In early April of 2020, our team launched the first RAPID national household survey to understand — and bear witness to — the experiences of families with young children in the US during the COVID-19 pandemic. As child development researchers, advocates, policymakers, and funders, we wanted to know more about how disruptions to everyday life, social isolation, uncertainty about the future, and numerous related stressors would affect child and family well-being. We also hoped that this information could inform policy and programs that support children’s well-being in the weeks, months, and years that lay ahead.

Through the survey, we sought to create a holistic picture of children in the context of their parents and communities. We asked about such topics as parent and child emotional distress, economic circumstances, and access to healthcare and child care. We knew that the survey needed to include families across racial and ethnic groups, at all income levels, and from all regions of the country. We also knew that the survey needed to be conducted on a regular basis to look at the dynamic effects of the pandemic as it unfolded over time; and we understood that we needed to turn the data around and disseminate it quickly to key stakeholders at federal, state, and local levels.

In the ensuing two years, the RAPID survey gathered information from 13,758 parents of young children through 94 surveys. In March of 2021 we added a survey of the early childhood provider workforce, and since that time have fielded 51 workforce surveys with data gathered from 2,599 child care providers. Our household and child care workforce surveys include participants in all 50 states, and respondents are diverse in terms of race, ethnicity, income, and family structure. We have built an extensive and growing quantitative dataset from these surveys and have also collected over 260,000 written responses to a set of open-ended questions included in each survey.

We deeply appreciate the families and child care providers who have partnered with us to share their experiences over the past two years; our team members who have collected, analyzed, and disseminated the data; and our partners in policy, advocacy, research, and philanthropy who have contributed their time, expertise, and other resources to this work.

This report contains a summary of key findings for the first two years of the RAPID surveys. The topics and trends we have been following (e.g., the prevalence of economic hardship, an inadequate supply of child care providers relative to demand, structural inequalities based on race and ethnicity — as well as the resiliency of families and providers) provide a living record of the pandemic. However, these issues didn’t begin in 2020 when the country locked down. These are longstanding issues and will continue to challenge young children and the adults in their lives well after the pandemic has faded into history.

Below are five key findings from the first two years of the RAPID survey.

1. Rates of material hardship have been high throughout the pandemic, and are negatively affecting parent and child well-being.

We have measured rates of material hardship (defined as difficulty paying for basic needs, such as food, housing, utilities, child care, and healthcare) in all of our surveys dating back to April 2020. From the beginning of the pandemic through February 2021, the percent of families having difficulty paying for at least one of these basic needs was consistently above 30% (representing more than 4 million families). This figure decreased to approximately 25% from March 2021 to January 2022, but then increased in February 2022 to 32%, one of the most dramatic one-month increases in hardship that we have seen since we started collecting data. Parents reported the most difficulties paying for utilities, food, and housing.

We have also examined parents’ emotional distress on a 1–100 scale as a composite of symptoms of depression, anxiety, stress, and loneliness. Throughout the pandemic, we found that parents of young children consistently experienced elevated levels of emotional distress compared to what they reported pre-pandemic.

Notably, although we cannot determine if there is a causal relationship, the levels of material hardship and parents’ emotional distress appeared to rise and fall in parallel with U.S. COVID-19 infection rates.

We also measured children’s emotional distress on a 1–100 scale as a composite of their internalizing (fearful/anxious) and externalizing (fussy/defiant) behavior reported by their parents. Levels of child emotional distress perceived by parents since the start of the pandemic have been significantly higher compared to their pre-pandemic levels and have been relatively stable over the last two years, with a slight decrease observed in recent months.

One of the most noteworthy findings has been a consistent chain reaction of hardship. In 2021, we reported that an increase in material hardship in one week was associated with an increase in parents’ emotional distress in the subsequent week, which, in turn, was linked to an increase in children’s behavioral problems in the weeks that followed. This chain reaction of hardship has remained in place throughout the two years of RAPID surveys.

[My biggest challenge is] that I need better health insurance for my son and I but can’t afford it. I also recently took a new job that paid more and had more opportunity, but still not enough to cover childcare, so I’ll be paying that with a credit card.” — Parent in Illinois

I live off paycheck by paycheck, so with the increased rate of EVERYTHING somedays I have to choose if I am eating or not so I can provide for my kids. — Parent in Minnesota

In the summer of 2022 through the end of the year, the federal government provided an expanded Child Tax Credit (CTC) to families as one component of pandemic support and recovery. During the time that it was in place, 76% of households in our national survey reported receiving the payments. We found that monthly CTC payments buffered families from material hardship and financial difficulties. In our survey data, nearly 60% of parents indicated that they used the monthly payments for basic needs, and over half of parents said they used the payments for unpaid bills and other essentials (including child care costs). We also found that among those who did not receive CTC

payments the proportion of families reporting material hardship steadily increased. In contrast, material hardship rates among households who did receive CTC payments did not increase during the time the CTC was in effect.

[The Child Tax Credit] has greatly improved my financial situation and provided a safety net of money every month to cover rent and expenses. — Parent in New York

I can’t even put into words what [the Child Tax Credit] means. It’s literally the difference between paying a bill or buying groceries, kids clothes and basic necessities, and I appreciate that it will help me keep groceries in my house. — Parent in Kentucky

2. The unpredictability of material hardship has additional negative effects on parent and child well-being.

In addition to elevated levels of material hardship and the effect that this had on children and families, we also saw that families with young children have experienced high levels of material hardship unpredictability — week-to-week and month-to-month changes in being able to pay for basic needs — since the beginning of the pandemic. Moreover, unpredictability of material hardship significantly and negatively affected parents’ and young children’s well-being. These effects were above and beyond the the negative effects of the level of hardship that a family experienced.

This highlights that, in order to support parent and child well-being, it is critical to not only provide adequate financial resources and assistance but also to promote stable financial conditions.

One potential way that material hardship unpredictability affects well-being is by disrupting family routines, such as regular bedtime, morning activities, and having family meals together. Interruptions in regular family routines, in turn, were associated with more emotional distress among both parents and their young children. This finding is aligned with numerous other studies that highlight the role that family routines have played in maintaining well-being during the COVID-19 pandemic.

The good news is that we found parent-child quality time (as defined by parents themselves) lessened the weight of these challenges and served as a protective factor. Although disrupted family routines were linked to more emotional distress for both parents and children among families that reported less quality time spent together, disrupted family routines did not lead to elevated emotional distress among parents who spent more quality time with their children during the pandemic.

Money [is our biggest concern]. My husband was sick for three weeks and he’s self employed, so no money for a month. I really want to go back to work but there’s no daycare openings for three kids and the school closes too much for me to get a job. — Parent in Maine

Uncertainty about what comes ahead. No idea what our jobs will be, if we will have enough money, if we’ll get childcare, where we’ll live, what we’ll be able to do, and on and on. — Parent in Montana

We need to be able to keep our Medicaid healthcare. My husband got a $2 an hour raise which is potentially going to affect our health insurance. We CAN’T afford to pay for it on our own! We can barely get food for ourselves. — Parent in Pennsylvania

3. Families with young children experience disruptions to child care, while child care providers face increased hunger, hardship and disruptions to employment.

Families with young children who are seeking child care are experiencing difficulties finding care and disruptions to the child care arrangements. In the past year, with the launch of our RAPID provider survey, it has become clear that child care providers have been facing significant challenges also, in terms of their financial circumstances, work conditions, and disruptions to employment and work schedule due to COVID-19. These challenges are two sides of same coin, and are having negative effects on the well-being of child care providers, parents, and young children.

For families with young children, inability to find care and disruptions to their current child care arrangements are associated with increased emotional distress for both parents and their children. The percent of parents having difficulty finding child care peaked between January and February 2022 (43%) with the emergence of the Omicron variant. Additionally, parents who experienced difficulty finding care and/or disruptions in care indicated higher levels of emotional distress compared to those who did not experience child care difficulties.

For child care providers, rates of material hardship and hunger have remained high, with approximately one in three child care providers consistently reporting experiences of material hardship or hunger in the past year of the pandemic. Experiences of material hardship and food insecurity were particularly high among child care center teachers and family, friend and neighbor (FFN) providers. Moreover, one in four child care providers reported having at least one other job, and over 40% indicated that providing child care accounted for less than half of their income.

Child care providers have also reported challenges with unstable work schedules, staffing shortages, as well as frequent cancelations and closures. For example, in November 2021 we reported that nearly 60% of center- or home-based providers were experiencing staff shortages due to difficulties recruiting and retaining qualified staff. This was a significant increase from before the pandemic (36%). The reasons behind this trend include low wages, burn out, no or unsatisfactory benefits, health/safety concerns, and lack of child care for providers’ own children. Staffing shortages, along with the rising COVID-19 infection rates with the emergence of virus variants also led to high rates of child care closure and cancelation. Our data from both household and provider surveys show that the rate of closure/cancelation peaked at the beginning of 2022 with the emergence of the Omicron variant.

These financial and workplace challenges have affected child care providers’ well-being. Emotional distress levels among providers increased when they experienced 1) more material hardship, 2) more hunger, 3) more uncertainty/instability in their work schedule, and 4) more cancelation/closure. We also found a concerning trend that many (38%) providers were considering leaving the workforce or closing their child care programs. This would cause even more staffing shortages and recruitment/retention difficulties in the child care workforce, making it even more difficult for parents to find child care for their young children.

[My biggest challenge is] finances and the amount of stress I’m under at work. The schedule constantly changes and we’re understaffed. I work 10 hour days with no breaks. — Center teacher in Colorado

[My biggest challenge is] getting and paying for child care for my own school age child. Managing the extreme stress of keeping the child care center afloat and taking care of the teacher’s stress/emotional load while balancing with my own family’s needs. The work is 80 hours a week. I’m a single mom. This is too much, with my daughter unable to go to school 5 days/week. — Center director in Virginia

No paid sick leave, no paid time off, long hours, getting burnt-out, little pay. — Home-based provider in Minnesota

Many of these difficulties experienced by the child care workforce predate the pandemic and will likely continue with the ongoing possibility of new COVID-19 variants. Prioritizing stability for parents and children and supports for child care providers, including financial assistance and increased compensation, are essential to guaranteeing a functional child care system that adequately protects and uplifts its workforce and that allows parents to return to work and support their young children.

[Not having] stable, reliable daycare [is our biggest challenge]. Not being able to provide routine for my kids. Not being able to focus on paid work during the day and not juggling work and childcare at home. — Parent in North Carolina

My daughter is enrolled in daycare but the month of January has been one COVID closure after another. Today is January 20 and she has had a grand total of 4 days of daycare this month. — Parent in California

4. Long-standing structural inequalities have persisted and grown more acute during the pandemic.

Throughout the two years of RAPID surveys, we have observed consistent inequalities based on families’ income level, race/ethnicity, and family composition. These inequalities are long-standing and woven deeply into the structures that support children and families in this country. They existed prior to the pandemic and have widened since.

Not surprisingly, material hardship and hardship unpredictability were higher among lower-income households (i.e., below 200% federal poverty level; FPL) as compared with middle and higher-income households. When comparing families of different racial/ethnic groups, we observed that Black and Latinx families have not only experienced more material hardship than White families, but also had to cope with more hardship unpredictability. Similarly, single-parent households and families of children with disabilities reported higher levels of material hardship and hardship unpredictability compared to dual-parent households or families of children without disabilities.

