Addressing the Impacts of Parent and Caregiver Loss on Children

ACF-DCL-22-08

Publication Date: October 27, 2022

Versión en español (PDF)

Dear Colleague:

Losing a parent or caregiver is a tragic and life-changing event for a child. Supporting children and families who have experienced loss is deeply embedded in the strategic goals and mission of the Administration for Children and Families (ACF). It is a necessary and urgent part of addressing the ongoing impact of COVID-19, which has taken so many lives in our communities, as well as the toll that overdose, suicide, violence, and other causes have taken on children and youth. ACF is committed to partnering with our grant recipients and state and local stakeholders to ensure that children, youth, and families who have lost a parent or caregiver are supported and connected with the services and resources they need to find stability again.

In recent years, losing a parent or caregiver has become an ongoing tragedy for children and youth caused by the co-occurring COVID-19 and drug overdose crises as well as increases in suicides and homicides. It is estimated that more than 229,000 children have lost one or both parents; 252,000 have lost a primary caregiver; and 291,000 have lost a primary or secondary caregiver due to COVID-19.[1] Families and communities of color, including tribal communities, have disproportionately experienced the negative impact of these losses. While they represent 39% of the U.S. population, children of racial and ethnic minorities made up 65% of those who lost a caregiver due to the pandemic. Compared to white children, American Indian and Alaska Native children were 4.5 times more likely to lose a parent or grandparent caregiver; Black children were 2.4 times more likely; and Hispanic children were nearly 2 times more likely to have lost a parent to COVID-19.

Overdose deaths have continued to rise as well, in both urban and rural areas, increasing 31% in the U.S. from 2019 to 2020.[2] In 2019 and 2021, an estimated 199,320 people died from a drug overdose.[3] Like COVID-19, racial and ethnic disparities persist in drug overdose deaths. While the total number of children who lost a caregiver to drug overdose is unknown, a study in Allegheny County, Pennsylvania, found that over a 16-year period more than 1,000 children lost a parent because of an unintentional drug overdose in that single county. HHS’ overdose prevention strategy , launched in October 2021, is actively promoting primary prevention, harm reduction, evidence-based treatment, and recovery supports.

Suicide and homicide remain leading causes of death  (PDF) for people between the ages of 15 and 44 in the U.S. Suicide rates in 2020 were 30% higher than in 2000 . In 2020, more than 45,000 individuals died by suicide. Tragically, suicide was the second leading cause of death among young people aged 10-14 and 25-34 years. These deaths devastate families and communities. Several populations are at high risk for suicide including American Indians, Alaska Native youth, LGTBQI+ youth, rural men, military veterans, and law enforcement officials. The CDC’s Suicide Prevention Strategic plan outlines four priorities for pursuing the vision of no lives lost to suicide. The homicide rate in the U.S. increased from 6.0 homicides per 100,000 in 2019 to 7.8 per 100,000 in 2020. This represents the highest homicide rates since 1995 . Disparities persist in homicide deaths. Black or African American, American Indian and Alaskan Native, and Hispanic or Latino persons have higher homicide rates than other racial and ethnic demographic groups. In response, CDC’s Division of Violence Prevention implements science-based programs, policies, and practices with partners and communities to create safer communities.

Human services programs play a critical role in supporting children and families who suffer from the tragedy of losing a parent or caregiver. I encourage you to consider how programs that offer concrete and family-focused supports can be deployed quickly and efficiently by knowledgeable service providers using trauma-informed approaches — and culturally and linguistically competent providers — to assist children and families impacted by parent and caregiver loss. A timely response to provide resources necessary to maintain or regain stability can help build the protective factors needed for long-term health and well-being. We can also all play a role in building community resilience in an ongoing way so that when families experience these tragedies, their communities are already equipped to provide both the acute and sustained support that families need.

ACF is working with agencies across the federal government and in partnership with states, tribes, territories, local governments, and grant recipients to ensure that families who experience parent and caregiver loss are aware of existing services, programs, and resources meant to offer support. We anticipate a variety of emotions as part of grieving and recovering from traumatic experiences associated with parent and caregiver loss. As a result, ACF and other Operating Divisions within HHS and across the federal government have taken actions to address the needs of children and families affected by loss. A summary of actions is included in an Appendix.

