Children’s Dental Health Month – Practice Taking Precautions during Pandemic: Don’t Postpone Your Child’s Dental Care
by guest contributor Rosie Kickish, DMD, Inspiration Dental in Riverview, FL Everyday life looks different…
The child welfare system faces a difficult double-bind during the current health crisis: children spending more time in potentially volatile home environments with fewer outside parties able to identify any dangerous conditions, while families currently in the child welfare system navigate prolonged separations and potential emotional trauma from separation.
Nationwide, about 670,000 US children have experienced maltreatment, or about 9 in every 1,000 children. This issue disproportionately impacts young children – 41 percent of those children experiencing maltreatment are under age 5 nationwide; adding in children up to age 10 represent 74 percent of all maltreatment cases. There are a lot of nuances in the reasons why children and families may enter into this system and what happens with their cases thereafter. For example, child neglect, rather than abuse, account for about three-quarters of all substantiated cases – neglect refers to children not receiving their basic needs of food, shelter, care and adequate supervision. It is easy to believe that the current climate of economic crisis, health concerns and general anxiety can further contribute to these rates.
There is very real concern that the current crisis and resulting stay-at-home orders will result in increased rates of intimate partner violence, child abuse and neglect – at the very same time that most families are cut off from formal and informal support networks who may be able to identify these dangers. Experts report that major periods of anxiety and fear in the broader society are often linked to an uptick in child abuse and even child deaths, as happened during the financial crisis which started in 2007.
Mandated reporters often provide an essential intervention for children experiencing abuse and neglect. While each state has different requirements, mandated reporters are professionals (and volunteers) working closely with families and children who are required by law to report suspected abuse and/or neglect: teachers, school staff, social workers, health care and mental health care professionals, child care providers and law enforcement, for example. South Carolina’s Director of Social Services Michael Leach explained that the timing of this crisis is particularly concerning for child welfare reports as March and April are the busiest months for referrals for abuse and neglect; referrals generally decline in the summertime when students are out of school for the summer, but the department reports they have already seen declined reports in March. Children are currently cut off from in-person interactions with many concerned individuals who may notice that something is amiss, from teachers to coaches to clergy to extended family members.
Limitations on in-person engagement in support of social distancing is impacting multiple parts of the child welfare process. NPR reports that the emotional toll is heavy on families who are currently separated through the system, as they are now relegated to only virtual means of connecting instead of previous visits which foster bonding and are an important part of reunification. The same piece highlights that child welfare agencies have had to make hard choices regarding the safety of their caseworkers in working with families in the context of a rapidly spreading virus, with the state of Maine suspending all caseworker visits to foster homes, while Los Angeles County has equipped caseworkers with necessary protective equipment to continue fieldwork. The American Bar Association hosted a webinar on the difficult decisions agencies must currently navigate; the recording is now available.
Writing in the Chronicle of Social Change, Jerry Milner and David Kelly of the U.S. Children’s Bureau within the Department of Health and Human Services draw attention to the long-term impacts of these separations during an age of isolation, if not properly managed:
“When children are removed from their parents, even when necessary for their safety, and artificial visiting arrangements are imposed that prevent parents from being parents and children from being children, they become distanced and that can be harmful to parents and children alike…As we struggle to develop responses and adapt, we cannot forget the simple fact that children miss their parents, parents miss their children and that absent aggravated circumstances, they deserve a fair shot to be together or get back together as soon as there is not a safety risk. Further, it is not merely a matter of longing for contact, it is a matter of healthy brain development, maintaining critical bonds and prevention of trauma that can persist for generations.”
They also stress that, where meaningful visits to mitigate trauma and separation are not viable, the child welfare system must work to avoid holding this time against families. The child welfare sector operates on timelines for reunification plans, timelines which may have already proved difficult which are now seemingly impossible in the economic crisis and separation. The most urgent need is among families nearing the statutory timeline for filing for termination of parental rights; Milner and Kelly write “[c]hild development and bonding will be used in arguments not to return children to their parents and to expedite adoptions in instances where families did not have a fair chance. We must be vigilant and prepared to stop this from happening, because justice demands it.
Globally, domestic violence rates have increased significantly as families have sheltered at home, at the same time that many agencies which works with survivors to leave their abusers have had to scale back on efforts. Shelters may not be able to operate in the same way as a result of social distancing guidelines, and advocates recognize that abuse survivors may be under greater surveillance from abusive partners while a household is forced to isolate. Even when children are more direct victims of violence, this takes a toll on their well-being as well – in fact, witnessing violence in the home is one of the classic Adverse Childhood Experiences (ACEs) which is identified as having long-term impact on health and well-being. The New York Times profiles global stories and responses which show the universality of this struggle, often with children in the middle.
There are no easy answers to these challenges. The Children’s Bureau has released a list of resources for the child welfare workforce as well as foster care families and children. The Zero to Three Foundation has offered a five-part webinar series through April and May exploring the current COVID-related issues in child welfare which professionals may face for: clinicians, home visitors, early childhood educators, child welfare professionals, and military and veterans groups.