There are similar disparities in emotional distress levels across these subgroups (although, notably, not in terms of race/ethnicity). In lower-income families, single-parent households, and families of children with disabilities, parents reported significantly higher levels of emotional distress than in higher-income, dual-parent households, or families of children without disabilities. These findings suggested that certain socio-demographically marginalized groups have been bearing a heavier load throughout the pandemic as a result of structural and systemic inequalities.

[My biggest concern is] medical coverage. I’m disabled but I’ve been kicked off disability for a while now. But I still need my medications. I got kicked off my parents insurance in March after turning 26. — Parent in Michigan

My biggest concern is to make sure that my child is having proper care and her future schooling will be good. We always remain tensed that she might face discrimination due to her race/ethnicity specially after the pandemic. — Parent in Utah

5. Amid these difficulties, parents and child care providers also focus on what has helped during the pandemic.

In spite of all the challenges discussed above, families with young children and child care providers have also shared what has been helping them cope with stress. Analysis of responses to the open-ended question: “What is helping you and your family the most right now?” show that both parents and providers identified external sources of support such as extended family, friends, and co-workers as helping the most. Parents of young children also indicated that flexible working arrangements, employment security, schools reopening, and maintaining daily routines were factors that further contributed to their resilience during this unprecedented time. Child care providers indicated that funding and grants from the government or social organizations have been major supporting factors. The top 10 most prevalent topics from parents and providers are presented below.

Top 10 factors that help families with young children

1. Support from family and friends
2. Emotional support
3. Flexible work arrangement
4. Spending time together
5. Partner’s employment security
6. School reopening
7. Child care help from grandparents/nannies
8. Outdoor activities
9. Receiving help from family, friends, neighbors, and government assistance
10. Stay busy & maintain daily routines

Top 10 factors that help child care providers

1. Current staff (in the child care center/programs)
2. Family and friends
3. No one is helping
4. Support from family members
5. State and federal grants
6. Child care support programs & other providers
7. Help from the government/state/tribes
8. Resources from government and social organizations
9. Center directors
10. Co-workers

Medicaid has made changing careers possible for me. Childcare scholarships have made an incredible preschool possible for our child. — Parent in New Jersey

Having paid parental leave at both our jobs [has helped us]. We would be much more concerned about the pandemic’s effects on our newborn if we had to enroll him in childcare now versus when our leave is up. — Parent in Maryland

A restoration grant saved my business! — Home-based provider in Illinois

My friendship with my co-teacher is the only thing keeping me going in this field at the moment. — Center teacher in Colorado

[What has helped me most is] I am a part of a national ECE directors group that meets weekly, and I have a small cohort of local directors with whom I can vent and share ideas. — Center director in Louisiana

Implications

Young children, parents and child care providers need ongoing social and economic support, not only to cope with the stresses brought about by the COVID-19 pandemic, but to be able to experience the stability that can help all children and adults thrive. As young children return to child care and preschool, special attention should be paid to the importance of social connections and family support. It is critical that the issues facing the child care system are addressed, so that all families can access child care when they need it and providers can experience economic stability, support their families, and continue to provide the attentive care that children and families rely on. As policies emerge to address these challenges, we should collectively turn to the voices of parents and child care providers to inform the path forward.

Looking ahead

We are continuing to field the national RAPID surveys. Many of the challenges and areas of resilience that we have observed during the two years of the survey pre-date the pandemic and will continue into the future. The RAPID surveys allow us to listen to families at frequent intervals and get a holistic view of the factors shaping the circumstances in which young children are developing and the impacts of those circumstances on the important adults in their lives. Through RAPID we have seen how children’s and families’ lives have changed in response to changes in the world around them. We will continue to use this tool to listen to and learn from parents and families as we move into the next phase of the pandemic and beyond. RAPID is an essential tool and resource for all of those working to better support children and families and the child care providers they rely on.

In addition to the national work, RAPID is expanding in several ways:

• Launching local surveys in communities, cities, and counties to provide actionable population-level data that can be used to support families, young children and the local programs, organizations and government agencies that work on their behalf.
• Launching state surveys to provide policy makers, systems leaders, and advocates with key information to facilitate allocation of funds to support children, parents, and the early childhood workforce.
• Partnering with measurement experts to add new content to RAPID in areas associated with child psychosocial development, family environment, and health.

RAPID is only one component of the collective impact work needed to achieve the full potential that the US early childhood ecosystem aspires to — of creating equal opportunity for all children, regardless of geography, economic circumstances, race or ethnicity.

About RAPID

RAPID surveys are designed to gather essential information continuously regarding the needs, health-promoting behaviors, and well-being of young children and the important adults in their lives. RAPID collects data monthly from 1,000 caregivers and 1,000 child care providers in all 50 states. The samples are large and the surveys are national in scope, however, the data are not technically representative of households with young children in the US. Additionally, the surveys are available in English and Spanish and can be taken on any device with an internet connection, but our samples are limited to those who have access to these resources and who speak English or Spanish. RAPID employs a unique data collection strategy and, as such, the data are a combination of cross-sectional and longitudinal. For more information about RAPID study design and methods, visit this page.

The following individuals contributed to this report: Philip Fisher, Joan Lombardi, Nat Kendall-Taylor, Sihong Liu, and Cristi Carman. We are also grateful to the RAPID National Advisory Council for input on survey content, data analysis and interpretation, and dissemination of results. We thank all of the families and early childhood care and education providers for their participation in the past two years of surveys.

Originally published at https://rapidsurveyproject.com on April 14, 2022.

Two Years in the Life of a Pandemic: Listening To the Voices of Parents was originally published in RAPID Survey on Medium, where people are continuing the conversation by highlighting and responding to this story.

From July to December 2021, millions of American families received monthly payments through an expanded Child Tax Credit (CTC). Throughout that period, we used the RAPID survey to collect data from 3,953 families with young children on their experiences with the CTC. Listening to this diverse sample of families (in terms of race, ethnicity, income, and geography) helps tell the story of how the CTC affected American families with young children. We now look back at these stories to explore families’ experiences with the monthly CTC payments before, during, and after their distributions.

June 2021: Households with young children were burdened with debt and overdue bills, and were looking forward to the monthly CTC payments helping them cover basic needs and pay off debt.

In June 2021, one of four families in our survey had unpaid debt and overdue bills. Fifty three percent of these families reported that they had more debt compared to before the pandemic. Black and Latinx families reported more debt compared to white families, which is likely a result of the increased financial uncertainty and material hardship that Black and Latinx families in the U.S. experience. Similarly, lower-income households (i.e. below 200% of the federal poverty level, or FPL), who account for 40% of the U.S. population, reported higher unpaid debt and overdue bills compared to their middle- (i.e. 200%-400% FPL) and higher-income (i.e. above 400% FPL) counterparts.

This rising debt during the pandemic was associated with parents’ experiences of emotional distress (a composite of depression, anxiety, stress, and loneliness symptoms). RAPID data has found a cascade of emotional distress among parents which is, in turn, associated with emotional distress among their children, as parents may be less able to consistently provide the nurturing care children rely on.

A high percentage of families (84%) in our national survey expected to receive the CTC payments. We found differences in the CTC expectation rate by race/ethnicity and income levels: fewer Black (80%), Latinx (79%), and lower-income households (85%) reported that they expected to receive the CTC payments than white (86%) or middle-income (91%) families.

The Center on Poverty and Social Policy at Columbia University estimated that the monthly CTC payments would reduce the number of children living in poverty by 45%. Our data aligned with this estimation. About half of the families with young children participating in our survey planned to spend the payments on basic needs, household necessities, or paying off debt.

In addition, one in four parents reported that they planned to put some of the payments into savings. Families’ plans on how to use the CTC payments again varied by race/ethnicity and income levels. Black (57%) and Latinx (57%) parents were more likely to use most or all of the payments to cover basic needs, household necessities, and debt than white parents (46%). And lower-income households (57%) were more likely to use the CTC payments in this way than were middle-income (44%) or higher-income (32%) families.

July 2021-December 2021: The CTC buffered families with young children from severe financial hardship.

Our surveys assessed families’ use of the monthly CTC payments from its initiation in July 2021 to December 2021 when the payments stopped. We found that the majority of families spent the payments on basic needs (e.g., food, housing, utilities; 55%) as well as unpaid bills and household essentials (including child care expenses; 52%). In addition, 38% of parents reported putting some of the CTC payments into savings for their children.

When comparing CTC spending in households of different sociodemographic characteristics, we saw significant differences. Three in four (73%) lower-income families used the CTC payments to meet their basic needs, and over half (57%) spent CTC on unpaid bills and other essentials, including child care expenses. These rates were lower among middle-income families (44% for basic needs; 50% for unpaid bills/other essentials) and lower still among higher-income households (28% for basic needs; 44% for unpaid bills/other essentials). In contrast, higher proportions of higher- (51%) and middle-income (42%) families put the CTC payments into savings for their children than lower-income (28%) households.

We also examined how the monthly CTC payments affected families’ experiences of material hardship. We found that the CTC effectively moderated material hardship and helped families maintain financial stability. In families that did not receive the CTC, rates of material hardship steadily increased between July and December 2021. In contrast, rates of material hardship since July 2021 remained stable among households that received the CTC. This buffering effect of the CTC was most pronounced among lower-income families.

January-March 2022: As the monthly CTC payments end, families with young children, especially lower-income households, face increasing financial challenges.

Policy makers chose not to extend the CTC and families received the last monthly CTC payment on December 15, 2021. As we have continued to survey families since that time, we have found that the majority of parents were aware that the monthly CTC payments had been discontinued (88%), and that they needed to file taxes this year to get the remainder of their increased 2021 CTC (90%). These rates were consistent across households of different race/ethnicity groups and income levels.

Given that the CTC payments can be distributed in two ways-through monthly payments and through a lump sum when filing taxes-we were also interested in parents’ preferences for receiving this tax credit. Two in three (66%) parents of young children preferred the monthly payments over a lump sum. This is not surprising considering that families with young children have also been challenged with high degrees of financial unpredictability during the pandemic.

In the face of week-to-week and month-to-month changes in employment, income, and material hardship, it seems that monthly CTC payments can better help households with young children consistently meet basic needs and maintain financial stability.

The ability to consistently provide basic needs for one’s family is a protective factor for parents’ and their children’s emotional well-being. Our data suggest that greater predictability in ability to meet basic needs is significantly associated with increased emotional well-being among both parents and their children.

This winter (2022), to more deeply explore the impact of discontinued monthly CTC payments on households with young children, we analyzed parents’ responses to the open-ended survey question “How would it impact your family’s financial situation if Congress decides not to continue the monthly Child Tax Credit payments?” The topics that emerged from parents responses highlighted the negative impact of the discontinuation of the CTC on families. The three most prevalent topics named by parents included “negatively affect financial situations,” “make it difficult to pay bills,” and “decrease savings for children.”

Moreover, we observed significant differences in responses between families of different income levels, indicating the existence of structural inequalities. The bar chart below shows the frequency with which specific topics occurred in the responses of lower- vs. middle-/higher-income households, controlling for the effect of race/ethnicity. As the figure shows, the main challenges brought by the discontinuation of the monthly CTC payments for lower-income households are directly related to financial hardships and meeting basic needs, whereas for middle- and higher-income families, the primary impact is on reduced savings.

