UH Restart Playbook
University Hospital Restart Playbook
Click above to read about or download University Hospitals Restart Playbook.
University Hospital Restart Playbook
Click above to read about or download University Hospitals Restart Playbook.
Lessons Learned From School Shootings | SpringerLink
Click the link above to purchase Steve Polands, psi Expert Partner, and Sara Fergusons newly published book on America’s perspective on school shootings.
The American Academy of Pediatrics has just released new COVID-19 Guidance for Safe Schools. Keep reading for more info or click here to view the original report.
The AAP strongly advocates that all policy considerations for school plans should start with the goal of keeping students safe and physically present in school.
The purpose of this guidance is to continue to support communities, local leadership in education and public health, and pediatricians collaborating with schools in creating policies for safe schools during the COVID-19 pandemic that foster the overall health of children, adolescents, educators, staff, and communities and are based on available evidence. As the next school year begins, there needs to be a continued focus on keeping students safe, since not all students will have the opportunity or be eligible to be vaccinated before the start of the next school year. Since the beginning of this pandemic, new information has emerged to guide safe in-person learning. Remote learning highlighted inequities in education, was detrimental to the educational attainment of students of all ages, and exacerbated the mental health crisis among children and adolescents. 1,2 Opening schools generally does not significantly increase community transmission, particularly when guidance outlined by the World Health Organization (WHO),3 United Nations Children’s Fund (UNICEF), and Centers for Disease Control and Prevention (CDC) is followed. 4,5 There are still possibilities for transmission of SARS-CoV-2, especially for individuals and families who have chosen not to be vaccinated or are not eligible to be vaccinated. In addition, SARS-CoV-2 variants have emerged that may increase the risk of transmission and result in worsening illness. However, the AAP believes that, at this point in the pandemic, given what we know about low rates of in-school transmission when proper prevention measures are used, together with the availability of effective vaccines for those age 12 years and up, that the benefits of in-person school outweigh the risks in almost all circumstances. Along with our colleagues in the field of education,6 the American Academy of Pediatrics (AAP) strongly advocates for additional federal assistance to all schools throughout the United States, irrespective of whether the current local context allows for in-person instruction.
Schools and school-supported programs are fundamental to child and adolescent development and well-being and provide our children and adolescents with academic instruction; social and emotional skills, safety, reliable nutrition, physical/occupational/speech therapy, mental health services, health services, and opportunities for physical activity, among other benefits.7 Beyond supporting the educational development of children and adolescents, schools can play a critical role in addressing racial and social inequity. As such, it is critical to reflect on the differential impact the COVID-19 pandemic and the associated school closures have had on different racial and ethnic groups and populations facing inequities. Disparities in school funding, quality of school facilities, educational staffing, and resources for enriching curricula among schools have been exacerbated by the pandemic. Families rely on schools to provide a safe, stimulating, and enriching space for children to learn; appropriate supervision of children; opportunities for socialization; and access to school-based mental, physical, and nutritional health services.
Everything possible must be done to keep students in schools in-person. Many families did not have adequate support to the aforementioned educational services, and disparities, especially in education, did worsen, especially for children who are English language learners, children with disabilities, children living in poverty, and children who are Black, Hispanic/Latino, and American Indian/Alaska Native. 8,9,10,11
The AAP strongly recommends that school districts promote racial/ethnic and social justice by promoting the well-being of all children in any school COVID-19 plan, with a specific focus on ensuring equitable access to educational supports for children living in under-resourced communities.
It is critical to use science and data to guide decisions about the pandemic and school COVID-19 plans. All school COVID-19 policies should consider the following key principles and remember that COVID-19 policies are intended to mitigate, not eliminate, risk. Because school transmission reflects (but does not drive) community transmission, it is vitally important that communities take all necessary measures to limit the community spread of SARS-CoV-2 to ensure schools can remain open and safe for all students.
The implementation of several coordinated interventions can greatly reduce risk:
With the above principles in mind, the AAP strongly advocates that all policy considerations for school COVID-19 plans should start with a goal of keeping students safe and physically present in school. The importance of in-person learning is well-documented, and there is already evidence of the negative impacts on children because of school closures in 2020.13
Policy makers and school administrators must also consider the scientific evidence regarding COVID-19 in children and adolescents, including the role they may play in the transmission of the infection. 14,15,16,17,18,19,20,21,22 Although many questions remain, the preponderance of evidence indicates that children and adolescents are less likely to have severe disease resulting from SARS-CoV-2 infection. 23,24 We continue to learn more about the role children play in the transmission of SARS-CoV-2. At present, it appears that children younger than 10 years are less likely to become infected and less likely to spread the infection to others, although further studies are needed. 25,26,27 Some data suggest children older than 10 years may spread SARS-CoV-2 as efficiently as adults. Additional in-depth studies are needed to truly understand the infectivity and transmissibility of this virus in anyone younger than 18 years, including children and adolescents with disabilities and medical complexities. Current SARS-CoV-2 variants may change both transmissibility and infection in children and adolescents even in those who have been vaccinated.
