• The World Association of Infant Mental Health has launched a special Covid-19 Perspectives Page entitled “WAIMH support in times of COVID-19 pandemic” which can be accessed on https://perspectives.waimh.org/2020/04/17/waimh- support-in-times-of-covid-19-pandemic/
  This page provides links to General Professional Information as well as Special Medical Information on Pregnancy, Infants and Young Children.

• The General Professional Information page includes a link to the paper “Should Infants Be Separated from Mothers with COVID-19? First, Do No Harm” by Alison Stuebe. This is an open source paper published in Breastfeeding Medicine. The link to the paper can be accessed directly on https://www.liebertpub.com/doi/full/10.1089/bfm.2020.29153.ams. The paper strongly advocates that breastfeeding infants and their infected mothers should not be separated. It cites the World Health Organization (WHO) which recommends that infants and mothers with suspected or confirmed COVID-19 “should be enabled to remain together and practice skin-to-skin contact, kangaroo care and to remain together and to practice rooming in throughout the day and night.” Breastfeeding is strongly recommended, given its known lifelong importance for maternal and child health.

• The Infant Mental Health Journal has compiled a list of resources and made accessible a number of publications to assist professionals working with infants and their caregivers at this which can all be accessed on https://onlinelibrary.wiley.com/doi/toc/10.1002/(ISSN)1234-5678.COVID-19- response?. This set of articles available focus particularly on at-home-strategies that promote infants and toddlers ability to cope with their emotions during stressful times. One of the articles written by Haruka Konishi, Ashley Karsten and Claire D. Vallotton entitled “Toddlers use of Gesture and Speech in Service of Emotional Regulation during Distressing Routines” positions the importance of gestures in communication between parents and their infants. It describes that toddlers communicated more frequently using gestures than speech, and used a greater range of self‐regulatory strategies through gesture than through speech. Moreover, older, verbal toddlers continued to use gestures during heightened distress when they could not find their words. Findings suggest that toddlers use symbolic communication to implement complex and diverse emotion regulation strategies during distressing daily routines, and that gestures provide children with opportunities to employ more diverse emotion regulation strategies than does speech alone, which may ultimately enhance children's abilities to regulate their emotions. This article may be of particular use and interest now for clinicians and caregivers alike.

• The Special Medical Information section on the WAIMH Covid-19 Perspectives Page includes a summary on the most recent published studies on pregnancy, infancy and young children summarized by Kai von Klitzing and can be accessed on https://waimh.org/page/covid_medical. According to the WHO and data from China, pregnant women do not seem to have an increased risk of a severe course of the illness. Based on a few case records and studies on immune reaction of newborns, a transmission to the unborn child in the maternal body cannot be excluded. In most cases, children of Covid positive mothers do not show symptoms after delivery. Only a few cases of newborn illness as a possible sequela of an infection in the mother’s body have been reported. A postnatal transmission to the newborn child is possible because of the close contact via droplet infection. To date there is no evidence for the existence of the SARS-CoV- 2 virus in the breast milk. The data and experiences are so far not sufficient to answer all open questions about COVID-19 during pregnancy with enough certainty. According to our current state of knowledge, the symptoms of Covid19 are markedly less severe in children as compared to adults. Because of the high contagiosity and the usually close contact among children and adolescents, it seems plausible that the virus can infect children and that children can transmit the infection (Based on Robert Koch Institute, Germany, April 13, 2020). Along with this information an excellent source for the latest guidelines on Covid-19 and pregnancy can be found on the Royal College of Obstetricians and Gynaecologists web page on https://www.rcog.org.uk/coronavirus-pregnancy.

• The Zero to Thrive initiative from the University of Michigan is led by Drs. Kate Rosenblum and Maria Muzik to promote the health and resilience of families from pregnancy through early childhood with research, education, partnership and service. They have a range of resources for professionals, perinatal women, families and caregivers, which can be found here: https://zerotothrive.org/covid-19/

Resources for psychotherapists

• Nancy MacWilliams, renowned psychoanalytic psychotherapist captures her reflections about this time in a brief paper entitled “Psychotherapy in a

Pandemic”. It beautifully summarizes the challenges of providing tele-therapy and maintaining a realistic perspective on the anxieties that inevitably permeate our therapeutic spaces.

“I had hoped to be in Sicily last month, talking with Italian colleagues about psychotherapy for patients diagnosed with personality disorders. Instead, I find myself quarantined in my home in the United States, “meeting” with my own patients via telephone and internet. Although it is possible to continue being therapeutic under these circumstances, it is also demanding.

