3
Social, Emotional, and Behavioral Effects
What happened in the lives of children and their families during the first years of the COVID-19 pandemic? While the global community generally shares a common set of experiences tied to the pandemic, it is useful to restate in a broad sense the experiences of children and their families as a foundation for describing what is known from research about the social, emotional, and behavioral effects for children now and in the future.
It is too soon to know the full consequences of the pandemic, but many organizations that work at the intersection of trauma and adversity, child development, and education have predicted the need for increased support for children who are experiencing the effects of such a prolonged, unpredictable, and stressful health crisis (e.g., National Child Traumatic Stress Network; National Association of School Psychologists; Substance Abuse and Mental Health Services Administration; Trauma Learning and Policy Initiative; Gurwitch & Brymer, 2020; National Association of School Psychologists and National Association of School Nurses, 2020; Mental Health Technology Transfer Center Network, 2020; Trauma and Learning Policy Initiative, 2020).
As described in Chapter 1, nearly all educational institutions, from preschools to K–12 to higher education, closed their buildings and shifted to remote learning in March 2020. Many remained closed through much of the 2020–2021 school year or offered hybrid schedules that combined remote and in-person learning. Students of all ages learned at home while their parents, caregivers, and other adults in their lives managed work and home life. As described in Chapter 6, many adults worked from home, some lost their jobs, and others continued to work outside the home, often in
conditions of stress, disruption, and fear. Children and adults alike faced ongoing fears of illness; the illness itself; and the illness and death of family members, close friends, and colleagues. As noted in Chapter 1, as of September 2022, it was estimated that more than 265,000 children in the United States had lost a parent, caregiver, or guardian (Hillis et al., 2021).1 Although everyone faced, in one form or another, some level of disruption, uncertainty, stress, and loss of connection to and community with others, these challenges were more acute for children and families in racially and ethnically minoritized and low-income communities, and to some degree, these experiences have persisted.
This chapter describes the experiences of children and their families during the pandemic and reviews research on what is known about social, emotional, and behavioral outcomes and the mechanisms that link experiences to outcomes. For this discussion, the committee has drawn on nascent research on the COVID-19 pandemic, as well as research on prior disasters and pandemics and studies of traumatic stress, grief, and bereavement.
Using the broad frameworks laid out in Chapter 2, the chapter first provides a brief review of what is known about the effects of the pandemic on children and their families. The focus is on social, emotional, and behavioral consequences, but also, consistent with the life-course view presented in Chapter 2, situates these consequences in a developmental framework that highlights broader issues tied to developmental delays and derailments (e.g., dramatic shifts in developmental-contextual expectations), cascades (e.g., effects on early developmental milestones that cascade into later developmental consequences), and societal changes. The next section looks at the mechanisms of action for those effects. The chapter’s final section identifies relevant interventions, strategies, and practices for addressing the continuing pandemic, including the committee’s conclusions on these topics.
SHORT-TERM EFFECTS AND CONSEQUENCES
Short-Term Social, Emotional, and Behavioral Consequences
As described in Chapters 1 and 2, child and family life has been fundamentally altered by the primary and secondary exposures to COVID-19, including the substantial public health measures intended to reduce the disease’s spread. Notably, widespread closures of child care programs and schools affected children worldwide. In addition, physical distancing measures, among other public health responses to the pandemic, posed distinct challenges for children’s caregivers, including high levels of stress and
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1 Also see https://imperialcollegelondon.github.io/orphanhood_calculator/#/country/United%20States%20of%20America
anxiety, potentially influencing their ability to insulate children from the instability, uncertainty, and worry caused by the pandemic. The strain faced by children and parents resulting from the pandemic can result in more challenging behavior among children (e.g., dysregulation, withdrawal, aggression, and noncompliance), which is often understood to represent underlying emotional and mental health issues.
Indeed, a growing body of empirical research is drawing attention to concerning trends in children’s behavioral health. In a nationally representative sample of U.S. parents, 14 percent reported their child had relatively worse behavior early in the pandemic than before the crisis (Patrick et al., 2020). However, such findings need to be considered with some caution. While they provide important signals about how children and families are faring, such retrospective reports of children’s prepandemic behaviors may not be accurate, particularly in times of crisis, when parents are likely to confound their own experiences with actual changes in their children’s behavior. However, a handful of studies have information from the prepandemic period to quantify observed pandemic-related changes in children’s outcomes. These studies, which compare cross-sections of children between the pre- and post-shutdown periods (e.g., Westrupp et al., 2020; Newlove-Delgado et al., 2021), show similar findings: post-shutdown elevations in children’s mental health challenges, including in their internalizing behaviors (i.e., symptoms of depression and anxiety).
