Finding Opportunity in Adversity: How One State is Identifying Ways to Strengthen Services to Young Children and Families During COVID-19

Photo credit courtesy of First 5 Alameda County

The COVID-19 pandemic and economic recession have created significant challenges for young children and their families while also dramatically impacting the budgets and operations of government and community programs that serve young children and families. Nowhere is this truer than the state of Nevada.

“As I think about the young children and families in Nevada, and the impact of the pandemic and recession, I am deeply concerned about their health and well-being. I want to make sure we are doing everything we can to respond to the disruption in their lives and the increased need for our programs and services. I am reminded of the famous quote by the late John Lewis, ‘If not us, then who?’”

— Richard Whitley, Director Nevada Department of Health and Human Services

The gambling and hospitality sectors are major employers and key contributors to Nevada’s state and local general funds. As travel, tourism, and entertainment activities have been limited to prevent the spread of the virus, state revenues have been hit hard and many jobs have been reduced or lost.[1]

Data from the January 2021 US Census Household Pulse Survey shows that in families with children under 18, nearly:

  • 600,000 families have experienced loss of employment income;
  • 140,000 households report sometimes or often not having enough to eat;
  • 55,000 families believe they are likely to have to leave their home due to eviction in the next two months; and
  • 500,000 families have experienced anxiety and depression.

Why focus on children and families in the prenatal-to-three life stage during pandemic response and recovery?

In the last decade, in response to the overwhelming brain science about the critical development that happens during the prenatal-to-three life stage, there has been significant interest in advancing state and local policies and programs that support young children and families. As the brains and bodies of young children grow, they are strengthened by environments that can meet their needs and strong relationships with responsive caregivers. Conversely, children’s healthy development and family well-being is compromised by toxic stress created by economic hardship, racism, neglect, abuse, and disruptions in the relationships with their caregivers.[2]

Committed to supporting young children and their families during this critical time, the Nevada Department of Health and Human Services has prioritized young children and their caregivers in many of their programs and strategic initiatives. The state has also participated in two national policy collaboratives focused on the prenatal-to-three life stage. The first is Pediatrics Supporting Parents, supported by the Center for the Study of Social Policy, Manatt Health, and DCR Initiatives, and the second is the Pritzker Children’s Initiative Prenatal-to-Age Three state grant program.

While the COVID-19 virus has not sickened many children, experts in the fields of child and family development are deeply worried about the as-yet-unknown impacts of the pandemic and recession on their lives, from missed social and educational interactions and disruption and stress in their families. In addition, children of color have been disproportionately burdened by the pandemic as their families and caregivers have experienced greater job losses, economic instability, illness, and death.[3]

COVID-19 Rapid Response. When the pandemic hit Nevada, many government agency long-range strategic plans were paused and the Nevada Department of Health and Human Services directed all their efforts to immediate COVID-19 response. Each of the five Divisions, Aging and Disability Services, Child and Family Services, Health Care Financing and Policy, Public and Behavioral Health and Welfare and Supportive services, took immediate action to address the urgent needs of the populations they serve. Specifically, they focused on supporting Nevadans’s access to basic needs like health insurance coverage, food security benefits through SNAP and WIC, and ensuring that critical child protection services and child care services remained available to families. The Divisions also worked swiftly to support care delivery transformation, moving many services (including early intervention) into virtual care and telehealth models. Finally, the Divisions worked directly with service providers to support their sustainability and survival.

Resilience and Recovery. While much of the rapid response work is ongoing, the Department is beginning to look ahead to recovery from the pandemic and assessing how they can support the long-term resiliency and eventual recovery of young children and families.

Several Prenatal-to-Three policy frameworks[4],[5],[6] offer guidelines to support Nevada’s planning and action:

  • Healthy Beginnings: Supporting healthy pregnancy, birth, and postpartum period for mothers  and babies.
  • Safe and Stable Families: Ensuring all families are safe and have the basic resources to provide a stable environment to support children’s healthy development.
  • Early Development, Care, and Learning: Creating access to early care and learning experiences that support child development and allow caregivers to work or pursue educational opportunities.

Each of these frameworks identify a menu of macro-policy options to support the health and well-being of young children, including Medicaid coverage policies, State Earned Income Tax Credits (EITCs), paid family leave, enhanced minimum wage, and state investments in early care and learning programs such as direct support to Head Start or child care tax credits and subsidies. At this time, Nevada has not adopted most of these policies and given the economic impacts and COVID related policy and program priorities, it may be some time before the state considers adopting any of these policies. 

