Jamaican Youth Coping with CriViD (Crime and Violence Disease) Epidemic superimposed by CoViD Pandemic Dr. GANESH SHETTY, MBBS,DM(Psych), MPH,FCYP (UWI), FCAP (Ca),CCaCPT, CCS(NCU) Consultant CHILD, ADOLESCENT & ADULT PSYCHIATRIST. Child & Play Therapist **Consultant Psychiatrist, *Counselling Unit, Medical Centre, Utech *Shekinah House, Seymour Park, Kingston-6 KSA HEALTH DEPARTMENT, CHILD & ADOLESCENT MENTAL HEALTH SERVICES & Learning Collaborative, Caribbean Association for Child & Play Therapy Dedication …… quarter of Jamaica’s children living in poverty and, more likely to be ill, engaged in child labour, having reduced access to adequate water and sanitation facilities and to be exposed to violent discipline; Girls more likely to become teenage parents….. And are more susceptible to CoViD 19 & its impact.. CriViD-Endemic • Over 12,000 People including Over 1200 Children • Murdered in Past 12 years Crime-Violence-Disorder Child, Two Adults Shot In August Town Home Invasion Cases 152 M Recovered 89.9M Deaths 3.19M Location Cases Recovered Deaths Jamaica 45,867 21,153 784 United States 31.9 million Coronavirus disease 2019 (COVID-19) is defined as illness caused by a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; formerly called 2019nCoV) 570,000 deaths Worldwide 778 CriViD EPIDEMIC Crime*Violent Behavior Poor Parenting Alcohol/Drug abuse Skills Teenage Pregnancies Poor Street Children Psychosocial School Drop-Out Support ADVERSE CHILDHOOD Dysfunctional Adulta, EXPERIENCES/ TRAUMA Unidentified/ Untreated Child Prostitution •Severe Depressions Mental Disorders •Suicide in youth •HIV infections Increase Increase Risk for Crime & Violence DM Risk of Ca Care-giver Bread-winner Morbidity Mortality Dysfunctional School Society Closure Domestic SUD Job Loss Violence Heart Business Child Abuse Disease School Drop Out Bankruptcy Severe SUD Mental Severe Disorders Mental Disorders Taking responsibility The Effect of the COVID-19 Pandemic on Jamaican Children Preliminary Results Income Loss Average share of income lost 46% Coping Strategies How have you made up for lost income? None 11% 86% Savings 36% Gifts - Overseas 30% Loans - Family Gifts - Local 17% Hustling 15% Loans - FIs Other 8% 5% Nutritional Effect Share of households that have experienced food shortages 44% Nutritional Effect How have you coped with the food shortages? 74% Smaller Meals 66% Fewer Meals 23% Planted Crops None 4% Bad Foods 3% • Closure of Schools • Participation in DistanceLearning • Pre/Basic =75 %Primary=90%Secondary =83% • • • 20 %=NO Access……to the Internet…to a Device 30-45% - Not Satisfied with DistanceLearning Reasons for Reluctance to Return toSchool • Fear of infection • No resources • Asthmatic children • Waiting to see situation Screen Time Increase from 3 hours to Participation Participation almost 7 hours per day. • • Supervision – 12 % little or no supervision • Emotional Impact of theCombination COVID PREVENTION MEASURES 1 out of 5 were unable to follow protocol because they could afford the recommend ed items Emotional Impact Share of households with children that experienced increases in the following 63% Boredom 57% Overeating 41% Frustration 39% Clinginess Anxiety 23% Sadness 23% Fear Uncooperativeness 21% 15% VIOLENT DISCIPLINE Changes in frequency of spanking and shouting/calling names What WeNeed • Strict bio-secure protocols in schools • To keep children safe • To reassure parents • Financial support for families • Specifically for nutritional support for children • • • • Universal internet access for school children Flexible work and leave arrangements for workers Psychosocial support services for children and parents Stronger mechanisms to detect and report child abuse COVID-19: What parents should know • The coronavirus disease (COVID-19) pandemic has greatly disrupted the lives of children and their families around the world. • As COVID-19 has spread, so has misinformation – fueling discrimination and stigma. • It is important to promote facts over fear, bringing trustworthy guidance and answering some of the questions family members might have. COVID-19: What parents should know • What is COVID-19 Pandemic ! • Only Way Out of It is by working together. Ø Get Vaccinated, Get Vaccinated, Get Vaccinated • • • • • • • • • • COVID-19 symptoms Symptoms requiring Urgent Medical Attention How does the COVID-19 virus spread? How can I protect myself and others from COVID-19? What precautions should I take for my family if we travel? COVID-19 Tests Is there a vaccine for COVID-19? What are CoViD Variants? Can pregnant women pass coronavirus to unborn children? Is it safe for a mother to