An even smaller set of studies has documented changes in children’s outcomes pre- and post-shutdown using data collected on the same set of children before the onset of the pandemic and after the shutdowns in 2020. Hanno and colleagues (2022) documented increases in children’s dysregulated, internalizing, and externalizing behaviors and decreases in children’s adaptive behaviors. In this same study, the shifts in children’s behavioral outcomes occurred at the same time as changes in family functioning, including increases in parents’ stress, household chaos, challenges in parents’ mental health, and parent–child conflicts. Similar patterns for children and parents were documented by Raghunathan and colleagues (2022), who further showed that the degree of family disruption accounted for the negative shifts in children’s outcomes, particularly in aspects of their self-regulation skills.
Self-regulation skills are considered foundational to the types of dysregulated, externalizing behaviors that appear most affected by the pandemic: they shape children’s ability to focus, control dominant impulses, switch attention between activities, and remember multistep directives. Adverse events in children’s environments, and experiences of adversity over time, such as the primary and secondary exposures described above, can trigger immediate physiological and emotional responses that, when activated for prolonged periods, can alter how children respond to ongoing stress,
resulting in continuing reactive, impulsive, and dysregulated behavior (see, e.g., the National Academies of Sciences, Engineering, and Medicine [the National Academies], 2019a).
Adolescents and young adults are also showing the strain of the pandemic. For example, a survey of 3,300 youth aged 13–19 early in the pandemic (Margolius et al., 2020) revealed increased levels of concern about their present and future, more time spent feeling unhappy or depressed, lack of social connection, and a desire for greater social and emotional support from their teachers and schools. A small number of studies have documented changes in externalizing and internalizing outcomes among youth between the prepandemic period and the pandemic’s onset. For example, Rosen and colleagues (2021) documented a roughly 20 percent rise in clinical or subclinical levels of externalizing and internalizing among older children and adolescents (7–10 and 13–15 years, respectively). Increases in externalizing and internalizing psychopathology were associated with exposure to more pandemic-related stressors in health, social, financial, school, and environmental domains.
The authors also report that children with a key set of protective factors fared better. These protective factors included such things as having a structured daily routine; low amounts of passive screen time; low consumption of news about the pandemic; and to a lesser degree, time spent outdoors and regular sleep (Rosen et al., 2021).
Delays, Derailments, and Cascades
Researchers focused on child traumatic stress have used a conceptual framework that balances consideration of the developmental consequences and psychopathology and their interplay (Pynoos et al., 1999). There may be developmental delays and developmental accelerations and a cascade of developmental consequences (Masten & Cicchetti, 2010), including profound derailments. For example, a temporary reading delay can cascde into reading failure, leading to peer rejection, behavioral disturbances, and, years later, school dropout.
The child disaster literature recognizes that disaster-generated developmental insults can disrupt key developmental transitions, such as the transition from middle school to high school or from high school to higher education. Disasters and the prolonged recovery environment can significantly interfere with anticipated or new developmental opportunities and concomitantly deflate developmental aspirations. For adolescents transitioning to young adulthood, especially salient are ongoing concerns about aspirational and developmental disruptions in achieving personal, career, and family goals. Among the most frequently reported COVID-19 adolescent concerns are those of lost opportunities for enjoyable activities and getting delayed in school (van Loon et al., 2021).
Traumatic stress studies have identified the added risk for a negative developmental cascade among traumatized and bereaved children who are already struggling educationally (Saigh et al., 1997), leading to school failure and restrictions on extracurricular high school activities (Saltzman et al., 2001). In the concerns about the educational effects from the pandemic, these studies suggest that highly COVID-19-exposed, marginal students need special outreach that combines mental health and educational support services.
In terms of the danger framework (see Chapter 2), research shows that adolescents who endure chronic exposure to danger—for example, recurrent terrorism—are at risk for subsequent reckless behaviors (Pat-Horenczyk, 2007; Brenner et al., 2022), including fighting, using drugs, having unprotected sex, breaking the law, carrying weapons, self-injury, driving dangerously, and running away from home. Interventions after disasters and catastrophic school shootings have been adapted to openly address reckless behavior as part of school, family, and community recovery programs. As adolescents emerge from the more restrictive phases of COVID-19, it will be important to reinforce or institute appropriate school and community programs.
COVID-19 also disrupted the living arrangements of families, with 52 percent of young adults (aged 18–29 years) living with their parents and families, becoming “the new boomerang kids” (Fry et al., 2020). There have been greater increases in this group among White young adults, compared with Black or Latino young adults; overall, young men have been more likely to return home than young women.
