There are approximately 1343 licensed and operational childcare centers and family child care homes in the county. Over a 4 week period of time (March 24-April 21), all operating centers were eligible to receive services. Given the widespread impact of the pandemic, the number of operating centers went from 1343 to 266 during the 4 week time frame. Of these, 95 providers completed the Risk and Resiliency survey. See Table 1 for sample demographic information.
This program was funded by a local agency, The Children’s Trust, in a large metropolitan community. The Jump Start program (in existence prior to COVID–19) provides in-person mental health consultation services to childcare centers to improve their capacity to work with challenging behaviors and reduce rates of expulsion in children ages birth to five. Services targeted center directors and teachers using an Infant/Early Childhood Mental Health Consultation (I/ECMHC) model (Hunter et al., 2016)). On March 16th, all in-person consultation services provided via the Jump Start program switched to a complete virtual model. Recognizing that childcare providers were overwhelmed with the current demands related to the pandemic, the program received funder approval to shift focus to provide COVID–19-related support.
To guide implementation of these supports, Jump Start utilized the Inter-Agency Standing Committee Reference Group for Mental Health and Psychosocial Support (MHPSS) in Emergency Settings (Inter-Agency Standing Committee, 2020). This provided a list of 14 globally recommended activities that should be implemented as a response to the COVID–19 pandemic. Those activities have been outlined in the document “Briefing note on addressing mental health and psychosocial aspects of COVID–19 Outbreak-Version 1.0” (Inter-Agency Standing Committee, 2020). Recommendations included integrating multiple levels of interventions within outbreak response activities. Jump Start adapted these MHPSS activities in response to COVID–19 (see Table 1).
To quickly and efficiently implement all 14 MHPSS recommendations, the Jump Start program rolled out three phases. Phase 1 consisted of workforce development corresponding to MPHSS recommendations 1, 3, and 5–9. By March 20th, Phase 2, a needs assessment survey, was developed as suggested by MPHSS recommendations 1, 3, and 14. Shortly thereafter, Phase 3, a tiered response system, was in place to address childcare center concerns regarding COVID–19, in accordance with MPHSS recommendations 2, 4,and 10–13. Given the urgency for providing these services, phases overlapped. For example, workforce training occurred in conjunction survey development and toolkit assembly.
Phase 1: Workforce Development (MHPSS #1, 3, 5–9)
Twenty-six existing Infant/Early Childhood Mental Health Consultants shifted their roles from providing mental health consultation focused on challenging behaviors in children to consultation focused on COVID-related issues. The consultants completed a 6-item survey that assessed their comfort and skills in providing COVID–19 support services in a virtual format. The survey was reviewed with their supervisors to develop an individualized training plan to ensure competent care. Two overall training needs (i.e., supporting young children during the pandemic and grief and loss) were identified by most consultants in the team. Therefore, a 3-hour seminar titled “COVID–19: Supporting Young Children in Uncertain Times” aimed at using a trauma-informed approach was developed to provide additional training. Topics included working with caregivers who had adverse childhood experiences, identifying child abuse, and the potential traumatic impact of this pandemic on young children and families. Through a trauma-informed lens, this presentation also provided tips for parents, educators and health professionals to speak to children about this pandemic. Additionally, the training addressed strategies to best support and build resiliency in both caregivers and children. This training helped shape the role of childhood professionals in mitigating children’s psychological harm from the COVID–19 pandemic.
A second seminar provided to the Jump Start staff was titled, “Supporting Grieving Children and Families: COVID–19 Factors.” This training provided an overview and comparison of grief responses in young children and adults, COVID–19-specific stressors that must be considered when individuals are grieving, and guidelines for consultants to both help themselves and their clients. This training also addressed multiple losses that individuals may experience which may complicate the grieving process. A recent study suggests that clinicians who had some training in grief reported greater self-efficacy for working with bereaved children (Waver, 2019). This training aimed to empower the Jump Start consultants with the tools they need to address grief reactions in the children, parents, teachers and other school personnel with whom they work.