In summary, findings from RAPID’s national surveys suggest that the monthly CTC payments played a critical role in reducing families’ financial hardship and helping households meet their basic needs. The data also show that the discontinuation of CTC payments has had a negative impact on families with young children. It is also clear that, because of inequities long-built into our structures and systems, the positive impacts of the monthly CTC payments were more profound among Black and Latinx families, as well as lower-income households with young children. Since the monthly CTC payments have been discontinued, these families are again experiencing difficulty paying for basic needs.

What parents are saying

The CTC has helped us to be in a position where we aren’t just surviving. We could actually provide our kids with fun recreational activities that they had been missing.
- Connecticut parent

It would have a negative impact [if the Child Tax Credit is discontinued] and make our lives more difficult as we are struggling to maintain our finances with it. We will have to make even more sacrifices than we already have, especially as prices continue to go up.
- Nebraska parent

Losing the Child Tax Credit has already impacted our family. We used the CTC for food, clothing, bills or other necessities needed for the month. Now that it has been discontinued we no longer have a cushion if we need more food or have an unexpected bill.
- New York parent

The CTC payment was allowing us to pay our car payment. Now without it we are struggling and are going to be late on rent because we are struggling to pay for both our car payment and rent. We are in a free fall.
- Pennsylvania parent

The CTC payments have been helpful for getting food, paying for school [and] keeping up with bills. To not have it this month has us scrambling to find side jobs or extra work to cover everything.
- California parent

Originally published at https://rapidsurveyproject.com on April 14, 2022.

How the Child Tax Credit Affected Families with Young Children was originally published in RAPID Survey on Medium, where people are continuing the conversation by highlighting and responding to this story.

By Joan Lombardi, Ph.D.

1971 was the year I started my first job. It was the year that featured movies like Clockwork Orange and Willy Wonka and the Chocolate Factory. It was the year the first e-mail was sent, the year Elon Musk was born and the year President Nixon vetoed the Comprehensive Child Development Act, setting public financing of child care in the United States back for years to come.

Women were expected to stay home full time, but most did not. The decades passed: 1981, 1991, 2001, 2011… The need for child care grew. The debate about the role of public support for child care continued. Yet despite some legislative action over the years, the vast majority of families were still left on their own to cover increasing costs.

Families were forced to use an old path when their lives needed a highway.

The facts piled up:

• In 40 states and the District of Colombia, the annual price of child care for two children exceeds annual mortgage payments for homeowners.
• 83% of parents with children under 5 say that finding affordable child care is a challenge.
• The medium annual income of child care providers before the pandemic was only $24,230, around $11.65 per hour.

Then the pandemic hit.

Families were forced to leave work as schools and child care closed. The realities that parents need public support for child care came into focus. Temporary funding was provided, but the need for child care financing is not temporary. Caregivers were called essential but their paychecks do not show it. Benefits for child care providers remain sporadic despite the growing health risks.

The voices of families and caregivers are more important than ever. Thousands of parents responding to the RAPID-EC national survey of households with children under age 5, conducted by the University of Oregon since the beginning of the pandemic, have shared their personal reflections on the importance of child care in their lives and the lives of their children. As one parent simple put it: Our biggest concerns are paying our rent and getting child care while we are working.

The children of 1971 are now all grown up; they have children and even grandchildren of their own. Fifty years is long enough to wait. Parents need time off, they need good jobs that pay adequate wages, they need social and economic supports, and they need quality child care. They need this endless debate to stop. In order to return to work parents need a place where their children can learn and thrive. This should not be an American dream, but an American reality.

It is summer and baseball is back. We’ve played a full nine innings and the score is tied. Proposals to build a stronger child care system have emerged with the potential for real change. We are moving into extra innings, and it is time to rally. It is time to bring this one home for families once and for all.

Joan Lombardi, Ph.D. served as the first Director of the Child Care Bureau launched in l995 (now the Office on Child Care) and is the author of Time to Care: Redesigning Child Care to Promote Education, Support Families and Build Communities (Temple University Press, 2003). She Chairs the National Advisory Team for the RAPID-EC national survey.

Sources

The US and the High Price of Child Care An Examination of A Broken System, 2019 Report, Child Care Aware of America

Affordable Child Care and Early Learning for All Families, A National Public Opinion Study, Center for American Progress, September 2018

The Early Childhood Workforce Index 2020, Center for the Study of the Child Care Employment

Child Care: The time has come to bring this one home for families was originally published in RAPID Survey on Medium, where people are continuing the conversation by highlighting and responding to this story.

This Sunday we all need to take a minute to acknowledge how hard mothers have been hit by the pandemic.

Nearly four times more women than men have lost jobs since the beginning of pandemic and data suggest that it’s been worse still for working mothers.

While the media has reported extensively about these gender differences, the way they have been advancing these data and statistics is misrepresenting the problem and distracting us from necessary policy actions.

There is a dominant frame — a way of positioning the issue — that has been circulating about women and work during the pandemic.

The “women leaving the workforce” frame presents the issue as being about mothers choosing to forgo work and wages. Precious little of our public discussion has framed this issue as one in which women are being forced to leave the workforce because of downsizing, layoffs, or a lack of available childcare. Headlines abound about women “contemplating leaving,” “dropping out” of the workforce, or “preferring to stay at home.”

The choice frame was most apparent in media profiles about the “workforce exodus.” For example, a Time magazine article told the story of a woman who “left her six-figure marketing job at a financial services firm” and had “mixed feelings about her decision.” We heard a lot about middle- and upper- class women who can afford to leave the workforce and who have mixed emotions about leaving their jobs.

But when we actually listen to women it becomes clear that, in most cases, choice has got nothing to do with it.

Recent research conducted by the RAPID-EC project at the University of Oregon shows that over a third of women surveyed were forced to leave the workforce or reduce their hours and 82 percent of the women who left the workforce could not afford to do so. Women who were forced to leave their jobs, whether they said they could afford it or not, reported higher levels of distress than women who were not forced. And importantly, so did their kids. This is hardly the media’s picture of women “deciding” to take a break from the workforce to spend more time with their young children.

Framing the stats around women and work during the pandemic as matter of “leaving” or “choice” does not reflect reality. And without adequate attention to the forces shaping women’s decisions, this kind of coverage clouds our thinking about what we need to do to address the issue with public policies, like pay equity or workplace policies that account for the needs of working mothers.

We could tell the story another way. We could focus on gross pay inequities prior to the pandemic that have forced mothers rather than fathers to leave their jobs. We could continue to highlight the “double shift” or how working women take on the vast majority of caregiving responsibilities in households so that they are the ones who have to leave the workforce. Or we might tell a story of a generalized de-valuing of women’s labor that has made them expendable in times of economic crisis.

Sunday is set aside as a day to honor mothers. One way to do this is by changing the ways we talk about mothers and work. We need to stop talking about the choices they have made to leave the workforce and start talking the forces and reasons that have pressured and led to those decisions. We need to widen the lens and focus on the factors that policy makers can address to get women back to work.

Biden’s families act will increase the affordability, quality, and reliability of childcare. This is a step in the right direction, and we need to go further. We need to uplift the value of having mothers in the workplace and the importance of creating workplace policies and childcare infrastructure that enables their full contribution — to their places of employment and to our country.

Guest Post: When We Talk About Mothers and Work During the Pandemic, Words Matter was originally published in RAPID Survey on Medium, where people are continuing the conversation by highlighting and responding to this story.

by Philip Fisher, PhD, Joan Lombardi, PhD, Nat Kendall-Taylor, PhD

One year ago last week, we wrote our first posting on data from the RAPID-EC national survey of families with young children. Even in this time of chaos and uncertainty, there was a set of ideas that were clearly emerging.

• The unfolding global pandemic was unlike anything any of us had ever experienced.
• Building on extensive prior research showing that early life experiences shape the architecture of the developing brain and other biological systems, we knew that the stress and adversity that accompanied the COVID-19 pandemic would have important effects on infants and young children.
• We could tell that voices of families with young children were not being heard, and that gathering and rapidly disseminating high-quality data about their experiences was essential to inform policy decisions, resource allocations, and service delivery. With a team that brought together science, advocacy, and communications perspectives on child development, we were in a unique position to gather and disseminate these data.
• The situation was evolving and changing rapidly and that it was necessary to gather data at very frequent intervals.

We are deeply grateful to the families who have shared their stories with us over the past year, to our team members who have gathered, analyzed, and disseminated the data, and to our many partners in policy, advocacy, research, and philanthropy who have contributed their expertise to the project.

To date there have been 54 RAPID-EC online surveys and 10,707 families across all 50 states who have participated. These families are diverse in terms of race/ethnicity, income, and family structure. They have contributed to an extensive and growing one of a kind quantitative dataset, and given voice to their experiences in over 140,000 responses to open-ended questions. The RAPID-EC survey has helped tell the story of American families with young children during this remarkable time.

Many of the issues that we have seen affecting families over the last year predate the pandemic and will remain once infection rates fade out and masks come off. These are issues that have long-demanded but not received adequate attention. They are issues that we must keep in focus during the recovery period and beyond. The RAPID-EC team will be continuing to survey families with young children, and adding to their voices, those of child care providers, but in this posting, we look back at three overarching findings from the first year of the survey.

1. The pandemic has made it difficult for many families with young children to pay for basic needs, which has had negative effects on caregiver and child wellbeing.

In the past year, the RAPID-EC survey showed that the pandemic has caused a “chain reaction of hardship” for many families with young children. Throughout the pandemic a very large proportion families with young children have been experiencing some form of material hardship (i.e., difficulty paying for basic needs like food, housing, and utilities): consistently throughout the past year, no less than 1 in 4 households with young children and at many times as many as one in 3 were experiencing such hardship.

We found that this material hardship is affecting family wellbeing. We measured emotional distress in adults as a composite of depression, anxiety, stress, and loneliness (on a 1–100 scale); and emotional distress in children as a composite of fearfulness/anxiety and fussiness/defiance (also on a 1–100 scale). As the severity of material hardship increased, so did emotional distress in both parents and children.

Looking across our weekly surveys we saw that the relationship between material hardship and emotional distress unfolded in a predictable way: parental reports of material hardship in any given week were associated with increased adult distress in subsequent weeks, and adult distress was, in turn, associated with increased child distress in the weeks that followed. We have described this effect as the “chain reaction of material hardship.”

We also found that emotional support was a powerful buffer against this chain reaction: adults who reported high levels of emotional support were less likely to be negatively affected by material hardships. When caregivers had emotional support it also protected their children from the negative effects of material hardship.

In the recent months we have seen another promising finding. As two stimulus payments became available between February and March, the proportion of families reporting material hardship has fallen back to levels seen in the early days of the pandemic. Importantly, for families whose financial circumstances improved during this time, there has been a corresponding decrease in emotional distress. Although we cannot discern from our data whether there is a causal relationship between these trends, it is promising that both indicators are moving in a positive direction. It will be important to determine if these recent trends continue, stabilize, or reverse as more time passes. RAPID-EC will be gathering information on this topic in the coming weeks and months in order to answer these questions.

Importantly, these recent trends should not obscure the fact that currently one in four families with young children — or about 3.6 million families in America — still cannot pay for basic needs and experience the resulting challenges to caregiver and child wellbeing.

Overall, we have seen that increases in material hardship negatively impact caregiver and child wellbeing, but also that this cascade can be stopped and reversed when families with young children have the support they need.

