Mitigating the impacts of the COVID-19 pandemic response on at-risk children

Abstract

Although children are not at the highest risk for coronavirus disease 2019 (COVID-19) 1 severe illness, necessary pandemic public health measures will have unintended consequences for the health and well-being of the nation's at-risk children.School closures, social distancing, reduction in health care services (eg, canceling nonurgent health care visits), and ubiquitous public health messaging are just some of the measures intended to slow the COVID-19 spread.Here, we (1) highlight the health risks of the pandemic response measures to vulnerable pediatric subpopulations and (2) propose risk mitigation strategies that can be enacted by policy makers, health care providers and systems, and communities (Table 1).The selected risks and proposed mitigation strategies are based on existing evidence and opinions of expert stakeholders, including clinicians, academicians, frontline service providers (eg, social workers), and public health leaders.We focus on risks and mitigation strategies for 3 at-risk subpopulations of children: (1) children with behavioral health needs, (2) children in foster care or at risk for maltreatment, and (3) children with medical complexity (CMC).Mitigation strategies delineated for these at-risk populations are also likely beneficial for any child and family.Importantly, children not already in these groups are at risk for facing new medical, behavioral, or social challenges that develop during the pandemic.In particular, children in households of low socioeconomic status are likely at the highest risk for new or worsening issues, underscoring the critical leadership role of Medicaid programs in these risk mitigation strategies. CHILDREN WITH BEHAVIORAL HEALTH NEEDSThe ∼1 in 6 children with behavioral health conditions whose treatments involve regular and frequent therapist contact are at especially high risk of exacerbations during disasters.2 In-person behavioral health care access during the pandemic has been reduced in medical, community, and school settings, where proportionally more low-income, minority students accessed care pre-pandemic.3 Strategies to maintain access include the promotion and reimbursement of telehealth behavioral health visits by the full range of licensed providers, promotion of mental health parity, and use This article has an accompanying video summary.