A few studies have examined the effects of COVID-19 on young adults, primarily college students, and revealed several patterns in disrupted autonomy and personal space; shifts in family roles; and challenges in navigating communication, expectations, and family interactions. Those returning home in March 2020 experienced more negative interactions with parents and increased fear for their own and their family’s health, perceived less acceptance by their parents about returning home, reported low personal autonomy, and engaged in fewer positive self-improvement and coping strategies for strengthening family relationships than they had previously experienced. These responses collectively were associated with increased depression and anxiety during the shelter-at-home phase of the pandemic (Hall & Zygmunt, 2021). Furthermore, 40 percent of parents reported returning to a state of more worrying about their young adult children, and 25 percent reported more conflict and disruption to their daily lives because the parents were ready to move to the next stage of their lives, now delayed because of children returning home (Hall & Zygmunt, 2021).
All disasters test the strength of the foundational bonds or agreements between those living together in society to adhere to certain norms for
behavior and self-sacrifice in service of the broader community (i.e., the social contract). Recent historical reviews suggest that such a test is especially true for pandemics. Conspiratorial thinking, stigmatization, threat denial, psychological resistance to public health mandates and guidance in the name of restoring freedoms, and (with modern medicine) vaccine hesitancy are expected phenomena (Taylor, 2019). Perceived failures in the social contract can generate anger and demoralization.
As has happened in previous pandemics, these issues have become conflated with political divisions (Hobfoll, 2021) and amplified through the power of social media to propagate misinformation. A recent global study found that trust in government and public health leadership—including fairness, effectiveness, accountability, and honest communication—was more important than other resource factors (e.g., prepandemic resource preparation) as the most reliable indicator of death from COVID-19 (Liu et al., 2022). While the societal values and investment in the social contract that will emerge from this pandemic among the current child and adolescent generations are unknown, disaster and adolescent traumatic stress studies suggest that high exposure and persistent adversity can alter the moral development of a generation (Goenjian et al., 1999), and adolescent victimization can result in greater discontent with the government and more engagement in various forms of political activity (Oosterhoof et al., 2017).
MECHANISMS OF ACTION
Research has identified several developmental mechanisms and processes that underlie links between exposure to trauma, experiences of chronic stress and strain, ongoing disruption, grief and bereavement, and the resulting developmental outcomes described above. In general, the developmental and prevention literature highlights such mechanisms as critical to identifying the interventions likely to mitigate the short- and long-term effects of large-scale events like the COVID-19 pandemic (Jones et al., 2019).
Prominent among the frameworks describing mechanisms and processes are those generally described as family stress models (e.g., Aber et al., 2000; LaFromboise et al., 2006; Gershoff et al., 2007; Masarik & Conger, 2017). Broadly, these models specify a set of pathways through which economic hardship, pressure, or strain arising from other sources (e.g., disasters, pandemics) affect child and adolescent developmental outcomes through adult psychological distress, family conflict, and challenges to the typical processes of parenting and caregiving. One could apply the mechanisms highlighted in these models to the relationships that are part of the regular, everyday interactions of children as they go about their lives (in relation to teachers and peers at school, for example) and to adults as
they go about theirs (in relation to coworkers, friends, and partners), all of which have been substantially influenced by the pandemic.
Other models go deeper, elucidating the neurobiological mechanisms linking direct exposure to stress arising from adversity to proneness to reactive profiles of self-regulation and behavior that are linked to behavior problems, aggression, and delinquency (Blair & Raver, 2015). Still other models highlight the ways blocked opportunities constrain developmental pathways and loss of connection to cultural, spiritual, and religious traditions and contribute to the acceleration of developmental challenges. Just as these models highlight a host of risk-related pathways and mechanisms, they also point to a set of protective mechanisms that are rooted in developmental opportunities and gains: relationships, belonging, and connection, as well as community and cultural traditions.
While the models described here are generally viewed as encapsulating universal mechanisms, other work illuminates processes specific to historically marginalized populations that are grounded in structural inequality and enduring experiences of discrimination and racism. These mechanisms, too, represent both risk pathways and important protective factors, such as positive coping.
It is important to recognize COVID-19 as an external stressor, situated in the context of social and political events. For Black families, for example, racialized experiences have historical linkages to oppression and inequality and impose harm that profoundly shapes their everyday life experiences. Recognizing the significance of context—including socioecological models (see Chapter 2), and a heuristic model of stress management in Black families (Murry et al., 2018)—allows the incorporation of proximal and distal processes that affect and influence the occurrence and responses of Black families to stressful life events.
Acknowledged in these theoretical frames is the notion that human development (and response) is a product of dynamic relational interactions that are inextricably linked with and infused into multiple interlocking contextual systems. Furthermore, although humans are influenced by their environments, they also are active agents in their own development with capacities to influence as well as be influenced (e.g., Tudge et al., 2009). Murry and colleagues (2018) specifically illuminate ways in which Black families navigate socioenvironmental contextual stressors through the use of strengths-based cultural assets, including spirituality, optimism, and drawing on the support of close relationships. Emphasized in this model is the notion of resilient coping behaviors that families use to prevent, avert, and reduce the potential negative consequences of external stressors on parents’ and caregivers’ health and well-being, as well as on family functioning, parenting, and their children’s adjustment and development.
