopening.
Covid-19 has affected many students … Some decided to engage themselves in

-generating activities and ’don’t see the need to continue with studies. (FGD with
adolescent girls aged 15–19 years-old, Mwanza)
Effects of COVID-19 at the Community Level

One of the most important effects of COVID-19 which affected the well-being of
study participants was the loss of jobs. In Tanzania, not only did adolescents observe
family members losing jobs, but adolescent boys were also anxious as many worked
after school, during weekends, and holidays. In Vietnam, it was noted that 80% of
people fell into unemployment because tourism ceased. In addition, the circulation
of misleading and contradicting news and information also led to anxieties – in
Tanzania, everyone became an expert on addressing the “pandemic.” This led to
distress and anxiety but also distrust and affected community cohesion.
Recommendations Relevant to all Countries

While intervening at all levels of the socioecological framework is critical, here,
drawing on our findings and the broader literature, our recommendations use the
school setting as an entry point:
• Continue to discuss (through process facilitated by teachers and others) with

school children why current school-based approaches (where they exist) are
not used and how they can be established or improved. One option may be to
have them run or managed by peers rather than teachers or “experts.”
• Co-create approaches with school children that will work for them given
their contexts, needs, and priorities.
• Prevention is better than cure—develop approaches that support well-being
(e.g. sports) rather than needing to address mental ill-health further down
the line.
• Digital/online approaches are an essential way forward—but there is a need to

blend them with face-to-face approaches.
• Digital/online approaches need to be adapted to contexts/environments to
not exacerbate digital divides, be age and gender-sensitive and not promote
addictive and other potentially dangerous behaviors.
• Raise awareness amongst teachers about the drivers and symptoms of mental
ill-health—including common mental health disorders—and provide them
with support to address them, including referral lists to other service providers
(Government, NGO, CBO) and context-appropriate tools/approaches.
• Where possible, assign (and appropriately resource) a specific teacher tasked
with addressing the mental health needs of school children—gender and age
needs to be taken into account along with skills and capacities
• Involve parents/other significant adults in “adolescents” lives—raise their
awareness about the drivers of mental ill-health, include them in approaches
designed by children, provide them with communication skills—PTAs could
be used as platforms for engaging parents
Conclusion
In all of the presented countries, the COVID-19 pandemic and the efforts to
control the virus seem to have had a mostly negative impact on children’s and
young people’s lives, particularly on mental, social, and academic development.
Students with disabilities and students from disadvantaged backgrounds were
particularly affected by school closures. Students in the five countries studied and
almost everywhere else as far as we know faced massive disruption to their learning
and social contacts.
There is some evidence that the stressors posed by the pandemic will have a
medium to long-term impact on psychological well-being (Hahlweg et al., 2020).
In Tanzania, the impact was different from in Europe, since young people had to
actively earn money and contribute to support their families before and during the
pandemic. In Tanzania, there was no online instruction. Even when schools
reopened, some students did not go back to school, girls got married and/or
pregnant, some boys went to work full time and did not resume their studies.
Mental health systems in the various countries coped in different ways, also
depending on how they operated before the pandemic. Some systems were
overstretched before the pandemic, in others, mental health provision barely
existed. All systems faced challenges, such as lack of or deficits in the online/
remote instruction and lack of support for vulnerable populations. Particularly
children, youth, and families vulnerable before the pandemic seem to have been
hit the hardest.
Developing prevention programs, building resiliency, peer support, online-
support measures (Hahlweg et al., 2020), and raising awareness of mental health all
seem to be useful strategies to address mental health problems in children and
youth. In addition, system and country-specific problems, such as lack of mental
health provisions and lack of professionals, also need to be focused on. The
pandemic clearly showed the profound importance and effect of school as an
institution for knowledge acquisition but, even more importantly as a “sociali-
zation world” (Bude, 2022). Its absence or closure has had a profound impact on
life for children, youth, families, and societies. Schools should thus only be closed
as a very last resort.
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7
PREPARING FOR FUTURE
PANDEMICS: A SCIENCE-BACKED,
HUMAN-CENTERED FRAMEWORK
Marcia L. Rock, Veronnie Faye Jones, and Lisa M. Hooper
Introduction
Researchers, teacher educators, frontline practitioners, policymakers, families,
students, and community members need to understand the short-term effects of the
COVID-19 pandemic on mental health and plan effectively for future pandemics by
having a shared understanding of mental health and well-being. In 2004, The World
Health Organization (WHO) defined mental health as “a state of well-being in
which the individual realizes his or her own abilities, can cope with the normal
stresses of life, can work productively and fruitfully, and is able to make a
contribution to her, his, or their community” (WHO, 2004, p. 10). More re-
cently, Galderisi et al. (2015) defined mental health as “a dynamic state of in-
ternal equilibrium which enables individuals to use their abilities in harmony
with universal values of society. Basic cognitive and social skills; ability to re-
cognize, express and modulate one’s own emotions, as well as empathize with
others; flexibility and ability to cope with adverse life events and function in
social roles; and harmonious relationship between body and mind represent
important components of mental health which contribute, to varying degrees, to
the state of internal equilibrium” (pp. 231–232).
Absent from the WHO (2004) and Galderisi et al.’s (2015) definitions is an
explicit and specific focus on culture, broadly defined. Thus, we emphasize how the
recent COVID-19 pandemic has exposed—once again—how racial and cultural
identities and cultural contexts (risk-prone ecological contexts) are implicated in
differential treatment experienced by gender, disability, racial, ethnic, and language
minority populations (Bernard et al., 2020; Sacks & Murphey, 2018). Although we
recognize that systems (e.g., schools) can be trauma-inducing for some populations,
systems can also be positive and resilience-promoting (Altman, 2021; Saleem et al.,
2021). As such, we consider school ecology as a useful prevention and intervention
DOI: 10.4324/9781003264033-7
Preparing for Future Pandemics 129
point for positive mental health (i.e., public health crisis) among youth and families
and thus a critical aspect of planning for future pandemics.
The COVID-19 Pandemic and the Concurrent Mental

Health Pandemic
Planning and preparing effectively for future pandemics and ongoing threats requires
stakeholders to understand that large-scale trauma events impact not only the mental
health of children and youth but also those who care for and educate them. Without
question, the COVID-19 pandemic has resulted in unprecedented school and life
disruptions (Reuge et al., 2021). According to data published through the World
Bank (Blake & Wadhwa, 2020), the Brookings Institution (Yeyati & Filippini,
2021), and the National Academies of Sciences, Engineering, and Medicine (2021),
in the United States and across the globe, COVID-19-related disruptions have
contributed to widespread increases in physical and mental illness, job loss, un-
affordable or inaccessible healthcare, school absenteeism and pushout, internet in-
equalities, food insecurity and insufficiencies, housing insecurity/homelessness, and
financial hardships. Pandemic-related economic downturns (Yeyati & Filippini,
2021) have pushed an additional 88–115 million people into extreme poverty,
defined as living on less than $1.90 a day (Blake & Wadhwa, 2020). Based on the
results of a meta-analysis to investigate global levels of depression and anxiety,
Castaldelli-Maia and colleagues (2021) asserted “mental health concerns should not
be viewed only as a delayed consequence of the COVID-19 pandemic, but also as a
concurrent epidemic” (p. 890).
COVID-19 Lessons
Interestingly, many COVID-19-related mental health lessons parallel findings of
physical health that emerged from past pandemics or large-scale traumatic hap-
penings, including those dating back to the 1918 flu pandemic (Danforth et al.,
2010; Morens & Fauci, 2007).
Thus far, COVID-19-related mental health lessons learned include the
following:
• Excess mental health declines are evident across age groups with children and
youth experiencing heightened vulnerability (Ferreira dos Santos, et al. 2020;
Singh et al., 2020; Varma et al., 2021).
• One of the greatest challenges centers on mental health resource availability
(Quirk, 2020).
• Mental health and educational systems are quickly overwhelmed by the sheer
volume of mental health needs of children, youth, and adults—the latter of
which includes parents, guardians, teachers, etc. (Kagy, 2021).
• The most disproportionally impacted populations, of children and youth, who
often shoulder the greatest mental health burden, include girls (Chen et al., 2020;
130 Marcia L. Rock et al.
Meade, 2021; Panchal et al., 2021), the disabled (Jones et al., 2020; Jordan et al.,
2021; Marques de Miranda et al., 2020; NASEM, 2021; Panchal et al., 2021;
Patel, 2020; Singh et al., 2020; OCR, 2021), and/or those who are culturally,
ethnically, or linguistically diverse (here and subsequently, “diverse” includes
individuals who are not White and/or did not have English as their first language;
NASEM, 2021; Quirk, 2020; OCR, 2021).
• Investment in preparedness and prevention, including mental health services
for children and youth, is typically too low (Burwell et al., 2020).
• Children and youths’ mental health and wellness are adversely impacted not
only by the threats associated with viral infection but also by short- and long-
term pandemic-related disruptions, such as closures, job loss, financial hardship,
food insecurity, sleep disruption, housing insecurity/homelessness, food in-
sufficiencies, gaps in physical, and mental health insurance and care, and family
stability (NASEM, 2021; Pokhrel & Chhetri, 2021).
• The COVID-19 pandemic qualifies as a global mass trauma event due to
widespread psychological and societal effects (Horesh & Brown, 2020;
Kaslow et al., 2020).
• Strategic planning and action to flatten the infectious disease curve must also
be applied to flatten the social, emotional, and psychological distress curve
(Kaslow et al., 2020).
Uniting for Planning, Preparedness, and Action:

Declarations of Urgency
Eighteen months into the COVID-19 pandemic, in recognition of systems’ failures
and in response to the pervasive mental health issues experienced by children and
youth and their families, the American Academy of Pediatrics (AAP), American
Academy of Child and Adolescent Psychiatry (AACAP), and Children’s Hospital
Associations (CHA) declared child and adolescent mental health a national emergency
(AAP–AACAP–CHA, 2021). In 2021, The American Psychological Association
(APA) also put forth “A Call to Action for School Psychology to address COVID-19
Health Disparities and Advance Social Justice” (Sullivan et al., 2021). In December
2021, the US Surgeon General, Dr. Vivek Murthy, echoed these calls to action by
declaring a new Advisory on Protecting Youth Mental Health (Murthy, 2021).
Parallel calls have been put forth on a global scale as well (e.g., Organization for
Economic Co-operation and Development [OECD], 2021), including calls for
multisector collaboration and cooperative undertakings on behalf of young
children (The Early Childhood Development Action Network, 2020). Taken
together, these professional declarations confirm that the mental health of
children and youth has emerged as an urgent public health issue in the United
States and abroad. In responding to the present public health crisis and in
ameliorating further harm, not only is there an urgent need to strengthen current
school-based mental health services but there is also a vital need to better prepare
and plan for future pandemics.
Preparing for Future Pandemics: A Science-Backed,