Visit the CDC COVID-19 Prevention Strategies for additional information on mitigation measures including physical distancing, testing, contact tracing, ventilation, and cleaning and disinfecting.
In the following sections, some general principles are reviewed that policy makers and school administrators should consider as they safely plan for in-person school. There are several other documents released by the CDC, the National Association of School Nurses, and the National Academy of Sciences, Engineering, and Medicine that can be referenced as well. For all of these, engagement of the entire school community, including families, teachers, and staff, regarding these measures should be a priority.
School Attendance and Absenteeism: Studies performed throughout the pandemic demonstrated wide variability in tracking of school attendance. As of January 2021, only 31 states and the District of Columbia required attendance to be taken.28 Definitions of attendance for individuals participating in distance learning have varied between and within states. Among jurisdictions that did report on attendance during the pandemic period, several studies demonstrate disparities in impact of chronic absence.29 In an evaluation of Connecticut’s attendance data from school year 2020-21, rates of chronic absenteeism were highest among predominantly remote students compared with students who were primarily in-person; that gap was most pronounced among elementary and middle school students. Chronic absence was more prevalent among Connecticut students who received free or reduced-price lunch, were Black or Hispanic, were male, or identified as English learners or having disabilities.29 National prepandemic chronic absenteeism data mirror several of these demographic trends.30
The best way to reduce absenteeism is by closely monitoring attendance and acting quickly once a pattern is noticed.31 During the the 2021-22 school year, daily school attendance should be monitored for all students; for students participating in in-person and distance learning. Schools should use multi-tiered strategies to proactively support student attendance for all students. Additionally, schools should implement strategies to identify and differentiate interventions to support those at higher risk for absenteeism. Local data should be used to define priority groups whose attendance has been most deeply impacted during the pandemic. Schools are encouraged to create an attendance action plan with a central emphasis on family engagement leading up to and through the start of school.
With the beginning of the 2021-22 school year, plans should be in place for outreach to families whose students do not return for various reasons. This outreach is especially critical, given the high likelihood of separation anxiety and agoraphobia in students. Students may have difficulty with the social and emotional aspects of transitioning back into the school setting, especially given the unfamiliarity with the changed school environment and experience. Special considerations are warranted for students with pre-existing anxiety, depression, and other mental health conditions; children with a prior history of trauma or loss; children with autism spectrum disorder; and students in early education who may be particularly sensitive to disruptions in routine and caregivers. Students facing other challenges, such as poverty, food insecurity, and homelessness, and those subjected to ongoing inequities may benefit from additional support and assistance. Schools should identify students who are at risk for not returning and conduct outreach prior to the beginning of the school year. Resources should be available to assist families with preparing their student for transition back to school.
Students with Disabilities: The impact of loss of instructional time and related services, including mental health services, as well as occupational, physical, and speech/language therapy during the period of school closures and remote learning is significant for students with disabilities. All students, but especially those with disabilities, may have more difficulty with the social and emotional aspects of transitioning out of and back into the school setting because of the pandemic. As schools prepare for or continue in-person learning, school personnel should develop a plan to ensure a review of each child and adolescent with an IEP to determine the needs for compensatory education to adjust for lost instructional time and disruption in other related services. In addition, schools can expect a backlog in evaluations; therefore, plans to prioritize students requiring new referrals as opposed to reviews and re-evaluations will be important. Many school districts require adequate instructional effort before determining eligibility for special education services. However, virtual instruction or lack of instruction should not be reasons to avoid starting services such as response-to-intervention (RTI) services, even if a final eligibility determination is delayed.
Each student’s IEP should be reviewed with the parent/guardian/adolescent yearly (or more frequently if indicated). All recommendations in the IEP should be provided for the individual child no matter which school option is chosen (in person, blended, or remote). See the AAP Caring for Children and Youth with Special Health Care Needs During the COVID-19 Pandemic for more details.
Additional COVID-19 safety measures for teachers and staff working with some students with disabilities may need to be in place to ensure optimal safety for all. For certain populations, the use of face masks by teachers may impede the education process. These include students who are deaf or hard of hearing, students receiving speech/language services, young students in early education programs, and English language learners. There are products (eg, face coverings with clear panels in the front) that may be helpful to use in this setting.
Adult Staff and Educators: Universal use of face masks is recommended, given that certain teachers must cross-over to multiple classes, such as specials teachers, special educators, and secondary school teachers, and in consideration of new SARS-CoV-2 variants. At this time, this recommendation for use of face masks includes staff and educators who have been fully vaccinated, especially for teachers with students who are unvaccinated (including pre-K, kindergarten, and elementary schools). School staff working with students who are unable to wear a face mask or who are unable to manage secretions, who require high-touch (hand over hand) instruction, and who must be in close proximity to these students should consider wearing a surgical mask in combination with a face shield.
School health staff should be provided with appropriate medical PPE to use in health suites. This PPE should include N95 masks, surgical masks, gloves, disposable gowns, and face shields or other eye protection. School health staff should be aware of CDC guidance on infection control measures.