Electronic connection has some positives – for example, patients have shown me their living spaces, babies, dogs, and other parts of their lives that I have only heard about previously – but it is also oddly tiring to stare at a screen most of the day. My colleagues are reporting the same exhaustion I feel in response to the special demands of teletherapy.

And under these circumstances psychotherapy itself feels different. Whatever their original reason for seeking treatment, the main topic my patients talk about is the coronavirus.

Every session begins with inquiries about my health and reports of their physical status and the condition of people they care about. Whereas previously, I might have responded to questions about my own health with inquiries about the patient’s curiosity, I now feel it is a matter of elemental courtesy to tell the patient how I am. Without a sense of safety that I remain okay, they cannot move on to other topics. The coronavirus has made my work feel more conversational, more intimate, more revealing of the realistic interdependencies between me and my patients.

The hardest thing for me to deal with psychologically has been the fact that dread of the coronavirus is not neurotic anxiety, and grief about its damage is not neurotic depression. I can help patients when realistic fear and loss are complicated by their personal triggers and vulnerabilities, but I cannot reduce emotional pain that is grounded in reality. Instead, I bear witness to realistic fear and overwhelming grief. Especially for those who have felt that others cannot stand to hear what they are feeling, this provides some consolation. I try also to give my patients the best information I have about keeping themselves safe. For realistic fears, realistic self-protective measures are the best “treatment.”

Clinical experience has taught me that one of the deepest fantasies of all human beings is the belief that somewhere there is an omnipotent, omniscient Other who can fix things. The first time I became aware of the power of this fantasy was when my two-year-old daughter had a full-scale tantrum because I would not make it stop raining. Some patients have a life-long emotional template of trying to get an imagined powerful mother to see how much they are suffering, because presumably then, she will intervene and save them. They bring that template to psychotherapy and spend session after session elaborating their pain, resisting a therapist’s efforts to help them see that their wish for an ideal parent must be relinquished and grieved so that they can enjoy the imperfect people and incomplete satisfactions of reality. In therapists, the counterpart of this fantasy, which has often propelled us into our profession, involves being an omnipotent rescuer who can bring perfect mental health to every patient. Over our careers, if we do not temper this fantasy, we will be destructively self-critical, frustrated, and unable to take pride in the help we realistically offer.

It is fundamentally terrifying that the world is not in the hands of benevolent, superior others, but is run by flawed, fragile human beings like us. In any ambitious psychotherapy, patient and clinician confront this reality both cognitively and emotionally. In a pandemic, this process moves to center stage as both parties are tempted to seek solace in fantasies of depending on a perfect parent. Psychotherapy involves facing hard truths. Like therapists on a grand scale, leaders who perceive and tell the truth inspire better responses to disasters than those who resist reality, try to maintain fantasies of themselves as omnipotent, and reassure the public with lies.

All that we can do as therapists, I think, no matter how our respective countries are dealing with COVID-19, is to be honest about how emotionally difficult things are right now. The main comfort we can offer to patients, even in a time of quarantine, is an intimate connection with someone who refrains from defensive distortions of a frightening, painful reality. This service does not come close to matching our fantasies of being omnipotent saviors, but it is still a precious thing.” Nancy McWilliams (April 5, 2020).

As many of you have moved to working online we have gathered a reading list that may be helpful to explore as you navigate this new way of being and working. We have attached it at the end of the newsletter.

• The Health Professions Council of South Africa has a guiding document for the ethical practice of telemedicine, which you can access from the following link https://www.hpcsa.co.za/Uploads/Professional_Practice/Conduct%20%26%20 Ethics/Booklet%2010%20Telemedicine%20September%20%202016.pdf

Although this document states that telemedicine may only be practiced in the context of an established relationship, they have published an amendment (available here https://www.hpcsa-blogs.co.za/notice-to-amend-telemedicine- guidelines-during-covid-19/), which states: “Telehealth should preferably be practised in circumstances where there is an already established practitioner- patient relationship. Where such a relationship does not exist, practitioners may still consult using Telehealth provided that such consultations are done in the best clinical interest of patients.”

• Further guidance on good practice in telepsychology can be found from the website of the Psychological Society of South Africa (PSYSSA). The following link includes guidelines, an article and an online consent form template. https://www.psyssa.com/suggested-guidelines-on-telepsychology-in-south- africa/

Resources for Parents, Expectant Mothers and Children

Many families and children may be struggling to come to terms with changes to their usual school or work routines. We would like to support you as a practitioner in providing much-needed support to those who rely on you, whether it is your clients/patients or your families. To this end, we have compiled a list of useful resources and information guides aimed at professionals, parents and expecting parents, which we hope you will find useful.

