The three guiding values of child welfare services are safety, permanency and well-being. Maintaining child safety is essential, and even the circumstances of a pandemic should not undermine the vital work of supporting permanency and well-being for children and their families. Implementation of the Family First Prevention Services Act and expanded prevention efforts, including those implemented during the COVID-19 pandemic, can help keep families safely together.
For the purposes of this document: children refers to infants, children and adolescents.
Children in foster care and their families have experienced being “distanced” from each other even before the COVID-19 pandemic began. Feelings of isolation and loneliness during the pandemic have compounded the uncertainty and change that may have occurred both before and during foster care placement. Perhaps most importantly, the pandemic has increased awareness of underlying racial and socioeconomic disparities that continue to affect children in foster care. Racial and ethnic inequities that result in Black, Indigenous and Hispanic/Latino families’ disproportionate involvement in the child welfare system can be addressed by providing families access to needed services that prevent unnecessary foster care and child welfare involvement, in addition to all sectors of the child welfare system identifying and eradicating systemic and institutional practices and policies that further racial inequities and disparities.
The educational system has experienced and continues to experience ongoing disruptions because of the pandemic. Children and youth involved with the child welfare system already experience more disruptions in their education than other students, and the pandemic has exacerbated these disruptions. The American Academy of Pediatrics (AAP) Interim Guidance for Safe Schools provides strategies for schools and communities to meet both the educational and safety needs of children and youth. Child welfare, educational and pediatric professionals should work together to ensure that the unique needs of children involved with the child welfare system are addressed as a part of the larger efforts around education.
We know from past crises such as Hurricane Katrina that the effects of disasters may not manifest until well after the event and can persist for years. In addition to all of the other challenges of the pandemic, many children have experienced the death of a parent or primary caregiver from COVID-19. Pediatricians must be ready to help children work through their grief in the months and years ahead while remembering that children are resilient and strong and that we can help support those strengths. Pediatricians stand ready to work alongside child welfare professionals to support their critical work devising optimal ways to serve children and families during the pandemic and beyond.
During crises such as the current pandemic, the protection of family integrity for children and families involved in the child welfare system remains extremely important. The AAP affirms that a stable home and caregiver are important to nurturing a child’s development and preventing trauma that can affect a child across the lifespan. This guidance is designed to support the continuation and improvement of that critical work so that all children and families may flourish.
Key Principles: Child Welfare During the COVID-19 Pandemic
- The child welfare system is an essential service that should be prioritized in the same way as services such as health care during the pandemic. The early years of brain development have profound impacts on child development, mental health and lifelong well-being. All members of the child welfare and family court systems need to continue to provide timely care and services to children and adolescents with the goal of permanency.
- For children in the child welfare system, continued family support and visitation with parents and siblings is critical to promote well-being, secure attachments and successful timely reunification and permanency. Courts and child welfare systems must continue to find ways to provide services for children even—and especially—during the pandemic.
- Child welfare and health professionals need to work together to ensure that children’s connections to their families remain strong while at the same time working to reduce the risks presented by COVID-19.
- Given that Black, Indigenous and Hispanic/Latino children are overrepresented in the child welfare system, clear formal guidance should serve to reduce inequities and promote decisions that support family connections and permanency for all children regardless of race or ethnicity.
- Kinship care retains children’s critical familial and cultural ties. Although older relative caregivers may face unique risks from COVID-19, child welfare practices should continue to prioritize kinship care whenever possible.
- Disparities among populations that are overrepresented in the child welfare system have become more apparent during the pandemic, with growing concerns around lack of access to technology and school supports. Although most schools have returned to in-person learning, there are likely to still be times when learning may occur in a virtual format. Child welfare professionals can help ensure that all children have the supports needed to be successful, including supporting kinship caregivers who may be challenged with helping children access and continue in virtual school classes.
- The AAP continues to reiterate that children belong in families. Placements in nonfamily settings, such as residential treatment, congregate care, or detention facilities, should be a last and temporary resort when a family setting is not able to meet treatment needs. Special considerations related to COVID-19 exist for these facilities.
- Adolescents and young adults transitioning out of foster care require additional support to cope with the social isolation and loss of school and employment routines caused by the pandemic.
