Coronavirus (COVID-19): impact on children, young people and families - evidence summary October 2020

Key messages

Over the last month, there has been a tightening of restrictions in response to a rise in COVID-19 cases and hospital admissions. At the same time, many children and young people are adjusting to changes in school and childcare settings. This briefing is the fourth in a series of high-level evidence summaries on the impact of COVID-19 on the wellbeing of children and families in Scotland, drawing on wider UK research where appropriate. As with previous briefings, the scope is fairly broad to cover a wide range of policy interests. This month, there are some new Scottish studies relating to particular groups of children and young people which will be of interest, including: children and families living in poverty; black and minority ethnic (BME) young people; and families impacted by disability. A summary of key themes and messages is set out below.

Mental wellbeing

• UK survey evidence suggests that key issues for young people as they came out of lockdown were concerns about COVID-19 transmission, adapting to COVID-19 measures in schools (physical distancing) and worries about future aspirations and longer term financial and job security. There are also reports of anxiety and fear associated with returning to 'the outside world' (YMCA survey).
• UK representative surveys using standardised measures of mental wellbeing continue to show little or only modest differences in mental wellbeing over lockdown compared to pre-lockdown baselines. However, this appears to mask differences in sub-groups – aside from known gender differences (girls continue to report lower mental wellbeing), wellbeing scores in one study (ImpactEd) were lower in pupils from lower income households, those with special educational needs and disability (SEND) and those with English as an additional language. This finding is consistent with findings from other studies previously reported (e.g. Oxford University's Co-SPACE Study).
• Data from the UK-wide Children's Society annual survey reports similar levels of family COVID-19 bereavement (8%) to that reported in a Scottish poll^[1] which suggests that nearly one in ten children may have experienced bereavement due to COVID-19. A report from Barnardo's highlights the importance of identifying and supporting children who have experienced a bereavement, particularly those from communities with higher risk of mortality from COVID-19 including BME families and those living in areas of high deprivation.

Poverty

• There are a number of Scottish studies that indicate increasing concern about the impact of rising poverty on the wellbeing of children and families. The evidence suggests that worsening financial situations continue to have a detrimental effect on families' mental health, particularly those reliant on social security.
• In a University of Glasgow study of high poverty communities, services report an increase in new families in crisis, many of whom may not be known to services. A key lesson learned from lockdown was that 'vulnerable' families who were eligible for a place in the school hubs had not taken up the offer, in part due to a sense of stigma.
• Food poverty is highlighted in a number of Scottish studies with one survey by Includem reporting that nearly half of low income families surveyed struggle to put food on the table on a regular basis. A University of Glasgow study highlighted food poverty as an issue in deprived rural communities.
• Other common themes from wider UK evidence this month (consistent with previous briefings) were digital exclusion, overcrowding and/or poor quality housing and lack of outdoor space – all of which impact negatively on the wellbeing of families.
• There is some economic analysis from the Sutton Trust that suggests that without intensive support and addressing the digital divide, the long-term negative impact of school closures on earnings is estimated to be much higher for young people from less well-off backgrounds.

Play deprivation

• Emerging UK evidence suggests that some children may have experienced a sustained loss of play and regular peer interaction during the pandemic. Younger (primary) age groups appear to be at greatest risk of loss of peer interaction (both online and in-person), with new evidence from the UK-wide Co-SPACE Study suggesting that this did not recover in the summer when many restrictions were lifted. This evidence is consistent with Scottish evidence previously reported (Public Health Scotland CEYRIS survey^[2]) and suggests that even after the lifting of restrictions children may still miss out on regular peer interactions, particularly those directly impacted by COVID-19 (see below).

Shielding/clinically vulnerable children and families

• It is becoming apparent that children who are/were isolating or shielding (or living with a family member who is) may be an under-recognised group at risk of adverse impacts from COVID-19. Data from the Children's Society annual survey and Scottish survey data estimates^[3] suggest that one in three children in Scotland may be at risk of potential adverse impacts due to increased risk of isolation.
• The most recent UK-wide Family Fund survey reports that, despite the lifting of shielding requirements, a third of families said they would not be changing their actions in line with the easing of restrictions due to their children's conditions.
• UK-wide research by the Royal College of Paediatrics & Child Health reports that some children who were shielding (in particular) felt forgotten during lockdown, and felt that the messaging and support services were inappropriate and aimed at the over 70s. Key priorities for young people who have been shielding were to provide mental health support as they reintegrate into society and better communication and messaging.
• One UK study of parents of children with cancer (the SHARE study) describes feelings of fear and anxiety during the pandemic, and the psychological, social and economic impact of isolation, with hospital no longer being perceived to be a safe place.

Children and families impacted by disability

• The most recent UK-wide Family Fund survey paints a worsening picture of the wellbeing of disabled and seriously ill children in the UK. Many families surveyed continue to struggle financially. Parental concern about the negative impact of COVID-19 on children's physical health, mental health and children's behaviour and emotions has remained very high, and in some cases increased over time. Although there has been some recovery in formal support, the evidence suggests that the majority of families surveyed are still not receiving the support they need, particularly in educational psychology, speech and language therapy and occupational therapy.
• Wider UK evidence shows that for some children with special education needs and disabilities (SEND) school closures had a beneficial effect on their anxiety levels, with some parents considering home education as a long-term option. Key factors that helped children were a more flexible approach to learning, less social pressure and more child-led learning. That said, a UK survey by the National Autistic Society reported increased levels of anxiety in autistic children due to loss of routine, with some reports of problems in return to school arrangements.