2. Long-standing racial inequality in families with young children has increased over the last year

The second fact that has consistently stood out in the RAPID-EC data and in other data is that structural inequalities based on race/ethnicity, which are long-standing and were well-documented prior to the pandemic, have gotten worse during the pandemic. For example, across the entire first year of the survey, Black and Latinx families have experienced significantly higher rates of material hardship than White families, and more Black and Latinx households that were middle/upper income before the pandemic have been experiencing hardships than White families in these same income levels. Indeed, during many weeks of the survey the proportion of Black and Latinx families unable to pay for basic needs was twice that of White families.

Not only have Black and Latinx families experienced more material hardship than White families during the pandemic but the differences between these groups has grown wider during this time. Notably, for Black households, this trend may be coming to an end; whereas it appears to be continuing for Latinx households, perhaps owing to greater barriers and worries associated with accessing governmental pandemic financial relief.

One finding of particular concern is that, compared with White families, a significantly larger proportion of Black and Latinx families who had been of middle/upper income prior to the pandemic, experienced difficulty paying for basic needs during the pandemic. Other research has documented differences in wealth between Black and White households earning similar incomes; as a result of our country’s history of structural racism. Black families also face challenges in accumulating wealth that their White counterparts do not. Differences in wealth along with a greater tendency to be supporting extended family members, and less secure jobs help explain why Black families at middle and upper income levels experienced greater levels of material hardship than White families of similar income levels during the pandemic.

These structural inequalities were also seen in our analyses of responses to the open-ended question, “What are the biggest challenges that you and your family are facing during the pandemic?” The bars below show the relative frequency with which specific topics occurred in responses offered by Black as compared to White respondents, after controlling for income. As the figure shows, Black and White families have experienced the pandemic in very different ways. For White families the primary challenges have been around social deprivation, whereas for Black families the primary challenges have been meeting basic needs.

It is clear that, because of inequities long-built into our structures and systems, Black families have born a heavier load during the pandemic and that the stress and challenges of the last year have only widened differences between the experiences of White and Black families with young children.

3. The Pandemic has Placed Extra Weight on Families with a Child with Special Needs

Our data, and other reports, have also shown that families with a child with special needs, in which numerous economic and social disparities were documented prior to the pandemic, have experienced disproportionately greater challenges in many domains over the course of the pandemic. These families have also had less access to social and emotional supports than other families.

For example, special needs households experienced higher rates of material hardship than other households, perhaps in part due to higher expenses associated with caring for a special needs child. Rates of emotional distress for both parents and children in special needs households have also been consistently higher throughout the pandemic. In addition, there are healthcare disparities between these and other households: 50% of special needs children missed a well-baby or well-child visit, significantly more than the 39% of other households. Also, one in four children with special needs (significantly more than other children) also did not receive routine vaccinations or preventative well-child visits.

This is especially concerning for families with children with special needs where such services are essential for monitoring of developmental progress and assuring referrals for early intervention services.

In addition, while other families may have been able to access and benefit from virtual services, it is well-documented that remote service delivery for children with special needs is challenging and not optimally effective. It is thus our expectation that children with special needs will benefit from additional support and access to in-person services in the aftermath of the pandemic.

Looking forward

Although the RAPID-EC survey was born out of the need to hear the voices of families with young children during pandemic, the story lines in our data are rooted in longstanding challenges that American families with young children faced prior to the pandemic. The pandemic did not cause these issues to arise, but rather has pressurized and thrown them into relief in a way that commands the attention of the general public and its policy makers. As we look ahead to the second year of the survey and beyond, our team is focused on extending the survey in three ways:

1. Focus on key issues related to early childhood policy and programs.

We are examining four areas where emerging federal, state, and local policy are focusing. These are pillars of stability and wellbeing that all families need to thrive. Our recurrent survey will allow us to track the impact of policies on these areas of wellbeing across time.

• Financial stability and relief from material hardship
• Access to integrated child and family services to promote health, behavioral health, housing, education
• Adequate emotional support from both formal (e.g., child care, home visitation) and informal (family, friends, and other community members) sources
• Time to focus on health and wellbeing, including paid sick leave and personal time, paid vacation time, and maternity/paternity leave

2. A new recurring survey of child care providers (RAPID-CC).

It has become apparent in our RAPID-EC survey data and in information from other sources that the recovery from the pandemic, and more generally the wellbeing of young children and families in the US, is inextricably tied to child care. Families need child care so that they can return to work, and this care needs to be high-quality, safe, and flexible; and, employers need child care so that their employees can return to work. In this country, child care comes in many types: Home and center-based, regulated and unregulated formal care, and many types of informal care provided by family, friends, and neighbors.

In March of 2021, we launched the first in what will be recurring bi-monthly RAPID-CC surveys of child care providers, which will parallel our RAPID-EC surveys. The RAPID-CC surveys will fill in some of the information gaps related to how providers are faring, what they need to be successful, and whether there are subgroups based on location (rural vs. urban), race/ethnicity, and other demographics, with different needs and assets.

3. Local and other targeted surveys.

Although many of the policy decisions that will impact households with young children will be made at the federal level, the implementation of these policies (and related systems and programmatic-level changes) will occur at state, county, and community levels. As such, we are planning to initiate partnerships that will allow for surveys to be carried out in local contexts with representative participation from specific communities. In this way, the RAPID surveys will become a tool for including family and provider voices in understanding the evolving needs of households with young children and the immediateecosystems in which they exist. We also plan to oversample from specific subgroups in which disparities and inequalities continue to exist, including Black and Latinx households and providers, households with a child with special needs, and other groups.

As we enter the second year of RAPID, we recognize the power of hearing from parents of young children and child care providers. They have faced circumstances that few anticipated and have made the wellbeing of children their top priority, often risking their own health in doing so. As we continue our work, our goal remains the same: elevate their voices and celebrate their efforts.

A Year in the Life of a Pandemic was originally published in RAPID Survey on Medium, where people are continuing the conversation by highlighting and responding to this story.

Overloaded: Families With Children Who Have Special Needs Are Bearing an Especially Heavy Weight, And Support Is Needed

Due to the pandemic, families with children who have special needs are experiencing interruptions in healthcare and decreased social support.

My 5 year old has autism and a speech delay. He has regressed so much. Teletherapy simply did nothing for him and even though his teachers and therapists tried so hard to engage him via video chat it simply didn’t work. ~RAPID-EC parent from New York

I am concerned about my youngest getting medical care. He has special needs and has limited physical therapy due to COVID. He also is supposed to be having surgery in the near future and I worry it may be delayed because of a COVID spike. ~RAPID-EC parent from Minnesota

They need to send out more money. They don’t realize the impact this has on families with special needs children. When daycare programs are closed and the special needs school program is only opened two days a week, and you can’t find someone to watch your child while you work, you can’t earn the money to pay the bills. We need more support with housing. It’s impossible sometimes. ~RAPID-EC parent from Georgia

This week we focus on households with one or more children with special needs. We look in particular at how and why the pandemic has interrupted children’s healthcare in these families. We also examine the social supports available to these families and potential consequences of the weight that COVID is putting on caregiver and child mental health.

Key Findings

• Children with special needs are going to fewer wellness visits and receiving fewer vaccinations than other children.
• Caregivers of children with special needs have fewer social supports than other caregivers.
• Both caregiver and child mental health is suffering in families with a child with special needs, with no signs of improving as the pandemic continues.

Background

In this week’s RAPID-EC posting we focus on families with a child with special needs. In one of our first postings last May, we noted that parents who have a child with special needs were experiencing more anxiety, depression, and loneliness during the pandemic than other parents, and that children with special needs were experiencing more emotional distress. Similar findings about the difficulties families with a child with special needs are experiencing have been reported elsewhere. Notably, these trends existed prior to the pandemic, when services were more available and accessible, but the stresses and strains of the pandemic have added to the challenges and burdens that these families are facing.

The pandemic continues to severely limit social supports and access to services that families with a child with special needs rely upon. The situation has become so dire that some families have filed lawsuits to obtain the services they need. To evaluate how the pandemic is impacting families with children with special needs, we looked at data from our RAPID survey related to both caregivers’ and children’s mental health and levels of social support. We also analyzed data about child wellness visits (an especially important touch point for screening as well as evaluation of developmental progress for children with special needs) and vaccinations. We looked specifically at which visits children are missing and why. In all of these analyses, we compared responses from caregivers who have children with special needs to responses from other caregivers. The data below are cumulative from April 6 through November 19th. Our results are as follows:

Households with a child with special needs have lower levels of social support and emotional well-being than other households.

• Caregivers who have children with special needs report lower levels of social support than others.
• Caregivers who have children with special needs are experiencing significantly more emotional distress, which has been consistent since April.
• Children who have special needs are also experiencing significantly more mental health problems (fussiness/defiance and fear/anxiety) than other children, which has also been consistent since April.

Children with special needs are also receiving less preventive healthcare than children without special needs.

• Children with special needs missed significantly more preventive health care visits (36% vs. 28%) and vaccinations (14% vs. 10%) than other children in the survey.

In particular, children with special needs ages 3–5 attend significantly fewer preventive healthcare visits than other 3–5 year olds.

Caregivers of children with disabilities report more structural barriers to accessing healthcare than caregivers without children with special needs.

• Concerns about catching COVID-19 was the single biggest reason for not attending preventive healthcare visits for all families. Over 80% of all caregivers reported that this as a reason for missing a visit. This was equally true both for households of children with special needs and other households.
• However, more than other families, caregivers of children with special needs reported that a number of other structural barriers were keeping them from attending preventive healthcare visits. These barriers included cost, inability to take time off work, lack of childcare, and needing to care for family members more frequently than other caregivers.

Implications

After 9 months, the disruptions to daily life caused by the pandemic have made life difficult for everyone. In households with young children, working from home, lack of childcare, distance learning, and other structural barriers have created an even heavier weight to bear and have made life particularly difficult.

Not surprisingly, given the well-documented day-to-day stresses and increased isolation, families with a child with special needs in our survey appear to be having an especially difficult time. They report having less access to social support than other families in our survey. The emotional well-being of caregivers with children with special needs is also suffering. We have seen that this caregiver distress can trickle downstream to children. It is therefore not surprising that we are also seeing negative patterns of mental health among children in these households.

On top of these implications for mental health, the missed preventive healthcare visits and vaccinations for young children with special needs will likely result in more negative health consequences as time goes on. Delaying childhood wellness checks and vaccinations could mean missing early developmental screenings, increased risks of contracting deadly childhood illnesses, and less access to resources to support healthy child development.

Without regularly scheduled healthcare visits, caregivers are likely to have significantly limited access to the established therapies that will lead to optimal outcomes for their children over time. While a child may have special needs that can be well managed through pre-pandemic standards-of-care, if caregivers can’t access this care, their children miss out on these supports and may regress in terms of key childhood milestones.

Recommendations

Caregivers in our survey who have children with special needs said the following when asked what their local policymakers and officials could do to help:

Think about families with kids who have special needs. They have a hard time dealing when schools shut down. Also, school is a respite for both the child and the families.

[Provide] affordable and safe childcare support and programs for special-needs children.

Send out more money. [Officials] don’t realize the impact this has on families with special needs children.

