What are the enduring lessons for child welfare from the COVID-19 pandemic?

The COVID-19 pandemic introduced economic hardships, health concerns, trauma, and uncertainty into the lives of families, which often contributed to heightened stress levels in those already vulnerable. The pandemic, however, also highlighted the strength and importance of local community networks of support and ushered in enthusiasm for innovation and a period of rapid change. The pandemic offered critical opportunities for child welfare leaders and partners to implement new strategies to improve the safety of children, adapt existing models of engagement and service delivery for vulnerable families, and explore new ways of supporting families.

During the pandemic, jurisdictions utilized alternative pathways and economic supports to strengthen families and improve child safety. Jurisdictions connected differently, using a range of approaches for visiting and engagement and providing access to treatment and parenting supports, including opportunities for families to participate remotely in virtual court hearings, casework services, visitation, and health services.

The pandemic experience also revealed potential strategies related to child safety, including the development of mechanisms for detecting child maltreatment outside of schools, increasing community-based supports and community partnerships to address non-maltreatment concerns of families traditionally referred to child welfare, and increased use of technology to improve access to child and family services. This brief explores these and other lessons learned from the pandemic that can inform and influence systems transformation.

Key themes and opportunities

In 2020 and 2021, Casey Family Programs hosted a weekly COVID-19 Leadership Forum, bringing together child welfare leaders from across the country as they sought to learn, adapt, and innovate amid the rapidly changing issues emerging in the pandemic. As a result of these and other conversations with colleagues, partners, and lived experts, a portfolio of more than a dozen resources was developed for the field. Key themes and lessons elevated through these resources include:

1. Alternate Pathways for Support. The crisis presented a need and created an opportunity to leverage or design new pathways for support that strengthen families when a call to the child protection hotline is not warranted. Critical avenues outside the child protection agency, such as 211/helplines/warmlines and community resource guides, offer effective mechanisms for connecting families with local supports and services.
2. Child Safety. Reports to child protective services plummeted, in part due to less surveillance by school personnel. During the three-month nationwide shutdown (that extended much longer in some parts of the country) — with school closures, less surveillance, fewer court-ordered family separations, and greater access to unrestricted cash assistance — data suggests most children remained safe. The lesson learned is that many families benefit more from upstream supports than child welfare intervention.
3. Community-based Support Networks. The value and impact of community-based and school-based networks on improving outcomes for families and children, including family resource centers, is increasingly being recognized in different states. Many small and large communities rallied to meet the health care or other needs of residents. Community groups and businesses, for example, helped deliver meals and resources. Many of those efforts, however, have subsided since the pandemic.
4. Family Time/Visits. When children are placed in foster care, family time and regular family visits are a right, not a privilege, and family relationships and engagement should not be curtailed in the name of public health emergencies.
5. Leading in a Crisis. The principles and tools of safety science can be implemented during times of crisis to improve child safety and strengthen families, as well as inform the actions of child protection agency staff at all levels. Leadership must hold true to its values amid crises in order to maintain momentum toward transformation.
6. Technology. The need to address the digital divide has persisted for years, but the pandemic highlighted and magnified inequities in accessing essential technology equipment and broadband, especially for children and families involved with the child welfare system. During the pandemic, they needed technology access to connect with a variety of virtual services and engage in family time.
7. Telehealth. Telehealth approaches to providing individual child and parent therapies are effective but should be offered within a menu of services that also includes in-person individual or group therapy. Telehealth has the potential to offer many children and families a lifeline to essential physical and behavioral health services that would not otherwise be accessible, especially in rural areas.
8. Virtual Casework and Services. Many potential limitations and many potential benefits to families arise from virtual interventions, including increased access, engagement, and other important efficiencies. To ensure that families are meaningfully engaged in online interventions, child protection agency staff should check in with them regularly about what is and what isn’t working, and what they may need to move forward.
9. Virtual Courts. Virtual or remote court hearings surfaced as a viable strategy to ensure that due process rights of children and families were protected, safety and permanency remained a priority, and court dockets did not become backlogged. Some courts rapidly adapted to conducting all hearings remotely, while others transitioned over time. Many courts have continued to use remote and hybrid hearings, especially given the benefits for families, which can include increased access with less disruption to childcare/work schedules, fewer conflicts related to transportation, and hearings feeling less intimidating.
10. Workforce. The pandemic provided real-time opportunities to explore workforce development strategies, such as designing and testing virtual or hybrid scheduling models for agency staff that many jurisdictions had thought impossible. Agencies also advanced a range of efforts to strengthen staff recruitment and retention, and used lessons from pandemic experiences to inform their approaches to racial equity and system transformation.

