Thousands of students around the region will be returning this month to classrooms and large-group settings for the first time in a year, but that doesn鈥檛 mean everything is back to normal.

Masks are commonplace. Social distancing rules will be in effect. And in many districts, students are grouped into cohorts, attending school in-person a few days a week, in the mornings or afternoons. And while many children and teens may be looking forward to returning to their friends and routines, they may also be worried about the changes involved.

UW News asked , a UW professor of school psychology who specializes in culturally responsive training for school psychologists, and , a UW professor of child clinical psychology who specializes in evidence-based treatment for children and adolescents, for some back-to-school tips for young people and their families.

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What are some of the things students (and parents) might need to adjust to?

Janine Jones: For those students who have not had a “COVID pod,” or bubble of people that they were in contact with during the past year, they will likely feel unsure of themselves and self-conscious about their听social connections.听There will likely be moments of awkwardness as they try to find their people again.听They may have moments of wonder about how to interact physically:听For example, lots of kids naturally hug one another.听Now they have been socialized to avoid doing so.听They will need to be taught new rules for how to interact with people that they care deeply about. Many of us have had that moment where there is the irresistible urge to hug someone we haven’t seen in forever.听I have found myself saying听at听least once, “OK, tighten up your mask and hold your breath! I’m coming in for a hug!”听Kids will need something to guide them into how to show they care in new ways.

Shannon Dorsey: Students are returning to interactions that will look different 鈥� but many kids have adjusted so well already to COVID-19 expectations, like that if you’re on the playground, you’re wearing a mask. They can do it, and they already do it! You see chase games with all kids fully masked. In some ways, I think mask-wearing has been a bigger challenge for adults than for kids. Summer camps and parents have organized ways to make distancing feel more normal (sitting in hula hoops, 6 feet apart, or on markings). Strategies that work to change children鈥檚 other behaviors can work on mask compliance and distancing, too 鈥� like commenting on and praising the things you want to see in students, such as keeping their masks on, and over their noses and mouths.

What might children and teens be anxious about?

SD: Some children and teens may have some social or school anxiety, especially if they were already anxious and had a year of being out of school and large groups. Facing up to fears, like reengaging with peers and being in class, will likely bring on some increased anxiety, but it will decline as the youth gets back into these interactions.

Of course, some youth may also be anxious about the COVID-19 risks of being together in schools. Parents and caregivers can help by reviewing what we know about the science and the actual (versus the perceived or felt) risks of going back to school, and sharing it in developmentally appropriate ways. Masks and social distancing are great prevention strategies. Schools haven’t been major spreaders, when masks, social distancing and cohorts are used, and when cases in communities aren’t too high. If a young person is particularly worried and not feeling confident, parents might work with them to make their own list of reasons school can be safe, which they can review and work into a coping statement. Younger kids might enjoy turning this kind of discussion into a recorded “public service announcement” or poster (just for their own family) 鈥� essentially a fun way to help the child internalize that school can be safe.

JJ: There is a continuum of ways that youth are responding to the return. Some are longing to return to school, while others are thriving in their home environments.听Across the entire continuum, there is anxiety.听 Students who are longing to return may experience anxiety about how their friendships听have changed. They may worry that they won’t be able to focus in a classroom when they know the teacher is looking at them.听They may worry about being judged by others because their previous experience at school was not so positive (but they still feel that going back is better than learning alone).

On the other end of the continuum, there may be youth who are socially more introverted.听They may have anxiety about all of the social challenges they previously experienced when trying to build relationships at school.听It will feel like the first day of school all over again until they feel connected and comfortable.听If I (or my school psychology students) are working with youth on either end of the continuum, we would talk with them about their strengths and what makes them feel good about themselves.听If they happen to be a youth who experiences panic attacks, we would spend time working through specific fears and scenarios well before the return.听 We would also have the youth know who the mental health providers are in the school, so that they can prepare to reach out to them if needed.

How can school be a safe, welcoming space to come back to?

听JJ: Schools MUST center the mental health needs of kids right now.听Yes, the business of school is all about academic learning, but the truth is that schools must serve the minds AND hearts of our youth.听The current youth mental health crisis is real.听The prevalence of depression, anxiety and suicidal ideation is higher than ever before.听Schools need to recognize that our youth are bringing their losses, pain, anxiety, and their hopes and dreams to school.听A safe, welcoming environment recognizes the whole child, gives them a place to see themselves as valued and important, and provides a window into a hopeful future.听The days of pressure cooker education must not return. They need an environment where they can be in community with others and truly feel like they are living and learning together.

How can families and teachers help ease the transition?

SD: Routine changes and transitions are hard for kids. I think we can ease the transition by knowing that the first weeks will be hard. Expectations may be high, and kids may struggle with being back in groups with only some of their classmates. Because this is a big transition and change, it can help to keep some other things and routines the same 鈥� like for elementary-age children, maintain bedtime and other activities you鈥檝e established for time after school.

JJ: All adults can spend time normalizing these feelings for youth: Talk about anxiety and fear as feelings that we all have. We have all experienced the complex ways that COVID-19 has impacted us socially. We had to learn new rules to interact with one another virtually, and some of those new rules are skills that we can continue to use in the future.听Talk about hope for the future and how we all have gifts and talents that might look a little different for a few more months, but they still exist within us.听Plan for how to use those strengths every day and make a new place in the world for the new “you.”

All adults should model for the youth in their lives how to focus on what is most important, to not let the听smaller hassles and annoyances take over our emotional well-being.听Showing听our听youth how to have a听renewed focus on what is most important and meaningful to them is critical. Adults should share their own examples of how they are able to put the little things of the past in perspective, and teach our youth how to look for and focus their emotional energy on the issues and experiences in life that matter the most to them.

