For those of you that have been following our Better Normal webinar series, recall that we started that series with a discussion about the challenges communities were facing with the coronavirus pandemic. In the weeks that have followed, we have noticed not only that the Better Normal series continues to be highly attended, but also that the most viewed and engaged with posts have been about these challenges. 

In this post, we wanted to share the kinds of issues related to adjusting to life amidst this pandemic, that have been happening both on the ACEs Connection platform, as well as in the conversations our staff is having with ACEs champions as they adapt their work to these new conditions. 

While this is certainly not an exhaustive list of relevant issues, we hope that it resonates. We also encourage everyone to share in the comments your thoughts on these issues, other issues you’d like to see discussed, and any promising resilience practices that you have observed, whether in the headlines or on the ground in your communities. 

ACCESSING SERVICES AMID MULTI-SYSTEM OVERWHELM

Economic Instability

Our members  are talking about the impact that the pandemic has had on the volume of needs in their communities. As we have all read in the headlines, there is increased food, housing and employment insecurity in communities nationwide. We know that food banks have an increased need, and not enough donations; while unemployment filings continue to balloon. How communities are coping with issues such as housing has recently been addressed as part of the ACEs Connection Better Normal series, accessible here. 

Because the pandemic has also affected staffing and resources available for these types of support, communities need more while they have less access to supportive services in each of these domains. In addition to the material difficulties posed by economic instability, both the increased volume of need, and exacerbation of inequities that already existed within these systems, can put communities at greater risk of the health toll of toxic stress. 

Capacity strapped systems are nonetheless identifying ways to meet the demand. However, the new strategies, and a disruption to traditional strategies for outreach mean that communities can feel disconnected from, and unaware of, resources that actually do exist. These dynamics of system overwhelm point to the need for navigators, whether individuals, call centers, and/or online signposts, to help families much more easily identify where the resources are. The ability to quickly direct community members to where they can get their material needs met, can go a long way toward helping decrease toxic stress. 

Vulnerable Populations

Pandemic conditions have made the needs of our community members who were already vulnerable, even more precarious. Healthcare providers, schools, shelters and other sources of support for people who may be experiencing abuse in the home, or have difficulty accessing resources due to their undocumented status, are less available. Meanwhile, in the transition, processes are less clear for those tasked with supporting these vulnerable populations. 

A high priority community for providers and policymakers has been domestic violence. Pathways to find support for those experiencing violence at home are less visible during this pandemic, as many types of medical appointments are diverted to make room for critical care; and as schools are closed, offering fewer touchpoints for children at risk of abuse. Child protection during covid19 has been addressed with a technical note from the Alliance for Child Protection in Humanitarian Action, to guide policy response concerning child protection issues. On ACEs Connection, the Better Normal webinars have included violence prevention and domestic violence.   Another vulnerable community is our undocumented neighbors, who are experiencing economic instability with limited access to structural safety net supports. 

Unhoused community members are also at a heightened risk, challenging local and state governments to rapidly identify housing options after years of increasing homelessness, particularly in California where housing costs have soared. Incarcerated people are perhaps the most vulnerable of all: With already compromised healthcare systems, it is difficult, if not impossible to follow the pandemic mitigation strategies in any meaningful way. But the risks of Covid19 have led California and other jurisdictions to rethink long standing policy regarding incarceration.  In California, even when federal action was pending against the state for overcrowding, the state was slow to act. Today, both local and federal institutions have begun to pivot to community supervision- a practice long contentiously debated  nationwide. 

In addition, stories have emerged showing that amidst the pandemic, certain communities are facing new sources of racism and even hate crimes related to pandemic conditions.  Anti-Asian sentiment has made members of the Asian community more targeted for harassment and violence. African American communities have reported that wearing masks as recommended by the CDC and as required in a few municipalities, makes them vulnerable to aggression when store owners view them as criminals. And Native American communities have concerns about being overlooked as the public health infrastructure rolls out, an issue being addressed through this forum to ensure these communities get timely informational, PPE, and treatment support. 

In the midst of shifting priorities, communities need ways of addressing racism and sending clear, consistent messages that racist acts will not be tolerated, and a commitment to refrain from using language that encourages or reinforces stereotyping. 

COPING WITH STRESS DIRECTLY RELATED TO COVID19

Managing fears and anxiety about health and wellbeing

Children as well as adults are struggling to make sense of the sudden, dramatic changes to daily life and sense of safety. Families need support in learning how to address the pandemic with children, and how to practice self care in the face of frightening, and often uncertain, information about the Covid19 disease. These concerns extend to the economic impacts of the public health mitigation strategies. These issues were discussed in our AC Parenting webinar, and one of our AC staff, Ingrid Cockhren, was recently interviewed in a story about how to best support children in this time of uncertainty. 

Effects of social isolation on mental health and community cohesion

Posts, comments, and webinars on ACEs Connection have addressed that, in addition to the health anxiety, and material impact to the changes in life and work, the physical distancing and shelter in place orders generate emotional distress from the experience of isolation. People cannot connect with family and friends, or access public spaces that provide opportunities for connection, as addressed in this post. 

In addition, particular populations are experiencing distress from their experiences during the pandemic, such as healthcare and other essential workers. 

