An Interview With Maria Angelova
Our children are facing challenges that didn’t exist just a short while ago. They are growing up with social media, constantly being connected, and the hurried pace of life today, as well as the pandemic, and the often frightening news. In short, our children are facing unprecedented mental health challenges. Anxiety, depression, and even suicide are on the rise. As parents and educators, what can we do to raise children who are mentally healthy? In this interview series, we are talking to authors, parenting experts and mental health professionals who can share their expertise and advice on Raising Children Who Are Mentally Healthy. As a part of this series, I had the distinct pleasure of interviewing Erica Fener Sitkoff, Ph.D.
Erica Fener Sitkoff is a clinical child psychologist who has spent more than 20 years translating the insights of her practice into policy solutions that ensure all children thrive. Today, she serves as the senior vice president of mental health strategy at FullBloom, a leading provider of special education, instructional intervention, behavioral health, and professional development solutions. In this role, Sitkoff works to develop strategies for building a comprehensive mental health services platform. She lives in California with her husband and son.
Firstly, thank you for the opportunity to discuss mental wellness in children. My journey, from working with families in a larger public school system to that of a child advocate, reflects my deep commitment to translating clinical insights into impactful policy solutions for children’s well-being.
As a licensed clinical child psychologist for more than 20 years, I have dedicated my career to addressing the mental health and well-being of students through policy and advocacy. I wanted to see the connection between my work and children getting access to the support and resources they need to thrive. No matter the state I was in or the sector I worked, I saw time and time again a recurring problem that hadn’t been adequately addressed: kids do not have access to the support they need when they need it.
I’ve worked hard to change that throughout my career, having held significant roles in organizations such as Voices for Georgia’s Children (Voices), the state’s largest child advocacy organization. Under my leadership, Voices made children’s mental health a key priority for Georgia, advancing policies that provided unprecedented investments in school-based health, and passed legislation that made it easier for children to get healthcare coverage. I also served in a senior advocacy role at the Conrad N. Hilton Foundation, focusing on youth initiatives and leading the investment strategy for the foundation’s International and Domestic Older Youth Initiatives advocacy portfolio.
Earlier in my career, I transformed the District of Columbia’s Public Schools (DCPS) student support division by implementing a host of reforms that ensured students received the therapeutic services they needed at the time. Frustrated by the barriers my students faced at school, I expanded the range of interventions available in schools, sparking a culture of accountability and engagement that enhanced the learning environment for all students. The gains we made at DCPS were once considered impossible. Inspired by this new proven possibility, I went on to support the transformation of student services and early intervention programs with other districts, advising communities of various sizes, geographies, and needs, boosting educational outcomes for diverse populations across the nation.
I’ve shared my expertise on several advisory board appointments and coalitions, including: the Governor’s Children’s Cabinet, Georgia’s Commission on Children’s Mental Health, Partners for Equity in Child and Adolescent Health at Emory University, and the National Children’s Advocacy Leadership Network.
Today, I’m senior vice president of mental health at FullBloom, where I explore opportunities to expand mental health offerings for the 150,000+ children we serve annually. In my role, I lead the business development efforts with key mental health stakeholders. I also evaluate the K-12 mental health services market and am responsible for developing a go-to-market strategy that outlines the most compelling opportunities across the industry to create brighter futures for the kids we serve.
What are some lessons you would share with your younger self if you had the opportunity?
I would tell younger me that relationships matter — the good and the bad. Relationships can challenge you in productive ways and support your dreams and what’s best for you. They can steer you in healthy directions or away from them. Seek out those people who make you feel great about yourself and champion you versus making you feel poorly about yourself. Creating positive relationships creates positive opportunities for you versus putting you in harm’s way.
Second, I would tell myself it’s OK to not be OK sometimes. When you are younger, everything feels so consequential. Things will get better. Remember, if feeling awful in some moment, it may not feel so awful in a month or a year. I would tell myself that bad things happen, but it’s how you handle the hardships that helps shape who you are and how to navigate hardships in the future. In these situations, instead of dwelling on the incident, focus on learning from it and what you do after the fact.
