Children and Youth Services Review 144 (2023) 106745

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Children and Youth Services Review

journal homepage: www.elsevier.com/locate/childyouth

Discussion

The moment is now: Strengthening communities and families for the future
of our nation
Whitney L. Rostad a, Katie A. Ports b, *, Melissa Merrick c, Laura Hughes d
a
Independent Scholar, Seattle, WA, USA
b
Health Equity Research Applied, Atlanta, GA, USA
c
Prevent Child Abuse America, Chicago, IL, USA
d
Gusto Partners, LLC, Detroit, MI, USA

A R T I C L E I N F O A B S T R A C T

Keywords COVID-19 has highlighted the historical lack of investment in the conditions that children need to thrive, and
Adverse childhood experiences demonstrates how a crisis can exacerbate children’s vulnerability to disease and violence. Exposure to early
Prevention adversity already affects millions of children across the country and puts them at risk for poor outcomes. With the
Equity
uncertainty of the pandemic, many more families are struggling and subsequently, more children are at risk for
Child well-being
exposure to adversity. Preventing early adversity and promoting the prosperity of our nation requires assur­
ing that all children, regardless of sociodemographic characteristics, have what they need to reach their full
health and life potential. Now is the time to address the social and structural conditions that contribute to the
inequitable distribution of risk for some families and which contribute to their unequal burden and impacts of
adversity, COVID-19, racial injustice, and other health crises. While many look forward to “a return to normal,”
returning to normal would be a missed opportunity to learn from our mistakes and ensure a bright future for our
nation. We must invest in children and families for the future health of Americans.

1. Introduction childhood adversity, and toxic stress demonstrates strong associations

The world is still in the midst of a pandemic. COVID-19 is wreaking
havoc across the globe and devastating communities as it spreads. To
slow the virus’s spread, countries and states across the U.S. ordered
residents to stay home and practice social-distancing while also
encouraging and even incentivizing vaccinations. In this sense, we are
all experiencing public health in action. Integral to public health,
however, is health equity and what a society does collectively to assure
the conditions in which all people can be healthy (Institute of Medicine,
1993). As we all experience this public health crisis, we see that
disproportionate impacts abound, and children and families are even
more vulnerable to the negative conditions that will impact their health
now and into the future.
Given the significant stressors parents and caregivers are experi­
encing in this global pandemic, including social isolation, job loss, and
reduced access to concrete supports, many children are at higher risk of
experiencing child abuse and neglect (CAN), and other adversities.
Unfortunately, as a country, we have never prioritized CAN prevention
as a public health imperative. The science of brain development,
between CAN and longer-term health consequences, including changes
in physiological development; physical and mental health problems;
engagement in health risk behaviors such as smoking and substance use;
and premature death (Anda et al., 2006; Bellis et al., 2019; Merrick et al.,
2019). Many at increased risk right now are the same children at high
risk before the pandemic—children who, because of racism, historical
trauma, and other structural or systemic factors, consistently comprise
lower income households, lack stable housing, and live in divested
communities, and consequently remain the most vulnerable to COVID-
19 and the resultant economic fallout. COVID-19 highlights the histor­
ical lack of investment in the conditions that children need to thrive, and
demonstrates how a crisis can exacerbate children’s vulnerability. While
many look forward to “a return to normal,” simply returning to normal
would be a missed opportunity to learn from our cross-generational
mistakes and ensure a bright future for our nation. Every member of
our society, and particularly those who have been privileged by our
policies and practices over time, has a role to play in developing or
supporting safe, stable, and nurturing environments for all children and
families (e.g., Merrick et al., 2019). Heretofore the authors use ‘we’ to

* Corresponding author.
E-mail address: kports@air.org (K.A. Ports).

https://doi.org/10.1016/j.childyouth.2022.106745
Received 17 December 2020; Received in revised form 28 October 2021; Accepted 24 November 2022
Available online 28 November 2022
0190-7409/© 2022 Elsevier Ltd. All rights reserved.
W.L. Rostad et al.
refer to the collective action needed to ensure healthy conditions. We
must invest in children and families for the future health of our nation,
and now is the time!
We must assure the environments, physical and sociopolitical, in
which families live support relationships that promote safety, stability,
and nurturance. This is particularly important in the current crisis, but
the innovations employed to get families through crises today need to be
sustained in what will be a long recovery. We must address the social
and structural conditions that contribute to the inequitable distribution
of risk that some families experience, and which contribute to their
unequal burden and disproportionate impacts of CAN, COVID-19, and
other health crises.
