Overview:

From the beginning, children have been sidelined in the discussion of COVID-19. The rumor that children do not get COVID — propagated by people as powerful as the president of the United States, magnate Elon Musk, and numerous others — hijacked the conversation early and held onto it. That initial falsehood provided fertile ground for what came next: Complete and total disregard for the pandemic’s devastating effect on the physical, emotional, economic and social well-being of the world’s children.

And the pandemic isn’t over. Yes, mask mandates are ending and most children have returned to school. But more than 18 million children — our country’s youngest — remain without access to vaccination. A mental health crisis is sweeping through our children and adolescents. Roughly 4 million children have been plunged back into poverty since 2022 began. More than 7 million children worldwide have lost a caregiver to COVID, including more than 247,000 in the United States. The racial and economic inequities among children that existed before the pandemic have been magnified by its challenges. And we have only just begun to consider COVID’s long-term effect on children’s health. 

First Focus on Children assembled medical staff, social scientists, advocates, state-level experts and members of Congress to do what others weren’t: Talk about kids and COVID. Our Kids and COVID Conversation Series asked these panels to discuss the pandemic’s outsized impact on every aspect of the lives of children, both in the United States and abroad, and to offer solutions.

Among their recommendations:

  1. Develop the mental health workforce aimed at babies, toddlers, children, and adolescents, and deploy these professionals to schools, child care centers, and other facilities frequented by children
  2. Strengthen the role of schools in mental health promotion, prevention, and intervention
  3. Implement a more inclusive definition of homelessness, and reform homeless assistance to reflect the way families and youth actually experience it
  4. Make detention a “step of last resort” in the youth justice system
  5. Deploy technology such as tablets and virtual meeting platforms to facilitate family interaction, education, visits with social workers, and, when appropriate, court proceedings in the child welfare system
  6. Eliminate all restrictions that prevent mixed-status families and their children from accessing economic, health care, nutrition, and other benefits through legislation such as the Lift the Bar Act
  7. Encourage far more robust COVID data collection and testing among children
  8. Employ a holistic approach to kids and COVID that considers the physical, emotional educational, systemic, and other issues and environments that affect children
  9. Make permanent pandemic-era improvements to the Child Tax Credit and the Earned Income Tax Credit
  10. Address the structural barriers to the economic security of children and the families that care for them by investing in child care and other social infrastructure
  11. Prioritize children in the global pandemic recovery by mounting a comprehensive, multi-sector response to COVID similar to the one used to fight AIDS
  12. Fix the severed school lifeline by offering universal access to school meals, cultivating a school-based health care workforce, and creating more community school coordinators

Find breakdowns of these and other recommendations by topic in the chapters that follow.

MENTAL HEALTH

Children’s mental health must have more providers, wider reach

Our country’s children are in the throes of a full-blown mental health crisis.

“Teens are talking and we need you to listen,” 17-year-old mental health advocate Trace Terrell said during First Focus on Children’s inaugural Kids and Covid Conversation.

Terrell, an intervention and outreach specialist for the peer-to-peer crisis hotline YouthLine, called on Congress to create a national peer-to-peer teen crisis line during First Focus on Children’s Kids and Covid Conversation on mental health, which examined — and proposed solutions for — the mental health crisis afflicting the country’s children and young people.

Even before the pandemic, the mental health crisis among youth was severe, with 1-in-5 children under the age of 18 experiencing a mental health issue, and the suicide rate among youth aged 10-to-24 increasing nearly 60% between 2007 and 2018. In the first 6 months of 2021, these numbers skyrocketed: children’s hospitals reported a 45% increase in self-injury and suicide in children ages 5-to-17 compared to the first 6 months of 2019. While the mental health challenges of the pandemic have affected children of all backgrounds, they have disproportionately impacted children of color.

The increased demand for mental health services coincides with a severe lack of resources for children and teens. Children experience mental health issues at the same rate as adults (1-in-5 adults has a mental health issue), yet they have significantly less support.