On-site School-Based Health Services: On-site school health services, including school-based health centers, should be supported if available, to complement the pediatric medical home and to provide pediatric acute, chronic, and preventive care. Collaboration with school nursesis essential, and school districts should involve school health services staff and consider collaborative strategies that address and prioritize immunizations and other needed health services for students, including behavioral health, vision screening, hearing, dental and reproductive health services. Plans should include required outreach to connect students to on-site services regardless of remote or in-person learning mode.
Immunizations: Pediatricians should work with schools and local public health authorities to promote childhood vaccination messaging well before the start of the school year and throughout the school year. It is vital that all children receive recommended vaccinations on time and get caught up if they are behind as a result of the pandemic. The capacity of the health care system to support increased demand for vaccinations should be addressed through a multifaceted, collaborative, and coordinated approach among all child-serving agencies including schools.
Existing school immunization requirements should be discussed with the student and parent community and maintained. In addition, although influenza vaccination is generally not required for school attendance, it should be highly encouraged for all students and staff. The symptoms of influenza and SARS-CoV-2 infection are similar, and taking steps to prevent influenza will decrease the incidence of disease in schools and the related lost educational time and resources needed to handle such situations by school personnel and families. School districts should consider requiring influenza vaccination for all staff members.
Schools should collaborate with state and local public health agencies to ensure that teachers and staff have access to the COVID-19 vaccine and that any hesitancy is addressed as recommended by the Advisory Committee on Immunization Practices (ACIP) of the CDC.Pediatricians should work with families, schools, and public health to promote receipt of the COVID-19 vaccine and address hesitancy as the vaccine becomes available to children and adolescents.
In order to vaccinate as many school staff, students, and community members as possible, school-located vaccination clinics should be a priority for school districts. Schools are important parts of neighborhoods and communities and serve as locations for community members after school hours and on weekends.
Vision Screening: Vision screening practices should continue in school whenever possible. Vision screening serves to identify children who may otherwise have no outward symptoms of blurred vision or subtle ocular abnormalities that, if untreated, may lead to permanent vision loss or impaired academic performance in school. Personal prevention practices and environmental cleaning and disinfection are important principles to follow during vision screening, along with any additional guidelines from local health authorities.
Hearing Screening: Safe hearing screening practices should continue in schools whenever possible. School screening programs for hearing are critical in identifying children who have hearing loss as soon as possible so that reversible causes can be treated and hearing restored. Children with permanent or progressive hearing loss will be habilitated with hearing aids to prevent impaired academic performance in the future. Personal prevention practices and environmental cleaning and disinfection are important principles to follow during hearing screening, along with any additional guidelines from local health authorities.
Children with Chronic Illness: Certain children with chronic illness may be at risk for hospitalization and complications with SARS-CoV-2. These youth and their families should work closely with their pediatrician and school staff using a shared decision-making approach regarding options regarding return to school, whether in person, blended, or remote. See the AAP Caring for Children and Youth with Special Health Care Needs During the COVID-19 Pandemic for more details.
Behavioral Health/Emotional Support for Children and Adolescents: The COVID-19 pandemic has created profound challenges for communities, families, and individuals, leading to a range of emotional and behavioral responses. There are many factors unique to this pandemic (eg, grief/loss, uncertainty, rapidly changing and conflicting messages, duration of the crisis, and need for quarantine) that increase its effects on emotional and behavioral health (EBH). Populations with a higher baseline risk, such as historically under-resourced communities, children and youth with developmental disabilities and other special health care needs, may be especially vulnerable to these effects. 32,33 The impact of the pandemic is also compounded by isolation and an interruption in the support systems families utilize.
Schools are a vital resource to continue to address and provide resources for a wide range of mental health needs of children and staff. The emotional impact of the pandemic, grief because of loss, financial/employment concerns, social isolation, and growing concerns about systemic racial inequity—coupled with prolonged limited access to critical school-based mental health services and the support and assistance of school professionals—demand careful attention and supports in place during all modes of learning, whether remote or in-person. Schools should be prepared to adopt an approach for mental health support, and just like other areas, supporting mental health will require additional funding to ensure adequate staffing and the training of those staff to address the needs of the students and staff in the schools.
Schools should consider providing training to classroom teachers and other educators on how to talk to and support children during and after the COVID-19 pandemic including how to support grief and loss among students. The United States has already accumulated more than 600,000 deaths from COVID-19; on average, it is estimated that each of these deaths impacts 9 people – many of these 4.5 million grieving individuals are children. Bereavement has a significant impact on the short- and long-term adjustment of children, their developmental trajectory, academic learning, psychosocial functioning, and emotional adjustment and behavior. Students experiencing significant personal losses can be referred to school and community-based bereavement support programs, centers, and camps, as well as to their pediatrician or other pediatric health care provider.34 Students with additional mental health concerns should be referred to school mental health professionals.
Suicide is the second leading cause of death among adolescents or youth 10 to 24 years of age in the United States.35 Schools should develop mechanisms to evaluate youth remotely and in-person if concerns about a risk of suicide are voiced by educators or family members and should be establishing policies, including referral mechanisms for students believed to be in need of in-person evaluation, even before schools resume in-person instruction.