Along these lines policy makers must take the following actions:

1. Provide the funding needed to increase direct supports for children with special needs, in order to assure their health and overall well-being
2. Increase the availability of social emotional and mental health supports for families who have children with special needs, including expanded funding for home visiting
3. Increase funding for respite services for families with children who have special needs

In addition to these actions, innovative strategies are desperately needed to increase access to early childhood special education services for children with special needs and their families.

Existing technology-based solutions that may be adequate for others, such as online learning, may not be effective for many children with special needs. This only adds to the burden being placed on parents to supplement conventional services, increasing both stress and isolation.

Coming together to acknowledge the extra burden that families with a child with special needs are experiencing, providing resources to make it through the pandemic, and supporting children with special needs and their families emotionally puts us all on a path to a better future.

Additional Readings

“The Forgotten Households,” Center for Translational Neuroscience.

“How COVID-19 Has Affected Special Education Students,” TuftsNow.

“Children with Special Health Care Needs,” kidsdata.org.

“The Pandemic’s Toll on Children With Special Needs and Their Parents,” The New York Times.

“The Pandemic Is a Crisis for Students With Special Needs,” The Atlantic.

“Families Of Children With Special Needs Are Suing In Several States. Here’s Why.” NPR.

“Under the Same Roof, for Better and for Worse,” Center for Translational Neuroscience.

“Returning to Care…But Worried,” Center for Translational Neuroscience.

“Something’s Gotta Give,” Center for Translational Neuroscience.

“A Hardship Chain Reaction,” Center for Translational Neuroscience.

“Health (Still) Interrupted: Pandemic Continues to Disrupt Young Children’s Healthcare Visits,” Center for Translational Neuroscience.

“Social Isolation Among Families Caring for Children With Disabilities,” NCBI.

About the project

When the COVID-19 pandemic emerged last winter, there were over 24 million children age five and under living in the United States. This period of early childhood is a critical window that sets the stage for health and well-being across the lifespan. As such, it is essential during the current health and economic crisis to listen to the voices of households with young children.

The weekly survey of households with children age five and under launched on April 6, 2020. Since then, we have been gathering weekly data about child and adult emotional well-being, financial and work circumstances, availability of healthcare, and access to child care/early childhood education.

These analyses are based on responses collected from 8,390 caregivers between the dates of April 6th, 2020, and November 19th, 2020. These caregivers represent a range of voices: 8.50% are Black/African American, 16.77% are Latinx, and 29.26% live at or below 1.5 times the federal poverty line. There were 12.51% of families having at least one child(ren) with special needs. Proportions/percentages are calculated based on the item-level response rates, not out of the total sample size. The data for these analyses are not weighted.

We will continue to report on these issues as we learn more from each new weekly survey. We will also be producing policy briefs that make concrete recommendations about how to address the challenges we are seeing emerge from the family surveys.

Our goal is to use what we are hearing from families to improve the well-being of all households with young children, during the pandemic and beyond.

Suggested citation

Center for Translational Neuroscience (2020, December 17). Overloaded: Families With Children Who Have Special Needs Are Bearing an Especially Heavy Weight, And Support Is Needed. Medium. https://medium.com/rapid-ec-project/overloaded-families-with-children-who-have-special-needs-are-bearing-an-especially-heavy-weight-4e613a7681bd.

Overloaded: Families With Children Who Have Special Needs Are Bearing an Especially Heavy Weight… was originally published in RAPID Survey on Medium, where people are continuing the conversation by highlighting and responding to this story.

American Families are struggling to afford food and being forced to decide which basic needs they can afford and which they will go without this holiday season.

As we enter the holiday season, millions of American families with young children are feeling the weight of the economic effects of the pandemic. Many are struggling to afford food and are being forced to decide which basic needs they will pay for and which they will go without. The following are some of their voices.

Just because many policy makers have never had to deal with being unable to afford childcare or worrying about access to high quality food or transportation, or choosing between affording rent or medical care, doesn’t mean these problems don’t exist. There is no way any parent who is dealing with this pandemic head on can “pull themselves up by their bootstraps.” We need systems at a state or federal level in place, not just individuals in a community who care. ~ Oregon parent

We are having issues making sure bills are paid. We have had to choose between food, vehicle, or internet for my job. ~ Tennessee parent

We are running low on food. I got paid last week. That was enough to cover my bills. We have a low, low budget for food and are looking for food pantries. ~New York parent

I have $150 left to pay bills and buy food for a family of five for the next two weeks. ~Mississippi parent

There are a lot of places money needs to go and the pandemic has decreased what is coming in. However, the amount needing to go out has not decreased! Food prices are going up and cheaper options are not always available. ~Kansas parent

We are losing our SNAP benefits at the end of the month. They have been a huge support. I am concerned for what this will mean for our food in the future. ~Ohio parent

We’re constantly running out of diapers, wipes, and food. Our rent has been late twice now and it’s actually still not paid for this month since I didn’t get my Families First stimulus check which is only $277 a month… that doesn’t last long. ~Tennessee parent

The cost of food is insane. ~Florida parent

Food goes so quickly. My son’s school offers free lunch but it’s during his school hours and he can’t be left at home alone so I can go get the lunch. ~Arizona parent

Most of the time we have just enough money to pay all the bills and have enough left over for food for the month. If my partner works a lot of overtime, we don’t really struggle, but on months that he does not get much overtime, we hurt. ~Oklahoma parent

In two weeks, the free lunch program that our local school runs will stop. The lunch program helped keep food in the house for my son to eat. When it ends for us, I am not sure what the future holds. I relied on it too much. ~Ohio parent

We are struggling to pay rent and food. Often I have to pull from our credit cards to make ends meet. ~California parent

We are worried about having enough food to feed all of our children 3 meals a day. ~Rhode Island parent

What do our data show about the prevalence of hunger?

Hunger among American families did not arrive with the pandemic; it is a longstanding problem with a prevalence that might surprise those unfamiliar with the topic. For example, 11% of all individuals in a 2019 general population survey reported experiencing hunger. In the same survey, significantly higher rates of hunger were reported among Black and Latinx-headed households, single-parent households, and lower income households.

It is also important to acknowledge that hunger in America will not vanish once a vaccine for COVID-19 becomes widely available and the coronavirus is under control. Rather, hunger is a longstanding issue with deep systemic roots that will continue to require the attention of policymakers long after the end of the pandemic.

Nevertheless, there is extensive evidence that since the beginning of the pandemic families are experiencing unprecedented levels of financial and material hardship.

It is estimated that one in six Americans — 54 million — have experienced hunger at some point during the pandemic.

As such, it is important understand how hunger is affecting families with young children. In order to examine this issue, we asked parents in our RAPID nationally representative survey of households a set of questions that were developed by the US Department of Agriculture (USDA):

1. The food that we bought just didn’t last, and we didn’t have money to get more.
2. We couldn’t afford to eat balanced meals.
3. Did you or other adult in your household ever cut the size of your meal or skip meals because there wasn’t enough money for food?
4. Did you ever eat less than you felt you should because there wasn’t enough money for food?
5. Were you ever hungry but didn’t eat because there wasn’t enough money for food?

Overall, our data show that hunger [1] was already a problem for many families with young children before the pandemic, with one in five parents in our survey reporting that hunger was an issue in their household pre-pandemic. This number is substantially higher than the total of 6.5% of children across age groups that was reported in the aforementioned 2019 survey. Although we cannot be certain of the reasons for this difference, the discrepancy between prior surveys of children 0–18 and our survey of children in the more limited range of birth-age five suggests that households with young children may be especially vulnerable to issues of food insecurity.

Our data further reveal that hunger has increased significantly during the pandemic — 28% of parents in our survey now report being food insecure.

Not surprisingly, rates of hunger are much higher for families at or below 1.5 times the federal poverty income guidelines for family size — 49% of these families are currently experiencing hunger. However, hunger has also increased significantly for families that were middle/upper income before the pandemic, increasing from 13% to 20%.

Hunger is significantly higher for Black and Latinx households in our survey than for White households (39%, 33%, and 25%, respectively). It is also higher in single-parent households than in dual-parent households (43% vs. 26%), and in households with a child with special needs relative to others (42% vs. 26%).

As with the overall rates of hunger among those in our survey, the rates of hunger in the above subgroups are higher than in surveys that have examined children 0–18 years of age. The elevated rates in these subgroups points to structural racism and social inequalities.

Food insecurity is affecting both child and parent well-being

In terms of child well-being, caregivers in families experiencing hunger reported significantly higher levels of children’s emotional distress, compared to those not experiencing hunger. Caregivers in families experiencing hunger also reported significantly higher levels of both fussiness/defiance and fear/anxiety in their children.

In terms of their own well-being, caregivers in families experiencing hunger reported significantly higher levels of overall emotional distress. They also reported significantly higher levels of depression, anxiety, loneliness, and stress, compared to caregivers in families not experiencing hunger.

As we have reported previously, hunger is causing a “chain reaction of hardship.” In our longitudinal data, families who meet the USDA cutoff for food insecurity subsequently report increases in adult distress, which is in turn driving increases in children’s emotional distress across weeks of the survey.

As developmental scientists and child advocates, we know that hunger and the distress it causes are unhealthy, and have the potential to lead to lasting impacts on child physical health and emotional well-being. This is unacceptable, especially since it can be prevented through policy actions that provide families with cash to buy food, and with public assistance programs such as pandemic SNAP to purchase food.

Recommendations

The primary responsibility for addressing hunger and other forms of financial hardship associated with the pandemic falls to policy makers.

1. Policy makers must listen to the voices of families with young children, some of which are represented here, and fulfill their moral and ethical role as elected and appointed leaders. They cannot continue to ignore the weight that families are bearing.
2. Especially in light of the months that have passed since the CARES Act that provided pandemic relief and protections to millions of Americans expired, it is essential that federal policy makers invest in a package of financial supports for households with young children, and that state and local governments expedite the delivery of relief to families in need with the utmost haste.

Ultimately, these issues transcend the pandemic — they were present before and will remain after the virus is under control. Nevertheless, as with many other issues, the pandemic has amplified issues of hunger in all families and exacerbated preexisting disparities across racial/ethnic and income groups. Because of this, the general public must hold policy makers accountable and demand that they provide the supports necessary so that no families in this country face hunger.

In addition, as we press for policy makers to attend to these critical issues, those with the means to do so may wish to take individual action. Tuesday, December 1st is Giving Tuesday, a day of global generosity intended to transform communities in positive ways. There are many ways to help support those in need during this time. One of the most straightforward is to donate to your local food bank. Resources for doing so can be found at the website of the national non-profit organization Feeding America.

[1] Note: We define hunger based on a USDA-established cutoff score on the above questions.

Additional Readings

“Hunger in America,” Feeding America.

“The Impact of the Coronavirus on Food Insecurity in 2020,” Feeding America.

“Reframing Hunger in America,” FrameWorks Institute.

“Household Food Security in the United States in 2019,” USDA.

“The COVID-19 Pandemic Is Straining Families’ Abilities to Afford Basic Needs,” Urban Institute.

“54 million people in America face food insecurity during the pandemic. It could have dire consequences for their health,” AAMC.

“Food Insecurity In The U.S. By The Numbers,” NPR.

“A Hardship Chain Reaction,” Center for Translational Neuroscience.

About the project

When the COVID-19 pandemic emerged last winter, there were over 24 million children age five and under living in the United States. This period of early childhood is a critical window that sets the stage for health and well-being across the lifespan. As such, it is essential during the current health and economic crisis to listen to the voices of households with young children.