Terrell and his fellow panelists —Miriam Calderón from Zero To Three, Dr. Sharon Hoover at the University of Maryland School of Medicine, and Scott Hutchins from Michigan’s Department of Education — made the following recommendations:

  • Bring services to where the children are — schools, pediatrician’s offices, child care centers
  • Recognize that babies and toddlers experience mental health challenges and develop the workforce to serve them and other children and youth. Uplift programs that improve the physical and mental well-being of all children, like the Child Tax Credit, early learning, and child care programs.
  • Strengthen the role of schools in mental health promotion, prevention, and intervention. Research has shown that youth are six times more likely to initiate and complete mental health treatment in schools than in community settings. “Every adult in the school building and every peer in the building plays a role in mental health,” she said.
  • Increase the number of mental health professionals in schools and integrate the program with existing systems — such as Medicaid — to make them reimbursable and sustainable. Michigan began building its school-based mental health services with a $30 million investment in FY 2019 — just $20 per student. This year, the $300+ million effort has more than 1,400 service providers in schools across the state.

For a comprehensive overview, see our fact sheet on Mental Health and Kids.

Watch the full discussion at FirstFocus.org

HOMELESSNESS:

Update “homeless” definition to better serve children

Before we can identify the number of children experiencing homelessness, we must agree on what it means to be “homeless.”

Homelessness advocates participating in First Focus on Children’s Kids and COVID Conversation Series called on the government to adopt a broader definition of “homelessness” and to implement measures that prevent future homelessness.

“Families who have been in hotels are not seen as homeless because they’re not physically in the streets and in the elements,” said Katrina Bostick, executive director at Family Promise of the Coastal Empire during First Focus on Children’s Kids & COVID conversation on homelessness and eviction. “That’s a huge gap for families. We need to look at how those federal barriers are adding to homelessness and how they can come down.”

Families and youth experiencing homelessness often live doubled up with friends, in hotels, cars or on public transportation. The Department of Education considers these families “homeless.” The Department of Housing and Urban Development — which distributes aid to people experiencing homelessness — does not. For that reason — and because they often do not have landlords or leases to identify them as housing insecure — these families, children, and youth on their own missed out on much of the emergency pandemic aid Congress set aside for them.[

The Homeless Children and Youth Act (H.R. 6287/S.1469), a bipartisan bill reintroduced in 2021, would amend HUD’s definition of homelessness to include children, youth, and families who are identified as homeless by other federal programs, including the Department of Education.

“There is a perception out there that staying with other people is a less vulnerable situation but that’s not what we see for families and children,” said Barbara Duffield, Executive Director of SchoolHouse Connection.

Even before the pandemic, an estimated 2.4% of school-age children — and nearly 6% of children under six — were experiencing homelessness. Homelessness is even more prevalent among children of color —Black, Hispanic, Native American, Native Hawaiian, and Alaskan high school students disproportionately experience homelessness compared to their white or Asian peers. Evidence suggests that those numbers rose during the pandemic as a result of job and income losses, but because most of the nation’s schools went to online learning, school liaisons identified 420,000 fewer students experiencing homelessness in the early months of the pandemic than before it began.

Among the recommendations presented by the panelists to address existing homelessness and prevent it in the future:

  • Implement a more inclusive definition of homelessness, and reform homeless assistance to reflect the way families and youth actually experience it
  • Help families maintain housing once they receive it, for instance, by increasing the minimum wage, and by placing housing where families have access to child care and transportation
  • Break the intergenerational cycle of homelessness by ensuring that families who experience the trauma of homelessness receive adequate mental health care

Watch the full discussion at FirstFocus.org

CHILD WELFARE AND YOUTH JUSTICE:

New approaches, fresh ideas for child welfare and youth justice

Alternatives to detention and the greater use of technology during the pandemic could open new doors for youth in the justice and child welfare systems.

New approaches during the COVID-19 pandemic offered fresh ideas for the child welfare and youth justice systems, experts and advocates said during First Focus on Children’s Kids & COVID Conversation Series.