School mental health professionals should be involved in shaping messages to students and families about the response to the pandemic and the changing school learning plans based on a variety of community SARS-CoV-2 factors. Fear-based messages widely used to encourage strict physical distancing may cause problems when schools resume in-person instruction, because the risk of exposure to COVID-19 may be mitigated but not eliminated. Communicating effectively is especially critical, given potential adaptations in plans for in-person or distance learning that need to occur during the school year because of changes in community transmission of SARS-CoV-2.
Schools need to incorporate academic accommodations and supports for all students who may still be having difficulty concentrating or learning new information because of stress or family situations that are compounded by the pandemic. It is important that school personnel do not anticipate or attempt to catch up for lost academic time through accelerating curriculum delivery at a time when students and educators may find it difficult to even return to baseline rates. These expectations should be communicated to educators, students, and family members so that school does not become a source of further distress
(See: Interim Guidance on Supporting the Emotional and Behavioral Health Needs of Children, Adolescents, and Families During the COVID-19 Pandemic)
The personal impact on educators and other school staff should be recognized. In the same way that students need ongoing support to process the information they are being taught, teachers cannot be expected to be successful at teaching children without having their mental health needs supported. The strain on teachers, as they have been asked to teach differently while they support their own needs and those of their families, has been significant. Additional challenges with staff shortages, changing learning modalities, and prolonged duration of the crisis are continuing to present additional challenges and further impact teachers and school staff. Resources such as Employee Assistance Programs and other means to provide support and mental health services should be prioritized. The individual needs and concerns of school professionals should be addressed with accommodations made as needed.
Although schools should be prepared to be agile to meet evolving needs and respond to increasing knowledge related to the pandemic and may need to institute partial or complete closures when the public health need requires, school leaders should recognize that staff, in addition to students and families, will benefit from sufficient time to understand and adjust to changes in routine and practices. During a crisis, people benefit from clear and regular communication from a trusted source of information and the opportunity to dialogue about concerns and needs and feel they are able to contribute in some way to the decision-making process. Change is more difficult in the context of crisis and when predictability is already severely compromised.
Food Insecurity: According to the United States Department of Agriculture, the number of food-insecure households has increased during the pandemic with a currently estimated 30 million adults and 12 million children living in households where they may not get enough to eat.36 We also know that disparities with food insecurity exist, with Black and Latino adults being twice as likely as white adults to report their households did not get enough to eat.34School planning must consider the many children and adolescents who experience food insecurity already (especially at-risk populations and those living in poverty) and those who will have limited access to routine meals through the school district in the event of school closure or if a child is ill. The short- and long-term effects of food insecurity in children and adolescents are profound.37 Schools can partner with community resources including federal and state food programs to mitigate the effects of food insecurity on children and families. More information about how families can access federal nutrition programs can be found in the AAP/FRAC Food Insecurity Toolkit.
Housing Insecurity: Like food insecurity, housing insecurity is a significant and sometimes overlooked issue that affects many families and will impact children’s ability to return and re-engage with school. With pandemic-associated job losses, there have been significant numbers of families with children who have been evicted or will soon be evicted from their homes. According to the US Census Bureau, as of February 2021, there are 5.2 million households with children who are behind on rent and 4.5 million homeowners with children behind on mortgage payments.38 Housing insecurity impacts a child’s education directly through missed school days and through transferring to a new school, which is associated with a 4 times higher risk of chronic absenteeism, lower grades and test scores, and increased risk of dropping out of school.39 Housing insecurity also impacts education indirectly by impacting a child’s overall physical and mental health, which can have negative consequences for educational achievement. Children who experience homelessness are at increased risk for malnutrition, asthma, obesity, and dental, vision, emotional, behavioral, and developmental problems.40 In addition, the increased toxic stress children experience when they live in unstable housing situations can contribute to anxiety and other mental health conditions that interfere with a child’s education. The interconnectedness of employment, housing, health, and education and the disproportionate impact this has had on communities of color because of structural racism must be considered as children return to school.41 Schools are encouraged to partner with community agencies to address the effects of housing insecurity and mitigate the impact this will have on the education of children.
Digital Divide: The digital divide has been a known disparity for decades, contributing to the “homework gap”—the gap between school-aged children who have access to high-speed internet at home and those who do not. According to a Pew research study in 2015, 35% of lower-income households with school-aged children did not have a broadband internet connection at home. According to the Pew Research Center, 1 in 5 teenagers are not able to complete schoolwork at home because of a lack of a computer or internet connection.42 This technological homework gap disproportionately affects Black families living in poverty.9 With the transition to virtual learning during the pandemic, this divide was highlighted as families struggled to adapt to school from home. In April 2020, 59% of parents with lower incomes who had children in schools that were remote because of the pandemic said their children would likely face at least 1 of 3 digital obstacles to their schooling, such as a lack of reliable internet at home, no computer at home, or needing to use a smartphone to complete schoolwork. Gains have been made over this past year with creative local and state solutions working toward providing improved access to both technology devices and internet connections for students, but a significant gap still exists, particularly for students living in poverty. This digital divide is a critical component to be addressed in schools even as children return to in-person learning as they navigate the increasing digital learning environment, academic recovery, and extended home learning materials. Access to both reliable high-speed internet and adequate devices beyond a smart phone are critical to promote equity and support academic success. Long-term sustainable funding is needed to support school districts in providing universal internet access and technology for all students.
