by Cara Capparelli for NFI Vermont

Keeping healthcare accessible right now is important for us all.

When many people hear the term “essential services”, mental health may not be the first thing that comes to mind. Continuing access to mental health support is not only important for everyone’s stress, it is vital for people who are healing after past psychological trauma.  NFI VT (Northeastern Family Institute) is a community mental health agency serving Vermont youth, families, and adults and specializes in helping children who struggle with significant emotional and behavioral challenges, often as a result of trauma. NFI prides itself on responding nimbly to challenges, and the current Covid-19 crisis is no exception.

For many kids who have lived through early abuse or neglect, trust is not something easily built. Creating relational connection is critical for kids who have histories of trauma and whose healing is dependent on being loaded up with lots of predictable, patient and repeated caregiving in order for them to trust in adults. Managing emotions and behavior and being able to “regulate” throughout a day is a goal that kids served by NFI take in small steps, a bit at a time, and work to eventually master.

While NFI’s residential programs, including crisis beds, remain open and are caring for youth in person, services for kids who live in the community have gone virtual. How do you therapeutically engage a traumatized kid over the phone or on the computer?

Lauren Porell, 25, has worked at NFI for nearly 3 years as a “Community Skills Worker”. Staff in this role essentially take the treatment plan created by clinicians, youth and family and put it into action with kids in their home and community.

Her typical work day, prior to the COVID-19 crisis, would find her helping kids learn to express emotions while cooking or doing art in the office; practicing “regulation” through activities like going to the gym or yoga; or building independent skills such as how to go apply for a job. All the while she offers a consistent and caring adult relationship with a goal of building safety and trust. And now that skill building and that connection have to be mediated through a screen or a phone.

“I’m trying to be really creative right now”, says Lauren. “Maintaining our connection is the most important thing and I’m working to help kids be comfortable with me through the phone and computer.”

She’s finding this harder to do on the phone and easier via video, despite a desire to limit kid’s overall screen time. Even while remote, play tops the menu of services.  One imaginative girl Lauren works with loves to create restaurants and they often act this out when in person. Now they do it virtually.

The client has set up a “food delivery service” and when Lauren calls in, the girl “prepares” the food using toys she has at home. When she calls that the order is “ready”, Lauren pretends to eat it, engaging the youth in a reciprocal play of relationship. They sometimes acknowledge their physical distance by Lauren calling the restaurant to say she’s “running late” to explain why she’s not there. Lauren has also helped to create a resource for activities that youth and adults can explore together.

Other staff at NFI are also coming up with creative strategies. One clinician is keeping teens engaged using the role playing game “Dungeon and Dragons” in a virtual group where client participants can, for example, explore the advantages and disadvantages of expressing big emotions and “raging” using a powerful character. Others are getting away from the screen and setting up a real life scavenger hunt with items staff know families have in their homes. They are also focusing on mindfulness practice with teens – checking in about their stress and needs and having some calm moments to just be together, even from a distance.

The navigation of technology is making staff thoughtful about its use. Lauren, perhaps uncharacteristic of her Gen Z membership, actually enjoys phone conversations and prefers face to face communication. She is finding young people, who have grown up on texting and video chat, are unaccustomed to phone calls. She wonders if her generation and that of her younger clients may weather this time of isolation a little more adeptly as they are used to navigating relationships remotely. And she is grateful to have digital methods of fostering attachment to her clients. “What would we do if this were 10 years ago? How would we have maintained connection?”

While these strategies being crafted by NFI may be specific to continuing mental health services, right now kids and adults everywhere are exploring creative ways to have real connection reach through a small screen.