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Ep. 49 - LiveWell Talk On...COVID-19 and its Impact on School Seniors (Craig Meskimen, MSW, LISW) May 6, 2020

Ep. 49 - LiveWell Talk On...COVID-19 and its Impact on School Seniors

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Host: Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital

Guests: Craig Meskimen, MSW, LISW, manager, Children's Specialty Services,
                UnityPoint Health - St. Luke's Hospital
               Libby Arnold, senior at Xavier High School

Dr. Arnold (00:09):

This is LiveWell Talk On COVID-19 and its impact on school seniors. I'm Dr. Dustin Arnold, chief medical officer at St. Luke’s Hospital. Many traditions that come with the end of the school year have been canceled due to COVID-19. This can be especially felt by the high school seniors and college seniors who may feel they've had lack of closure as they transitioned into the next phase of their life. Here to talk with me today is Craig Meskimen, manager of Children's Specialty Services at St. Luke's Hospital. Welcome.

Craig Meskimen

Well thanks for having me.

Dr. Arnold

In addition to Craig today to make sure that he gets it right. We have a special guest, Libby Arnold, who's my daughter who's a senior at Xavier High School. She goes by Libby, but it's Elizabeth when she's in trouble. Welcome.

Libby

Thanks

Dr. Arnold

Craig. Let's start with your background as manager of child specialty services here. And what you oversee…

Craig Meskimen (01:05):

My background at the children's specialty services is I manage the outpatient child programs here at the hospital. So the LIFE program, which is a group outpatient therapeutic program for school aged kids who are experiencing mental health concerns. They come to us and I oversee those programs as well as the TIES program, which is a parenting program for kids 18 months through six years old. And we also have a footprint within the Cedar Rapids school district for a variety of case management and other support networks for local schools.

Dr. Arnold (01:39):

And has your volume of service increased with the pandemic? Decreased, stayed the same?

Craig Meskimen (01:45):

We are completely shut down because of the nature of our services. We provide group supports, individual stuff is still able to happen virtually. But the nature of our services with the confidentiality issues, we are completely shut down at this time.

Dr. Arnold (02:02):

You know, we think about the ORs and the ERs and the clinics. We don't think about some of these other outpatient programs that are vital to our community health. Now let's start with the sports. I know you like sports and Elizabeth plays sports at Xavier. People had goals. They set goals, they train, they're looking forward to their senior year and just to have it taken away, Not arbitrarily, but it's hard. I mean if you tear your ACL, you can feel that, you understand why you're not participating, but this, you don't really feel it. You don't really feel what happened. So what's your advice? What are you seeing?

Craig Meskimen (02:39):

A couple of different things with that. I think the most important thing is to acknowledge that it's happening, right? And that's a very therapeutic way of putting it. Essentially we want to sit in that emotion and realize we're losing out on what our expectations were for our senior year, whether that be sports, whether that be graduation or the prom. There's lots of different things that serve as rites of passage towards the end of your high school senior year that signified this entry into adulthood. You have a right to be upset, angry, sad about that. We want to work our way through those stages of grief. I think that's the important part right away is to make sure that you're acknowledging that and not trying to deny those emotions and deny those feelings.

Craig Meskimen (03:24):

The thing that also is important with this is don't do it alone. I mean as a adolescent there is a significant need to be social. I asked you Libby earlier what you guys are doing to stay connected. We are in a great time technology wise where we can communicate with others via Zoom or Facebook or Instagram or whatever else there is. I'm not a social media guru, but there are a variety of ways where we can stay connected and grieve through these losses together with our peers that we have grown up with. So there is some commonality there that can certainly help.

Dr. Arnold (04:00):

Yeah, that's interesting. Social media certainly has become an integral part of our society prior to this. And you know, we've talked in other podcasts about what's the world going to look like from a virtual social media standpoint after this. And then that will be interesting. Libby what are some of the emotions you've experienced with missing out on - let's just start with your track season.

Libby

It was really difficult cause at first we didn't know. We thought we would have a season or part of a season because they released part of a schedule so everyone kind of got their hopes up. They were training, me and my sister were doing hurdle workouts. Our coach made PVC hurdles like out of pipes. Those are really fun to do and work with. So we were just training and training and then we found out. it was really hard to realize. It took me a while to even process it and I don't feel good right now. I need to sit down cause this is just like a lot of information.I don't know what to do now cause like sports have been so big part of my life, I never got to close out my track season. So that was kind of hard to deal with.

Dr. Arnold

 So understandable. Now personally I'm happyI don't have to buy a prom dress. So that's the upside here, you know, that saves some money. So I'm happy about that. But all joking aside, we certainly understand this. The rite of passage you don't get. There is an issue with closure that I think you have. I'll give some personal experience my dad passed away and I, I missed out on a graduation ceremony because of that, but there was a sense of no closure. I think that's true.