Organized Activities: It is likely that sporting events, practices, and conditioning sessions as well as other extracurricular activities will be limited in some locations while reopening fully in other locations. The AAP Interim Guidance on Return to Sports helps pediatricians inform families on how best to ensure safety when considering a return to sports and physical activity participation. Preparticipation evaluations should be conducted in alignment with the AAP Preparticipation Physical Evaluation Monograph, 5th ed, and state and local guidance.
Written by Dr. Carly Wilbur, UH Pediatrician and psi Medical Director
Wallet, keys, phone… mask: We check our pockets before leaving the house or the car. Pretty soon, if Americans continue to take advantage of the readily available COVID-19 vaccines, we may be able to drop that last item off the list. Airplane travel, celebrations with large indoor gatherings of strangers, full days at the office or at school without wearing a mask— after 15 months of pandemic restrictions, these activities that were once so familiar may seem foreign and even scary. One might think that re-entry to what we used to consider normal would be instinctual, but the toll the pandemic has taken on us emotionally, physically, and financially impacts how flexible we can be while returning to baseline. This is a timely topic, but one that can be confusing. Official recommendations change weekly in response to trends in COVID infection, so it can be difficult to pin down the “right” way to behave.
In terms of summer get-togethers, current guidance from the CDC indicates that even indoor gatherings of vaccinated individuals should be safe. The CDC endorses fully-vaccinated individuals to participate in full-capacity worship services, attend classes at a gym, eat at an indoor restaurant or bar, and attend indoor sporting events— all without the need for disease-prevention measures like masking or physical distancing.
But what about unvaccinated individuals? Children under 12 years of age are too young to receive the COVID-19 vaccine, so the best way to facilitate their group play is to utilize the great outdoors. Summer camps can safely allow unvaccinated children to play outside with just a few feet of distance from one another. If the weather doesn’t agree with that plan, masking and physical distancing indoors are still the standard. What about mixed age groups? If families with vaccinated adults and younger children want to share a meal or an activity, is there a safe way to manage that? The data have shown that overwhelmingly, mRNA vaccine recipients will not contract a serious case of COVID even after a close contact, and their risk of virus transmission to others is also greatly reduced. So is it safe for a toddler who attends day care to hug his vaccinated grandmother? Yes. Is it safe for a vaccinated parent to carpool with young children from different homes? Yes. Can schools re-open in the fall without masks? Maybe.
High schools with strong levels of student and teacher vaccination may be able to return to pre-COVID learning arrangements with very low risk of contagion. Middle schools that include only 7th and 8th graders may enjoy the same freedom. Until the vaccine eligibility age is lowered, however, 6th graders and their younger colleagues may find themselves continuing to require masks, generous desk spacing, and plexiglass dividers. There is hope that COVID vaccination will be available to children 6 years and older by the fall, so those predictions may change.
But it’s not just younger individuals who aren’t vaccinated. As of the start of June 2021, only half of eligible adults (16 years of age and older) in the US and 600,000 kids aged 12-15 have been vaccinated against COVID-19. Unfortunately, the science behind the movement has been eclipsed by the politics of the time. The topic of COVID vaccination is polarizing, and it’s unlikely that either side of the debate could convert someone to the other side. What we need to remember is that individual freedoms are protected in our country and we must always remain decent to one another.
According to experts, portions of the population that are fully vaccinated are cleared to return to pre-COVID activities, but unvaccinated children and adults ought to continue to take precautionary measures. There are, however, some protocols that everyone should follow as we embark on this journey together. Be realistic: pre-pandemic life was not perfect, so temper expectations as you return to work, school, traffic, the post office, and other everyday activities. Be patient: there are still shortages and delays associated with suboptimal staffing and production issues. Be brave: for some, remote school or work was a blessing, and in-person interactions may present a challenge as normalcy returns. Be flexible: we managed to adjust and restructure so much of our lives over the last year, and we can certainly do it again in the coming months. Be kind: unless you own Amazon or Purell, you did not have a stellar year. We have all struggled, whether financially, physically, emotionally, socially, or academically. Practice compassion and remember the words of J.M Barry, creator of Peter Pan:
“Be kinder than necessary because everyone you meet is fighting some kind of battle.”
Dr. Carly Wilbur is psi’s Medical Director and is a board-certified pediatrician with University Hospitals Rainbow Babies and Children’s Hospital in Cleveland, Ohio. To learn more, click here or email: firstname.lastname@example.org.
