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Pages 116-171

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From page 116...
... . Among the portfolio of interventions available to schools, strong evidence suggests that tutoring has positive effects on school attendance, academic achievement, and social and emotional outcomes.
From page 117...
... Research suggests that learning gains from summer learning programs are greater when programs last at least 5 hours per week and 5 weeks during the summer and when the programs are offered over multiple summers. This is particularly the case for programs serving low-income and racially and ethnically minoritized students, who are more likely than others to have experienced multiple stressors and sources of disruption during the pandemic.
From page 118...
... Several barriers hamper students' continuous attendance, including lack of transportation, need to provide child care for younger siblings, need for income from summer jobs, and the sense that programs are just "more school." For example, a randomized evaluation of a voluntary full-day 2-year summer learning program in five urban school districts found that each summer approximately 20 percent of students signed up but did not attend a single day the first summer, as many as 48 percent did not attend a single day the second summer, and a large number attended only sporadically (McCombs et al., 2020)
From page 119...
... This objective is as important as the specific content of a program. Scaling challenges are exacerbated by the staffing shortages across public schools resulting from the pandemic, which is particularly severe in some regions of the country (IES, 2022b)
From page 120...
... Several initiatives already in place provide useful blueprints.8 Reengaging Students and Families and Restoring Enrollment As detailed above, public school enrollments dropped nationwide during the pandemic, with the sharpest declines in the earliest grades. There are a variety of potential reasons for the decline, including family decisions to home-school, students needing to work because of family financial circumstances, and students being homeless.
From page 121...
... By extension, expanding metrics gives school officials more information for designing appropriate interventions. To the extent that returning to school includes hybrid approaches, monitoring attendance in remote settings will also assist with effective student engagement.
From page 122...
... . One approach to establishing personal connections between students and adults is reflected in Nashville's Navigator Initiative, in which teachers and other school staff meet regularly with students to get to know them better and to learn what kind of support they need (Jacobson, 2020; Metro Nashville Public Schools, 2021)
From page 123...
... Programs such as Teach for America have demonstrated a track record of attracting noneducation majors to consider teaching by emphasizing the intrinsic reward of teaching and demonstrating the opportunities to promote equity and social justice. Other strategies focus on the practical barriers to entering teaching, by offering, for example, student loan forgiveness for time on the job, rent or mortgage assistance for high-cost markets, supports for credentialing and advanced degrees, and the articulation of clear and compelling pathways for advancement and professional growth (Podolsky et al., 2016)
From page 124...
... . Develop a More Robust Pipeline of Future Educators Expanding the pipeline of future educators and school staff is a critical component of strengthening the workforce.
From page 125...
... States, constitutionally responsible for education, will need to pay special attention to equity implications, since it is widely documented that the impact of teacher shortages and staff turnover disproportionately affects low-income communities. Pandemic Proofing Schools Underlying many of the challenges schools have faced during the pandemic is the fear that many students, families, and educators have about contracting COVID-19 in school buildings.
From page 126...
... One estimate suggests that school districts would need an annual infusion of $85 billion more than they currently spend in order to fully upgrade school buildings (21st Century School Fund, 2021)
From page 127...
... . Setting aside funding for such mitigation measures that could be quickly activated in the face of future disease surges would increase both the actual and perceived safety of school buildings.
From page 128...
... . Graduation rates dip across U.S.
From page 129...
... Morbidity and Mortality Weekly Report, 69(49)
From page 130...
... . School districts frequently identified mul tiple building systems needing updates or replacement.
From page 131...
... . Nation's Public School Enrollment Dropped 3 Percent in 2020-21.
From page 132...
... . A blueprint for scaling tutoring and mentoring across public schools. AERA Open, 7. https://doi.org/10.1177/23328584211042858 Kuhfeld, M., & Lewis, K
From page 133...
... Near-term effects of voluntary summer learning programs on low-income students' learning opportunities and outcomes. RAND Corporation.
From page 134...
... . Estimated resource costs for implementation of CDC's recommended COVID-19 mitigation strategies in pre-kindergarten through grade 12 public schools -- United States, 2020-21. Morbidity and Mortality Weekly Re port, 69, 1917–1921.
From page 135...
... D.C. school enrollment expected to drop after years of increases.
From page 137...
... Evidence on the effectiveness of interventions to buffer those effects is coming to light as the pandemic evolves, largely based on prepandemic supports for children and families who are at higher risk of poor health due to structural racism, poverty, and limited opportunities. Children and families in racially and ethnically minoritized groups and those in underserved and marginalized communities have been disproportionately affected by COVID-19 because of the direct and indirect effects of the infection and the public health preventive measures, which reflect gaps in societal safety nets for these children and families (Cheng et al., 2020)
From page 138...
... These data indicate that children aged 0–17 have a higher burden of infection (74.6%) , than any other age group, including those aged 18–49 (63.7%)
From page 139...