breastfeed if she is infected with coronavirus? • Does COVID-19 affect children? Why wear a mask or face covering? AGE GROUP PRESCHOOL REACTIONS • • • • • • Fear of being alone, bad dreams Speech difficulties Loss of bladder/bowel control, constipation, bed-wetting Change in appetite Increased temper tantrums, whining, or clinging behaviors HOW TO HELP Ø Patience and tolerance Ø Provide reassurance (verbal and physical) Ø Encourage expression through play, reenactment, story-telling Ø Allow short-term changes in sleep arrangements Ø Plan calming, comforting activities before bedtime Ø Maintain regular family routines Ø Avoid media exposure , Fake News AGE GROUP REACTIONS Primary School • Irritability, whining, (ages 6-12 years) aggressive behavior • Clinging, nightmares • Sleep/appetite disturbance • Physical symptoms (headaches, stomachaches • Withdrawal from peers, loss of interest • Competition for parents’ attention • Forgetfulness HOW TO HELP ü Patience, tolerance, and reassurance ü Play sessions and staying in touch with friends through telephone and Internet ü Regular exercise and stretching ü Engage in educational activities (workbooks, educational games) ü Participate in structured household chores ü Set gentle but firm limits ü Discuss the current outbreak and encourage questions. Include what is being done in the family and community ü Encourage expression through play and conversation ü Help family create ideas for enhancing health promotion behaviors and maintaining family routines ü Limit media exposure, talking about what they have seen/heard including at school ü Address any stigma or discrimination occurring and clarify misinformation AGE GROUP High School REACTIONS • (ages 12-18 yrs) • • • • • • Physical symptoms (headaches, rashes, etc.) Sleep/appetite disturbance Agitation or decrease in energy, apathy Ignoring health promotion behaviors Isolating from peers and loved ones Concerns about stigma and injustices Avoiding/cutting school HOW TO HELP v Patience, tolerance, and reassurance v Encourage continuation of routines v Encourage discussion of outbreak experience with peers, family (but do not force) v Stay in touch with friends through telephone, Internet, video games v Participate in family routines, including chores, supporting younger siblings, and planning strategies to enhance health promotion behaviors v Limit media exposure, talking about what they have seen/heard including at school v Discuss and address stigma, prejudice and potential injustices occurring during outbreak Children’s Mental Health During COVID-19 EXACERBATION OR RELAPSE OF PRE-EXISTING MENTAL DISORDERS • • • • • • • • • • Difficulty Concentrating Boredom Irritability Restlessness Nervousness Loneliness Uneasiness Worries Social isolation and loneliness Anxiety? Depression? If you see PTSD Symptoms? •Experiencing –disorganized or –agitated behavior •Re-experiencing –repetitive flashbacks, with trauma themes, nightmares. trauma-specific reenactment •Avoiding- conversations, activities, places, or people •Numbing- detachment, foreshortened future • Hyper arousal- insomniac, irritable, inattentive, hyper vigilant ,easily startled . SEEK HELP How to talk to your child about Coronavirus Disease 2019 (COVID-19) 8 tips to help comfort and protect children (UNICEF) 1. Ask open questions and listen 2. Be honest: explain the truth in a child-friendly way . 3. Show them how to protect themselves and their friends 4. Offer reassurance How to talk to your child about Coronavirus Disease 2019 (COVID-19) 5. Check if they are experiencing or spreading stigma 6. Look for the helpers 7. Take care of yourself 8. Close conversations with care . THREE Self-care Tips For Parents (Take Care of Yourself Before Taking Care of Them) 1.Basics- Eat, Sleep & Move 2.Seek Help 3.Distance Physically, But Connect Socially SIX Ways Parents Can Support Their Children 1. Be calm and proactive 2. Stick to a routine 3. Let your child feel their emotions 4. Check in with them about what they’re hearing 5. Create welcome distractions 6. Monitor your own behavior 7. Significant Changes in Child’ Emotion & Behavior-Get Professional Help How to Keep Your Child Safe Online 1.Keep them safe with open communication 2.Use technology to protect them 3.Spend time with them online 4.Encourage healthy online habits 5.Let them have fun and express themselves Ways To Help Keep Children Learning 1.Plan a routine together 2.Have open conversations 3.Take your time 4.Protect children online 5. Stay in touch with your children’s School What will a Return To School during COVID-19 look like?’ 1.When and how will schools be reopened? 