After more than a year of virtual learning and social distancing, many children and teens continue to struggle with depression and anxiety.

This Mental Health Awareness Month, we explore the pandemic's impact on the mental the wellbeing of our youth, and local resources to help.

That and more.

Stay with us as we dive into Your South Florida.

Hello, and welcome to Your South Florida.

I'm sure Chira Cassel, CEO of Children's Bereavement Center and your guest host for today's program.

This past year, has been difficult for many as we've had to adjust to a new world full of social distancing and uncertainty.

But while some adults might be better equipped to manage these challenges, our youth continue to struggle.

A study by the journal, Psychiatry Research, shows there has been a "Strong negative mental health impact "on children and teens due to the pandemic.

"The impacts were even greater if the child "came from an economically disadvantaged family, "or were dealing with pre-existing mental health conditions."

As part of our most recent town hall, I was joined by Maureen Dunleavy, Regional Vice President for Guidance/Care Center, Inc, and Board Certified Psychiatrist, Doctor Michelle Chaney, to discuss the pandemics impacts on the mental health of children and teens, and local resources to help families.

Let's start by talking about the warning signs of mental health issues in young children.

A recent report from the CDC noted a surge in mental health related emergency room visits, among children throughout the pandemic.

Doctor Chaney, what changes in behaviors should parents be looking out for, to avoid having to go to the ER for a mental health crisis, and are the signs different in older children's versus teens?

I think it's not always easy to recognize when someone is struggling, especially if they aren't particularly forthcoming with their emotions.

And families really want to look for changes in behavior and changes per personality, that can hopefully prevent a trip to the emergency room, when there's a more acute crisis going on.

So if your child is isolating themselves more, not talking as much, not enjoying activities that used to bring them joy, as well as expressing kind of a decrease in motivation.

These are all red flags, especially if they're not taking time to connect with any friends even virtually.

As though paying close attention to changes in sleep is very important.

Your child is too little, or suddenly all the time during the day, and perhaps still reporting that they're fatigued.

In addition, reporting challenges in concentration and an appetite, gaining or losing weight, these are other signs that their mood may be negatively impacted.

So young children may not have the vocabulary or even the understanding to articulate what they're feeling, and may report more physical symptoms including stomach aches or headaches, and younger children may also regress and become clingy and more demanding, often fearing separation from parents.

For adolescents and older teens, their experience may interfere in this important developmental period of building autonomy and independence from family.

So the loss from this pandemic has been particularly profound in this age group.

Many may appear more irritable and argumentative.

It's also important to look out for signs of substance use and any expressions of suicidal ideation.

Maureen, Guidance/Care Center works closely with Monroe County Schools.

You've said you have noticed an increase in mental health needs for students there.

What are the issues that students are dealing with, and how has the center mobilized to help?

We've definitely seen an increase and anxiety in the children that we serve.

Things like having panic attacks or worries come up.

And historically, I've worked with children my whole career.

We know that springtime is a vulnerable time for students 'cause it's usually the last quarter before summer break, there's a lot of testing going on.

We are particularly vulnerable in the Keys and in South Florida, because hurricane season is approaching, and for those children that have been through hurricanes previously, that can also increase anxiety.

So what we've done in our community is we've co-located all of our children's counselors to be in the Monroe County Schools, to provide outreach to be available to help sprain, handle crises, deal with any of the issues that are happening.

We did that also during the pandemic virtually, and of course, reintegrated as the schools went back to five days a week.

We also have a mobile crisis response team in Monroe County, which is a 24 hour phone access to be able to reach a person if you're having a behavioral health crisis.

And crisis counselors and peers will actually come out to either the school or the home, to help deescalate that crisis, up to triage and figure out what will be helpful, plan, enroll and link those individuals to the services that our community provides.

I know that also there are mobile crisis response teams in other areas of Florida.

I know that Banyan also has one through Miami Dade County.

So I'm know that they're also available throughout the state.

Childhood trauma, like exposure to violence, can severely affect youth and have long lasting impacts on their mental and physical health.

Earlier we spoke with licensed mental health counselor, Stephanie De La Cruz, Clinical Director at the Center for Child Counseling in Palm Beach County.

She tells us about the center's initiative to fight the impacts of childhood trauma, and other ways they're working to help the community.

I'm on the sky.

I'm Stephanie De La Cruz, I'm a licensed mental health counselor.

I'm the Clinical Director for Clinical Services at the Center for Child Counseling.