Programs and Resources to Support Families After Parent and Caregiver Loss

ACF is committed to communicating information about programs and resources to support families after parent and caregiver loss and fostering partnerships that support children, youth, and families who have experienced parent or caregiver loss. We encourage you to share the following strategies and resources to support these families.

Economic Supports

Resource

Summary

Target Audience

Target Population

Link

Temporary Assistance for Needy Families (TANF)

Program provides states and territories with flexibility in operating programs designed to help low-income families with children achieve economic self-sufficiency.  States use TANF to fund monthly cash assistance payments to low-income families with children, as well as a wide range of services.

Government agencies, nonprofit organizations

Low-income individuals and families with children

Contact information for state TANF programs: https://www.acf.hhs.gov/ofa/map/about/help-families

Using TANF funding to provide housing assistance during the COVID-19 pandemic: https://www.acf.hhs.gov/opre/report/using-tanf-funding-provide-housing-assistance-during-covid-19-pandemic

Low Income Household Water Assistance Program (LIHWAP)

LIHWAP provides funds to assist low-income households with water and wastewater bills. LIHWAP grants are available to States, the District of Columbia, the Commonwealth of Puerto Rico, U.S. Territories, and Federally and state-recognized Indian Tribes and tribal organizations that received fiscal year 2021 Low Income Home Energy Assistance Program (LIHEAP) grants.

Government agencies, nonprofit organizations

Low-income individuals and families with overdue water bills

LIHWAP information: https://www.acf.hhs.gov/ocs/map/lihwap-map-state-and-territory-contact-listing

LIHWAP Data Dashboard: https://lihwap-hhs-acf.opendata.arcgis.com/

Low Income Home Energy Assistance Program (LIHEAP)

The Low-Income Home Energy Assistance Program (LIHEAP) helps keep families safe and healthy through initiatives that assist families with energy costs. LIHEAP  provides federally funded assistance to reduce the costs associated with home energy bills, energy crises, weatherization, and minor energy-related home repairs.

Government agencies, nonprofit organizations

Low-income individuals and families

LIHEAP Clearinghouse: https://liheapch.acf.hhs.gov/snapshots.htm

Community Services Block Grant (CSBG)

The Community Services Block Grant (CSBG) provides funds to alleviate the causes and conditions of poverty in communities.

Government agencies, nonprofit organizations

Low-income individuals including the homeless, migrants, and the elderly

CSBG Fact Sheet: https://www.acf.hhs.gov/ocs/fact-sheet/csbg-fact-sheet

CSBG Map and State and Territory Grantee Contact Information: https://www.acf.hhs.gov/ocs/map/csbg-map-state-and-territory-grantee-contact-information

CSBG-funded Community Action Agencies (CAAs) in your area: https://www.acf.hhs.gov/ocs/programs/community-services-block-grant-csbg

American Rescue Plan

The American Rescue Plan (ARP) Act (P.L.117-2) provides critical and unprecedented support to children, families, and communities in response to the COVID-19 pandemic and resulting economic downturn, which have been exacerbated by historic racial injustices.  ARP endowed ACF with $48.7 billion in supplemental funding to meet the needs of children, families, and communities.

Government agencies

Children, families, and communities

Information on how to access benefits available through ARP: https://www.whitehouse.gov/american-rescue-plan/

Information on ACF-ARP funded programs: https://www.acf.hhs.gov/american-rescue-plan

Kinship and Family Support

Resource

Summary

Target Audience

Target Population

Link

Kinship Navigator Programs

Kinship navigator programs are services that assist kinship caregivers in learning about and accessing programs and resources to meet the needs of the children they are raising. Common services include information and referral, support groups, counseling, and legal services.

Government agencies, nonprofit organizations  

Kin caregivers

List of Kinship Navigator Programs and Contact Information:  https://www.childwelfare.gov/organizations/?CWIGFunctionsaction=rols:main.dspList&rolType=Custom&RS_ID=148

Grandfamilies and Kinship Support Network

This national technical assistance center for kinship families offers a way for government agencies and nonprofit organizations to collaborate across jurisdictional and systemic boundaries to improve how families are served and supported.

Government agencies, nonprofit organizations

Kinship families - Families where a relative of a child provides for the care and custody of the child due to a serious family hardship.

