Children in the pandemic: Contributions of the National Course on Mental Health and Psychosocial Care in COVID-19

Crianças na pandemia: contribuições do Curso Nacional de Saúde Mental e Atenção Psicossocial na COVID-19

Abstract

Objective

Considering the psychosocial repercussions of the COVID-19 pandemic on children, this case study aims to describe the work process involved in the construction and execution of the Children in the COVID-19 Pandemic module, which comprised the National Course on Mental Health and Psychosocial Care in COVID-19, hosted by the Fundação Oswaldo Cruz.

Method

Data from the materials that made up the module (booklet, video lesson, forum, and live broadcast), the profile of those enrolled, as well as emerging themes from participants' questions and comments (forum and live broadcast) were analyzed.

Results

Thirty-one percent of the course participants, who were predominantly female psychologists, completed the module. The booklet, developed with an accessible language, met the general guidelines for the development of manuals aimed at providing guidance on health care, seeking to address emerging demands in order to qualify the care for children in the context of COVID-19.

Conclusion

There was a great diversity of themes addressed in the material resulting from the forum and the live broadcast, which were discussed in order to contribute to the planning of psychosocial care strategies aimed at mitigating the negative repercussions of the pandemic on child development, as well as to offer a space for sharing knowledge and experiences on professional practice during this major public health emergency.

Keywords:
Child; Coronavirus infections; Mental health; Pandemics; Training courses

Resumo

Objetivo

Considerando as repercussões psicossociais da pandemia de COVID-19 às crianças, este estudo de caso tem o objetivo de descrever o processo de trabalho envolvido na construção e execução do módulo Crianças na Pandemia COVID-19, que compôs o Curso Nacional de Saúde Mental e Atenção Psicossocial na COVID-19, promovido pela Fundação Oswaldo Cruz.

Método

Analisaram-se dados provenientes dos materiais que compuseram o módulo (cartilha, videoaula, fórum e live), o perfil dos inscritos, bem como as temáticas emergentes em questionamentos e comentários dos participantes (fórum e live).

Resultados

Concluíram o módulo 31% dos participantes do Curso, os quais eram, predominantemente, mulheres psicólogas. A cartilha, desenvolvida em linguagem acessível, atendeu às diretrizes gerais para elaboração de manuais voltados à orientação sobre cuidados em saúde, buscando abordar demandas emergentes, no sentido de qualificar a atenção às crianças no contexto da COVID-19.

Conclusão

Houve grande diversidade de temáticas abordadas no material decorrente do fórum e da live, as quais foram discutidas com vista a contribuir para o planejamento de estratégias de atenção psicossocial voltadas a mitigar repercussões negativas da pandemia para o desenvolvimento infantil, bem como oferecer um espaço para compartilhamento de conhecimentos e experiências de atuação profissional frente a essa grave emergência de saúde pública.

Palavras-chave:
Criança; Infecções por coronavírus; Saúde mental; Pandemias; Cursos de capacitação

The Coronavirus Disease 2019 (COVID-19), declared as a pandemic by the World Health Organization (WHO) in March 2020, consists of a new and unexpected event that has globally affected the mental health of the general population (Fontanesi et al., 2020; Spinelli et al., 2020). Studies conducted in different countries since the early stages of the disease spread have revealed an increase in reactions and symptoms of depression, anxiety, and stress among adults (Wang et al., 2020; World Health Organization [WHO], 2020). This increase has been particularly associated with health measures of social distancing, fear of virus infection, the death of social network members, and the loss of employment or income during the pandemic (Enumo et al., 2020; Schmidt et al., 2020; WHO, 2020).

Aside from adults, the new coronavirus has also caused psychosocial repercussions for children (Dalton et al., 2020; Philip, 2021). However, when considering the first six months of the emergence of COVID-19, the implications for childhood have been relatively little explored in the scientific literature (Spinelli et al., 2020). The scarcity of research targeting this age group has also been observed in the context of other epidemics and pandemics, despite their vulnerability suggesting the importance of studying them (Jiao et al., 2020). Children experienced abrupt changes in their routines and social interactions as a result of school closures and the need to avoid face-to-face contact with peers, grandparents, and other social network members (Coyne et al., 2020; Philip, 2021). Many of them experienced reduced physical activity and increased use of digital media (e.g., television, computer, tablet, and smartphone), for school demands, as well as for leisure and social interactions (Sá et al., 2020; Stavridou et al., 2020).