The weekly survey of households with children age five and under launched on April 6, 2020. Since then, we have been gathering weekly data about child and adult emotional well-being, financial and work circumstances, availability of healthcare, and access to child care/early childhood education.

These analyses are based on responses collected from 2684 caregivers between the dates of August 10th, 2020, and November 5th, 2020. These caregivers represent a range of voices: 7.71% are Black/African American, 15.95% are Latinx, and 26.19% live at or below 1.5 times the federal poverty line. Proportions/percentages are calculated based on the item-level response rates, not out of the total sample size. The data for these analyses are not weighted.

We will continue to report on these issues as we learn more from each new weekly survey. We will also be producing policy briefs that make concrete recommendations about how to address the challenges we are seeing emerge from the family surveys.

Our goal is to use what we are hearing from families to improve the well-being of all households with young children, during the pandemic and beyond.

Suggested citation

Center for Translational Neuroscience (2020, December 1). Facing Hunger: The Weight of the Pandemic Is Falling on American Families. Medium. https://medium.com/rapid-ec-project/facing-hunger-the-weight-of-the-pandemic-is-falling-on-american-families-1cbeb047a955.

Facing Hunger: The Weight of the Pandemic Is Falling on American Families was originally published in RAPID Survey on Medium, where people are continuing the conversation by highlighting and responding to this story.

Many single parents are lonely and overwhelmed as they face the challenges of balancing work and raising families — alone.

Key Findings

From having difficulty meeting basic needs to feeling overburdened and under supported, the pandemic is challenging families raising young children. This is especially true for single parents of young children, who exist in large numbers across the entire economic spectrum and among all racial and ethnic groups in the US. Single parents face especially pronounced challenges during this time as a result of having to rely on a single income and by being socially isolated.

• In our national representative survey of households with children age five and under, single parents report higher levels of emotional distress than caregivers in other households with young children. This includes higher levels of anxiety, depression, loneliness and stress.
• Single parents are also reporting higher levels of distress in their children. Our data show that differences in well-being between children in single parent households and those in other households have increased since the beginning of the pandemic.
• What explains the difficulty that single parent families with young children are facing during the pandemic? The isolation of single parents during the pandemic has been documented elsewhere (although the resilience of many single-parents during the pandemic has also been noted). Building on these existing findings, we see that single parent households in our survey are more likely than other households to be experiencing financial difficulties and to have become unemployed during the pandemic. They are also more likely to be experiencing material hardship (i.e., difficulties paying for basic needs, including food, rent, utilities, and childcare).

These economic and material hardships are directly affecting children in single-parent households, leading to increased fussiness and fearfulness in young children. In addition, the emotional distress that single parents are experiencing as a result of difficulties paying for basic needs is cascading down to children, which is having additional negative effects on child well-being.

These findings show that targeted relief efforts are needed to provide support to single parents and their children during the pandemic.

Background

During the pandemic, we have all have been experiencing challenges from social isolation, balancing work and personal life, and feeling uncertain about our health and safety. Many have also lost work or had their incomes reduced. For those with families, the pandemic has been especially difficult. Figuring out how to work in the absence of child care was particularly difficult in the early months of the pandemic, when most providers were shut down. Even where it is now available, the costs of childcare have increased by an estimated 47%, due to reduced enrollment and increased costs of PPE and cleaning supplies. This has made child care less affordable, especially for those on limited budgets.

Rates of family conflict have also increased during the pandemic (although, our survey also finds parents report deriving more emotional support from their children now as compared to before the pandemic). Managing children’s online learning is another challenge for families, especially for those with elementary school-age children in addition to younger children. We have found that parents are shouldering the vast majority of the burden of supporting their children’s education on top of trying to work.

These challenges are amplified in many single-parent families. Although single parent households are as much defined by their diversity as their similarities, many have fewer financial resources as a result of being single wage-earners and fewer emotional and social supports.

In this week’s posting we focus on the particular complexities that single-parent households with young children are facing during the pandemic.

The proportion of single-parent families in the United States has been increasing steadily in recent decades.

In 2019 the US Census estimated that over 5 million children age 5 and under in this country live in a single parent household. Single parent households exist in large numbers across the economic spectrum, and among all racial and ethnic groups. The majority of single parents are women, who have, in general, been more negatively impacted by the pandemic than men in terms of income and employment.

Given the many ways that we have seen the pandemic challenge households with young children, we were interested in whether single parent households are experiencing more difficulties during the pandemic than other families, and if so in what areas of life. Although there are anecdotal reports of such difficulties in the media, the high quality data from our survey help provide a fuller picture of this important issue.

What do the survey data show?[1]

1. Single parents are experiencing higher levels of emotional distress. We computed a composite score of parental distress that includes parent’s report of their own levels of anxiety, depression, stress, and loneliness. We find that the average level of distress for single parents — across the entire span of the survey, dating back to early April — is significantly higher than for other families.

This is true across all of the domains that comprise our emotional distress composite measure: anxiety, depression, stress, and loneliness.

2. Children in single-parent households are also experiencing higher levels of distress. We asked parents to report on the well-being of their children, including levels of fussiness and fearfulness. We find that, since April children in single parent households have higher overall levels of distress than children in other families.

This includes higher levels of both child fussiness and fearfulness.

Has the gap in emotional distress within single-parent households increased since before the pandemic?

When asked retrospectively about their well-being prior to the pandemic, single parents reported higher levels of overall distress than did other families. This was true of parental and child distress. This leads to the question of whether we are continuing to observe trends that pre-date the pandemic or whether the pandemic is widening the gap between the wellbeing of single parent families and others. It turns out that the answer is different depending on whether we look at parent or child wellbeing.

Our data on parent well-being show that the gap between single- and other parents has remained the same since before the pandemic; we are observing an increase in distress for parents in both groups. This does not mean that the differences in distress between single parents’ and others’ during the pandemic can be disregarded. Imagine two houses on a cliff above the ocean, one closer to the edge than another. If storms erode the cliff, the two houses are still the same distance apart, although the one closer to the edge is now in much greater peril than the other.

When it comes to child wellbeing, our data show that children in single-parent families have actually grown significantly more distressed than children in other families as compared to before the pandemic. This is true of overall distress and, specifically of child fearfulness.

Put simply, the pandemic has widened the gap between the wellbeing of children in single-parent households and that of those living in other families.

What accounts for the differences in well-being between single-parent households and others?

It appears that the differences between single parent households and others are associated with economic and material hardships.

Across all domains of material hardship that we measure, significantly more single parents report difficulties paying for basic needs.

Nearly twice as many single parents are struggling to pay for food, housing and utilities, and three times as many single parents report difficulty paying for childcare (33% vs. 11%).

We also find that compared to other parents, significantly more single parents have become unemployed during the pandemic (32% vs. 25%).

Financial and material hardship appear to be key drivers of adult and child distress. We have previously reported on this “chain reaction of hardship” among families in our survey. Specifically, we found that when adults report difficulty paying for basic needs in a given week, there is increased levels of parent emotional distress in subsequent weeks, which in turn leads to elevated child distress in the weeks that follow.

Our data on single parent households is more limited (smaller sample size and fewer participants completing the survey on multiple occasions). Nevertheless, we find similarly that material hardship is connected with child distress in two ways:

1. First, it has an indirect effect on child distress by increasing caregiver distress.
2. Second, it has a direct effect on child distress.

In short, material hardship continues to be at the root of diminished well-being in both parents and children during the pandemic.

Implications of these findings

If we want to support the health and well-being of households with young children during the pandemic, we must focus on the ability of families to pay for basic needs.

The complexities of maintaining employment while caring for young children is a recurring theme in our surveys. Our data suggest that these issues are amplified in single-parent families — not only in terms of much higher levels of food insecurity and lack of money to pay for rent, utilities, and childcare, but also in terms of significantly more employment loss.

The gap in well-being for children in single parent families is especially concerning. This gap existed before, but the pandemic is widening it. In particular, we are seeing increases in single parent reports of child fearfulness relative to children in other households. The extent to which levels of fearfulness are chronically elevated would suggest that the biological systems designed to help the body respond to stress are perpetually running on high alert. There is extensive research showing that experiences of this type of toxic stress can have lasting effects on health and well-being across the lifespan. As such, policy makers, social service providers, and communities must prioritize meeting the financial, material, and emotional needs of single-parent households during the pandemic and beyond.

Recommendations

1. Policy makers must make enacting public health measures to control and contain the coronavirus among their highest priorities. As the current surge in infection rates continues in the absence of mandates requiring masks and social distancing in many states, the economic and social impacts of the pandemic are particularly challenging for single parent households.
2. Policy makers must provide targeted financial relief to single parent households who are struggling financially. The imperative for such relief lies in the elevated levels of distress among both single parents and their children relative to other households, and especially the increasing gaps in child distress. The science of early childhood development provides conclusive evidence that single parent households need relief now and cannot wait for a new relief package to work its way through Congressional gridlock.
3. Special attention must be paid to making safe and high quality child care available and affordable to single parent households. This includes all forms of childcare, including center-based and non-center-based, and licensed as well as license-exempt and family, friend, and neighbor care. Such support will facilitate single parents’ ability to work, thereby helping to mitigate the material hardship issues described above; in addition, the potential return on investments is large in terms of the national economic recovery from the pandemic.

[1] Note: The proportion of single-parent households in our survey was lower, based on US Census data, than the proportion nationally (15% vs. 27%). We compared the demographics of our sample with national data on single parents. Our single parent sample is comparable in terms of race and ethnicity and geographic distribution; however, our sample has a higher proportion of lower income individuals than national data on single parent households.

Additional Readings

“I Never Felt Like a ‘Single’ Parent. Then the Coronavirus Hit,” The Nation.

“Single Parents Are Struggling, but Enduring, Through the Pandemic,” The New York Times.

“The True Cost of Providing Safe Child Care During the Coronavirus Pandemic,” Center for American Progress.

“Under the Same Roof, for Better and for Worse,” Center for Translational Neuroscience.

“Something’s Gotta Give,” Center for Translational Neuroscience.

“America’s Families and Living Arrangements: 2019,” United States Census Bureau.

“Single Parenting in a Pandemic,” The New York Times.

“ ‘Incredibly Scary’: Single Moms Fear Falling Through Holes In Pandemic Safety Net,” NPR.

“Two kids, no support system and $167 in unemployment benefits: One single mom’s plight in the age of Covid-19,” CNBC.

“Frosted Flakes for dinner. Hiding in the laundry room. This is life for single moms right now,” CNN.

“Pandemic Will “Take Our Women 10 Years Back’ in the Workplace,” The New York Times.

“A Hardship Chain Reaction,” Center for Translational Neuroscience.

About the project

When the COVID-19 pandemic emerged last winter, there were over 24 million children age five and under living in the United States. This period of early childhood is a critical window that sets the stage for health and well-being across the lifespan. As such, it is essential during the current health and economic crisis to listen to the voices of households with young children.

The weekly survey of households with children age five and under launched on April 6, 2020. Since then, we have been gathering weekly data about child and adult emotional well-being, financial and work circumstances, availability of healthcare, and access to child care/early childhood education.

