Final Draft IJWC Fall 2022 copy 101 International Journal of the Whole Child 2022, VOL. 7, NO. 2 Children and Families: Health and Wellness Adverse Childhood Experiences of Elementary School Students Exacerbated by Covid-19: A Conceptual Framework Tyreeka Williamsa, Angel Dowdenb aNorth Carolina Agricultural and Technical State University, bNorfolk State University Tyreeka Williams is a third-year doctoral candidate at North Carolina A&T State University. She is currently licensed as a K-12 school counselor serving at Oak Ridge Elementary School. Her research interests include school counseling supervision and trauma informed care for immigrant and refugee students. She also teaches future counselors in training online at Concordia University. Tyreeka serves as a SACES Emerging Leader for the 2022-2024 cohort. Additionally, she is an active member of American Counseling Association (ACA), North Carolina School Counseling Association (NCSCA), and serves on the executive board team of the Alpha Tau Omega Chapter of Chi Sigma Iota. Tyreeka is a tenured U.S. Army soldier as well as a member of Alpha Kappa Alpha Sorority Incorporated. In her spare time, she enjoys reading for leisure, spending time with her family, and doing hot yoga for relaxation. Dr. Angel Dowden, LCMHC-S, LPC, NCC, ACS is a Professor and Department Chairperson in the Department of Secondary Education and School Leadership at Norfolk State University (NSU). Dr. Dowden is a Licensed Clinical Mental Health Counselor Supervisor, Nationally Certified Counselor, Approved Clinical Supervisor, and Licensed Professional K-12 School Counselor. Dr. Dowden earned her doctoral degree in Counselor Education and Supervision at North Carolina State University. Dr. Dowden has over twenty years of counseling and counselor education experience. Dr. Dowden’s research interests include African American populations and mental health, social justice and multicultural counseling, qualitative methodologies, and trends in school counseling. Abstract Prior to the COVID-19 pandemic, 44% of elementary-aged students reported experiencing adverse childhood experiences, while 13% reported experiencing three or more (Blodgett & Lanigan, 2018). During the COVID-19 pandemic, parents faced many hardships such as economic and health disparities. This resulted in an influx of reported and presumably unreported adverse childhood experiences. The most reported experience included child neglect and psychological maltreatment (Sonu et al., 2021). While not seen as popular in the media and literature, the impact of psychological maltreatment is more severe than any other form of abuse (Hines, 2020). This paper will discuss the current conceptual findings, legal definitions, 102 theoretical underpinnings, policy and practice implications as it relates to child neglect and psychological maltreatment of elementary-aged children. Understanding Adverse Childhood Experiences Adverse childhood experiences (ACES) are defined as any traumatic event that occurs to a child before the age of 18 (Gilgoff, 2020). More specifically, this encompasses any event ranging in severity that disrupts the child’s physical, emotional, mental, or psychological development (Kalmakis and Chandler, 2014). Adverse childhood experiences may include but are not limited to parental divorce or separation, exposure to violence and domestic abuse in the child’s place of residence, or exposure to alcohol and drug abuse. During the pandemic, there was a reported 54% increase in child neglect and psychological maltreatment of elementary-aged children compared to other adverse childhood experiences discussed (Rapp et al., 2021). Child neglect is legally recognized as “parental failure to meet a child’s basic needs” (Hines, 2020). Child neglect can be displayed in many different facets of the child’s life including but not limited to physical, psychological, medical, mental health, and educational neglect. While child neglect has a stand-alone definition that is legally recognized, psychological maltreatment does not (Baker et al., 2021). Psychological maltreatment lacks a clear and concise definition due to diverse meanings and understandings held across state lines. Additionally, it is not uncommon for people to only pay attention to immediate visualized consequences such as wounds from physical abuse. However, due to the short and long-term impact of child psychological maltreatment in today’s society, states are now just beginning to concentrate on a focused definition. For now, the literature recognizes child psychological maltreatment as the following: “repeated pattern or extreme incident of caretaker behavior that thwarts the child’s basic psychological needs and convey a child is worthless, defective, damaged goods, unloved, unwanted, endangered, primarily useful in meeting another’s needs, and/or expendable (Bernet, 2017). Theoretical Underpinnings Attachment theory is the theoretical underpinning that provides an understanding of adverse childhood experiences (Grady et al., 2017). Bowlby (1953) outlined that how parents provide, support, and care for their children largely depicts their attachment style and impacts their ability to sustain and withhold both friendships and romantic relationships later in life. The four attachment styles recognized are secure, anxious ambivalent, disorganized and avoidant (Bowlby, 1988). Attachment style is largely developed from infancy through the first year of life. Secure attachment style is the healthiest of the four known attachment styles, leading to healthy relationships long-term; both romantic and platonic (Levy et al., 2011). The child is aware that he/she is loved, secured, and supported appropriately and healthily. Anxious ambivalent attachment style insinuates an unhealthy relationship established with parents where the parents were not very attentive to the child and potentially demonstrated neglectful behaviors (Meyer et al., 2001). Neglectful behaviors during childhood may lead to lower self-esteem, decreased sense of self-worth, contributing to complexities in romantic relationships later on in life such as 103 validation seeking behavior. Disorganized attachment style is a result of parents not being consistent in the child’s life whether it’s consistent in discipline, love, security, and support (Baer & Martinez, 2006). This could result in the child developing fear that their partner or friend may leave the relationship. Lastly, avoidant attachment is considered the least healthiest form of attachment. Avoidant attachment occurs when parents simply provide the bare minimum for their children such as housing and food; however, the parents ultimately avoid their children after basic needs are met. This form of attachment style leads to relationship misunderstanding that can result in a lack of value in maintaining significant relationships. “Attachment styles provide the cognitive schemas, or working models, through which individuals perceive and relate to their worlds” (Shorey & Snyder, 2006). It is critical to understand that attachment style directly reflects and relates to the psychological state of functioning both in short term and long term. Predictors of Child Neglect Historically, the predictors of child neglect have been difficult to conceptualize. To establish a foundation for understanding, an ecological approach to exploring the macro, meso and microlevels of child neglect was introduced. Uri Bronfenbrenner (Ryan, 2001) introduced an ecological (now referred to as bioecological) systems approach which highlights various systems that contribute to a child’s development. This theory emphasized the complex layers that are involved with a child’s development to including but not limited to: family, religion, school, community, culture, and more (Ryan, 2001). The layers are classified into systems that influence the child, for example the biological makeup of a child is in the microsystem and community is a part of the larger exosystem. Economic insecurity and poverty are the largest contributors of child neglect (Hines, 2020). When parents are struggling financially to survive, a child can become a secondary or even third focus depending on the circumstance. From a macro level, substance abuse is another large contributing factor in child neglect (Ondersma, 2002). A meso level assessment of the child neglect problem gleans light on the predictors of child neglect to include lack of social engagement and positive interaction of social groups. Additional challenges from a meso level include the inability for children to have positive outlets which lead to increased exposure to community violence and dangerous behavior. On the other hand, microlevel assessment predictors explores the child themselves. For example, if the child is diagnosed with a mental, intellectual, or physical health disorder, unfortunately they are more prone to experiencing child neglect (Cruden, 2019). Given these levels, it is essential to understand that when considering child neglect, key predictors might include poverty, lack of social interaction, substance abuse, and physical, mental, and intellectual diagnoses. Predictors of Child Psychological Maltreatment Child psychological maltreatment is similar to child neglect in that it encompasses a wide range of emotional, physical, and mental maltreatment. From a macro lens, in comparison to child neglect, a lack of education and low socioeconomic status also are major predictors of child psychological maltreatment (Arslan et al., 2022). From an exo lens, family isolation and lack of a familial support system largely impact the mental development of a child (Baker et al., 2019). 104 Additionally, from a micro lens a child experiencing child psychological maltreatment is likely to experience a high level of irritability/fussy behavior (Hines, 2020). Consequences Child neglect and psychological maltreatment provide significant consequences to the overall well-being of children. Specifically, two pivotal studies were analyzed to conclusively highlight these impacts. First, Hecker et al., (2019) conducted a study in Tanzania on primary school students who suffered consequences from child maltreatment. The conceptual findings concluded that the association between neglect and internalizing problems showed a large and significant effect (Hecker et al., 2019). The study also affirmed previous study findings that children suffering from consequences of child neglect have an increased risk of experiencing “depressive systems, peer problems, and inferior emotional regulation skills” (Hecker et al., 2019). Next, Mwakanyamale and Ndomondo (2019) conducted a study on students in both Tanzania and China to assess the relationship between psychological maltreatment and stress on their self- esteem. The study concluded that there is a significant effect and confirmed that psychological maltreatment not only impacts students in the moment but has an everlasting impact on the overall functioning and well-being of primary school-aged students. As they navigate the most important developmental stages of their lives, it is imperative for children to receive counseling services to excel socio-emotionally and academically. Impact of Covid-19 The COVID-19 pandemic significantly contributed to the increase in both unreported and reported child neglect and psychological maltreatment cases. Hines (2020) highlighted income loss and unemployment as contributing factors to both child neglect and psychological maltreatment. When a parent is frustrated financially and is not meeting their basic Tier 1 needs of Maslow’s hierarchy, sometimes they will unintentionally or intentionally let their emotions out onto their children. The COVID-19 pandemic has truly changed the landscape of the workforce. Millions of people worldwide lost their jobs and subsequently millions were forced to work remotely and/or experienced reduced hours/income. This type of significant and sudden shift impacts the family dynamic, specifically during COVID-19 when children were forced to remain home and complete school virtually. Berube et al., (2020) assessed the fears associated with the COVID-19 transition. Parents immediately felt a sense of isolation and were afraid for their children to be in the house with a lack of social engagement, connectedness, loss of learning, and other consequences as a result. In addition to their fear for their children, parents fear having to navigate parenting and the social reaction to the pandemic. Parents feared raising their voice, scolding or yelling at their child, and having less patience” (Berube et al., 2020). Unfortunately, the ongoing Covid-19 pandemic persists, and parents have expressed significant exhaustion and parental burnout due to being the sole caretakers and providers for their children, which has the potential to lead to child neglect and psychological maltreatment. 