The COVID-19 pandemic has undeniably shifted family dynamics. Many parents balanced economic challenges. Children developed new ways to socialize, play and learn. The physical and mental effects of these shifts are beginning to emerge, thanks to research led by Stephen Patrick, M.D., a neonatologist at Monroe Carell Jr. Children’s Hospital at Vanderbilt and director of The Center for Child Health Policy at Vanderbilt University Medical Center. Discoveries recently sat down with Patrick to discuss how his findings are informing policy shifts.
Polls to Inform Policy Shifts
Discoveries: Your team conducted two polls to see how COVID-19 was affecting families with children, one national poll and one limited to Tennessee. What motivated them?
Patrick: We wanted to see how the pandemic was affecting families with children, and how their lives were being disrupted. We did the national poll that ran in Pediatrics early in the pandemic, in June 2020, just as Congress was working on a major piece of legislation to address COVID-19’s impact on families.
Our goal was to help inform the policies meant to help families with children by providing up-to-date information. We presented our findings to Senate staffers from both sides of the aisle. In Tennessee, we also shared our findings with state-level policymakers.
Discoveries: Why was it important to target families with children?
Patrick: Families with children experience poverty disproportionately in America. When a crisis hits, they start from a place of greater vulnerability to disruptions like losing a job, or insurance or child care. Also, many low-income kids connect with health and social services at school. We wondered how school closures were affecting those families.
Both polls focused on food insecurity, changes in child care arrangements and health insurance coverage; also, changes in parents’ mental health and kids’ behavioral health. The national poll tallied the responses of 1,011 parents that spoke either English or Spanish and that had at least one child under 18. The Tennessee poll involved responses from 1,100 parents with at least one child under 18.
Mental Health Declines Without Insurance
Discoveries: What were some key findings?
Patrick: Nationally, 27 percent of parents reported declines in their own mental health and 14 percent reported declines in their kids’ behavioral health.
Ten percent of families experienced both kinds of declines. Among them, 48 percent had lost regular child care and 16 percent had changes in health insurance, usually losing coverage.
Interestingly, declines parents reported in their own mental health and in their kids’ behavioral health were actually similar for families with different racial and ethnic backgrounds. They were also pretty similar across income and educational groups. Unmarried female parents and unmarried couples did report declines in their own mental health at higher rates.
Discoveries: What did you uncover that might contribute to these declines?
Patrick: It was striking how closely the degree of disruption that a family felt was tied to unemployment, which rippled out in so many damaging ways, including, of course, loss of insurance. Many families no longer had access to mental or behavioral health care.
Nationally, we found about a 3 percent drop in children covered by employer-sponsored insurance. That’s about 2.5 million kids.
In Tennessee, we saw a doubling of uninsured kids but only a slight increase of kids enrolled in Medicaid. The Medicaid system doesn’t respond well to sudden economic shocks. It didn’t during the Great Recession or during this pandemic. We’ve been writing about these problems with Medicaid for more than a decade.
“Nationally, 27 percent of parents reported declines in their own mental health and 14 percent reported declines in their kids’ behavioral health.”
Food Insecurity Despite Resources
Discoveries: What did you learn about food insecurity among families with children, nationally?
Patrick: The problem set in quickly; 32.6 percent of parents reported having this problem in March 2020 while 36 percent had it in June 2020.
About 18 percent of parents said their children had qualified for free or reduced-price school lunch before COVID-19. That meant those kids qualified for free school-sponsored programs during the crisis and for a new program called P-EBT, for Pandemic Electronic Benefit Transfer, that lets low-income families shop for food in their own communities. But parents have to sign up. We found that about 15 percent of parents qualified, yet only about 5 percent reported enrolling.
“It was striking how closely the degree of disruption that a family felt was tied to unemployment, which rippled out in so many damaging ways.”
Encouraging Signs for Families
Discoveries: Did any bright spots emerge in the polling?
Patrick: In Tennessee, we found many barriers that had been holding back telehealth before COVID-19 immediately went away. That’s true generally.
Lots of state laws around licensure were also relaxed; when it comes to providing distance treatment for addiction, rules were waived federally. Some of the more relaxed rules may stay in effect.
Discoveries: How might the pandemic inform other policies for families?
Patrick: Especially with behavioral health, telehealth has so much potential. Congress should consider helping schools with more funding, and also by ensuring there’s reimbursement for different service modalities. Not all families have internet for video chats; audio-only calls need to be included too.
The legislation passed in March to expand the child tax credit could reduce child poverty in the U.S. by half. The expansion isn’t permanent, but it had some bipartisan support, and may become permanent.
Also, the first Rescue Act included $750 million dollars for Head Start. For the first time, policy makers are discussing child care as a critical infrastructure issue, something essential for most families with kids.
“We need a national children’s agenda that extends to the states. One that is data-driven, focused on clear and achievable outcomes, and focused on coordinating government at federal, state and local levels.”
An Ongoing Conversation
Discoveries: What recurrent themes have emerged over the decades you’ve been studying the impact of government policies on families with children?
Patrick: It can be so hard for families to access benefits they are entitled to with such a patchwork of state and federal programs. This results in low enrollment in some programs, like WIC. Programs can also be duplicative and inefficient. We have to make things simpler for parents.
We really have no strategy as a country for our nation’s children and it’s our kids who are paying the price. We need a national children’s agenda that extends to the states. One that is data-driven, focused on clear and achievable outcomes, and focused on coordinating government at federal, state and local levels.
Discoveries: Have you noticed any changes during your time studying these issues?
Patrick: Conversations about equity, our glaring health disparities, and issues like child care and food security are different today from the ones I’ve heard for decades. There’s a commitment to change and an urgency that is encouraging.
People are paying attention in a way they weren’t before, and although our system isn’t designed for rapid transformation, we are starting to see policy shifts that families urgently need.