In addition to these two scheduled trainings, consultants took advantage of web-based training opportunities provided by the University on delivery of virtual services via telehealth. Zoom was the identified virtual platform to utilize. In addition, all consultants completed the 8-hour online course “Psychological First Aid,” (NCTSN Learning Center, n.d.) about the essential psychosocial care principles and making necessary referrals. Consultants also participated in weekly mindfulness exercises with a trained professional to manage their own stress and incorporate individual resiliency planning. Other online seminars were completed on an individual basis, based on each consultant’s training needs. Clinical supervisors were mindful of each consultant’s personal circumstances and were flexible and supportive, taking time in weekly supervision sessions to check in individually and discuss effective coping strategies. Finally, the University kept the staff informed daily about COVID–19 current events, evidence-based practices for preventing transmission, seeking healthcare support, and tips regarding psychosocial wellbeing.
Phase 2: Assessment of Needs (MHPSS # 1, 3, 14)
The Risk and Resiliency Survey was distributed to all childcare facilities that were operating between March 24 and April 21. All 1343 childcare centers were called two-three times over the 4 week period. Two hundred and sixty six providers were open at some point during the 4 week period. The survey was administered via phone and entered into Qualtrics or the Qualtrics link was emailed to the provider to complete at their leisure. Given the time of crisis, and the fact that this was not designed to be a research project but rather a service program, services were not withheld if the survey was not completed.
Phase 3: Resource Provision (MPHSS 2, 4, 10–13)
Survey responses from the Qualtrics database were compiled twice weekly by the program manager and triaged to a consultant who served the zip code of the center or had a previous relationship with the provider. Once the consultant received the survey, she developed an individualized Risk and Resiliency Action Plan that highlighted the identified needs based on the scores from the survey. The Action Plan provided the caregivers with a tiered level of support services with six levels ranging from an online toolkit to weekly individual virtual consultation (see Table 4). The providers that were contacted but did not complete a survey also had a consultant assigned to them so that an Action Plan could be developed. The Action Plan determined which of the six tiers of service (from least to most support) the participant could benefit from and the tiers were not mutually exclusive. That is, some participants needed multiple levels of support. These tiers aligned with the intervention pyramid for mental health and psychosocial support as defined by the Inter-Agency Standing Committee (Inter-Agency Standing Committee, 2020), ranging from addressing basic services to providing specialized services for individuals with more severe conditions.
Tier 1. Multi-modal/media/lingual COVID–19 Online Toolkit & Resource Hub. A website was developed to house the on-line tool kit, videos, and calendar of workshops. Content was organized around six pillars chosen based on the WHO COVID–19 Healthy Parenting Guidelines (World Health Organization, 2020): Helping manage worries about COVID–19; Responding to early learning program needs due to COVID–19; Managing the behavior of the children in class that may be related to fear/anxiety related to COVID–19; Accessing resources in the community in response to COVID–19; Access to balanced meals during COVID–19; and Upholding the recommendations of handwashing, social distancing, and creating a routine/schedule. An online toolkit, which was a compilation of resources, was curated based on these pillars. The Jumpstart website was modified to include an area with COVID–19 resources for both childcare providers and caregivers. The web page for childcare providers included tips for early learning programs based on CDC guidelines. This page also contained a video developed by the Jumpstart team to assist childcare providers with implementing CDC safety guidelines. The Jumpstart COVID–19 resources page contained information geared towards caregivers as well, including information on explaining COVID–19 in a developmentally appropriate manner, supporting social and emotional health, physical health, and activities for kids. Animated videos were developed and housed on the website in English, Spanish, and Creole, including one to help young children understand social distancing.one. All video content created was also made available on the Jumpstart YouTube channel.
Tier 2.Referrals for Supportive Services in the Community: Food, Unemployment benefits, Free/low-cost Wi-Fi, Telebehavioral health services, Trauma services, External online resources.