The Center for Child Counseling has a variety of different programs, where we specialize in different ages or presenting concerns.

So we do have our Child and Family Center, where we're able to provide services for children zero to 18 and their caregivers.

We strongly believe that it's important for caregivers to also attain mental health services if needed, to help them with their natural supports and with their skills because we know that impacts the children tremendously, with their mental health.

We're able to provide a variety of different online trainings.

We have some that are in Spanish and in Creole, so that caregivers who have different languages are also able to obtain those trainings.

And then we have our Childcare and Community Social-Emotional Wellness Program.

And that's one of our programs were co-located in various childcare and elementary schools and Palm Beach County.

And we are able to provide the classroom assistance, the support, the observations, and the assessments.

We provide preventative groups where we are teaching all of the children in the classroom, about identifying emotions, about how to use different coping skills.

We don't want to wait until a child has a diagnosis, or is having challenges, or being suspended or getting Baker acted.

We serve variety of different communities within Palm Beach County.

A lot of them are high risk and with low social economic status.

We wanna make sure that we're targeting children and families who have a history of traumatic experiences, and we wanna make sure that we're able to be available to them.

Our other program is our Childhood Trauma Response Team, where we're collaborating very closely with a dependency system, to help children who have been removed from their biological families, who have a history of child abuse or neglect or household dysfunction.

In regards to our ACEs initiative, what we are doing is approaching ACEs.

So adverse childhood experiences, and a public health approach so that we're able to help children and families and communities healed from those adverse experiences.

Hi guys.

Hi, how're you?

This past year has been extremely challenging for a lot of families, children that may have been doing well prior to the pandemic and their families have gone through a lot of different changes, some different losses.

And so we have been able to assist in providing therapy services to address some of those challenges.

So let's take four of these One of the things that we had to be a little bit creative about through this past year is the means of providing the therapy services because our agency, one of our main interventions is play therapy.

And as you can kind of see from my background with the sand tray and the different figures, we wanna make sure that the children have the tools that they need to be able to process their traumatic experiences.

And so we believe that with play.

that the toys are their words and play is their language.

We're very grateful that we were able to get some donations to be able to create individualized play therapy kits, that children are able to utilize at home.

I really do feel like it has been highlighted a lot throughout the last year, the importance of mental health, and that prevention is really key.

We don't have to wait until it's a crisis.

This is just how I feel right now, and what are some healthy choices that I can make, to be able to manage those feelings and those experiences The rise in domestic violence this past year has been called a pandemic within a pandemic.

Victims have essentially been isolated with their abuser.

Dr. Chaney, what signs should others be aware of if they feel a child might live in a violent household?

And what is your approach to helping children exposed to this kind of trauma?

Yes, I think that we need to be aware that children have been specifically vulnerable to abuse during COVID-19.

A research shows that increased stress levels among parents is often a major predictor of physical abuse and neglect of children.

And stressed parents may be more likely to respond to their children's anxious behaviors or demands in aggressive or even abusive ways.

And with millions of parents are already struggling with low wage work, lack of affordable childcare, meeting their family's basic needs, the stress has increased exponentially in the time of COVID.

So such conditions may stimulate violence in families where it didn't exist before the pandemic, and worsen situations in homes where mistreatment and violence has already been a problem.

We know that 60% of the time there is domestic violence between partners, there's also violence towards children.

So I think being aware of this increased risk is really important.

And also being aware that children are at additional increased risk if their parent or caregiver has mental health challenges themselves.

If the child has a mental health or developmental disorder, if there's additional financial insecurity in the home, history of interpersonal violence and a history of parent or caregiver substance abuse.

So some signs when talking to children to be aware of, although often difficult to see, if there are any kind of physical signs like cuts or bruises or expressions of pain, if you are working or playing with a child if there's any signs of traumatic play, or lack of personal care or hunger, does the child look fearful or shut down in the presence of a caregiver?

I think we also wanna try to take action to alert victims of abuse that there is help available.

There's a number of hotlines, the National Domestic Violence Hotline, the Child's Help National Child Abuse Hotline, even the local department of children and family services.

If people really don't know where to go, can be a helpful resource.

And so I think that's really important.

Personally, I think the threshold for screening for domestic violence in my practice have been lowered even more than before COVID.

And I think I really try to use a trauma informed care approach, to try and help build resilience in my patients, and connect the child and the family to resources in the community that can be most helpful.

