BHIPP Bulletin
Volume 7, Issue 2
August 2021
Returning to School During COVID-19: Resources for Pediatric Health Care Providers
This months' BHIPP Bulletin is a guest contribution from Dr. Nancy Lever, PhD, Clinical Psychologist, Co-Director of the National Center for School Mental Health and Executive Director of the University of Maryland School Mental Health Program. This month's BHIPP Resilience Break "Supporting Youth Returning to School: The Role of the Primary Care Provider" was presented by Dr. Sharon Hoover, Co-Director of the National Center for School Mental Health. To view the full session recording, slides, and related resources: click here!

As we begin the 2021-2022 school year, supporting the mental health and well-being of students is essential and will require a collaborative approach across caregivers, educators, health providers, and other adults in the lives of young people. Critical in this equation are pediatric health care providers, often the first professionals that families turn to when they are concerned about a child’s well-being.  

At the start of the pandemic, there was a lot of speculation about how the pandemic was negatively impacting the mental health of students. We know from past pandemics that we can anticipate surges in behavioral health care needs related to the pandemic, including for children and adolescents who are experiencing the burdens of family financial insecurity, caregiving load, and social isolation during a time of more limited access to supports. Past pandemics, such as the Influenza of 1918, 2009 H1N1 flu, and the 2014 Ebola virus all were associated with increases in depression, anxiety, stigma, and shaming. Longitudinal negative impacts of other large-scale community crises (e.g., natural disasters) on children’s behavioral health and academic functioning have also been well documented and help to foreshadow the mental health needs that youth are currently experiencing or may experience over time.

Mental health challenges for youth were high already pre-pandemic and now data indicate that the rates have risen. In a nationally representative survey of young people aged 13-19 conducted in April and May of 2020, it was found that approximately 25% of young people felt disconnected and more than 1 in 4 reported
  • increase in sleep loss due to worry
  • feeling unhappy or depressed
  • feeling constantly under strain
  • loss of confidence in themselves

More recent findings indicate that mental health-related emergency visits for youth are on the rise, with an increase of 24% for children ages 5-11 and 31% for youth ages 12-17. Further, 22% of parents report that their child’s mental or emotional health is worse now than before the pandemic. 

So now, what can pediatric primary care providers do to support their patients and families with mental health concerns? Here are three areas for consideration to help address and improve youth mental health.

1)   Ask Mental Health and COVID-related Screening Questions and Use Screening Measures
Taking the time to ask COVID-related and mental health screening questions can offer an entry into the needs that a youth or family may have and can lead to improved supports and resources. Below are examples of COVID screening questions that can be asked during visits:

Since COVID and school closures:
  • What has been the most difficult for your family?
  • What positive opportunities, if any, have arisen for your family?
  • Have any of your family or community members become ill or died from COVID?
  • Have you had any job loss or financial loss?
  • Has your child’s mood or attitude changed during the pandemic?
  • Have you had any trouble with food or housing?
  • How will your child be returning to school (in-person, hybrid, distance)?
  • How did distance learning go for you/your child in the Spring? Did you learn anything that could be helpful now?
  • How do you/your child feel about this year’s school plan? Do you have any specific concerns? Anything you are looking forward to?
  • Will your child be returning to the same school or going to a new school?

Examples of screeners that we recommend to use during visits include:

2)   Address Back to School Anxiety During COVID
Back to school anxiety will be more prevalent than ever, with many children having not been in school for over 16 months. Being away from families, navigating peer relationships and returning to the rigors of in-person learning will be anxiety provoking. The Child Mind Institute offered an excellent article on helping students handle back-to-school anxiety. Key steps to use with a child experiencing anxiety include:
  • Validate their feelings
  • Set the tone
  • Help them think positive
  • Practice separating
  • Have a routine
  • Emphasize safety measures
  • Encourage flexibility
  • Seek help as needed

3)   Develop routines and promote regulation

In working with families and as a trusted adult is it important to reassure youth and families that they are safe and there is hope. Part of developing a sense of safety is to establish routines that are predictable and positive for youth. Routines can help everyone to stay connected and can reduce stress. If the routines that youth and families have in place are working, then it is fine to stick to them. If not, help them to create new ones that work during this challenging time. Examples of routines can include having family meals together, bedtime stories, basic hygiene routines (brushing teeth, combing hair, getting dressed), health routines such as exercising, and sleep routines (when, where, and how to go to sleep).