2. Social determinants of child well-being
The conditions in which individuals live have profound implications
for their lifelong health and well-being. Research has long highlighted
the connection between structural and societal conditions and exposure
to childhood adversity and violence (Klevens & Metzler, 2019). The
COVID-19 pandemic has underscored the inequitable distribution of
conditions that promote health. Indeed, the pivot of many employees to
remote work and home confinement was certainly smoother for some
families than others. While all families are experiencing additional
stressors in this uncertain time, many blue-collar and service industry
workers cannot work remotely and certainly cannot afford not to work
during a pandemic regardless of symptoms, exposure, and risk level. In
fact, among those who make up the bottom 10 % in earnings, only 31 %
have access to paid sick leave (Desilver, 2020), which means that many
families have had to choose between disease prevention or forgoing
basic concrete needs.
Many households report they struggle with an unexpected $400
expense (Brady, Fullerton, & Cross, 2009). As such, those families
finding themselves unexpectedly unemployed do not have the means to
support their families during months of economic shutdowns. As we
highlight further in the paper, government subsidies rolled out in 2021,
but many families had already experienced economic instability for
months before payments had been received. The workers at highest risk
for job instability before and during the crisis are comprised of women
and racial/ethnic minorities who earn less wages than their white, male
counterparts, and thus, greater work instability from COVID-19 will
further widen the income inequality we see in this country. In addition,
daycare closures, schools moving to remote learning, and mandatory
quarantines for kids exhibiting systems regardless of testing results have
created new child care burdens for mothers and fathers, making it a
challenge to hold down a job that does not provide remote options and
additional flexibilities. This will contribute to the unequal burden of
childhood adversity, as economic instability and parental stress are key
risk factors for CAN. Families in deep poverty are also likely to be living
in marginalized communities, and measures to mitigate the virus’s
spread likely exacerbated their social isolation and lack of access to
social supports.
Social determinants of health, such as access to education, nutritious
food, and healthcare are crucial to children’s health and well-being. As
schools moved to online platforms, the digital divide and inequitable
access to education has become even more apparent, as students from
low-income and minority families are more likely to report that they
cannot complete assignments because they lack reliable access to the
internet or a computer (Anderson & Perrin, 2018). Additionally, over 30
million children rely on free or reduced meals at school and many low-
income families lack access to nutritious food as they live in neighbor­
hoods without affordable, nutritious foods (i.e., “food deserts”).
Pandemic-related labor and distribution shortages have made it even
more challenging to get nutritious foods to families who rely on free and
reduced lunches and other food assistance programs.
In the midst of a pandemic, the need for universal healthcare could
not be more apparent, but unfortunately, over 27 million people in the
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Children and Youth Services Review 144 (2023) 106745
US remain uninsured (Berchick, Barnett, & Upton, 2019). Healthcare
access may be particularly consequential for children of color, as
Medicaid expansion has been linked to reduced mortality among Black
adolescents (Wherry & Meyer, 2015). Expanded health insurance
coverage for low-income children has also been associated with higher
levels of education completion (Cohodes, Grossman, Kleiner, & Love­
nheim, 2014) and, in adulthood, they pay more in taxes and claim less in
tax credits (Brown, Kowalski, & Lurie, 2015). Those without access to
internet who cannot utilize telehealth options, and who lack health care
coverage are particularly vulnerable during a public health crisis.
Recent events have highlighted the ramifications of racism and
continued oppression of communities of color in public health and social
crises. Criminal justice policies, particularly regarding drug possession,
have led to the mass incarceration of men of color and exacerbated the
instability of their children and families. One in every 28 children has a
parent behind bars, but for Black children the number is 1 in 9, a rate
that has quadrupled in the past 25 years (The Pew Charitable Trusts:
Pew Center on the States, 2010). Incarceration can devastate the health
and well-being of individuals, their families, their communities, and
society at large (Jubitana, 2019). In the current pandemic, outbreaks in
prisons have been common and decisions to reduce crowding have
resulted in the early release of non-violent offenders. Still, people who
have incarceration histories have a harder time acquiring stable hous­
ing, employment, and education (London & Myers, 2006; Pager, West­
ern, & Sugie, 2009), which will be even more difficult with business
closures and surging unemployment.