Impacts on child safety and family well-being

Evidence on the impact of the pandemic on child maltreatment has been mixed, and research still is evolving to accurately capture the COVID-19 pandemic’s impact on child safety. To date, a few themes have emerged in the areas of child maltreatment, child mental health, and economic supports for families.

Child maltreatment

Findings related to child maltreatment during the pandemic are mixed.¹ That said, statistical evidence does not point to a surge in cases, despite concerns that lockdowns might lead to dramatic increases in child maltreatment. In a systematic review of 12 studies on child maltreatment during the pandemic, five identified an increase, six noted a decrease, and one found no difference.² In New York City, data indicated that child safety was maintained, with no rise in child abuse cases during the shutdown and no significant rebound after reopening. Another national study found no significant rise in child abuse related to COVID-19, with reports decreasing, emergency department visits for suspected child abuse declining, and hospitalizations remaining stable.³ This study suggested that a combination of family strengths, community resources, government assistance, and positive parenting practices may have helped prevent maltreatment, with researchers determining that decreased monitoring could not fully explain the decline.⁴

In analysis based on the National Syndromic Surveillance Program, emergency department visits for suspected or confirmed child abuse or neglect decreased during the pandemic, among all age groups. The number of emergency department visits resulting in hospitalization remained consistent, however, and the percentage of visits related to child abuse or neglect ending in hospitalization increased significantly. In another study that sought to determine the change in the rate of emergency department encounters related to child abuse, researchers found that rates for lower severity cases were significantly reduced during the pandemic, whereas higher-severity encounters were not.⁵ Further analyses are necessary to determine whether pandemic changes led to true reductions as opposed to a decreased recognition of child abuse. In a multicenter study of U.S. children’s hospitals, researchers found declines in child abuse cases during the pandemic.⁶ The severity of those cases, however, was similar to prior years. This may reflect true decreases, compromised infrastructure for detecting abuse, or delayed effects of the pandemic.

While overall child maltreatment-related emergency department visits declined, emergency visits due to neglect increased during the pandemic. A review of emergency visit records at a children’s hospital in the southeastern U.S. compared a specific period around the 10^th week of 2020 to those over the same period in prior years, and found the number of emergency room visits due to neglect from inadequate adult supervision increased by 62%.⁷

Some evidence suggests children of different racial backgrounds were uniquely affected during the pandemic with respect to maltreatment. A 2020 national child welfare report showed that although there were fewer abuse-related fatalities overall during the reporting period, the fatality rate among Black children increased.  Florida study examined demographic differences in rates of substantiated child maltreatment resulting in foster care placement before and during the COVID-19 pandemic. Findings demonstrated that rates of placement increased for white youth due to emotional abuse, while rates of placement due to inadequate supervision, emotional neglect, and/or parental substance use decreased for Black children.⁸

Child mental health

Research suggests that the pandemic exacerbated anxiety and depression among children, in part due to school closures.⁹ Rates of children ages 6 to 17 diagnosed with either anxiety or depression have been increasing steadily since the early 2000s, and this trend continued into and beyond the pandemic.¹⁰ For example, emergency department visits for mental health diagnosis by children and adolescents up to age 17 increased 11.5% (from 784.1 to 886.4 visits per 100,000 population) between 2016 and 2020. Between 2008 and 2021, death due to suicide among adolescents ages 12-17 increased by 75.7% (rising from 3.7 to 6.5 deaths per 100,000 population).