Human-Centered Framework
Epidemiologists predict future pandemics will wreak even greater havoc on human
health and well-being (Leach et al., 2021). If we are to strengthen mental health
services and avoid greater declines, especially those experienced disproportionally by
females (Chen et al, 2020; Meade, 2021; Panchal et al., 2021), children and youth
with disabilities (Jones et al., 2020; Jordan et al., 2021; Marques de Miranda et al.,
2020; NASEM, 2021; Panchal et al., 2021; Patel, 2020; Singh et al., 2020; U.S.
Department of Education’s Office for Civil Rights [OCR], 2021), and/or those who
are racially, culturally, and/or linguistically diverse (NASEM, 2021; Quirk, 2020;
OCR, 2021), then stakeholders’ planning and preparedness efforts must include (a) an
emphasis on increasing well-being, (b) strengthening school and community-based
mental health services, (c) enhancing service coordination efforts, and (d) ameliorating
longstanding disparities.
In this section, drawing not only on the science of pandemic planning (CDC,
2018; Kaslow et al., 2020; NASEM, 2020; Schuchat et al., 2011) but also on
lessons learned from the past (Danforth et al, 2010; Morens & Fauci, 2007) and
current pandemics (Burwell et al., 2020; Maxmen, 2021), we offer a framework
for consideration and use. In Figure 7.1, we provide an illustration of our framework.
Importantly, our proposed framework also incorporates evidence-informed decision-
making (Barends et al., 2014; Brownson et al., 2018), which involves the “process of
distilling and disseminating the best available evidence from research and evaluation;
context, systems, and environment; stakeholders’ values and preferences; and practi-
tioner experience and expert judgment and using that evidence to inform and im-
prove practice and policy” (NASEM, 2020, p. 39).
Strong leadership is needed to identify, invite, and convene members of a
dedicated team (Danforth et al., 2010; Kaslow et al., 2020), the mission of which is
to engage in multidisciplinary mental health planning and preparedness. When
assembling teams, school mental health researchers also emphasize the importance
of team composition, which should include diverse members and community
partners (Reaves et al., 2022). Specifically, members should include social, emo-
tional, behavioral health specialists (Kaslow et al., 2020), frontline school and
related services personnel, parents/guardians, facilities and operations personnel,
agency providers (e.g., child welfare, juvenile justice, advocacy organizations),
community leaders and members, and children and youth (National Center for
School Mental Health [NCSMH], 2020). In terms of the latter, to tailor mental
health planning, preparedness, response, and recovery in ways that better meet the
needs of vulnerable populations, it is vital to include girls, children and youth with
disabilities, and/or those who are racially, culturally and/or linguistically diverse.
Maximizing engagement and ensuring diverse representation among team members
involves identifying and minimizing barriers (e.g., transportation, language, sche-
duling), in part, through culturally informed branding, alternative participation
formats, and accessible information (NCSMH, 2020).
132
Marcia L. Rock et al.
FIGURE 7.1 Preparing for Future Pandemics: A Science-Backed, Human-Centered

Framework (See Barends, et al., 2014; Brownson, et al., 2018; CDC, 2018; Kaslow et al.,
2020; NASEM, 2020; National Center for School Mental Health [NCSMH], 2020)
Note: “Used with permission from Microsoft.” Retrieved from: https://www.microsoft.com/enus/
legal/intellectualproperty/copyright/permissions
Size
Generally, researchers have reported differing findings regarding team size and
effectiveness. Although optimal team size is impacted by various factors, such as
tasks, expertise, timelines, and so forth, the typical recommendation ranges be-
tween 3 and 8 members (Wheelan, 2009). More recently, however, effective team
size has been reported to include as many as 32 members (Mao et al., 2016). Team
size should also be determined with local context in mind, such as school and
community size. If a larger team is assembled to ensure diverse representation and
to account for size, smaller action-oriented teams can be created within it.
Climate, Culture, and Psychological Safety

Given the scarcity of resources (i.e., services, funding) and the pervasive effects
(i.e., home, school, community) of mental health challenges, a partnership-based
approach (NCSMH, 2020) forms the foundation for successful planning and
preparedness network. Although partnerships based on collaboration are the ideal,
effectiveness can be oft thwarted by conflict, complexity, and confusion (Mellin,
2009; NCSMH, 2020). To minimize dysfunction, all members should have a clear
understanding of the unique and shared aspects of the team’s mission. Attention
should also be dedicated to ensuring all members value the collaborative nature of
the network’s planning work and the projected outcomes associated with it
(Mellin, 2009; NCSMH, 2020).
To maximize success, consider generating Memoranda of Understanding
(MOUs). Through the National Center for School Mental Health (NCSMH,
2020), team leaders and members can access customizable MOU templates.
Also, important for leaders and team members to determine are day-to-day
operational guidelines and routines, which include leaders, members, and
partners’ roles and responsibilities, convening schedules, workflow processes,
decision-making protocol, and norm-setting procedures. Relatedly, team cli-
mate and culture are important considerations. Researchers investigating high-
performing teams have identified psychological safety, not only as a mediating
variable between organizational factors and team learning (Edmondson, 1999)
but also as a moderating variable (see Edmondson & Lei, 2014, p. 34). As such,
network members and leaders must work diligently to ensure psychological
safety is achieved and maintained through clear, open communication, productive
conflict, and inclusivity (Edmondson & Lei, 2014).
Knowledge and Expertise

Leaders must ensure, too, that all team members are well prepared to engage in
mental-health-related pandemic planning, preparedness, response, and recovery
(NCSMH, 2020). Science-backed approaches to pandemic planning and pre-
paredness include those developed for public health by the Centers for Disease
Control and Prevention, Kaslow et al. (2020) (e.g., Caring Communities initiative),
and the National Academies of Sciences, Engineering, and Medicine (2020). When
used in concert with empirically validated approaches that support adult learning,
which include a clear content focus, active learning (e.g., coaching), coherence,
duration, and collective participation (Desimone, 2009), team performance is
maximized, allowing them to work more effectively and efficiently when crafting
response plans, identifying resources, and building capacities that support mental
health services during pandemics, or other large-scale traumatic events, as well as
during non-pandemic times.
Interval-Based Approach
Based also on the CDC’s (2019) framework, which Kaslow et al. (2020) adapted
for mental health-related pandemics, we also recommend teams take a phased
approach to planning, preparing, and responding. Specifically, Kaslow et al. (2020)
identified six phases of a behavioral health pandemic response strategy: pre-
planning, response readiness, response mobilization, intervention, continuation,
and amelioration. During pre-planning and response readiness phases, team leaders
and members identify social, emotional, and behavioral health needs and inventory
resources to develop local plans. They also build knowledge, flexibility, and trust
among team members, establish connections with community leaders, providers,
and members, which allows coordination and action to commence as rapidly as
possible when needed (Kaslow et al., 2020).
Response mobilization and intervention phases are characterized, as the names
imply, by carrying out the mental health-related interventions and adjusting them
as needed. Kaslow et al. (2020) emphasize that during these phases team members
and leaders must focus on flattening the emotional distress (i.e., mental health
pandemic) curve as quickly as possible to prevent mental health systems and ser-
vices from being overburdened. Continuation and amelioration phases are aimed
at providing longer-term mental health supports (Kaslow et al., 2020). As distress
waves diminish, recovery efforts focus on helping stakeholders distinguish and
provide mental health services that mitigate not only expected levels of lingering
distress but also more lasting and drastic psychosocial challenges. Overall, taking a
phased approach maximizes the likelihood that planning and preparedness work
translates into action and recovery. We also recommend that the same team
members and/or smaller sub-team members (e.g., action teams) engage in all six
phases to ensure cohesive, timely, planning, coordination, and action.
Shared Values and Dispositions

Drawing further on the framework proposed by Kaslow et al. (2020), we recommend
team leaders and members embrace human-centered, community-oriented values.
Specifically, Kaslow et al. (2020) asserted that effective, transformational leaders
are “inspirational, relationally oriented, empathic, inclusive, collaborative, authentic,
service-oriented, and values-based” (p. 876). These shared values and dispositions
form the foundation for members and stakeholders to contribute to the team’s
planning, preparedness, response, and recovery work, negotiate conflict, and join
with partners (e.g., mental health care, community organizations, families/guar-
dians, government officials/representatives)—all of which are needed to generate
cohesive, coordinated, and comprehensive, school-based mental health services that
support the most vulnerable populations of children and youth.
Advocate for Mental Health

An important aspect of preparedness, planning, response, and recovery involves
mental health advocacy. Mental health advocacy efforts should be aimed at helping
others (e.g., school professionals, community providers, societal members) better
understand the heightened risks associated with pandemics (Kaslow et al., 2020;
Morens & Fauci, 2007), including mental health risks and how pre-morbid levels
of functioning may be implicated in exacerbating mental health issues.
Equity and Access

Another key aspect of mental health advocacy involves team members and leaders
helping others understand how pandemic or other trauma-related mental health
challenges adversely impact local communities. When advocating, team members
and leaders must pinpoint where mental health disparities are most pronounced
and insist on more equitable distribution of information, resources, and care
(Kaslow et al., 2020). For example, if telemental health services are needed to
provide care and support remotely to vulnerable children and youth in rural areas,
then additional funds must be secured not only to secure devices but also to support
use. Or, if youth mental health, especially girls’ and those with disabilities, spirals
deleteriously downward, advocacy should focus on securing additional supports and
services, in part, through social media outreach.
Stigma
Another essential area for advocacy centers on team members and leaders’ in-
tentional efforts to reduce mental health stigma through planning, preparedness,
and action. Approximately, 20% of children and youth are considered to need
mental health services but only a small proportion of these actually receive them
(Langer et al., 2015; Merikangas et al., 2010), even when they are made more
accessible through school-based services. Researchers have identified mental
health stigma as one of the primary barriers thwarting children and youths’ will-
ingness to access services (Bowers, et al., 2013). Because mental health stigma
includes cultural elements (The National Council of La Raza [NCLR], 2016),
team leaders and members must advocate for culturally responsive and sensitive
approaches to reduce and/or overcome it. For example, Latino children and
youth, whose families likely have experienced linguistic barriers and harsh judg-
ment, this includes interventions and supports that stress the strengths of youths,
families, cultures, and communities rather than their mental pathologies. Brar et al.
(2020) used mobile fotonovelas (i.e., comic-style strips that illustrate a dramatic,
soap opera-type plot related to health and wellness) delivered via text messages, in
Spanish and English, to improve individuals’ receptiveness to prevention, screening,
and self-management of COVID-19. This approach could also be adapted for use to
promote mental health and wellness.
Engage in Strategic, Culturally Responsive, Action Planning