With no option for social distancing in congregate care facilities experts engaged in “creative thinking,” said Jennifer Rodriguez, executive director of the Youth Law Center, and began evaluating alternatives to detention and institutional settings. Fewer children were admitted to these centers, more were placed in the community, and many were released.

“There’s something very hopeful in the fact that when an emergency hit the system, we didn’t need to lock up as many kids,” said Joshua Rovner, senior advocacy associate at The Sentencing Project.

But inside the youth justice system, conditions grew worse: Infected children were isolated in solitary confinement; staffing shortages curtailed access to food, care and monitoring; the end of parental, educational and other visits further isolated these children. Racial and ethnic disparities grew as bias influenced who was released and who was kept behind.

“What became crystal clear if it wasn’t already is that these places are not places for children to grow up,” said Rodriguez, who characterized the failure to learn from the successes of the children who were outplaced as a “missed opportunity.”

The panel urged policy makers to preserve and integrate innovations in both the child welfare and youth justice systems that delivered positive results, including:

  • Virtual hearings: While not appropriate in all cases, virtual hearings allowed children and parents to participate in their cases remotely. “Virtual hearings have their place and may be an innovation that helps court rooms be more accessible,” said Allison Green, legal director at the National Association of Counsel for Children.
  • Access to devices for children in extended foster care: Traditionally treated as contraband, during the pandemic devices to access the internet were seen as a gateway to family, connections, education, visits with social workers, and court proceedings.
  • Detention as a “step of last resort:” In Maryland, for example, court officials issued guidance that created a 40% drop in overall commitment and detention of youth. The guidance discouraged detention unless the child posed a threat to public safety.

“To the extent that we can keep that same mindset, I think that’s going to be the challenge of the movement,” said James Dold, founder of Human Rights for Kids.

Other panelists included Shereen White, director of advocacy and policy at Children’s Rights, Tony Parsons, federal policy specialist at Youth Villages, and First Focus on Children’s senior director for child welfare and youth justice Aubrey Edwards-Luce.

Watch the full discussion at FirstFocus.org

MIXED STATUS FAMILIES:

“Survivor mode” is go-to for immigrant families

Mixed-status families pay taxes and staffed the front line of the pandemic, but government aid programs passed over their children

Advocates for children of immigrants are calling on lawmakers to eliminate restrictions that create — and perpetuate — barriers to support and services.

One-quarter of all children in the United States have an immigrant parent and more than 6 million citizen children live with a family member who is undocumented. While school closures, family sickness, job loss, and other elements of the COVID-19 pandemic affected all the country’s children, panelists at First Focus on Children’s Kids & COVID conversation series said mixed-status families struggled with added burdens on their mental, physical and economic health.

“They constantly live in ‘survivor mode,’ even before COVID,” said Muleba Sumbwe, wellness resource coordinator for UndocuBlack Network, who is also the child of undocumented immigrants.

Many of the federal government’s COVID relief programs excluded mixed-status families — and often their citizen children. These families, many of whom pay U.S. taxes, disproportionately staffed the frontlines of the pandemic as “essential workers” and disproportionately suffered from its health and financial stresses.

“We are here in this country, we are part of the economy, so to feel that we don’t have the support in the pandemic, it was hard,” said Evelyn Ramos, co-chair of the immigration policy committee at United Parent Leaders Action Network. “I used some of my savings to pay rent and a few things…I don’t ask for resources for me, but obviously, I have two daughters born here and they deserve to have resources.”

State and county government often filled the gaps, the panelists said, but lack of information, transportation challenges, and work schedules often made it difficult for immigrant parents to access these services.

Mental Health

Even before the pandemic, the rise of anti-immigrant rhetoric and hostile policies of the Trump Administration, such as the expanded public charge rule, saddled many children in mixed status families with mental health challenges, such as the fear of parents being deported. The new fears and isolation of the pandemic exacerbated these issues and the unique challenges faced by these communities.

“When things shut down, many families didn’t have the tech or broadband needed to be connected to their healthcare providers, including their mental health providers,” said Gabriella Barbosa, a daughter of immigrants who is managing policy director of The Children’s Partnership in California. These families also struggle with a lack of mental health providers who reflect the cultures, languages and diversity of the country’s immigrant families, she added.