GAIMH Videos

Our sister-association, the Gauteng Association for Infant Mental Health (GAIMH) are compiling videos to support parents during lockdown. Nicole Canin, child psychologist and chairperson of GAIMH and Dr. Mike Marinus discuss a range of useful topics ranging from Maintaining routine with flexibility during lockdown, to Talking to young children about Covid-19, and Understanding acting out behaviour. Their videos can be found via this link: https://www.facebook.com/413016168818709/videos/1108468426203957/

Ububele Video Series

Ububele is an NGO that specialises in providing mental health services to parents/caregivers, infants and children under 7 in the Alexandra Township area. To fund these free services in disadvantaged communities, Ububele’s psychologists are currently offering online chats and support groups to parents, teens, and children in the private sector -at a small cost.

The following videos are available:

• Group for New Parents

How are you managing with your new baby in lockdown?
Katharine Frost will host an online chat for mothers and fathers with a new baby in the house. She’ll talk about what good-enough parenting at this time means, share some interesting knowledge about new babies and how relational they are from the very beginning and will share some resources with you that may be helpful now and in the months to come.
To watch a short video about the group, go to the Ububele facebook page here.
Date: Thursday the 23rd of April 2020 from 10h00-11h00.
Bookings: To make a booking for this online conversation click here.

• Group for Preschoolers

Is your child struggling with the COVID-19 lockdown and all the changes it’s brought? Through using Persona Dolls, Nomsa, Zaheera and Sable will speak to the children about their concerns and feelings around the lockdown. Persona Dolls help children talk about their feelings in a safe way, and help them build an understanding of all the mixed emotions they may be processing during this difficult time. The group is aimed at children aged 4 to 7 years.
To watch a short video about this group, go to Ububele facebook page here.
Date: Friday, 24th April at 1pm, via ZOOM.
Bookings: To make a booking for this online group click here
https://www.quicket.co.za/…/103918-persona-doll-group-for…/…

• Special Time Conversation for Parents

We are living in unprecedented times - so how do you parent through it all?
If you are a parent or caregiver for children between the ages of 5 and 12, Ububele invites you to join them as they try to answer that question together in a supportive and containing space where parents can get the much needed support while learning about helpful tools and tips to use during the lockdown and beyond such as SPECIAL TIME.
To watch a short video about this group, go to Ububele facebook page here.
Date: 24th of April 2020 at 10h00
Bookings: To make a booking for this online conversation click here
 https://www.quicket.co.za/…/103915-special-time-conversat…/…

• Teen Support Group

While this pandemic and lockdown is difficult for adults to manage, this time is particularly trying for teens. This support group will allow teens to connect with others around the same age as themselves, feel connected, understood and able to speak freely. Teens will need to be between the ages of 12 to 14 years to participate.
To watch a short video about this group, go to Ububele facebook page here.
Date:28th April 2020 15h00 - 16h15
Bookings: To make a booking for this online conversation click here
https://www.quicket.co.za/…/103917-teens-covid-19-support…/…

Resources for parents of young children

Here are some resources for parents of young children to help them deal with some of the emotions and behaviours that they may experience at present.

• The Child Mind Institute Facebook Page is having twice daily live Q&A that parents can participate in that focuses on parenting at this unusual time: https://www.facebook.com/ChildMindInstitute/

• Empathic Intervision, a collaboration between Dr. Lidewij Niezink and Katherine Train, is aimed at enhancing empathy in a range of work and personal settings. They have compiled a list of empathy games, fun interactions between parent and child, to enhance communication and empathy between childrens and parents, which may be found here: https://empathicintervision.com/2020/04/01/lets-play- empathy/?platform=hootsuite&utm_campaign=HSCampaign

Resources for expectant parents

• The Harvard website has answers to the most common questions of expectant parents: https://www.health.harvard.edu/blog/pregnant-and-worried-about- the-new-coronavirus-2020031619212
• Comprehensive guidance from the Royal College of Obstetricians and Gynaecologists: https://www.rcog.org.uk/en/guidelines-research- services/guidelines/coronavirus-pregnancy/

Resources for Children during Coronavirus

• Save the Children International Resource Centre has published a Covid-19 resource series and includes links for Caring for Children with Coronavirus and multiple formats of helping children to understand Coronavirus and what is happening in the world around them at the moment. This can be found on https://resourcecentre.savethechildren.net/type/child-friendly-materials
• Excellent workbook to work through feelings children have about Coronavirus and to assist with a child friendly explanation of the virus developed by Manuela Molina of Mind Heart Kids and can be accessed on https://www.infinitefamily.org/wp-content/uploads/2020/03/Child-Friendly- Explanation-of-Coronavirus.pdf
• WHO Children’s book “My Hero is you” available in PDF: https://interagencystandingcommittee.org/system/files/2020- 04/My%20Hero%20is%20You%2C%20Storybook%20for%20Children%20on%20COVID-19.pdf

