How to Support Youth Post COVID-19 With More Flexible Policies Caitlin Langhorne Griffith, Victoria Pless, Martha Yeide Over the past few months, COVID-19 has highlighted how current policies and funding do not support an equitable approach to health. However, states and territories have begun to leverage statutory and regulatory flexibilities to improve health outcomes for the disproportionately affected during this pandemic. One of the ways that states and territories can support these groups and maximize these flexibilities during and post-COVID-19 is by deploying a Shared Risk and Protective Factor (SRPF) Framework to address negative health outcomes. Research has demonstrated that addressing both the risk and protective factors across sectors can lead to multiple improved health outcomes, including heart disease, asthma, depression, and substance use. Because youth are at increased risk of exposure to Adverse Childhood Experiences (ACEs), and have fewer supportive resources, they are a particularly vulnerable group potentially affected by COVID-19 policies and funding. ACEs are a risk factor shared across numerous health outcomes, such as substance use disorder, chronic disease, and mental health. However, implementing the SRPF Framework can promote protective factors in upstream ways, like reducing and mitigating the impact of ACEs. During the COVID-19 response, some areas where state officials can take advantage of policy flexibilities to better support youth and reduce some ACEs include youth experiencing food insecurity, youth with incarcerated parents, and youth witnessing violence in the home. Ultimately, these examples illustrate the benefits of extending innovative policies to decrease negative outcomes and promote health across the lifespan beyond COVID-19. Youth and Food Insecurity Food insecurity is a public health issue that plagues the United States and has been associated with negative health outcomes including obesity and unhealthy brain development. More than 11 million children in the U.S. live in food insecure homes, with an estimated 11 percent of households reporting food insecurity at least some time during 2018. New data show that food insecurity has increased for youth during the COVID-19 pandemic, with almost one in five of mothers — 17.4 percent —with children ages 12 and younger reporting their children were undereating because they could not afford enough food. When state officials closed schools to prevent the spread of COVID-19, food access was upended for youth who participate in free-or-low-cost school meal programs. States can mitigate this disruption by safeguarding access and expanding these programs to ensure the continued physical and mental development of youth. Jurisdictions have implemented innovative practices allowed under expanded flexibilities to ensure that youth receive regular nutrition during COVID-19. Vermont is conducting telephone appointments for the Women, Infants and Children (WIC) nutrition program due to social distancing, and has also expanded the list of foods available through WIC during the COVID-19 pandemic. Forty-seven states and territories have implemented the Pandemic Electronic Benefit Transfer (EBT) benefit passed as part of the CARES Act. This allows households to offset the cost of meals that would have been consumed at school by youth. Wyoming has adapted its WIC program services, which includes providing curbside deliveries and conducting phone screenings. Youth with Incarcerated Parents It is estimated that between 1.7-2.7 million youth have incarcerated parents. This leaves them at a higher risk of adverse outcomes, including mental health problems, poor school-based outcomes, and increased antisocial behavior later in life. Parental closeness between incarcerated parents and youth can be an effective strategy to promote resiliency, and jurisdictions are implementing programs focused on connecting the incarcerated individuals with loved ones. The Pennsylvania Department of Corrections has created a virtual visitation program for all state-run facilities, and all inmates are eligible to participate. In Connecticut, organizations such as Children with Incarcerated Parents have created programs that provide free calls with incarcerated parents each month during the COVID-19 pandemic. Other innovative avenues to connect children with incarcerated parents include the Governor of Illinois issuing an executive order suspending the transfer of some inmates from county jails into the Illinois Department of Corrections during the public health emergency. This approach may increase the likelihood that inmates remain geographically closer to home. Washington executive order 20-47 suspended statutes that limit an individual’s ability to receive post-conviction relief, as well as prosecutors’ and courts’ ability to file and process criminal cases. Washington executive order 20-50 broadened the Governor’s authority to grant clemency to reduce the prison population. New Jersey Gov. Phil Murphy issued an executive order establishing an Emergency Medical Review Committee, which will review which inmates can be released to home confinement—identified by the Board of Parole—and outlined the process for ensuring those who are released are aware of reentry benefits. Youth Witnessing Violence in the Home Witnessing violence at home also is associated with a higher risk of negative health outcomes, as well as experiencing or perpetrating violence later in life. "Stay at home" or "shelter in place" orders during the COVID-19 response has corresponded with increased risk of family violence and increased calls to domestic violence hotlines, posing another public health crisis as many children have been exposed to violence in their homes. While trends also show a decrease in reports of child neglect and abuse, this decline may be due to restrictions on the child welfare surveillance systems that monitor and intervene in situations of abuse and neglect. State lawmakers have offered help to those experiencing domestic violence, despite restrictions on travel. Massachusetts and Maine ordered all state hotels to only provide rooms for vulnerable populations or essential workers, including those that may be experiencing domestic violence. New Hampshire established the COVID-19 Emergency Domestic and Sexual Violence Services Relief Fund for shelters across the state to aid those who may be experiencing domestic or sexual violence. Nevada developed a process for individuals to file online temporary domestic violence protective orders. The District of Columbia developed a process so individuals can file an extreme risk protection order through an online form and phone call, which can remove firearms from individuals who may be dangerous. Finally, California released a safety planning guide for those who may be experiencing domestic violence. The COVID-19 response has prompted states to provide flexibilities in funding and suspend or modify policies that would have made it more difficult to protect the public’s health — and in turn would have exacerbated negative health outcomes among youth. Through innovative practices these efforts have worked to mitigate the negative impacts of food insecurity, youth with incarcerated parents, and youth experiencing violence in the home. Health officials can be at the forefront of this innovation to ensure that protective factors are leveraged to reduce disparities and impact multiple outcomes with upstream approaches for youth. website