A hallmark of improved preparedness, response, and recovery is strategic planning
(CDC, 2018; Morens & Fauci, 2007) that is data-informed, culturally responsive,
and action oriented. When engaging in strategic planning, network members must
determine when schools will close (Couzin–Frankel, 2020) for whom and why.
For instance, based on statistical modeling, researchers posit reactive school clo-
sures, during cumulative pandemic phases, result in smaller reductions compared
to substantial reductions (i.e., 40% or higher), during peak periods (Ferguson et al.,
2006). By comparison, drawing on an analysis of 1918 influenza pandemic data,
Markel et al. (2007) reported proactive school closures (i.e., one day in advance of
a spike) were far more effective than reactive closures (i.e., seven days after a
spike). What remains more difficult to discern is how school closings and openings
might be differentiated to meet the needs of vulnerable populations of children
and youth (i.e., girls, those with disabilities, those who are racially, culturally, and/
or linguistically diverse) and their families residing in the most resource-
constrained communities. Based on the COVID-19 pandemic, however, one
lesson has been made clear: team members must determine whether school clo-
sures result in full denial of FAPE for children and youth with disabilities. As noted
previously, failure to do so often results in costly, adversarial, and time-consuming
litigation and rulings confirming school/district personnel must provide in-person
services to children and youth with disabilities (e.g., L.V. v. New York City
Department of Education, 2007).
Needs Assessment and Resource Data

Team members and leaders must also use social, emotional, and behavioral risk
data derived from local, state, national, and international sources to inform
decision-making. First, they must assess which mental health risks, and for whom,
are evident in their state and local contexts (Kaslow et al., 2020). Second, they
must use social, emotional, and behavioral risk data to inform strategic planning,
preparedness, response, and recovery work (Kaslow et al., 2020). Doing so allows
teams to be better informed in meeting the unique mental health strengths and
needs of vulnerable children and youth within the local context. Third, team
leaders and members must inventory existing school and community mental health
resources and assess their adequacy to meet local needs (Kaslow et al., 2020),
which allows them to identify and address existing and predicted gaps in strategic,
action plans.
Comprehensive, Coordinated School-Based Mental Health

To aid teams in comparing mental health data with necessary resources, we offer a
continuum for Comprehensive, Coordinated School-Based Mental Health. Based
on extant, relevant literature, the pillars include whole school well-being models,
preventative and responsive mental health interventions, tailored interventions and
supports for vulnerable populations, and crisis interventions. We briefly describe
each in what follows and offer a Planning Blueprint in Figure 7.2.
The first pillar includes whole-school models that support school personnel
and student well-being. One of four identified models, The Whole School,
Whole Community, Whole Child (WSCC) Model (CDC & ASCD, 2014), was
developed by the Centers for Disease Control and Prevention and ASCD. The
WSCC model is aimed at improving learning and health through ten, unified
components: physical education and physical activity, nutrition environment
and services, health education, social and emotional climate, physical environ-
ment, health services, counseling, psychological, and social services, employee
wellness, community involvement, and family engagement (CDC & ASCD, 2014).
Prior to the COVID-19 pandemic, WSCC researchers established improvements in
academic achievement and social, emotional, and behavioral outcomes (Centeio
et al., 2021; Darling–Hammond & Cook–Harvey, 2018; Gaias et al. 2020). Further,
“understanding staff concerns in the context of the Whole School, Whole
Community, Whole Child model better positions the school community to address
ongoing gaps and changing needs as schools continue to address COVID-19
complications” (Pattison et al., 2021, p. 376).
Preventative and responsive interventions that are provided as school-based
mental health services (SBMHS) constitute the second pillar. Typically delivered by
school personnel, such as counselors, social workers, psychologists, social, emo-
tional, behavioral specialists, nurses, special education teachers, and paraeducators
(Skaar et al., 2021), SBMHS have gained support from the Council for Exceptional
Children’s (CEC) Division for Emotional and Behavioral Health (DEBH) and are
aligned with calls by professional organizations (e.g., National Association of School
Psychologists [NASP] for expanded mental health service provision (Kern, et al.
2017). SBMHS researchers have reported compelling benefits (Kern et al., 2017)
including reductions in barriers, such as cost, transportation, and accessibility,
improvements in mental health service provision to at-risk children and youth
(Barrett & Turner, 2001), and increases in meeting the mental health needs of
children, youth, and families who are racially, linguistically, and/or culturally
diverse (Montañez et al., 2015).
When taking stock of SBMHS, team leaders and members need to ensure
preventative and responsive mental health interventions are culturally responsive
138
Marcia L. Rock et al.
FIGURE 7.2 Planning Blueprint: Comprehensive, Coordinated School-Based Mental Health

Note: “Used with permission from Microsoft.” Retrieved from: https://www.microsoft.com/enus/legal/intellectualproperty/copyright/permissions
(The National Council of La Raza [NCLR], 2016) and include evidence-based

practices (Hoagwood et al., 2001), high leverage practices (McLeskey et al., 2019),
and practice-based evidence (Kratochwill et al., 2012; Lieberman et al., 2011).
Examples include but are not limited to multi-tiered systems of academic and
behavioral support (MTSS) (Arora et al., 2019), social-emotional learning (SEL)
(Durlak et al., 2011; Taylor et al., 2017), trauma-informed care (SAMHSA, 2014),
cognitive-behavior therapy (CBT) (Mychailyszyn, et al., 2012), mental health
literacy (Kutcher et al., 2015; Milin et al., 2016), mindfulness programs (Zoogman
et al., 2015), social skills development (Albrecht et al., 2015), positive behavior
intervention and support (PBIS) (Horner et al., 2009; McIntosh et al., 2014) and
PBIS + SEL (Cook et al., 2015).
Given the high prevalence rates of Adverse Child Experiences and other traumatic
events youth may experience, many school systems have adopted trauma-informed
practices. The Substance Abuse and Mental Health Services Administration
(SAMHSA, 2014) has been the leader in defining and promoting trauma-informed
practices. SAMHSA contends that trauma-informed approaches are underpinned by
four essential principles. First, effective practices must include a realization of trauma
and the effects it has on individuals, families, groups, organizations, and communities.
Second, effective practices incorporate a recognition of and clarity about trauma
symptoms. Third, effective practices recognize how an organization or system responds
to trauma by understanding the importance of the following components: safety,
trustworthiness, transparency, peer support, collaboration and mutuality, empower-
ment, voice and choice, and cultural, historical, and gender issues. Four, effective
practices acknowledge the importance to resist re-traumatization (SAMHSA, 2014).
These four principles afford school personnel the knowledge and skills to understand
child and youth behavior, avoid re-traumatization, and promote positive whole child
and whole school outcomes.
Additionally, teams should consider EBPs that successfully increase access to and
reduce inequities in school-based mental health interventions, not only prior to
COVID-19, but also during the pandemic. One such approach is TRAILS
(Transforming Research into Action to Improve the Lives of Students) (Kilbourne,
et al., 2018). TRAILS combines two evidence-based mental health interventions to
reduce anxiety and depression—mindfulness and CBT. In 2020, researchers
successfully adapted TRAILS for virtual delivery as a rapid response mental
health intervention, dubbed Coping with COVID-19 (CC-19) (Rodriguez–Quintana,
et al., 2021).
The third pillar consists of tailored interventions and supports for vulnerable
populations, including girls, children and youth with disabilities, and/or those who
are racially, culturally, and/or linguistically diverse whose needs are not met
through whole school well-being models, nor through preventative and re-
sponsive mental health interventions. For example, Garmy et al. (2015) found that
girls who received a school-based, mental health intervention for depression re-
ported a lack of appeal and acceptance largely because they perceived the program
as negatively focused. As such, mental health interventions for girls experiencing
depression may need to focus more on positive, strength-based approaches (Garmy

et al., 2015), a finding confirmed also through Schultz and Mueller’s (2007) sys-
tematic review.
Kern et al. (2017) also cautioned that SBMHS are often ineffective in meeting
the mental health needs of children and youth with disabilities. Thus, additional
interventions and supports are warranted. For example, students with Autism
Spectrum Disorders (ASD) and Emotional Behavioral Disorders (EBD), may
benefit from a mental health + positive behavioral support model, which com-
bines function-based assessment and intervention with cognitive behavior therapy
(Skaar et al., 2021).
Additionally, the majority of EBPs supporting children and youths’ mental health
have been developed without racial, cultural, and linguistic considerations. To in-
tegrate cultural factors into evidence-based mental health practices and improve ef-
fectiveness, Jones et al. (2017) recommended school psychologists and other personnel
use clinical interviewing tools such as the Jones Intentional Multicultural Interview
Schedule (JIMIS, [Jones, 2009]) and the Cultural Formulation Interview from the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric
Association, 2013), employ models (e.g., ADDRESSING framework) to make cul-
tural adaptations to preventive and responsive interventions, “push through” personal
discomfort, engage in discussions with families and cultural brokers, and ensure that
school-based mental health interventions account for intersectionality (e.g., race,
ethnicity, class, gender, disability) in an integrated, rather than an isolated manner.
Crisis interventions constitute the fourth pillar. In addition to accounting for
the first three pillars (i.e., school wellness models, preventative and responsive
mental health interventions, and tailored supports for especially vulnerable
children and youth), team members and leaders must address how school-based
crisis interventions will be provided. Crisis events may be in the form of natural
disaster(s), death(s), and/or mass violence (Sokol, et al., 2021). The scope of
these mental health crises may vary considerably—from one child or youth to
small or large groups of children and youths or to an entire school and/or
community. One approach that reflects the most up-to-date recommendations
for school-based crisis intervention (Sokol et al., 2021) is The PREPaRE
curriculum (National Association of School Psychologists [NASP], 2020). “The
PREPaRE acronym includes the sequential and hierarchical steps of crisis
prevention and intervention: Prevent/Prepare for psychological trauma;
Reaffirm physical health, security, and safety; Evaluate psychological trauma;
Provide interventions and Respond to psychological needs; and Examine the
effectiveness of prevention and intervention efforts” (NASP, 2020, p. 1).
Additionally, teams should ensure crisis interventions are culturally sensitive and
effective with vulnerable populations of children and youth, including girls,
children and youth with disabilities, and/or those who are racially, linguistically,
and culturally diverse. For example, in evaluating Life is Precious™, a suicide
prevention program, Humensky and colleagues (2017) reported there were no
completed suicides by Latina adolescent girls.
Providers and Recipients

