Addressing the Long-Term Effects of the COVID-19 Pandemic on Children and Families (2023) / Chapter Skim
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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 that the pandemic introduced for children and families in marginalized communities. This report documents the committee's findings, conclusions, and recommendations with respect to three broad questions included in its statement of task: 1.
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In addition, the pandemic intersected with and likely helped trigger other major social events and broader unrest, including the widespread protests for racial justice in 2020; a rise in opioid addictions and deaths; and increasing polarization, politicization, and misinformation in public discourse. Over the course of the COVID-19 pandemic, Black, Latino, and Native American people have experienced a disproportionate burden of cases, hospitalizations, and deaths in comparison with their White counterparts.
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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 racially 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 students than in the previous school year; • increases in chronic absenteeism, with 72 percent of public schools nationwide reporting higher chronic absenteeism rates than prepandemic; and Prepublication copy, uncorrected proofs 3
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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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Pediatric clinicians and health care organizations quickly implemented telemedicine, even in the face of big utilization swings, higher-acuity patients, an increase in patients with behavioral and mental health crises, and later, a surge of serious respiratory illness among children that overwhelmed pediatric inpatient units and emergency departments. 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.
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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, and 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. Address Social, Emotional, and Educational Needs To address the individual and collective adversity caused by the pandemic, 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.
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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 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.
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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 standards 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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HHS should lead and coordinate efforts to: advance and implement polices that ensure mental health parity to physical health for preventive and treatment-related behavioral health services provided in clinical settings, communities, and schools; expand Medicaid payment to be inclusive of nonmedical professionals for preventive and community-based behavioral services; and strengthen the child behavioral health workforce by increasing implementation of training programs in evidence-based mental and behavioral care, expanding opportunities for racially and ethnically minoritized individuals to enter a pathway for child behavioral health workforce participation; and expanding loan repayment programs for child behavioral health care professions. Address Economic Needs In the early months of the COVID-19 pandemic, low-income families who were economically vulnerable prior to the pandemic were particularly hit with economic hardship.
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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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Recommendation 9: Public and private agencies, at the federal, state, and local levels, should eliminate existing barriers to and support mechanisms for child- and family-serving systems to collaborate on the systematic linking of data on children and families, across health, education, social services, juvenile justice, child welfare systems with other federal and state administrative data, to optimize and promote advancement in services, policy, programs, and research to address the negative effects of the pandemic on child and family well-being. Recommendation 10: Relevant federal government departments and agencies should prioritize and fund rigorous research, and the infrastructure to support it, on the effects of the pandemic on children and families.
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