2.Is it safe for my child to go back to school? 3.What precautions should the school be taking to prevent COVID-19 virus from spreading? 4.What questions should I be asking my child’s teacher or school administrator? 5.What should I do if my child has fallen behind? SIX strategies for Teens facing a New Normal…… 1.Recognize that your anxiety is completely normal 2.Create healthy distractions 3.Find new ways to connect with your friends 4.Focus on you 5.Feel your feelings 6.Be kind to yourself and others Indoor Play Ideas to Stimulate Young Children at Home Babies 0-9 months • Peek-a-boo! • See and say • Family band • The body game Pre-school children 3-4 years • Dress up • “I’m going to catch you!” • Name that noise Toddlers 1-2 years • Box car • Kitchen drummer • Free draw • Ball pass • Toddler challenge Young children 5-8 years • Obstacle race • Wash away! • Make believe • Build-a-snack Taking Care of Your MindBody –Connections BODY • Eat • Sleep • Exercise Reelax • Deep Belly Breathing • Muscle Relaxation • Visualization • Meditation MIND • Don’t consume too much TV, FB, Insta • Accurate Information Connections • Connect with Family & Friends • Maximize your time • Virtually Be Creative: Take Virtual Walk in the Wilderness Virtual visit to the Beach Deep Belly Breathing ***4x 4x4-6 *** S-K-Y Breathing Progressive Muscle Relaxation the shortened version, which includes contracting & relaxing four main muscle groups: • face • neck, shoulders and arms • abdomen and chest • buttocks, legs and feet You can use progressive muscle relaxation to quickly de-stress any time. If you dissociate, you may feel disconnected from yourself and the world around you. For example, you may feel detached from your body or feel as though the world around you is unreal. Ø3 types of grounding: 1. Mental (focusing your mind) 2. Physical (focusing your senses) 3. Soothing (talking to yourself in a very kind way) Mental Grounding ØIt is an excellent strategy to use when you are feeling unfocused or scattered. 1.Describe your environment in detail; use all your five senses. 2.Play a “categories” game with yourself/team. 3.Describe an everyday activity in detail. 4.Imagine: use a pleasant and comforting mental image. 5. Read something, saying each word to yourself. 6. Use humour:. 7. Count to 10 or says the alphabet very slowly. Physical Grounding ØUse this when you are feeling disconnected— 1. Focus on your breathing, 2. Grab tightly onto your chair 3. Clench and release your fists. 4. Notice your body: 5. Touch various objects around you 6. Carry a grounding object in your pocket – 7. Run warm or cool water Challenge/Stop/Distract the Automatic Negative Thoughts (ANTs) Cognitive Behavioral Therapy-CBT Increase Pleasant Activities Improve Social Skills to Decrease Avoidance , Improve Emotion Management Skills Increase Positive Emotions, Manage Distressing Emotions REFRAMING Changing your perspective on a given situation to give it a more positive or beneficial meaning to you SOCIAL DISTANCING PHYSICAL DISTANCING REFRAMING My friends and I can’t see each other = My friends and I are protecting each other I’m stuck at home I’m safe at home I’ve lost all my freedom I’ve given up my freedom for a good purpose I miss the things I love I’m increasing my gratitude for the things I love CAUTION: Reframing is for Comfort & Not Permission to be Careless. If you are Angry or Afraid?? *If you’re ANGRY and you know it count to ten; *If you’re angry and you know it count to ten; *If you’re angry and you know it and you don’t want to blow it, if you’re angry and you know it count to ten. If you’re AFRAID and * you know it breathe slowly; *If you’re afraid and you know it breathe deeply; *If you’re afraid and you know it and you do want to ease it, if you’re afraid and you know it breath slowly and deeply *If you’re angry or If you are angry and you know it, • Walk Away , (from Trouble) , • *If you are angry and you know it, Walk Away , (from Trouble) , • *If you are angry and you know it & you don’t want to blow it, • If you are angry and you know it, • Walk Away , (From Trouble) • * afraid, do all three (children say “ Same time” And count in their mind, breath, and walk on spot) *If you’re angry or afraid, do all three, *If you’re angry or afraid, and you don’t want to lose it , if you’re angry or afraid, do all three (children say “ Every Time” ) GRATITUDE & HAPPINESS JOURNAL Betta Mus Com……. Divided We Fail! United We Can!! ONCE WE CAN UNITE BY SHUTTING THE RED EYES & TRANSFORMING THE BAD MINDS, THERE IS NO PROBLEM OUR CREATIVITY & INGENUITY CAN NOT SOLVE!! " We are all in this together! " " If We Don’t Work Together, We will Die Together!!
