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The Senate is on vacation until next week, having left Washington last month without delivering on the needed support that states and localities urgently require to support families and working people across the country who are living on the edge of financial and health disaster.
For parents across the country who are focusing on getting their children back to school, whether they are ramping up for remote or hybrid learning regimens or adjusting to new routines, the stress is palpable, especially for mothers. Many, like me, are spending hours sifting through webinars, taking surveys, reading FAQs, digesting adjustments to Individual Education Plans (IEPs), learning new COVID-19 health protocols and making decisions on either full distance learning or hybrid ‘pod’ learning – based not on what is best for educational outcomes, but on other factors including economic and/or health security. It is a lot for any caregiver to deal with.
Schools are scrambling to manage the impossible with few or no new financial resources. The dual task of creating healthy spaces for teachers and students while also delivering high-quality educational content is a resource-intensive task that, without additional equitably distributed support, will ultimately fail those who are most at-risk and traditionally excluded. Now – layer on one more vital role that schools play: caring for children’s physical and mental health.
Schools increasingly play a role in delivering health services to students, from vision screens to mental health support, often being a primary source of care to maintain good health. Schools as a delivery system can be especially important for families that are stretched economically and cannot take time off from work to manage routine health issues. As we have documented in the past, Medicaid in particular is a key partner in driving some of this change and is an important financial partner in expanding access to health care for children and youth within schools. Learn more here.
COVID-19 has complicated this trend in delivery innovation and created urgency for the system to address an increased spike in health care needs. Many children across the country have not been to their pediatrician in months, meaning that routine childhood vaccination rates are down by as much as 50 percent in some states. Moreover, provider touch points on other issues, whether chronic illness (e.g., diabetes or asthma) or those related to COVID-19 (trauma or anxiety), are going unaddressed. In particular, mental health and related issues with anxiety or depressive symptoms are spiking, especially among youth. Research shows that over a third of adolescents (35 percent) rely on schools as their primary resource for mental health services and 1 in 5 children have a mental or behavioral health issue.
Kids are weary of quarantine and fearful of getting sick or their parents getting sick. COVID-19 needs to be understood and treated for what it is – a traumatic event that requires both a health and educational response. It should not go unstated that Black and brown children are feeling the brunt of this pandemic disproportionally. Against the backdrop of the murder of George Floyd and the many other traumatizing news stories involving police violence against Black people, and the greater likelihood that they have lost a family member or friend, children of color are at great risk. They are also more likely to rely on Medicaid, have a chronic condition and are more likely to attend highly segregated schools.
While some schools are trying their best to prepare for this complex situation, many are not. This sets up our school systems for a surge of health care demands that they may not be prepared to meet, all on top of monitoring for any COVID-19 outbreaks. For example, one district in Arizona – traditionally under-resourced for education funding and for school health – is asking librarians, administrators and teachers to call high school students and check on their well-being. This is symptomatic of a deeply underfunded system that needs resources.
For our youngest students, returning to an in-person setting has been lifted up as paramount for brain development and staying on track for learning. Yet, are we ready to address the emerging mental health issues of our youngest students? In a recent survey, summarized by our friends at Center for Children and Families, families with children under age five are feeling intense stress and anxiety that co-occurs – meaning both caregiver and child are suffering. For younger children, a caregiver is key in helping manage fear and anxiety. Strategies like ‘name it to tame it’ are helpful for supporting younger children but are difficult to employ if caregivers are overwhelmed. Finally, school-aged children with special needs will be confronting multiple challenges including recovering from a loss of health supports (therapeutic services) during quarantine, adjusting to new modalities of learning while also potentially being at higher risk due to medical frailty. Resources to support schools by expanding access to health services through Medicaid can be a game changer.
There are some tools circulating that are helpful for schools to consider once they can think beyond COVID-19 protocols. Medicaid is increasingly relying on telehealth. Schools as providers should be no exception. According to Manatt Consulting, most states have expanded telehealth access for well-visits, therapies and behavioral health – these are three core areas for which schools can be an ally, ensuring full access to needed health services. Inequities remain regarding broadband for some families – more than 50 percent of low-income families lack access, compounded for people of color and rural families, so schools can leverage their efforts to secure educational access to also meet telehealth needs. Second, schools can and should be in touch with the health of their students; using proven surveys and assessments, schools should both understand their students’ health needs while also deepening connections to pediatric networks to partner and support families. Schools’ focus on social-emotional health is an entry point for mental health specifically and physical wellness broadly but should not be conflated as the same thing. The pandemic has laid bare the inequities in health access for children and the role that schools must and should play as a partner to the health care delivery system.
Parents and stakeholders can do two things. First, people should demand that members of Congress return and fund Medicaid and school recovery, including financing of infrastructure and health services for students. Second, we must both press and support school administrators to design pathways to health services and have tools to identify and address health issues – both physical and mental.
Congress is failing to address the needs of our students, teachers and families. They have the power to support schools as a health delivery system by funding Medicaid – we must continue to hold them accountable, demanding that they do their jobs.