COVID-19 themselves. Parents and caregivers of these children were more likely to be essential workers who could not work from home, putting them at higher risk of infection and creating additional barriers for them to provide support for the social and emotional needs of their children.

As described in Chapter 3, the impact of the pandemic on developmental trajectories may vary not only because of the “dose” of the exposure (e.g., death of a parent from COVID-19 or loss of a full academic school year, compounded with disrupted developmental tasks), but also because of individual and family protective characteristics and the capacities of communities and families to buffer children from those experiences. Many low-income and racially and ethnically minoritized families have multiple sources of strength and resiliency that have allowed them to flourish despite their negative experiences. However, overall, the pandemic’s effects have disproportionately fallen on low-income and minoritized children and their families.

Without targeted investments in programs, services, supports, and interventions to counteract the pandemic’s direct and indirect negative effects on child and family well-being, the pandemic’s effects are likely to be long lasting, not only on children and families, but also for society at large. This final chapter summarizes the main conclusions presented in Chapters 3–6 and offers the committee’s recommendations based on these conclusions. Together, the recommendations are a path forward to recover from the harms of the pandemic and to address the inequities that have made the pandemic’s impact disproportionate. The committee recognizes that its recommendations will need to be implemented in a manner that is consistent with local needs and attentive to issues of equity, including building on cultural and community strengths and values. Our recommendations focus on four key areas:

1. addressing the immediate and short-term effects (direct and indirect) of the pandemic on children and their families;
2. mitigating potential shifts in the life-course trajectory of children and families due to the pandemic;
3. collecting and quickly responding to comprehensive, child- and family-focused data to help understand the pandemic’s ongoing effects on children and families; and
4. preparing for the next pandemic (“pandemic proofing”).

Without a focused strategy to invest in policies, programs, services, supports, and interventions to correct the altered life trajectories resulting from the pandemic, society will end up paying the cost of a generation of children who enter adulthood with worse mental health, greater burden of chronic disease, and lower academic attainment than they would have

without having experienced the pandemic. The investments will need to be targeted to children and families from low-income and racially and ethnically minoritized communities, who bore the brunt of the pandemic on top of preexisting societal inequities.

Just as the effects of the pandemic need to be understood with the time, history, and ecological lenses of a life-course perspective, so too should relevant interventions and strategies that are intended to mitigate its effects. This fundamental idea suggests that the most effective interventions are those that focus on relevant developmental tasks, stretch key developmental windows, and are ecologically embedded and relevant to individual and group experiences, extending from the past and into the future. Moreover, investments are needed to ensure that across all child- and family-related sectors (e.g., education, health, social services, and juvenile justice), data are collected and used to better understand how life-course trajectories have shifted because of the pandemic. Such data collection will need to be done in a community-partnered and culturally relevant manner that allows for a comprehensive, accurate, and timely understanding of the pandemic’s myriad effects on these families. These data will allow adaptation and adjustment to child- and family-focused interventions, policies, and programs in real time to meet emerging and evolving needs.

PRIORITIZE CHILDREN AND FAMILIES

National policies and plans have begun to address some of the most critical needs of children and families that have been caused by, exposed by, or exacerbated by the pandemic; however, in many cases, greater focus and investment on children and families are needed.

Recommendation 1: The secretaries of the U.S. Department of Health and Human Services and the U.S. Department of Education, in coordination with the Domestic Policy Council, the Office of Management and Budget, states, Native American tribes, localities, and the nonprofit and private sectors, should establish a task force on addressing the effects of the COVID-19 pandemic on children and their families, with a focus on those who have experienced the greatest negative burdens of the pandemic: Black, Latino, and Native American children and families and those with low incomes.

The rest of the committee’s recommendations will benefit from the creation of such a task force to provide essential leadership, coordination, and accountability. Previous reports (including those from the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association [Box 5-1], the Office

of the Surgeon General, and the COVID Collaborative, all referenced in Chapter 5) have provided recommendations to guide a national response to address the increased burden of mental health symptoms that have affected children and their families prior to and throughout the pandemic: these recommendations have not yet been fully implemented, despite broad consensus in the urgency of addressing the mental health care needs of children. The recommended task force will need to provide the necessary oversight to ensure that these recommendations and other critically important recommendations are implemented to buffer the negative effects of the pandemic on children and families.

The task force would focus on interagency efforts to optimize the implementation of laws, regulations, and policies to address the full range of the pandemic’s effects on child behavioral health; on children who lost a caregiver due to COVID-19; on children and families suffering COVID-19-related and exacerbated economic hardships; on children who suffered deficits in social, emotional, behavioral, educational, mental, and physical health and well-being because of the pandemic; and on the potential long-term health consequences for children infected with COVID-19.

