The Parents Are Not Alright: A Call for Caregiver Mental Health Screening During the COVID-19 Pandemic

Understanding the Association Between Childcare Precarity and Emotional Distress

BACKGROUND

For families with young children, securing reliable childcare may present a significant challenge. Rising costs, limited resources and the COVID-19 pandemic have heightened the precarity of childcare arrangements. Childcare precarity, defined as a state of insecure or unreliable childcare arrangements while parents work or attend school, reflects unpredictability in family life and early care and education settings and has important implications for families' economic and psychosocial well-being. This study aims at broadening the conceptualization of childcare precarity to include childcare search status and examine its association with caregiver and child emotional distress.

METHODS

Participants were 3115 caregivers in the United States (88% female, 67% white) who completed the RAPID Survey between November 2022 and December 2023 and reported working or attending school. We assess whether including a childcare search status as an indicator of precarity improves the cross-sectional prediction of caregiver and child emotional distress beyond commonly used indicators (unreliability and disruptions). Using a person-centred approach, we also conduct an exploratory latent class analysis (LCA) to identify distinct experiences of childcare precarity and associated emotional distress.

RESULTS

Childcare unreliability and disruptions were associated with caregiver distress. For children, unreliability was associated with fear/anxiety, while disruptions were associated with fussiness/defiance. Childcare search status was also linked to both caregiver and child emotional distress, improving model fit compared to baseline models. Our exploratory LCA identified a five-class solution as optimal, with emotional distress outcomes varying significantly across classes and correlating with levels of precarity.

DISCUSSION

Our findings highlight the importance of a multidimensional approach to childcare precarity. Identifying distinct precarity profiles can inform targeted policy interventions to support diverse family needs. Future research should validate these findings and explore the broader impact of early life unpredictability.

Screening for Depression in Caregivers of Children with Developmental Disabilities: A Quality Improvement Initiative

INTRODUCTION

Screening for depression in caregivers of children with developmental disabilities is not routine, representing missed opportunities for support.

METHOD

A quality improvement project was initiated in our pediatric clinic. Root causes of limited screening included unclear guidelines for support, caregiver perception that help is unavailable, and lack of a quick screening tool. A clinical pathway was constructed and integrated into existing practice using quality improvement methodology.

RESULTS

Baseline screening rate was 5%-10%. During the 12-week pilot, weekly rates ranged from 46.0% to 91.0% (mean 70.2%). Monthly rates subsequently averaged 55.0%. Approximately 20% had a positive screen; over half were caregivers of children with autism. About 5% had moderate depression, of whom 40% required referral to social workers.

DISCUSSION

Structured depression screening of caregivers of children with developmental disabilities is feasible and sustainable in a busy clinic. Further research is needed to measure the impact on child and family outcomes.

Paternal Depression and Anxiety During the COVID-19 Pandemic

The COVID-19 pandemic significantly impacted the lives of families worldwide. Findings suggest a substantial impact of the COVID-19 pandemic on maternal mental health. Yet, much less is known about the impact of COVID-19 on paternal mental health. This study describes depression and anxiety and risk and protective factors among fathers of young children largely residing in Canada during the COVID-19 pandemic. Fathers (N = 70) of children 0 to 8 years old self-reported depression (EPDS, CESD, CESD-R) and anxiety (PASS, GAD-7) symptoms, while mothers (N = 236) provided reports of paternal depressive symptoms using the EPDS-P. Fathers evidenced clinically significant depression (37.1%) and anxiety (22.9%). Linear regression models with significant bivariate correlates indicated that depressive symptoms were associated with a mental health history and experiencing recent stressful events in the past month, while anxiety symptoms were related to mental health history over and above other correlates. Mother-reported paternal depression was prevalent (61.9%) and associated with lower mother-reported marital quality and higher maternal depressive symptoms. Of the fathers reporting clinically significant mental health concerns, less than one-third reported accessing mental health services. Paternal depression and anxiety symptoms were elevated during the pandemic, when compared to pre-pandemic comparisons. The risk and protective factors for paternal depression and anxiety included mental health history, recent stressful events, maternal marital quality, and maternal depressive symptoms. Longitudinal studies evaluating the persistent impact of the COVID-19 pandemic on paternal mental health are needed to inform continued efforts to repair the pandemic's impact on family wellbeing.

