We’ve written a lot in the past few months about the COVID-19 pandemic and its impact on Medicaid and CHIP. We’ve also written about the devastating impact of the pandemic on the economy and state budgets. Unfortunately, the devastation doesn’t stop there. Today, we invited two of our partners at the Children’s Defense Fund, Stefanie Sprow, the Director of Child Welfare Policy, and Steven Olender, Senior Policy Associate of Child Welfare and Mental Health Policy, to tell us about how the pandemic is impacting the children and families in or at risk of entering the child welfare system, and offer some ideas about what could be done to support vulnerable children and families.

Kelly: Thanks, Stefanie and Steven, for joining us today, though I wish we were having this conversation under different circumstances. Most SayAhhh! readers are Medicaid/CHIP policy wonks, like me, so I want to start with a pretty basic question before we get into the current crisis. Can you tell us who is served by the child welfare system and what kinds of services are typically delivered?

Stefanie: Simply put, the child welfare system exists in this country to ensure that children are kept safe. Ideally, this means that the system works to prevent any abuse or neglect before it starts, or if a family is already in crisis, to intervene with services to help stabilize that family to keep children safely at home and out of foster care. We know that parents want what is best for their children, but a variety of circumstances, including substance use, untreated mental illness or, as we are seeing now during the COVID crisis, extreme stress, lead to children experiencing abuse and neglect. The two biggest reasons for children being brought into the child welfare system are neglect, which is associated with 62% of removals, and parental drug abuse which is associated with 36% of removals (these categories are not mutually exclusive).

When abuse or neglect does occur, the child welfare agency evaluates to see if a child can remain safely at home, often providing support services to families that will help them keep their child safe. If it is determined that a child has been harmed and is not safe to remain at home, that child is removed into foster care. In care, services are provided to the child to help them recover from the trauma they have experienced and the parents are provided services like counseling, drug treatment, parent education or safety planning to help prepare them to safely reunify.

The goal in child welfare is for families to safely reunify, but if that is not possible, the child welfare system will move forward with other permanency options, like adoption or guardianship.

Kelly: Thank you for that background. Just before the COVID-19 pandemic, what were child welfare agencies and advocates working on? Were there any policy developments that were showing promise?

Steven: As Stefanie just mentioned, in the vast majority of cases where a child enters the foster care system, the abuse or neglect that brought them in could have been prevented if we were able to provide effective interventions for problems such as substance use and untreated mental illness. However, until recently, states and tribes could not access most child welfare funds until a child had been pulled into the system. The Family First Prevention Services Act, or Family First, which was enacted in 2018 and is currently in early stages of implementation, represents the most significant reform to child welfare in decades. Family First, not to be confused with the recently enacted Families First Coronavirus Response Act, allows jurisdictions to use federal dollars to intervene when a child is identified as at risk of entering care, providing evidence-based mental health, substance use and parent skill-based programs for families, so that we can stabilize families and children can stay safely at home. Family First really represents a paradigm shift, helping to move the child welfare system further upstream.

To date, only five states and DC have approved plans under the Family First Prevention Services Act, but five states and two tribes have submitted plans for approval. It’s a bit early for us to see results from these programs, but it’s exciting to see these programs moving toward prevention.

Kelly: Yes, prevention is key. How has the pandemic changed child welfare work? One thing we’ve read about is that the number of child abuse and neglect reports is much lower than normal. How are reports typically made, and how has COVID-19 changed the process? What kinds of reports are child welfare agencies receiving now?

Stefanie: We are certainly seeing that, across the country, reports of child abuse are down significantly. But I want to be very clear that this does not mean that there is less child abuse and neglect. In fact, the opposite is true. COVID-19 creates something of a perfect storm for child abuse and neglect. We know that in times of extreme stress, the rate of child abuse goes up significantly. That’s something we see in natural disasters and something that we saw during the 2008 financial crisis. However, things are much worse during this pandemic because of social distancing. Family isolation is one of the most significant risk factors for child abuse, but it is something that we are requiring now. Families cannot access the people, resources and services that help support them during difficult times, so the stress that leads to child abuse is compounded.

We know that rates of abuse are rising substantially. But children aren’t going to school or day care, they are skipping well-child visits, they aren’t going to church or interacting with the other people who would recognize something is wrong and report their concerns to the child welfare agency. Our system relies on community members and mandated reporters to alert the agency if a child is at risk so that the agency can investigate and, if necessary, intervene before abuse or neglect gets worse. Without mandatory reporters, the child welfare agency often is only alerted to a child being abused when the abuse has gotten bad enough that the child is hospitalized. Hospitals have been reporting a significant increase in the incidence and the severity of child abuse, including abusive head trauma, broken bones, burns and even fatalities. Children and families need support now, because if we don’t intervene, this could just get worse.

Kelly: That is very alarming. Is the crisis impacting older youth differently?

Steven: Older youth in care are at an increased risk during COVID because they are far more likely to be placed in group care facilities instead of in foster family homes. Youth in these facilities are not only extremely isolated during COVID, which is dangerous for youth who have experienced extreme trauma, but they also are at greatly increased risk of contracting the virus. In group homes, it is difficult to keep social distance and changing staff means that there are more opportunities for youth to be infected, like you can see in the example of the group home in Michigan where nearly 40 youth and nine staff members tested positive for the virus after a teen died.