Economic supports

Research noted that pandemic-era economic supports were associated with positive impacts on child well-being.¹¹ In one study comparing trends in child maltreatment before and after Child Tax Credit payments in 2021, using data from pediatric emergency department patients in a  hospital system in the southeastern U.S., federal income supports to parents were associated with immediate reductions in child abuse and neglect-related emergency department visits.¹² Another systematic review of the influence of working tax credits on child maltreatment, revealed a possible association between the benefit and reduced rates of child neglect and entry into foster care.¹³

Medical experts also noted that pandemic-era supports, such as paid family leave, basic income, child tax credits, and protection from eviction and foreclosure, have played a protective role.¹⁴ In a study focusing on abusive head trauma in children under age 5, injuries were found to have decreased during the pandemic, suggesting a possible correlation between social welfare policies and child abuse prevention.¹⁵

1 Carsley, S., Thomas, S., Oei, T., Smith, B., Harrington, D., Pike, I., Macpherson, A.K., & Richmond, S.A. (2024) Child abuse and neglect during the COVID-19 pandemic: An umbrella review. Child Abuse & Neglect, (149).

2 Rapp, A., Fall, G., Radomsky, A. C., & Santarossa, S. (2021). Child maltreatment during the COVID-19 pandemic: A systematic rapid review. Pediatric Clinics of North America, 68(5), 991–1009.

3 Sege, R. & Stephens, A. (2022). Child physical abuse did not increase during the pandemic. JAMA Pediatrics, 176(4): 338-340.

4 While overall reports to child protective services declined, some studies found that reports of child maltreatment-related head injuries to certain hospitals increased. See, for example: Kourti, A., Stavridou, A., Panagouli, E., Psaltopoulou, T., Spiliopoulou, C., Tsolia, M., Sergentanis, T. N., & Tsitsika, A. (2023). Domestic violence during the COVID-19 pandemic: A systematic review. Trauma, Violence & Abuse, 24 (2), 719-745.

5 Chaiyachati, B. H., Wood, J. N., Carter, C., Lindberg, D. M., Chun, T. H., Cook, L. J., Alpern, E. R., & PECARN Registry Study Group and PECARN Child Abuse Special Interest Group (2022). Emergency department child abuse evaluations during COVID-19: A multicenter study. Pediatrics, 150(1), e2022056284.

6 Kaiser SV, Kornblith AE, Richardson T, et al. (2020). Emergency visits and hospitalizations for child abuse during the COVID-19 pandemic. Pediatrics. doi:10.1542/peds.2020- 038489

7 Bullinger, L.R., Boy, A., Messner, S., & Self-Brown, S. (2021). Pediatric emergency department visits due to child abuse and neglect following COVID-19 public health emergency declaration in the southeastern United States. BMC Pediatrics 21(401).

8 Musser, E. D., Riopelle, C., & Latham, R. (2021). Child maltreatment in the time of COVID-19: Changes in the Florida foster care system surrounding the COVID-19 safer-at-home order. Child Abuse & Neglect, 116(Pt 2), 104945.

9 Bell, I. H., Nicholas, J., Broomhall, A., Bailey, E., Bendall, S., Boland, A., Robinson, J., Adams, S., McGorry, P., & Thompson, A. (2023). The impact of COVID-19 on youth mental health: A mixed methods survey. Psychiatry Research, 321, 115082.

10 Bitsko, R. H., Holbrook, J. R., Ghandour, R. M., Blumberg, S. J., Visser, S. N., Perou, R., & Walkup, J. T. (2018). Epidemiology and impact of health care provider-diagnosed anxiety and depression among U.S. children. Journal of Developmental and Behavioral Pediatrics: 39(5), 395–403.

11 Drake, P., & Williams, E. (August 5, 2022). KFF issue brief: A look at the economic effects of the pandemic for children.

12 Bullinger, L.R., Boy, A. (2023). Association of expanded child tax credit payments with child abuse and neglect emergency department visits. JAMA Network Open. 2023;6(2):e2255639.

13 Holdroyd, I., Barton, G., Holdroyd, D. (2023). The effect of working tax credits on child maltreatment rates: A systematic review. Child Abuse & Neglect (143), 106279.

14 Campbell KA, Wood JN, Berger RP. (2023). Child abuse prevention in a pandemic—A natural experiment in social welfare policy. JAMA Pediatrics 177(12):1263–1265.

15 Maassel, N.L., Graetz, E., Schneider, E.B., Asnes AG, Solomon, D.G., & Leventhal, J.M. (2023). Hospital admissions for abusive head trauma before and during the COVID-19 pandemic. JAMA Pediatrics 177(12):1342–1347.