Examining the Impact of COVID-19 on Education and Service Access for Diverse Families of Young Children With and Without Developmental Delays

The rapid transition to virtual learning due to the COVID-19 pandemic created unprecedented challenges that significantly impacted caregivers of young children, particularly those with developmental delays and children from non-English speaking households (Valicenti-McDermott et al., 2022). The current study aims to describe caregivers' concerns regarding the COVID-19 pandemic in general and specific educational concerns following school closures, and to determine whether their concerns varied as a function of whether the child had a developmental delay or the parent's ethnicity. Results revealed that caregivers of children with DD endorsed a greater number of general and education-specific COVID-19 concerns compared to caregivers of TD children, and non-Latinx caregivers of children with DD reported more general COVID-19 concerns compared to Latinx caregivers of children with DD. With respect to education-specific concerns, caregivers of children with DD reported a greater impact from the loss and/or delay of services and reported feeling significantly less capable of conducting educational activities in the home compared to caregivers of TD children. However, almost all caregivers in the study endorsed some level of stress from remote instruction. These findings suggest there is a specific need for attention to caregiver mental health and an examination of long-term educational outcomes resulting from extended school closures during the COVID-19 pandemic.

COVID-19 vaccine hesitancy, vaccination, and mental health: A national study among U.S. parents

The COVID-19 pandemic led to increased mental health concerns among parents. Emerging studies have shown links between COVID-19 vaccine hesitancy and psychological distress, including among parents. The primary aim of this study was to extend these emerging findings by examining the role of COVID-19 vaccine hesitancy in mental health functioning in a national sample of U.S. parents, accounting for the effects of COVID-19 vaccination status and underlying medical conditions increasing COVID-19 risk. A nationally representative sample of U.S. parents (N = 796) completed a cross-sectional survey between February-April 2021, including measures of depressive, anxiety, and COVID-19 acute stress symptoms; COVID-19 vaccination status; underlying medical conditions increasing COVID-19 risk; and COVID-19 vaccine hesitancy. The sample consisted of 51.8% fathers, Mage=38.87 years, 60.3% Non-Hispanic white, 18.1% Hispanic/Latinx, 13.2% Non-Hispanic Black/African American, 5.7% Asian, and 2.8% Other Race. Hierarchical regression models adjusted for demographic covariates revealed that greater COVID-19 vaccination hesitancy and presence of an underlying medical condition were consistently associated with higher levels of depressive, anxiety, and COVID-19 acute stress symptoms among parents. Having had at least one COVID-19 vaccination dose was associated with greater levels of COVID-19 acute stress, but was not associated with depressive or anxiety symptoms. Results add new evidence from the U.S. in support of the link between COVID-19 vaccine hesitancy and psychological distress, point to the potential utility of behavioral health care workers in helping reduce vaccine hesitancy, and provide tentative data suggesting that COVID-19 vaccination for parents alone may not have provided mental health relief.

The Resilience of Caregivers and Children in the Context of COVID-19: A Systematic Review