In Brazil, not all children had the opportunity to resume school activities remotely, mainly due to difficulties in accessing digital media or a broadband connection (Farias & Giordano, 2020). In November 2020, 13.9% (approximately five million) of children and adolescents between 6 and 17 years old were out of school in Brazil; of this total, 41% were between 6 and 10 years old, an age group whose access to education before the pandemic was practically universal (United Nations Children's Fund [UNICEF], 2021). In this scenario, children in socio-economic vulnerability are disproportionately affected, which tends to intensify inequalities as well as increase the risk of teaching-learning problems and dropping out from school (Schmidt et al., 2020; UNICEF, 2021).

Furthermore, as global attention is focused on measures to mitigate disease transmission and the negative economic effects of this severe crisis, children are being exposed to a great deal of information on COVID-19, both through digital media and conversations in their homes, which is associated with hypervigilance (Dalton et al., 2020; Linhares & Enumo, 2020). Although the rate of physical complications due to the new coronavirus infection is relatively lower for children compared to adults (Fontanesi et al., 2020; Jiao et al., 2020), they tend to be more vulnerable to the psychosocial repercussions of the pandemic, given the immaturity of the cognitive and emotional regulation system in childhood (Zhou, 2020).

In a study conducted in China, the first epicenter of the pandemic, mothers and fathers reported emotional and behavioral reactions in children and adolescents (n = 320) due to COVID-19, including increased dependence on caregivers, irritability, distraction, sleep difficulties, and fear that family members could be infected (Jiao et al., 2020). In the United States, the experience of a program serving refugee families revealed that, during the pandemic, children exhibited boredom and isolation, which may have been exacerbated by their vulnerability to potentially traumatic pre-migration experiences, poor housing conditions, food insecurity, and suspension of activities in which they participated, including school (Endale et al., 2020). In the United Kingdom, with the pandemic, mothers, fathers, and caregivers of children and adolescents with disabilities or specific health conditions (n = 241) reported that their children showed more frequent manifestations of anxiety, fear, distress, and challenging behavior (Asbury et al., 2020).

According to Asbury et al. (2020), some participants reported positive implications, such as spending more time with family members and a calmer and safer routine without an excess of activities outside the home. In Brazil, mothers, fathers, and caregivers of children up to 12 years old (n = 536) also reported performing more (52.1%) or much more (19.1%) family activities during confinement, which suggests that this period may contribute to improve relationships between family members and favor the development of self-sufficiency skills in children (Sá et al., 2020). On the other hand, the need to share home spaces for long periods, as well as the restriction of activities outside the house, including leisure and social interactions, tend to be a stressor to family members, increasing the risk of interpersonal conflicts (Silva et al., 2020).

In general, mothers, fathers, and caregivers can help children cope with the changes arising from COVID-19, especially through open and sensitive communication, considering the characteristics of their developmental stage (Dalton et al., 2020). This commonly fosters emotional regulation in childhood, as well as adaptation to the new routine and restrictions of the period (Weaver & Wiener, 2020). However, caregivers have also experienced insecurities and uncertainties (Asbury et al., 2020; Fontanesi et al., 2020; Stavridou et al., 2020). In this sense, financial losses, weakening of social and institutional support, as well as the overload of activities (e.g., childcare, remote or on-site work, and household chores) are stressors that can affect the adaptive coping ability, with implications for the caregiver-child relationship (Coyne et al., 2020; Yavorsky et al., 2021). In this scenario, there tends to be an increase in authoritarian parenting style, with emphasis on manifestations of verbal hostility (Fontanesi et al., 2020), as well as violence against children (Sserwanja et al., 2021; WHO, 2020).