However, the Department of Health and Human Services leadership saw the opportunity to examine how their current programming and COVID response efforts are supporting Nevada families in the prenatal to three life stage. The Director convened his key Division Directors to explore the following questions:

  • What programs and initiatives in the Divisions are focused on the prenatal-to-three population?
  • Which policies and programs intersect or overlap?
  • Are we working across the Divisions to ensure we are not working at cross-purpose and creating confusion and barriers for families?
  • Can we find new opportunities to increase our impact for families by collaborating across Divisions?

Through just a few short strategy sessions with Division staff, the Department leadership quickly identified the breadth of work being done to support young children and families:

  • Healthy Beginnings
    • Medicaid Coverage and Services—Prenatal care, birth, and postpartum care services, healthy weight supports
    • Family Planning and Perinatal Services
    • Public Health Surveillance and Response
    • Infant and maternal mortality reviews, infant health surveillance
  • Safe and Stable Families
    • Supporting Family Basic Needs TANF, WIC, SNAP, health insurance, child support, child care subsidies
    • Family Support Programs
    • Home visiting, addiction recovery supports, Early Infant and Child Mental Health Consultation
    • Child Abuse and Neglect Prevention and Response
  • Early Development, Care, and Learning
    • Access to Health Care Services Vision, hearing, behavioral health, and social and emotional development services
    • Developmental Screening and Early Intervention
    • Access to High Quality Early Learning
    • Subsidies, provider supports, quality ratings, workforce development

Five Key Areas of Work

After identifying and evaluating the work being done throughout the Department, leadership recognized five key priorities for addressing the needs of young children and families.

Eligibility Policies and Processes. Maintaining strong alignment and efficient processes, even as federal COVID response policy is impacting the programs administered by the Department differently.

Family Planning and Prenatal Care. Aligning Medicaid and public health family planning and prenatal care services for all women, and especially for women with complex health and behavioral health needs, including substance use disorder.

Food Security and Nutrition. Urgently responding to food insecurity among families with young children through WIC, SNAP, SNAP-Ed, child care food programs, and Medicaid policy.

Family Support and Behavioral Health Programs. Urgently responding to parent and caregiver stress, social isolation, anxiety, and depression and supporting the social and emotional development of young children.

Early Identification and Intervention. Maintaining access to critical screenings and services while pursuing work to strengthen the understanding and recognition of developmental delays, and improving referral processes and financing for early intervention services.

Structures to Support Collaboration

Mapping existing policies and initiatives and opportunities for greater collaboration is only the first step toward alignment, coordination and improved services for families. The Department leadership and staff are now looking at mechanisms to enhance collaboration and service delivery through:

  • Creating informal affinity groups or “lunch bunches” for staff working on similar policy areas and programs to meet regularly and exchange information, share ideas, and collaborate;
  • Establishing formal cross-divisional teams or councils, like Nevada’s Food Security Council;
  • Identifying a single staff person in each Division that can support collaboration and cross divisional work, and report to Division and Department leadership on progress; and
  • Developing a standing meeting cadence for Division and Department leadership to keep teams focused on shared objectives and goals for each priority area.

“I was heartened to see all the work being done across the Divisions to support young children and their families. I am excited to strengthen our collaboration and make sure we are doing as much as we can, as efficiently as we can, to maximize the impact of all of our efforts.”

— Suzanne Bierman, Director of the Division of Health Care Financing and Policy, Nevada Medicaid Director


Nevada’s experience provides an example of how other states and local jurisdictions, even in times of constrained resources, can find new opportunities to strengthen state services for young children and families. Other can follow Nevada’s lead by:

  • Convening agency leaders and staff to critically review all programs and initiatives supporting pregnant women and young children to find opportunities for alignment and collaboration.
  • Collecting and analyzing data about the experiences of children and families in the prenatal to three life stage in critical programs such as Medicaid, SNAP, child welfare and services for families with children with disabilities or developmental delays.
  • Ensuring that family support programs such as outreach and enrollment programs, case management/care coordination services, home visiting and parent support programs are both responding to the urgent needs families, but also looking ahead to how they can support the long-term resilience and recovery for both children and their caregivers.

The recovery of our families and support for young children and their caregivers to heal from this experience will be the foundation for the nation’s long-term recovery. State and communities can take action today to find opportunities to align efforts and maximize their support for families.

[1] Pandemic Driven Declines in Tourism Take Toll on Many State Revenues, Pew, October 2020.
[2] Toxic Stress, Center for the Developing Child
[3] COVID-19s Disproportionate Effects on Children of Color, Urban Institute, August 2020
[4] National Collaborative for Infants and Toddlers
[5] Prenatal to Three Policy Impact Center
[6] National Conference of State Legislators Prenatal to Three Policies