key: cord-0718450-5gh9hl0n authors: Mirman, Jessica Hafetz; Marsac, Meghan L.; Kelly, Rod title: Communicating With and Supporting Youth Diagnosed With COVID-19: A Trauma-Informed Care Approach date: 2021-12-17 journal: J Adolesc Health DOI: 10.1016/j.jadohealth.2021.10.006 sha: 691985bed571f1b30e557288f6559738f1acdd59 doc_id: 718450 cord_uid: 5gh9hl0n nan Providers can implement a tiered resource approach to care and communication for those adolescents diagnosed with COVID-19: universal supports for all youth (e.g., psychoeducation, education about likely medical care pathways, routine emotional health screenings for youth and parents); targeted interventions for youth with risk factors such as those presenting with some emotional health symptoms or family risk factors (e.g., monitor symptoms, brief mental health consultations); and clinical intervention for those who demonstrate significant mental health symptoms or whose mental health symptoms interfere with medical care (e.g., mental health treatment) [6] . As a first step, providers can ascertain what fears a young person has about COVID-19 keeping in mind that some may have concerns about dying or hurting others while others may have more practical concerns (e.g., When can I play sports?). For those who are worried, providers can focus messaging on how they will be cared for and how to seek help if they need it, taking care to avoid blaming language. Providers can share recommendations on managing disease transmission within the home, taking families' unique circumstances (e.g., multigenerational households, culture) into account. For adolescents experiencing anger, fear, confusion, or guilt about their diagnosis, providers may need to spend additional time addressing these emotions or refer adolescents for a brief mental health intervention. Some adolescents may self-blame, perceiving they have failed at prevention. Providers can emphasize positive messages of staying home to promote selfcare by "building up the body" and capitalize on adolescents' Focus on taking care of yourself. I will help your parents if they need it e Will I ever get better? Some young people that get COVID19 do not feel sick at all. Others feel unwell for a little while and need to rest, and then completely recover! Rest can help you feel better. You or your parents can call our office with any questions you have when you are not feeling well Am I going to die? It is very unlikely that will happen. Most young people with COVID19 have no symptoms or recover quickly Symptoms requiring hospitalization What kinds of treatments am I going to get? Some treatments in the hospital might include helping breathing, medicines to help with inflammation, and medicines to help your body's immune system deal with the virus. Sometimes young people can feel unwell a few weeks or months after they got the virus. The teams in hospitals are very used to giving this kind of help. The doctors and nurses at the hospital will explain any treatment they think is needed and why What is going to happen to me in the hospital? While you are in the hospital you will get treatments to make you more comfortable and to help your body to do its work Will I ever get better? We expect almost all young people to get better from this virus. The treatment we give in hospitals helps your body get rid of the virus itself. Let's give the treatment time to work Am I going to kill someone? What if I got someone else sick already and do not know? The virus is no one's fault. When other people get COVID19, we will take care of them too Am I going to die? We expect almost all young people to get better from this virus. We are keeping you in the hospital so that we can keep a close eye on you and give you any help you need at the time you need it. If you have any worries about anything or any questions about how you are recovering just ask us at any time. We will come and chat with you and your family need for autonomy and friendship by reorientating them to focus on actions for the present and immediate future, that is, taking care of themselves and being a good friend to others by staying home. Troubleshooting barriers to isolation generates opportunities to develop tailored solutions (e.g., safe ways to stay connected with friends through video chats, online games). For youth who have impairing mental health symptoms either before or resulting from a COVID-19 diagnosis, providers can facilitate a referral to a mental health professional. Some adolescents, given their developmental need for autonomy and confidential healthcare, may be more willing to share their emotions with someone outside their family or peer group. Providers face the challenge of striking a balance between not providing false reassurance that young people will be fine, while not worrying them and their parents about the small percentage of cases who develop significant disease. Giving the family small bits of information about COVID-19 as applied to their situation can be helpful. If youth develop acute respiratory distress syndrome, Pediatric Multisystem Inflammatory Syndrome/Multisystem Inflammatory Syndrome in Children [7] , or Long-COVID, providers can provide information about symptom management at each stage. Lack of face-to-face contact can be stressful for families and disrupt parent-patient-provider communication in instances where members of the family are advised to isolate or the patient is sedated. Proactively anticipating this disruption and agreeing on a communication plan at the point of care (e.g., scheduled phone calls, identifying a family point person) can help to minimize this problem. Providing education about common challenges that adolescents face with these conditions and when to seek help may ease some worries for teens and their families. Active surveillance for Long-COVID (currently underrecognized) in adolescents may help some families mitigate the psychological sequelae of young people feeling they are not believed or supported by providers [8] . Targeted interventions for those with more severe symptoms may include reviewing medical information/next steps more frequently, identifying more supports that the teen can be connected to via technology, providing the teen with more consistent medical providers (e.g., a named nurse or doctor who conducts the majority of consultations), and/or mental health treatment. Depending on the level of clinical interventions needed to manage physical symptoms, these factors may be more pertinent during the postillness care and recovery period. Screening for known traumatic stress risk factors (e.g., trauma history, pre-existing mental health challenges) can help identify patients likely to need more support. In summary, a trauma-informed care framework can strengthen communication among adolescent patients, parents, and providers. This is a key component of high-quality adolescent healthcare [9] , and is an important strategy to use to minimize traumatic aspects of medical care and communication for youth diagnosed with COVID-19 [10] . The purpose of using trauma-informed messaging is to alleviate mental health symptoms (e.g., anxiety related to COVID-19 diagnosis) and prevent further or retraumatization. Key principles and shared messaging for providers can be a useful way to get these important conversations started. Such conversations will become increasingly important and common as the number of adolescents infected with SARS-CoV increases worldwide. REACT-1 round 12 report: resurgence of SARS-CoV-2 infections in England associated with increased frequency of the Delta variant. medRxiv Mental health-related emergency department visits in adolescents before and during the COVID-19 pandemic: A multicentric retrospective study Risk and rationality in adolescent decision making: Implications for theory, practice, and public policy Traumatic stress in the age of COVID-19: A call to close critical gaps and adapt to new realities Translational developmental studies of stress on brain and behavior: Implications for adolescent mental health and illness? Pediatric Psychosocial Preventative Health Model (PPPHM): Research, practice, and collaboration in pediatric family systems medicine Clinical characteristics, treatment and outcomes of paediatric COVID-19: A systematic review and meta-analysis Long COVID in children: A report summarising the views of young people, parents and doctors Partnerships between parents and health care professionals to improve adolescent health Implementing a trauma-informed approach in pediatric healthcare networks Fear-based messaging, especially around low probability events, is generally not conducive to behavior change. We recommend focusing on prosocial guidance such as being a good friend or finding other motivators (e.g., honesty, independence) that are salient and valued for the teen and their family providers can follow-up on teens' specific concerns as appropriate. d This can be a practical factual question or a sign of emerging stress, providers can consider screening and monitoring mental health, and referring as appropriate. e This question should be viewed as indicator of the caregivers needing more support Contributors Statement: Dr. Jessica Hafetz Mirman conceptualized, drafted, and critically revised the manuscript. Drs. Meghan Marsac and Rod Kelly contributed content, reviewed and critically revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.