In a study conducted in Italy, it was found that mothers and fathers (n = 854) who reported greater difficulties in coping with quarantine restrictions showed higher levels of stress, which in turn were associated with equally higher levels of emotional and behavioral problems in their children (Spinelli et al., 2020). Importantly, the stress experienced by participants was both at the individual level (e.g., feeling nervous or angry) and at the dyadic level (e.g., experiencing difficulty interacting with the child or dealing with their emotional and behavioral reactions), potentially negatively impacting the well-being of their children. On the other hand, consistent with the findings of Spinelli et al., the psychological problems presented by children and adults were not related to living in an area at higher risk of new coronavirus infection, nor to the physical characteristics of the family environment. Taken together, these findings suggest the importance of psychosocial interventions aimed at promoting child and family development for the general population, i.e., not restricted only to specific territories or population segments.

Given the repercussions of COVID-19 for mental health in all age groups, including childhood, psychosocial care strategies have been recommended as a key element in the response and recovery phase of the pandemic, taking into account the risk that the impairment to people's emotional well-being will generate long-term social and economic impacts for societies (WHO, 2020). Particularly in Brazil, in late March 2020, after the publication of the legislative decree that recognized the state of public calamity in the country, a Working Group (WG) on mental health and psychosocial care in the pandemic was formed, in a voluntary and collaborative effort, organized by the Escola de Governo Fundação Oswaldo Cruz (Fiocruz) Brasília, in partnership with the Study and Research Center for Emergencies and Disasters, linked to the Escola Nacional de Saúde Pública Sergio Arouca (ENSP-Fiocruz) (Kabad et al., 2020). The WG was led by nine researchers from the mental health field, including psychologists, psychiatrists, and social scientists, with the goal of providing rapid responses for professional practice in the context of COVID-19, based on scientific evidence. External collaborators also composed the team, i.e., 117 researchers linked to 25 institutions from Brazil and other countries, with academic production and expertise in the WG's core themes (Kabad et al., 2020; Noal et al., 2020).

Between April and May 2020, the WG produced guiding technical documents (i.e., 20 booklets structured in a friendly format, with simple and direct language), containing recommendations aimed primarily at workers and managers of the Sistema Único de Saúde (SUS, Brazilian Unified Health System) and the Sistema Único de Assistência Social (SUAS, Brazilian Unified Social Assistance System). These technical documents, which are freely available and without charge, have been widely disseminated in universities, professional associations (e.g., Psychology, Medicine, Pharmacy), city halls, among other institutions. In this same period, the “National Course on Mental Health and Psychosocial Care in COVID-19” was also launched, which had 69,240 registrations, from Brazil and other countries. The course was offered through distance learning, with 40 hours duration, in partnership with 37 lecturers, with the support of the Universidade Aberta do SUS (SUS Open University) and the Núcleo de Educação à Distância da Fiocruz (Fiocruz, Center for Distance Education). It contained 16 modules, each with a technical guiding document (booklet), video lesson, discussion forum, and synchronous virtual meeting, which was broadcasted via YouTube (for more details on the work process and the productions of the WG, see Kabad et al., 2020).

Among the modules of the “National Course on Mental Health and Psychosocial Care in COVID-19”, this article specifically highlights the one that refers to the theme “Children in the COVID-19 Pandemic” (Fiocruz, 2020a; 2020b; 2020c; 2020d), which sought to compile the main findings on the intensification of family interactions and the reduction of support networks for all children, including those with specific health conditions, refugees, or migrants, in order to offer subsidies for professional practice. Given the above, this case study describes the work process involved in the construction and execution of the “Children in the COVID-19 Pandemic” module, which comprised the “National Course on Mental Health and Psychosocial Care in COVID-19”, analyzing data from the materials that made up the module, the profile of those enrolled, as well as emerging themes from participants' questions and comments. Thus, it seeks to contribute to the planning of psychosocial care strategies aimed at mitigating the negative repercussions of the COVID-19 pandemic on child development.