Next, know that you are not the main character in everyone’s story. People are never focusing on you as much as you might think. When you are younger, it feels like all eyes are on you at all times and this couldn’t be further from the truth.
Lastly, I would say that you are stronger than you think and you can, in fact, do very hard things. That does not mean things will always be or feel easy; it means you have the ability and can reflect on times when you have gotten through something you never thought you could, and just knowing that can motivate you when you need it the most.
None of us are able to experience success without support along the way. Is there a particular person for whom you are grateful because of the support he/ she gave you to get where you are today? Can you share that story and why you are grateful for that person?
I am extremely grateful for the support of my sixth-grade English teacher, “Mr. C” as we called him. Sixth grade — the first year of middle school for many — is a transformative year that can be wrought with challenges. But Mr. C did something that was transformative in a positive way for many of my peers and me.
He established a practice where every Friday we took the first 10 minutes of class to write in a journal that we shared with him. We could truly write about anything and Mr. C would write us back. Entries could be mundane or about something that was weighing on us. This journaling/pen pal exercise was so impactful for me. Sitting for this interview, I realized I’m carrying much of what I learned from that process into my work today and my parenting. I was so much more comfortable sharing things by writing them down, and through that unique serve and return, I became more resilient than I otherwise would have.
Even now, I can vividly recall some of my journal entries, including those about the sudden ending of my friendship with my bestie, and when my parents argued. It was a consistent safe space of support. My world felt like it was ending when my best friend abruptly decided she no longer wanted to be friends. How could that be? We sat together at lunch five days a week and were inseparable on the weekends. I couldn’t understand why and felt so alone and sad. Mr. C’s words of wisdom and encouragement helped make sure I didn’t interpret this loss as meaning I was “less than” or worthless. His journal responses helped me learn that there are seasons to friendship and reassured me that I will build other positive relationships. Every week, he consistently and in different ways drove home those messages, and he was right. He also put on the first jazz musical performance for the school and ensured everyone had a role — including me singing and dancing in front of a large audience for the first time. That year could’ve been terrible and put me on a different path, but instead, it brought me out of my comfort zone and made me stronger. And it happened through writing notes back and forth every Friday with Mr. C. It was not long after that that I became known in my friend group as the go-to person to talk to about any and everything that was bothering them. Go figure, I became a psychologist.
When I think about it, much of what Mr. C did is similar to the student mental health services we deliver to schools across the country through EmpowerU. He created psychological safety through written communication, a sturdy consistent support, that many of us, including me, didn’t have anywhere else.
Are you working on any exciting new projects now? How do you think it might help people?
I am very excited about FullBloom’s new partnerships and initiatives aimed at bridging gaps in mental health services. We are currently building out our resiliency and mental health programs for schools, enhancing mental health support for children. One of those programs is our addition of EmpowerU, an innovative, evidence-based mental health solution that combines daily professional coaching and online lessons to expand K-12 educators’ capacity to support students struggling with non-academic barriers to success.
In the education world, we often get the questions of “What are we missing?” and “Why are we where we are with young peoples’ mental health challenges?” I believe one reason for the current mental health crisis in today’s children and teens is due to the lack of a universal system that — early on — helps identify young people when they are at risk. This would allow us to intervene early enough to put them in a position of control. It’s important to allow children to be in the driver’s seat of managing their mental well-being, supporting them in building those tools within themselves. For too long, it was either universal prevention at a more cursory level or clinical intervention in the wake of something bad that has happened. There was really nothing in between. But now we have a solution that meets the needs of children wherever they are across the spectrum.
Ok, thank you. Let’s talk about raising emotionally and mentally healthy children. In the Western world, humans typically have their physical needs met. But what has led to the tremendous downgrade in emotional and mental health that we are seeing today, especially for children? What is lacking in the mental health arena? Why are so many of our children struggling today?
Firstly, one reason we are seeing an increase in student mental health issues is simply because we’re getting better at recognizing them. They likely existed at significant levels before, we just weren’t good at naming them.