Recommendation 2: All federal and state agencies and departments involved in COVID-19 pandemic relief planning and future public health disasters should address the needs of pregnant people, children, and low-income and racially and ethnically minoritized populations, including children and adolescents in the foster care and juvenile justice systems, in the planning and management of public health disaster relief and recovery efforts.

Children and families will need to be prioritized in pandemic management and preparedness planning. Consideration and prioritization of children and families in the planning and management of public health disaster relief and recovery efforts will need to take place across a number of domains, including testing, development and rollout of vaccines, therapies, and interventions; identifying and addressing the sequelae and consequences of public health efforts aimed at mitigating COVID-19 transmission (e.g., closing schools, physical distancing); and collecting information from multiple sectors that currently keep siloed data (on health care, education, early childhood, juvenile justice, and social services). Linking data on children across these various sectors will be critical to understand the full impact of the pandemic on children’s physical and mental health.

ADDRESS SOCIAL, EMOTIONAL, AND EDUCATIONAL NEEDS

As detailed in Chapters 3 and 4, low-income and racially and minoritized families have experienced the most negative effects of the pandemic

largely because of historical inequities in access to societal opportunities to thrive. Across all measures of school engagement and cognitive skills, students appear to be worse off than they would have been absent the pandemic, and those effects are generally more pronounced for the low-income and racially and ethnically minoritized communities that are the focus of this report. Moreover, it is clear that the COVID-19 pandemic has taken a substantial toll on the social, emotional, behavioral, mental, physical, educational, and economic health and well-being of children and adults in those communities.

To address these losses, adequate time, attention, and resources are needed to help children process their pandemic experience; cope with uncertainty and change; rebuild social, cultural, and community connections; and readjust to group learning environments. Supporting students’ social and emotional needs will not only make it easier to address academic fallout in the long run, but also provide them with the internal resources and external support to cope with what is likely to be an indefinite period of uncertainty and change.

A number of prepandemic intervention strategies and approaches have been shown to effectively address some of the key mechanisms that link exposure to pandemic-related disruption, stress, worry, grief, and bereavement to developmental outcomes. Effective interventions focus on (1) building and maintaining supportive relationships and connections; (2) providing children with opportunities to learn and practice foundational social and emotional skills; (3) fostering connections to adults and experiences that offer opportunities for ongoing screening and observation to identify children who are struggling and connect them to more intensive support; and (4) building sources of resilience in communities that can be modified and expanded to help children and families recover.

Without targeted interventions, the pandemic-caused engagement and achievement losses among students will have lasting economic damage, with effects that persist throughout their adult years. Current federal pandemic-era funding focused on education has been critical for recovery, but it will not be sufficient to bring students and schools in high-poverty districts to a level that achieves equitable opportunity—which will be critical in preparing for the next pandemic.

including the U.S. Department of Health and Human Services, as well as with state and local authorities and educational agencies. These investments should meet the needs of children facing the most barriers, such as children requiring special services.

• Enrollment and reengagement: Continue and expand support for a variety of locally tailored strategies for enrolling and reengaging children at all levels of education, including early childhood, K–12, and college, as well as students who have special needs, with the goal of returning enrollment and attendance rates to prepandemic levels, if not higher.
• Academic recovery and achievement: Allow investments in a flexible portfolio of evidence-based interventions to address the education gaps created during the pandemic, with the goals of compensating for missed learning and for returning students’ academic achievement to prepandemic grade-level expectations or better, with a particular focus on closing socioeconomic achievement gaps that widened during the pandemic.
• Positive social and emotional development: Support and expand on currently used and evidence-based and promising programs and interventions that focus on the promotion of social and emotional development in children from early childhood through high school. School districts and early childhood centers will need funding to adequately address pandemic-related deficits in social and emotional development in early childhood and K–12 settings, and to provide ongoing support for optimal social and emotional development.
• Education workforce: Attract, train, support, and retain an expanded educator workforce at the early childhood and K–12 levels with the goal of both strengthening the severely contracted early childhood sector and supporting the K–12 staffing needed to reengage students and restore missed learning.
• Pandemic proofing: Invest in and pursue a variety of measures to prepare schools for future pandemics with the goal of reducing future schooling disruptions, specifically those that decrease the likelihood of disease spread in schools, increase the safety of in-person schooling (and communicating such risk-reduction measures to parents and teachers), and reduce the use of remote schooling.