Information about The Grandfamilies & Kinship Support Network: https://www.gu.org/app/uploads/2022/03/GU_NTAC_TwoPager_FINAL.pdf  (PDF)

Indian Child Welfare Act

Enacted in 1978, the Indian Child Welfare Act (ICWA) was created to protect the best interest of Indian Children and to promote the stability and security of Indian tribes and families by the establishment of minimum Federal standards for the removal of Indian children and placement of such children in homes, which will reflect the unique values of Indian culture.

Government agencies, nonprofit organizations, families

American Indian and Alaska Native children and families

Information about the Indian Child Welfare Act: https://www.bia.gov/bia/ois/dhs/icwa

Assistance and Benefits for Families who Experienced a Death

Resource

Summary

Target Audience

Target Population

Link

COVID-19 Funeral Assistance

The Federal Emergency Management Agency (FEMA) provides COVID-19 funeral assistance to cover up to $9,000 per funeral for expenses for eligible individuals. FEMA representatives take applications by phone, and multilingual services are available. COVID-19 Funeral Assistance applications must be completed with a FEMA representative; you cannot apply online. 

Families who have experienced a loss due to COVID-19

Families who have experienced a loss due to COVID-19

Information about FEMA COVID-19 Funeral Assistance: https://www.fema.gov/disaster/coronavirus/economic/funeral-assistance

Social Security survivor benefits

Social Security survivor benefits are paid to family members of eligible workers. Family members, including a spouse, children, and dependent parents may receive survivor benefits when a family member dies.

Families who have experienced a loss

Widows, widowers, and dependents of eligible workers

Information about Social Security survivor benefits: https://www.ssa.gov/benefits/survivors/

Behavioral Health, Trauma, Resilience and Grief

Resource

Summary

Target Audience

Target Population

Link

Traumatic Grief Resources

The National Child Traumatic Stress Network has several resources for supporting children who have Childhood Traumatic Grief. Resources are offered in multiple languages and include tip sheets, briefs, podcasts, and training curriculum.

Professionals working with children and youth; youth

Children, youth, and those supporting children and youth, including parents and relatives

National Child Traumatic Stress Network Resources on traumatic grief:

https://www.nctsn.org/what-is-child-trauma/trauma-types/traumatic-grief/nctsn-resources

Trauma and Resilience in Young Children and Families

The Head Start Early Childhood Learning and Knowledge Center (ECLKC) has several resources about the impact of trauma and provides information about adverse childhood experiences (ACEs)
 

Head Start Heals campaign increases awareness about how Head Start and Early Head Start programs are uniquely qualified to address trauma and promote resilience in young children and families. 

Head Start and Early Head Start professionals

Young children and families who have experienced trauma

Brief on Adverse Childhood Experiences: https://eclkc.ohs.acf.hhs.gov/publication/trauma-adverse-childhood-experiences-aces

Head Start Heals: Podcast Series:

https://eclkc.ohs.acf.hhs.gov/mental-health/article/head-start-heals-podcast-series

Behavioral Health Treatment

SAMHSA has a Behavioral Health Treatment Services Locator, a confidential and anonymous source of information for persons seeking treatment facilities in the United States or U.S. Territories for substance use/addiction and/or mental health problems.

Professionals working with children and families; children, youth, parents

People who are seeking mental health and/or substance use treatment services

Behavioral Health Treatment Services Locator: https://findtreatment.samhsa.gov/

Treatment Referral Routing Service

SAMHSA provides free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

Professionals working with children and families; children, youth, parents

Individuals or families seeking mental health or treatment services

SAMHSA’s National Helpline: https://www.samhsa.gov/find-help/national-helpline

Call: 800-662-HELP (4357)

TTYE: 800-487-4889

Visit the online treatment locator

Send zip code via text message: 435748 (HELP4U) 

Trauma-informed care featuring examples from American Indian and Alaska Native communities

Webinar on trauma-informed care, an organizational framework that involves understanding, recognizing, and responding to the effects of trauma. The webinar highlights examples from American Indian and Alaska Native (AIAN) communities to discuss trauma and trauma-informed care and explores what it means for building parent and family resilience.

Professionals working with children and families, including Head Start staff; children, youth, parents

Parents and families

The webinar recording can be accessed at: https://eclkc.ohs.acf.hhs.gov/video/understanding-trauma-informed-care-build-parent-resilience

Mental health needs of children experiencing foster care, adoption, or guardianship

The National Adoption Competency Mental Health Training Initiative (NTI), provides web-based training for child welfare professionals and mental health professionals to enhance their ability to understand and address the mental health needs of children experiencing foster care, adoption, or guardianship, including the impact of separation from birth families and loss associated with rejection, abandonment, multiple placements and broken attachments.