And I think too, with what Dr. Cheney saying that creating that sense of safety, really tuning into ask questions, not be afraid to talk about it, and to connect people to resources is really what's key.

How does Guidance Care Center, help kids who have been exposed to trauma?

So we have a whole host of services, everything from prevention to like we talked about our Mobile Crisis Response Team.

We also have a Community Action Team, which is for a youth and young adults who are at highest risk of being hospitalized, or in the Department of Juvenile Justice.

We also work very closely with the child welfare system here, and help to not only assist children that have been removed from the home, but also in those cases where there is high risk, because maybe there's a substance abusing parents, or there are other risk factors to help provide wraparound services to that family, so that youth can stay safely in the home.

Have you also been receiving Maureen a higher volume of domestic violence related trauma calls as well?

I would say that definitely we've had an increase in all types of calls.

We looked at the numbers in the past year and we had about a 5% increase in our services from the year and have provided about 15% more services than we have in previous years.

So the need is definitely there.

Our Mobile Crisis Response hotline, fields all calls.

So we handle any call from any resident who is having a behavioral health crisis, or just needs to be connected to resources.

And of course I mentioned earlier that if it is a youth that is having a mental health crisis or may need to be hospitalized, we are going to help go out and deal with that situation.

So hopefully get them connected to treatment and services.

We do a lot of screening as Dr. Cheney mentioned also where, we're looking at the person in front of us and we're looking at safety, we're looking at, are they feeling suicidal, is there domestic violence in the home, are they using substances?

Are there any issues of child abuse?

Obviously we're all mandated reporters so we have to report those things as well.

But the goal is always to keep the person safe, and to help to provide treatment.

Dr. Cheney, for any teens that may be watching now, what advice do you have if they're scared to ask for help?

And also maybe for something to the parents or guardians who are unsure of where to start?

I think just acknowledging that it can be very scary, to reach out for help, and often reaching out for help is the hardest part.

So I think recognizing that you are not alone and that there are resources out there that can help you get through this.

So the pandemic is, I think we may have mentioned earlier, it's increased the conversation a lot about the importance of mental health needs.

And I think has helped to reduce some of the negative stigma, that has previously been associated with mental health and reaching out for help.

So I would, if possible and you feel comfortable trying to reach out to someone that you trust, it's your parent, teacher, your pediatrician, that is always a great place to start.

And if you don't feel comfortable there are anonymous hotlines that are available.

The National Suicide Hotline, there is a Crisis Text Hotline.

There's lots of resources online affiliated with NAMI, and if you go to their website there's lots of different resources that you be can connected with, and get help for crisis, or then connected with other resources in the community.

So I would also say a similar thing to parents.

Again, reaching out for help can sometimes be the hardest thing to do.

And I think again, just recognizing that you're not alone.

Similar to children reaching out for help, reaching to somebody that you trust, is a really good place to start.

Like your child's pediatrician, guidance counselor at school.

And also kind of the the NAMI's resources that I mentioned before for a teenager also applies to parents.

They have a wonderful peer to peer support groups and other types of options that can be incredibly helpful.

Research indicates that half of all lifetime cases of mental illness begin at age 14.

Can either of you maybe speak to why that is?

When we talk about anxiety and depression, these are treatable disorders, but they're not curable.

So I think that's the other piece when we talk about mental health, when we're talking about teens or we're talking about adults as in our lifetime we're gonna manage these feelings and issues.

And sometimes we're gonna manage better than others depending upon what's going on in our life.

So to build up a toolbox of coping skills and different things that we can utilize and not to be afraid, As Dr. Cheney mentioned, to reach out for help.

Reaching out for help does not mean that you failed.

It means that at this point in time, I may need a little bit more assistance than I will later in life.

It's not a forever life sentence, it's just managing in the moment.

So the more tools that people can have whether that's learning to the things that we tell ourselves, and working with a therapist, or it's medication, or we're in the hospital for a short time, or we learn natural coping skills like connecting with someone we trust or being out in nature, are all different things that can help us move towards managing those feelings and in a productive way.

Maureen, I'm also wondering how have you tried to stay connected to the Keys community during this pandemic?

What has been your biggest challenge?

We've tried to stay very visible and raise awareness that help is available.

I know a lot of individuals families were struggling financially, and we're worried about, well I can't reach out for help, I can't afford it.

And we will help you whether you can afford it or not.

So we've tried every medium we could to raise that awareness whether it was being on the radio, or press releases, or doing outreach in the community.

Throughout the pandemic we were open and available.