Studies examining the protective capacities of Black families have identified several factors and processes that enable families to rebound from
adversity, including optimism and beliefs that value close relationships with family and community residents. These resources have been linked to increased capacity to adapt and engage in adaptive problem-solving strategies and, in turn, create renewed strength and resourcefulness, or self-righting, and growth in response to crises or challenges (Walsh, 2003).
A key protective factor is the powerful effect of mental framing of one’s current situation as a stress-coping strategy through dispositional optimism. Optimism is a relatively stable trait, and optimists generally tend to expect positive outcomes, which in turn influence how individuals respond to challenging circumstances. Having a positive outlook on life has been associated with better psychological adjustment to negative life events, increased access to positive social networks, and better physical health (Taylor, 2010). Studies of stress coping among Black mothers, for example, have demonstrated associations between optimism and high levels of effective child management and its moderating role in reducing the effect of economic stress (Taylor, 2010). Cutrona and colleagues (2000) provide evidence illustrating that despite living and raising children in impoverished and crime-ridden neighborhoods, optimism combined with positive affectivity (e.g., good interpersonal relationships) enabled Black mothers to effectively manage the challenging environmental conditions in their daily lives.
These personal characteristics were particularly protective for women residing in high-disorder neighborhoods: for example, constructing cohesive relations with neighbors can confer additional mental health benefits on Black mothers’ positive outlook on life. A positive outlook may increase morale, thereby offering support for the protective-reactive moderation process theory. One’s worldview may be a sign of considerable adaptability and resilience, buffering families from adversities by insulating them in ways to overcome negative life events (Bogenschneider, 1996). Being hopeful for the future may be especially relevant to well-being when the present appears bleak. Other protective processes in Black families include preparing children to live in a racialized society and instilling a sense of pride as a member of the Black community.
Demands and challenges associated with systemic racism and oppression have the potential not only to compromise caregivers’ psychological functioning, but also to shape how and what Black parents do to help their children manage and navigate race-related stressors. Slurs, false accusations, or exclusion from activities based on race have been shown to undermine children’s mental representation of themselves, affecting emotional and behavioral regulation, with a developmental progression of feeling helpless and demoralized and elevating the risk for depression (Berkel et al., 2009). At the same time, parenting processes in Black families can foster positive intrapersonal protective processes, including the enhancement of
self-control and capacity to regulate emotions, which in turn have been associated with several positive developmental outcomes, including enhancement of psychological well-being and risk avoidance (Berkel et al., 2009).
INTERVENTIONS AND APPROACHES
The interventions highlighted in this section were selected by the committee because they are designed to work by addressing some of the key mechanisms described above that link exposure to pandemic-related disruption, stress, worry, grief, and bereavement to developmental outcomes. In general, they focus on building and maintaining supportive relationships and connections and sense of belonging, which in many cases means working with adults (parents, caregivers, educators) to effectively manage their own stress and address their own mental health. In addition, some interventions are designed to provide children and adolescents with opportunities to learn and practice foundational social and emotional skills and perspectives that enable them to manage and respond to ongoing experiences of uncertainty and disruption. Across the interventions, a central feature is a connection to adults and experiences that offer opportunities for ongoing screening and observation to identify children and adolescents who are struggling and to connect them to needed support.
Early Childhood Interventions
Early childhood interventions (e.g., home visiting, preschool education, designated early intervention for children showing or at risk for specific developmental delays) have for decades been understood to play an important role in offsetting the effects of adversity on healthy growth and development (Karoly et al., 1998; Jones & Zigler, 2002); to be an essential public good that enables parents to work (Tekin, 2021); and to be of general benefit for young children, especially as they enter into the period of transition to formal schooling (LoCasale-Crouch et al., 2008).
Home Visiting
Overall, home visiting is a prevention strategy that has universal (e.g., Parents as Teachers2) and targeted models (e.g., Nurse Family Partnerships,3 Family Spirit4).
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2 See https://parentsasteachers.org
They are intended to provide information, resources, and support to expectant parents and families with young children. Specifically, home visiting programs are expected to improve children’s long-term developmental outcomes by providing parents with knowledge and skills (e.g., coping and problem-solving skills); emotional support; access to community, cultural, and health services; and direct instruction in effective and supportive parenting practices.