... . Over three-quarters of COVID-19-related hospitalizations of children aged 0–17 were among children younger than 4 or older than 12 (Siegel et al., 2021; Wiltz et al., 2022)
From page 140...
... It is thought to be a hyperinflammatory condition associated with antecedent SARS-CoV-2 infection, which is presenting as a postinfectious immunologic disorder. The pathophysiology and longterm outcomes are not well understood, but vaccination with two doses of mRNA1 vaccine is highly effective in preventing MIS-C in children aged 12–18 (Zambrano et al., 2022)
From page 141...
... diagnosis up to 30 days after infection in comparison with children without COVID-19 and children with prepandemic acute respiratory infections. Non-SARS-CoV-2 acute respiratory infection was not associated with an increased risk for diabetes.
From page 142...
... A large, longitudinal cohort of children aged 2–19 found sharp increases in body mass index (BMI) throughout the pandemic, with younger school-aged children and overweight or obese children experiencing the largest increases.
From page 143...
... The direct impact of COVID-19 infection during pregnancy is well documented: pregnant women infected with COVID-19 have a higher risk of preeclampsia, intensive care unit hospitalization, and death than both noninfected pregnant women and nonpregnant women of reproductive age (Allotey et al., 2020; Joseph et al., 2021; Joseph et al., 2021; MyClymont et al., 2022)
From page 144...
... . A study of preterm births trends in California showed marked disparities by maternal education: the early-pandemic improvement in preterm birth mostly was seen in highly educated mothers; increases in preterm birth during the rise in infections in the winter of 2021 primarily affected persons with low education (Torche and Nobles, 2022)
From page 145...
... Vaccination was authorized for adolescents aged 12–15 in May 2021 and for children aged 5–11 in October 2021. There was no vaccine authorized for children aged 6 months to 5 years until June 2022, more than 2 years after the outbreak of the pandemic.
From page 146...
... of those aged 12–17 had completed the two-dose series. The variation by state is wide: for those receiving at least one dose, the rates ranged from 2 to 40 percent for children aged six months to four years, from 17 to 78 percent of those aged 5–11, and from 40 to 100 percent of those aged 12–17.
From page 147...
... 2021 COVID-19 vaccine April 27 CDC updates the ACIP recommendations for the use of Janssen (Johnson 2021 & Johnson) COVID-19 vaccine because of reports of thrombosis with thrombocytopenia syndrome among recipients May 10 FDA expands EUA of Pfizer-BioNTech COVID-19 vaccine for adolescents 2021 aged 12–15 May 14 CDC publishes ACIP interim recommendations for the use of Pfizer2021 BioNTech COVID-19 vaccine for adolescents aged 12–15 June 25 FDA revises EUA Pfizer and Moderna patient and provider fact sheets 2021 regarding concern for increased risks of myocarditis and pericarditis associated with their vaccines July 6 CDC updates the ACIP recommendations after reports of myocarditis 2021 Aug 23 FDA approves Pfizer-BioNTech vaccine for youths and adults 16 and older 2021 (the EUA remains in effect for those 12 years of age and older and for the third dose for immunocompromised individuals 12 years of age and older)
From page 148...
... Among all children aged 5–17, survey data indicate that vaccine coverage with at least one dose was 73.4 percent among Asian children, 49.0 percent among Latino children, 45.0 percent among White children, and 44.7 percent among Black children (Valier et al., 2022)
From page 149...
... . Vaccination During Pregnancy: Effectiveness and Uptake Since September 2021, CDC, as well as other national medical and health organizations, has recommended that pregnant women receive COVID-19 vaccination to prevent maternal and infant morbidity and mortality (CDC, 2022d)
From page 150...
... . Evidence shows that COVID-19 vaccines are highly effective during pregnancy, inducing an immune response comparable to that in nonpregnant women (Gray et al., 2021)
From page 151...
... These factors all worsened or were increasingly visible during the COVID-19 pandemic. This increased need for behavioral health among low-income and racially and ethnically minoritized children cannot be met with the current workforce shortage of child behavioral health providers (American Association of Child and Adolescent Psychiatry, 2018; Health Resources and Services Administration, 2022)
From page 152...
... . Prior to the release of the 2021 Surgeon General's advisory, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association recognized the pandemic's impact on the existing mental health crisis and its outsized impact on communities of color; they declared a national state of emergency in children's mental health and offered recommendations for addressing the crisis (see Box 5-1)
From page 153...
... • Fully fund comprehensive, community-based systems of care that connect families in need of behavioral health services and supports for their child with evidence-based interventions in their home, community or school. • Promote and pay for trauma-informed care services that support relational health and family resilience.
From page 154...
