It's a vicious cycle.
As students, staff and families experience stress and anxiety from challenges caused by the COVID-19 pandemic, they are faced with yet another challenge - coping with and addressing these mental health concerns.
Bridget Frank, special services director for the Jefferson City School District, who was a school psychologist for 11 years, said she has seen a significant increase in stress and anxiety among students, staff and families caused by the pandemic.
"It's natural for students and staff members to have more anxiety and stress that are the result of just those natural things that happen with a pandemic: changing work schedules, changing school schedules, quarantines, layers of protection," Frank said. "We've had to cope and adjust and change a lot, and so I would say it is a substantial increase for everybody."
These stressors can make people more vulnerable to depression, anxiety and other mental health issues.
Many people have lost coping strategies they've had before. For example, people are social distancing from family and friends who have been a source of comfort in the past.
People have had to adapt by developing new coping strategies or improving the strategies and skills they already had, Frank said.
Students who are learning remotely sometimes have difficulty coping with social isolation and the pressures of online learning.
All middle schools and high schools in the Jefferson City School District did distance learning for the week of Nov. 16 due to a staffing shortage from teachers being quarantined and a lack of substitutes. The middle schools also did distance learning Oct. 13-23.
As of Thursday, 440 JC Schools students have been quarantined since school started from being close contacts of COVID-19 cases at school, and this doesn't count the number of students who were quarantined due to exposure outside of school.
School routines are important coping mechanisms for young people with mental health issues. When schools are closed, they lose an anchor in life and their symptoms could relapse, according to The Lancet Child & Adolescent Health.
JC Schools stays connected to students who are quarantined or enrolled in virtual learning as much as possible through methods such as video chatting, and special-education services continue virtually for students enrolled in virtual learning, Frank said.
These students have virtual access to school counselors, but the coronavirus has robbed many students of valuable face-to-face support.
Experts say student progress depends on how educators support their emotional and mental health.
The Missouri Department of Elementary and Secondary Education created the Task Force for Learning Acceleration to address learning loss that likely occurred during school closures in the spring, and the task force placed high priority on the social and emotional needs of students and staff.
The task force determined educators will need help adjusting curriculum and delivery methods, and it recommended school districts structure those changes with a primary focus on the social and emotional needs of students.
It recommended educators and staff members be sensitive to the mental health of students, recognize the impact of trauma on learning, remain flexible, and provide at-risk and vulnerable students with more assistance than others.
"We realize that our educators have to help students and staff members process their loss and fear while simultaneously facing the possibility that equity and opportunity gaps are wider than ever before," Blaine Henningsen, assistant commissioner for DESE's Office of College and Career Readiness, said during a state Board of Education meeting.
The task force recommended creating intentional strategies to meet the needs of vulnerable students.
"Even though this impact can be experienced by many students, it's particularly true for those at-risk and vulnerable students who may already have been suffering from trauma before the pandemic," Lisa Sireno, the standards and assessment administrator for DESE's Office of College and Career Readiness, said during a state Board of Education meeting.
A school should have no more than 250 students per student counselor, according to the American School Counselor Association.
For JC Schools, this ratio is about 300:1. Nationally, it's 430:1.
JC Schools has 30 counselors: one per elementary building, six for the middle schools, 10 for the high schools, two at Jefferson City Academic Center and one at Nichols Career Center. It also has four full-time school psychologists, two school psychologist interns and 12 school psychological examiners.
The district also has four social workers - one at Southwest Early Childhood Center and three who primarily serve elementary but support secondary when needed - and 11 behavior interventionists.
Behavior interventionists work with elementary and middle school students with the greatest need on their social, emotional and behavioral skills.
The district provides behavior interventionists with frequent professional development and training on mentally healthy practices and how to work with students who are experiencing significant social, emotional and behavioral concerns. Outside agencies, including the University of Missouri, have also helped with this training.
The district also partners with Compass Health to provide school-based therapists who are licensed counselors. After receiving parental consent, these therapists provide individual therapy to students who need it in the school setting.
"Unfortunately, they have had some staffing shortages as well, and they have not been able to provide as many school-based therapists as they have in the past, but we still heavily rely on them," Frank said.
This school year, the district has had two school-based therapists. In past years, it has had nine. Compass Health is trying to hire and has approval for more, but those spots are currently unfilled, she said.
Because of staffing shortages, the district's counselors and behavior interventionists have been substituting for teachers often, which has added many challenges. But getting to work with students in a classroom environment has also given the counselors opportunities.
"(There are) lots of challenges as far as schedules and doing some of the normal groups or lessons that we typically would provide but also some great opportunities for the classes that they are subbing with to practice some of those skills with the counselor while they're actually your teacher for that day, too," Frank said.
Every JC Schools teacher is expected to use four essential features of good classroom practices: high-quality instruction, good classroom structures, culture and climate, and behavioral strategies.
These features are essential for all children, but especially those most at risk. Children, especially those at risk, need relationships, consistency and structures to meet their social and emotional needs, Frank said.
"We've really focused on our efforts on embedding that into every classroom so that every student has the opportunity to develop those social, emotional and behavioral skills," she said.
High-quality instruction means providing instruction on a students' instructional level but also making it engaging and relate it to their life, Frank said.
"When their instruction is meaningful and meets them where they are, students learn better and they feel connected to school," she said.
Good classroom structures include consistent rules, routines and easy transitions so students know what to expect. The COVID-19 procedures have helped with providing structure, Frank said.
For example, students know to use hand sanitizer and put on a mask when they enter the building and to walk only one way in the hall. Some of the new procedures have even been a source of comfort for students and a way for them to continue to develop their social and emotional skills.
"As an example, breakfast and lunch in the classroom has been actually a source of calm and has given our students the chance to connect with their classmates and talk and just be kids again in a safe, socially distanced way," Frank said.
Culture and climate means building good relationships with the students, which teachers and students quickly learned was difficult to do from a distance during the closure in the spring.
"Our teachers were so thrilled to see our students that they really grasped on to this," she said. "We're seeing our teachers do this in many really kind of heart-tugging ways this year."
When students are in quarantine, some teachers have delivered their work to their homes and found other ways to connect with them, such as via video-chat or by writing letters.
Behavioral strategies include praising students when they're doing what they're supposed to, giving them feedback and correction when they make mistakes, and teaching them mistakes are opportunities to grow, Frank said.
Thomas Jefferson Middle School and all the elementary schools use the Second Step curriculum to teach social, emotional and behavioral skills such as coping mechanisms, decision-making and how to internalize the impact their decisions have on others.
"We've been focusing on embedding good mentally healthy practices in every one of our classrooms, so I feel like we're on the right path," Frank said. "I feel like the efforts we've made over the last couple of years have definitely helped this year be easier and smoother."