REFLECTIONS DURING COVID-19: HAVE WE BEEN CRIPPLING CHILDREN'S LIFELINES By Marginalizing Women ?

Many households throughout the world are coping with the new normal of staying at home to flatten the curve and to safely ride out the medical emergency brought on by Coronavirus-19 (COVID-19). The sudden change in living, working, and parenting has brought stress, reticence, and grief into homes. Physical distance and face masks are the new norm. Some people are working remotely, sometimes at a faster pace, seemingly for longer hours. Meanwhile, many people are out of work or have businesses that are in trouble financially, and they are hoping for financial relief.

The range of childhood experiences unfolding during COVID-19 remind us of the variety of life experiences that can happen across and within social and demographic groups. During the pandemic, some children are at home engaging in activities such as karate and music lessons via live streaming. Some are cooking or baking. Some in semi-rural and rural areas may be enjoying a retreat to a simpler time, reading, landscaping, and helping out in the garden. Meanwhile, many children and teens feel trapped, with nowhere to go, and little stimulation from the outside world. This is perhaps due to being in the small space of an apartments, or perhaps for other life, familial, or individual reasons. So, a subsection of the population includes children across socioeconomic groups who are isolated and stressed during COVID-19.

While managing stress and uncertainty, some parents have circumstances and resources that allow them to adjust to the new conditions quite smoothly, whereas many do not.

​Working from home, many parents feel pressure to morph into educators as their children complete the school day at home. This is especially true for parents of children with specific learning needs. Schoolwork is the tip of the iceberg. Some parents are worried about potential exposures to the virus if they take their children to the pediatrician for medical needs unrelated to COVID-19. Some separated parents feel strain surrounding shared custody and related movement of children between homes, particularly given the societal expectation to “shelter in place.”

Some parents have left their children for extended periods of time because of their own work, because of travel restrictions, or because of a family members’ illness. Parents risking exposure to the virus while at work are concerned that they could be endangering their own lives or the lives of their children. Some parents are spending hours online trying to stock up on groceries to ensure that there is food in the house, some are wearing masks and venturing into grocery stores, while many parents are stopping off at schools and food banks, grateful for the assistance so they may feed their children. Some are looking at their finances and trying to budget for taxes. Some don't have any money, and are waiting for some financial relief from the government. Parents are questioning, “What are realistic educational, medical, parenting, and financial expectations for me and for my children during this pandemic?”

COVID-19 has caused devastating loss of life, pain, and stress upon so many. It has accentuated the best and the worst of our culture. It shines a light on our resilience and adaptability, and it also re-reveals our inequitable society. Deaths due to this illness have been distributed unevenly across demographics, and this is because of previously established and preventable health disparities (Graham, 2020).

COVID-19, with the suffering it has brought on, has given us a moment to look at what we have collectively created as a society.​

“Mobilizing to confront the pandemic and, eventually, to reconstruct the shattered economy, requires not only medical and economic expertise but also moral and political renewal.”  - Michael Sandel, April 19, 2020, Opinion, New York Times

I am writing now in the hopes of mobilizing local schools, hospitals, legal institutions, and colleagues. I am inviting your interest in affecting social injustices in order to influence the physical and psychological health of historically disenfranchised groups of children and their parents. As a practicing Psychologist, I am aware that these social, psychological, and medical factors are all interconnected.

Even as I write about hardship and suffering, I think it is important to note that, as we face COVID-19 together, the profession of mental health knows that not all people will walk away with pathological anxiety or trauma. History and my clinical training informs me that resilience will arise, and this will be observed across demographics, including subgroups being unfairly burdened (e.g., grocery clerks, hospital workers). Expectedly, people across demographics will draw upon internal resources (e.g., hope, desire, good-will) and systemic resources (e.g., family, friends) as they process their experiences. Nonetheless, we owe it to ourselves to reconsider our treatment of historically marginalized groups (i.e., How are we each contributing to the marginalization? What are we actually doing to combat it?) and to do so on a personal level, as well as in our leadership behavior in organizations and communities.