That said, factors such as increased academic pressures, societal changes, lack of accessible mental health services, and the impact of technology and social media are certainly impacting our children’s mental health. What is very interesting to me is that while we focus on the physical well-being of our children, we still don’t fully recognize the strong connection between their physical and mental or emotional wellness. This is, in my opinion, a huge failure, as often mental concerns manifest as physical concerns — headaches, fatigue, gastrointestinal issues. We need to do a much better job meeting some of these physical concerns by addressing the potential mental causes.
Additionally, the isolation and trauma from the COVID-19 pandemic continue to affect our children. They grieved the loss of loved ones, and in the midst of that were isolated from their supportive friendships and missed out on fun activities that served as a release. The loss of instruction they experienced also caused anxiety across all ages. Once they came back to school in-person, many were behind where they typically would be, causing a great deal of anxiety and stress, particularly for older students who worried what this all meant for their post-high school path.
Social media is another reason many of our children struggle today. It’s a distraction from school that can contribute to poor academic outcomes. It’s also a distraction from actual physical connectedness and in-person interaction, which we know is important for our mental well-being. Without limits, it can keep kids from enjoying the outdoors and physical activity, which we also know is a direct connection to health and mental well-being. It also promotes the false image of what life is, which can lead young people to feel inadequate, creating challenges and impacting peer dynamics in relationships.
I truly believe what we are lacking is a support system to meet young people where they are in their mental health, and when they need help. Unfortunately, we don’t have enough licensed clinicians to meet these needs at the clinical level and we’re not recognizing it until it’s reached that level. Kids are going too long without getting the support they need, which is causing a great deal of unnecessary harm. Our health care system typically doesn’t cover support for early interventions, making individuals wait until they have a diagnosis to authorize any services. We must redefine the foundational levels of support available to our children. When we’re finally able to offer a system that strengthens universal lessons and is able to identify and proactively intervene, kids will learn the skills needed to speak up when something of emotional concern is going on. Without the proper tools, kids default to showing us something is wrong through their behavior — and that can be really harmful. When your child starts acting out and you are getting calls from their school, your child is trying to tell you something. From a young age, we turn to behavior to get what we want. As babies, we cry because we want to be picked up, or are hungry, or need a nap. As children grow and develop language skills, they can and should start using language to get their needs met. There is a lot of research in the infant and early childhood mental health space, demonstrating the importance of nurturing young children’s language development in ways that include learning to communicate their emotions and, in healthy ways, telling people what their needs are.
How does technology play into the equation of mental and emotional well-being? What about social media?
Let me first say that technology isn’t going away. Excessive screen time, cyberbullying, and social media usage impact children’s self-esteem, relationships, and overall mental health. I think we’re at a place now where we have to teach our children how to responsibly use technology. While social media can be negative, it also provides a place to get support and find others experiencing similar feelings or situations. We have an opportunity to educate kids on how to use these tools for help.
I’m hopeful we can teach young people to be thoughtful about the sites they visit and understand when a page is disreputable. As parents, teachers and caregivers, we must ensure our children know how to recognize when they are consuming information or are part of a dynamic online that is unhealthy for them; we must set rules early on; and we must walk alongside them in order to effectively demonstrate responsibility.
Across the country, we are seeing many districts from New York to Los Angeles banning smartphones in schools. These districts are playing a significant role in shining a light on how technology use creates distractions from learning, causes peer challenges, and leads to social challenges. As an adult, if you’re constantly getting messages or your emails are constantly popping up at work, it’s a distraction from what you’re trying to do. It’s no different for students. Teachers are having to battle it out with them for their attention in class.
This loss of instruction and learning is actively happening every day because of smartphones in our schools. Messages and alerts go off constantly and kids are compelled to look and respond immediately. This becomes a dangerous feedback loop that kids can’t escape. As adults, we have to help them unlearn this behavior.
Obviously, this is a huge issue, and it seems to be growing. What are some small, practical tips, or tweaks, that parents and educators can easily implement to help their children who are struggling?