Relatedly, another integral aspect of planning, preparedness, response, and re-
covery requires team leaders and members to determine implementation
(Gkiotsalitis & Cats, 2021), within and across the four pillars, such as who provides
and who receives mental health interventions and supports, when, and for how
long. Providers can include teachers and other school staff, social, emotional,
behavioral health specialists, community-based professionals, parents and other
family members, guardians, and even students themselves (Kaslow et al., 2021). To
enhance effectiveness and build capacity, team members and leaders need to
consider how different stakeholders will be prepared to provide the four pillars of
comprehensive, coordinated mental health. For example, Koschmann et al. (2019)
used coaching successfully to implement evidence-based mental health practices in
schools that not only increased providers’ confidence, skill, and attitudes toward
CBT but also decreased students’ depression and anxiety.
Recipients can include teachers and other school staff as well as children and
youth with an emphasis on prioritizing school-based mental services and inter-
ventions for the most vulnerable populations as well as those who care for and
educate them (Kaslow et al., 2021; Villegas et al., 2021). In Figure 7.3, based on the
most up-to-date literature, we offer planning and preparedness recommendations
teams should consider for (1) teachers, administrators, and other school personnel;
(2) children, youth, and peers; (3) parents/guardians and families; and (4) commu-
nity leaders, members, and organizations.
Delivery
Strategic, culturally responsive, action-oriented planning also requires teams to
determine, in advance, how mental health services and interventions, within and
across each pillar, will be delivered. Some might be delivered in person, while others
might be offered online (e.g., telemental health), or in a hybrid format. Prior to the
COVID-19 pandemic, Stephan et al. (2016) established school telemental health
(TMH) as a flexible, effective, and feasible option for ensuring a continuum of
mental health care to children and youth, noting that hybrid delivery may be the
most preferable. Important considerations include addressing the digital divide,
providing technology to children, youth, families, and the workforce, ensuring
broadband access, and offering training that supports technology use. Importantly, to
meet the academic, social, emotional, and behavioral support needs of children and
youth with disabilities, teams must also plan for and provide assistive technology
(AT), instructional technology (IT), and Accessible Educational Materials (AEM)
according to individualized education plans (IEPs) (IDEA, 2004). Another aspect
that warrants consideration is how teams communicate and disseminate planning,
preparedness, response, and recovery work (Danforth et al., 2010). Because schools
are uniquely positioned “as a common point of access” for increasing mental health
services to children and youth who need them, Baker et al.(2021) asserted that
Teachers, Administrators, and Other School Personnel

Increase mental health and well-being screening for teachers, administrators, and other workforce personnel (NASEM, 2021).
Provide psychological triage (technology access) (e.g., apps, tele mental health) (NASEM, 2021).
Offer workforce support groups (NASEM, 2021).
Provide ongoing professional development in mental health and well-being (NASEM, 2021).
Collaborate with mental health providers to provide integrated, interconnected systems of care (NASEM, 2021).
Offer school-based mental health centers and/or partnerships with community mental health service providers that teachers and
other school personnel can access for services (https://www.childtrends.org/blog/school-based-health-centers-can-deliver-care-
to-vulnerable-populations-during-the-covid-19-pandemic)
Provide integrated mental health, nutrition, and wellness programs for teachers and other school personnel (NASEM, 2021).
Waive waiting periods for school employees to access health benefits, including mental health care (Gewertz, 2021).
Offer same day virtual counseling through school-based mental health clinic (Gewertz, 2021).
Improve school psychology staffing ratio from 1:1,211 (national average) to 1:500 (recommended ratio) (National Association of
School Psychologists, 2021).
Increase family engagement and outreach (Centers for Disease Control and Prevention [CDC] Teacher, Parent, Student Mental
Health-Triangulated Report, 2021).
Provide mobile workforce options
Communication (Dalton et al. 2020)
Children and Youth
Increase P-12 student mental health and well-being screening (NASEM, 2021) –paying close attention to vulnerable groups,
such as girls, students with disabilities, and/or students who are racially, culturally, ethnically, and/or linguistically diverse.
Engage in psychological and academic triage (NASEM, 2021).
Increase assistive and instructional technology support access (e.g., apps, tele mental health (NASEM, 2021).
“Create a safe physical and emotional environment by practicing the 3 R’s: Reassurance, Routines, and Regulation.”
(https://www.childtrends.org/publications/resources-for-supporting-childrens-emotional-well-being-during-the-covid-19-
pandemic)
Engage student support groups (NASEM, 2021).
Incorporate teen Mental Health First Aid (tMHFA) – “a school-based training program to teach high school students how to
identify and respond to signs of mental illness in their peers.” (Powder, 2021)
Provide enhanced academic, social, emotional, and behavioral support commensurate with students’ strengths and needs
(NASEM, 2021).
Offer integrated, interconnected systems of care for children and youth (NASEM , 2021).
Provide integrated mental health, nutrition, and wellness programs for children and youth (NASEM, 2021).
Offer same day and/or on demand virtual counseling through school-based mental health (NASEM, 2021).
Provide longer term virtual counseling and support through remote school-based mental health clinics (NASEM, 2021).
Solicit and consider stakeholder voices (e.g., student panelists’ recommendations), such as the following:
“...the importance of effective mental health programs, teacher support, and inclusive curricula in supporting students’ mental
health needs” (NASEM, 2021, p. 4)
“...schools need to focus on mental health and inclusivity every year...” not just during a pandemic (NASEM, 2021, p. 4)
Flexibility needs to be extended post pandemic (NASEM,2021, p. 4)
Offer children and youth school-based sleep intervention(s) (NASEM, 2021).
Ensure children and youth receive IDEA and Section 504 services (NASEM2021).
Provide diverse, socioculturally appropriate mental health services and interventions (American Psychological Association
[APA], Working Group for Addressing Racial and Ethnic Disparities in Youth Mental Health, 2017)
Parents, Guardians, and Families

Offer increased mental health and wellness screening to parents, families, and caregivers (CDC Teacher, Parent, Student Mental
Health-Triangulated Report, 2021)
Partner to provide integrated interconnected systems of care (e.g., wrap around services, respite care) (CDC Teacher, Parent,
Student Mental Health-Triangulated Report, 2021)
Partner to provide increased insurance/Medicaid benefits (CDC Teacher, Parent, Student Mental Health-Triangulated Report,
2021)
Partner to provide access to tele mental health. Recognizing the potential impact of parents/guardians on their children’s
wellbeing and future opportunities, Hinton et al. (2017) conducted a randomized control trial of Triple P Online – Disability
(TPOL-D), a promising telehealth intervention for a mixed-disability group. “At post-intervention parents receiving the TPOL-D
intervention demonstrated significant improvements in parenting practices and parenting self-efficacy, however a significant
change in parent-reported child behavioral and emotional problems was not detected. At 3-month follow up intervention gains
were maintained and/or enhanced. A significant decrease in parent reported child behavioral and emotional problems was also
detected at this time.” (Hinton et al., 2017, p. 74).
Offer increased opportunities for online learning and support (Nieuwboer, Fukkink, & Hermanns, 2013).
Extend frequent opportunities for engagement and connection with school and community professionals (CDC Teacher, Parent,
Student Mental Health-Triangulated Report, 2021)
Increase access to transportation, food resources, employment resources, and low or no cost mental/behavioral health care (CDC
Teacher, Parent, Student Mental Health-Triangulated Report, 2021)
Balance access and online security in online parent support groups (Cypers & Lopez, 2021).
Provide diverse, socioculturally appropriate mental health services and interventions (APA, Working Group for Addressing
Racial and Ethnic Disparities in Youth Mental Health, 2017).
Reduce cultural stigmas associated with mental health (Quirk, 2020).
Community Leaders, Members, and Organizations
Create strong, comprehensive community safety net, in part, by cultivating public (school) private partnerships to provide low or
no cost integrated, interconnected systems of care to children, youth, families, and school personnel (Cheng et al., 2020)
Increase access and parity for mental health services and funding (NASEM, 2021, p. 4; CDC Teacher, Parent, Student Mental
Health-Triangulated Report, 2021)
Increase awareness and widespread use of pediatric B-MH screening (e.g., Bright Futures Toolkit [Winders et al., 2012])
Prepare lay providers for task-shifting mental health services. (Javadi, et al. 2017)
Build capacity and quality of care for mental health and psychosocial support (Perera et al., 2021).
FIGURE 7.3 Mental Health Planning and Preparedness Recommendations

skillfully constructed information and deployed communication based on the sci-

ence of dissemination improves not only school-based services but also overall public
health. Lackluster dissemination undermines both. Simply put dissemination is vital
to effecting change (Ashcraft et al., 2020).
Communication and Content

Drawing on dissemination science (Baker et al., 2021; Purtle et al., 2020) allows
teams to communicate and share information in ways that intentionally accelerate
the impact of mental health research, policy, and practice for vulnerable children
and youth. Based on a synthesis of dissemination literature, we recommend teams
consider Purtle et al.’s (2020) guidance when generating and curating content,
which includes the following: provide information about cost-effectiveness and
economic impact, offer relevant state and local data, ensure clear, concise, and
brief messaging, provide local stories relevant to vulnerable populations (while
avoiding cultural stereotypes), and acknowledge widespread stigma and bias re-
garding mental health. When generating targeted messaging campaigns, teams also
need to pay close attention to reducing cultural stigma regarding mental health
(Cohut, 2020). In doing so, they must plan for whom and how information and
services will be communicated and disseminated to meet differing stakeholder
needs (e.g., vulnerable children and youth, parents, guardians and families, school
personnel, community leaders, members, and providers).
Tailored, Tiered Dissemination