Most critically, additional funding is needed to support high-poverty schools. Because the vast majority of schools serving children from low-income families are and have been underfunded relative to schools with

children from higher-income families, the initial three rounds of federal funding that schools received during the pandemic have not been sufficient to both remedy the damage described in this report and address the preexisting inequities in schools. With additional resources, schools will be better able to overcome prepandemic gaps in funding, as well as the compounded needs for educational supports that arose because of the pandemic, potentially reducing the wide funding gap in public school systems.

This funding needs to be sufficient to address enrollment and reengagement, academic recovery and achievement, recovery and optimization of positive social and emotional development, workforce support and expansion, and preparation for the next pandemic.

Enrollment and Reengagement

Efforts in enrollment and reengagement in early childhood and K–12 education will require reliable data on children who are eligible, but not currently enrolled (e.g., in formal early childhood education settings), those who are currently enrolled but may be at risk for dropout (e.g., early warning and on-track systems to identify high school students with worrisome attendance patterns), and those who have already disengaged from traditional education (e.g., adolescents who did not complete high school). As described in Chapter 4, efforts to reengage students require a relational approach, with some success seen in programs that use navigators, for example, to reestablish these connections. While evidence for interventions to reach these types of students is sparce, options to consider can include the following:

• For early childhood education, provide outreach to families of children eligible for but not enrolled in formal early childhood education (such as Head Start or pre-K), to address reasons for nonenrollment, and potentially enroll them in high-quality early child care settings.
• For K–12 schools, provide outreach to families of students who disenrolled during the pandemic to address their needs; develop strategies for reengaging K–12 students who are enrolled but have poor attendance or performance; and provide support for either reenrollment or connection to credit recovery options for students who did not complete high school during the pandemic.
• For post–high school: offer and provide college application support to college-ready students who graduated high school during the pandemic but did not enroll in college.

This level of outreach to potential and former students will require a significant level of staff time that is not currently available to schools.

Additionally, early childhood settings and K–12 schools can leverage community-based partnerships with health care providers, both to identify children and parents in need of behavioral health intervention and support (through universal screening) and to connect those children and families to community-based services. This approach would require an infrastructure for screening and identification, as well as data collection to connect children and families across early education, school, and primary care and behavioral health care systems. It would also require a community- and school-based workforce to provide direct behavioral interventions to children and families, reducing the strain on the limited resources for behavioral health in the nation’s health care systems. This type of integration across systems for behavioral health services requires significant changes in Medicaid (see Recommendations 4 and 5, below).

Interventions designed to work by addressing some of the key mechanisms that link exposure to pandemic-related disruption, stress, worry, grief, and bereavement to developmental outcomes will be critical to address pandemic-related deficits in social and emotional health and development. In general, such interventions focus on building and maintaining supportive relationships and connections, which in many cases means working with adults (parents, caregivers, educators) to effectively manage their own stress and address their own mental health. In addition, some interventions are designed to provide children with opportunities to learn and practice foundational social and emotional skills and perspectives that enable them to manage and respond to ongoing experiences of uncertainty and disruption. Across the interventions, a central feature is connection to adults and experiences that offer opportunities for ongoing screening and observation to identify children who are struggling and to connect them to more intensive supports.

Education Workforce

Efforts to reengage students in school and to increase instructional time will require hiring more educators and staff, as well as potentially expanding the hours of current but underutilized educators and staff. Schools will need more counselors, in-school tutors, and afterschool staff. Funding will be needed to target the hiring, training, and supporting of educators focused on reengaging students and addressing missed learning opportunities, as well as those in areas with preexisting shortages, such as teachers for special education and English-language learners. Recruitment efforts could also consider a volunteer workforce, including parents and nonparents, with appropriate training and support.

Similarly, given the pandemic’s effects on workers in early care and early education programs and previous inequities in compensation, early

childhood educator pay will likely need to be increased to attract sufficient numbers of qualified workers.

Early childhood education and K–12 workers have also faced, both as individuals and perhaps as parents themselves, the negative effects of the pandemic, and in many cases, these educators are the same population of families—Black, Latino, and Native American and low-income—that is the focus of this report. The workforce can be strengthened further by investing in support for educators, particularly as the burden of students’ social, emotional, and behavioral health problems competes with academic learning.