Child Welfare and Mental Health Professionals

Children who are experiencing foster care, adoption, or guardianship

Information on the National Adoption Competency Mental Health Training Initiative: https://adoptionsupport.org/nti/access/access-for-individuals/

Infant and toddler trauma-responsive care

The Infant/Toddler Specialist Network (ITSN), part of the Office of Child Care’s State Capacity Building technical assistance (TA) Center, has developed a module within the Trauma Responsive-Care Training for Trainers that is designed to assist infant/toddler providers and TA providers to support families who have experienced trauma, including grief and loss. This training is available in both English and Spanish.

Infant and toddler child care providers and TA providers

Families with young children who have experienced trauma

Information on Trauma-Responsive Care Training for Trainers Opportunity: https://childcareta.acf.hhs.gov/infant-toddler-resource-guide/trauma-responsive-care-training-trainers-opportunity

Traumatic Experiences

This webpage compiles resources for professionals to recognize and help children and youth address past trauma.

Child-serving professionals

Children and youth who have experienced trauma

Resources on helping children address past trauma: https://www.childwelfare.gov/topics/adoption/preplacement/helping/

Secondary Traumatic Stress

This fact sheet offers child-serving professionals information about secondary traumatic stress (STS). It describes how individuals experience STS, who is at risk, how to identify STS, strategies for prevention and intervention, and essential elements to address STS.

Child-serving professionals

Child-serving professional who are working with children who have experienced trauma

Resources on Secondary Traumatic Stress: https://www.nctsn.org/resources/secondary-traumatic-stress-fact-sheet-child-serving-professionals

Adverse Childhood Experiences (ACEs)

The Centers for Disease Control and Prevention (CDC) provides several resources on preventing ACEs, responding to ACEs in trauma-informed ways, and protective and risk factors for ACEs.

Professionals working with children, youth, and families; communities seeking resources to build resilience and prevent adversity

Children, youth, families, communities

Preventing Adverse Childhood Experiences (ACEs): Leveraging the Best Available Evidence: https://www.cdc.gov/violenceprevention/pdf/preventingACES.pdf  (PDF)

Fact Sheet on Adverse Childhood Experiences: https://www.cdc.gov/violenceprevention/aces/fastfact.html

Information about Protective Factors:

https://www.cdc.gov/violenceprevention/aces/riskprotectivefactors.html#anchor_1609868131796

988 Suicide and Crisis Lifeline

988 offers 24/7 access to trained crisis counselors who can help people experiencing mental health-related distress, including thoughts of suicide, mental health or substance use crisis, or other emotional distress. People can call or text for themselves or if they are worried about a loved one who may need crisis support.

States, territories, tribes, mental health and substance use disorder professionals

Individuals who are struggling or in crisis or worried about someone who may need crisis support

Call or text 988 or chat https://988lifeline.org/

Disaster Distress Hotline

The Disaster Distress Helpline is a 24/7, 365 day-a-year hotline for immediate crisis counseling. Staff members provide counseling and support before, during, and after disasters and refer people to local disaster-related resources for follow-up care and support. This multilingual and confidential crisis support service is available to all residents in the United States and its territories.

Professionals working with children and families; children, youth, parents

People who are experiencing emotional distress related to any natural or human-caused disaster.

Call or text 1-800-985-5990

Head Start Services

Resource

Summary

Target Audience

Target Population

Link

Head Start Eligibility

Head Start provides early learning and comprehensive services to support the cognitive, social, emotional, and mental health of the most vulnerable young children and their families. Individuals and organizations supporting children who have lost a parent or caregiver could explore whether the children are eligible through existing Head Start eligibility criteria.

The ACF-Office of Head Start’s Information Memorandum on Head Start and Early Head Start Eligibility for Children in Kinship Care provides a useful resource for considering potential program eligibility. Children are income eligible for Head Start if family income is at or below the federal poverty guideline and programs have limited flexibility to enroll families over this income threshold. Children are categorically eligible if they receive public assistance (TANF, SSI, SNAP); are in foster care; or are experiencing homelessness.