The most comprehensive study of U.S. home visiting programs to date is the legislatively mandated evaluation of the Maternal, Infant, and Early Childhood Home Visiting programs called Mother and Infant Home Visiting Program Evaluation (MIHOPE). MIHOPE focused on four commonly implemented programs across the United States: Early Head Start, Healthy Families America, Nurse-Family Partnerships, and Parents as Teachers (see Michalopoulos et al., 2019). Overall, MIHOPE indicated that home visiting affected several key outcome measures when children were 15 months old, including improving the quality of the home environment, reducing the frequency of parents’ use of psychological aggression toward their children, fewer emergency department visits for children, and fewer child behavior problems.
Similar results have been found in other groups. For example, in a randomized controlled study of the Family Spirit home visiting model developed with and for Native American families, compared with a standard age group, teenage mothers at 12 months postpartum had greater parenting knowledge and self-efficacy, improved home safety attitudes, and fewer externalizing behaviors, and their children had fewer externalizing problems (Barlow et al., 2013). In a report to Congress about the federally funded tribal home visiting programs, performance measurement data showed improvement in indicators of six legislatively mandated benchmark areas: maternal and newborn health; child injuries, abuse, neglect, or maltreatment and emergency department visits; school readiness and achievement; crime or domestic violence; family economic self-sufficiency; and service coordination and referrals (Lyon et al., 2015). Overall, findings from the research on home visiting, including in diverse populations, indicate a pattern of positive changes in families that are closely linked to the kinds of challenges with parenting and related child outcomes that can arise when families experience prolonged strain, as has been the case for many families during the pandemic.
Early Education and Care
Among a large array of interventions designed for the early childhood period, formal center or classroom-based preschool programs—in particular, federally funded national programs such as Head Start and state-funded
public programs—have received the most research and policy attention (e.g., Yoshikawa et al., 2013). The focus here reflects a generally held theory of action that high-quality, culturally and linguistically responsive preschool experiences provide children with a developmental boost, helping them to acquire the foundational pre-academic, social, and emotional skills that will enable them to succeed in school (e.g., Hanno et al., 2021), as well as a belief that investments in the early childhood period will produce positive net returns for society.
Overall, there is a great deal of evidence that high-quality, center-based preschool experiences make a difference in children’s outcomes at the end of the preschool year, with even stronger benefits after 2 years (Yoshikawa et al., 2013). Writing for the Brown Center Chalkboard on the benefits of preschool, Weiland and colleagues (2022, p. 1) note: “Since the 1960s, over 70 reasonably well-conducted evaluations have examined the effects of preschool versus local alternatives, along with dozens of studies that compare different preschool models to each other.”
It is important to note that “local alternatives” include a wide variety of options, including care solely by a parent or relative, family child care, community-based and parochial group care, and for-profit center-based care, among others. More recent work suggests that some of these non-center-based options (e.g., family child care) also result in positive outcomes for young children (Jones et al., 2020). As formal options (public preschool, Head Start, for-profit center-based care, etc.) can be out of reach for many parents because of limited space, high cost, income requirements, and accessibility (e.g., local availability), informal options, which many families choose even when other options are available, need to be considered a critical component of the early education and care landscape.
Weiland and colleagues (2022) summarize the overall benefit of preschool programs for young children: “On average, children who attend preschool enter kindergarten with stronger school readiness skills than if they had stayed home. Importantly, benefits are larger for children from families with low incomes, dual-language learners, and children of color” (p. 2). The school-readiness skills with positive effects tend to include cognitive and language skills; early literacy and numeracy; and social and emotional competencies, such as self-regulation and social competence (e.g., Gormley et al., 2005; Raver et al., 2011; Weiland & Yoshikawa, 2013; Minervino, 2014; Gray-Lobe, 2021). Early Head Start can also improve health literacy for parents, reducing unnecessary emergency room visits and improving health decision making (Teutsch et al., 2016). Head Start also ensures children have developmental screenings, immunizations, well-child visits, dental and nutrition services, healthy meals, and connections to other social service programs, all of which were disrupted by the pandemic (Teutsch et al., 2016). All of these skills also support children’s connection to their cultural
heritage and can be an important driver of Native language revitalization in Indigenous communities (Sarche et al., 2020).
A critical caveat to the broad body of evidence on the effect of preschool programs is that the quality of such programs varies tremendously (e.g., Bassok & Galdo, 2016), and quality itself makes a large difference in children’s outcomes (Hanno et al., 2021). Indeed, quality is also an important factor in parental choice (Gordon et al., 2021). The important features of quality, highlighted in research and summarized by Yoshikawa and colleagues (2013), include frequent, warm, and responsive interactions between caregivers and children (Mashburn et al., 2008; Raver et al., 2011); interactions that include instructional support, such as detailed feedback and sequenced and elaborated support for learning, often with the support of a well-designed curriculum (Howes et al., 2008; Mashburn et al., 2008); interactions involving consecutive turns in which the caregiver and child discuss and elaborate on a given topic (Wasik et al., 2006; Justice et al., 2008); and settings that provide opportunities to engage in age-appropriate activities with a range of varied materials (Peisner-Feinberg et al., 2001; Justice et al., 2008; Sylva et al., 2012).