Craig Meskimen (05:32):

The important part that we forget as adults is that this is the entirety of, in Libby's example, this is 18 years of her life, this is a hundred percent of her existence has been as a child. And there is these rites of passage that go along with all of these different things from prom, from track, from graduation that just got wiped out in a matter of a few days essentially. So there's a process to coming to grips with that.

Dr. Arnold (05:56):

Yeah. Libby what, what do you think, I know you have, cause you live with a physician, you hear about COVID -19, but what about your friends, do you think they understand that the significance of the virus and the need to social distance and to, you know, not to overuse the phrase, flatten the curve? Do they appreciate that or are they just kind of lost in a sense of wonder why this is happening?

Libby

I think it's a little bit of both. I have friends that are like, I miss you. I can't see you. I need to stay home. we need to get this over with. So maybe we can have a graduation ceremony. And then there's others who are completely oblivious to what's going on and still hanging out with friends, still going out.

And I'm just like from a senior standpoint why? Cause all the seniors are like we have to stay home. We are but we still want to have that closure and some people don't follow that. Some people do. And it's just hard cause like you can't control everyone and everyone has the same thought process that a senior does.

Dr. Arnold (06:36):

Do you think they appreciate it, I've always been respectful of snow days, right? Because you have to make that decision ahead of time. You're dependent on other people for the information, the meteorologist, the forecasters and you err on the side of safety, but then you don't want to be the proverbial boy who cried Wolf. That's a tough call. Do you think some of your classmates are maybe in denial that this is happening?

Libby

Oh, definitely. There's, I've had some friends that can't even put their cap and gown on because they're not ready to have at home graduation. Everyone, some people still have their hopes up that we'll have this graduation ceremony. Maybe not May 24th, maybe June 24th, maybe July 24th. But some people have already had that closure. They've submitted their cap and gown picture and they're like, all right, let's go to college. But there are some that are like, especially me, who haven't had that closure yet and aren't ready to put high school completely behind.

Dr. Arnold

Craig. What are some warning signs that a parent should take away from this to say, you know what, I don't think my son or daughter's coping with this.

Craig Meskimen (08:05):

What we want to look for there is if they're not moving through things appropriately, right? We always rely on the parent to be the expert of the child. And so what we're looking for is dramatic shifts. So, you know, some generic ones that we put down or maybe eating too much or not eating enough dramatic changes in sleep patterns, long moments of sadness or high anxiety type behaviors. The general rule before I would say was a lot of times they'd say dramatic changes that lasts for two weeks. That was something that we always kind of talked about. I think with our current situation, what I tell parents is if you're concerned, you call someone you call a support, you call a source. Whether that's, if you work at the hospital, you call EAP, you call your pediatrician, you call someone that's familiar with behavioral health services. I think that's what you err on because this is such a unique time in our history

Dr. Arnold (08:57):

Let me stick to the medical side. You're the diagnostic capability. Diagnostic pathway is going to be confused because now you're starting to have stir craziness of being inside, which is going to cause abnormal patterns of behavior from that stand point. You've talked about working through it as a group, they're not alone. What is some advice you'd give to the parents that they don't think their child is in trouble and they might be dealing with it, but they want to preserve some degree of functionality to them and, and help them short of getting counseling. What are some things that a parent could do?

Craig Meskimen (09:31):

Absolutely. And I guess the first thing, and this is actually more of a conversation I've been having with folks as the pandemic has gone on as parents reaching out and asking that very similar question. I think the first thing you can do is really kind of take yourself back to when you were an adolescent, right? To an adult here in Libby. Talk about track is probably not the biggest thing in the world. When we know 59,000 people have passed away, but to an adolescent that is a gigantic thing that is her world. And so it's important to respond to that in an inappropriate manner. We would call it empathy. Really trying to make sure you're understanding where she's coming from. My quick thing that I like to say is empathy is not an agreement, right? So we're not agreeing that that's the most important thing in the world. I don't intend to do that, but I think it's just important to acknowledge this stinks. This is affecting all of us. I'm really sorry that you're having to go through this and acknowledging that, that this is a dramatic thing. I think that's, that's where you want to start is making sure that, that you're meeting them where they're at with an empathetic response and trying to understand their point of view.

Dr. Arnold (10:34):

Yeah. I think there's a tendency, particularly the old school parent that buck up and deal with it. And that may not always be the best approach.

Craig Meskimen (10:42):

And I want to say for some kids that works. You've talked about how you have kids that already have taken their pictures and things like that. They're way ahead of that process, right? Because maybe they had a parent that did that. Maybe they're just more advanced and dealing with that, but some, it's not going to work. You know, you can't bring a cookie cutter response to something like that.