COVID-19 has hit communities of color and lower SES the hardest,
both in terms of illness severity and deaths (Rossen et al., 2021). Simi­
larly, risk for exposure to CAN is unequal. While all children are at risk,
conditions like poverty, racism, and historical trauma keep some chil­
dren and families at greater risk of experiencing CAN and other public
health crises. However, these same conditions also put some children
and families at greater risk of unnecessary involvement with punitive
systems like child protection because poverty is often confused with
neglect (Milner & Kelly, 2020). Indeed, while child protection systems
should not remove children because of poverty-related concerns alone,
the unfortunate reality is that it happens all too often (Dettlaff et al.,
2011; Zlotnick, 2009). Given the pandemic has been accompanied by
significant economic shocks, the pandemic may not only lead to
increased maltreatment by exacerbating parenting stress, more children
may be removed simply because more families are living in poverty as a
result of the pandemic’s economic fallout. As such, traumatic inter­
vention will not be necessary if we truly transform how we as a society
provide supports and services for families before they find themselves in
crisis.
The disproportionate burden of violence experienced by some chil­
dren and families, primarily those of color, without citizenship, and
living in low-income households, is increasingly understood as a major
contributor to health inequities in the U.S.; health inequities that are
contributing to increased death rates in these same families amidst the
current public health crisis. Indeed, conditions like poverty and racism
are pre-existing conditions that increase risk of various health problems,
and that has been painfully clear with COVID-19. As such, addressing
the social and structural determinants that influence the conditions in
which families are raising children can point to powerful levers of
change that can sustain long-term prevention and health promotion.
Prevention strategies that address risk and protective factors that
contribute to structural conditions (e.g., federal, state, local, and orga­
nizational policies) not only have the potential for large impacts on
population health, but also require less individual effort. Policies that
promote family well-being (e.g., livable wages, universal healthcare,
affordable housing, childcare subsidies) are needed, and to do this
effectively, we need to change our national narrative around why peo­
ple, especially children, struggle.
W.L. Rostad et al.
3. Developing new narratives that are supportive of children
and families
There remains a gap between what we know about the consequences
of social and economic inequality and what evidence-based solutions we
choose to implement. This may be the result of dominant narratives
regarding poverty and adversity, which tend to focus on blaming in­
dividuals for their hardship, and therefore, believing they are unde­
serving of assistance. Subsequently, policies shown to be effective at
lifting people out of poverty are often unpopular and evoke pejoratives
such as ‘free handouts’, ‘welfare queens’, and ‘nanny states’. These
negative tropes reinforce dominant and misleading narratives that can
be used to strategically suppress the political will needed to create
supportive environments for children and families.
Narratives are stories rooted in shared values and common themes
that influence how individuals and groups process information about
circumstances and experiences and subsequently guide decisions and
actions (or support for actions) (Jenkins, 2018). Narratives surrounding
public health issues like CAN provide information on who and what is
responsible for the problem and how to solve it (Niederdeppe, Bu,
Borah, Kindig, & Robert, 2008). Ultimately, narratives help people make
sense of their world, and they are powerful tools for garnering support
for policies. To move toward adopting the policies proposed below,
there needs to be a societal shift in our understanding of why people
experience adversity, including poverty. This understanding could lead
to a shift in our narratives and ultimately, in greater support for equi­
table, family-friendly policies.
A dominant narrative in American culture is that individual choices
determine an individual’s outcomes (i.e., fallacy of pulling yourself up
by the bootstraps). In addition to implicit biases, this narrative leads to
blaming individuals for their problems and, thus the default solution is
one that is focused on fixing “bad” children and parents. The perception
that people in poverty are not trying hard enough and therefore un­
worthy is deeply engrained in the ethos of the US. These narratives
perpetuate ideologies that some lives matter more than others in that
there are ‘deserving’ and ‘undeserving’ people in poverty, that sharing
resources is not possible, or that we are all on our own. These fallacies
are, at their root, the logic of white supremacy whereby hyper-
individualism, greed, violence, and fear are used to shape harmful
narratives that drive ineffective action in unjust systems, and perpetuate
stigma on those seeking help, which reduces the generosity of the public
and limits effective implementation of policies that address the condi­
tions children and families need for maximal health and prosperity
(Wilson, 1987). For example, in the US, the narrative that individuals
are entirely responsible for their outcomes results in people viewing
social and economic supports as a welfare system whereby individuals
are undeserving of assistance if they are not working for pay. As such,
“acceptable” policies almost always come in the form of a tax credit
where stipulations are placed on the poor in exchange for aid, requiring
that those receiving public assistance demonstrate they are using the
support to change their behaviors and choices in a way that lifts them
out of poverty (e.g., work requirements, drug testing) (Lindsay, 2004).
Working against lifting people out of poverty are the too common policy
restrictions on accruing assets while receiving support. For example,
many economic support policies have a benefits cliff, such that small
increases in earnings can push people over the eligibility threshold for
benefits even though they still need economic support (National Con­
ference on State Legislatures, 2019). In addition, people must pass a
savings or resource test where they demonstrate a lack of most assets
before they can receive and continue to receive benefits. Lifting one’s
self out of poverty requires the accrual of assets so that the next time
they are in need they can use their savings versus social supports.