Method

This is a qualitative, descriptive, and exploratory case study. The highlighted case is the “Children in the COVID-19 Pandemic” module of the “National Course on Mental Health and Psychosocial Care in COVID-19”, which is composed of a booklet, a video lesson, a discussion forum, and a synchronous virtual meeting, commonly referred to as a live broadcast. For Stake (2006), in an instrumental case study, the case itself is secondary and plays a supporting role, being a facilitator for the understanding of the research question. For the analysis of the present case, the following guiding question was considered: "How was the Children in the COVID-19 Pandemic module constructed and executed, who were the participants, and what were the themes emerged from the target audience?". All the documents elaborated for the course (registration form, booklet, video lesson) and the records of execution (discussion forum and live broadcast) served as the data sources.

Because this is a study that emerged spontaneously, and is related to an activity carried out for teaching and training purposes, it meets the assumption in Resolution nº 510/2016, of the Brazilian Health Council, which refers to the non-registration and evaluation of this type of proposal by the system of Research Ethics Committees and the National Research Ethics Commission (Art. 1, sole paragraph). In compliance with the ethical principles of privacy and identity protection, data that could identify the participants were omitted.

To characterize the participants of the “Children in the COVID-19 Pandemic” module, we collected the data filled in the Registration Form at the “National Course on Mental Health and Psychosocial Care in COVID-19”, composed of 21 questions, subdivided into four blocks: (a) personal data (e.g., sex, date of birth, and country/state/city of birth); (b) address; (c) education (level of education); and, (d) complementary data (profession, occupation in COVID-19, institution where they work, and main doubt or difficulty in working in the field of mental health and psychosocial care). Data were also collected in the documents that made up the “Children in the COVID-19 Pandemic” module, namely: (a) Booklet, with 20 pages, which addressed aspects related to mental health and psychosocial care for children in the context of COVID-19 (Fiocruz, 2020a); (b) Thirty-minute video lesson, conducted by one of the specialists who collaborated in the preparation of the booklet, which was made available to participants on the “National Course on Mental Health and Psychosocial Care in COVID-19” platform, and to the general public on YouTube (Fiocruz, 2020b); (c) Discussion forum, entitled 'Ask the Professor', which was characterized as a space for interaction between students and professors, in which participants recorded questions and comments about the module. The forum was accessible to participants from May 11 to September 28, 2020, on the course platform (Fiocruz, 2020c); (d) YouTube live broadcast, streamed on July 15, 2020, which included the participation of five of the experts who collaborated in the preparation of the booklet, as a closing activity of the “Children in the COVID-19 Pandemic” module. Like the video lesson, the live broadcast was made available on the course platform and on YouTube (Fiocruz, 2020d).

As the case in focus involved varied documents, different analysis strategies were employed. The first stage sought to identify the work process involved in the construction of the module, analyzing all the didactic material produced for this purpose. The second stage characterized the execution of the course and, in particular, the module, by means of descriptive statistical analysis based on the information obtained from the Registration Form. Absolute (n) and relative (%) distributions were used, with the help of the Excel spreadsheet editor. The third stage used questions and comments from the participants in the “Ask the Professor” forum and in the live broadcast as a data source. Word clouds were generated using the NVivo 13 software, grouping together derived words. This resource performs a lexical analysis from the most frequent words in the text segments considered, grouping and graphically organizing them, enabling quantitative and qualitative data analysis. In the end, data triangulation was prioritized (Stake, 2006), because the data collection sources in the highlighted case involved different documents.

Results and Discussion

How was the “Children in the COVID-19 Pandemic” Module Constructed and Executed?

From the analysis of the set of documents that made up the “Children in the COVID-19 Pandemic” module it was possible to identify that 22 researchers participated in the development of the teaching materials, under the coordination of three of the leaders of the WG on mental health and psychosocial care in the pandemic. The five authors of the present paper were part of this team, which was composed of members from different backgrounds (psychology, medicine, history, and journalism) and areas of expertise (child development, family relations, public policy, human rights, as well as emergencies and disasters). It was possible to verify that the didactic materials produced addressed several aspects related to mental health and psychosocial care in childhood in the context of COVID-19, aiming to support the work of health professionals with children and their families, through the presentation of potentially challenging situations and guidelines for practice (Fiocruz, 2020a, 2020b).

