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Hundreds of thousands of kids have lost a parent or primary caregiver to COVID-19 and need support services, mental health experts say, with communities of color particularly devastated.
“Some families lost several people within a span of a few months, and just having one loss after another—that kind of accumulation of more grief—we see higher levels of distress in some of the kiddos we’re seeing,” said Cecilia Segura-Paz, a licensed professional counselor-supervisor at the Children’s Bereavement Center of South Texas.
Because of the pandemic, some children didn’t get to attend a funeral or bereavement services. Others didn’t get a chance to say their last goodbyes. For some youth in underserved communities in South Texas, Segura-Paz said, existing economic hardships, food and housing insecurity, and disruptions to education have deepened and complicated their grief.
Through local partnerships and school-based programming, Segura-Paz said, her center was able to provide more counseling services and peer support groups for children, but high counselor caseloads, provider shortages and conflicts with class time during in-school sessions may have hindered children from getting the help they need.
From January 2020 to November 2021, more than 167,000 children under 18 lost a parent or in-home caregiver to COVID-19, according to a December report titled “Hidden Pain” by researchers at the University of Pennsylvania, Nemours Children’s Health and the COVID Collaborative. The report found that Black and Hispanic children lost caregivers at more than double the rate of White children, while American Indian, Alaska Native, Native Hawaiian and Pacific Islander children lost caregivers at nearly four times the rate of White children.
Psychologists say this loss has caused an uptick in anxiety, depression, trauma- and stress-related disorders in some children. Mental health professionals, like others in health care, have experienced burnout amid much higher caseloads. Last fall, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association declared a national state of emergency in children’s mental health.
The Biden administration has directed some pandemic relief aid to student mental health programs and some states passed related legislation, but none of the efforts have focused solely on children who have lost caregivers. With states’ 2022 legislative sessions underway, mental health advocates hope the youth mental health crisis will push lawmakers to pass laws that increase access and availability of services, expand mental health awareness and alleviate a strained mental health workforce, especially in rural areas.
“As we move forward through this pandemic, I don't want people to feel as though, if the pandemic is getting better, then the youth mental health issue will go away,” said Dr. Christine Crawford, associate medical director of the National Alliance on Mental Illness, a national mental health advocacy organization. “The reality is that that's not the case, because this crisis preexisted COVID. And it’s even more dire in these rural areas because there is hardly any mental health support in place.”
For some kids in Texas who lost a caregiver, it has been difficult to find social support while also readjusting to school, reconnecting with peers and struggling to maintain good grades, Segura-Paz said. Students at her center consistently worried about problems such as their family members’ mental health or how bills were going to get paid.
Katrina Van Houten, a high school math teacher in the Del Valle Independent School District in Travis County, Texas, recalled changing classroom instruction in December 2020 because six parents had died of COVID-19. Instead of teaching only math, she decided to focus on social and emotional learning.
“I don’t think I’ve ever taught so little math. I was teaching a lot of how to survive in reality,” Van Houten said.
Some of her students are doing better but still are dealing with the side effects of losing a parent, such as working a job to compensate for lost income, she said.
“When I talk to them, they’re like, ‘I just go to school during the day, but I got to work at 5 and get off at midnight,’ and then they try to do their homework,” she said in an interview. “I’ve lost parents when I was young, so I understand the issues that come with it. It just makes me give them a lot more grace.”
States are working to address some of the problems. Last year, 14 states passed 36 bills to beef up children’s mental health services and expand mental health training opportunities for school resource officers and teachers, according to a database compiled by the National Conference of State Legislatures, which tracks state policy.
In 2020 and 2021, at least eight states—Arizona, Colorado, Connecticut, Illinois, Maine, Nevada, Utah and Virginia—enacted laws allowing excused school absences for mental health reasons or expanded on existing laws that allow it, according to Stateline research.
In Washington state, Democratic Gov. Jay Inslee signed a bill into law that will establish a comprehensive school counseling program, require school districts to promote behavioral health resources on social media, and allow reimbursement for certain services related to mental health assessment and diagnosis.
In Utah, Republican Gov. Spencer Cox signed a bill that adds mental or behavioral health as a valid excuse for a school absence. Virginia enacted a law in 2020 requiring state agencies to conduct a joint feasibility study on developing an early childhood mental health consultation program. The program would be available to all early care and education programs serving children up to age 5.
More legislation likely will be considered this year. In California, Democratic state Sen. Nancy Skinner plans to introduce a measure that would create a savings account with up to $5,000 for children whose parents died from COVID-19. Lawmakers in Massachusetts proposed bills that would allow students to take excused absences for mental health reasons.
The policies proposed by federal and state government officials should be holistic and sustainable and should include bereavement support, which is instrumental in helping families and children heal, said Dr. David J. Schonfeld, founder and director of the National Center for School Crisis and Bereavement at Children’s Hospital Los Angeles.
“Grief has always been an issue, and we don’t really have a very good mechanism for providing grief support because we don’t pay for it in our country, because bereavement is not considered an illness,” said Schonfeld, a developmental-behavioral pediatrician. “As a result, health insurance doesn’t cover the counseling. We don’t refer to it as therapy or counseling, and most bereavement support is by faith-based organizations and laypeople provided free of charge.”
Five large states—California, Florida, Georgia, New York and Texas—accounted for 50% of total caregiver loss from COVID-19, according to the “Hidden Pain” report. Arizona, Mississippi, New Mexico and Texas had the highest rates of caregiver loss.
COVID-19 has taken a disproportionate toll on older adults of color because they are more likely to have preexisting health conditions, limited access to health care and exposure to environmental factors that make them more vulnerable to the virus.
Dan Treglia, lead author of the “Hidden Pain” report and associate professor of practice at the University of Pennsylvania’s School of Arts and Sciences, said some children of color who have lost caregivers have faced economic and social adversity prior to COVID-19, which warrants more resources to help them cope and adapt.
Children in the hardest hit communities, especially in rural areas, have fewer health care providers available and difficulty accessing telehealth appointments, which can affect whether, how and when young people can access services, Treglia added.
“Very few children require mental health services at a clinical level, but nearly all children will require the love and compassion of adults that are in their lives and communities,” Treglia said. “Oftentimes, that can require their local faith-based organizations or nonprofits to step up and play roles … but in many rural areas, [peer support groups and mentoring programs] are not going to be around the corner. They’re going to be much scarcer and much more difficult to come by.”
The American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association provided recommendations to policymakers in their declaration last fall, including increasing funding for mental health screening, access to technology and school-based mental health care and community-based programs.
Treglia and the co-authors of his report suggested policymakers, educators and leaders in the nonprofit and private sectors consider creating a COVID-19 bereaved children’s fund, putting in place screening for complicated grief, strengthening social services and increasing affordability of mental health services, among other measures.