Temporary income supports that penalize people for accruing assets is
counterproductive to their intent and renders our current policies
largely ineffective at actually lifting people out of poverty for the long
term (Wilson, 1987). This is vastly different than other developed
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Children and Youth Services Review 144 (2023) 106745
nations whereby services and economic supports are seen as a necessity
to family and child well-being, and are provided more universally
(Lindsay, 2004).
In the 1990 s, several wealthy nations adopted child tax credits (CTC)
to address concerns of increasing child poverty (McCabe & Popp Ber­
man, 2016). In Canada, the discussion regarding CTCs centered on
children, whereas in the U.S., the distinction between the taxpayer and
welfare recipient overshadowed children. As a result, the “logic of tax
relief for taxpayers” was adopted in the U.S., in which “families should
be exempt from paying taxes until they have enough income to avoid
poverty” and the extent of relief was determined by how many de­
pendents a family was supporting (McCabe & Popp Berman, 2016).
Within this logic, providing tax relief to the poorest families is perceived
as inappropriate because these families do not have tax liability; alter­
natively, supplementing the income for working families is perceived as
inappropriate because they do not need it. Conversely, in Canada and
other countries, the “logic of income supplementation for families with
children” dominated, wherein “neither wages nor unemployment ben­
efits take into consideration the fact that some people support dependent
children while others do not” (McCabe & Popp Berman, 2016). Under
this logic, income supplements are perceived as appropriate because
they are tied to family size, not employment or tax liability.
Ultimately, new, transformational narratives are needed to garner
support for and sustainability of changes in policies and systems out­
lined in this paper. Public awareness efforts could improve the public’s
understanding of the structural policies (e.g., housing, labor, education
policies) and processes that lead to living conditions (e.g., poverty,
housing instability, incarceration) that create toxic stress for children,
how these conditions affect children’s brain architecture and function,
and how ultimately these can impact health, education, employment,
income, and future generations. Describing the structural circumstances
that contribute to adversity can also promote greater compassion for
families. Greater compassion could amount to reductions in patholo­
gizing behavioral patterns caused by structural determinants and
increased understanding and support for diagnosing and addressing
structural determinants of health. Indeed, studies have shown that
communication of societal factors can change the public’s understand­
ing of a problem and increase support for social and economic policies
(Barry, Brescoll, & Gollust, 2013; Bostrom, 2004; Niederdeppe, Shapiro,
Kim, Bartolo, & Porticella, 2014; Young, Hinnant, & Leshner, 2016). In
addition to public health campaigns (a top-down approach), community
organizing (a bottom-up approach) is a strategy that can be effective at
building community or collective power to change narratives that sup­
port local solutions for social and economic conditions contributing to
inequitable burdens of injury and disease (Speer et al., 2020).
The pandemic has changed our perception of a “struggling family,”
as millions of parents across the country filed unemployment claims and
lost reliable income, and provides an opportunity for a less hyper-
individualized narrative around well-being. As COVID-19 changes the
landscape for families raising children, shifting from a narrative that
emphasizes individual responsibility to one normalizing that all families
could find themselves in need is necessary to facilitate the type of
transformation needed to respond to the impacts of the crisis and
strengthen families in recovery. A narrative that encourages connect­
edness, empathy, utilization of services, and acknowledges the difficulty
of child-rearing in the context of structural and social conditions is
needed to reduce not only the stigma of help-seeking, but to change the
way we view and support families. This is not an individual problem.
This is a societal problem, and as such, all sectors need to come together
with a shared vision for the health and well-being of our children, and
the future prosperity of our nation. New narratives such as these could
increase political will to build a new public child and family well-being
system that does not return us to the pre-pandemic status quo.
W.L. Rostad et al.
4. Adoption of policies that assure healthy conditions for
families
On a societal level, the pandemic has exposed serious flaws in fed­
eral, state, and local policies and highlighted the failure of federal and
state governments to adequately strengthen supports for American
families before crisis occurs. While not comprehensive, the following
section discusses critical buckets of policies that should be considered by
policymakers for helping families through the crisis and recovery, and in
preparation for future crises.