- Whenever possible, in-person visitation is preferable—both for family visitations and for visits between child welfare professionals and children.
- Agencies should prioritize obtaining regular feedback from birth families and caregivers regarding visitations so that adjustments can be made to best promote connection and secure attachment between the child and family members.
- A combination of in-person and virtual visits can be considered to increase the frequency of parent-child and sibling interactions. It may be especially useful to use virtual visits to prepare a child for an in-person visit (for example, a parent’s appearance may have changed, helping children become familiar with wearing masks and discussion of what to do for fun at the visit), to follow-up on an in-person visit (address sadness or acting-out behaviors), or as a substitute for a planned in-person visit if it must be postponed because of COVID-19 risks.
- Everyone involved in the visits should adhere to the same guidelines to reduce the risk of COVID-19 infection. Regional transmission rates can be determined in real-time using the CDC county-level COVID-19 data tracker; this information can help guide additional prevention efforts during visits.
Now that safe and highly effective COVID-19 vaccines are available for children and adolescents 5 years and older, visitation can be much safer and less stressful for everybody. The AAP strongly encourages everyone who is eligible to receive the recommended doses of COVID-19 vaccine as soon as possible. The CDC continues to update guidance to define “fully vaccinated.” Child welfare agencies can assist by ensuring that all eligible children in their custody have access to the vaccine. Child welfare agencies should provide accurate and timely information and care to parents and foster families.
- The CDC provides guidance for everyone involved with a visit (child, caregiver and household members, birth family and child welfare professionals) to help prevent the spread of COVID-19 during gatherings. Some things to consider while planning a visit:
- Determine regional transmission rates in real-time using the CDC’s county-level COVID data tracker. The AAP still promotes the benefits of masking to reduce transmission of COVID-19.
- Prior to the visit, monitor symptoms of those who will be involved with the visit. Those who are sick or experiencing symptoms of COVID-19 should stay home and not attend the visit, following CDC guidelines for isolation when someone has COVID-19. People who have known or suspected exposure to COVID-19 should also wear a well-fitting mask or respirator around others for 10 days from their last exposure, regardless of vaccination status or history of prior infection, per CDC guidelines.
- Especially when community transmission rates are high, consider meeting outside. If meeting indoors, try to use spaces that are well-ventilated (ie, with windows that can be opened).
- Those who are at risk for severe illness should wear a mask or respirator that provides them with greater protection. Those at higher risk can include those who are unvaccinated as well.
- All vehicles used to transport children should be cleaned before and after a visit. Consider having all individuals in the vehicle wear masks, regardless of vaccination status or recent exposure, when community transmission levels are high or an individual in the vehicle is considered high-risk. Keep windows open as appropriate for better ventilation to reduce the possibility of transmission of COVID-19.
- Unless all participants in the visit are up to date with COVID-19 vaccinations, everyone should wear a face mask when gathering indoors, except children <2 years old. Masks should be worn by all individuals, including those who are vaccinated, when in an area of high transmission or when individuals participating in the visit are considered high-risk. Regional transmission rates can be determined in real-time using the CDC’s county-level COVID-19 data tracker.
- In very rare cases, a child may not be able to wear a mask. Visits should not be canceled because of the inability to wear a mask.
- Hand hygiene should be implemented for every participant frequently before, during, and after the visit, using soap and water or hand sanitizer.
- Gloves are not required except for when changing diapers. Gloves should be discarded and hands washed in soap and water or hand sanitizer once the diaper change is completed.
- If the guidance above is addressed (ie, up-to-date on vaccines, symptoms monitored, masking when indicated), normal physical contact (ie, hugs and other forms of affection) between parents and children can be supported. As a reminder, individuals involved with the visit who have been exposed to COVID-19 should wear a mask and may consider limiting physical contact. Those with symptoms should not attend this visit until they have completed the recommended isolation period.
- Maintain a log of everyone present at the visit, with contact information. If anyone who was present develops symptoms of COVID-19 within 2 weeks of the visit, they should contact the child welfare professional. The CDC guidance for close contact exposure to COVID-19 should be followed.