Pandemic Proofing

To reduce future schooling disruptions, investment in infrastructure to decrease the likelihood of disease spread in schools is critical. To this end, substantial continuing investments will need to be made in the upgrading of school ventilation systems, which can reduce spread of airborne diseases. Funding needs to be targeted at schools with the oldest and least functional ventilation systems. The federal government and state governments can also set aside funds for the purchase of disease detection and mitigation supplies for possible future needs. When needed, school districts can be rapidly provided with such supplies (such as high-quality masks, tests, and other needed future pandemic supplies) sufficient for effective monitoring and mitigation.

ADDRESS PHYSICAL AND MENTAL HEALTH NEEDS

The COVID-19 pandemic has had a significant negative impact on the physical and mental health of many children and families and has been disproportionately negative for children and families who are Black, Latino, and Native American and who live in households with low incomes; these populations were also more likely to have unmet physical and mental health needs prior to the pandemic. The experiences faced by children during the COVID-19 pandemic will lead to long-term behavioral, mental, and physical health problems that will need to be addressed well into the future.

There have been important federal policies enacted to help address the physical and mental health and well-being of children who have been and may continue to be most directly affected by the COVID-19 pandemic, but there is still much to do. These children have suffered traumatic stress from serious illness, hospitalization, or the loss of a family member or loved one. Without a focused strategy to correct the potential negatively altered life courses that the pandemic has shifted for so many children, they may enter adulthood with worse mental health and a greater burden of chronic

disease, leading to greater negative consequences for this generation as they age.

Federal efforts to halt disenrollment from Medicaid during the public health emergency were critical for access to health care for low-income families throughout the pandemic, but this provision will end on March 31, 2023. Medicaid will be an important part of ensuring that children in low-income families have coverage to address the increased physical and mental health burden that they have faced: the recently announced federal requirement for states to provide a 12-month continuous eligibility period for all children (effective January 2024) represents critical progress.

In addition to these actions by the U.S. Department of Health and Human Services, it will be critical for federal policy makers to pursue coverage solutions for parents with incomes below the poverty level and

who live in states that have not adopted Medicaid expansion and thus are caught in the “coverage gap.” These solutions will need the partnership of Congress for new legislation to cover these individuals, or from states, to adopt expansion.

ADDRESS ECONOMIC NEEDS

As detailed throughout this report, the negative socioeconomic consequences of the pandemic were widespread, but they fell particularly on children and families in households with low incomes and those from racially and ethnically minoritized groups.

Without the continuation of important federal pandemic-era provisions, and with the rising costs of essential goods, families in poverty will face a slow, difficult, and likely incomplete economic recovery. Additionally, because of widespread state-level variation in the type, amount, and duration of means-tested and social insurance provisions, the poorest families—who disproportionately live in states with the most constrained safety nets, particularly in the South and Southwest—may have severely restricted access to such provisions.

In order to address these needs, efforts are needed to incentivize safety net parity across states, ensure access to paid family and sick leave programs, and prioritize cash transfers to families.

• effects of the pandemic on other illnesses, including infectious diseases and chronic illness; and
• mental and behavioral health trajectories, risk factors for poor outcomes, and protective factors for positive outcomes for mental health in children and their families.

Longitudinal studies on some of these topics have begun, while others require federal funding and support. Currently funded childhood longitudinal studies can provide critical evidence of the long-term effects of the pandemic on child health and well-being outcomes throughout development, but these studies are limited in that they do not extend from infancy through early adulthood. Extension of current longitudinal studies that enrolled pregnant people or young infants, or a large national study that spans infancy through early adulthood, is needed to fully understand the pandemic’s long-term effects on the social, emotional, behavioral, educational, physical, mental, and economic health and well-being of children and their families.

In addition to funding rigorous research on the pandemic’s effects, funding infrastructure for systems and data purposes across states to enable researchers to specifically study myriad effects of the pandemic on family socioeconomic well-being in the near, mid-, and long terms needs to be a priority. It will be important for those investments to include:

• expand existing nationally representative survey data—such as the Survey of Income and Public Program Participation, the Current Population Survey, and the Panel Study of Income Dynamics—to include pandemic-related questions for families, adults, youth, and children;
• prioritize rigorous research to identify whether the type of pandemic-era economic programs can enhance marginalized families’ socioeconomic mobility, as well as health and well-being, in the aftermath of COVID-19; and
• continue to fund research and experimentation methods on the effects of reducing administrative burdens in safety net and social insurance programs.

The Office of Management and Budget (OMB) recently began an initiative on administrative burden reductions in public programs, and OMB is recommending this work continue and be further bolstered with increased funding and rigorous research and methodologies, including assessing the heterogeneous effects of reduced administrative burdens among diverse populations and states.

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