The long-term effects of the COVID-19 pandemic on children and youth will not be known for many years. Although these age groups are remarkably resilient, they have experienced wide-scale adverse childhood events related to the increase in poverty, mental, and emotional stressors and the learning loss that has occurred. The December 2020 COVID-19 relief law (Public Law 116-260) and the March 2021 American Rescue Plan Act (Public Law 117-2) contain a remarkable set of provisions that will dramatically reduce child poverty and address these adverse events. Congress and the Biden administration have an opportunity to build on these landmark laws with other actions that will improve child and youth health in the United States for decades to come.
Child Poverty In The US
Prior to the pandemic, children in the United States were more likely to live in poverty, experience insecure housing, and go hungry than in other industrialized countries. The pandemic has only worsened the situation.
- Poverty: According to one government estimate, the number of children living in poverty was projected to increase by 25 percent, to nearly one in every five children, during the pandemic.
- Housing insecurity: Nearly one-third of renters with children younger than the age of 18 reported in January 2021 that they had not paid last month’s rent.
- Nutrition: Nearly one in six parents reported in March 2021 that they did not have sufficient food in their house during the past week.
Increases in mental health concerns due to COVID-19 have been highlighted as particularly concerning. A longitudinal study from England found that mental health problems among children had increased by more than 50 percent—to 16 percent of all children and youth—from 2017 to July 2020. And a recent study found that rates of suicidal ideation and attempts in one pediatric emergency department were higher in a number of months in 2020 than in 2019 and appeared to correspond to times when COVID-19-related stressors and community responses were elevated.
Without any interventions, the impact of these stressors on the overall health of the nation will be felt for decades, as these social determinants are all associated with adverse health outcomes in childhood and over the life course. One recent article estimated that the loss of time in school due to the pandemic would translate into 800,000 to 13,000,000 years of life lost among primary school-aged children in the United States alone.
These losses are being borne disproportionately by children of color. Black and Latinx individuals saw particularly steep increases in poverty as a result of the pandemic. Unemployment rates rose more among people of color during the pandemic than they did for White Americans; notably, employment rates among Black women have not rebounded as they have for other groups. Additionally, people of color are less likely than White Americans to have access to health care, which may have also contributed to widening gaps in outcomes for children and youth.
Landmark Legislation Passed By Congress
A recent report from the National Academies of Sciences, Engineering, and Medicine (NASEM) modeled specific policies that, in combination, could reduce child poverty by 50 percent over 10 years, resulting in five million fewer children living in poverty. Their work outlines an evidence-based way for policy makers to improve the long-term health and socioeconomic trajectory of children and youth. The policies found by the NASEM to have the largest impact include:
- Poverty: a direct allowance for children and reforms to the Earned Income Tax Credit and the Child and Dependent Care Tax Credit;
- Housing insecurity: an expansion of the housing choice voucher program; and
- Nutrition: an increase in Supplemental Nutrition Assistance Program (SNAP) benefits.
The December 2020 coronavirus relief law and the March 2021 American Rescue Plan included multiple provisions—many of which are directly aligned with the policies explored by the NASEM—that will immediately improve child poverty and other social factors that negatively affect health outcomes over the next year. Key provisions include:
- Poverty: direct payments to many families and increases in the size of the Child Tax Credit, including making it fully refundable (similar to a direct child allowance). The latter provision alone is estimated to reduce child poverty by 40 percent this year, lifting more than four million children out of poverty (including nearly three million children of color).
- Housing insecurity: an extension of the eviction moratorium and additional funds for rental assistance;
- Nutrition: an expansion of SNAP; and
- Child care and education: increased funds for childcare, early childhood education, and K–12 schools.
Critical Next Steps
The recently passed policies will dramatically reduce the number of children living in poverty right now. Building on this momentum, Congress and the Biden administration should also pursue permanent changes to ensure that these gains are sustained over time. In particular, they should focus on the following areas and develop coordinating structures that support implementation of the law and advance additional policies needed to help children and youth thrive in the long term.
Ongoing Financial Resources To Families With Children
The fully refundable Child Tax Credit expansion passed in the recent stimulus package by Congress will expire at the end of the year. To address this, many have proposed permanently extending these tax credits. Notably, the United States is one of the only industrialized countries that does not provide support along these lines to families. Making permanent changes in the Child Tax Credit that will get money directly into the hands of low-income families, so that reductions in child poverty are sustained, should be one of the top priorities of Congress and the Biden administration.
Increasing Access To High-Quality Child Care And Education
We suggest that a longer-term focus on child care and education would also be worthwhile for multiple reasons. First, higher educational attainment is associated with both better health and many other desirable societal outcomes, including reductions in substance use and unintended pregnancies. Second, low-income children—particularly children of color—have seen a dramatic decrease in in-person learning during the pandemic; one survey found that more than half of Black and Latinx fourth graders were learning entirely remotely, while fewer than one-quarter of White children were. Finally, increasing access to child care is a gender equity issue, since women disproportionately stay at home to take care of children rather than work.
One way to increase access to child care and to reduce poverty that was highlighted in the NASEM child care poverty report would be to make permanent another tax credit, Child and Dependent Care Tax Credit (CDCTC), that was also expanded and made fully refundable in the American Rescue Plan. During the campaign, President Joe Biden laid out an even more ambitious plan, calling for universal pre-kindergarten for three- and four-year-olds and an expansion in the CDCTC; the administration has since reiterated support for these items. Congress and the Biden administration should pursue permanent changes such as these that embrace high-quality early care and education for children of all ages and in all settings. Ultimately, reducing the cost of child care will help many low-wage families and boost national economic productivity.