Child Responses to COVID-19 in a Private Practice

I specialize with children, and thus have observed a range of responses to COVID-19 by a variety of children who are patients. My patients tend to be 3-17 year olds, represent neurodiversity (i.e., ADHD, ASD, Dyslexia, NVLD), and have mild to severe challenges with mood and anxiety. Their struggle with mood and anxiety is something that they managed before COVID-19. They are a diverse group socially, culturally, and economically. Some patients’ families are in the top 1% of the income bracket, while other patients’ families are living from check to check and receiving some form of public assistance. 

For the group of children and teens I work with, this past month has been a mixed bag of relief, disappointment, and opportunity. Some are happy that they get a moment to be with family, and relieved that they don’t face the same social pressures that they encountered in school. Some are grateful that their parents are validating and offering structure at this time. Some are feeling reduced stress. They enjoy a break from this fast-paced neurotypical society. Some are finally taking time to focus on sleep, exercise, and protein intake. Almost all of them miss their closest friends. 

Many of my patients are trying to navigate schoolwork without the full spectrum of special education services in place. During this pandemic, schoolwork has been particularly taxing on young neurodiverse children and their families in instances where there was a lack of productive teamwork between the school and the family before COVID-19, or where educational needs were not being fully met before the pandemic.

Some of the more emotionally and behaviorally impaired patients are struggling with circadian rhythms and coping skills, the very issues that were present before the pandemic. A couple were thrust out of needed residential and psychiatric hospital settings due to COVID-19 and now they cannot access the level of care that would be best. 

​​Marginalized Children and Families Before and After COVID-19: Illuminating Injustices

​As has been discussed in the Boston Globe and elsewhere, there are portions of the population that are far more impacted by the crisis due to the inequitable world we live in, due to health disparities, due to systemic prejudice, and because of discrimination. Previously known health disparities which we have co-created over the years are interacting with COVID-19 and disproportionately taking lives. ​

"Even in a global health crisis, Black and brown people can’t practice social distancing from the systemic, institutional, and foundational racism that overshadows and undermines our lives." - Renee Graham, The Boston Globe, April 10, 2020

I have been thinking a lot about disenfranchised kids (e.g., children with learning differences, children who are biracial, children who represent “the racial minority” in their schools, and children in single parent homes). This has been on my mind because this has been a long-standing topic of concern, and also because this is a subgroup of my caseload. It is my experience that children in my caseload who are in single parent homes, black, have learning disabilities, are immigrants, or are in the minority in their school entered the COVID-19 situation without all of their needs met due to systemic injustice. While talented and capable in countless ways, while bringing intellect and creativity to the table, many of these children have been stressed, and their gifts seem squandered. ​

Children who are immigrants deal with student-on-student harassment, harsh discipline in schools, civil rights violations, subtle and not-so-subtle pressure to conform and abandon their culture, and possible language barriers without proper accommodations (Koch, Gin, & Knutson, n.d.; Grossman & Liang, 2008). The below realities also ring true to me as I think about patients in my practice:
​

“Black students and students with disabilities are more likely to receive harsh school discipline than their counterparts” (American Psychological Association, The Pathway from Exclusionary Discipline to the School to Prison Pipeline).

“Students of color with disabilities face increased disproportionality across harsh discipline categories” (American Psychological Association, The Pathway from Exclusionary Discipline to the School to Prison Pipeline).

“Disproportionate suspensions of girls of color are alarming” (American Psychological Association, The Pathway from Exclusionary Discipline to the School to Prison Pipeline).
​
"...racial/ethnic discrimination is a part of life for many Asian Americans...racial/ethnic discrimination is consistently linked to poorer adjustment for Asian American adolescents (in terms of lower self-esteem, less school engagement, poorer grades, and greater depressive symptoms, alienation, somatization, and loneliness.” (Juang & Alvarez, 2011).​

Marginalized Women

Single mothers are dealing with added stress associated with limited resources, limited family and leisure time, maternal chronic health concerns, increased child needs, some of which are due to discrimination, toxic to their well being (Benner, Wang, Shen, & Boyle, et al. 2018), and now they manage increased risk of exposure to COVID-19. It is within this context that I would like to discuss the plight of single mothers representing cultural diversity (e.g., women of color, immigrants) and those who have escaped intimate partner violence, many of whom are managing economic strain while attempting to best care for their children. Right now, my largest concern is for these parents and their children before, during, and following COVID-19.