Families with young children and professionals working with families with young children

Families with young children

Head Start Locator Tool is a tool for finding local programs: https://eclkc.ohs.acf.hhs.gov/center-locator

Information Memorandum on Head Start and Early Head Start Eligibility for Children in Kinship Care:

https://eclkc.ohs.acf.hhs.gov/policy/im/acf-im-hs-19-03

Staff Wellness in the Head Start Workforce

The Office of Head Start issued an Information Memorandum to all Head Start and Early Head Start grant recipients on supporting staff wellness, which is integral to serving children who have experienced trauma.

Head Start Professionals

Head Start Professionals

Information Memorandum: https://eclkc.ohs.acf.hhs.gov/policy/im/acf-im-hs-21-05

Resources for staff wellness developed by the National Center on Health, Behavioral Health, and Safety (NCHBHS):

https://eclkc.ohs.acf.hhs.gov/about-us/article/national-center-health-behavioral-health-safety-nchbhs

Children with Disabilities

Resource

Summary

Target Audience

Target Population

Link

Supporting Families and Caregivers of Children and Youth with Disabilities

The Child Welfare Information Gateway has a resource page for families and caregivers raising children with disabilities to help in accessing needed services. The resource highlights state and local examples.  

Professionals working with families who have children with disabilities

Families and caregivers raising children with disabilities

Resources for families and caregivers raising children with disabilities, including state and local examples: https://www.childwelfare.gov/topics/systemwide/service-array/services-disabilities/youth/grandparents/

Relationship-Based Practices: Talking with Families About Developmental Concerns

This training module provides information about raising a concern with a parent about their child’s development and how to engage parents in a collaborative process of observing their child together.

Early Child Care Providers

Children and families with Developmental Concerns

The training module and course summary can be found at: https://eclkc.ohs.acf.hhs.gov/family-engagement/learning-module/relationship-based-practices-talking-families-about-developmental-concerns

Transition to Kindergarten: Partnering with Families and Schools

This simulation engages the viewer in practice of the Strengths-Based Attitudes (SBAs) and Relationship-Based Practices (RBPs) as applied to relationship-building between a Head Start Coordinator and a receiving public school Special Education Team Leader.

Head Start staff and public-school Special Education staff

Children who have been receiving special developmental services and will have an individualized education plan (IEP) in their new public school

The training module and course summary can be found at:

https://eclkc.ohs.acf.hhs.gov/family-engagement/learning-module/transition-kindergarten-partnering-families-schools

Parent, Youth and Family Engagement

Resource

Summary

Target Audience

Target Population

Link

Engaging People with Lived Experience

Youth, parents, and kinship caregivers who have experienced parent or caregiver loss should be engaged in ongoing consultation and program development, implementation, and evaluation to ensure that services are responsive to their needs. This report features methods and emerging strategies to engage people with lived experience.

Government agencies, nonprofit organizations

Children, youth, and families with lived experience

Brief on Methods and Emerging Strategies to Engage People with Lived Experience:  https://aspe.hhs.gov/sites/default/files/documents/47f62cae96710d1fa13b0f590f2d1b03/lived-experience-brief.pdf  (PDF)

Building Partnerships with Families Series

This series features resources to learn strategies to strengthen relationships with families, including preparing for challenging conversations with families, understanding families’ cultural perspectives, and partnering with families of children who are dual language learners.

Head Start and Early Head Start staff and other professionals working with children and families

Parents and families

The series of resources can be accessed at: https://eclkc.ohs.acf.hhs.gov/family-engagement/article/building-partnerships-families-series

Strategies to Support and Engage Families Virtually

This resource explores the benefits of engaging families virtually; five evidence-based strategies for virtual family engagement; and planning for virtual family engagement

Professionals working with children and families

Parents and families

https://eclkc.ohs.acf.hhs.gov/family-engagement/strategies-support-engage-families-virtually/strategies-support-engage-families-virtually

*Please note, this list represents a range of supports for children, youth, and families who have been impacted by parent and caregiver loss. It is not intended to be comprehensive of all potential supports, benefits, and resources that could benefit this population. We are committed to growing this list as additional information is developed.

As our country works to address the impacts of the COVID-19 pandemic, as well as the devastation of the overdose crisis, rising suicide rates, and the epidemic of gun violence, we must work together to ensure that children and families who have experienced loss from these crises are not alone in regaining stability and well-being. ACF remains committed to the well-being of children, youth, and families, especially those who have experienced parent and caregiver loss.