The first didactic material developed by the team was a booklet (Fiocruz, 2020a). Its elaboration occurred between late April and early May 2020, i.e., before the WHO declared Latin America, and in particular Brazil, as the epicenter of the pandemic, which happened only in late May 2020 (Feuer, 2020). Thus, the publication of the booklet in early May 2020 occurred prior to the critical period of COVID-19 in several Brazilian states, enabling the timely dissemination of knowledge in order to collaborate in the response and recovery phase of the pandemic (Kabad et al., 2020).

When analyzing the booklet, it became evident that the general guidelines for the elaboration of manuals aimed at health care orientation (Echer, 2005) were considered. Similarly, it was noted that it included references to the experiences of other countries that had already been affected by the COVID-19 pandemic (e.g., China, Italy, Spain, and the United States), lessons learned from other recent epidemics (e.g., Severe Acute Respiratory Syndrome [SARS], Middle East Respiratory Syndrome [MERS], and Ebola), as well as technical guidance from Brazilian and international health organizations. Thus, the booklet sought to address emerging demands at that time and challenges that could be faced in Brazil with the evolution of the pandemic, in order to qualify the care for children in the context of COVID-19.

For ease of reading and understanding, as well as to serve as a quick reference guide on the repercussions of the pandemic on families with children, the booklet addressed the following topics: Family interaction; Family routines; Talking to children about the pandemic; Risk factors for violence against children in the pandemic; Assistance to refugee or migrant children in times of COVID-19; Access and reception of acute demands; and Preparing for the end of quarantine and social distancing. To consider diversity and complementarity in terms of areas of expertise, different professionals from various fields and backgrounds were called in, offering technical support anchored in scientific knowledge about multiple topics and approaches (Noal et al., 2020). Topics such as the care of children in hospital isolation and the grieving process in the context of COVID-19 were not deepened in this booklet, to avoid redundancy, because they had been explored in other materials of the course.

Given the diversity and complexity of the themes, as well as the need to offer a relatively brief didactic material with accessible language, anchored in scientific evidence and in a user-friendly format (Echer, 2005; Enumo et al., 2020), active hyperlinks were inserted in the booklet, directing the reader to pages with additional content on some of the topics covered (Fiocruz, 2020a). Attention was also paid to the design of the material, aiming to make it attractive through colors and text layout, encouraging people to read it. Thus, although initially aimed at SUS and SUAS workers and managers, the booklet could also be used by professionals from other areas or even by the general population.

To ensure the scientific rigor and technical quality of the material, the booklet was submitted to the analysis of two evaluators with expertise in child development and psychosocial care. The final version of the booklet was published on the Fiocruz website on May 6, 2020, with free and open access (Fiocruz, 2020a).

After the publication on the Fiocruz website and social networks, the booklet began to be disseminated by other institutions throughout the country (a Google search performed on May 20, 2021, using the combination of descriptors "Crianças na Pandemia COVID-19" [Children in the COVID-19 Pandemic] and "Fiocruz", found more than 2,600 results). These data suggest the dissemination achieved by the booklet (Kabad et al., 2020), with potential for positive impact for the care of children in the context of COVID-19.

The second educational material analyzed consisted of a video lesson, lasting approximately 30 minutes, lectured by one of the experts who collaborated in the preparation of the booklet (Fiocruz, 2020b). This video lesson detailed the themes addressed in the booklet and was made available on the platform of the “National Course on Mental Health and Psychosocial Care in COVID-19”, accessible by its participants, and on Youtube, accessible by the general public. As of May 20, 2021, the video lesson had 20,702 views on YouTube.

Also available in the platform of the “National Course on Mental Health and Psychosocial Care in COVID-19”, was a discussion forum about the “Children in the COVID-19 Pandemic” module, called “Ask the Professor” (Fiocruz, 2020c). This forum was made available with the intention of promoting interactions between students and professors, characterized as an instrument to register questions and comments about the module. Some questions were answered by professors on the platform itself, while others were addressed during the live broadcast.