• Alex Scheffler & Professor Graham Medley of the London School of Hygiene & Tropical Medicine, as well as a team of consultants created the book “Coronavirus: a book for children” suitable for primary school age children.
  https://nosycrowcoronavirus.s3-eu-west- 1.amazonaws.com/Coronavirus_ABookForChildren.pdf

• Save the Children have curated a really fantastic selection of resources: https://www.savethechildren.org/us/what-we-do/emergency- response/coronavirus-outbreak/resources
• Sesame Street have a range of resources for parents and children: https://sesamestreetincommunities.org/topics/health- emergencies/?utm_source=SS.org%20Caring%20for%20Each%20Other%20Pag e%20links&utm_medium=Link&utm_campaign=Caring%20for%20Each%20Oth er
  

Training Opportunities

IMHP (Infant Mental Health Promotion) is a coalition of individuals and professional representatives from agencies concerned with infants and their families in Canada. They are offering free Basic training in infant mental health online with presentations. If you have students or staff who have capacity it is good training that has no cost. The following topics are covered in the training:

• Principles of Core Prevention and Intervention
• Early Brain Development
• Importance of Caregiving Relationships
• Attachment and Self-Regulation
• Temperament and “Goodness of Fit”
• Responding to Challenging Behaviours
• Infant Cues
• Understanding Developmental Milestones
• Screening for Concerns

The training can be accessed here: https://www.imhpromotion.ca/

Resources for providers

This website from the Maternal Mental Health Leadership Alliance (MMHLA) has links to resources on a range of topics, from caring for your mental health, to assisting others who are experiencing mental health difficulties: http://www.mmhla.org/index.php/covid-19/

Reading List for Online Therapy:

Barak, A., Fenichel, M., Jones, G., Meunier, V., Munro, K., Suler, J., Walker-Schmucker, W., Zelvin, E. (2002). Myths and Realities of Online Clinical Work. CyberPsychology & Behavior, 5:2, 2002. Mary Ann Liebert, Inc.

Bee, P.E., Bower, P., Lovell, K. et al. Psychotherapy mediated by remote communication technologies: a meta-analytic review. BMC Psychiatry 8, 60 (2008). https://doi.org/10.1186/1471-244X-8-60

Berger, M. & Skinner, A. (2009). Psychological services over the internet. The British Psychological Society Professional Practice Board.

Biagianti, Bruno & Hidalgo Mazzei, Diego & Meyer, Nicholas. (2017). Developing digital interventions for people living with serious mental illness: Perspectives from three mHealth studies. Evidence Based Mental Health. 20. ebmental-2017. 10.1136/eb-2017- 102765.

Dunn, K. (2012). A qualitative investigation into the online counselling relationship: To meet or not to meet, that is the question. Counselling and Psychotherapy Research: Linking research with practice. 12:4, 316-326.

Henton, Isabel & Midgley, Nick. (2012). Counselling and Psychotherapy Research: Linking research with practice 'A path in the woods': Child psychotherapists' participation in a large randomised controlled trial. Counselling and Psychotherapy Research. in press. Simpson, (2014).

Tele-web Psychology in Rural South Australia: The Logistics of Setting Up a Remote University Clinic Staffed by Clinical Psychologists in Training. Australian Psychologist. 49, 193–199.

Innocente, G.M. (2015). Client-Clinician Texting: An Expansion of the Clinical Holding Environment. Spring 5-192015. Doctorate in Social Work (DSW) Dissertations. 71.
Leguil, C. (2017). Your Ego Online, Psychoanalysis. In: The Social Media Age. Le Monde, 31st August 2017.

Lapidot-Lefler, N. & Barak, A. (2015). The Benign Online Disinhibition Effect. Cyberpsychology: Journal of Psychosocial Research on Cyberspace. 9:2. Article 1. Reese, R.J., Mecham, M.R., Vasilj, I., Lengerich, A.J., Brown, H.M., Simpson, N.B., & Newsome, B.D. (2016). The effects of telepsychology format on empathic accuracy and the therapeutic alliance: An analogue counselling session. Counselling and Psychotherapy Research. British Association for Counselling and Psychotherapy. 16(4): 256– 265.