According to World Health Organization (2014) dissemination guidelines, we
recommend teams take a three-tiered approach—disseminating for awareness,
understanding, and action. In Tier I, teams aim to establish and raise awareness
with targeted audiences and groups (e.g., general public) who do not require
detailed knowledge but would benefit from basic knowledge of planning and
preparedness work. Tier I dissemination typically includes press releases, social
media posts or tweets, and so forth, using non-technical language. Dissemination
for Understanding, Tier II, involves targeting several audiences/groups (e.g.,
frontline practitioners, children and youth, parents/guardians, families, com-
munity leaders, members, and providers), directly and intentionally, who would
benefit from a deeper understanding of mental health planning and prepared-
ness. Tier II products typically include newsletters, listservs, stakeholder meet-
ings and convenings, social media posts, and tweets (e.g., private Facebook
groups, Twitter chats, blogs). Dissemination for Action, Tier III, is dissemina-
tion related to a change in orientation. That is, teams intentionally target au-
diences that include stakeholders who are well-positioned to influence or bring
about change within and across the systems that influence children and youths’
mental health issues and determinants. To achieve substantive influence and
change, teams need to be strategic about the audiences targeted not only for
planning and preparedness efforts but also for the policy and research needed to
support those efforts. Tier III products typically include planning and pre-
paredness briefings, research and policy briefings, “Call to Action” campaigns
(through traditional and social media outlets), blogs, journal articles, presentations,
Town Hall meetings, and so forth.
Accessibility
Teams must also dedicate time and attention to determining how they will disseminate
information and communicate not only in multiple languages (IDEA, 2004; OECD,
2021) but also in various formats (e.g., online, in-person, hybrid). For example, when
considering accessibility for deaf stakeholders, team members and leaders need to
provide interpreters for in-person and/or online meetings. Information communicated
and disseminated via online websites must meet Americans with Disabilities Act (ADA)
and Web Content Accessibility Guidelines (WCAG) guidelines.
Coordinate, Collaborate, and Translate Planning into Action

Internationally, during the COVID-19 pandemic, countries with the highest le-
vels of planning and preparation experienced the highest fatalities (Council on
Foreign Relations, 2020). In short, planning did not predict success, which
seemed to have occurred because of poor coordination. This means networks
must plan for and account for behavior change (see Kaslow et al., 2021; Morens &
Fauci, 2007; Schuchat et al., 2011), specifically as it relates to coordination and
collaborative implementation (NAESM, 2021) of mental health and wellness
services within and across the four pillars.
Implementation + Improvement Sciences

Implementation and improvement sciences offer approaches for facilitating change
in systems and individuals (Ovretveit et al., 2021). In recent years, each has been
used with some success in education (Bryk, 2020). However, when looking to-
ward a post-COVID-19 era, given ever-increasing diversity, complexity, and need
in education, a growing recognition is emerging that overlapping the two reduces
disparities for vulnerable populations and allows for quick, responsive change to
occur during pandemics and/or other widespread trauma events (Ovretveit et al.,
2021). Similarly, in public health, change efforts, in large-scale systems and in
individual practices, are increasingly undertaken by combining implementation
and improvement sciences (CDC, 2018; Elkana & Lopez, 2021; Means et al.,
2020). Implementation and improvement sciences do not require exact replica-
tions (Ovretveit et al., 2021). Instead, they offer stakeholders processes, structures,
and principles for determining not only how strategic plans will be carried out but
also how they will be monitored and evaluated (e.g., When? By whom?) in their
unique contexts.
Housed at the University of North Carolina Chapel Hill, and accessible online at
https://nirn.fpg.unc.edu/national-implementation-research-network, the National
Implementation Research Network (NIRN), offers teams a wealth of resources,
including research briefs, tools, templates, and processes for determining not only
how strategic plans will be carried out but also how they will be monitored and
evaluated (e.g., When? By whom?). The Carnegie Foundation also offers resources
that support the application of improvement science, which teams can access online
(https://www.carnegiefoundation.org/our-ideas/). Additionally, when using a com-
bined approach (i.e., implementation + improvement sciences), teams must address
coordination efforts that allow for cost determination (Faherty et al., 2019) and budget
allocations that include reallocations along with any necessary reductions.
Monitor and Evaluate Effectiveness

Successful planning and preparedness work also requires team members to monitor
and evaluate the effectiveness (CDC, 2018; Danforth et al., 2010), during each of
the six phases (Kaslow et al., 2020). In this way, team leaders and members ensure
continual evolution of planning, prevention, response, and recovery services based
on the most up-to-date knowledge, need, and information. Specifically, mon-
itoring and evaluating the effectiveness of mental health service delivery and
outcomes, within and across the four pillars, is vital to determine what is working
for whom under what conditions, what needs to be changed as well as when and
why. The short- and long-term costs associated with each pillar will also need to
be considered to ensure mental health services are effective, equitable, sustainable,
and affordable. Two approaches that support continuous improvement are research-
practice partnerships and plan-do-study cycles.
Research-Practice Partnerships
Coburn et al. (2013) defined research-practice partnerships (RPPs) as “long-
term, mutualistic collaborations between practitioners and researchers that are
intentionally organized to investigate problems of practice and solutions for im-
proving outcomes” (p. 2). RPPs consider the oft-differing needs of stakeholders,
yielding unique benefits for each. Also, as described by Coburn et al. (2013), RPPs
allow stakeholders to explore organizational, work, and individual factors that
support and thwart change efforts, which in this case pertain to school-based
comprehensive, coordinated mental health for vulnerable children and youth.
Specifically, RPPs help to bridge the research-to-practice gap, by improving the
use of EBPs and HLPs, while also producing practice-based evidence. Taken
together, RPPs yield new knowledge and understanding not only about what
makes things worse but also what it takes to make them better. Teams should
consider that RPPs center on high-quality research methods and designs and have
been used effectively to advance evidence-based practiced in child welfare and
child mental health (Palinkas et al., 2016).
Plan-Do-Study Act (PDSA) Cycles

PDSA cycles are an integral component of shared decision-making in RPPs.
Designed for weekly or bi-weekly implementation, typical PDSA cycles are useful
for frontline practitioners and partners who plan for and provide children and
youth with a school-based, comprehensive continuum of mental health care.
However, teams need to consider that for vulnerable children and youth these
timelines might prove too rapid. For instance, for children and youth with dis-
abilities, although the amount of time needed for an evidenced-based math or
reading instruction to be effective varies, elementary children who are not making
progress, or who are failing to achieve, typically require 8–16 weeks of inter-
vention, lasting 30–120 minutes daily (Vaughn et al., 2012). This timeframe
equates to two to four school months.
Allotting for longer PDSA cycles also matters when making a substantive
change in the dosage of a child or youth’s academic, social, emotional, and/or
behavioral intervention because an IEP meeting must be convened, which would
be challenging on a weekly or bi-weekly basis. That said, if the dosage of an
academic, social, emotional, and or behavioral intervention remains constant in
accord with a child or youth’s IEP, yet progress monitoring data, which are ob-
tained twice a week, within the 12-week PDSA cycle, reflect subtle declines in a
child or youth’s performance, then small changes can be made that do not require
modifying the IEP. For example, school personnel or teams might decide to use a
plus/delta chart to gain input from vulnerable children and youth about why they
are not progressing (e.g., mental health intervention is too long, not helpful, or too
negatively focused) and use those data to make changes, such as breaking the
mental health intervention into smaller chunks, recording data, offering positive,
strength-based alternatives, providing feedback, evaluating the results, and de-
termining next steps.
Summary: A Call to Action

In this chapter, we defined mental health, summarized the known impacts of
COVID-19 on mental health, described lessons learned, and offered a model to
guide school and community stakeholders as they prepare effectively for future
pandemics. To maximize successful proactive and reactive approaches, we con-
clude with a Call to Action for science-backed, human-centered planning, pre-
paration, response, and recovery. In doing so, we advocate for increased
investment across sectors, both through financial and human capital, in culturally
responsive mental health education and programming to mitigate longstanding
mental health disparities experienced by vulnerable children and youth, especially
girls, those with disabilities, and/or those who are racially, culturally, and/or
linguistically diverse, with a focus on prevention and promotion of mental health.
The time to commence with planning and preparation is now. Failing to do so
will only contribute further to the “scandalous neglect” of children’s mental health
in schools (see Kauffman & Badar, 2018) and deepen longstanding inequities.
These inequities will have catastrophic effects on current and future generations
and result in short- and long-term human mental health costs that are simply
unaffordable and intolerable.
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8
SUMMING UP WHAT WE
KNOW—AND WHAT WE DON’T
James M. Kauffman, Jeanmarie Badar, Daniel P. Hallahan,
and Paige C. Pullen
We know little compared to what we don’t know about the ways in which
COVID-19 has changed people’s lives and may change them in the future. What
we don’t know can be summarized more succinctly than what we do know. That is
true in part because what we know, or think we know, must be qualified and is
contingent rather than something we can declare without fear of any rational
contradiction. It is also partly true because the pandemic has phases that will con-
tinue and depend on changing conditions and ways of measuring people’s risk and
logical determination of safe social behavior and wise social policies (see Jha, 2022).
The Knowledge Context