105 Lawson et al., (2020) conducted two regressional analyses to assess the relationship between job loss and increased psychological maltreatment for children. The results supported the hypothesis noting that parents who dealt with strife from sudden job and income loss were more likely to physically abuse or psychologically maltreat their children. In opposition, families with positive reframing coping skills were more prone to decrease this type of treatment. It is now more imperative than ever to focus on psychoeducation surrounding topics such as parental burnout during this time. Ray et al., (2020) conducted a correlational study assessing the consequential effect of the increase in ACES experienced by children during COVID-19. N=58 students ranging in ages 5- 12 were recruited from a local elementary school to take a questionnaire regarding their social/emotional health. The findings revealed that students who reported experiencing one or more adverse childhood experiences were more likely to have a decrease in social/emotional health and an increase in behavior problems. Current Trends in Research Self-reported cases of child neglect and psychological maltreatment decreased during the COVID-19 pandemic. Elementary-aged students were secluded in the house with no external outlet to share any traumatic events experienced in the home. As a result, elementary-aged students returned to the school building with a myriad of mental health concerns such as anxiety, depression, suicidal thoughts, and more (Doom et al., 2021). It has been documented that Covid-19 had a significant impact on child neglect and psychological maltreatment; however, research currently points to a decrease in referrals, largely due to children not having educational personnel involved in their home life and an inability to report. Bullinger et al., (2021) highlights the drastic shift that parents were challenged with since March 2020. This implies that if child physical abuse increased as much as many child advocates warned, then it is going largely undetected by child protective services (Bullinger et al., 2021). This trend in research leads to future policy implications regarding how to navigate child abuse and neglect in the case of a future pandemic or world events that forces children to be home. Policy Implications Several policy implications could help target child abuse/neglect victims and families that display this behavior. However, instead of directing the attention towards families, it is salient to pay attention to bigger picture items such as structure, infrastructure, and systemic policy that have a trickle-down effect on how parents operate within their household. Economically insecure children experience three to nine times more maltreatment than economically secure children (Conrad-Hiebner & Byram, 2020). If unemployment, income loss, and low socioeconomic status are the leading predictors of both child neglect and psychological maltreatment, perhaps society should look at what is hindering families from achieving quality education to secure sufficient employment. Infrastructure policies should be analyzed to put issues such as redlining in perspective, housing, and separation of quality education for those who are less fortunate. Ultimately, a top-down approach to improving outcomes that are implications for child neglect and abuse are essential to curtailing the problem. 106 Practice Implications Two paramount implications for improving the problem include psychoeducation and trauma informed care. Psychoeducation surrounding the topic of child neglect and psychological maltreatment will be largely beneficial for targeted groups such as first-time parents. First-time parents are without a doubt at higher risk for this behavior due to their overall lack of knowledge. If counselors want to take effort in prevention strategies, the first step would be to provide the appropriate education to those who are unaware such as first-time parents ages ranging from 20- 28. Another practice implication would be the use of trauma-informed-care with multicultural considerations when working with children who are victims of neglect and psychological maltreatment. This requires all staff of clinical practices to be trained as well as school stakeholders in the principles of trauma informed care. More so, school counselors and mental health clinicians must consider cultural backgrounds when working with client/student victims to provide the best suitable interventions and treatment plans. Recommendations Many studies focused on the impact of COVID-19 to child neglect and psychological maltreatment were conducted in the beginning of the pandemic. It is recommended that future studies examine how statistics surrounding child victims have either decreased or increased and measure parental burnout (Griffith, 2020). Additionally, it is imperative for future research to explore the implications of COVID-19 as it relates to child psychological maltreatment and neglect and how other contextual factors such as exposure to substance abuse, income loss or social isolation increase the likelihood of maltreatment for elementary-aged children. Lastly, salient to the impact of adverse childhood experiences, it is important to examine the consequences of this influx on the long-term mental health of primary school-aged children (Kathirvel, 2020). Conclusion Child neglect and psychological maltreatment are two leading forces of child abuse; but tend to be the least reported. From the attachment style theoretical framework, these subjects are large predictors of how an elementary-aged child will be able to form substantial and significant relationships as they matriculate into and throughout adulthood. Socio-economic status, mental health disorders, and family history of abuse/neglect are all significant predictors of child neglect and psychological maltreatment. There are several policy and practice implications stemming from the current COVID-19 pandemic and the lack of referrals reported. 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