... Data for 2016–2019 from the National Survey of Children's Health show a prepandemic increase in the prevalence of parent-reported diagnoses of anxiety for children aged 3–17 from 7.1 percent in 2016 to 9.0 percent in 2019, and of depression from 3.1 percent in 2016 to 3.9 percent in 2019 (Lebrun-Harris et al., 2022)
From page 155...
... A systematic review estimated a pooled prevalence of 25.2 percent for depressive symptoms and 20.5 percent for anxiety symptoms among children (Cheah et al., 2020; McGuine et al., 2020; Glynn et al., 2021; Luthar et al., 2021; Murata et al., 2021; Racine et al., 2021)
From page 156...
... Data on suicide risk screening among those patients seen in primary care settings may give a less biased sample than those seen in emergency departments. Two different studies examining suicidality on suicide risk screenings among primary care patients found a modest but significant increase in the rate of suicidality (from 6.1% to 7.1% and from 11.1% to 12.2%, respectively)
From page 157...
... . Children and adolescents who have required hospitalization and intensive care from COVID-19 infection are at heightened risk of developing the full spectrum of PTSD symptoms, which has previously been shown to occur in children treated for injuries and severe physical illness (Saxe et al., 2003)
From page 158...
... Bereavement and Prolonged Grief Disorder As discussed above and in Chapter 1, the COVID-19 pandemic has led to loss of a parent or caregiver for over 265,000 children, and racially and ethnically minoritized children were disproportionately impacted by this loss and related grief. For most, the grief reactions, while profound, diminish in strength and frequency gradually over time.  There is a subset of children, however, with grief reactions that remain severe, extended, and accompanied by significant impairment in several domains of daily life.
From page 159...
... ; this includes a tiered public health approach described at the end of this chapter.6 Sleep Disturbance Sleep disturbances are ubiquitous in situations of ongoing danger. Danger- and trauma-related sleep disturbances are among the most insidious of PTSD symptoms for children and adolescents.
From page 160...
... , social media use has been associated with adverse mental health consequences and impaired sleep quality among children; sleep disturbances can further contribute to negative mental health outcomes (Alonzo et al., 2021; Marciano et al., 2022)
From page 161...
... At the same time, however, CDC reported a 53 percent decrease in emergency department visits related to child abuse, though this decrease was in the context of a 72 percent overall decrease in pediatric emergency department visits (Swedo et al., 2020)
From page 162...
... . Another study found that the sharp rise in unemployment during the pandemic was associated with increases in firearm violence and homicide (Schleimer et al., 2022)
From page 163...
... . It is important to note that intimate partner violence and child abuse often co-occur given the increased risk for maltreatment when children are isolated at home (Humphreys et al., 2020)
From page 164...
... . Unemployment benefits and income supports during the pandemic have also been critical to addressing food insecurity: studies have demonstrated that pandemic-related expanded child tax credits were associated with a decrease in food insecurity (Shaffer et al., 2022)
From page 165...
... . Missed and delayed visits were more prevalent among families who also reported financial hardships: rates of missed or delayed visits were 37.6 percent among families with food insecurity, compared with 25 percent for families not reporting food insecurity (Lebrun-Harris et al., 2021)
From page 166...
... . Caregivers' reports of emotional distress, depressive symptoms, anxiety, and stress increased after the pandemic began and were higher for those in households with children who have special health care needs (Liu et al., 2021)
From page 167...
... . Racially and ethnically minoritized children were disproportionately covered by Medicaid, with 61 percent of Black children, 55 percent of Latino children, and 59 percent of Native American and Alaska Native children covered by Medicaid/CHIP in 2021 (Artiga et al., 2021)
From page 168...
... These factors result in "churn" -- as Medicaid beneficiaries lose coverage and then reenroll within a short period of time, creating consequential gaps in coverage. Studies have shown that churn in Medicaid is associated with higher health care costs, delayed care, less preventive health care, more emergency department visits, unfilled prescriptions, and less access to health care (Brantley & Ku, 2022)
From page 169...
... . The Consolidated Appropriation Act also amended the American Rescue Plan Act of 2021 by giving states the option to permanently extend postpartum coverage for women for 12 months for comprehensive benefits and continuous eligibility (KFF, 2023b; Park et al., 2023)
From page 170...
... , 39 states and Washington, DC, had adopted Medicaid expansion as of November 2022, which expanded coverage to adults aged 18–64 with incomes up to 138 percent of the federal poverty level and provided states with enhanced federal matching rates for this new population (KFF, 2022a)
From page 171...
... Under the ACA, individuals and families in expansion states with incomes of 100–400 percent of the federal poverty level can purchase coverage in the ACA marketplace; in nonexpansion states, they can do so with incomes of 138–400 percent of the federal poverty level. The American Rescue Plan temporarily increased the value of premium tax credits for those already eligible for subsidies on the ACA marketplace and expanded eligibility for subsidies to adults and families who were previously not eligible because their incomes were higher than 400 percent of federal poverty level (Sommers & Haffajee, 2021)


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