“The #coronavirus pandemic has exposed the lack of infrastructure, support, resources and care for single parents, most of which are women. Flexible work arrangements must be applied at all levels to support the economic security of every family. #COVID19” - Tweet by UN Women, April 3rd, 2020

Single mothers tend to be marginalized, stigmatized, manage multiple roles, have relatively less job satisfaction, and struggle to access needed resources (Richard & Lee, 2019). These stressors are thought to cause maternal psychopathology and can undermine parents’ ability to parent mindfully, consistently, and with warmth (Daryanai, Hamilton, Abramson, &  Alloy, 2016).  Stress due to marginalization and discrimination can generally spill over into relationships (Barton, Beach, & Bryant, et al., 2018), and I sometimes observe this in parent-child relationships in single parent homes. ​

In some cases, I have been offering evidence based services for years with these children, which has included everything I know, all of my knowledge, skill, and ability, and it seems as though the single parents households and I are paddling against the current and working hard only to stay in one place. In other words, after offering evidence based treatment with a strong alliance with the parents and children, systems of care in place, and collaboration with the child’s medical and mental health team, I’m still observing health disparities in my own practice. And these disparities cut across culture. They are related to single parent homes.

I invite you to entertain the thought that the broader systems we are existing within could be the  strong current working against these families and hindering potential treatment gains. I'd like to consider the hypothesis that broader systems are inadvertently undermining parents, and therefore undermining treatment. Thus, the very best treatments we can offer these children aren't enough, given the context. If my hypothesis is true, we must do more than train the parents, we must address the broader systems. What needs to change in the broader systems? 

​For years, I have observed microaggressions inadvertently cast at single mothers, sometimes in ways that are known to the kids. I notice school and community partnerships seem so fragile. The families and I are jointly wondering, are these broader systems based issues the main problem? In other words, are the single mothers the scapegoat for the schools’, hospitals’, and courts’ shortcomings? Dare we ask that question?

​When it comes to children with disabilities and children of color in single parent homes, I conceptualized the broader systems (e.g., schools, hospitals, courts, police, and other helpers) as the metaphorical “other parent,” having the potential to strengthen or undermine the mother’s authority in the child’s eyes. Having contemplated the issues with the families I work with, I believe undermining the single mother’s authority has the potential to cripple the child’s lifeline and direct the child towards the “school to prison pipeline.” Perhaps mindfulness and productive teamwork practiced by professionals with these mothers could make a world of difference for these children and put a barrier in the pipeline.

Moms Who Are Women Of Color

Especially for single moms who are women of color and managing financial strain, there is a constant effort to find a way to get what a child needs and a sense of pain and frustration when there aren't enough resources. There wasn’t enough social and community support before COVID-19 for these parents, and now that we face this pandemic, resources are even more slim and risks are higher.

One of the parents I partner with is working in the community, thereby putting her life in danger out of financial necessity. Being in a physically unsafe situation can be quite stirring, and she handles the stress with grace. Meanwhile, without adequate special education services in place (both before and during the pandemic), based upon her child’s grades on assignments, she is aware that her child is failing to understand the material in school. Previously unaddressed learning needs are showing up in the quality of the child’s work. With COVID-19, previously unmet learning needs are being accentuated. Over the years, I have observed implicit bias and related micro- and macro-aggressions directed towards this mother and it is heart wrenching to observe. Once, I came across a report to the Department of Children and Families (DCF) regarding this mother from a “professional” in one system. The report was so blatantly racist that even DCF acknowledged the illegal nature of the report and swiftly moved on. This kind of transgression by a “professional” in a school system reflects the ways in which systems have the capacity to inflict harm on single parent families, and children who are often aware of such transgressions. In my view, this particular instance was highly damaging to the child and the parent-child unit.

Mothers Who Are Immigrants

Mothers who are immigrants are sometimes lawyers, physicians, educators and other professionals in their homeland. While they cannot practice here in the US, these individuals bring great intellect and capability to their communities. They may raise their children in a way that brings the best of their own culture integrated with American culture, offering a stronger foundation for their children. In my view, cultural knowledge is like the mortar in the foundation of the child’s self esteem, deepening a sense of pride in their family and themselves.