The COVID-19 pandemic has necessitated caregivers and school-aged children to adapt to ongoing changes and uncertainty. Understanding why some caregivers and school-aged children area able to adapt and others are not could be attributed to resilience. The relationships between caregiver or child resilience and socioeconomic status (SES) in the context of COVID-19 remain largely un-explored. Therefore, the purpose of this qualitative systematic review was to explore (1) what is currently known about the relationship between caregiver and child resilience in the context of COVID-19; and (2) the role of SES on caregiver or child resilience throughout the COVID-19 pandemic. Four databases (i.e., MEDLINE, Scopus, PsycINFO, and CINAHL) were systematically searched, title/abstract and full-text screening were conducted, and 17 articles met the inclusion criteria (i.e., discussed resilience of caregivers/children during COVID-19, mean age of children between 7-10, primary research/grey literature, English), including 15 peer-reviewed and two grey literature sources. Thematic analysis revealed five themes: (1) the mitigating effects of child resilience; (2) overcoming the psychological toll of the pandemic; (3) the unknown relationship: caregiver and child resilience; (4) family functioning during COVID-19; and (5) the perfect storm for socioeconomic impacts. Results from this review provide the first synthesis of the impact of the COVID-19 pandemic on the resilience of caregivers and school-aged children. Future research should conduct longitudinal data collection to understand the possible long-term impacts of the pandemic on these populations' resilience. Understanding these impacts will be integral to assisting families in bouncing back from the long-lasting adverse circumstances caused by the COVID-19 pandemic.

Addressing challenges at the intersection of early intervention and child welfare

BACKGROUND

The Keep Children and Families Safe Act amendment to the Child Abuse Prevention and Treatment Act (CAPTA) of 2003 mandated children under age three who are involved with Child Welfare (CW) to receive a referral to the system for early intervention (EI). While there is strong rationale for providing developmental services to young children and families impacted by maltreatment, the early implementation of this policy brought about many challenges related to interagency coordination and readiness of providers to provide cross-systems care. Currently, as the system and providers within the system recover from the effects of Covid-19, a predicted increase in need of services may exacerbate historical gaps in the provision of services to families involved with CW.

PARTICIPANTS AND SETTING

This policy-focused paper explores issues impacting CW and EI providers who coordinate care between CW and EI services.

METHODS

This paper provides a historical examination of these challenges and proposes an approach for improving developmental services for families referred from CW, specifically through the lens of addressing resources and supports available to providers.

RESULTS

The proposed approach includes an increase and reprioritization of resources to support provider readiness and well-being.

CONCLUSIONS

By focusing on support for providers, the authors propose a reduction of stress and improvement of services at each level of the "well-being" system.

Behavioral, Affective, and Cognitive Parenting Mechanisms of Child Internalizing and Externalizing Problems during the COVID-19 Pandemic

The COVID-19 pandemic has led to increased mental health concerns, including depression and anxiety among parents and internalizing and externalizing problems among youth. To better understand the mechanisms and moderators of child mental health during the pandemic, the current study tested two moderated mediation models in which parent depression and anxiety indirectly impacted child internalizing and externalizing problems through negative effects on multiple parenting variables, with these associations moderated by families' exposure to COVID-19-stressors. A national sample representative of U.S. parents (N = 796, 48.2% female, Mage = 38.87 years, 60.3% Non-Hispanic white, 18.1% Hispanic/Latinx, 13.2% Non-Hispanic Black/African-American, 5.7% Asian, 2.8% Other Race) completed a cross-sectional online survey in February-April 2021. Children ranged from 5-16 years old (Mage = 10.35 years, 59.8% Non-Hispanic white, 17.2% Hispanic/Latinx, 13.7% Non-Hispanic Black/African-American, 4.5% Asian, 4.8% Other Race). Parent depression/anxiety was directly and indirectly associated with child internalizing and externalizing problems. For both internalizing and externalizing problems, indirect associations occurred by means of increased parent hostility and inconsistent discipline and decreased routines and parent supportiveness. There were also specific indirect effects through decreased monitoring (internalizing problems) and parenting self-efficacy (externalizing problems). Multiple indirect effects were moderated by number of COVID-19-stressors experienced. Notably, COVID-19-stressors did not have direct effects on child mental health when other variables were considered. Findings highlight the buffering effects of parents for child mental health, the need to address parent depression/anxiety in child interventions, the utility of existing evidence-based parent interventions during the pandemic, and the need to assess families' level of exposure to COVID-19-stressors.