March 24, 2022

Dear Governors:

The COVID-19 pandemic caused the Nation's children and youth to face unprecedented challenges and further exacerbated preexisting inequities. Childcare centers, schools, after-school programs, and recreational activities closed, disconnecting nearly 60 million children and youth from essential resources and supports.¹ Many families faced job loss, economic hardship, and food insecurity.

Our Nation's children have been particularly impacted by the COVID-19 pandemic, including significant impacts on their mental health. As of June 2021, approximately 140,000 children have lost a parent or grandparent caregiver to COVID-19.² Youth reports of psychological distress have doubled since the pandemic began, with 25 percent reporting depressive symptoms and 20 percent reporting anxiety symptoms.³ Trauma and stressor-related disorders, including acute stress disorder and adjustment disorder, are common among young children under five, as a result of the pandemic.⁴ Children and youth with intellectual or developmental disabilities and those with prior childhood trauma are at particular risk for pandemic-related mental health challenges,⁵ as are those who have faced previous discrimination in the health care system, including children and youth of color, immigrant children, children with disabilities, and those who are LGBTQ+.^{6 7}

The Biden-Harris Administration is committed to improving the health and well-being of children. This is why the U.S. Department of Health and Human Services (HHS) and the U.S Department of Education (ED) have joined together to develop and align resources to ensure children have the physical and behavioral health services and supports that they need to build resilience and thrive.

Specifically, in the coming months, our Departments will provide additional technical assistance, resources and support that will (1) provide guidance on the federal funding available for school-based physical and behavioral health services, including how Medicaid can support the delivery of these services; (2) help reduce federal administrative burden for states and localities, including local educational agencies, and barriers to the provision of school-based physical and behavioral health services; and (3) improve and strengthen access to physical and behavioral health services.

While the pandemic's long-term impacts on children and youth are not fully understood, working together to build resilience in children, youth, and families can promote equity and support recovery efforts. A major focus of this joint effort is to help states and communities take full advantage of the funding available under the American Rescue Plan Act of 2021 (ARP) and to sustain services funded with American Rescue Plan resources once these funds expire. We will elevate opportunities under the ARP along with existing federal resources to build a lasting and sustainable health care infrastructure for our children and youth. We welcome and encourage your engagement, questions, and partnership on any of the resources we have published. Our joint effort will build on progress made, as both Department's work together to make accessible, quality health services in schools a reality for all children and youth.

Sincerely,

Enclosure

1 Masonbrink, A. R., & Hurley, E. (2020). Advocating for children during the COVID-19 school closures. Pediatrics (Evanston), 146(3) doi:10.1542/peds.2020-1440

2 Hillis, S. D., Blenkinsop A., Villaveces A., Annor F. B., Liburd, L., Massetti, G. M., Demissie, Z., Mercy, J. A., Nelson, C. A., Cluver, L., Flaxman, S., Sherr, L., Donelly, C. A., Ratmann, O., & Unwin, J. T. (2021). Covid-19-Associated Orphanhood and Caregiver Death in the United States. Pediatrics. DOI: 10.1542/peds.2021-053760

3 Racine, N., McArthur, B. A., Cooke, J. E., Eirich, R., Zhu, J., & Madigan, S. (2021). Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis. JAMA Pediatrics, 175(11), 1142–1150. https://doi.org/10.1001/jamapediatrics.2021.2482

4 Issue Brief (September 21, 2021). Child and Adolescent Mental Health During COVID-19: Considerations for Schools and Early Childhood Providers. U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, available at https://aspe.hhs.gov/sites/default/files/documents/0bcc372f4755cca29ebc80a47cfe300e/child-adolescent-mh-covid.pdf

5 https://aspe.hhs.gov/sites/default/files/documents/0bcc372f4755cca29ebc80a47cfe300e/child-adolescent-mh-covid.pdf

6 United States. Public Health Service. Office of the Surgeon General. (2021). Protecting Youth Mental Health. U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General, available at https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf

7 U.S. Department of Education, Office of Special Education and Rehabilitative Services, Supporting Child and Student Social, Emotional, Behavioral, and Mental Health Needs, Washington, DC, 2021, at 10-13, available at https://www2.ed.gov/documents/students/supporting-child-student-social-emotional-behavioral-mental-health.pdf