Written by Thom Fladung, Hennes Communications
Congratulations, School Leaders. You survived 2020-21 – a school year unlike any other, featuring the continuation of a public health pandemic, the most hyper-charged political atmosphere in memory and social justice issues that roiled the nation.
Your reward: Start getting ready for 2021-22.
But unlike, say, January 2020, when we began hearing mysterious reports of a serious illness in China, lessons learned from the past year and a half can be carried into the coming school year and many school years to come.
Those lessons include how to apply the best practices of crisis communications along with the specialized practice of outrage management and make it work in a culture dominated by social media, where every slight or disagreement seemingly turns into a battle royale.
This has all placed a greater premium on communicating with your key school stakeholders – your teachers, your staff, your students, your parents – than has ever been the case.
The Damage Control Playbook
Let’s start with the fundamentals of effective crisis communications. At Hennes Communications, we depend on our Damage Control Playbook and its five simple concepts:
Steps to Managing Outrage
Headlines from news stories across the nation have had a familiar ring:
“Parents outraged that school district will begin the year with virtual classes”
“Parents outraged over decision for blended learning in schools”
“Parents outraged after school board meeting on reopening plans”
There’s a lot of outrage to go around out there.
A specialized subset of crisis communications has emerged that now is commonly referred to as outrage communications or outrage management. Peter Sandman, a colleague and friend to Hennes, has been one of the leading proponents of this discipline. Here are some steps he’s outlined and that we’ve refined for outrage management.
Communicating Your Way Through A Pandemic
We’ve also gotten new lessons – or been reminded of old ones – while communicating through this pandemic.
What to do on summer vacation
Now is the time to take those learnings from communicating during a pandemic and turn them into a communications action plan for the fall. Take advantage of this time.
Here are some of the strategies and tactics to consider as your school’s communicators begin that work.
What else to do on summer vacation
Show me, don’t tell me
This is one of journalism’s oldest, truest clichés. To make people believe what you’re saying, don’t just recite policies and practices. Show them what you mean.
Consider using Facebook Live or videos or some other method to show and not just tell your stakeholders what you’re doing. Before school starts, show me what your classroom in 2021-22 is going to look like. Recruit student volunteers or ask your teachers to play the part. Show me the hallways between class changes. Show me the lockers. Show me how you’re continuing to clean high-touch areas. Take me inside what you’re planning to do – before you do it.
Plan and adjust
Remember that communications plans are not evergreen documents. Review and update regularly to address emerging issue and concerns. This golden rule will be even more relevant during the 2021-2022 school year. Adjust your communication methods and perhaps add some new ones. Study what other districts are doing and adopt some of their good ideas.
Most important, you will want to hear from parents, teachers, staff and students and adjust your plan to address their needs.
They looked to you for leadership during a challenging time. They’re still looking.
Thom Fladung is managing partner for Hennes Communications. Contact him at email@example.com or 216-213-5196 to learn more about presentations on crisis and issues communications for educators and more.
Written by Christine Worthington, Virtualpsi Coordinator and Field Supervisor
Technology…let’s ponder that word for a minute…technology. To some, this word is exciting and stirs feelings of future growth and promise. To others, this concept can be frightening and intimidating.
Currently, in our field, technology is often considered synonymous with teletherapy. However, I have come to notice that technology is not just related to teletherapy, but is integral to both in-person and online services. So, what are the future trends of technology and telehealth, and how will technology impact our field going forward?
It’s no secret that teletherapy has experienced significant growth and support since March 2020, and this upward trend is expected to continue. This growth will bring increasingly more technology into our homes, therapy rooms, research and work settings every day. Interestingly, many SLPs are recognizing that the technology being used during virtual instruction can also be used during in-person sessions with excellent outcomes. Teletherapy resources can be brought to the in-person therapy rooms and used efficiently and effectively. For example, the current use of iPads and tablets during in-person sessions has afforded the overburdened SLP with easy to use, portable material. A variety of apps can be utilized to address many therapeutic needs and treatments from early intervention to adults. Additionally, digital downloads of games and interactive instructional resources are just a click away.
The growth of technology does not stop with online platforms, iPads, tablets, or interactive therapeutic resources. The advancement of technology in our field can also be witnessed through 3D printing, virtual reality, and artificial intelligence. 3D printing can be utilized to create lifelike images such as hearing aids and artificial larynxes, and help students visualize articulatory movements with 3D animations. New products, such as TikTalk, use artificial Intelligence (AI) to promote accuracy and provide SLPs with new tools to promote home practice and consistency.
The applications are endless and the clinician just needs to imagine how this technology can positively impact their work. Virtual reality and artificial intelligence are not quite impacting our field yet, but discussions are occurring to imagine how these technologies can be used and implemented in research and education. Technology does not need to intimidate or create a sense of uncertainty. Embrace the concept and allow the mind to imagine the future of our field with all these amazing new trends at our fingertips.
Click above to hear Mike Tornow and Brooke Khamis discuss psi services, LifeAct, Raising the Bar of Education and more on The Summit FM!
Written by Dr. Carly Wilbur, UH Pediatrician and psi Medical Director.
