Child and Maternal Health

Understanding and Mitigating: Unintended Consequences of COVID-19 for Infants, Children and Young People

July 31, 2020 by No Comments | Category GIRFEC, health visiting, Maternity, NHSScotland

A Rights and Value Based Responses to COVID-19

Child Health Commissioners in Scotland have prepared the following statement.

In the midst of change and competing demands on time and energy there are always opportunities alongside the risks. This blog explores those identified by Child Health Commissioners in Scotland to inform how we move through and respond to the impact of COVID-19.

The influence and anticipated impact of COVID-19 has required a whole population response of social distancing and the effective lockdown of society to reduce the spread of infection and to minimise the impact on health care demand as the virus passes through the population.

The requirements of lockdown and the anticipated economic impacts present the following challenges to the day to day lives of infants, children and young people:

  • Poverty and food insecurity with families and carers struggling to feed their children and sustain tenancies.
  • Changes to family routines and loss of both formal and informal support with children: nurseries and schools closing, out of school activities ceasing including respite; simply not seeing relatives and friends.
  • Gender based violence where infants, children and young people have been effectively trapped in an abusive and, or controlling households.
  • Reduced or changes in services that support parent’s needs: from a reduction in face time universal midwifery and health visiting services, to having access to mental health teams and drug and alcohol workers who support parents to stay well and parent well. These approaches are likely to be required for some months to come as we move out of Lockdown.
  • Supporting children and young people, their families and the adults with responsibility for them, to return safely to school in

COVID-19 can be understood as having shifted the relational landscape of the day to day as well as access to services and support. The experience of relational safety underpins attachment for infants and young children and lends itself to the development of a measured stress response as they grow and develop. This in turn underpins the development of resilience. Resilience is best understood as a resource to be nurtured through life. It involves acquiring the skills to negotiate and navigate the day to day at an individual level (internal) alongside and interplaying with external factors such as family and community networks (external). Now is the time to take the opportunities to mitigate the short, medium and longer term impacts of COVID-19 by optimising and refreshing existing policy and practice to ensure the future health and wellbeing of Scotland’s infants, children and young people.

Scotland has made the commitment to enshrine the UNCRC  in legislation, so that the fundamental rights of children and young people are considered in the development of legislation, policy and practice. Now is the time to ensure that the responses to COVID-19 are informed by such a rights based approach with related consideration of the use of equality impact assessments as services are brought back on track. NHS Board Child Health Commissioners have a leadership role in their NHS Boards and with integrated children and young people service partners to support this approach.

It is now better understood how relationships underpin good experience of services while experiences of adversity and trauma can make it harder to access services and ask for help. This is no less the case for parents who are struggling. Now is the time to deliver the Scottish Government commitment to embed trauma informed and responsive culture and practice into GIRFEC assessment processes to take account of both structural effects (poverty, gender based violence, racism) and the inter-personal effects of abuse and neglect on growth and development and the intergenerational impacts on parenting styles and capabilities.

Staff and practitioners also benefit from experiencing organisational safety, from workplace culture and practice, this increasingly understood as a prerequisite for families to be able to engage well with services.

Initial responses to mitigating risk have understandably focused on children and young people known to services through child protection and care experienced processes. There is a need to recognise and understand the risks for a wider, less visible group of children and young people who are not in current scope of attention of services, while no less vulnerable. They may indeed have been the more vulnerable while schools remain closed, as they were less visible and not accessing a wider network of relationships that serve to buffer adversity at home and in out of school relationships. Now is the time to understand the full extent of need in the lives of infants, children and young people through the application of proportionate universalism in understanding and responding to need.

The challenges of difficult life circumstances/environments and relationships can be mediated by services that understand how health and health needs are impacted by structural factors, experiences of adversity in the home and the additional challenges for children and young people with acute and chronic mental and physical health needs.

Child Health Commissioners in Scotland are clear that there is no better time than now, respond to the unintended consequences of COVID-19 by taking a proactive and responsive approach of a rights based informed, trauma informed and responsive approach to children and young people and their families the impacts can be mitigated over the short, medium and longer term. Success will be determined by the quality of all our relationships.

National Child Health Commissioners Group (Scotland)

July 2020

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