Addressing the Long-Term Effects of the COVID-19 Pandemic on Children and Families (2023) / Chapter Skim
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of the National Academies of Sciences, Engineering, and Medicine (the National Academies) convened an ad hoc committee with wide-ranging expertise across child mental and physical health, health disparities, economics, education, learning and development, and public policy to examine the long-term impact of the COVID-19 pandemic on the well-being of children and families, with a particular focus on addressing the challenges and obstacles 1The reason that these communities have borne a disproportionate share of the pandemic's impact is rooted in structural racism, which has created long-standing and pervasive inequities in the systems and structures that are foundational to physical, mental, social, and emotional health and educational and economic well-being.
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The committee refers to these groups as low-income individuals and those who have been racially and ethnically minoritized. SOCIETAL CONTEXT OF THE COVID-19 PANDEMIC Disasters or large-scale public health events like the COVID-19 pandemic can reveal preexisting vulnerabilities that are due to long-standing societal inequities: that is, the societal shock of the COVID-19 pandemic did not occur in a vacuum or a neutral environment.
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That is, the full characterization of the effects of the pandemic on children and adolescents had three fundamental characteristics: it is developmental, that is, shaped by individual and societal experiences prior to the pandemic as well as the salient developmental windows and tasks at play at its onset and throughout; it is ecological, that is, situated in a sociodemographic, familial, community, societal, historical, and cultural context; and it is variable in its effects and consequences for racially and ethnically minoritized families and communities. 3For more information, see National Academies of Sciences, Engineering, and Medicine.
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The most significant interruption was the closure of schools, which resulted in children's increased anxiety, reduced social interactions and peer relationships, lost learning opportunities in a school environment, and a widening of achievement gaps. The evidence shows: • declines in early childhood program enrollments -- the programs experiencing the highest enrollment losses were those serving ra cially and ethnically minoritized families, low-income families, and families that did not speak English at home; • for kindergarten, 9 percent fewer students enrolling in 2019–2020 than in the year before the pandemic, with larger declines in fully remote school districts, which disproportionately enrolled low income students; • for grades 1–8, average decline of a 3 percent in enrollment; • overall, declines in enrollment in public K–12 schools in the first school year after the pandemic began, with 1.3 million fewer stu dents than in the previous school year; • increases in chronic absenteeism, with 72 percent of public schools nationwide reporting higher chronic absenteeism rates than pre pandemic; and
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Economic Effects In the early months of the COVID-19 pandemic families were hit with economic hardship, including job loss and food insecurity. This economic hardship disproportionately affected low-income and racially and ethnically minoritized families who were economically vulnerable prior to the pandemic.
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Recognizing a serious gap in the nation's emergency preparedness for children and families, the Health Resources and Services Administration established and funded the Regional Pediatric Pandemic Network to help children's hospitals and their communities be ready to care for children during future disasters and public health emergencies. In response to the immediate and ongoing consequences of the COVID-19 pandemic, the federal government provided time-limited provisions through a series of laws to mitigate deleterious health and economic effects of the pandemic on households and individuals.
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• Under the American Rescue Plan, the Child Tax Credit (CTC) was expanded and shifted to monthly payment, resulting in a reduction of food insecurity in low-income households and reductions in household poverty.
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A number of prepandemic evidence-based social, emotional, and behavioral interventions, 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, including early childhood interventions, social and emotional learning interventions, school-based mental health supports for youth, and community-based parenting and family preventive interventions. Given the negative educational outcomes from the pandemic, it is important to consider potential interventions to mitigate the damage.
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• 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 ex pand on currently used and evidence-based and promising pro grams and interventions that focus on the promotion of social and emotional development in children from early childhood through high school.
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Those effects have been disproportionately borne by children who are Black, Latino, and Native American; who live in households with low incomes; and who had unmet physical and mental health problems prior to the pandemic. To address both the short- and long-term effects of the pandemic on these children, mitigate potential shifts in their life-course trajectories, and prepare for the next pandemic, efforts are needed to bolster the health care system so that all children have access to high-quality, continuous, comprehensive, and accessible physical and mental health services.
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To implement this recommendation, the department can establish and enforce standards of care for the state programs for Medicaid and the Children's Health Insurance Program that include national stan dards for equitable payment rates, presumptive eligibility, continuous eligibility periods, and network adequacy. Specifically, the department should implement four changes: • Increase Medicaid payment rates to be in line with Medicare rates for the same services.
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In order to address these needs, efforts are necessary to incentivize safety net parity across states, ensure access to paid family and sick leave programs, and prioritize cash transfers to families to mitigate the economic effects of the pandemic. Safety Net Programs Recommendation 6: The federal government should incentivize states to expand key safety net programs, including Temporary Assistance for Needy Families, and child care subsidies.
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Given the evidence on the positive effects of such paid leave provisions, implementing such programs or incentivizing states to implement their own programs can provide much-needed support to all workers, particularly marginalized workers who are disproportionately less likely to have similar employer-provided benefits. Recommendation 7: The federal government should support federal paid family leave and paid sick leave programs, building on similar pandemic-era and existing state-level programs.
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Currently funded childhood longitudinal studies can provide critical evidence of the long-term effects of the pandemic on child health and wellness outcomes throughout development, but these studies 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 long-term impact of the pandemic on children.
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By investing in children and families today, the nation can avoid higher overall costs to society at large, as a generation of children, despite living through the COVID-19 pandemic, grows to adulthood with health and well-being that is optimized to allow them to reach their full life potential. These investments will need to be targeted to children and families from racially and ethnically minoritized and low-income communities who bore the brunt of the pandemic on top of preexisting societal inequities.
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