To address education needs for older children and equity, the federal government could provide technical assistance to those school districts that want to use novel approaches for the summer months when low-income children lose ground, compared to their wealthier peers, or for after-school programming. This effort could involve assisting Title I schools with resources needed for additional work hours and staff, cooling costs, and transportation needs, among others. Additional support is also needed to help school districts increase broadband access among low-income families.
Addressing Physical, Social, And Emotional Health In Homes, Child Care, And Schools
Ensuring that children and youth have access to high-quality, holistic services to address their full range of needs should be another important priority for Congress and the Biden administration, especially because of the increase in food insecurity and children’s mental health challenges, both exacerbated by the pandemic. School systems and child care providers need more financial resources and guidance to help them address these issues.
To meet these challenges, Congress should support children’s nutritional needs by providing additional funding for school meals to cover costs incurred during the pandemic response. Additionally, Congress should reduce barriers for child care centers and family child care homes to participate in the Child and Adult Care Food Program, which funds healthy food for children and adults in various child care and adult day care settings.
In addition, the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) has seen a significant 25 percent decline in participation over the past decade, for a variety of reasons, which may include improving economic conditions prior to the pandemic, falling birth rates, stigma, transportation barriers, and concerns about enrollment in immigrant communities. To help enhance access to nutritious foods offered through the WIC program and reduce barriers to participation, Congress should extend the eligibility period for postpartum mothers, increase the age limit for participating children from five to six years old, and streamline the enrollment process. The US Department of Agriculture should also update the WIC food package to expand the value, increase the variety, and strengthen the nutritional quality of WIC-approved foods.
Congress should also help support increased access to children’s mental and behavioral health services, especially in schools, primary care, and early care and education settings. Key policies could include:
- Funding additional positions for licensed clinical social workers, nurses, and mental health professionals in schools, as well as infant and early childhood mental health consultants in childcare settings;
- Reducing barriers to accessing care by increasing the Federal Medical Assistance Percentage for pediatric tele-behavioral health services to 100 percent of Medicare rates, including services offered in community settings such as schools;
- Building on existing state-level coordinating bodies to help schools and childcare centers develop greater capacity to integrate tele-behavioral health services, implement consultative models, and mainstream mental health into other areas of policies and programs, and to incentivize states to put in place policies that make these services sustainable through their Medicaid and commercial insurance policies; and
- Supporting additional training and resources for primary care providers, nurses, educators, childcare providers, and other paraprofessionals to build and support resilience, increase provider knowledge around infant and early childhood mental health, and deepen understanding of adverse childhood experiences to help children, youth, and their parents address isolation, mental health challenges, and learning loss.
Finally, Congress should strengthen funding for programs that support new families. For example, home visiting programs such as the Nurse-Family Partnership, which partners a registered nurse with an expecting mother and provides ongoing home visits through the child’s second birthday, have been shown to reduce child abuse and injuries, decrease the subsequent rate of births to young mothers, and improve educational outcomes. Congress should use Medicaid and other funding streams to expand evidence-based programs focused on parents, infants, and young children.
Better Alignment And Coordination Of Systems By The Federal Government
As Congress and the Biden administration advance policies to directly address the social factors impacting children’s health, we encourage the administration to implement strategies that will increase coordination across programs. Existing federal programs to support children and youth are scattered across multiple federal departments and agencies; no one entity has responsibility for coordinating these programs, identifying what is working and what isn’t, and collaborating with states and local governments to improve outcomes for children. With the addition of the landmark provisions included in the American Rescue Plan, greater coordination around implementation, as well as a focus beyond the coming year, will be critical.
Accordingly, Nemours—along with more than 400 other endorsing organizations and individuals—urges the Biden administration to prioritize federal leadership for children and youth by creating an enduring “integrator” structure in the executive branch. This could include the development of a federal Children’s Cabinet (modeled after successful state-based children’s cabinets) and an Office on Children and Youth within the White House, which would develop National Goals for Children and Youth and a National Strategy for Children and Youth, including a federal policy agenda focused on promoting equity and making permanent reforms to advance the gains included in the American Rescue Plan.
A key role of the Office and Cabinet would be the provision of funds and technical assistance to states and communities to help them more efficiently implement evidence-based programs to alleviate poverty and address mental health concerns for children and youth. To do this most effectively, specific actions could include:
- Replicating the Obama administration’s Social Innovation Fund model to provide states with guidance on how they can braid federal funds using existing authority as well as work with a vanguard set of states to test new waiver authority for the administration of a targeted set of poverty and mental health programs for children and families.
- Working with the Department of the Treasury to explore outcomes-based financing models that reward states and communities for achieving measurable results, akin to the social impact partnership program created by the Social Impact Partnership to Pay for Results Act, which passed in 2018 with bipartisan support, Additionally, the Office and Cabinet could provide assistance in identifying ways to pair the models with public-private partnerships to invest in helping children thrive through pooled funding mechanisms such as children’s wellness trusts, “baby bonds,” or other funding innovations.
The American Rescue Plan and the prior packages enacted into law contained desperately needed provisions that will dramatically reduce child poverty and address other health-related social needs. Congress and the Biden administration should build upon these laws and implement permanent changes that could sustain the reduction in child poverty that these laws will achieve. To maximize impact and effectiveness, the administration and Congress should create a federal leadership structure to better coordinate children’s services at the national, state, and local levels to address whole child health. In combination, these actions have the potential to transform the trajectory of children and youth in the United States and help them emerge from the multilayered impacts of the pandemic.