Vaccinations

Mixed status families also faced myriad barriers to getting vaccinated, panelists said, including lack of access to health care, lack of transportation, and translation issues, as well as elemental distrust of the vaccine system among some communities of color. To overcome these barriers, community-based organizations hosted information sessions, used social media and other “interactive advocacy” techniques, and brought the vaccines to trusted community spaces that families already frequent and could access easily.

United Parent Leaders Action Network organized a children’s vaccination event that used colorful, bilingual fliers and chose a venue that was familiar and comfortable to the community. “And we used the magical words ‘free, no ID necessary, no insurance needed,’” Ramos said.

Removing Barriers

To undo the damage of the pandemic and ensure that children of immigrants receive the medical, financial and other support they need, panelists recommended:

  • Continued outreach on public charge and other issues to make families aware of the benefits to which they are entitled
  • Engaging attorneys, teachers, doctors and other trusted community members in spreading information
  • Eliminating all restrictions that prevent immigrant families from accessing economic, health care, nutrition and other benefits through legislation such as the Lift the Bar Act, which would eliminate the 5-year waiting period currently required before legally present immigrants can access Medicaid, the Children’s Health Insurance Program, nutrition programs and other services. For more information, see our Fact Sheet on the Lift the Bar Act.

Watch the full discussion at FirstFocus.org

PHYSICAL HEALTH AND VACCINATIONS:

Epidemiologist urges holistic approach to childhood COVID

Despite early misconceptions that children don’t get COVID, childhood COVID accounts for 19% of all COVID-19 cases in the United States.

What you see depends on where you stand.

Epidemiologist Theresa Chapple brought an out-of-the-box perspective to First Focus on Children’s Kids and COVID Conversation Series that started with the consequences of comparing childhood COVID to the adult experience.

“When we’re looking at asthma, we really focus in on childhood asthma and what that means, and the impact childhood asthma has on missing school and quality of life for children,” Dr. Chapple said during First Focus on Children’s conversation about physical health and vaccinations. “It makes really good sense to have these conversations where we’re drilling in on children and not comparing them to adults but comparing them to what a healthy childhood is like.”

The unfortunate comparison of children to adults set off a cascade of events, Dr. Chapple said, including low child vaccination rates, underestimates of COVID’s social, emotional and physical impact on children, misinterpretations of educational outcomes and a host of other challenges for children.

Questions we should be asking:

  • What happens when kids gets COVID? What are the specific physical impacts? How does fear of the disease — and of infecting people they love — affect their well-being? COVID is now among the top 10 causes of death in children. “That does not get said enough,” Dr. Chapple said. “Children with COVID can have life-changing events.”
  • Are we measuring the right things? “Deaths and hospitalizations are the tip of the iceberg,” Dr. Chapple said. “We need to drill down further – what happens before death? What happens before hospitalizations?”
  • What is our goal as a community? As the United States? “From a public health perspective, I wonder why our goal isn’t to prevent transmission, to keep people from getting the disease,” Dr. Chapple said, citing arguments of personal choice about vaccination and other mitigations. “Do we want to focus on individual protections? Or should we be focusing on protecting the health of our communities? These are real conversations that need to happen.”

Recommendations:

  • Overhaul data collection: Home tests, lack of household transmission numbers and the persistent view that COVID is not a big deal in kids have created a lack of documentation for core data that could help medical experts evaluate developmental delays and other residual effects in years to come. “Policies that encourage appropriate data collection and testing among children is the number one thing we need,” Dr. Chapple said.
  • Make system-level mitigations: For instance, every car has airbags. Every school, child care center, bouncy house, indoor play space and other child-centered venue should have adequate ventilation.
  • Reduce class sizes: Individual attention is among the many reasons that smaller classes benefit children, Dr. Chapple said. Inhibiting the transmission of COVID is just one more.