- The individual with symptoms should also contact their primary care provider, who can direct their health care related to COVID-19.
- When in-person visits cannot safely occur, attention is needed to ensure that virtual visits are accessible and developmentally appropriate for the child(ren) involved.
- Child welfare professionals should ensure that all people involved have access to and understanding of the necessary technology.
- Visits should be developmentally appropriate for the child(ren) involved.
- Shorter, more frequent visits will likely work better than single longer virtual visits, particularly for younger children or those with developmental delays.
- Having games or activities planned for the visit can make it more successful and fun.
- Having a facilitator can be helpful, both to engage all participants and to provide technological support.
Child Welfare Concerns for Children Who Are COVID-19 Positive or Exposed
- Communication with the child’s primary care physician should be initiated immediately. If there is not yet an established primary care physician, then the local health department resource should be contacted to determine testing. Follow the directions of the health care provider for the child’s immediate health needs and possible treatment recommendations.
- Most children will simply require
- Children should be kept with their families whenever possible.
- With the requirements of isolation, families may need additional supports, such as grocery or pharmacy deliveries.
- Foster and kinship families who care for a child who has tested positive for or been exposed to COVID-19 should have access to education, training and consultation about what to do when exposed, treatment options, isolation recommendations, and general infection prevention and control strategies, including the use of masks.
- Child welfare professionals should refer to current infection prevention and control guidance when conducting in-person visits with children who are COVID-19 positive or have a confirmed exposure.
- Caregivers and child welfare professionals who have been fully vaccinated do not have to quarantine after a potential exposure, per current CDC guidelines on exposure. However, individuals should wear a face mask when around others for 10 days and should be tested 5 days after the exposure.
Considerations for COVID-19 Vaccination
The AAP strongly recommends that all people, and especially those who are involved in the child welfare system, be vaccinated against COVID-19 as soon as they are eligible. See the AAP COVID-19 vaccine policy and CDC for up-to-date recommendations on COVID-19 vaccines. It is recommended that all children and youth be caught up on all their vaccinations, including the influenza vaccine.
Children and youth who are involved with the child welfare system (both in family-based and congregate care settings) and their caregivers often have medical conditions that place them at higher risk of developing more severe COVID-19 illness. People of racial, ethnic and cultural groups who have been disproportionately affected by the pandemic are disproportionately represented in the child welfare system. Child welfare professionals often work in high-risk, first-responder roles. Keeping all of individuals safe and healthy is vital to the continued functioning of essential child welfare services.
Child welfare systems should collaborate with state and local public health to ensure that children in their guardianship are vaccinated with the COVID-19 vaccine as recommended by the CDC. Pediatricians should work with families, child welfare systems and professionals to promote receipt of the COVID-19 vaccine now that it is available to children ages 6 months and older.
Collaborating with the Pediatric Community
- Child welfare professionals and caregivers should maintain close communication with a child’s health care provider when a child is COVID-19 positive or exposed or has symptoms of COVID-19.
- Pediatricians should work with foster and kinship families at this time, helping to educate and link to appropriate local supports.
- Pediatricians should work with local child welfare agencies to provide consultation around individual cases and to help agencies develop protocols and strategies to deal with the issues of COVID-19 related to social work staff, foster and kinship families and congregate care facilities.
- Although testing of asymptomatic children is not recommended, a negative COVID-19 test result is sometimes required as a condition for reunification or placement into foster, kinship or congregate care. In this situation, pediatricians can work with local hospitals, urgent care centers and pharmacies to establish protocols to facilitate expeditious testing.
- Guidance Related to Early Care and Education/Child Care During COVID-19
- Guidance on Providing Pediatric Well-Care During COVID-19
- Caring for Children and Youth With Special Health Care Needs During the COVID-19 Pandemic
- Responding to the Needs of Youth Involved With the Justice System During the COVID-19 Pandemic
Interim Guidance Disclaimer: The COVID-19 clinical interim guidance provided here has been updated based on current evidence and information available at the time of publishing. Guidance will be regularly reviewed with regards to the evolving nature of the pandemic and emerging evidence. All interim guidance will be presumed to expire on June 30, 2023 unless otherwise specified.
American Academy of Pediatrics