Q&A: Covid's impact on child mental health in Italy

How did you realize that COVID-19 requires more than a healthcare related response?

We know from previous epidemics in different regions that the risk for children and young people to experience violence increases as does domestic violence. This means that an epidemic requires means to reduce levels of stress from the very beginning.

With a pandemic also comes a sense of overall uncertainty that can lead to increased fear, particularly among children, and demands interventions aiming to build resilience and ensure mental well-being. Negative mental health impacts can have long-term effects.

Now that some time has passed, and many countries have entered a second or even third wave, we can see more clearly how the pandemic affects many areas of people’s lives.

In this context, education is a very relevant topic for SOS Children’s Villages. Millions of children spent time at home and often missed out on their education and social opportunities. Meanwhile, many of their families struggle with increasing unemployment.

It is worth highlighting that schools also play an important role in many countries in identifying and reporting possible signs of abuse or maltreatment, and in other cases in providing meals and safe spaces for millions of children. 

The burden COVID-19 put on the healthcare system also led to delays in treating other diseases and providing support including mental health support needs. There is thus a vast “collateral damage” all of which has an impact on children's and families mental health.

What has helped children and families?

Children and families are faced with a ‘new normal’ requiring them to change behaviours to adapt. For instance, remote work has been an advantage for some families but for others it has posed new challenges in their daily lives.

We need to provide as much structure and guidance as possible for the daily routines of families staying at home. Parents were not always able to provide adequate physical, emotional and intellectual development activities for their children at home during the lockdown.

Our responses need to also consider the long-term consequence of the pandemic. Our family strengthening programmes seem to be quite effective in countering trends we see of increased domestic violence and child protection risks.

We need to adapt our interventions. SOS Children’s Villages Italy has been involved in a series of trainings of trainers done remotely. Piloted together with the International Federation of Red Cross and Red Crescent Societies (IFRC) which executed the trainings, the World Health Organization (WHO) and the City University of New York, these trainings allow for the delivery of low intensity brief psychological interventions which consist of five sessions and can be delivered by people who have no specific background in psychology to help individuals affected by adversity.

We have been so far conducting these trainings in Somalia, Somaliland, Ethiopia, Rwanda, Burundi, Nigeria, Italy Sweden, Belgium and Greece. They have been the first remote trainings ever done using this methodology.

Another partnership we launched, entitled the ‘Team Up Coalition’ together with War Child Holland, Save the Children Netherlands and UNICEF Netherlands also focuses on mental well-being of children and providing resources and guidance to families. It follows the training-of-trainers model and those who have been trained will be able to deliver movement based interventions in SOS Children’s Villages’ programmes. The intervention is structured around 12 group sessions with children, which we were also able to carry out during the pandemic. We did it in Italy and we might apply the programme in Lesbos, Greece, providing children with a respite from their difficulties.

We have seen positive outcomes of how tapping into community resources and training people can help fill the gap in supporting the mental health well-being of children and families. We also see that it gives SOS Children’s Villages in different countries a sense of control in what they can offer to respond to new challenges by providing support remotely via helplines or chats.

How can we build resilience and coping skills for improved mental well-being?

Resilience and coping mechanisms of children and families need to be given particular attention.

You need to empower people to be able to cope with the new challenges, engage their children in the right activities and to be still able to spend quality time with their children for the overall well-being of the family.

Children and families need to maintain contact with the outside world. This is important for their well-being as well as for child safeguarding purposes. They should also keep a sense of agency in their every-day lives and feel they have choices.

Resilience and coping skills are often there. It is more about strengthening them. There are, of course, some people who need further support including those who faced challenges before the pandemic.

Brief cognitive behavioral exercises and relaxation techniques can generally help. There is also increasing evidence of how connection with nature is beneficial for mental health well-being and in building resilience. Therefore, we delivered nature connectedness intervention which users could access during quarantine online through a collaboration with the University of Derby Nature Connectedness Research Group.

What about the mental well-being of caregivers?

An often neglected element is the mental well-being of caregivers. Self-care of caregivers is not only crucial for their well-being but also for being able to care for others at time of enormous strain.

Those working on the frontline, including nurses, teachers, volunteers and caregivers, can ensure continuity and stability in the care system but often face alarming levels of stress themselves due to the pandemic.

The pandemic had revealed once again that this is a very neglected area. What we do to support caregivers and others working on the frontline is not necessarily enough. All care facilities should closely monitor and identify the well-being needs of all of their staff.

It would also be important to have a stress management policy that staff could adhere to. Caregivers might be afraid to say that they are near burnout. Organizations should establish protocols in this area to support them.

Employers should stay in dialogue with staff about their well-being and support needs. At SOS Children’s Villages Italy, we focus on communication, information sharing and protocols and procedures to provide support to help build the strength and resilience of those working on the frontline.

What additional services did SOS Children’s Villages Italy provide?

We set up a helpline which can be reached every day of the week (24/7) and trained people in the community could respond to call and help facilitate interventions where needed.

We also explored remotely accessible communications tools and put a chat into place to allow easier and more immediate access to help if needed.

We also realized that some areas relevant to children in alternative care as well as children living with their families were not really covered, including mental health and psychosocial support (MHPSS) and education, especially for young children until the age of six. Therefore, we partner with some pedagogues and experts at Emmer School and developed resources which are available on our website* for people to structure their day at home to support children's development and education. We also run webinars. We recently launched a webinar on back to school with experts interacting with the public to receive answers to their questions on what it means to manage transition to back to school.

What has worked and where are improvements needed?

Newly established services and interventions should be set-up with a long-term vision beyond COVID-19. New parts of the population might face new challenges and vulnerabilities.

Training people in the community who do not necessarily have a mental health background to be available at times where many government services are stretched has proved to be essential in many contexts, not necessarily only in countries with limited resources but also in high-income countries.

Collaboration with other organizations helps provide more and more diversified services; it helps to expand reach of resources and identify children in need.

We have also seen positive developments of SOS Children’s Villages associations providing space and time for staff to attend trainings, despite increasing workloads in order for them to adapt their skills to the new situation.

The IFRC online training received a lot of positive feedback and shows that distance training can work.

Improvements are still needed in some areas. Interventions need to be promoted in the current context and adapted to customs, culture and the infrastructure of specific regions. For instance, online counselling is not yet widely accepted in some countries. 

We also need to continue record learnings and experiences to broaden the knowledge on the situation and on possible effective responses.

Orso Muneghina is Head of International Programmes and Emergencies SOS Children’s Villages Italy and Lead of the Global MHPSS Hub of the SOS Children's Villages Federation.

Learn more:

*Information materials are available here: https://www.sositalia.it/cosa-facciamo/temi/risposta-all-emergenza/emergenza-coronavirus   

More information on the collaboration of SOS Children’s Villages Italy with the University of Derby Nature Connectedness Research Group is available at: https://www.derby.ac.uk/research/about-our-research/centres-groups/nature-connectedness-research-group/covid-19-resources/sos-cvi/