Watch the full discussion at FirstFocus.org

ECONOMIC IMPACTS:

Children enjoyed better, more stable lives with pandemic aid

At the height of the pandemic in 2021, government programs in the American Rescue Plan cut child poverty in the U.S. by 36%.

Federal pandemic assistance helped close the persistent gap in material hardship for U.S. families with children, analysts from Poverty Solutions at the University of Michigan said, and those advances stuck even in the face of rising inflation.

“The concerns over rising prices have dominated the headlines, but those concerns need to be placed in conversation with the gains of low-income households,” Patrick Cooney, Assistant Director of Economic Mobility for Poverty Solutions, told First Focus on Children’s Kids and COVID panel on the pandemic’s economic impact. 

In fact, Poverty Solutions found that stimulus payments and safety net improvements such as increased unemployment benefits placed the average U.S. household — and especially low-income households — in a better financial position in 2020 and throughout 2021 than they had been in 2019. Material hardship persisted however for households with children — a gap that was narrowed by the improved Child Tax Credit. The improved CTC expired at the end of 2021.

“When we look at all the things we should be doing, that’s the piece that’s most obvious we need to get done,” Cooney said.

The perpetual caveat, of course, is that the recovery is uneven. Women, and especially low-income women and women of color, have borne the brunt of pandemic job losses, said Julie Vogtman, Director of Job Quality for the National Women’s Law Center. The stimulus measures helped children eat, go to school and remain housed during the pandemic, she added, but they weren’t designed to combat the structural barriers to economic security that women faced long before the pandemic began, such as lack of child care and wage inequality.

“Care infrastructure investments are the thing we cannot give up on,” she said. “We need to finally treat child care like the public good that it is and invest in it accordingly.”

Older and former foster youth — often called transition-age youth (TAY) — benefitted from improvements to the Earned Income Tax Credit (EITC), said Anna Johnson, an associate director with John Burton Advocates for Youth, who called on Congress to make these changes permanent. These 18-24-year-olds experience the highest rates of unemployment, she said, and will take the longest to rejoin the workforce and recover income losses. Advocates helped 147 current and former foster youth claim nearly $370,000 in federal and state refunds in the filing cycle that ended with tax day on April 18, she said. The average return will be $2555 per person.

“This isn’t pocket change,” she said. “They go and pay off their debts, they buy food for their kids and they fix their car so they can go to work. We need this to be ongoing to recover.”

Recommendations:

  • Reinstitute the improved Child Tax Credit
  • Combat the structural barriers to economic security that women face by investing in child care and other social infrastructure
  • Make permanent the pandemic-era improvements to the Earned Income Tax Credit

Watch the full discussion at FirstFocus.org

GLOBAL IMPACTS:

How to prioritize children in the global recovery

Nearly 52 million children around the world have been documented with childhood COVID and more than 7 million have lost a caregiver to the pandemic. 

COVID’s impact on children around the world doesn’t stop at the number of cases, deaths and orphans. The pandemic, and its forced isolation, its economic disruption, have reached into every aspect of children’s lives, from education to family relationships to their physical and mental health and well-being.

In First Focus on Children’s Kids and COVID Conversation on Global Impacts experts called for increased funding, coordination and tracking of new and existing programs to deal with the simultaneous worldwide crises of orphanhood, educational gaps, violence against children and other wide-ranging results of the pandemic. Among their recommendations:

  • Create a plan for equitable distribution of vaccines worldwide, which will stem the rise of orphanhood
  • Create a global plan for vaccinating children
  • Work to serve orphaned children in family-based settings, rather than orphanages
  • Resume surveys to track violence against children, which were suspended during the pandemic
  • Fully fund programs for water, sanitation and hygiene, menstrual hygiene and other interrelated issues that can prevent children from attending school
  • Establish global, national and local movements to combat violence against children that put survivors at the center of the conversation
  • Increase the global social service workforce
  • Better track U.S. budget investments in children worldwide
  • Mount a comprehensive, multi-sector response to COVID similar to the one used to fight AIDS

Watch the full discussion at FirstFocus.org*******

EDUCATION and NUTRITION:

Fixing the severed school lifeline

Centering meals, health care and other community services at schools would help restore the vital role they play for children and the families who care for them.