Tier 3. One-Time Phone Call for Support (e.g. stress management). This included the establishment of a warm line. Select consultants were trained in stress management and community referrals. These consultants provided available blocks of time during which an interested participant could call in or schedule an appointment at a later date.
Tier 4. Virtual Workshops/Webinars related to Parenting Skills, Child Development, and COVID–19 for Teachers, Directors, and Parents. The Jump Start team gathered and vetted workshops/webinars that were available online. A calendar of events was created and posted on the Jump Start website.
Tier 5. Virtual Peer Support Groups for Directors, Teachers, and Parents. Jump Start Mental Health Consultants facilitated weekly peer support groups via Zoom in English and Spanish. A fourth type of peer support group, for family child care homes, was created based on the needs of the community. Mental health consultants tailored the group to their needs, as many of these family child care homes remained open during the pandemic, and had expressed different demands and challenges than larger centers. All groups provided an opportunity for the members to support each other and express their concerns in a safe environment.
Tier 6. Virtual Individual Consultations with a Mental Health Consultant. Consultations were tailored to needs that participants identified when they completed the survey and through the creation of a COVID–19 Action Plan. Some topics of consultations included reopening procedures, CDC guidelines, preparing caregivers and children for the “new normal”, managing challenging behavior due to fear/anxiety, providing resources for distance learning, facilitating use of new technology in the center, community referrals, and managing their own stress.
Demographic information was compiled via review of records for participants previously enrolled in Jump Start. For new participants, demographic information was collected via phone interview.
Risk and Resiliency Survey
A Risk and Resiliency Survey based partially on previously validated measures was developed to assess the impact of the viral epidemic on mental health in childcare providers. We adapted 12 items from the Everyday Stressors Index (Hall, 1983) to assess the degree of caregiver distress regarding finances, employment, health of family members, transportation, housing, and relationships. Two novel items were added to assess concerns related to childcare and schooling from home. Each item was adapted to specify concerns “as a result of COVID–19,” and was rated on a Likert scale ranging from (1) not at all bothered, (2) a little bothered, (3) somewhat bothered, (4) bothered a great deal, or (0) don’t know.
We used nine selected items from the Experiences Related to COVID–19 Questionnaire (Skinner & Lansford, 2020). Items assessed sleep, anxiety, sadness/depression, anger, eating, arguments, and hopefulness regarding the future along a four-point Likert ranging from “strongly disagree” to “strongly agree.” Participants also provided a global rating of how personally disruptive the COVID–19 pandemic has been to daily routines, work, and family life ranging from 0 (not at all) to 10 (extremely).
We assessed providers’ use of ten coping strategies, including mindfulness and relaxation, eating well-balanced meals with family, connecting with others virtually, physical activity, protective health behaviors (e.g., handwashing, social distancing), enjoying activities, engaging in fun activities for children, engaging in fun activities for children with special needs, resources to talk with children and families regarding COVID–19, and resources to manage challenging child behavior. Participants endorsed current use of each strategy (yes or no), and indicated whether they were interested in learning more about each.
Eight items based on the WHO COVID–19 Healthy Parenting Guidelines (World Health Organization, 2020) assessed provider self-efficacy along a four-point Likert scale ranging from “not at all confident” to “very confident.” Providers rated confidence in managing their own and their children and families’ worries related to COVID–19, responding to early learning program needs, managing child behaviors, accessing community resources in response to COVID–19, accessing well-balanced meals (based on U.S. Household Food Security Survey), remaining positive, and upholding CDC recommendations of handwashing, social distancing, and maintaining a schedule.
Eight additional items assessed telehealth readiness and acceptability. We assessed the urgency of providers’ need for telehealth services (i.e., I don’t want services at all, I can wait, or I want services right now). We used a checklist to evaluate provider preferences for one or more remote/online service according to the six tiers of support (see Table 4).