The live broadcast had the participation of five of the experts who collaborated in the preparation of the booklet and was streamed on YouTube, lasting approximately 100 minutes, with 22,439 views by May 20, 2021 (Fiocruz, 2020d). In addition to the resumption of the questions raised in the “Ask the Professor” forum, questions and comments posted synchronously in the chat by those who followed the virtual meeting were also discussed by the experts. For the selection of questions and comments to be addressed live, the moderation team considered the relevance and frequency with which they appeared in the forum or during the live broadcast (for details about this process, see Noal et al., 2020).

After the virtual meeting, the recording was also made available on the course platform, so that those enrolled who did not have the opportunity to watch it synchronously could do so asynchronously, ensuring greater flexibility to follow the module, especially by professionals at the frontline of COVID-19 (Noal et al., 2020). Both the video lesson and the live broadcast are available on YouTube, which allows access also by people who were not enrolled in the course (Fiocruz, 2020d), but who are interested in the theme.

Who Participated in the Children in the COVID-19 Pandemic Module?

The “National Course on Mental Health and Psychosocial Care in COVID-19” had a total of 69,240 registered participants (Fiocruz, 2020e). The analysis of the course's access and completion records revealed that among the total number of participants, 17,282 successfully completed it, having been certified at the end. Conversely, 12,966 never accessed the platform. The “Children in the COVID-19 Pandemic” module was completed by approximately 31% (n = 21,260) of the course participants.

Analysis of the data recorded on the registration forms allowed us to learn a little more about the module's participants. The enrolled participants declared that they were predominantly female (86%), from 3,508 locations, both nationally, covering all Brazilian states, and internationally, including countries such as Argentina, Ecuador, France, Guatemala, Mozambique, and Portugal. Among the participants' professions, the most prevalent were psychologists (n = 37,619), social workers (n = 5,077), nurses (n = 3,849), educators (n = 2,327), and occupational therapists (n = 970). In addition, 7,775 were college students, 2,506 identified themselves as having no profession, and 1,249 reported being unemployed at the time. It is noteworthy that a portion of participants, despite not working directly with children, showed a special interest in the theme, because they were mothers, fathers, or caregivers of children. The most frequently indicated workplaces included Psychosocial Care Centers (n = 4,138), Social Assistance Reference Centers (n = 1,094), and Specialized Social Assistance Reference Centers (n = 551), as well as consulting rooms (n = 2,479), or private clinical practices (n = 1,314).

What Themes Emerged in the “Ask the Professor” Forum and in the Live Broadcast?

The discussion forum aimed to promote participant interactions and to raise questions about the “Children in the COVID-19 Pandemic” module, which were answered both on the course platform and live broadcast. In the forum, 4,839 registrants participated. The 298 comments identified were analyzed using the word cloud feature. The comments were divided into questions about specific topics (back to school, autism, grief, ADHD, among others), compliments, and sharing of experiences, often with the intention of a collective construction of answers to the questions presented. No comment had a negative or conflicting tone regarding the content of the material produced. From this strategy, the exact and derived words (e.g., caring, care) were grouped and organized according to their frequency, with the most recurrent ones appearing centralized and in a larger size, as can be seen in Figure 1.

Figure 1.
Forum Word Cloud

It is possible to note the most referenced words highlighted, including children (n = 252), pandemic (n = 77), social (n = 46), parents (n = 43), caring (n = 42), and work (n = 39). When analyzing the meaning of the words most mentioned in the forum comments, it is evident the concern of professionals in seeking guidance to work with children and their families in order to minimize the potentially negative repercussions of the pandemic, including the psychosocial implications of social distancing measures. Different studies suggest that mothers, fathers, and caregivers have experienced insecurities and uncertainties in the current scenario (Asbury et al., 2020; Fontanesi et al., 2020; Stavridou et al., 2020), as well as activity overload (e.g., childcare, remote or in-person work, and household chores), especially due to the weakening of social and institutional support networks (Coyne et al., 2020; Silva et al., 2020). Women seem particularly vulnerable to suffer negative consequences in the context of COVID-19, especially considering the labor market, household, and childcare demands during the pandemic, which exacerbate pre-existing gender inequalities in social and family relations (Yavorsky et al., 2021).