Other key findings relating to specific issues and/or sub-groups:

• Black and Minority Ethnic (BME) Children and Young People - Research by Intercultural Youth Scotland reports BME young people's feelings of disadvantage (compared to their white peers) in relation to their education in particular, and future opportunities as a result of COVID-19. Other key issues raised were worries about the disproportionate impact of COVID-19 on BME people and the impact of police presence during lockdown, which it is reported limited opportunities for BME young people to exercise and socialise during lockdown. Elsewhere, findings from a large Welsh survey during lockdown reports that across most of the factors measured, BME children fared worse. This included play, outdoor exercise, food security, support, information, learning and mental wellbeing.
• Care experienced young people – as previously reported, the body of evidence continues to highlight care leavers as most at risk of mental health impacts due to experiences of loneliness and social isolation during lockdown which were exacerbated by lack of digital access. There is emerging UK evidence that kinship carers struggled significantly during lockdown, with one in four survey respondents worried that they will be unable to cope with a second lockdown (Grandparents Plus survey). As previously reported, there continues to be emerging (UK) evidence of a rise in reports of child on carer violence during lockdown.
• Domestic abuse – Scottish evidence reports that throughout lockdown services received reports of children being exposed to increased levels of abuse. There were some reports of children who had fled domestic abuse experiencing severe isolation and digital exclusion, with remote engagement with younger children being reported as very difficult. The most consistent finding throughout lockdown and Phases 1 to 3 related to domestic abuse perpetrated via child contact. There were reports of perpetrators using the restrictions as a justification for increased contact and women facilitating child contact outwith agreed conditions, in order to placate perpetrators and manage abuse.
• Adverse childhood experiences - the newly formed UK Trauma Council has published a report which sets out how the pandemic is impacting on children's experiences of trauma in terms of increasing the risk of ACEs (e.g. domestic abuse, bereavement, family mental illness, extreme poverty etc.) and limiting the ability of adults and services to identify children and mitigate the impact of trauma. More evidence is needed on the extent to which children have been exposed to ACEs during the pandemic, and how those with prior experience of childhood adversity and/or trauma have been impacted.
• Child exploitation/modern slavery – For the first time, ONS modern slavery statistics report that more National Referral Mechanism (NRM) referrals were received for child potential victims than adults (over the period Apr-Jun), which is partially driven by an increase in the identification of 'county lines' cases. Research on looked after children in England and Wales suggests a move towards local recruitment of children by criminal gangs, rather than recruiting children in cities to travel long distances (Crest study).
• Online safety and bullying - There is some emerging UK evidence of an increase in online bullying during lockdown (YMCA survey). There are also indications of increases in online sexual abuse during the pandemic (based on data on UK-wide Childline and NSPCC helpline data). A NSPCC briefing suggests that this may be aggravated by children and young people using online platforms to counter loneliness without sufficient understanding of online risks.

Lessons learned and looking forward – common themes

Looking across the evidence, there are number of common themes that may be helpful when considering post-lockdown policy responses. These are set out below:

• A targeted response - overall, the evidence suggests the need for more targeted messaging and information and recovery planning (interventions) focused on the needs of specific sub-groups of children and families.
• Trauma-informed approach – drawing on evidence about the negative impact of lockdown on children and young people's mental health and the increase in adverse and/or traumatic experiences for some children, various reports call for more trauma-informed/nurturing approaches in schools in particular and a renewed focus on mental wellbeing especially for disadvantaged groups.
• Friendships and relationships – a recurring theme is the importance of re-establishing friendships, as well as the critical importance of positive and supportive relationships for children's wellbeing more generally. Having somewhere safe to meet with friends is highlighted in some of the evidence which, given the recent changes in restrictions and the onset of winter, may merit some attention.
• Choice, participation and flexibility - a number of reports this month highlight the importance of choice and participation for children's recovery and wellbeing, for example in healthcare settings (e.g. choice over mode of healthcare access). Research continues to voice a desire from young people for a more active role in recovery efforts.
• Mitigating the impact of poverty - Suggestions for addressing some of the concerns about poverty raised in this months' reports include school breakfast provision, basic needs such as food and digital access to be considered a human right and a package of financial measures such as a top-up payment until the Scottish Child Payment is operational and a government housing grant for families at risk of eviction.
• Safety – A number of studies point to the significance of safety for children's wellbeing in the current environment – in a clinical sense (avoiding COVID-19 transmission) but also in a physical sense (having a safe space to hang out with friends) and psychological sense (feeling safe).

Evidence Gaps

We are seeing some of the persistent evidence gaps closing as new research is planned or underway, and the body of wider evidence accumulates and converges. Going forward, there is a need for more longitudinal research in Scotland to monitor the impact of the pandemic in the longer term, particularly for disadvantaged sub-groups, as well as the need for a better understanding of the prevalence and experiences of COVID-19 illness, shielding/vulnerability and bereavement in families. As restrictions change, it is important to monitor how children and families are adapting and the impact this is having on different sub-groups. Going forward, research priorities should be focused on lessons learned, protective factors/assets and 'what works' to support targeted policy interventions.