/s/

January Contreras

Assistant Secretary


Appendix: Actions to Address Needs of Families Affected by Parent and Caregiver Loss

Addressing Mental Health and Social-Emotional Needs

  • The U.S. Department of Health and Human Services is implementing the HHS Roadmap for Behavioral Health Integration  (PDF) to advance the President’s Strategy to Address our Mental Health Crisis. The Roadmap details policy solutions to better integrate mental health and substance use care into the health care, social service, and early childhood systems to ensure all people have equitable access to evidence-based, culturally appropriate, person-centered care.
  • ACF, the Substance Abuse and Mental Health Services Administration (SAMHSA), Centers for Medicare and Medicaid Services (CMS), Health Resources and Services Administration (HRSA), the Centers for Disease Control and Prevention (CDC), and the Administration for Community Living (ACL) issued a joint Dear Colleague letter on supporting the mental health needs of children  (PDF), on May 25, 2022, which encouraged states, tribes, and jurisdictions to maximize efforts to support children’s mental health and well-being. The letter outlines HHS’ plans to support and facilitate coordination across federal funding streams to advance and expand mental health services for children.
  • ACF and the U.S. Department of Education issued a Dear Colleague Letter (PDF) in June 2022 that included four recommendations and action steps for early childhood systems and programs to work collaboratively to ensure that young children and their caregivers have access to high-quality resources that equitably support social-emotional development and mental health. 

Supporting Kinship Families and Relative Caregiving   

  • In August 2019, ACL launched the RAISE Family Caregiving Advisory Council and the Advisory Council to Supporting Grandparents Raising Grandchildren . Both Councils have developed recommendations for improving support to family caregivers in reports to Congress. The National Family Caregiving Strategy was released in September 2022. The Strategy includes strategies to specifically support children and caregivers who have experienced parent and caregiver loss due to COVID-19, overdose, and other traumatic events. Learn more about the program by visiting National Family Caregiver Support Program .
  • During emergency circumstances, including natural disasters or pandemics, challenges are amplified for kinship families and grandfamilies. Recognizing this, the Advisory Council to Support Grandparents Raising Grandchildren developed a COVID-19/Emergency Preparedness Resource Guide.  (PDF) ACF has supported states, territories, and 11 tribes in the development, expansion, and evaluation of kinship navigator programs through the title IV-B, subpart 2 formula grants. ACF provides technical assistance to promote kinship family support services and peer-to-peer connection and collaboration among kinship navigator program leaders.
  • The Family First Prevention Services Act created a new federal Kinship Navigator Program under title IV-E of the Social Security Act. Title IV-E agencies can claim 50% reimbursement for eligible evidence-based kinship navigator programs. To date, the Ohio Kinship Supports Intervention and the Arizona Kinship Support Services have been identified as meeting the Title IV-E Prevention Services Clearinghouse evidence-based criteria.

Preventing Overdose and Supporting Recovery

  • In October 2021, HHS launched the Overdose Prevention Strategy which promotes research and evidence-informed methods to improve the health and safety of our communities. The strategy is guided by four principles — equity; data and evidence; coordination, collaboration, integration; and reducing stigma — and includes four priorities − primary prevention; harm reduction; evidence-based treatment; and recovery support.

Strengthening Economic Supports

  • ACF published a report on how to use TANF funding to provide housing assistance during the COVID-19 pandemic. The report describes housing-related challenges that families faced during the pandemic, both nationally and in four communities. The policy insights and lessons learned shared in this report can offer jurisdictions key insights as they look to more comprehensively support families who are facing financial instability due to parent or caregiver loss.
  • The American Rescue Plan (ARP), one of the largest stimulus packages in U.S. history, provided over $48.7 billion to several ACF programs. ARP funds ACF programs related to child welfare, energy/utility assistance, family violence/sexual assault, Head Start, Native languages, rental assistance, and child care, all of which are important resources for recovering and grieving families.

 

[1] Source: The Global Reference Group on Children Affected by COVID-19 and Crisis https://imperialcollegelondon.github.io/orphanhood_USA/

[2] Source: Centers for Disease Control and Prevention https://www.cdc.gov/drugoverdose/deaths/index.html

[3] Source: Centers for Disease Control and Prevention https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

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