A number of approaches to interventions designed for center-based preschool hold particular relevance to mitigating the impact of COVID-19 disruptions and stress on young children’s school readiness, particularly their social and emotional skills. The relevance of these approaches arises from their specific focus on the adult and child skills most likely to be influenced by pandemic experiences (recently documented by Hanno et al., 2021, among others). In addition, these examples have been evaluated with randomized designs.
The Chicago School Readiness Project (CSRP) is an intervention adapted from the Incredible Years social and emotional development program5 and supplemented with mental health consultation and coaching for educators. It was designed for, implemented, and studied in Head Start centers in Chicago. The program focused on building educator capacity to effectively and proactively support children’s development of emotional competencies, self-regulation, and executive function, with particular focus on children struggling with emotional control and behavior problems (Raver et al., 2011; Jones et al., 2013). It is important to note that the specific outcome targets of this intervention are highly susceptible to the forms of stress and disruption experienced by many young children during the first years of the pandemic and represent essential foundations to school readiness in young children (e.g., Bailey & Jones, 2019). The evaluation of CSRP showed positive effects on self-regulation and pre-academic skills,
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with effect sizes at the end of the preschool year ranging between 0.37 and 0.43 (Raver et al., 2011), and persisting through adolescence (Watts et al., 2018). Also promising are efforts to embed interventions aimed at bolstering the parent–child relationship in early care and education programs, such as was tested in the six-site “Buffering Toxic Stress” consortium funded by the Administration for Children and Families.6
Mental Health Consultation
Mental health consultation is an approach for early childhood that is focused on adults working in classrooms with young children. It is the core approach employed in the CSRP intervention described above and is rapidly expanding across the United States (see, e.g., Reyes & Gilliam, 2021). In this model, a mental health professional is teamed with an early childhood care and education provider in an ongoing problem-solving and capacity-building relationship (Cohen & Kaufmann, 2000; Donohue et al., 2000). The key mechanism in this model is a collaborative, trusting relationship between a consultant with mental health expertise and an early education and care provider (Johnston & Brinamen, 2006; Perry et al., 2010).
Overall, the approach can address multiple goals, including stress reduction and emotional regulation techniques for the provider; early identification of children with significant emotional or problem behaviors who may need a referral for mental health assessment, diagnosis, and treatment; reducing problem behaviors and increasing social skills in children who may be at risk for developing a clinically significant disorder without targeted interventions; and promoting the social and emotional development of all children in the program by improving the climate, structure, and operations.
Across numerous studies, including a small number of syntheses, there is clear evidence that mental health consultation results in improved teacher practice and engagement with young children, including their use of proactive and positive discipline strategies; reductions in child suspension and expulsion (Brennan et al., 2008); and, not surprisingly, reductions in children’s externalizing behaviors and some improvements in their social skills (Perry et al., 2010; Gilliam et al., 2016; Reyes & Gilliam, 2021). Importantly, these outcomes are those identified in research as most affected by the pandemic for both young children and adolescents and are also the most susceptible to adult experiences of stress and strain. This approach of collaborative mental health consultation has not been adapted for elementary
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6 See https://www.acf.hhs.gov/opre/project/early-head-start-university-partnership-grantsbuffering-children-toxic-stress-2011#:~:text=The%20Buffering%20Toxic%20Stress%20Consortium,buffer%20children%20from%20toxic%20stress
or secondary educators, but its focus on supporting adult mental health as it addresses young childrens’ social and emotional functioning holds promise as a strategy for a wider array of adults who work with children and adolescents.
Social and Emotional Learning Interventions
Over the past three decades, there has emerged a growing consensus among researchers who study child development, education, and health that social and emotional skills are essential to learning and life outcomes. Broadly speaking, social and emotional learning refers to the process through which individuals learn and apply a set of social, emotional, and related skills, attitudes, behaviors, and values that help direct their thoughts, feelings, and actions in ways that enable them to succeed in the settings where they learn and grow (e.g., Jones et al., 2017). Furthermore, research indicates that high-quality, evidence-based programs and policies that promote these skills among children can produce positive outcomes for children, including improved behavior, attitudes, physical and mental wellbeing, academic achievement, and college and career readiness and success (Bierman et al., 2010; Diamond & Lee, 2011; Durlak et al., 2011; Hurd & Deutsche, 2017; Jones et al., 2017; McClelland et al., 2017).