In this sense, the frequency of words related to family, commonly the primary context of children's development (parents: n = 43; family: n = 33; family member: n = 23) also draws attention. On one hand, if home confinement allows the possibility of sharing more time with family members (Asbury et al., 2020; Sá et al., 2020), on the other, it can cause stress, increasing the occurrence of conflicts (Silva et al., 2020), authoritarian parenting style (Fontanesi et al., 2020), and violence against children (Sserwanja et al., 2021; WHO, 2020). Regarding conflicts, previously established aspects had to be renegotiated in many families, such as the challenges in reaching an agreement on the appropriate time limit of children's screen use, according to questions registered in the forum (screens: n = 4; mobile: n = 4; computer: n = 2). Studies conducted in Brazil and abroad have revealed the significant increase in the exposure time of children to screens during the pandemic, both for school tasks and for leisure (Sá et al., 2020; Stavridou et al., 2020).

The word violence, in turn, was mentioned 20 times in the forum, standing out in comments and questions about protective measures for children, considering that during the pandemic they tend to be confined with their aggressors. In addition, schools, traditionally acting as spokespersons for cases of violence against children, were predominantly closed in the year 2020 (Schmidt et al., 2020). Through discussions at the forum, the importance of networking, based on a multidisciplinary and intersectoral perspective (e.g., health, social assistance, education, public safety, institutions that guarantee rights, and civil society), was highlighted to face complex demands, such as those involving situations of violence, which may arise or intensify during the pandemic (Fiocruz, 2020a).

Words related to school activities also became evident in the forum (school: n = 31; scholastic: n = 19; class: n = 24; teachers: n = 11; education: n = 7). In this sense, there were comments and doubts pertaining to strategies to help children in school activities in the remote modality, when these were being offered and the children had resources to attend them. Thoughts were presented about the high levels of stress and overload of the family members, particularly the mothers, who are commonly the main responsible for monitoring the school activities in the remote modality. Different authors have discussed the multiple roles that family members, and particularly mothers, occupied during the pandemic, given that, in this context, they have started or increased to accumulate work, domestic, and educational tasks, which makes their daily lives challenging, as previously discussed (Silva et al., 2020; Spinelli et al., 2020; Yavorsky et al., 2021). The demand for guidance on this topic is relevant and exposes a concern present in several Brazilian households up to the first semester of 2021, a time when on-site school activities had already resumed in some institutions. Requests to address this topic in greater depth were made by those enrolled in the “National Course on Mental Health and Psychosocial Care in COVID-19”. Thus, a synchronous remote meeting, initially not planned by the WG, was streamed on July 21, 2020, addressing back-to-school perspectives and possibilities in the context of the pandemic. By May 20, 2021, this live broadcast had 19,993 views (Fiocruz, 2020f).

Regarding the “Children in the COVID-19 Pandemic” live broadcast, the 102 questions and comments made during its transmission were subjected to lexical analysis. Those related to the presentation of the participants and acknowledgments were not considered. The highlighted words were children (n = 51), care (n = 18), pandemic (n = 12), work (n = 7), COVID (n = 6), and feel (n = 6).

Figure 2.
Live Broadcast Word Cloud

As can be seen in Figure 2, the main themes in the live broadcast resembled those identified in the forum, which were presented and discussed earlier. However, we identified with greater frequency the presence of words related to death and grief in questions and comments made during the live broadcast (grief: n = 4; death: n = 3; loss: n = 3; decease: n = 2; farewell: n = 2; rituals: n = 2). One possible explanation for this finding relates to the period in which the live broadcast was held (i.e., July 15, 2020), given that this was a month in which several Brazilian states (e.g., Paraíba, Piauí, Rio Grande do Norte, and Sergipe) peaked in mortality rates as a result of COVID-19 (Fiocruz, 2020g). Other states peaked between June and August 2020 (e.g., Bahia, Distrito Federal, Espírito Santo, Rio de Janeiro, São Paulo, and Rio Grande do Sul). Therefore, in July, when the live broadcast occurred, themes concerning death and grief were unfortunately in strong evidence in the daily life of the Brazilian population. In this sense, the questions and comments referred to communicating with children about death, strategies to include them in farewell rituals and facilitate the elaboration of the mourning process in children.

