When kids have severe behavioral problems — disruptive, impulse-control disorders, say — it’s stressful for families even in the best of times.
These conditions, which include intermittent explosive disorder, kleptomania and pyromania, involve long-lasting, frequent episodes of angry or aggressive behavior toward people and property. These children or teens may simultaneously have conditions like attention deficit hyperactivity disorder or depression.
The pandemic has placed great strain on these families, as mental health clinics shuttered during lockdowns and access to treatment and services became more difficult.
“For many of these kids, taking medication is critical, in addition to counseling and all kinds of behavior management,” says Ukamaka Oruche, an associate professor and director of global programs at Indiana University School of Nursing. As a researcher and nurse practitioner specializing in child and adolescent mental health, helping kids and parents like these is a primary focus of her work. When the pandemic reached Indiana, she says she was filled with dread for her patients and their families.
“These are kids who have very antisocial, very defiant, very oppositional-type behavior that often leads to functional impairment in multiple areas of life,” Oruche explains. “They’re having challenges at home, difficulty in school. Sometimes they end up with the juvenile justice system.” These kids, who pose a tough challenge — and sometimes an actual threat to parents — account for the greatest number or referrals to mental health clinics and centers, she notes.
With the abrupt onset of COVID-19 restrictions for Hoosiers, clinics quickly shut down, and parents and kids had nowhere to go. “When you’re talking about low-income persons living in very tight spaces, it makes for a very challenging emotional and home atmosphere for everyone,” Oruche says. “It becomes more difficult when we’re in lockdown and have limited space to even breathe.”
Oruche marshalled her resources and sprang into action. She quickly developed educational tools, including videos, for keeping these kids on track during the pandemic while incorporating emotional self-care for parents.
“I wanted to get some information out to them to say: ‘Yes, the clinics are closed. However, you can continue to access services,'” Oruche says. “‘You can get your child’s medication. You can have telehealth to continue to get support.’ So that was critical for me, to get out there, especially when you talk about a population of kids who are already having emotional problems and behavior problems.”
Throughout the pandemic, already stressful environments worsened for kids with behavioral challenges. Whereas before they may have been able to go outside to play and run off energy: “We were forced to stay indoors. Imagine: Now the parent has to manage this child indoors 24/7. There is no more of the break they get when the child is in school. It was just all the parents.”
A fair number of the families Oruche works with contracted COVID-19. “In many cases it affected pretty much everyone in the household,” she says. “So, one person gets infected. It becomes difficult when you don’t have the space so someone can go quarantine themselves in a room. They may not have the resources.”
Getting the Word Out
Oruche has been on a mission: She has been reaching out to disseminate essential tips to a growing audience including parents of children with severe mental health issues. Her guidance spans the following issues:
— How to access treatment, medication and services even with clinics closed.
— Turning to telehealth options to keep receiving support.
— Managing disruptive behavior at home.
— Maintaining structure and routine even with virtual learning instead of in-person classes.
— Limiting kids’ TV time and getting outdoors as much as possible.
— The critical importance of self-care during this stressful time.
She embarked on a slew of media and public appearances, accepting one invitation after the next to get her message out to a public in need. Within three months, she disseminated information, tips and advice for families, caregivers and others through these venues:
— In March, her video “Parenting Children With Behavioral Challenges” appeared on the Indiana University: Research Impact webpage, which was shared by groups ranging from state nurse associations to the International Society of Psychiatric-Mental Health Nurses.
— The Indiana Nurses Association hosted a live Facebook interview with Oruche on the mental health of front-line workers like nurses during the COVID-19 pandemic in mid-April.
— Be Well Indiana, a state mental health initiative, featured Oruche’s video plus written tips on parenting children with behavioral challenges while prioritizing self-care during COVID-19, in late April.
— WNOW-FM, a commercial radio station serving the Indianapolis metro area and a voice for the Black community, did an April 27 interview with Oruche exploring the pandemic’s toll on mental health and substance abuse.
— In a May 27 press conference held by Indiana Gov. Eric Holcomb to update on the state’s fight against COVID-19, Oruche gave advice on caregiving and parenting children, and attending to mental health needs, as the pandemic moved into summer.
— That day, WISH-TV-Indianapolis featured a clip of Oruche’s discussion on how adverse childhood experiences — a parent losing a job, being away from friends, or the sudden deaths of family members — impact kids’ development, behavior and life expectancy.
— On June 16, The Conversation, a network of nonprofit media outlets, featured an invited publication by Oruche on how racism in the U.S. health system hinders care and costs lives of African Americans.
Last week, the American Academy of Nursing recognized Oruche with its COVID-19 Courage Award in Innovation for her leadership and continuing pandemic contributions.
“Every aspect of my work, whether it’s practice or my research, has been dedicated to improving the lives of vulnerable populations, particularly those that are facing mental health issues,” Oruche says. “That’s what drives me — that’s what I’m passionate about. I recognized that mental health doesn’t affect any one group of people — it affects us all. When you don’t have a lot of resources, then it’s that much more difficult to navigate. But it affects everyone.”
Oruche is launching her latest study, funded by the National Institutes of Health, aimed at improving interactions between health care providers and parents of adolescents receiving treatment for disruptive, impulse-control and conduct disorders. The goal is to increase engagement, communication and shared decision-making between parents and providers: “Ultimately, this is about making sure that the kids get what they need and have the best mental health outcome.”
And she is also careful to emphasize that parents must prioritize their own well-being, too.
“Parents don’t always have time to take care of themselves, especially these parents,” Oruche says. “It was important to remind them: As you go through all of this, remember: You have to take a minute for yourself. If you’re going to do a good job of taking care of your child, you have to take care of yourself as well.”
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Ensuring Kids With Behavioral Issues Aren’t Left Behind In the Pandemic originally appeared on usnews.com