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For more information, contact Jones at jjones2@uw.edu or Dorsey at dorsey2@uw.edu.

A first-of-its-kind clinical trial involving more than 600 children in Kenya and Tanzania, in which community members were trained to deliver mental health treatment, showed improvement in participants鈥� trauma-related symptoms up to a year after receiving therapy, new research shows.

Led by the 天美影视传媒 and Duke University, researchers trained laypeople as counselors to deliver treatment in both urban and rural communities in Kenya and Tanzania, and evaluated the progress of children and their guardians through sessions of trauma-focused cognitive behavioral therapy.

The 听is published online Jan. 22 in JAMA Psychiatry.

An estimated have experienced the death of a parent, which can result in .

In low and middle-income countries, many of those children end up living with relatives or other caregivers where mental health services are typically unavailable.

鈥淰ery few people with mental health needs receive treatment in most places in the world, including many communities in the U.S.,鈥� said lead author , a UW professor of psychology. 鈥淭raining community members, or 鈥榣ay counselors鈥� to deliver treatment helps increase the availability of services.”

Cognitive behavioral therapy (CBT), a type of talk therapy, generally involves focusing on thoughts and behavior, and how changing either or both can lead to feeling better. When CBT is used for traumatic events, it involves talking about the events and related difficult situations instead of trying to avoid thinking about or remembering them. has been tested before among children, and , Dorsey said, but this study is the first clinical trial outside high-income countries to examine sustained improvement in post-traumatic stress symptoms in children over time.

This research built off the work of study co-author , a professor of public policy and global health at Duke. Whetten has been conducting in Tanzania and four other countries on the health outcomes of some 3,000 children who have lost one or both parents.

鈥淲hile concerned with the material needs of the household, caregivers of the children repeatedly asked the study team to find ways to help with the children鈥檚 behavioral and emotional 鈥榩roblems鈥� that made it so that that the children did not do well in school, at home or with other children. We knew these behaviors were expressions of anxiety that likely stemmed from their experiences of trauma,鈥� Whetten said. 鈥淲e therefore sought to adapt and test an intervention that could help these children succeed.鈥�

Africa is home to , most due to HIV/AIDS and other health conditions.

For the Kenya-Tanzania study, two local nongovernmental organizations, and , recruited counselors and trained them in CBT methods. Based on researchers鈥� prior experience in Africa, the team adapted the CBT model and terminology, structuring it in groups of children in addition to one-on-one sessions, and referring to the sessions as a 鈥渃lass鈥� offered in a familiar building such as a school, rather than as 鈥渢herapy鈥� in a clinic. The changes were aimed at reducing stigma and boosting participation in and comfort with the program, Dorsey said.

鈥淗aving children meet in groups naturally normalized their experiences. They could see, as one child said, 鈥業鈥檓 not the only one who worries about who will love me now that my mama is gone.鈥� They also got to support each other in practicing different skills to cope with feelings and in thinking in different ways to feel better,鈥� she said.

Counselors provided 12 group sessions over 12 weeks, along with three to four individual sessions per child. Caregivers participated in their own group sessions, a few individual sessions, and group activities with the children. Activities and discussions were centered on helping participants process the death of a loved one: being able to think back on and talk about the circumstances surrounding the parent鈥檚 death, for example, and learning how to rely on memories as a source of comfort. In one activity, children drew a picture of something their parent did with them, such as cooking a favorite meal or walking them to school. Even though children could no longer interact with the parent, the counselors explained that children could hold onto these memories and what they learned from their parents, like how to cook the meal their mother made, or the songs their father taught them.

鈥淭he children learned that you don鈥檛 lose the relationship,鈥� Dorsey said. 鈥淵ou have to convert that relationship to one of memory, but it is still a relationship that can bring comfort.鈥�

The guardians learned similar coping skills, she said. Children who have experienced parental death are usually cared for by a relative, so caregivers, be they the other parent, a grandparent or an aunt or uncle, were also grieving the loss of a family member while taking on the challenge of an additional child in the home.

Participants were interviewed at the conclusion of the 12-week program, and again six and 12 months later. A control group of children, who received typical community services offered to children who are orphaned, such as free uniforms and other, mostly school fee-related help, was evaluated concurrently.

Improvement in children鈥檚 post-traumatic stress symptoms and grief was most pronounced in both urban and rural Kenya. Researchers attribute the success there partly to the greater adversity children faced, such as higher food scarcity and poorer child and caregiver health, and thus the noticeable gains that providing services could yield. In contrast, in rural Tanzania, children in both the counseling and control groups showed similar levels of improvement, which researchers are now trying to understand. One possible explanation with some support from an ongoing qualitative analysis, Dorsey said, is that children and caregivers in Tanzania, and particularly in rural areas, may have been more likely to share with others in their village what they learned from therapy.

Even with the different outcomes in the two countries, the intervention by lay counselors who were trained by experienced lay counselors shows the effectiveness and scalability of fostering a local solution, Dorsey said. Members of the research team already have been working in other countries in Africa and Asia to help lay counselors train others in their communities to work with children and adults.

“If we grow the potential for lay counselors to train and supervise new counselors and provide implementation support to systems and organizations in which these counselors are embedded, communities can have their own mental health expertise,鈥� Dorsey said. 鈥淭hat would have many benefits, from lowering cost to improving the cultural and contextual fit of treatments.鈥�

The study was supported by the National Institute of Mental Health. Additional co-authors were , and of the UW Department of Psychology; of Duke; of Johns Hopkins University; of Ace Africa; of the Tanzania Women Research Foundation; of Drexel University College of Medicine; and of Kilimanjaro Christian University Medical College.

For more information, contact Dorsey at dorsey2@uw.edu.

Grant number: R01 MH96633