The year 2022 is a particularly troubled time for the concept of truth, fact, and
veracity. Some try to parse the difference between truth and fact, holding fast to a
belief that truth never changes, although facts might, yet being uncomfortable
with or contemptuous of the idea that scientific fact may change with new in-
formation or with a change in circumstances. And because science cannot answer
all questions regarding the best public policies, some people believe science is
never to be trusted to answer any questions and that “alternative facts” have le-
gitimacy equal or superior to those supported by empirical evidence. Various false
claims and conspiracy theories are used to bludgeon empirical evidence and dis-
parage the scientists who seek or provide it. Moreover, children and adolescents
are likely to believe adults and may be particularly vulnerable to disinformation
(Moyer, 2022).
In the stew of reliable information, misinformation, and disinformation about
COVID-19, concern for the mental health of children and adolescents is likely to
get lost. If someone truly believes the pandemic and its effects on bodily health are
just the hype of fake news, manufactured for political reasons to scare people into
compliance with government mandates, then it will be easy for that person to deny
the reality of mental health problems of children, adolescents, or adults. At best,
they will believe that mental health problems were caused by phony reports that
did, in fact, scare people.
DOI: 10.4324/9781003264033-8
156 James M. Kauffman et al.
On the contrary, mental health concerns not only increased during the pan-
demic, but these increases were additive to an already escalating public health crisis
(Bernstein, 2022). Between the years 1999 and 2014, suicide was already the
second leading cause of death among children and adolescents and increased by
33% during that time period (Ruch et al., 2019). According to National Surveys of
Children’s Health (NSCH) data, anxiety and depression trended upward over
multiple administrations of the survey from 2004 to the present. Unfortunately,
data from the Office of Special Education Programs Annual Reports to Congress
demonstrate that services provided to students in schools with emotional disorders
(ED) decreased in the same years (see Pullen et al., 2022).
During the COVID-19 pandemic, increases in anxiety and depression have
been documented above and beyond comparisons between 2014 and 2019
(Benton et al., 2022; Hawes et al., 2021; Qin et al., 2021). Between March and
October 2020 emergency room visits related to mental health issues increased for
children from 5 to 17 years old (24% for ages 5–11; 31% for ages 12–17; White
et al., 2021). What we know from these data is that mental health among children
and adolescents has been a public health crisis since before the pandemic, and it has
been exacerbated by the many realities of the past two years.
Given the obvious membership of the individuals contributing to this book in
“the reality-based community,” we can summarize some of what we do not know
and need to find out about the effects of COVID-19 on the mental and physical
health of children and adolescents, as well as adults. It is important to recognize
both what we know and what we don’t know at this point in early 2022.
Although what we do know now is not trivial, our hope is that in the coming
months and years we will be able to say with confidence much more about what
we do know and what we should do to provide appropriate services and support
to children and adolescents.
What We Don’t Know.

First, some things we do not know. Chapter 2 suggested some of the things
needing more research, which is clearly an admission that there are things we
don’t know but hope to find out. Included are many questions about how
virtual and in-person teaching are the same and how they are different and how
future teachers are best prepared. However, all the chapters leave many ques-
tions unanswered. Moreover, although we know the pandemic has had a ser-
iously negative effect on young children’s learning to read, for example
(Goldstein, 2022), we don’t know the immediate or long-term effects of this
deficit on mental health.
Among the things we don’t know are the long-term effects of the disease, not
only on learning but also on mental wellness and physical health. For example, we
do not know the long-term effects on bodily health. What is called “long
COVID,” long-lingering effects on bodily as well as mental health, are not
known.
Summing Up What We Know—And Don’t 157
Possibly, having had COVID will predispose people to have later health diffi-
culties. Other diseases that have long-delayed effects include poliomyelitis (the post-
polio syndrome is well known now) and chickenpox (which later can cause shingles,
a condition against which adults can now be vaccinated). We must entertain the
possibility that a wave of physical and/or emotional problems attributable to
COVID-19 will occur many years after 2019.
We do not know when and how the pandemic will end, or when, or what
variants of the virus will appear, or when they might be detected. We do not
know the extent to which life will return to something approximating the
“normal” that existed before the pandemic (Jha, 2022).
We do not know what effects the easing of mandated vaccination and masking
will have, nor do we know the long-term costs and benefits of either. We do not
know what variants of COVID will evolve, nor do we know when a totally
different pandemic may occur or where it will originate.
We do not know how mental health services might be expanded to meet
the worsened access to needed care. Clearly, mental health services were in-
adequate prior to the pandemic, and one effect of the pandemic has been the
exposure the widespread need for more accessible mental health services for
families, both adults and children (Bernstein, 2022).
What We Know
We do know some things about the pandemic and its management and misman-
agement (Lewis, 2021). What we know is hard, if not impossible, to prioritize—to
mention in the order of importance. The relative importance of what we know will
depend, at least to some degree, on the circumstances and responsibilities of the
reader.
We know that the United States was not well prepared for the pandemic and
that it compares unfavorably to other nations of similar wealth in its management
of the disease. Some nations seemed better prepared for the pandemic and had a
more systematic, consistent set of public health policies in place and/or a more
consistent response of citizens to the disease.
We know that the COVID-19 pandemic has worsened the mental health of
the world’s population, including children and adolescents. Worsening mental
health has been especially characteristic of youngsters who are incarcerated, are
poor, have disabilities, or are among those with some combination of these. We
know that anxiety, anger, uncertainty, disruption of routines, social isolation, and
deterioration of family relationships contribute to the mental/emotional distress of
children and adolescents.
The worsening of the mental health of children and youth caused by the pan-
demic is not imaginary or over-emphasized. It is real and ongoing. In the United
States, the neglect of children’s mental health was scandalous before the pandemic
(Kauffman & Badar, 2018; Warner, 2022). The reality of the pandemic’s effects
makes the creation and expansion of school-based mental health services more
critical than ever. Warner (2022) correctly portrayed children’s mental health ser-
vices as grossly inadequate prior to the pandemic and appropriately described the
crisis created by the pandemic as merely worsening an already terrible situation.
Unfortunately, she did not highlight the importance of schools or special education
in addressing children’s mental health needs.
Another thing we know is that the COVID-19 pandemic has made a lot of
people angry (e.g., Krugman, 2022). Anger has not been limited to any single group
in the United States, nor is it peculiar to the United States. It is found across the
globe among people of all ages, religions, ethnicities, and gender identifications.
Moreover, people are angry for many different reasons. Some are angry because of
what they see as the intransigence of those who disbelieve the scientific community,
trivialize the seriousness of the pandemic, and/or resist mandates or recommenda-
tions that they see as impinging on their personal freedom. Some are angry because
they believe government or nefarious powers are trying to control them or because
they believe a deity will protect them and they have no need for the mandates or
interference of earthly powers. In many nations, especially in the United States, the
pandemic and reactions/responses to it have been highly politicized.
Students have been especially traumatized by the pandemic. Manning et al.
(2022) enumerated nine ways in which COVID-19 has been and is traumatic:
• social isolation
• death of family members
• financial insecurity
• increased possibility of unchecked child abuse and maltreatment
• food insecurity
• school closures
• protests and civil unrest
• school-wide increased stressors
• individual and collective grief
Undoubtedly, we could add to the list, including fear of infection and other
worries, restrictions, and limitations. For example, we know that fear of infection
is sometimes rational for some children with disabilities. Those with chronic
health conditions, especially if those conditions compromise their immune sys-
tems, are particularly vulnerable (Lewis, 2022).
We know also that the COVID-19 pandemic played havoc with the lives of
teachers. They, too, have been traumatized by the sudden expectation that they
teach remotely. Many of their students were unable to join online classes because
they lacked devices and/or Internet connections. Especially for some special edu-
cators, the services they provided in person were simply not things for which online
presentation is appropriate or even possible. Effective instruction and behavior
management are complicated by virtual instruction.
Although not obviously or directly a mental health issue, we know that the
pandemic has most seriously affected the reading of children who are Black,
Summing Up What We Know—And Don’t 159
Hispanic, are from families with low income, have disabilities, and are at risk for
dropping out of school or involvement with criminal justice (Goldstein, 2022). So
far, studies suggest that wearing masks does not interfere with young children’s
language development but wearing them does lessen the chances of their infection
by the COVID-19 virus (Serrano, 2022).
At the same time, we know that some students responded well, sometimes even
better, to the virtual classroom than to in-person instruction (Manning et al., 2022,
discussion with teachers). Some teachers have found virtual instruction exhilarating.
So, although the effects of the pandemic have been traumatic or disastrous for some
people, they were advantageous for others. This seems to be the case for most, if not
all, natural and human-caused disasters.
We know that our responses to any kind of public health crisis will be better if
multiple agencies are coordinated and work together. For best results in any public
health crisis, in the case of COVID-19 or future crises, multiple stakeholders should
work together to create school-based mental health services. School personnel,
researchers, parents/guardians, community members, and mental health service
providers must join in advocacy efforts aimed at securing additional funding for the
mental health workforce. The need for increased school-based (and community)
mental health is clear; however, we also know the COVID-19 pandemic has
wreaked havoc on an already insufficient mental health workforce (Bernstein, 2022).
The state to which schooling will return after the pandemic will not be the
“normal” of the past. For one thing, virtual and hybrid (part virtual, part in-person)
teaching will continue. “Class,” “school,” and administrative units are likely to be
redefined and made available depending on the digital devices and networks to
which students and teachers have access. This holds both the possibility for more
equal access to education and the possibility of continued or widening differeences
in access that depends on the financial resources of families.
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INDEX
Page numbers followed by f indicate figure and by t indicate table
AAP-AACAP-CHA. see American of children, school lockdown and 110

Academy of Pediatrics (AAP), COVID-19 and 37
Academy of Child and Adolescent COVID-19 quarantine and 59
Psychiatry (AACAP), and Children’s Antecedent strategy 48–49
Hospital Associations (CHA) (AAP- Anxiety
AACAP-CHA) CBT and 141
Accessibility, future pandemics and 144 COVID-19 at the school-level and 119
ACEs. see Adverse childhood experiences during COVID-19 pandemic 156
(ACEs) high-school students and 75–76
Active student engagement 41 incarcerated youth and 58
ADDRESSING framework 140 as mental health problem 115t
Adolescents rates during lockdown 108
COVID-19 and experience of stress and school-age students and 81
sadness 38 TRAILS and 139
impact of COVID-19 on 5 Assessment, future pandemics and 136–137
in Portugal, COVID-19 pandemic in
112–113, 114–116t Bainum Family Foundation 77
Adverse childhood experiences (ACEs) Behavioral health pandemic response
75, 139 strategy, phases of 134
Advisory on Protecting Youth Mental Behavioral needs 3–4t
Health 130 Behavior management 46–50
African Americans, COVID cases of 38 BPIS. see Positive Behavioral Interventions
American Academy of Pediatrics (AAP), and Supports (BPIS)
Academy of Child and Adolescent
Psychiatry (AACAP), and Children’s CASEL framework 81
Hospital Associations (CHA) (AAP- CASEL Program Guides, Collaborative for
AACAP-CHA) 129 Academic, Social, and Emotional
Amsterdam, COVID-19 and children Learning (CASEL) Program Guides
in 110 CBT. see Cognitive-behavior
Anger. see also Anxiety; Depression therapy (CBT)
across the globe, COVID-19 and 158
162 Index
CEC. see Council of Exceptional Community(ies)