Dr. Arnold (10:59):

I've always said my, as a physician, my relationship with parents, there's two models. You either have a paternal relationship with your patient where you tell them what's best for them and they want that. And then other times it's a fraternal where you, it's a joint decision. You come to the agreement or the consensus on what the treatment's going to be or what the next step medically together. And there are patients that want that. I think what you're describing is there, this is one of those situations, parenting where you kind of have to do both. Be paternal but also be a friend and a brother or sister to your child just to, just to, like you said, empathy, not agreeing with it, but just being empathetic

Craig Meskimen (11:38):

And yyou just said it, doctor. You're kind of replacing all of these roles that they maybe would be able to get in person when their social life was normal before this pandemic. So we have to think on the fly of how we want to do this. I also encourage parents to gain control by letting go. This is a time where we want to really tighten everything up. We want to schedules to be rigid. We want them to follow all of our rules, do things like that. This is an opportunity for you to kind of let go of some stuff. Social media is a perfect example. This is a way to stay connected with their friends. So let's relax maybe our limits that we previously had before the pandemic. Let them kind of have more time with that. Setting schedules. I know there's probably online learning that's happening.

Some schools get to determine, the students get to determine when they're doing it. If you want to do it at 10 o'clock at night, some parents might struggle with that, but I would suggest if we can trust they're getting it done, let them do it at 10 o'clock at night. Gain control by letting go.

Dr. Arnold

Now, let's, let's talk about this. First of all, when these Libby and Emma started going to school and I saw the need to that they would do so much on the computer, right? And I would think about my own childhood, how we wouldn't have had the resources to have something like that, we wouldn't have probably had wifi, et cetera. I worry about that when I see them and I think about there's, there's, there's probably kids out there that don't have access to social media.

They don't have access to it, you know, a nice iPad, et cetera. What, what advice would you give those parents?

Craig Meskimen (12:58):

That's a tough question. I know. Tough question. You know, because what you're bringing in there is a lot of different socioeconomic factors, right? In this day and age to not have wifi probably brings in a whole bunch of other stuff. My advice would be is school is still happening. You know, it's, it's very, different. But it's still happening. So reach out to those school people that you've reached out to when, when things were normal and talk to them. What can I do? I don't have wifi or their packets that I can do. Are there different activities, different ways of structuring the day. It's all going to be kind of based on their age and developmental level.

Craig Meskimen (13:38):

You know, the younger kids I noticed need more structure their day can have, the better they're going to be behaviorally because they can anticipate, you think of young kids, they have no control over anything in their life, what time they eat, any of that stuff. So if we can give them something that's predictable, it really gives them a sense of a relief. Older kids, you know, it's kind of the opposite. They, they do have more control over those things, but I think that's the great, the best place to start is reaching out to the school and just explaining what you just did and say, what are my options because of our current situation.

Dr. Arnold

 I mean, we found in medicine you can ignore the social determinants of health care as a, as a physician, but they're still there. Yeah.

And they will impact the outcome for that patient. So you can either acknowledge them and try to embrace them. You might not be able to fix them, but you can at least embrace it and try to come up with a treatment plan for that patient that, that, that factors in that. And I think the same for children and in this time it went through now and you're right, that structure is hard because it's, it's not like we've said, okay, we're going to do this May 1st, bam, we're back to business as usual. It's like, well, you know, we'll see.

Craig Meskimen (14:17):

And I think that's such a hard premise as we, nobody knows, you know, so kids look to parents for guidance. Well, we have idea, you know, you're in a unique position where you're maybe ahead of most on this because of your role. But even with that, we're still kind of waiting for information to come down the pipe that's going to determine

Dr. Arnold (14:59):

Well, and it's kind of like, so Libby, when I say we'll see, when you ask her something, what does that usually translate to?

Libby

 A big no.

Dr. Arnold

Yeah, and I think, I think his parents were in the state. The governor's telling us, we'll see. You're right. That lack of control the teenagers are experiencing that as well as parents are experiencing.

Craig Meskimen (15:20):

And so what are we telling our kids? We don't know what's happening, but we do know you can't go anywhere. You can't do what you're normally used to doing.

Dr. Arnold (15:29):

Yeah. And now especially, it's an invisible virus invisible enemy. But this is really great information. Libby, do you have any parting words or advice for your friends in this time of social isolation, social distance

Libby

That we'll be okay and we'll get through it and that we just do our part and stay quarantined. Hopefully we all can go to college soon.

Dr. Arnold

That's good advice, Greg. Thanks for taking the time to do this is great information and it's, I always enjoy these podcasts that are outside the mainstream medical talks.  Because I think there's, like I said, these are, have such an influence on care and outcomes and I'm glad that we appreciate in this day and age.

Once again, that was Craig Meskimen, manager of Children's Specialty Services at St. Luke's.