So how do we help children know when it is or is not the right place and time to engage in social media? How do we teach them to turn it off and step away? To me, it’s similar to how we teach kids that they can’t eat 10 scoops of ice cream — because it will make them sick. We have to teach that dosage is important. We must tell them they can only have a certain amount of social media or tech time because too much becomes unhealthy.
Here are some small, practical tips that parents and educators can easily implement to help children who are struggling:
- Get outside. There’s research that shows kids do better in class and academically when they have built-in physical activity and outdoor time. Technology limits that.
- Learn how to moderate your child’s technology use. Tell them they can have technology time, and exactly how much time. We know that taking everything away is not necessarily good because kids won’t learn how to moderate themselves. I like setting timers or allocating certain times of the day for tech time.
- Monitor what technology they use. Frequently review with your child their smartphones and computers to understand where they are spending most of their time, what apps and games they have downloaded and, if necessary, offer alternatives. For example, encourage the use of apps that can enhance their well-being, like those designed for mindfulness, and games that promote positive behavior and interactions. They are engaging in tech because they want to have fun, so help them reflect on how their choices are impacting their feelings and behavior.
- Talk about it as a family and have your children make their voices known. Having family meetings about topics such as this, so that your kids can voice what they want, is valuable. Let them make their case in an effective way and then you, as caregivers and parents, can respond, talk it out, and be clear on the boundaries you set. Ten minutes might be the max for some kids, but for others, 30 minutes might be right. Get there together.
As a mom myself, I encourage parents to try different things to see what works for their family and their specific kids. It’s not one size fits all. Each family can choose for themselves if allowing tech time in the morning helps or hurts a child’s morning routine or if time after school impacts their homework. It’s important to be clear about what type of tech is useful and set those rules, adjusting as needed.
In your professional opinion, what are certain triggers or signs that the state of a child’s mental and emotional health is not at its best? What is the best way to be proactive and address these signs from the get-go?
Warning signs might manifest through changes in behavior, academic performance, social interactions, or physical health. These signs emphasize the importance of early intervention and support.
Ways to be proactive and address these signs from the outset include watching to see if kids are not acting like themselves. You know your child. If they are early risers and start sleeping in; if their eating habits change; if they are communicating with you differently; or they are not doing activities they like doing, ask yourself why. Sometimes this reflects age and natural changes in physiological development. But more often than not these are all signs something is going on. Simply ask the question, “How is it going?” Just checking in with them regularly and consistently, showing you are always there even if they don’t respond to you at first, is important.
So, look at behavior, continue to show up and ask the questions. Reflect it to them. You can even dig a little deeper with your questions, saying “So, I notice like you like waking up later. Are you going to sleep later every day or only on weekends?” or “I haven’t seen this friend in a while. Is everything OK with them?” They might not tell you right away, and it might be the third, fourth, or fifth time you ask, but that steadiness of showing up, being present, and letting them know that you’re there makes all the difference.
Do you think we can do a better job of educating our children about their emotional and mental health? What would that look like?
Yes, I do think we as a society as a whole can do a better job of educating our children about their emotional and mental health and wellbeing. We discuss nutrition and other habits and strategies to ensure we’re healthy physically, so we should teach strategies to build resiliency too. Parents and educators all need to advocate for integrating resiliency education into school curricula, promoting mental health awareness and destigmatization from a young age.
America’s schools need a universal resiliency and wellness program that equips kids with the language and tools they need to effectively cope, persist, and express when something more serious is going on. Educators need early identification systems to identify those students who might fly under the radar. And there should be a collaborative system that allows parents and teachers to better communicate with each other, ensuring kids are getting the right help at the right time.
Partnership is key. There are so many opportunities in school environments to identify kids who might need support, but the expectation that schools are supposed to — by themselves — meet that need, is unrealistic and not appropriate. Strong partnerships between parents, schools, and specialized partners can help foster that support. That is the answer. We must equip both educators and parents with the tools they need to help reinforce those messages.