During the live broadcast, words related to feelings, as well as emotional and behavioral reactions of children during the pandemic (suffering: n = 7; feel: n = 6; fear: n = 4; aggressiveness: n = 2) were also highlighted, and these manifestations have been described in the literature (Asbury et al., 2020; Jiao et al., 2020; Linhares & Enumo, 2020). On the other hand, strategies to deal with these manifestations and favor children's adaptation to the challenges of the period were also discussed during the live broadcast, such as playful activities (games: n = 4; play: n = 1).

It is noteworthy that other strategies of psychosocial care aimed at children were present in the documents that composed the analyzed module, such as: organization of family routine, conscious use of technology, emotional validation, availability of communication channels to access health services, among others. However, these did not emerge as the focus of discussion. Despite the attempt to anticipate relevant issues that could occur due to the pandemic, the social distancing, and the closing of schools, the production of the materials took into consideration a broader panorama of the situation, seeking to lay out general lines to be used as reference in the construction of specific strategies, without the intention of presenting readymade answers to the professionals. Many questions and comments presented in the forum and during the live broadcast referred to very particular demands, often involving pre-existing needs, children's rights violations, or other aggravations.

Final Considerations

The process of construction and execution of the "Children in the COVID-19 Pandemic” module of the “National Course on Mental Health and Psychosocial Care in COVID-19” was described, characterizing its participants and analyzing the emerging themes brought up in the main questions and comments. It is understood that this case study can contribute to the planning of psychosocial care strategies aimed at mitigating the negative repercussions of the COVID-19 pandemic on child development, given that studies with this design have the potential to evaluate a real-life phenomenon, especially when dealing with instrumental cases. Moreover, we particularly highlight the potential of the module proposal, and of the course as a whole, to offer a space for sharing knowledge and experiences of professional practice amidst this serious public health emergency.

The "Children in the COVID-19 Pandemic” module aimed to fill an emergency gap, arising from the training of Brazilian professionals in mental health care and psychosocial attention in disaster situations and public health emergencies. The initial concern was to make available materials that could be consulted according to the demands of frontline workers from different areas, without making it compulsory to attend all modules. Therefore, there wasn't an evaluation process of the course as a whole, or of its modules separately, which would make it possible to measure the learning of the participants or the applicability of the content made available in different fields and work contexts. The only evaluation required was that of the participants' satisfaction with the contents offered, and a self-evaluation in terms of interest, involvement, and investment of time.

The care for children's health, considering the notion of integrality, will be increasingly necessary, because situations that show the physical and mental fragility of individuals and collectives may become recurrent, given the greater scarcity of natural resources, climate change, population growth, and the intensification of social inequalities. In this sense, it is suggested that initiatives like the “National Course on Mental Health and Psychosocial Care in COVID-19” continue to be developed and implemented to empower professionals from various fields and areas of expertise, enabling the sharing of theoretical and practical knowledge. As the demand for this type of action was evident by the number of people interested and who completed the course, it is hoped that the case presented will serve as an example for new initiatives that arise in the same direction.

Acknowledgments

The authors thank all the contributors and participants of the “National Course on Mental Health and Psychosocial Care in COVID-19”, in particular the team involved in the construction and execution of the “Children in the COVID-19 Pandemic” module: Adriana Marinho, Bárbara Costa Andrada, Carolyne Cesar Lima, Carlos Machado de Freitas, Claudia Mascarenhas Fernandes, Cristina Ventura, Daphne Rodrigues Pereira, Fabiana Damásio, Fernanda Serpeloni, Ilana Katz, Iolete Ribeiro da Silva, Juliana Crespo Lopes, Kalil Maihub Manara, Maria Aparecida Moysés, Maria Isabel Abelson, Mariana Rosa, Michele Kadri, Nicolly Papacidero Magrin, Patrícia Almeida, Ricardo Lugon Arantes, and Simone Gonçalves Assis.

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Edited by

Editor:

Raquel Souza Lobo Guzzo

Publication Dates

• Publication in this collection
  29 Mar 2024
• Date of issue
  2024

History

• Received
  27 May 2021
• Reviewed
  16 Dec 2022
• Accepted
  12 Apr 2023