These analyses are based on responses collected from 7427 caregivers between the dates of April 06, 2020 and October 22, 2020. These caregivers represent a range of voices: 9.26% are Black/African American, 18.90% are LatinX, and 29.10% live at or below 1.5 times the federal poverty line. Proportions/percentages are calculated based on the item-level response rates, not out of the total sample size. The data for these analyses are not weighted.

We will continue to report on these issues as we learn more from each new weekly survey. We will also be producing policy briefs that make concrete recommendations about how to address the challenges we are seeing emerge from the family surveys.

Our goal is to use what we are hearing from families to improve the well-being of all households with young children, during the pandemic and beyond.

Suggested citation

Center for Translational Neuroscience (2020, November 11). Home Alone: The Pandemic Is Overloading Single-parent Families. Medium. https://medium.com/rapid-ec-project/home-alone-the-pandemic-is-overloading-single-parent-families-c13d48d86f9e.

Home Alone: The Pandemic Is Overloading Single-parent Families was originally published in RAPID Survey on Medium, where people are continuing the conversation by highlighting and responding to this story.

The gradual return of young children to non-parental care highlights the fragility of the United States’ child care infrastructure.

Key Findings

More than half of the families in our survey report using some form of non-parental care for their young children prior to the pandemic. Immediately after the onset of the pandemic, that number dropped by more than half, to just 20% of households. In the ensuing months, families have been returning to using child care, although rates of use are still slightly below pre-pandemic levels.

• Many parents returning to care have significant worries about child safety. Over the course of the pandemic, there has been a steady increase in the proportion of families expressing concern about exposing a child or other family member to COVID-19 as a result of using child care.
• Our data also show shifts in the type of care parents are choosing. Immediately after the onset of the pandemic, the use of center-based care diminished substantially; it has since gradually increased. In contrast, there was a much smaller drop in the use of care by a home-based provider (including a paid and unpaid family, friend, or neighbor) at the start of the pandemic, and this type of care continues to be used by a higher proportion of families than center-based care.

All of these trends are occurring in a US child care system that was already struggling to meet the needs of families before the pandemic.

We discuss the implications of these trends for policy makers, for the economy, and for families as we head the winter months with COVID-19 infections surging and no financial relief package in place.

Background

The arrival of the pandemic in the US last spring led to the immediate shutdown of many areas of the economy. This included all forms of child care, with the exception of care for the children of essential workers.

The loss of child care placed an extraordinary burden on households with young children. Across the economic spectrum from low- to middle/upper income, many families had to manage caring for their young children while working from home.

Loss of child care during the pandemic is having negative effects on both economic recovery and critical issues of gender equity in employment.

As various sectors of the economy have re-opened, challenges with both the availability of and willingness to use child care have affected the return to work of those who employed in office and service-industry jobs.

In prior posts, we have reported that many parents are relying on them self or (in two-parent households) their spouse to take care of their child. Indeed, 90% of households in our survey report that they or their spouse is their primary source of child care.

Evidence from other surveys suggests that women are disproportionately leaving the workforce during the pandemic, and that, in part, this is due to a lack of child care. A study by the US Census found that women between 25–44 years of age are nearly three times as likely as men to not be working due to child care demands (32% vs. 12% respectively).

In this week’s post, we examine trends in the use of child care from before the pandemic to the present.

Other sources have reported that, since the initial shut-down, many child care providers have struggled to stay in business, owing to a combination of:

1. higher operating costs associated with protective supplies and regulations to assure health and safety, and
2. lower enrollment and lack of federal action to increase funding.

In the absence of new financial relief, one report found that 40% of child care providers surveyed — half of whom are minority owned businesses — expect that they will have to permanently shut their doors. These circumstances will threaten a child care system that was already foundering before the pandemic.

We analyze overall rates of child care utilization since last spring — specifically, whether the proportion of families using non-parental care has changed over time.

We also assess parents’ concerns about using child care, and how that has changed during the pandemic.

Finally, we look at the types of care that parents have been relying upon, comparing the rates of center-based care to home-based care, and further examining trends in different types of home-based care being used.

What do the survey data show?

Overall, rates of non-parental child care use dropped from 55% before the pandemic to just under 20% in early April, when the RAPID survey began.

Since that time, the use of child care has gradually increased, and is currently being used by just under half of households.

Many parents have significant concerns about using child care.

We analyzed responses to the open-ended question, “What are the biggest concerns and challenges for you and your family right now?” We selected all responses that referred to child care and used structural topic modeling to identify concerns related to child care.

Worry about children or other family members being exposed to COVID-19 from child care was one of the most common topics. The following statements are representative of more general concerns that we saw in the data.

A parent in Indiana is concerned about:

Keeping my family healthy while both parents work full time and toddler goes to child care center and 7 year-old goes to grandparents. Too many chances for virus exposure, but not many options.

A parent in Maryland worries about:

Figuring out child care that doesn’t put us at a higher risk of the virus

A Texas parent:

The kids will be going back to their child care center in October and we are pretty concerned about increasing our family’s exposure to the virus, but we just need the child care all day so desperately.

We examined trends in these concerns from mid-May and found a continuous increase in the proportion of families with these concerns.

By the time of our most recent survey, more than 1 in 5 families expressed this concern — up from 1 in 17 in May.

This increase parallels the return to using child care; thus, although families are increasingly using child care, an increasing number are also worried about whether it is safe to do so.

The types of child care being used by families also appears to be changing.

Before the pandemic, equal numbers of families were using center-based care (including pre-school, day care center, public pre-kindergarten, Head Start, or faith-based nursery school) and home-based care (including paid or unpaid care by family, friend or neighbor, or care from a home-based provider).

When the pandemic started, the use of center-based care dropped precipitously — from 29% to just 4% of households.

Since that time, it has increased steadily (now back up to 23%), but still has not returned to pre-pandemic levels.

In contrast, the use of home-based care dropped far less at the onset of the pandemic (from 28% to 17% of households), and has since increased to rates that are actually above pre-pandemic levels (31%).

Implications of these findings

Child care in the United States is at a breaking point

Before the pandemic, child care in the US was already under stress.

The availability of quality care to meet the needs of families was inadequate, particularly for low income families and families of color, and in many areas of the country there were child care deserts.

Affordability was also a challenge, with the cost of care taking a large bite out of family income. Childcare subsidies to help support these costs existed, but very few families eligible were able to access them.

Since the onset of the pandemic, these same issues have continued and families have been faced with a whole new set of challenges that have made access to safe, quality child care a major worry.

All types of child care need more support

Home-based care—which has been used more than center-based care throughout the pandemic—needs enhanced support, including attention to income and racial equity issues.

In addition, center-based child care needs relief to remain viable in the face of decreases in enrollment and increases in operating costs.

The prevalence of and preference we observe for home-based care—including family, friend, and neighbor (FFN) care—calls for renewed attention to assure that these providers are included in the subsidy system, have access to a full range of supports including networks, home visiting, and coaching, and are compensated equitably.

The shifts away from center-based care are hurting child care centers, where revenue (tuition) has dropped and costs of social distancing, cleaning and sanitizing, and purchasing protective equipment have increased. Centers are closing and child care educators and support staff are unemployed.

Without federal action, we will not be able to maintain the supply of center-based care for parents as they return to this setting over time.

Taken together, the closure of centers, the rise in the use of home-based care, and the worsening financial status of most families with young children, means that parents’ ability to find and afford care that meets their needs will only get worse.

Improved child care is essential to American prosperity

Addressing the problems with child care, both those that existed pre-pandemic and those that have arisen since, is critical to the health and economic well-being of the American people.

Addressing the burgeoning crisis in child care should be a national priority.

Without a functioning system of child care, children and families will continue to experience high levels of stress that science shows that can negatively impact brain, behavior, emotional development, and health across the lifespan.

The risk of infection to child care providers, children, and family members may increase as the infection surges through the fall and winter. Moreover, the recovery of the economy from the pandemic-caused recession depends and the return to the workforce of those who have been sidelined due to the lack of child care (especially women) on a functioning child care system.

Now more than ever, the future depends on our ability to re-envision and implement a safe and equitable national system of child care that works for all families.

Recommendations

1. Urge federal policy makers to take action to stabilize the child care industry. Advocates and a number of national legislators are currently requesting $57B in federal stimulus funds to ensure programs can re-open and stay open to support the rebuilding of our economy.
2. Provide direct cash support to households of young children to enable them to afford informal child care during the pandemic (and address other material hardships).
3. Assure health and safety provisions for all child care including increased funding, guidelines and support to maintain healthy environments for children, families and providers.
4. Intentionally include family, friend and neighbor providers in relief efforts including emergency grants, access to protective equipment, and training on COVID health and safety protocols.
5. Intentionally include family, friend and neighbor providers and other home-based providers in robust mixed delivery child care systems going forward. Ensure these caregivers are adequately compensated and can access support to facilitate developmentally appropriate care to young children.
6. Invest in durable infrastructure to engage and support home- based providers including FFN care; home-based networks can provide culturally responsive monitoring support, quality resources, and connect caregivers to community services including mental and physical health.
7. Accelerate piloting and implementation of quality improvement programs to meet the needs of FFN caregivers including home-visiting, emotional support groups and play and learn groups as methods to deliver health and safety and quality support.

Additional Readings

“In the Covid-19 Economy, You can Have a Kid or a Job. You Can’t Have Both,” New York Times.

“Working Moms Bear Brunt of Home Schooling while Working During COVID-19,” United States Census Bureau.

“Early Progress: State Child Care Assistance Policies 2019,” The National Women’s Law Center.

“Inequitable Access to Child Care Subsidies,” CLASP.

“Researchers Warnd Nearly Half of U.S. Child Care Centers Could Be Lost to Pandemic,” NPR.

“Coronavirus Pandemic Could Lead to Permanent Loss of Nearly 4.5 Million Child Care Slots,” Center for American Progress.

“If the Senate Doesn’t Bail Out the Childcare Industry, Economists See Women Leaving the Workforce En Masse,” Business Insider.

“The Child Care Crisis Is Keeping Women Out of the Workforce,” Center for American Progress.

“The Coronavirus Will Make Child Care Deserts Worse and Exacerbate Inequality,” Center for American Progress.

“Family, Friend, and Neighbor Care,” U.S. Department of Health and Human Services Office of Child Care.

“Strategies for Supporting Family, Friend, and Neighbor Care Providers,” National Women’s Law Center.

“One in Five Child Care Jobs Have Been Lost Since February, and Women Are Paying the Price,” National Women’s Law Center.

“Family, Friend, and Neighbor Care: Facts and Figures,” National Women’s Law Center.

“Health Child Development Depends on Quality Child Care—And So Does the Economy,” Learning Policy Institute.

“America’s Child Care Deserts in 2018,” Center for American Progress.

“Regulation and the Cost of Child Care,” Mercatus Center.

“COVID-19 Transmission in US Child Care Programs,” Pediatrics.

“Structural Topic Models for Open-Ended Survey Responses,” American Journal of Political Science.

“The Lifelong Effects of Early Childhood Adversity and Toxic Stress,” Pediatrics.

About the project

When the COVID-19 pandemic emerged last winter, there were over 24 million children age five and under living in the United States. This period of early childhood is a critical window that sets the stage for health and well-being across the lifespan. As such, it is essential during the current health and economic crisis to listen to the voices of households with young children.

The weekly survey of households with children age five and under launched on April 6, 2020. Since then, we have been gathering weekly data about child and adult emotional well-being, financial and work circumstances, availability of healthcare, and access to child care/early childhood education.