4.1. Workplace policies
Paid family leave provides working parents the ability to spend time
away from work caring for their children and themselves without stress
related to unemployment or long periods without pay. The ability to
take time off work without fear of losing income can reduce the burden
of choosing between health and safety and being able to provide for
children. In the case of COVID-19, a parent can stay home and reduce
their risk of transmitting the disease. Paid leave policies have demon­
strated effectiveness at improving child wellness, reducing family and
maternal stress and depression (Association of State and Territorial
Health Officials). For example, after California passed paid family leave
legislation in 2004, the state saw a reduction in rates of pediatric abuse
head trauma, the leading cause of fatal child abuse among young chil­
dren (Klevens, Luo, Xu, Peterson, & Latzman, 2016). Given stay at home
orders and guidelines to quarantine among those exposed to COVID-19,
our public health response requires universal access to paid leave.
Other critical policies include predictable work schedules and the
availability of quality, affordable childcare so parents can work. Flexible
and predictable work schedules allow parents to manage work and
caregiving responsibilities, including finding reliable childcare. Child­
care is increasingly expensive and unaffordable for many families in this
country, and costs will surely increase given the large numbers of
childcare centers that were forced to close during the pandemic. Most
low-income families rely on programs such as Head Start and childcare
subsidies to be able to obtain and afford childcare, which benefit both
parents and children. For example, parents who receive childcare sub­
sidies are more likely to work standard hours (Press, Fagan, & Laughlin,
2006), work full time (Marshall, Robeson, Tracy, Frye, & Roberts,
2013), and earn more (Ha, 2009). Moreover, the receipt of childcare
subsidies has been linked to fewer investigations of abuse and neglect
(Yang, Maguire-Jack, Showalter, Kim, & Slack, 2019). While childcare
subsidies have been associated with positive outcomes, parents would
not need to rely on them if childcare was more affordable and univer­
sally available, as is the case in other wealthy nations with more uni­
versal childcare policies (e.g., Germany, Norway).
4.2. Income policies
More than a decade of research has shown that anti-poverty policies
(e.g., Earned Income Tax Credit [EITC]) are effective at lifting families
out of poverty, and are linked to several well-being outcomes (Averett &
Wang, 2016; Klevens et al., 2017; Kovski et al., 2021; Rostad, Ports,
Tang, & Klevens, 2020). Increasing the generosity of state-level EITCs,
the largest anti-poverty program in the United States, has been associ­
ated with decreases in reported neglect, particularly among young
children (Kovski et al., 2021). State EITC policies have also been linked
to fewer abusive head traumas among young children (Klevens et al.,
2017) and reductions in foster care entries (Rostad et al., 2020), but only
when they are refundable and benefit families with little to no tax
liability.
Anti-poverty tax credit policies like the EITC and child tax credit are
contingent on employment and operate so that as income rises, the
benefits of the policy diminish. Further, a recent report demonstrates the
potential for unintended consequences as low-income families who
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claimed the EITC were more likely to be audited by the Internal Revenue
Service and audits were concentrated in areas with a large Black pop­
ulation (Mock, 2019). While tax credits can be helpful, they are only
helpful to those within a limited income range, and even then, there are
associated risks for taking advantage of that policy. Economic policies
need to go above and beyond tax liability, because stronger economic
supports for lower income families would not only keep families out of
poverty, but would also allow families to save money for times of crises,
and perhaps, the current pandemic would not feel so catastrophic for so
many.
Raising minimum wages can improve the financial situation of those
in poverty, narrow the poverty gap, and break the poverty threshold
(Raissian & Bullinger, 2017), yet the federal minimum wage has
remained stagnant since 2009. In addition, minimum wages do not al­
ways equate to a livable wage. According to economists, families must
make $52 k to $156 k to feel financially stable and enjoy the perks of
middle-income (Kochhar, 2018). This requires a basic income that in
many cities far exceeds $15 an hour. Still, just a $1 increase in the
minimum wage has been linked to reductions in neglect reports, and the
effect was strongest for young and school-aged children (Raissian &
Bullinger, 2017). Of additional importance is that benefit cliffs have not
been adjusted to reflect how much families actually need to survive
(National Conference on State Legislatures, 2019). As such, earning $15
an hour keeps families in poverty, while excluding them from taking
advantage of social supports like SNAP that they still need. Accordingly,
policies may be effectively reducing the number of families in poverty,
but less so when it comes to conferring the economic security needed in
a public health crisis. As such, income policies like basic income and
livable wages in addition to efforts to address benefits cliffs are needed
so that families are able to live and save for unknown crises.