In the chaotic onset of the coronavirus pandemic, school nutrition leaders appealed to the Trump Administration to let them handle the crisis as if it were a natural disaster, a change that would have allowed more food to flow to more children and to their families. The answer was no.

“We need to sit down and figure out how to do this not if but when it happens again,” Katie Wilson, Executive Director at Urban School Food Alliance, told First Focus on Children’s Kids and COVID Conversation panel on Education and Nutrition this week. “There is a way, we do it with natural disasters, why we thought this was different, I don’t know. So many families were in need, almost instantaneously. They were looking to schools as a safe place.”

For millions of children, schools provide a lifeline — to education, food, health care and other services. As they scrambled to reach students and their families during the pandemic, school officials entered uncharted territory. During our final panel on Kids and COVID, educators

examined what went right, what went wrong and how to help the nation’s schools — and its students — recover. Their recommendations include:

  • Leverage school meal programs

School nutrition employees began feeding students curbside within 24 hours of school closures, Wilson said. To leverage the full potential of school meal programs, now and during future disasters, she recommends eliminating the income test for school meal programs and providing universal school meals. “It’s the only thing in a school building where a child’s family income impacts whether they get access to a service,” she said. In addition, during future disasters, the government should allow schools to serve the community as a whole, rather than adhere to per meal reimbursement and other restrictions of school meals, she said, which would allow them to reach more people more efficiently.

  • Cultivate a school-based health care workforce

The majority of school-based health centers remained open during the pandemic, School Based Health Alliance CEO Robert Boyd told the panel, and provided critical primary care, mental health care, COVID and vaccine education, and shot clinics. Many centers also initiated or expanded telehealth services, he said, including for mental health. To maintain and build on this success, Boyd recommends cultivating a steady workforce by channeling students into the profession as early as middle school and using the public university infrastructure to train them. Workforce is the No. 1 issue in health care in schools — as in other health care settings — Boyd said.

  • Create more community school coordinators

Community schools — which are public schools that partner with local organizations to connect students, families and the larger community to each other and to resources — played a critical role during the pandemic, said José Muñoz, Director of the Coalition of Community Schools. In places like Asheville, N.C., Oakland, Calif., Skokie, Ill. and Cincinnati, community schools rallied to provide family food boxes, resiliency kits for kids, vaccine clinics, after-school programming and other needed services. To build on that success, Muñoz said, the country needs more “community school coordinators,” which he described as the equivalent of a director of operations. “Think about the power of the public school,” he said. “Every single day you have access to people that live in a broader community. We’re way under-utilizing the power of the public school community. But it has to be someone’s job every day.”Muñoz cited a study in Albuquerque that found that every $1 invested in community school coordinators delivered a $7.11 return on investment.

In the end, panelists offered on overarching takeaway from their pandemic experience: “Feed all kids. Educate all kids. Provide free health care to all kids who need it,” Boyd said. “It’s that simple. We’re the greatest country in the world. It’s a sin. It’s a shame. It’s a travesty to not take care of our kids. Let’s keep the focus on the kids. They’re the future.”

Watch the full discussion at FirstFocus.org

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CONCLUSION:

Where we go from here

Children made great strides during the pandemic. Emergency pandemic aid — improved tax credits, increased food benefits, economic impact payments, and other child-centered initiatives — achieved historic levels of well-being for U.S. children. These investments reversed more than a decade of decline in federal spending on children, helping lift nearly 4 million out of poverty and producing the largest year-to-year increase in the share of U.S. federal spending on kids since First Focus on Children began tracking 15 years ago.

With the sense of urgency waning — and the U.S. Public Health Emergency likely to end this summer — lawmakers are once again sidelining America’s children. The First Focus on Children Kids and COVID Conversation Series produced important revelations about what works for kids and about the concrete steps we as a country must take to protect them. We cannot stop talking about the children now. We must capitalize on this progress. And propose long-term solutions to these long-term problems.

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