As the COVID-19 pandemic unfolded, many schools and workplaces shifted to an online platform. This necessarily increased the amount of time we all spent using electronic devices to communicate, learn, and connect. While the American Academy of Pediatrics recommended fewer than two hours per day of total screen time prior to the move to remote learning, these guidelines have been updated to reflect the realistic demands of our current digital age.
Not all screen time is bad. The effect it has on the mind and body varies with age, content, timing, and other important factors.
AGE— Screen time for children under two years old is still not encouraged, however during the COVID lockdown, experts modified this recommendation to allow for real-time video chatting so that loved ones could stay in touch. For toddlers, it is advised that only high-quality educational programming be selected, and that parents or caregivers watch alongside younger children so that the experience can be shared and reflected upon together. Solo use of a phone or tablet for viewing in toddlers is not endorsed. For school-aged children, parents must establish clear rules and boundaries, including reviewing internet safety and avoidance of dangerous engagement in social media. For pre-teens and adolescents, this point bears repeating: it is easy for kids at this developmental stage to get swept away in a fad or a scam. They must be told in clear terms that their privacy (ranging from social security number, to home address, to intimate photos) must be prioritized and they are never to engage in behavior that is harmful to themselves (i.e. trending challenges) or others (bullying, trolling).
CONTENT— It is too easy, given the “frictionless interface”, purposely designed to effortlessly slide the user’s attention from one screen to the next, to fall into what’s called an internet rabbit hole. This reference, from Alice in Wonderland, is a metaphor for a method of transporting someone into a surreal and disturbing situation. Clicking on a link located on an age-appropriate site can lead down a road to something unsuitable and traumatizing for younger children. Teenagers and adults can also get caught up in the “gamification” of apps and social media sites, where designers intentionally set up competitive elements to encourage in-app purchases and promote online marketing. This is all to say where you start isn’t always where you land online.
BRAIN CHEMISTRY— Research continues to delve into the effect that screens have on children at a young age. Even in moderation, there are biologic consequences for exposure to the blue light wavelength that screened devices emit. It is surmised that extended exposure can cause long-term damage to the eyes, including macular degeneration, early development of cataracts, retinal toxicity, eye strain, and dry eyes. While an iPad can serve as a great babysitter for a busy parent trying to get dinner ready, inert observation does nothing to further a child’s imagination, encourage creative problem-solving, or develop self-comfort mechanisms. It can serve as a welcome distraction for a hyperactive child, but doesn’t teach them to channel their energy into a productive outcome. Videos of unboxing toys or watching others play video games does not stimulate the imagination. For older children, they should consider whether their screen contact makes them feel better or worse afterward, if it was overall a positive or negative experience. Learning to play guitar or draw calligraphy online and coming away with a new self-taught skill is an entirely different endeavor than passively watching Ninja play Fortnite on Twitch. At nighttime, the effect of the blue light wavelength is magnified. Scientists have discovered that exposure to screens, regardless of the filter applied, suppresses the secretion of melatonin, the body’s naturally-occurring hormone that makes us sleepy. That means that having a TV or phone in the bedroom impedes the circadian nature of the sleep-wake cycle.
SOCIAL INTERACTION— Some screen use encourages social communication, connection, or useful contact, and other screen use does not. Real-time video calls with friends and family, or even judicious use of online gaming with other known players is beneficial. Video chatting throughout the COVID pandemic may have been the only way some grandparents could “visit” with family. It has value when it is used to promote family togetherness, and to prevent social isolation. On the flip side, when screens are prohibited during family dinnertime and bedtime, it encourages in-person intimacy and communication, and protects certain shared encounters that foster emotional closeness and healthy attachment.
Not all screen time is created equal. Using a device to attend classes, learn a new skill, connect with friends and family, or distract an antsy child for a moment is a testament to the ways we put technology to work to improve our lives. But too much screen time can cost us in terms of eye strain, social media addiction, exposure to inappropriate content, disruption of innate sleep chemistry, and exposure to the kind of stressors that contribute to trial-and-error skills-building. Screen time has its role, but it should not replace the need for eating, sleeping, studying, playing, exercising, or interacting with real people. As teachers, parents, and caregivers, we must remain vigilant to these hazards, and set a good example at the dinner table, during bedtime, and any other opportunity when we can to demonstrate good impulse control, put down our screens, and look at each other.
Written by Dr. Carly Wilbur, UH Pediatrician and psi Medical Director.
Diabetes in school-aged children is not an uncommon finding. It is estimated that over 200,000 Americans under the age of 20 carry this diagnosis. In healthy individuals, the pancreas automatically produces insulin in response to the ingestion of carbohydrates (also known as sugars) in the diet. In diabetics, the pancreas fails to meet this demand, so these patients must not only limit their sugar intake but also use injectable insulin to help the body metabolize dietary carbohydrates.
Ideally, carbohydrates in food provide an energy source for cell function. However, if the sugars in the diet don’t get properly metabolized, these molecules build up in the blood causing hyperglycemia, or high blood sugar. Clinical symptoms of hyperglycemia include headaches, blurry vision, frequent urination, excessive thirst, or even coma. Chronically high blood glucose levels can cause irreversible damage to the nervous system, eyes, heart, and kidneys.
