What Does COVID-19 Mean for Child Welfare?

                                                                                By Jasmine Masand 

Rates of reported child maltreatment have plummeted in recent weeks, and at first glance, falling rates of child maltreatment referrals might seem hopeful. In Los Angeles, reported cases have dropped nearly fifty percent, and child welfare workers in Texas have observed a dip in child maltreatment tips that began in early March. In health care, we often equate success in a given area to decreased rates of adverse events, such as decreased rates of hospital readmissions or less unnecessary emergency department utilization. However, in our new separated reality, decreasing rates of suspected child maltreatment could signal that more children are now isolated without access to other adult and community supports.

Vulnerable children are now isolated from the adults that often act as the eyes and ears of the child welfare system, and the drop in reported child maltreatment suggests that the children who are struggling in their home environment are more isolated than ever. In North Carolina, over half of child welfare referrals warrant an investigation or assessment, and over ninety percent of maltreatment cases involve the child’s parents. Most child welfare referrals come from teachers, health care providers, neighbors, and other adults who interact with a child and their family. With school cancelled for the rest of the year, and many people avoiding doctor's office and other routine activities, caring adults are unable to monitor the most vulnerable children in our communities.

In addition to reporting challenges, experts worry about a potential increase in the incidence of child maltreatment and child exposure to intimate partner violence within homes. As WUNC and the New York Times recently reported, research has shown that the COVID-19 circumstances has increased stress levels in working families, especially when family members have experienced job loss. Although it’s difficult to draw an exact link between increased family stress and child maltreatment, the anecdotal evidence is troubling. Hospitals in Orlando and Texas have reported a significant increase in hospital visits for children with serious injuries related to suspected abuse.

The combined effects of strain on working families and isolation of children exposes the limitations of an already stressed child welfare system. North Carolina child welfare services, including foster care, are administered at the county level. This year, I was part of a graduate student team researching best practices to improve health care for foster children in North Carolina. I learned that key service providerslike social workers, teachers, doctors, caregivers in the foster care system, and even law enforcement officers all have critical insight into a child's well-being.In recent weeks, I have heard anecdotally how this network of caring adults has been weakened by the pandemic. My good friend who is an educational psychologist in training now worries about the children she used to counsel on a weekly basis, since many parents cannot arrange remote counseling sessions for their children.Another peer who works as a social worker has been overburdened with an ever-increasing number of families in need, and the available social services and community organizations are backlogged with requests for assistance.

The pandemic has increased financial strain, food insecurity, and housing insecurity in our communities, and these social drivers of health must be addressed at the community level to support the mental and physical health of vulnerable children (see Xi et al and Brown and Xie reflections).These challenges, along with domestic violence, are included in North Carolina's Healthy Opportunities initiative to address social drivers of health as part of health care in the state. As our health and human services infrastructure becomes less burdened by COVID-19, state leaders should consider investing in social insurance benefits and community-based supports. Policymakers at the local, state, and federal levels can consider the following suggestions to assist at-risk youth and families during the pandemic:

In the short term, state and local agencies can compile online resources for caregivers to help facilitate access to online education platforms and information about telemedicine coverage and any other relevant changes in Medicaid covered services or protocols. Some states, including Tennessee and Kentucky, have highlighted resources for telemedicine and online content for foster children on the main pages of their health and human services agency webpages.

In addition, policymakers should continue promoting information-sharing and telemedicine platforms that can support health care engagement across foster children, caregivers, and other key health & child welfare stakeholders. Strict data regulations are necessary to protect the privacy of children in foster care, but they can also limit coordination between child welfare and health care entities. Ongoing efforts to expand the NCCARE360 human services referral network will help the state meet child welfare-specific goals by supporting families holistically. The platform could also be used to track community-based services more effectively for children in foster care. In addition, increased use of telemedicine platforms due to the pandemic could create a lasting opportunity for greater coordination between child welfare case workers and health care providers.

Broader social supports such as increased food assistance benefits and rent relief can provide whole-family support by decreasing stress in homes and increasing permanency for children who have interacted with the child welfare system. Increasing access to and monetary value of benefits like SNAP, TANF, and unemployment could reduce family stress and improve mental health. Cash and food assistance programs can also contribute to children's physical health by ensuring adequate nutrition and enabling needed health-related spending.

Finally, child welfare agencies and health and human services administrators can encourage the use of Medicaid andCHIP coverage for behavioral health services for children. Under Medicaid andCHIP laws, family counseling services can be covered for children with certain behavioral health diagnoses. Policymakers should push information about telemedicine coverage for behavioral health services to increase access for families that need extra support.

Children may be less susceptible to the worst physical symptoms of COVID-19 illness, but the pandemic critically endangers children who are already at-risk due to their home environment. Policymakers must recognize that investing in short-term aid and social supports to families under financial strain could protect the youngest and most vulnerable in our communities.