These analyses are based on responses collected from 7,457 caregivers between the dates of April 06, 2020 and October 08, 2020. These caregivers represent a range of voices: 9.32% are Black/African American, 18.89% are LatinX, and 29.14% live at or below 1.5 times the federal poverty line. Proportions/percentages are calculated based on the item-level response rates, not out of the total sample size. Please note that caregivers were able to select more than one option for type of non-parental care being used. The data for these analyses are not weighted.

We will continue to report on these issues as we learn more from each new weekly survey. We will also be producing policy briefs that make concrete recommendations about how to address the challenges we are seeing emerge from the family surveys.

Our goal is to use what we are hearing from families to improve the well-being of all households with young children, during the pandemic and beyond.Additional readings

Suggested citation

Center for Translational Neuroscience (2020, October 27). Returning to Care…But Worried. Medium. https://medium.com/rapid-ec-project/returning-to-care-but-worried-5093fda63dab

Returning to Care…But Worried was originally published in RAPID Survey on Medium, where people are continuing the conversation by highlighting and responding to this story.

Key Findings

This week we report on how the coronavirus pandemic has impacted preventative health care measures for young children — specifically, well-baby/well-child health check-ups and scheduled vaccinations.

• We find that, since the start of the pandemic, 28% of families with young children in our sample have missed a well-baby/well-child visit. This represents a threefold increase compared to before the pandemic.
• In addition, we find that 12% of children have not received a recommended vaccination. We find that this is due primarily to caregivers’ concerns about contracting COVID-19.
• Attending preventive health care visits is particularly challenging for families with children 18 months and older.
• Overall, lower-income households are significantly more likely than middle/upper-income households to have difficulties making a preventive health care visit or a vaccine.
• We also observe differences in rates of disruptions to preventive health care based race and ethnicity.

Background and Methods

Well-baby/well-child visits and vaccinations are core components of preventive healthcare in the US. Currently, the American Academy of Pediatrics recommends ten visits in a child’s first two years and then annually through the end of adolescence, in order to track developmental milestones and intervene as early as possible when health issues are identified. In addition to these wellness checks, the Centers for Disease Control and Prevention recommends a scheduled series of vaccinations for young children, in order to prevent 14 deadly childhood diseases.

The American Academy of Pediatrics has issued guidance and information regarding the pandemic, and has emphasized that wellness visits and vaccinations are still essential during the coronavirus pandemic . However, barriers related to the pandemic have prevented participation in these and other forms of preventative care. In a previous post published in late May, we observed approximately 27% of young children were not able to attend a well-child visit since the start of the the pandemic. This represented an almost 300% increase in the rate of missed visits compared to before the pandemic.

As the pandemic continues into the fall, we return to the topic of preventive health care. We analyze data from our recurring nationally representative survey of households with children age 5 and under to determine the extent to which, as households have adjusted to life during the pandemic, there has been a return to pre-pandemic levels of participation in preventive healthcare. If obstacles to accessing preventive health care services have continued to affect these families, it would raise concerns about early identification and screening of children’s physical and mental health, developmental status, physical safety, and other important domains of well-being.

In order to address these questions, we examined data from our surveys across time about missed child’s wellness visits or vaccinations, as well as which visits were missed (i.e., what age) and the reasons for not attending these visits. We looked at patterns for the overall sample, as well as by household income level (above or below 150% of the federal poverty line), and race and ethnicity. The data we present below are cumulative from April 6 through October 6.

Overall, we found that many children are continuing to miss wellness checks and scheduled vaccinations as the pandemic continues.

• 29% of caregivers reported a missed wellness visit for their child.
• 12% of caregivers reported a missed scheduled vaccination for their child.
• Wellness checks and vaccinations for older children (18 months to 5 years old) are being missed the most.

These data show that eight months into the pandemic missed child wellness visits and vaccinations are continuing at a steady rate. These rates are similar to those observed in May and show no evidence of decreasing over time.

Concern about contracting COVID-19 is preventing caregivers from attending wellness visits.

We asked participants why they were unable to attend visits. Options included concern about contracting COVID-19, caring for other family members, inability to find childcare, cost, time away from work, vaccine hesitancy, and other. Concern about contracting COVID-19 was by far the most common response, endorsed by 78% of those who had been unable to attend a visit. No other option was identified by more than 20% of caregivers in the survey.

Lower income children experience more obstacles to attending wellness visits than upper-income children.

Overall, lower-income children were significantly more likely to miss wellness visits and vaccinations than middle/upper-income children (32 % compared to 25%).

• Lower-income caregivers reported significantly more (1) inability to find childcare and (2) difficulty finding care for other family members.
• Differences in ability to attend wellness visits based on income were especially pronounced among White respondents (33% for lower income vs. 23% for middle/upper income).

Middle/upper income Black and Latinx households experience more obstacles to attending wellness visits than their White counterparts.

• Middle/upper-income Black children missed more wellness checks than middle/upper-income White children. This difference appears to be tied to caregiving responsibilities — middle/upper-income Black caregivers reported significantly higher rates of caring for other family members as the reason for a missed visit.
• Middle/upper-income Latinx children missed more vaccinations than middle-upper-income White children. Latinx caregivers reported significantly higher rates of concern about contracting COVID-19 as the reason for forgoing vaccinations than did White caregivers.

Implications

The high number of families with young children who are experiencing obstacles to child wellness checks and vaccinations is concerning for several reasons:

• At wellness visits, young children are screened for gross and fine motor delays, behavioral abnormalities, autism spectrum disorders, speech delays, social difficulties, learning delays, and genetic syndromes. Diagnosing and addressing these issues as early as possible is essential for achieving optimal outcomes over time. Lack of access to preventative care means that for many children, this isn’t happening.
• Diminished vaccination rates could lead to higher rates of contracting deadly childhood illnesses and new outbreaks of diseases that were largely eliminated until recently (eg, measles, whooping cough).
• Wellness checks provide supports for families and can help prevent abuse and neglect and address it when it is occurring. Typically, teachers and caregivers outside the home provide a first line of defense for observing signs of abuse and neglect. With limited access to these care providers, doctors and nurses at wellness checks are a vital way of preventing and addressing child abuse and neglect. Our data show that these supports are not available to many families.

Two core issues are clear in the data:

1. First and foremost, families with young children continue to see accessing preventive health care as a significant safety risk. Put simply, both real and perceived risk of well-baby/well-child visits (especially for children 18 months an older) to family health is a barrier to care. In order to address this, it is essential that public health and safety measures be implemented to more effectively bring the virus under control; as we have said repeatedly in prior postings, the absence of effective measures to control the spread of COVID-19 is at the core of all the challenges families in our survey are facing. In addition, it is necessary for the pediatric health care system to both do more to insure safety and enhance efforts to communicate about how safety is being maintained.
2. Second, as has been true of a number of prior topics on which we have reported, different issues — requiring somewhat different solutions — exist based on income and race/ethnicity. For example, lower-income households need help with structural barriers to accessing care, including difficulty finding childcare and caring for other family members. Similarly, middle/upper income Black households need solutions that address barriers related to caring for other family members. In contrast, for middle/upper income Latinx households concerns about contracting COVID-19 are leading to lower rates of vaccination. These concerns are understandable, given the elevated rates of infection among Latinx individuals.

If barriers to childhood preventative health measures are not addressed as the coronavirus pandemic continues, we are likely to see many children experience serious health consequences. This will have immediate consequences for the health of the US population; for example, we may see an uptick in childhood diseases that were previously eradicated through widespread childhood vaccination regimens. Increased rates of illness will have economic impacts in terms of lost work productivity and income for parents. Over the long term, lack of early identification and support for children with developmental disabilities and for those experiencing maltreatment will affect well-being, academic achievement, and related areas. These are likely to increase costs to the health care and education systems. In contrast, addressing the barriers to preventive healthcare for young children will help buttress young children and their families from many impacts of the pandemic and ensure that needs are adequately addressed in a timely manner.

Recommendations

• The AAP has launched a campaign called #CallYourPediatrician, designed to encourage parents to schedule wellness checks for their children. Efforts like these are needed to insure that rates of preventive care return to pre-pandemic levels.
• Policy makers must take action to more effectively control and contain the spread of COVID-19, and to prioritize the preventive healthcare needs of households with young children in the face of the pandemic.
• Pediatric health care providers must continue to improve communications about the measures being taking to ensure the safety of preventive health care visits and vaccinations.
• Policy makers must provide funding to support the capacity of healthcare practices to provide outreach related to safety and perceived safety of well-child visits.
• “One size fits all” solutions won’t work. Differential efforts must be undertaken by both policymakers and health care practitioners to address the barriers to preventive pediatric care in specific subgroups. Inequalities associated with access, which existed in low income households and households of color prior to the pandemic and continue to exist, must be taken into account in developing strategies.
• Policies must be implemented that allow time away from work, child care, and other structural supports for well-child visits, and that make it possible to obtain reliable and affordable sources of care for other family members to make such visits possible may increase access.

Additional readings

Critical Updates on COVID-19. American Academy of Pediatrics.

Recommendations for Preventive Pediatric Health Care. American Academy of Pediatrics.

#CallYourPediatrician Campaign. American Academy of Pediatrics.

Health Officials Fear Postponing Preventive Care Has Long-Term Risks. New York Times.

Children’s Health and Well Being During the Coronavirus Pandemic. Kaiser Family Foundation.

AAP Schedule of Well-Child Care Visits. American Academy of Pediatrics.

Well-Child Visits Are Essential. Centers for Disease Control and Prevention.

Guidance on Providing Pediatric Well-Care During COVID-19. American Academy of Pediatrics.

Health, Interrupted. Center for Translational Neuroscience.

The Fullest Look Yet at the Racial Inequity of Coronavirus. New York Times.

About the project

When the COVID-19 pandemic emerged last winter, there were over 24 million children age five and under living in the United States. This period of early childhood is a critical window that sets the stage for health and well-being across the lifespan. As such, it is essential during the current health and economic crisis to listen to the voices of households with young children.

The weekly survey of households with children age five and under launched on April 6, 2020. Since then, we have been gathering weekly data about child and adult emotional well-being, financial and work circumstances, availability of healthcare, and access to child care/early childhood education.

These analyses are based on responses collected from 7312 caregivers between the dates of April 06, 2020 and October 06, 2020. These caregivers represent a range of voices: 9.38% are Black/African American, 19.08% are LatinX, and 29.13% live at or below 1.5 times the federal poverty line. Proportions/percentages are calculated based on the item-level response rates, not out of the total sample size. The data for these analyses are not weighted.

We will continue to report on these issues as we learn more from each new weekly survey. We will also be producing policy briefs that make concrete recommendations about how to address the challenges we are seeing emerge from the family surveys.

Our goal is to use what we are hearing from families to improve the well-being of all households with young children, during the pandemic and beyond.

Suggested Citation

Center for Translational Neuroscience (2020, October 13). Health (Still) Interrupted: Pandemic Continues to Disrupt Young Children’s Healthcare Visits. Medium. https://medium.com/rapid-ec-project/health-still-interrupted-pandemic-continues-to-disrupt-young-childrens-healthcare-visits-e252126b76b8

Health (Still) Interrupted: Pandemic Continues to Disrupt Young Children’s Healthcare Visits was originally published in RAPID Survey on Medium, where people are continuing the conversation by highlighting and responding to this story.