In order to dose the correct amount of insulin, diabetic patients must first prick a finger and extract some blood, and test that blood on a glucose monitor. Most diabetes patients have a baseline amount of long-acting insulin that they use every morning and night, and they adjust the daytime short-acting doses on a sliding scale in direct response to blood glucose readings. Insulin is then delivered using a syringe and injecting into the fatty layer just under the skin.
Diabetes requires vigilant tracking of diet, blood glucose levels, and insulin delivery. It also demands awareness of subtle cues that signal the onset of an episode of poor glucose control. These expectations may be unrealistic in younger children, and so the burden of responsibility falls on the staff and administrators at school to help keep diabetic children safe throughout the school day. But there is no one-size-fits-all approach to a diabetic’s care, and individualized disease management can be confusing. In addition, while technological advancements have created more enhanced supervision possible, the constantly-changing landscape of available devices, and the platforms on which they function, have added extra layers of complexity to the management of school-aged children with diabetes.
To avoid multiple finger pricks and needle sticks throughout the day, devices like a Continuous Glucose Monitor (CGM) and an Insulin Pump can be helpful. Instead of spot-checking blood glucose levels before and after meals, a CGM uses a sensor that is attached to the body to monitor and track blood glucose levels every few minutes, around the clock, allowing for more comprehensive overview of the patient’s glycemic control. Using a wireless hand-held device, the patient can enter the glucose reading obtained from the CGM into the bolus calculator of an Insulin Pump and the device automatically computes and dispenses the necessary insulin dose. Used together, a Continuous Glucose Monitor and Insulin Infusion Pump take a lot of the guesswork out of diabetes management. Some pump devices can even receive wireless transmission directly from a CGM, saving the user the step of entering the blood glucose level. However, nothing is error-free, and the patient and those adults in the school building tasked with their safety must be prepared to recognize the symptoms of hyperglycemia or hypoglycemia and manage these swiftly and effectively.
Because carbohydrates are the body’s main energy source, symptoms of low blood sugar (or hypoglycemia) include shakiness, dizziness, poor concentration, sweating, irritability, rapid heart rate, and irritated mood. With younger patients, or new-onset diabetics, their familiarity with these symptoms may be less than optimal, and indicators may be ignored or go unrecognized. Someone inexperienced with caring for diabetics may too easily dismiss a diabetic teenager’s low energy or bad mood as age-appropriate, and dangerously abnormal blood glucose levels could go unchecked, causing immediate and lasting damage.
Diabetes care plans can be very confusing. By nature, they must be detailed and inclusive, planning for every possibility, from hypoglycemia to hyperglycemia, in addition to all the incremental responses to normal glucose levels. Diabetics have to watch their diet and avoid excessive carbohydrate intake. This is difficult in 3rd grade when every child’s birthday comes with cupcakes for the class. This is still difficult in 7th grade when kids swap lunch items. This is even difficult in 12th grade when the vending machine is a constant temptation.
Diabetic Ketoacidosis (DKA) is a serious complication that can land a diabetic in the hospital, and likely in the Intensive Care Unit (ICU). Typically patients in DKA will have a blood sugar >300 and will show signs of metabolic distress (high levels of ketones in the urine). While there are predictive factors, like smoking, stress, young age, drug use, and infectious illness, sometimes we don’t know what triggers a patient’s DKA episode. Complications of DKA include kidney or brain damage, shock, and even death. What might be a mild stomach flu in an otherwise-healthy student can be very dangerous in a diabetic one. Stressing one’s system with recreational drugs or even sleep deprivation can have serious consequences for diabetic students. It’s vital that all personnel involved with overseeing diabetic patients feel comfortable with that role.
Diabetes care in the pediatric population can be a challenge. Even when all the instructions are followed, a young patient’s hypoglycemic unawareness or an older patient’s all-nighter for a school project can alter the way their body’s metabolism functions. Experience helps practitioners gain some comfort level with treating diabetes in children and adolescents, and along with newer technology that offers hands-free digital communication, perhaps the future holds some hope for a safer environment for diabetic kids.
psi’s S.A.F.E. Schools is an evidence-informed series of resilience-building programs aimed at grades K-5 (S.A.F.E Buddies), 6-8 (S.A.F.E. Skills), and 9-12 (S.A.F.E. Success). Recognizing that student social, emotional, behavioral, and academic success requires a strong support system, S.A.F.E. Schools also includes the S.A.F.E. Educators (focused on school staff) and S.A.F.E. Communities (focused on parents/caregivers) programs to promote stress management, self-care, and resiliency in adults. The K-12 S.A.F.E. programs address the Ohio Department of Education social-emotional learning standards. Importantly, psi’s S.A.F.E. Schools also includes a series of focused sessions on topics such as bullying and violence prevention, safe technology use, social skills training, emotional intelligence, and teen dating violence.
More information to come!