4.3. Wealth-building policies
The largest contributor to wealth in the U.S. is owning a home
(Mitnik & Grusky, 2015), and families of color are far less likely to own
homes than their white counterparts, which, accordingly, mirrors racial
disparities in wealth. Black families are more likely to rent and live in
public housing in smaller homes that may be overcrowded – a setting
that makes families particularly vulnerable during an infectious disease
outbreak. To understand the increased risk of COVID infection and death
in communities of color, it is important to acknowledge the decades of
federal policies that reduced their access to homeownership, pushed
them to poor quality housing at the margins of communities, and
perpetuate the wealth gap that contributes to the health inequities made
salient by the pandemic. Further, housing-related concerns (e.g., related
to instability, safety, and insecurity) are a common reason for child
welfare involvement and the removal of children from their families
(Fowler et al., 2013; Zlotnick, 2009). Opportunities for homeownership
may be an important means to helping families obtain housing security
and build their financial security as they recover from the crisis. Policies
to improve homeownership may include inclusionary zoning and other
government investments in building and subsidizing housing akin to
efforts post World War II. The New Deal provided opportunities for
middle-income white families to take advantage of affordable, suburban
homes and allowed them to build wealth to recover from the Great
Depression (Rothstein, 2017). Similar efforts could be replicated and
made available to those families most vulnerable – racial and ethnic
minorities. Homeownership can support stability for children (Fowler &
Farrell, 2017; Warren & Font, 2015) and help families grow equity—a
necessary step towards generational wealth and economic mobility, and
may ultimately reduce inequities in children’s exposure to CAN and
other ACEs.
Opportunities to build wealth and move up the socioeconomic ladder
may also include child savings accounts (CSAs), which aim to improve
financial security and capabilities, as well as educational outcomes, for
low- and moderate-income families. Although CSAs vary widely in
W.L. Rostad et al.
design, the intent is to establish a savings account in a child’s name with
an initial “seed” deposit from a community organization, private insti­
tution, or government. CSAs have been associated with greater savings
over time (Butrica, Carasso, Steuerle, & Toohey, 2008), better educa­
tional outcomes (Elliott & Beverly, 2011), and have the potential to help
children build wealth over their lifetime. CSAs have improved parents’
educational expectations for their children, reduced depression symp­
toms among mothers, and increased likelihood of attending and grad­
uating college (Markoff, Loya, & Santos, 2018).
4.4. Implementing equitable policies
Hundreds of years of federal and state policies have systematically
ensured inequality – in income, housing, healthcare, education – and
inequitable access to opportunities to better oneself, their families, and
future generations. We have designed our systems to penalize poverty,
and thereby, race – this is especially salient in child welfare and law
enforcement. Neglect is the leading form of child maltreatment (Child
Welfare Information Gateway, 2021), but neglect is often used as a guise
for poverty (Milner & Kelly, 2020). We understand that neglecting the
basic needs of children is harmful; we also understand that removing
children from their homes is harmful. And yet we continue to implement
solutions that harm children and widen inequalities. Children of color
are removed from their homes and communities, and placed in
congregate care settings at much higher rates than white children; they
also stay longer in those settings, and are less likely to receive the ser­
vices they need (Roberts, 2002). There is no excuse for a child to wait in
the system for more than six months until they find a home, particularly
if the only barrier to reunification is a lack of necessary economic and
housing supports. At the same time, there is no excuse for a person of
color who cannot afford bail to sit in a jail cell for months and even years
awaiting trial for a crime that is yet to be adjudicated.
Law enforcement policies that concentrate police in low-income
neighborhoods of color, allow stop and frisk, and value law and order
above all else have led to the mass incarceration of people of color –
greatly diminishing their own access to opportunity upon reentry, and
consequently, their children’s. Reentry following incarceration is diffi­
cult, but the collateral consequences make it near impossible to better
oneself and avoid recidivism. Those convicted of a felony (e.g., mari­
juana possession) have limited access to employment opportunities as
many employers are not willing to hire someone with a criminal record;
have limited access to affordable housing as they are not eligible for
housing programs, and consequently, may not be able to live with their
families upon release; and in most states, do not have the right to vote or
the opportunity to participate in civil society (Finzen, 2005). Adding
insult to injury, many people of color are convicted of felonies for
possession of marijuana, which is now legal in several states and offers a
lucrative business opportunity for those without criminal records
(Union, 2020).
We must decriminalize poverty. The pandemic and civil unrest have
highlighted how socioeconomic and racial disparities—as a result of
conditions that inequitably distribute access to opportunity—contribute
to gross inequities in burden of disease and violence. As a country, we
must intentionally and urgently address segregation and the lack of
opportunity for families of color as a result of decades of racist policies.
The continued segregation of communities has major implications for
the civil unrest of today, as well as the burden of COVID in communities
of color. We need policies that help desegregate neighborhoods, narrow
health inequities, and address hostile relations between police and
communities of color.