There are a great number of social and emotional programs available for schools, early childhood education providers, and out-of-school-time organizations, and these programs vary widely in emphasis, teaching strategies, implementation supports, and general approach. For example, some programs target emotion regulation and prosocial behavior, while others focus more on executive function, growth mindset, character traits, or other similar constructs. Some programs rely heavily on teacher modeling and whole-class discussions as their primary approach, while others incorporate such methods as read-alouds, games, role-play, and music. Programs also vary substantially in their emphasis and material support for adult skill-building, school culture and climate, family and community engagement, and other components beyond direct child-focused activities or lessons.
There have been a small number of large multiprogram studies and trials of specific interventions in preschool, school, and afterschool contexts. Results from these studies are mixed. For example, large-scale, multisite, national studies show small or null effects (e.g., Social and Character Development Research Consortium, 2010), but many smaller, single-site studies report important and meaningful effects (e.g., Jones et al., 2011). Specific social and emotional learning interventions that have been subject
to building randomized trials, such as the PATHS program,7 MindUp,8 RULER,9 4Rs,10 Positive Action,11 Second Step,12 and Making Choices13 (see Jones et al., 2017, for a review focused on elementary school programs), generally show effects in the areas targeted by the intervention. For example, the RULER program broadly targets emotions; its feelings words curriculum focuses on building emotion skills (see, e.g., Rivers et al., 2013), and not surprisingly, the implementation of the program results in changes in children’s emotional competencies (Hagelskamp et al., 2013). The MindUp program emphasizes self- and physiological regulation and has showed positive results in children’s cognitive and emotional regulatory skills (Schonert-Reichl et al., 2015).
In general, social and emotional learning programs tend to have their largest effects among students with the greatest number of risks or needs, including those of lower socioeconomic status or those who enter school behind their peers either academically or behaviorally (e.g., Jones et al., 2011). For example, the Good Behavior Game14 affected aggression only among children who demonstrated low levels of on-task behavior at the outset of the study (Leflot et al., 2013). In Making Choices, children who were considered to be at risk of problem behaviors when the study began demonstrated larger gains in social contact and cognitive concentration (Fraser et al., 2004). At the school level, it appears that social and learning interventions are more effective when school-level factors are optimal: that is, institutions that are ready to effectively take on and implement those programs may see larger overall benefits for students than other institutions (e.g., Bierman et al., 2010). Within schools, those who struggle the most show the greatest short-term gains (Jones et al., 2017).
Schools, early childhood education settings, and out-of-school-time programs provide a unique opportunity to build students’ social and emotional skills; address trauma, including that specific to pandemic experiences; and move toward educational equity. Currently, there are few evidence-based programs or interventions that successfully integrate these
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7 See https://pathsprogram.com/
8 See https://mindup.org/
9 See https://clcfc.org/using-the-yale-university-pre-k-ruler-for-social-and-emotional-development/?gclid=Cj0KCQiA3eGfBhCeARIsACpJNU9URUyMhro0KOJL4fE7cDFhEYKAFnSF7Hw3bB0C7QIj2FkI28JO_AwaAnKLEALw_wcB
10 See https://www.morningsidecenter.org/4rs-program
11 See https://www.cebc4cw.org/program/positive-action
12 See https://www.secondstep.org/what-is-second-step?src=google&kwd=second%20step%20program&campaignid=605233614&adgroupid=24311091741&keyword=second%20step%20program&device=c&gclid=Cj0KCQiA3eGfBhCeARIsACpJNU8hjyDex6cgx3-fnhONbddZsToOgINjXUFFXOMnPCj4qJBs40qq1oUaAmqAEALw_wcB
three areas, which can lead to unintended consequences, including focusing on student deficits rather than leveraging student assets and building on the rich experiences, knowledge, skills, and curiosity that students bring into the classroom (Zacarian et al., 2017; Ginwright, 2018). For example, a program that focuses exclusively on trauma may only target such self-management skills as anger management or mindfulness and such characteristics as grit and resilience, without addressing injustices related to trauma or building on already existing cognitive, social, and emotional competencies (Aspen, 2018).
An approach that is both trauma-informed and culturally sustaining will include two elements: (1) building social and emotional skills that buffer against the negative effects of trauma while also addressing the realities of poverty, violence, and discrimination that are enduring and that have been exacerbated during the pandemic; and (2) tapping into the strengths and opportunities of students’ cultural beliefs, practices, and worldviews, allowing prevention assets not only to build on each other, but also to interact and multiply (Aspen, 2018; Berlinski, 2018; Sun et al., 2022).