Children (CEC) development of networks 88
CEEDAR. see Collaboration for Effective leaders, mental health planning and
Educator Development, preparedness recommendations for
Accountability, and Reform 142f
(CEEDAR) resource mapping 88–89
Center on Positive Interventions and Comprehensive, Integrated Three-tiered
Supports 47 (Ci3T) model 78, 79f, 81, 82, 83
Centers for Disease Control and Prevention Comprehensive mental health systems
(CDC), percentage of mental health (CMHS) 77
disorder 2 COPSY. see Corona and Psyche Online
Children Study (COPSY)
COVID-19 and mental health of 36–38 Corona and Psyche Online Study
emergency care in Germany during (COPSY) 100
COVID-19 102 Corona crisis 111
impact of COVID-19 pandemic in Costa Rica, prison for minors in 71–72
Germany 98–102 Council of Exceptional Children (CEC) 39
impact of COVID-19 pandemic on 5 COVID-19. see also COVID-19 pandemic
mental health planning and preparedness as ecological disruptor 10–11
recommendations for 142f impact on effective instruction 42–45
mental health system, Netherlands’ 112 incarcerated youth and fear of becoming
pandemic and worsening of mental health infected 61–62
of 157–158 influence on lives of teachers 29
in Portugal, COVID-19 pandemic in instructional issues in special education
112–113, 114–116t and 23
reading ability, COVID-19 pandemic and in March 2020 20, 34
158–159 mental health lessons 129–130
school lockdowns impact on mental preventing spread by restricting visitations
health 110 60–61
Chronosystem 8f, 9–10 social, emotional, behavioral issues and 24
Ci3T model. see Comprehensive, spread in juvenile correctional facilities
Integrated Three-tiered (Ci3T) model 59–60
Climate, future pandemics and 133 spread of the virus in 2019 1
CMHS. see Comprehensive mental health stress, sadness and 38, 57
systems (CMHS) students experienced mental health
Cognitive-behavior therapy (CBT) disorder 2
139, 141 COVID-19 pandemic. see also Greece;
Collaboration and integration 87 Netherlands; Portugal; Preparing for
Collaboration for Effective Educator future pandemics Tanzania; Vietnam
Development, Accountability, and behavior management and 46–50
Reform (CEEDAR) 39 communication of educators with
Collaborative for Academic, Social, and students during 1
Emotional Learning (CASEL) Program concurrent mental health and 129–130
Guides 79t, 80, 82 ecological systems theory and 7, 8f, 9–10
Communication and content, future effects of 21–22, 35
pandemics and 143 impact of 3–4t
Communication of educators with student, impact on children and adolescents 5, 36
during COVID-19 pandemic 1 impact on effective instruction 42–45
Community awareness, mental health impact on Greek schools and students
literacy and 87–88 104–106
Community Engagement Continuum instructional issues 22–23
framework 12 lessons learned from 29–31
Index 163
long-term effects of 156–157 Germany, COVID-pandemic impact on

management and mismanagement of 157 schools, children and youth welfare
mental health and 156, 157 98–102
schools and Greek government during Giannakopoulos study 107–108
103–109 Girls, incarcerated, COVID-19 and 73–74
silver lining from 30 Government Response Stringency Index 104t
social, emotional, behavioral issues 24 Greece
Crisis intervention 140 COVID-19 and government in 103–109,
Culture, future pandemics and 133 104t
Internet access in 106
Data sharing 89 Gross Domestic Product (GDP), in
DEBH. see Division for Emotional and Greece 103
Behavioral Health (DEBH)
Delivery of mental health services, future Hate crimes, race 5
pandemics and 141, 143 Health Resources and Services
Depression Administration (HRSA) 77
CBT and 141 High leverage practices (HLP) 39
during COVID-19 pandemic 156 HLP. see High leverage practices (HLP)
high-school students and 75–76 Hopeful Futures Campaign 87–88
as mental health problem 115t HRSA. see Health Resources and Services
rates during lockdown 108 Administration (HRSA)
school-age students and 81 Hybrid learning 23–24
Digital services 89–90
Distance learning 1 IEP. see Individualized Education
Division for Emotional and Behavioral Programs (IEP)
Health (DEBH) 137, 139 IES. see Institute of Education Sciences
(IES); Institute of Education
EBPs. see Evidence-based practices (EBPs) Sciences (IES)
Ecological systems theory (EST), COVID- Implementation and improvement sciences,
19 pandemic and 7, 8f, 9–10 future pandemics and 144–145
Educational programs, COVID-19 and InCK model. see Integrated Care for Kids
suspension of 62–63 (InCK) model
Educators Inclusive/practical issues, logistical/practical
behavior management practices of 36 issues in 27
virtual instruction and 38–39 Individualized Education Programs (IEP) 6
Effectiveness, monitoring and Infrastructure, staffing and 43–44
evaluating 145 In-person teaching, logical/practical issues
Emergency care, children and youth in in 26–26
Germany during COVID-19 102 Institute of Education Sciences (IES) 47, 79f
Equity and access, future pandemics Institute of Medicine 76
and 135 Institutions of Higher Education, role in
Evidence-based practices (EBPs) 78, 140 mental health literacy and training 91
Exosystem 8f, 9 Instruction
Explicity instruction 39–41, 48 explicit 39–41
impact of COVID-19 on 42–45
Family(ies) learning and 43
communicating with 86 Instructional behaviors 40–41
COVID-19 and experience of stress and Instructional issues in special education,
sadness 38 COVID-19 and 22–23
COVID-19 pandemic and children of Instructional practices, effective 39–42
low income 158–159 Instruction issues, COVID-19 and 21–22
and social-emotional support 44–45 Integrated Care for Kids (InCK) model 88
Funding, to support school-based mental Internet access, in Greece 106
health 91–92
164 Index
Interval-based approach, future pandemics literacy, community awareness and 87–88

and 134 needs 3t, 4t
needs among incarcerated youth 58–63
Jackson Elementary School prior and during pandemic, youth 37–38
tier 1 for supporting students’ mental stigma, future pandemics and 135–136
health 82–83 Mental health planning and preparedness
tier 2 for supporting students’ mental recommendations 142f
health 83–84 Mental health problems, in children of
tier 3 for supporting students’ mental Tanzania 117
health 84 Mental health system
Juvenile correctional facilities in Netherlands, deficits in 111–112
closures and restriction on visitations in Vietnam 117
60–61 Mesosystem 8f, 9, 10
fear of becoming infected with COVID- Mexico. see also Quintana Roo state
19 61–62 juvenile correctional facilities in 72–74
mental health services to youth 58 Microsystem 8f, 9, 10
in Mexico 72–74 Minors, Costa Rica and prisons for 71–72
quarantine and 61 MOUs. see Memoranda of understanding
spread of COVID-19 and 59–60 (MOUs)
suspension of educational programs Murthy, Vivek 130
62–63
technology use in 63–65 National Center for School Mental Health
in the United States 69–71 (NCSMH) 133
National Health System (NHS) 116, 116t
KEMTE survey 106, 107, 108 National Implementation Research
Knowledge and expertise, future pandemics Network (NIRN) 145
and 133–134 National Surveys of Children’s Health
(NSCH) 156
Language, use of consistent 88 NCSMH. see National Center for School
Learning Mental Health (NCSMH)
instruction and 43 Netherlands
ramifications of COVID-19 45–46 deficits and possible solutions in Dutch
Lessons learned, from COVID-pandemic mental health system 111–112
29–31 impact of school lockdowns on children’s
Logistical/practical issues mental health 110
in inclusive and special education 27 impact of vulnerable groups of pandemics
in virtual and in-person teaching 25–26 to control pandemic 111
Long-term approaches, to COVID-19 Netherlands Institute of Human Rights 109
impact 46 Networks, integrated 88
NIRN. see National Implementation
Macrosystem 8f, 9, 10 Research Network (NIRN)
Management strategies, positive 47–48 NSCH. see National Surveys of Children’s
Matos and Equipa Aventura Social 113, Health (NSCH)
114t
Memoranda of understanding (MOUs) ODR. see Office discipline referrals (ODRs)
77, 133 Office discipline referrals (ODRs) 81
Mental health. see also Mental health system; Office of the Surgeon General 78, 88, 90
Portugal; Students mental health Oklahoma School Counselor Corps grant
advocacy efforts 135 program 92
concerns during pandemic 156 “One-stop-shop” model 88
COVID-19 pandemic and 156, 157 Online education 34. see also Virtual
definitions of 128 teaching
lessons 129–130
Index 165
Online instruction, students with disabilities delivery of mental health services

and 23 141, 143
Opportunities for students to respond equity and access 135
(OTR) 41 implementation and improvement
OTR. see Opportunities for students to sciences 144–145
respond (OTR) interval-based approach and 134
OxCGRT. see Oxford COVID-19 knowledge and expertise 133–134
Government Response Tracker mental health stigma 135–136
(OxCGRT) Plan-Do-Study Act cycles 146
Oxford COVID-19 Government Response providers and recipients 141
Tracker (OxCGRT) 103 research-practice partnerships 145
shared values and dispositions 134–135
Parents summary: call to action 146–147
mental health planning and preparedness tailored, tiered dissemination 143–144
recommendations for 142f team size and effectiveness 133
stress and anxiety during COVID-19 Prevention-focused systems, tiers of 80–81
57–58 Prisons, for minors in Costa Rica 71–72
PDSA. see Plan-Do-Study Act (PDSA) Professional collaboration, COVID-19 and
cycles 28–29
Plan-Do-Study Act (PDSA) cycles 146 Professional learning 86–87
Planning Providers, future pandemic and 141
engaging in culturally responsive Psychological safety, future pandemics
action 136 and 133
providers and recipients 141 Public policy and policy-makers, COVID-
strategic, engaging in 136 19 and 14
translating into action 144
Policy and legislation, school-based mental Quarantine mimics solitary confinement,
health and 92 COVID-19 59
Portugal Quintano Roo state 72
COVID-19 pandemic in 112–116,
114–116t Reach Out program 88
mental health problems in pandemic Recipients, future pandemics and 141
studies and interventions 113, Remote instruction 34. see also Virtual
114t, 116 teaching
mental health problems in pre-pandemic Remote learning in schools, in
studies 113 Germany 102
Positive Behavioral Interventions and Remote teaching 106, 108
Supports (BPIS) 78, 80, 82 Researchers, COVID-19 and 12–14
Post Traumatic Stress Disorder (PTSD), Research-practice partnerships, future
incarcerated youth and 58 pandemics and 145
Practitioner-partnership models 12 Research-practice partnerships (RPPs) 145
public policy and policy-makers 14 Resource data, future pandemics and
researchers 12–14 136–137
Pre-correction, steps in using 49 Resource mapping 88–89
PREPaRE curriculum 140 Robert Wood Johnson Foundation &
Preparedness, response, recovery, and 136 Harvard T. H. Chan School of Public
Preparing for future pandemics 131–146, Health 5
132f RPPs. see Research-practice partnerships
assessment and resource data 136–137 (RPPs)
climate, culture, and psychological
safety 133 SAEBRS. see Social, Academic, and
communication and content 143 Emotional Behavior Risk Screener
comprehensive, coordinated school-based (SAEBRS)
mental health 137, 138f, 139–140 SAMHSA. see Substance Abuse and Mental
166 Index
Health Services Administration Short-term, ramifications of COVID-19