Caring for the Caregivers

As always, caregivers’ needs can be overlooked when they are seen as the source of support for others. This issue was addressed in the ACEs Connection Caregivers webinar, a well attended and well engaged event at the onset of the pandemic crisis. 

Health Care Workers: In our webinar discussion on Pediatrics and Maternal, Child and Adolescent Health, the space was provided to share and brainstorm around some of the emotional challenges of needing to work harder at the same time the field is facing capacity overwhelm. Here's a summary of the discussion. This blog addresses strategies health care providers can use to avoid burnout during this challenging time.

While the struggles of health care workers have been given more attention, other workers designated as “Essential” face similar demands, and have similar concerns and fears as health care workers. 

Self Care: Self-care is important for everyone at this time, due to the multiple sources of anxiety under the conditions of the Covid19 pandemic. Many people also find themselves, as parents, or having elderly relatives they care for, with additional demands on their emotional labor. In talking informally with communities about the general topic of community initiative building, we have heard many people share that they are struggling with the new demands they are experiencing. In particular, the need to parent and educate children while keeping up with working from home, all without clear processes in place for adapting their regular work responsibilities to a remote framework, is straining. 

Even without an official title, there are many people in households nationwide who are caregivers in need of an intentional caregiving routine, as the demands on their energy increase in volume and/or scope. This topic was addressed in this webinar on the Community Resiliency Model, helping participants identify resilience building strategies they can use in their own lives and share with others. 

In addition to the strains of caregiving, the stressful nature of the crisis and caregiving demands can, alone or in concert, aggravate unresolved mental health challenges that pre-existed the crisis. This circumstance, addressed in this webinar, highlights the need for accessing additional support despite our confinement. 

RESILIENCE STRATEGIES TO COPE WITH LIFESTYLE IMPACTS OF COVID19

School Closures

As mentioned above, for many if not most parents- even teachers!- managing their own children’s education has been very stressful. There is a skills gap parents have to confront- to know something is not to be able to teach it; and sometimes parents don’t know the content! In addition, some families actually lack access to the internet, where all learning is now dependent. 

One of our most popular webinars in our Better Normal series- so full we could not take all interested participants- was the webinar on Education. The ACEs in Education community page has developed a set of resources to help support communities struggling to support both parents and teachers as they adjust to educating children at home. 

From community discussions, many of our community facilitators have heard (or experienced) the fact that school closure has caused a great deal of distress among children of all ages, who are very invested in their peer relationships. The sudden loss of important relationships, including adults in their schools with whom they had caring connections, creates emotional distress. Parents of older children sometimes struggle to keep them home and away from their friends, or worry about the emotional distress exhibited by children who are staying home. 

Navigating laws and best practices around Telehealth

In a time where the general  population is more in need of medical and mental health care due to the conditions of the pandemic, both medical and mental health practice has had to turn to tele-health before that emerging infrastructure has fully saturated all agencies. This is leading to a great deal of confusion and stress for practitioners in these fields. 

Both medical and mental health providers have strict policies to follow about where and how they can practice, and the ramp up to needing telehealth infrastructure did not come with adequate time to mount a learning curve. Fortunately, as shared on ACEs Connection, there are resources to help providers work through these details, which now includes the upcoming webinar from ACEs Aware focused on telehealth. Similar tips about managing telehealth are available for behavioral health providers through CTAC.

One ACEs Connection community member who is a therapist, shared that colleagues find tele-health to be a challenge for establishing connection with clients; best practices for overcoming this challenge in order to deliver the best care are needed. Pediatricians, and likely other medical providers, are concerned about clients missing wellness appointments that help prevent more serious issues from occurring, and need support to ensure their patients can connect via telehealth. 

In addition to practice issues, clients face material barriers such as having access to technology to engage in telehealth appointments. While telehealth helps increase access for many clients who may have formerly struggled with transportation or mobility challenges to attending medical or mental health problems, lack of access to the internet and computers or other devices is emerging as an additional barrier. 

CONFRONTING HEALTH AND SOCIAL INEQUITIES EXACERBATED BY COVID19

Special Needs Students

School closures have also highlighted an area of inequity in education: the educational rights of special needs students. Special needs students have Individualized Education Plans that are intended to protect their rights, but the sudden school closures have left the implementation of these plans unclear. In addition to the needs of administrators and  teachers to fulfill their legal obligations related to special needs students, this disruption is emotional distressing, and even less addressed, for the students themselves. 

Racial health inequities: High rates of Covid19 related infection, critical illness and death in African American, Native American and Latino communities

Our society’s existing health disparities have only been highlighted, and exacerbated, by the pandemic crisis. In California, Latino communities are outpacing others in covid19 infections. African Americans nationwide are dying at disproportionate rates, while Native American communities have struggled to receive the resources they need to effectively prevent and treat infections. 

ACEs Connection is committed to foregrounding these conversations, sharing information about the disparities in exposure, infection, critical illness, and death rates. In addition, we are creating space for this discussion, starting with our recent webinar on health equity. 

Please share your thoughts, additional issues related to pandemic challenges, and resilience practices that you've encountered in the comments section!