School-Based Mental Health Supports for Youth
School counselors play a critical role in K–12 schools, supporting student development and success across social, emotional, and academic domains. As licensed professionals, school counselors promote students’ well-being and social and emotional development by providing critical short-term counseling, implementing developmental classroom lessons, supporting multitiered systems of support, and making referrals for specialized support (Savitz-Romer, 2019). In addition, counselors assume the role of academic supporters through development of study skills, coursework support and selection, and reduction of barriers to rigorous and college-ready coursework (Holcomb-McCoy, 2022). School counselors are essential leaders in promoting postsecondary readiness through early college readiness, career education, and future planning (Savitz-Romer, 2019). Across these three developmental domains, evidence consistently finds school counselors promote positive outcomes for students (Savitz-Romer & Nicola, 2022).
The onset of the COVID-19 pandemic brought about a novel set of stressors for school counselors. As schools shifted to remote instruction, school counselors faced a myriad of organizational constraints in fulfilling their professional responsibilities, including increased administrative duties, lack of role clarity, and inadequate support from their schools and districts (Savitz-Romer et al., 2021). The increasing threats to students’ mental health from the pandemic and increased attention to students’ social and emotional skills coincided with those and other obstacles that compromised school counselors’ efforts (Savitz-Romer et al., 2021). Given
these challenges, classroom teachers have also become an important part of the mental health and counseling support system, and programs like Positive Behavior Interventions and Supports (PBIS)15 are being used by many schools so that teachers can carry a preliminary role in counseling, freeing up school counselors to focus on the most serious mental health challenges for students.
Parenting, Family, and Community-Based Preventive Interventions
Exposure to both risks and protective factors during childhood may affect developmental trajectories over the life course. Negative trajectories can be changed through interventions—that is, changes in children’s environment that redirect what has happened to them (the National Academies, 2019b). For example, such programs as Strong African American Families16 build strength-based factors and assets in parents—including involved and vigilant parenting; adaptive racial socialization; open, clear, and supportive communication in families; and supportive family relationships—that can foster resilience in children through increases in youth protective factors (e.g., positive racial identity, future orientation, internalization of parental norms, and values regarding risk-avoidance behaviors). Increases in these resilience processes contribute to children’s self-sustaining trajectory of emotional and self-regulation that in turn dissuades them from engaging in risky behaviors to cope with stressful situations from middle childhood through young adulthood (Murry et al., 2011). These programs also demonstrate the importance of enhanced parenting efficacy as a mechanism to alleviate depressive symptoms among African American parents (Beach et al., 2008), which is associated with stronger relationships in families raising children in challenging situations (Beard et al., 2022).
COVID-19 has taken a toll on parents, and even those who possess effective parenting knowledge may still find themselves unable to behave skillfully in the context of stress because of an inability to regulate their emotions (Bögels et al., 2010). Parents with low levels of emotional regulation and cognitive control may benefit less from parenting skills training because they may have difficulty enrolling and engaging in the program, may be more distracted during training, and may be less able to implement what they have learned (Coatsworth et al., 2010). However, studies have shown that mindfulness and emotion regulation enhance parental responsiveness by developing parents’ capacity to control and shift their attention as needed to identify and respond to their children’s needs. Overall, addressing
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the potential long-term effects of COVID-19 on children and their families will require multilevel preventive intervention approaches and strategies.
CONCLUSIONS
As schools, out-of-school-time programs (e.g., afterschool programs, mentoring), and early childhood education settings increasingly return to prepandemic routines, educators and others who work with young people will face a population that has been through, and continues to experience, individual and collective adversity because of the pandemic. For some children, that may be adding to existing adversity; for others, it may be a new experience. Educators are certain to face increased pressure to focus on academics and make up for delayed learning caused by the pandemic, but it will also be important to dedicate adequate time and attention to addressing children’s social and emotional well-being to help them process their pandemic experience, cope with uncertainty and change, rebuild social, cultural, and community connections, and readjust to group learning environments.
Conclusion 3-1: The COVID-19 pandemic has taken a substantial toll on the social, emotional, behavioral, and mental health of children and their parents. To address this individual and collective adversity, adequate time, attention, and resources are needed to help children process their pandemic experience; cope with uncertainty and change; rebuild social, cultural, and community connections; and readjust to group learning environments. Supporting students’ ongoing social and emotional needs will not only make it easier to address academic fallout in the long run, but will also provide students with the internal resources and external support to cope with what is likely to be an indefinite period of uncertainty and change.
Conclusion 3-2: A number of prepandemic intervention strategies and approaches have been shown to effectively address some of the key mechanisms that link exposure to pandemic-related disruption, stress, worry, grief, and bereavement to developmental outcomes. Effective interventions focus on (1) building and maintaining supportive relationships and connections, (2) providing children with opportunities to learn and practice foundational social and emotional skills, (3) fostering connections to adults and experiences that offer opportunities for ongoing screening and observation to identify those who are struggling and to connect them to more intensive support, and (4) building sources of resilience in communities that can be modified and expanded to help recovery for children and their families.
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