Africa's Masai warriors greet each other with the phrase “Kasserian Ingera,” which translates to “And how are the children?” This greeting underscores the importance of children's well-being as a marker of success in their community. The traditional response translates to “All the children are well.”
As we assess the ongoing COVID-19 response, including the reopening and recovery plans of our states, we need to move children to the top of the list of considerations. As clinicians, and as moms, we felt a huge sense of relief when early data suggested the novel coronavirus was less severe in children and when we didn't see a large volume of critically ill children in our hospitals.
However, children are not completely immune from the physical, economic or social effects of COVID-19, and without specific attention and strategy, the well-being of kids will be the ultimate lagging indicator of our collective success or failure.
In fact, the recent global demographic shift of infection to younger people indicates we may already be behind.
Even more profound are the social effects children feel when fragile support systems are disrupted.
This pandemic has put that fragility on full display.
Dr. Sullivan was honored to represent Indiana in testifying at a recent congressional hearing about our state's efforts to support child care services during the pandemic to keep them available for essential workers while protecting children, families and child care employees.
At the Indiana Department of Child Services, though many of our services are occurring virtually during these challenging times, when a child's well-being is in question, we are there. If safety is in question, a family case manager visits that child in person to assess the situation and help ensure a safe environment.
DCS depends on the community to engage and support families, which is critical in keeping children safe. It is more important now than ever for the public to pay attention.
Young children are unable to clearly vocalize stress and anxiety, and may manifest those feelings by acting out. This can push the best parenting skills to the limit and exhaust a caregiver's patience. It is critical to check in with extended family members who have children. Supporting the family is key to preventing child abuse and neglect.
In addition, Indiana's Family and Social Services Administration is charged with supporting Hoosiers' mental health, and we are constantly evaluating the feedback from our programs and services. Last month we received this from our 211 call center:
“People have always called us for help with basic needs like food and rent but now they call us sobbing. We have always received calls from individuals impacted by domestic violence calls but now we are talking to people while they are hiding in the bathroom with the abuser in another room. We have also seen a substantial increase in the number of people with mental health issues that were well managed or manageable prior to COVID-19. These aren't just crisis calls. They are calls from people experiencing trauma.”
Hidden behind this message are the children who can't call 211.
Adverse childhood experiences are occurring right under our noses.
They are the negative events that can accumulate during childhood and subsequently affect development, personal risk behaviors, long-term health and even life expectancy.
Adverse childhood experiences are tracked on a 10-point scale. A score of just four indicates outcomes for children that, as adults, have the potential to change their future, sometimes dramatically. Will “did you live through a pandemic?” become the 11th question in the assessment?
As we move into recovery, it's important for parents, caregivers, teachers and anyone else who interacts with kids to understand that all children, even in the best of circumstances, have been going through a traumatic time. But now, an understanding of adverse childhood experiences is key for policymakers as well.
The prescription for adverse childhood experiences is resilience. Resilience is built on multiple levels – personal, community and systemic. The question “How are the children?” should be ever present as we continue planning, testing and reopening activities.
Our charge is to find our way to a place where our recovery from COVID-19 includes a comprehensive plan to support our children and mitigate the effects of the experiences they had. Only then can we start to answer, “All the children are well.”
Dr. Jennifer Sullivan, left, is secretary of the Indiana Family and Social Services Administration; Terry Stigdon is director of the Indiana Department of Child Services.
• Sew or buy masks for a school or child care program
• Purchase cleaning supplies for your school or child care
• Drive your kids to school if you can so that others' kids can ride the bus
• Supervise safe walks to school in school districts that need it
• Donate food, time or money to a local food pantry
• Be a mentor in a child's life