Ultimately, we need policies that change the context for families and
mitigate the impacts of the current crisis, including policies that reduce
risk for CAN, and strategies to address the disproportionate burden of
COVID on communities of color. The inevitable economic devastation
for thousands of families requires proactive policies that help them
recover and rebuild their financial security to ensure the health and
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well-being of society. Moving forward, we need to sustain innovations
that are found to make the default “choice” a healthy-one.
5. Investing in children today for a more prosperous and
equitable tomorrow
The U.S. operates under the assumption that tax cuts to corporations
and the wealthy will trickle down to benefit every-one else. In reality,
wages have remained stagnant, income inequality has grown exponen­
tially, and opportunities for upward mobility for the lower and middle
classes are disappearing. We have also seen “deaths of despair” rise, as
deaths attributable to alcohol, drug use, and suicide are increasing (Case
& Deaton, 2020). These deaths represent a landscape in the U.S. in
which access to resources and opportunities are concentrated at the top,
while the struggles associated with financial insecurity increasingly
undermine health and contribute to premature death. The pandemic has
shed a bright light on the downfalls of this type of economy and the
policies that uphold it; it is time to declare this is not a viable strategy for
a country that aims to ensure the right to “life, liberty, and the pursuit of
happiness” to all of its citizens.
The past several months have seen sweeping changes in the policy
landscape in the U.S. in response to the pandemic. Indeed, we have
never seen this level of generosity in policy and it’s this generosity that
has kept many low- and middle-income families from moving (deeper)
into poverty. The American Rescue Plan Act (ARP) included major
policy changes that greatly benefit families and children, particularly
children of color, the most powerful of which were changes to the Child
Tax Credit (CTC). The CTC was introduced in 1997 as a nonrefundable
tax credit to help offset the costs of raising children, later expanded to be
partially refundable for families earning above a certain income
threshold (in 2001, $10,000 or more; in 2009, $3,000 or more); in 2018,
the amount of the credit was increased from $1000 to $2000 per eligible
child, with up to $1400 of the credit refundable. Still, because the credit
was partially refundable, it did not reach the families that needed it most
as it excluded families with too little earnings to be eligible for the full
credit.
The ARP increased the maximum credit to $3600 for every young
child (0–6 years) and $3000 for every older child (6–17 years) in the
household and made the credit fully refundable so that families with
little to no tax liability are eligible for the full credit. These changes to
the CTC are projected to cut child poverty by almost half, with larger
reductions for Black, Hispanic, and Native American children whose
families had previously been excluded from CTC benefits (Center on
Poverty and Social Policy, 2021). The ARP CTC also allows families to
receive monthly advance payments through December 2021 so they do
not have to wait until next year to receive the benefit. Families started to
receive payments in July, which have already had significant impacts on
their economic well-being, as fewer families reported food insufficiency
and difficulty paying their bills after the first CTC payments were issued
(U.S. Census Bureau, 2021), and approximately 3.5 million children
have been kept out of poverty by both the July and August payments
(Parolin & Curran, 2021).
The ARP included several other provisions that have helped families
weather the pandemic, including increased funding for housing assis­
tance, the Supplemental Nutrition Assistance Program (SNAP), and
childcare. Billions of dollars were allocated to mitigate housing issues
related to the pandemic, which included emergency rental assistance,
homeowners’ assistance, emergency housing vouchers for families
experiencing or at risk for homelessness, and utility assistance. These
programs along with state and federal eviction moratoriums are ex­
pected to reduce housing insecurity, homelessness, and help families
avoid displacement. Given that housing insecurity has been linked to the
spread of COVID-19, these programs should also help reduce infection
transmission (Benfer et al., 2021). The ARP also included billions of
dollars for nutritional assistance, including an extension of the 15 %
increase in SNAP benefits and investments in the WIC program, to
W.L. Rostad et al.
combat hunger and provide families greater access to healthier eating
options. This investment was not only good for families; increases in
SNAP benefits also stimulate economic recovery by freeing up families’
income to be spent on goods and services that otherwise would have
been spent on food (Rosenbaum, Dean, & Neuberger, 2020). Finally, in
response to the childcare crisis the pandemic has laid bare, the ARP
included the greatest investment in childcare in decades. Billions of
dollars were invested in childcare assistance to increase childcare access
and reduce costs for more families, including essential workers, and help
childcare providers stay afloat during the pandemic.