Youth also benefit from having adults support the development of emotional regulation. When children are stressed, their bodies respond by activating their stress response systems. To help them manage these reactions, it is important to both validate their feelings (e.g., “I know that this might feel scary or too much for you to handle”) and encourage them to engage in activities that help them self-regulate (e.g., exercise, deep breathing, mindfulness or meditation activities). A great resource for helping students with regulation is the Virtual Calming Room. It offers students, families, and staff tools and strategies for managing emotions and feelings and building resilience during the pandemic.

This piece highlights just a few ways that pediatric health care providers can support the health and well-being of patients and families. Keep in mind that during challenging times, one of the most powerful tools are relationships. Being a caring and informed listener who can ask about concerns, identify mental health challenges, and offer practical strategies, resources, and referrals (as needed) is powerful and will make a difference in the lives of youth. Thank you for all you do to support children and families and please stay connected with our National Center for School Mental Health through our website, and Facebook (centerforschoolmentalhealth) and Twitter (@NCSMHtweets).

References: click here  

As always, if you have questions about behavioral health needs of your patients, we encourage you to call the BHIPP consultation line at 855-MD-BHIPP (632-4477), open 9am-5pm Monday-Friday, for resource/referral networking or consultation support.

BHIPP Announcements
Looking for COVID-19 resources to support children, families, and providers?

As the pandemic continues children, families, and providers may struggle with mental health concerns. BHIPP has compiled resources to support the needs of patients and providers. Newly added to our COVID-19 resources, check out the American Academy of Pediatrics: Mental Health Initiatives which includes resources for pediatric health care providers to support healthy mental development of youth.

As always, we welcome you to call the BHIPP line at 855-MD-BHIPP (632-4477), open 9am-5pm Monday-Friday, for consultation support or for information about local mental health resources for your patients.
BHIPP in Your Neighborhood
  • September 17, 2021 12:30-1:30pm
  • BHIPP Resilience Break co-hosted with Maryland Addiction Consultation Service (MACS) in honor of Recovery Month
  • Benzodiazepine and Prescription Stimulant Use in Youth: What’s the Impact on SUD and its Treatment? presented by Marc Fishman, MD
  • Register here!
  • October 8, 2021 12:30-1:30pm
  • BHIPP Resilience Break in honor of ADHD Awareness Month
  • Helping Families Manage ADHD in Primary Care presented by Mark Riddle, MD
  • Register here!
  • October 16, 2021 8:00am-1:00pm
  • A Maryland BHIPP CME/CEU Mini-Conference: Addressing & Managing Pediatric Mental Health in Primary Care presented by Sarah Edwards, DO and Carisa Parrish, PhD
  • Co-hosted by Mid Shore Behavioral Health and Talbot County Health Department for providers on the Mid-Shore of Maryland
  • Interested in attending? Message our team!
  • October 18 & 19
  • Maryland Rural Health Conference (Virtual)
  • BHIPP Team presentation and virtual exhibit booth
  • More information about the conference here!

  • Interested in organizing a (virtual) training event? Need more information? Message our team!
BHIPP Holiday Closures Calendar
Please note that the telephone consultation line will be closed on the following upcoming holiday(s):

  • Monday, September 6, 2021
BHIPP is supported by funding from the Maryland Department of Health, Behavioral Health Administration and operates as a collaboration between the University of Maryland School of Medicine, the Johns Hopkins University School of Medicine, Salisbury University and Morgan State University.

BHIPP and this newsletter are also supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $433,296 with approximately 20% financed by non-governmental sources. The contents of this newsletter are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government. For more information, visit

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