For older youth who were in extended foster care, the situation is bleak. Those who were in school lost their housing and on-campus jobs as universities shut down. Others lost their livelihoods as businesses closed. While other young adults turn to their families for support or a place to live, older youth in foster care and those who recently aged out of the system don’t have anyone to turn to. Many are left homeless or couch surfing, which puts them at increased risk of contracting the virus.

Our partners at FosterClub conducted a survey of young people from foster care, which found that more than half had challenges with food security including nearly 1 in 5 who had run out of food entirely because of the pandemic. Nearly two-thirds of all youth surveyed had been laid off or had their work severely cut. Many didn’t know how to apply for unemployment and, of those who did, half did not receive benefits. More than half of these youth did not receive a stimulus check.

These young people need help and they need it now.

Kelly: What about the foster families that care for children? How are they being impacted by the virus?

Steven: This crisis has been incredibly difficult for foster families, just like it has been hard  on all families. With schools and child care centers shut down, foster families are caring for youth full time, often for children with substantial special needs, which are not being met now. Youth with mental and behavioral health needs, as a result of the trauma they have experienced, are often not getting the support they need right now, and foster parents, who are not trained as therapists, are bearing the brunt of that.

We are particularly worried in this crisis about kin caregivers, relatives who step in to care for children when their parents are unable to, both inside and outside of the formal child welfare system. Kin caregivers make up more than 30% of all formal foster care placements, but for each child being cared for by relatives in the child welfare system, there are 19 being cared for outside of the system. Families outside the formal system don’t receive most of the financial support and other services that system-involved families receive. On top of this, kin caregivers are often older relatives and their increased risk from COVID makes it difficult for them to safely access the different services that are available for food and other necessities during the crisis. Many of these older adults aren’t working, so they are likely to be supporting the child in their care with money from their retirement savings, which have been greatly depleted by the economic downturn caused by the virus.

Kin caregivers are the last line of defense that prevents children from entering traditional foster care. If we fail to support them, we will see a huge influx of children entering foster care, which would dramatically overwhelm the child welfare system.

Kelly: Families are under tremendous stress right now. Even the most fortunate families are struggling to balance work, parenting, and new homeschooling responsibilities. For some families, the situation is far worse – finding they are suddenly out of a job and food staples are scarce. It seems like a time when even more interventions are needed to support struggling families, but how can that be done?

Stefanie: What is needed immediately is resources. For far too long, this country has underinvested in child welfare and that has left our systems unprepared for this new paradigm.

Along with nearly 600 national, state and local organizations, we have called on Congress to act swiftly to provide comprehensive funding that supports the entire child welfare continuum, from funding early prevention, secondary prevention, supports for the child welfare system and funding to support youth as they are aging out of care.

When designing this suite of funding options, we focused on programs that were flexible, because the impact of COVID on child welfare looks different in every community. Importantly, we also focused on programs that were already in place and able to utilize funds immediately. These funds will provide resources to programs in every community that are operating now, but that need additional support to increase their capacity to meet growing needs or to adapt their service models to function during social distancing.

Every day that passes without action, Congress is allowing more children to suffer from abuse that would be preventable if the child welfare system had more resources to support families. Without Congressional support, children are languishing in a child welfare system that hasn’t been able to adapt to meet their needs. Without action, older youth risk homelessness and food insecurity because the system that is meant to protect them can’t do so without resources.

Kelly: It sounds like vulnerable children and teens have a lot of pressing needs that should be addressed right away. Thank you for sharing all of that valuable information about what steps should be taken to protect them. One more question before you go – as you look ahead a few months and the economy starts to open up and kids go back to school or child care, what do you anticipate needing then? Are there steps we can be taking now to prepare?

Stefanie: What we see in child welfare as the pandemic crisis ends will be largely incumbent on the way we respond to the crisis now. If we don’t adequately respond to this crisis, we will likely see a deluge of new child welfare cases once social distancing ends. We talked before about how the number of reported cases of child abuse was artificially low because children aren’t being seen by mandatory reporters. Well, when the schools and child care centers and places of worship open, when those kids are seen again, we will likely see a huge spike in reports that the child welfare system is not prepared for.

This will get so much worse as states slash their budgets because of the economic impact of COVID. We’ve already seen states announce major budget cuts in response to declining state tax revenue.

We can prepare for this by providing the resources to respond effectively to this crisis now. We also can take this moment to look more deeply at how our child welfare systems are run and why they were so vulnerable in the first place. States can take this moment to re-examine their policies around licensing family members as caregivers or to deepen their investment in prevention through Family First. But we need to act now, because without swift action, the child welfare emergency will be just beginning when the national emergency ends.

Kelly: Thank you for your time today and for all your work to protect vulnerable children and teens. To learn more about the Children’s Defense Fund and their child welfare work during the COVID-19 pandemic, please visit childrensdefense.org.