(SAMHSA) 45–46
SARS-CoV-2. see COVID-19 pandemic SMH. see School-based mental
SBMHS. see School-based mental health health (SMH)
services (SBMHS) Social, Academic, and Emotional Behavior
School-based mental health services Risk Screener (SAEBRS) 81
(SBMHS) 137, 140 Social, emotional, behavioral issues,
School-based mental health (SMH) 76–77 COVID-19 and 24
collaboration and integration 87–92 Social and emotional learning (SEL)
communicating with families 86 programs 82–84
community-based factors and 87–92 Social/emotional learning (SEL)
comprehensive, coordinated 137, 138f, programs 81
139–140 Social-emotional support, engagement and
conducting universal screening 44–45
procedures 86 Social needs 3t
consistent language 88 Social Service Provider Deployment Act
data sharing 89 (SodEG) 100
digital services 89–90 Social Skills Improvement System-Social
engaging youth 91 Emotional Learning (SSiS-SEL) 81
funding to support 91–92 SodEG. see Social Service Provider
integrated networks 88 Deployment Act (SodEG)
mental health literacy and community SRSS-IE. see Student Risk Screening Scale
awareness 87–88 for internalizing and externalizing
partnership with policymakers, medical behaviors (SRSS-IE)
professionals, and community SSIS-SEL. see Social Skills Improvement
agencies 85 System-Social Emotional Learning
policy and legislation 92 (SSiS-SEL)
professional learning 86–87 Staff, correctional 71
resource mapping 88–89 Staffing and infrastructure 43–44
training and staffing 90–91 Stress and sadness, COVID-19 and 38, 57
Schools. see also Jackson Elementary School; Student achievement, principles correlated
Online education; School-based with 40
mental health; Schools lockdown Student Risk Screening Scale for
closing around the globe 1, 21 internalizing and externalizing
closures 107, 110, 112, 113 behaviors (SRSS-IE) 81
community agencies and 77 Students. see also Students with disabilities
effects of pandemic on students and 35 COVID-19 pandemic and 158
Greek government during COVID-19 with depressive episode and mental health
and 103–109 treatment 75
impact of COVID-19 in Germany on high school, emotional and mental health
98–102 issues and 75–76
implementation of SMH supports 85–92 impact of COVID-19 on 38
pandemic and mental health in 75–76 perceptions of positive outcomes 29–30
remote learning in Germany 102 and social-emotional support 44–45
resource mapping 88–89 Students mental health
Schools lockdowns agencies and organizations with resources
in Greece 106, 107, 108 for 79t
in Netherlands 110, 111 impact of COVID-19 pandemic on 107
to reduce transmission of COVID-19 60 Students with disabilities
SEL programs. see Social and emotional COVID-19 and 6
learning (SEL) programs instruction to 23
Sentio Solutions 107 views of 27–28
Shared values and dispositions, future Substance abuse, incarcerated youth and 58
pandemics and 134–135 Substance Abuse and Mental Health
Index 167
Services Administration (SAMHSA) UKE. see University Hospital (UKE)

75, 76, 77, 139 United Kingdom, COVID-19 pandemic
Suicide effect on mental health 6
during 1999 and 2014 156 United States
youth and rates of 37 adoption of tiered systems of support 78
Suicide ideation, incarcerated youth and 58 allocation of funds to mental health
Surgeon General Advisory 80, 89 services 6
Systematic universal screening procedures budget for School-based health
81–82 professionals’ program 90
COVID-19 and mental health disorder
Tailored, tiered dissemination, future students 2
pandemics and 143–144 juvenile correctional facilities in the
Tanzania 69–71
challenges limiting mental health care 117 low-income areas, pandemic and 35
COVID-19 pandemic in 116–120 preparation for the pandemic 157
data collection in 118 Universal screening procedures,
effects of COVID-19 at the community conducting 86
level 120 University Hospital (UKE) 100, 101
effects of COVID-19 at the household University Medical Center (UMC),
level 118–119 Amsterdam 111
effects of COVID-19 at the individual Urgency declarations, uniting for 130
level 118 US Department of Health and Human
effects of COVID-19 at the school level Services 77
119–120
Teachers. see also Educators Vietnam
in 2020-2021 44 data collection in 118
COVID-19 pandemic and 158 effects of COVID-19 at individual
personal issues for 29 level 118
providing feedback to students 42 effects of COVID-19 at the community
Teaching. see also Instruction; Virtual level 120
teaching/instruction effects of COVID-19 at the household
Teaching, remote 106, 108 level 118–119
Team size and effectiveness, future effects of COVID-19 at the school level
pandemics and 133 119–120
Technology, use in juvenile correctional Vietnam, COVID-19 pandemic in
facilities 63–65 116–120
Telemental health 89 Virtual environment
Telemental health services 135 challenges of 44
Tiered systems coordination of services and 28
prevention-focused systems 80–81 secondary students and 24
role of 78, 80–85 teachers and learning new 36
systematic universal screening procedures Virtual learning 1, 21, 22
81–82 advantages and disadvantages 30
targeted social and emotional learning Virtual teaching/instruction 20, 22, 24
programs 82–84 challenges of educators and 36
TRAILS. see Transforming Research into logistical/practical issues in 25–26
Action to Improve the Live of Students students with disabilities and advantages
(TRAILS) of 27
Training and staffing, school-based mental
health and 90–91 What Words Clearinghouse (WWCH)
Transforming Research into Action to 79t, 82
Improve the Live of Students Whole School, Whole Community, Whole
(TRAILS) 139 Child (WSCC) Model 137
168 Index
WSCC Model. see Whole School, Whole incarcerated, implications of measures for 72
Community, Whole Child (WSCC) incarcerated, implications of reducing risk
Model of outbreak 71–72
WWCH. see What Words Clearinghouse incarcerated, mental health needs among
(WWCH) 58–63
mental health planning and preparedness
Youth recommendations for 142f
in community-based solutions, mental health prior and during pandemic
engaging 91 37–38, 58
emergency care in Germany during mental health system, Netherlands’ 112
COVID-19 102 pandemic and worsening of mental health
impact of COVID-19 pandemic in of 157–158
Germany on 98–102
incarcerated, anxiety and 58 Zoom
incarcerated, COVID-19 quarantine communication via 1
and 61

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The Mental Health and Well-being of Children and Adolescents

James M. Kauffman, Ed.D., Professor Emeritus, University of Virginia, USA.

Jeanmarie Badar, Ph.D., Independent Scholar, Afton, Virginia, USA. Dr.

Books in the series include:

Edited by James M. Kauffman and

British Library Cataloguing-in-Publication Data

Library of Congress Cataloging-in-Publication Data

ISBN: 978-1-032-20528-1 (hbk)

List of Figures vii

1 A Sketch of the Problem 1

2 Addressing the Need for Research into the Effects of

3 Virtual and Personal Academic Instruction and Behavior

4 How COVID-19 Worsened the Mental Health Problems of

5 School and Community Reforms that Help Navigate the

6 Students’ Mental Health Issues in Europe and Other

7 Preparing for Future Pandemics: A Science-Backed,

8 Summing Up What We Know—And What We Don’t 155

1.1 Ecological Systems Theory and COVID-19 Pandemic 8

1.1 Social, Emotional, Behavioral, and Mental Health Needs 3

examined various approaches for promoting the mental health of children in

Bernd Ahrbeck, Ph.D., is a Professor of Psychoanalytic Paedagogy at the

Sarup R. Mathur, Ph.D., is Ryan C. Harris Memorial Professor in Special

Professor at the London School of Hygiene and Tropical Medicine (LSHTM),

Impact of COVID-19 Pandemic Citation

Impact of COVID-19 Pandemic Citation

manifestations of anxiety, including clinginess, inattention, irritability, and obsessive

that, globally, adolescents during 2019–2021 experienced higher levels of stress,

Purpose of The Remaining Pages of the Chapter

Applying Concepts of Ecological Systems Theory

FIGURE 1.1 Ecological Systems Theory and COVID-19 Pandemic

The developing child or adolescent (herein referred to as a child) is directly in-

COVID-19 as an Ecological Disruptor: An Illustration of

• lockdown (March 2020)

Where Do We Go From Here?

Researchers need to draw on rigorous designs that will allow us to understand

Public Policy and Policy-Makers

Connelly, F. M. , & Clandinin, D. J. (1990). Stories of experience and narrative inquiry.

during COVID-19: A meta-analysis. Journal of American Medical Association, 175(11),

General Effects of the Pandemic

Instructional Issues in Special Education

students in hybrid learning than normally exist in a secondary school environment,

Social/Emotional/Behavioral Issues in Special Education

Logistical/Practical Issues in Virtual and In-Person

Logistical/Practical Issues in Inclusive and Special Education

• Limited opportunity for group work in class because of social distancing

• Ups and downs of the pandemic, breakthrough infections, especially with

Collaboration with Others

Personal Issues for Teachers

Lessons Learned and Hope for the Future

Students’ Perceptions of Positive Outcomes

• Some children developed new hobbies

Other Possible Positive Outcomes

needed on the effects on academic achievement and mental health problems of

NBC News (2021, February). Kids under pressure. https://www.challengesuccess.org/

Effective Instructional Practices

A group of research-supported instructional behaviors used to design and

through clarity of language and purpose, and reduction of cognitive load. It

Ellis and Worthington (1994) conducted a research synthesis on teacher effectiveness

1. Focus instruction on critical content.

The elements of explicit instruction are not novel approaches to instruction.

Active Student Engagement

Effective feedback must be strategically delivered and goal directed;

Hattie and Timperley (2007) provide a model of feedback to enhance learning. In