It is hard to imagine a more significant policy change in US history
than what was achieved with the CTC under the ARP – indeed, making
the credit fully refundable and allowing monthly payments mirrors the
child allowances in other wealthy nations that have historically been
more generous with their income supports for families. Despite the
significant benefits of the ARP’s CTC to children and families and its
potential to narrow race inequities, these changes are currently set to
expire in 2022. While the Biden administration is trying to extend these
changes as part of their Build Back Better Plan, it faces considerable
roadblocks in a highly polarized political climate. Opponents to CTC
permanency argue that the program is too costly and dis-incentivizes
work. However, the research does not support these arguments.
Recent research estimates that a fully refundable CTC of ARP generosity
levels allowing for monthly payments would cost around $100 billion,
but produce nearly $800 billion in benefits to society through in­
vestments in children (Garfinkel, Sariscsany, Ananat, Collyer, & Wimer,
2021). There is also evidence from Canada that a fully refundable CTC
could boost employment, not reduce it (Koebel & Schirle, 2016).
Further, it cannot be emphasized enough that this single policy could
slash child poverty and drastically narrow race inequities (Center on
Poverty and Social Policy, 2021). Accordingly, advocacy efforts should
lift up the potential of this investment (in addition to investments in
childcare and affordable housing outlined in the Build Back Better Plan)
to improve the well-being and health of children, particularly young
children and children of color, and reduce their risk for exposure to early
adversity, including CAN.
Despite the current political polarization in the U.S., we all have in
common the desire for health and well-being for our children, our
families, and ourselves. Moreover, people are realizing that the status
quo no longer provides a reasonable path towards achieving the
’American Dream’. As such, advocacy for solutions that improve social
and economic conditions for families, such as the expanded CTC under
ARPA, should capitalize on our commonalities and message across both
sides of the aisle. Developing new, positive narratives and disseminating
action-oriented messages that highlight evidence-based policies,
empirical facts, and uplift lived experiences are powerful advocacy
strategies for garnering widespread support for the types of policies that
actually work for American families (FrameWorks Institute, 2004; Speer
et al., 2020). When people understand the root causes of poverty and
adversity, they can better understand population-level solutions, and
they are better equipped to vote for solutions and the change we need to
see to ensure a healthier and more prosperous tomorrow. Both public
health campaigns and community organizing can bolster the collective
power needed to change existing, harmful narratives and advocate for
local and national solutions that provide the conditions for all children
and their families to thrive.
We need to reimagine a new economy that invests early in children’s
lives to promote conditions for families that are supportive of health and
well-being across the lifespan. In this reimagined economy, universal
health promotion is prioritized, and families have what they need to
help their children thrive, including economic supports, safe and
affordable housing, access to resources, and family friendly work pol­
icies. Social distancing can be achievable for all families and will curtail
pandemics. CAN will be rare as families will have the necessary re­
sources to meet their children’s basic needs, freeing up bandwidth to
attend to children’s social and emotional needs, and parents will have
6
Children and Youth Services Review 144 (2023) 106745
less stress because they will have fewer concerns about their financial
security. Promoting supportive conditions for families in their children’s
formative years will set children on trajectories to becoming productive
adults that contribute to the economy through their employment and
ability to purchase goods across the lifespan. And indeed, the research
tells us this is so: children who are exposed to less adversity do better in
school, take fewer sick days at work, are less likely to be poor, are less
likely to develop substance use disorders, and are less likely to develop
chronic health conditions that can lead to premature death (Merrick
et al., 2019; Metzler, Merrick, Klevens, Ports, & Ford, 2017). Ultimately,
this contributes to a population that is more resilient in the face of
pandemics and economic crisis.
Despite the robust science outlining the critical importance of child
well-being, the prioritization of primary prevention efforts to address
CAN and other adversities have been severely lacking. By almost every
indicator of health and well-being, children in the U.S. are faring worse
than children in other developed nations, in large part because we do not
invest as much in children and families (Edelman, 2016). The gap be­
tween what we know and what we choose to do is alarming. If we invested
in the prevention of CAN in the same manner that we invested in pre­
venting infectious disease, cancer, or smoking, we could significantly
reduce children’s exposure to CAN, and, consequently, also reduce
chronic and infectious disease and other harmful outcomes (Merrick
et al., 2019). Importantly, the costs of pandemics to child well-being
would be minimized. Communities, states, and the federal government
must develop a shared vision – to ensure that all children thrive and
reach their full potential. All sectors – government, business, philan­
thropy, community-based organizations, and faith institutions – have a
role to play in primary prevention and promoting well-being. Budgets
should reflect a priority on upstream prevention and an investment in
children. COVID-19 has exposed that the U.S. does not value the well-
being of children and families. But it has also provided an unprece­
dented opportunity to ensure that, in the future, policies reflect a society
that understands that it takes a village to raise a healthy child.
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
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