People could walk in or call, and so just to let people know we were there and not to be afraid to reach out.

So we've tried to stay connected in many ways and I've told people, that when you reach out to others, when you make the effort to stay connected, that helps you as much as it helps the other person.

So the more that you do that whether you reach out to a neighbor, a family member, or friend or someone at school, in any way of connecting whether it's text or call or FaceTime, you're also really helping your own mental health as well.

So I think that was the biggest thing that we'd done.

And obviously with isolation and having to having things shut down, and having everyone's anxiety spike, were the definite challenges, having all of the need.

And I think when you talk about all of us that live in South Florida, like we're going through it too.

So yes, you're feeling anxious, but I'm also feeling anxious because of, I'm going through the same experience you are.

And so we wanna obviously help share the tools to get through it together.

So what do you think about if there are parents or guardians out there who are, nervous to broach the subject of, are you okay with a child?

Do you maybe have some words of advice for them out there?

I think again, it's understandable to perhaps be nervous about talking to your child's if you've never broached this subject with them before.

But I think COVID, and everything that has come from COVID, has given an opportunity to kind of check in.

You can start by just having a conversation about what's going on kind of in the community, and doing a check-in, perhaps just as a place to start.

Again, talking about this as a shared experience, trying to normalize what's happening and how everybody has been struggling, and just then kind of shifting that to talking more directly to your child where, I like to kind of have a check-in with you.

How are you feeling?

How are you doing?

Are kids at school?

Or where are you all at right now in terms of these discussions among your peers?

I think that that can sometimes be a good place to start.

I think probably the biggest thing is, to really tune into if you feel like something is not right whether we're talking about your child, or your friend, or your neighbor, that's the time to really reach out and say hey, I haven't seen you in awhile, I haven't heard from you in a while, something seems a little off, how are you doing?

Not to be afraid to ask, how are you, how are you feeling?

You seem to be struggling.

And these kinds of conversations that we have we can't be afraid to talk about, to ask the questions.

Are you feeling all right?

Are you thinking of suicide?

To state that we wanna keep people safe.

We wanna be a calm comfort to people and we want to create a sense of safety.

I think too often, we expect others to reach out to us if they're having a hard time.

You may see on social media, my door's always open, I'll be available, but oftentimes the way that we're going to really impact others is by tuning in that something's not right and reaching out to them, even if it's as simple as just sending a text to say, hey, I haven't heard from you, how are you doing?

And do you have any other advice for in this last year, other issues that you think are important for us to just call out, what should we be looking at, as far as our children are concerned or anything else that we should just be aware of at this time?

I've tried to tell a lot of families that we work with to stay focused on right now and what's the next right thing.

It's so easy given so many unknowns especially with everything we've been through in the past year.

How long are we gonna do this?

What's gonna be the result and so to just stay focused on today, and what we need to do today in this present moment because most often especially when we're talking about anxiety, and children and teens and adults, most of the things that we worry about never happen.

And if they do happen, we are much better able to deal with them than we think we will be.

So we spend all of that time worrying, and it's really unproductive energy.

So we wanna focus on right now what do we know, what's the next right thing, what do we wanna do today, and what's in with my control, 'cause we always have choices, even though we can't control whether school's gonna be open or what's gonna happen next, we always have choices with how we respond to things and that's what we have to stay focused on.

Because that will ultimately make your child and yourself feel have some sense of power, and obviously be in control rather than being hopeless and helpless.

Yes, I think that's really great advice.

The only other thing that I would add in that I can sometimes do in working with families is also to remind parents, to be kind to themselves.

And one of the things you were mentioning earlier that this is all just kind of a shared kind of trauma that we're all going through together.

And if parents are trying to kind of manage almost impossible demands right now, and so kind of having a check-in with themselves and being able to get help for themselves if they need it, and kind of recognize that the stress and the anxiety and the way they're handling this does trickle down, and affect their children.

So I think it's just really important to be kind to themselves and take the time to practice self-care.

And there's a lot of stuff you can do that doesn't cost anything.

We live in a beautiful area, where you can go outside, you can go to the beach, you can go to the park, you can go for a walk, you can play a game as a family.

There are lots of things that don't cost any money at all that will do wonders, to reduce stress and help improve your mental health.

You can watch the full town hall on our Facebook page, @YourSouthFL.

And you can always find additional health and wellness resources, on South Florida PBS's 24/7, Health Channel.

And at allhealthtv.com.

I'm Chira Cassel, thanks for watching.