August/September 2020Vol. 21, No. 6Learnings for Children's Services From the COVID-19 Pandemic

Written by Patrick W. Lawler, chief executive officer, Youth Villages

As 2020 began, many advocates for significant change in child welfare systems were encouraged. Passage of the Family First Prevention Services Act in 2018 had brought the first major change in federal child welfare funding in a generation. With it came the hope for a transformation in child welfare—a real shift toward valuing families and identifying and using effective services to reduce or limit the duration of out-of-home placements. Implementation had been slower than hoped, but funding was available to states to transition as more evidence-based programs and state plans were approved.

Then, the COVID-19 pandemic ended business as usual for child welfare departments and private providers across the country. Now, governments at every level as well as private agencies are working together to meet the needs of children and families in new ways: contracts have become more flexible and frontline specialists are our essential workers—our heroes.

The organization I lead works on many levels—as a private provider of services; as a partner developing and sharing evidence-informed program models; as a consultant supporting state systems to improve outcomes; and as an advocate for the children, families, and young people we serve.

Although COVID-19 is an ever-changing challenge, we want to share a few early learnings from our work and what we expect going forward.

Flexibility and family focus. From our organizational experience, we know that a crisis can propel lasting change. In the midst of a state budget crisis in 1995, we gained our first state contract that included intensive in-home services. At that time, the state was only funding our residential treatment programs. We told officials we could help more children with less funding if they would give us the flexibility to also provide services in the child's own home.

We now have 141 intensive in-home services contracts across the country. Very few are performance based, and some are very restrictive. As COVID-19 caused disruptions, we were given more flexibility by state and county officials, as everyone pulled together to get services and support to families and young people. Hopefully, the spirit of collaboration and focus will stay with us after the national health emergency ends so we can put families first.

Safety and support for staff. The safety of the children, families, and young people we serve, as well as that of our staff, is always our top priority. The pandemic added layers of concern for all of us. Our residential staff are essential workers who must be on our campuses every day to meet the needs of children with serious emotional and behavioral problems. We continued to accept referrals in all our programs. To help keep staff and children safe, we obtained personal protective equipment and developed comprehensive policies and protocols. Our community-based and administrative staff began working remotely from home. As a result, we are discovering that some positions may lend themselves to long-term remote status.

Meeting basic needs. We emphasize our evidence-based therapeutic interventions, but our first priority always is to evaluate safety and simple, basic needs. As the crisis began, we surveyed our staff to find out what impact the pandemic was likely to have on the families and young adults they serve. We found a high percentage had become unemployed or were losing hours at work, resulting in housing and food insecurity. Because donations supplement our programs, we were able to immediately distribute gift cards and cash to meet the most urgent needs of young people and families. Meeting basic family needs is critical to helping children avoid unnecessary foster care placements and allowing the reunification process to continue for others.

The well-being of older youth in foster care and those transitioning to adulthood is a particular concern during the crisis, as they are more likely to be disconnected from supportive adults. Many transition-age young people did not receive a stimulus check and have had difficulty accessing unemployment benefits, which puts their housing in jeopardy. We have joined with FosterClub and hundreds of advocates to support targeted relief for these young people in the next federal stimulus package, including a supplemental increase in federal Chafee funding (#UpChafee) to meet emergency and continuing needs as young people recover from the crisis.

Technology and broadband internet access are also basic needs. Four years ago, we issued touchscreen computers to more than 1,100 community-based staff, so that they could work more efficiently in the field using our medical records system and online support tools.

The technology capacity of those we serve was a very different story. In as many as 40 percent of families, devices were unavailable and/or internet service was unreliable or absent. We began working to ensure a solid connection with those we serve. Technology questions are now included in all admission paperwork, and we take steps to get devices and internet access secured on the front end so families and young people can participate fully in digital sessions.

Telehealth now and later. Our community-based models are built on face-to-face sessions in the home and community, which became impossible because of the pandemic.

Now, we simulate face-to-face sessions with telehealth—video when possible and audio only when not. During strict lockdowns, specialists see children, families, and young people in person only when absolutely necessary (such as in a crisis situation, for safety, or when issues simply cannot be handled through telehealth). In-person sessions are generally outdoors on front porches and in driveways—with masks and social distancing enforced. On our residential campuses and children in foster homes, video allows critical virtual visits with parents as in-person meetings were canceled.

We found that some children, families, and young people engage better through digital technology than they did in person. Others do not, and frontline specialists have adapted. COVID-19 restrictions eventually will end, but we believe the use of technology to enhance children's services will be dramatically increased by lessons learned during the crisis. Here are some ideas:

Extra sessions and check-ins with youth, parents, and foster parents can be done through telehealth with a focus on engagement, timely support, and safety.
Conducting some foster parent training via telehealth could enable more potential parents to participate.
Evidence-based individual therapy sessions that require a particularly trained specialist—not available in their location—could be done via telehealth, allowing more families to benefit.
Telehealth could be used for routine admission or preplacement interviews.
Leadership could support specialists and engage families with video check-ins and visits.

Although we are now more nimble and open to change, the crisis has created new challenges.

Child protection questions. States are reporting a tremendous decline in the number of child protective services reports. By the time children go back to school this fall—if they do—they will have been at home for 6 or 7 months without the oversight that being in public places and at school provides. In this environment, it's more important than ever that each child is protected and appropriate services to preserve and restore families are provided.

Budgets under pressure. Unfortunately, we may have to face an increased demand for children's services at the exact time state budgets are under the most pressure in a decade. The economic collapse that followed the COVID-19 lockdowns has caused a decrease in tax revenue at every level of government. We will be fighting to justify programs and services that save families and give young people a successful start in life—just as many states are preparing to implement Family First.

It will be a while before we know how this upheaval has affected the performance of child welfare systems and providers across the country. Did we keep children safe? Did we give families and young people the support they needed? The numbers will eventually tell us, but I already do know the COVID-19 crisis drew us out of familiar comfort zones and forced us to work together in new ways—always putting the needs of children, families, and young people first.

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Youth Villages, founded in 1986, is a national leader in children's mental and behavioral health committed to building strong families, delivering effective services and significantly improving outcomes for children, families, and young people involved in child welfare and juvenile justice systems across the country. The organization's 3,000 employees help more than 30,000 children annually in 21 states across the United States.