Pressing Issues Facing Children and Families: Reflections One Year into the Pandemic

Health Care Coverage, Access & Quality

Just over a year ago, we wrote a piece highlighting areas of particular concern for children and families as the COVID-19 pandemic was unfolding. While in many ways we remain in a crisis, the landscape looks very different than it did in March 2020, with a road to recovery that is very uneven and inequitable. It’s once again time to take stock of the most pressing concerns for children and families, particularly in under-resourced communities, and analyze our response to date.

How the Country Has Responded to Support Families During the Pandemic

Some acute crisis points from a year ago—such as child care access, food distribution and child welfare system operations—have improved, stabilized or pivoted. Administrators of many social safety net programs, which saw high increased demand in spring 2020, have tried new models of hybrid or virtual delivery or restricted in-person services. (Programs that have been less nimble in their response have faced continued criticism.) Community organizations working tirelessly to stand up responsive programming and share information on how to access resources have been pivotal in this effort, as have philanthropic contributions to stabilize and support social service providers.

In terms of federal response, the American Rescue Plan had a welcome focus on livelihood support, continuous postpartum insurance coverage, and investments in child care, K-12 education and behavioral health. Anti-poverty measures like the Child Tax Credit and enhanced unemployment insurance are also critically important and have the potential to halve the child poverty rate. However, many of these welcome fixes are temporary and need to be made permanent.

In Medicaid, the freeze on disenrollment during the declared public health emergency has allowed for continuous coverage, which is critical for children and families. That protection, plus the important role of this safety net program for those who lost their employer-sponsored health insurance or had a drop in income, have made for a huge spike in Medicaid enrollment in Pennsylvania.   

Given these policy developments, there is much to celebrate and yet, still much more to be done. Federal livelihood supports and health coverage provisions leave out undocumented immigrants, undermining societal recovery. Much of the financial support flowing to under-resourced communities is temporary. We remain optimistic that the attention to paid leave catalyzed by the pandemic, including in relation to the safe functioning of schools, will lead to needed permanent federal paid leave policies, but this has not yet materialized.

Although the crisis points for children and families are different than they were a year ago, they are no less pressing. The following issues are of particular concern to us at PolicyLab:

Inequities in education access

With continued variation in how K-12 schools are operating—whether in-person, fully remote or some hybrid model—as well as inequities in high-speed internet access, the COVID-19 pandemic has further exacerbated disparities in access to quality education and safe learning environments in this region and across the country.

In Pennsylvania, 300,000 students are without internet access including more than 100,000 children of color. Public Citizens for Children and Youth highlighted that the students most likely to be without internet access are also the least likely to live in a district that has returned to in-person instruction.

Access to in-person instruction is important not only for educational outcomes, but also for the important role schools play in health promotion through providing food, physical activity, counseling and developmental supports. PolicyLab researchers have posited that remote schooling has been a contributing factor to striking increases and disparities in childhood obesity during the pandemic. Moreover, school health centers play a critical role in access to behavioral and sexual health services for adolescents with implications discussed below.

Growing crisis of social isolation and behavioral health

The pandemic has exacerbated the youth behavioral health crisis. Children and teens are experiencing layers of stressors, including disruption of routines, school and peer disconnection, interruptions in medical and therapeutic care for existing health conditions, familial economic hardship, morbidity and mortality among loved ones, and for children of color, the concurrent trauma of race-based violence and other forms of racism.

According to the Centers for Disease Control and Prevention, from March to October of 2020, emergency room visits related to children’s mental health rose dramatically compared to the previous year—a 24% increase for children ages 5-11 and a 31% increase among adolescents ages 12-17. 

PolicyLab’s behavioral health experts have reported seeing an influx of pediatric patients with more severe, unmet behavioral health concerns related to mental health visits to the emergency department, sleep disorders and eating disorders. They have also stressed that people of color are overwhelmingly experiencing significant amounts of distress, and that we need to fully understand the impact of COVID-19 on racial/ethnic minority youth’s behavioral health.

Surging gun violence

Gun violence across the country is rampant, with pandemic-related community/school closures, emotional and economic stressors, and social service disruptions likely contributing to increased gun sales and gun violence. Our city of Philadelphia is on track to experience its most violent year ever. CeaseFirePA surveyed Philadelphia youth on their experiences and found that over half have witnessed gun violence at least once, while one-quarter had seen gun violence four or more times.

This is taking its toll on youth. In the same survey, more than two-thirds of youth reported concern for their own personal safety, and 80% feel there is not enough being done to support young people who are impacted by gun violence.

Alarming rates of sexually transmitted infections in adolescents

Sexually transmitted infections (STIs) are at an all-time high in the United States, and adolescents and young adults have been disproportionately impacted. Meanwhile, the pandemic has strained the supply chain for materials needed for regular STI screening as well as public health programs that are essential for STI screening and treatment.

PolicyLab adolescent health specialists have raised the alarm about the detrimental consequences of ignoring this “other epidemic among teens.” Our experts have also drawn attention to the fact that with preventive screening likely deferred for many asymptomatic patients, we may only be seeing the tip of the iceberg in terms of STI cases.

A strained child care system

Seventy six percent of mothers with children under age 10 say child care has been among their top three challenges during the pandemic. The pandemic has clearly demonstrated the relationship of the child care system to parents’ participation in the workforce, particularly for women.

The American Rescue Plan provides a necessary infusion of funding to support the child care system, which is still reeling from financial challenges exacerbated by the pandemic. In Pennsylvania, 260 centers closed permanently between March and September 2020. The costs of providing center-based child care increased substantially, in part because of the greater financial burden brought on by the need for additional health and safety measures.

Even when centers reopened in many states, the sector suffered from low utilization as families’ caregiving needs and preferences have altered with changes in employment and fears of safety. It remains essential to build trust among families and communities in the safety of child care, and to financially support the sector to allow for improved access, affordability and quality.

What’s Needed to Support Children and Families Going Forward?

Social safety net and prevention-focused programs have arguably become more important than at any other point in recent history. And while these systems and programs have demonstrated ingenuity and resiliency during this crisis, the road ahead includes challenges. We see concerning declines in access to some community programs, as indicated by lower referrals and utilization, despite increased need for many families—signaling a potential need to restore trust and accessibility of services. Many programs have faced staffing challenges due to financial constraints, employees’ caregiving demands or health status. Shifts to hybrid or virtual service delivery models have come with changes in administrative and financial considerations for family serving systems, offering both benefits and challenges.  

We see an opportunity to learn from the pandemic, including about how best to support immigrant communities. And as we continue to grapple with racial and ethnic disparities in vaccine access and uptake in Pennsylvania, and across the country, it is essential to listen to, support, and be responsive to community voices and community-based organizations.

As we look at the road ahead to societal recovery, is there an opportunity to make permanent some of the “fixes” put in place through the pandemic response or to think differently to address long-standing issues? Whether through reimagining the education system, addressing child poverty, or considering what a “fair work week" is for families, can we stand up equity-focused policies that will make our society more resilient for the next crisis? We cannot predict where we will be one year from now, but we would welcome being able to reflect that this prolonged period of crisis had some silver linings for systemic change.


For more on PolicyLab’s work responding to the COVID-19 pandemic, visit our COVID-19 resource hub.