In the US, immigrant families I have worked with tell me that there is sometimes a sense of being “othered” and they sense they are perceived as having lesser value or of being less entitled to resources. So, competition is expressed towards them within the community. In the context of a highly homogenous, mostly white New England community, one mother, a professional who is an immigrant, described being seen as “exotic” and strange by some community members. One mother who is an immigrant described being ignored by community members in public settings. Another mother explained that people in homogeneously white communities seem to like the idea of diversity in theory, but then struggle to embrace diversity when implementation of culturally sensitive practices are recommended. She noted, “In theory, people might want to be ‘welcoming,’ yet struggle to truly integrate us into their lives.” The psychological literature on the topic of immigration validates these women’s voices (Koch, Gin, & Knutson, n.d.; Meyers, Aumer, & Schoniwitz, et al., 2020).

And, I observe the effect of such mistreatment. I see these single mothers who are immigrants begin to question their own social, psychological, and cognitive capacities. Sometimes I see them internalizing the oppression and blaming themselves for the challenges they face in their social environment, including their challenges in parenting their children. I see the way that microaggressions in their environment sometimes chip away at their maternal-esteem and undermine their ability to confidently raise their children. Worse, I observe their children internalize the messages from the mainstream that their mother has less value. Managing COVID-19 which gets in the way of communication, already strained, has the potential to further isolate and alienate these mothers and their children.

Mothers and Children Exposed to Domestic Violence

During the pandemic and before the pandemic, I’ve been concerned about women and children who have histories of domestic violence in the home. Some of these women have been exposed to shared traumas with their children and have shown incredible resilience to get their child to a new situation which is physically safe. They bring their children with them to my office and ask that I help them to address the issues that the child is managing. Because I’m a solo practitioner, I’m not in a position to pick up children or families in the throes of active violence. Therefore the mothers I’m consulting to have escaped domestic violence and are picking up the pieces with their children.

Children exposed to domestic violence are often traumatized “may develop distorted and maladaptive views of relationships and may assume age-inappropriate roles and responsibilities within the context of their relationships with parents” (Intimate Partner Abuse and Relationship Violence Working Group, 2001). Cooperativeness, helping attitudes, and charitability can be hindered by such early childhood stress (Jirsaraie, Ranby & Albeck, 2019). They can sometimes tend towards externalizing or aggression due to childhood exposure to violence (Intimate Partner Abuse and Relationship Violence Working Group, 2001). These children can sometimes be difficult to parent, and more likely during times of stress and when questions of physical safety are present. For these children, powerlessness felt around COVID-19 combined with limited resources and strained relationships is highly jarring.

The mothers are using every bit of their energy to intentionally develop strong parenting practices, and they are attempting to work productively with mental health providers, schools, hospitals, and legal systems. They have their minds set that they want their children well, and they want their children to flourish.

I have observed ER staff, due to unconscious bias, inadvertently minimize children’s very predictable psychological issues. The reality is that, in light of early exposure to violence, we can predict that these children might not come out of their past unscathed and that externalizing tendencies may present after the exposure to violence (Intimate Partner Abuse and Relationship Violence Working Group, 2001).

​I see these mothers with histories of intimate partner violence judged as maintaining the child’s very predictable issues. The above-mentioned data gets ignored as mothers in these circumstances often get blamed for the child’s very predictable challenges. There is a huge stigma surrounding intimate partner violence. I observe that parenting a child following such a situation can be extremely challenging, taxing, and isolating. Doing this during a pandemic seems excruciating. In my view, these mothers are some of the least understood and most undermined in their parenting practices.

​Recommendations

Recommendations for Schools, Hospitals, and Legal Institutions

School, hospitals, and legal professionals, I hope to reach you. You interact with these children and parents. I’d like to bolster your curiosity about the context in which these mothers and their children are situated, now during COVID-19, and also as we move forward. These mothers and children need your assistance. I am reaching out today because I believe that you are positioned to make things better. Mostly my recommendations relate to partnering and teaming with single parent households. This is because, in my view, the wellness of children with single parents depends upon our ability to partner. This includes our willingness and ability to communicate in a timely manner, to provide support, to embody patience, and to mindfully monitor the situations in which children with single parents exist. Such teamwork could make a big difference for them and especially for their children. I recommend you do the following:

1. Maintain curiosity and openness towards the child and family.
2. Refrain from assuming that parenting deficits are at the heart of the child’s issues. Remember that early childhood trauma can result in effects that are sometimes difficult to treat, even with multiple evidence-based interventions. Keep in mind that “spillover effects,” which refer to the ways in which stressors such as socioeconomic hardship can spill over into relationships. Look into supports that might lessen stress
3. Ask if systems are adequate for supporting the child. Is childcare in place? Is it adequately supporting the child and family?
4. Ask where backup for parental authority is coming from as the parent is attempting to nurture and socialize the child.
5. Refrain from pushing your work (e.g., as educator, school social worker) on the parent. If the child is misbehaving at school, don’t expect the parent to affect school-based behavior or make a knee jerk assumption that the parent has a role in such behavior.
6. Give more support to immigrant families and allow the parents input. Get them involved and allow them, as they are, to be part of American culture (Koch,Gin, & Knutson, n.d.; Gonzalez, Borders, & Hines, et al., 2013).
7. Schools, ensure any advanced placement and honors programs in your schools include an appropriate distribution of children across demographics (based on school composition). If not, ask what has gone wrong systemically.
8. Increase funding for diversity training for school, medical, and legal staff, so they may become culturally and linguistically competent.
9. Recruit diverse individuals, broadly defined (e.g., culture, economic, social, learning differences, etc., with a deep understanding of the above-mentioned issues) into community leadership roles.
10. Let’s put our money where our mouth is. Support these families at the local level and in our organizations, and let's not stop until we see each child emotionally and physically well. That begins with healthy foods, music, language, nature, exercise, academic supports for educational enrichment, and leisure. That includes free, effective, and meaningful mentorship and extracurricular programs. And, culturally sensitive maternal wellness services should be offered.

Recommendations for Researchers

I hypothesize that implicit bias and related inadvertent microaggressions towards the parent in front of the child, and also recommendations made by schools, hospitals, clinics, or the legal system have the potential to affect parent-child relationships. I recommend that we study the effect of the communications between systems and parent-child dyads on the quality of parent-child relationships.

We already know about the effects of community hardship on maternal mental health; the effects of socioeconomic hardship, violence, and discrimination on children’s mental health; the effect of maternal stress and mental health on parent child relationships; the effects of parenting skills on parent child relations; and of child psychopathology on parent-child relations (Choi & Kangas, 2020; Daryanai, Hamilton, Abramson, & Alloy, 2016; Goldstein, Harvey, & Friedman-Weieneth, 2007; Gurwitch, Messer, & Masse, et al., 2015; Herr, Jones, & Cohn, et al., 2015; Kagan, Frank, & Kendall, 2017)

But what about the effect of systems’ communications with the parent-child dyad? Please consider this as a topic of study.

Recommendations for Communities

While we are waiting for the research to catch up, I’d like to put out a request that right now we take a moment to reflect. Let us be mindful regarding our biases and judgments about culture, immigration, women, domestic violence, and socioeconomic status because such biases may inadvertently fuel microaggressions in front of mother-child dyads who represent these populations.

​It is my perspective, based on anecdotal data in my everyday practice that microaggressions cast at the mother in front of the child have the potential to chip away at the foundation of the parent-child relationship. This can be a particularly toxic recipe for these vulnerable dyads of parents and their children.

Community members, please note, undiagnosed learning disabilities and unmet learning needs can wreak havoc on a young child's emotional health. There is a reason the school to prison pipeline includes children with learning disabilities. You can help create a solution. For children who seem stressed by schoolwork, whose family has financial hardship, and who comes from a historically marginalized group or single parent household, community grants could be made available to offer these children thorough neuropsychological evaluations. Such assessments could be life altering for many children. Such assessments could ensure adults in the children's lives are aware of each child's academic, emotional, and psychological needs. Needed assessments may make it easier for adults to work together to meet children’s needs, and lead to less misunderstandings regarding these children and the source of challenges.
​
Recommendations for Psychologists

We as Psychologists need to partner more effectively, educate more honestly, & we need to set our sights on lending a hand to families struggling with limited resources. We need to help correct the many misunderstandings regarding the source of those families’ troubles. We as helpers, all of us, providers in private practice, schools, hospitals - have got to stop waving a finger at single parent households and start looking at the ways in which we are contributing to the problems that these parents face with their children. We must draw upon science to inform our thinking. And, let’s not disregard what we see with our own eyes.
​
Please note: The above  blog is not meant to be a commentary on my local school district, which I’ve been partnering closely with, but more a reflection of regional and national trends. 

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