An overview of the challenges faced
by vulnerable children and their
families during COVID-19
A scoping review
Coci Anamaria Ioana
One-year master thesis 15 credits Supervisor: Lilly Augustine
Interventions in Childhood
Examinator:
Spring Semester 2021 Name: Anna Karin
SCHOOL OF EDUCATION AND COMMUNICATION (HLK) Jönköping University
Master Thesis 15 credits Interventions in Childhood Spring Semester 2021
ABSTRACT
Author: Coci Anamaria Ioana
An overview of the challenges faced by vulnerable children and their families during COVID-19 Subtitle A scoping review
Pages: 27
The pandemic is not only a crisis itself but has created multiple crises for vulnerable population as well. Worldwide, they encountered multiple challenges to assistance and protection, but due to the pandemic, their needs might have increased. As the number of refugees, migrants, and asylum-seeker is rising, all the health risks and the challenges that this group is exposed to, demonstrates the need for increased support, protection, and assistance. This scoping review aims to investigate if the arisen challenges faced by vulnerable children and their families, have exacerbated in the con-text of COVID-19, in published research literature. In this scoping review, information was col-lected on multiple databases between January and February 2021. Seven empirical studies were an-alysed in order to examine which are the new challenges that have arisen due to COVID-19 and explore if they worsened in this context. Seven areas emerged due the pandemic: hygiene measures, food insecurity, child labour, child marriage, freedom of movement, access to education, access to services and sources of information, while five areas have worsened: economic, psychological, vio-lence, discrimination and overcrowding. The findings are showing that COVID-19’s disease burden is higher in vulnerable contexts, due to the living conditions, high risks jobs, and poor access to services. The outcomes of these challenges are likely to be long-standing, as they breached into the processes and structures of the family system Although efforts to control the virus’s spread remain critical, the negative effects on vulnerables, must be addressed and identified to avoid the risk of more challenges getting exacerbated, and reduce the parental stress that will lead to the well-being of the future generations. Limitations, practical implications and future research are discussed.
Keywords: refugees, migrants, asylum-seekers, vulnerable children, vulnerable family, challenges, COVID-19 pandemic Postal address Högskolan för lärande och kommunikation (HLK) Box 1026 551 11 JÖNKÖPING Street address Gjuterigatan 5 Telephone 036–101000 Fax 036162585
Table of Contents
1 Introduction ... 1
2 Theoretical Background ... 2
2.1 Vulnerable Populations ... 2
2.2 Environmental influence on child development ... 3
2.3 Diathesis/Vulnerability - Stress Model ... 3
2.4 Bronfenbrenner’s Bioecological Model of Human Development ... 4
2.5 Rationale ... 6 3 Aim ... 6 4 Research Question ... 6 5 Method ... 7 5.1 Study Design ... 7 5.2 Search Strategy ... 7 5.3 Selection Process ... 8 5.4 Screening procedure ... 9
5.4.1 Screening process - Title and abstract level ... 10
5.4.2 Screening process - Full text ... 10
5.5 Data Extraction ... 10
5.6 Quality Assessment ... 10
5.7 Ethical considerations ... 12
5.8 Data Analysis ... 12
6 Results ... 13
6.1 Overview of the results ... 13
6.2 Characteristics of the participants ... 13
6.3 Pre-pandemic challenges ... 16
6.4 Post-pandemic challenges ... 17
6.4.1 Economic challenges ... 17
6.4.2 Organizational challenges ... 18
7 Discussion ... 20
7.1 Reflections on the findings ... 20
7.2 The Bioecological and Diathesis-stress model ... 22
7.3 Methodological Issues ... 24
7.4 Limitations of the current review ... Error! Bookmark not defined. 7.5 Practical Implication ... 25
8 Conclusion and future research ... 26
9 References ... 28
9.1 Appendix A – Search procedure ... 36
9.2 Appendix B - Extraction Protocol ... 38
9.3 Appendix C – Quality Assessment ... 39
9.3.1 NIH QAS Tool for Observational Cohort and Cross-Sectional Studies (2014) ... 39
9.3.2 Mixed Methods Appraisal Tool, Pluye et al., (2009) ... 40
9.3.3 CASP (2017) ... 41
1
1 Introduction
According to World Health Organization (WHO, 2021), a coronavirus disease (COVID-19) has swept across the globe, with more than 100 million cases and more than 2 million deaths at the time of writing. This pandemic has triggered a crisis without precedent in modern times, affecting multiple fields such as humanitarian, socio-economic, human rights, and global health (UNICEF, 2020). In the face of a pandemic everyone is vulnerable, and as reported by the UN Refugee Agency (UNHCR, 2020), “The virus has shown that it does not discriminate”.
For those with less, the likelihood of adverse effects is the greatest, the pandemic has exacer-bated their dire living conditions (UNICEF, 2020). Around three-quarters of the world’s migrant and refugee families live in overcrowded settlements, camps, or reception centres, lacking access to clean water, sanitation, and health services (UN Refugee Agency, 2020). According to Derose et al., (2007), refugees, migrants, and asylum-seekers are often identified as a vulnerable population, as they are a group that has in common an increased risk of poor psychological, physical, social health effects and insufficient health care. Henceforth, these groups will be referred to in this scop-ing review as are “vulnerable”. Based on a report from 2019, approximately 33 million minors were living outside their country of birth, out of which many were displaced across the border due to violence and conflict (UNICEF, 2019).
A recent report by UNICEF (2020), stated that refugee families stand to be massively affected by the socioeconomic impacts of COVID-19. This group have also been identified by Orcutt et al., (2020), as an extremely vulnerable population, especially during the COVID-19 pandemic, due to the dire health, economic, living and working conditions they face. The effects of the pandemic intensified the previous vulnerabilities and a general lack of access to services, meaning that vul-nerable children will be adversely affected and struggle long after the public health crisis will come to an end (UNICEF, 2020). The immediate effects of COVID-19 on these children and their fam-ilies resulted in exacerbating the pre-existing challenges that this population was already facing before the pandemic (UNICEF, 2020).
2
2 Theoretical Background
2.1 Vulnerable Populations
For a very long time, humanity has been moving from place to place. While many people migrate out of choice, there is a great number of people migrating out of necessity (UN, 2019). Some people move to escape conflicts, terrorism, persecution on human rights violations, while others move to search for more economic or work opportunities, or to join their families abroad. Yet, other people are moving to keep away from the adverse effects of different environmental factors such as natural disasters or climate changes (UN, 2019). One of the main reasons that led to successive waves of global displacement are conflicts. Woefully, the greatest effects that these conflicts and displace-ments are constituting are among the most in need of protection: children and their families (UN-HCR, 2014).
While the words “asylum-seeker”, "refugee", and "migrant" are increasingly used inter-changeably in the media and public discourse, there is a significant legal distinction between the three. A definition will be provided in order to define the concepts used under the umbrella term “vulnerable”. Confusing them can lead to problems for refugees and asylum-seekers, and for States trying to respond to mixed movements, as well as to misunderstandings in discussions of asylum and migration (UNHCR, 2016). The importance of including these three groups in the present study is due to the fact that vulnerable people have a lot of similarities, especially when it comes to the risk they face (such as psychological and social health outcomes, as well as insufficient health care), but they also experience related realities. The fundamental difference between these three groups lies in the decision to travel.
According to UNHCR (n.d), an asylum-seeker is someone demanding international asylum but whose refugee status has not yet been decided. In contrast, The 1967 protocol from the 1951 Convention, relating to the Status of Refugees (p.11), and UNHCR (n.d.) define a refugee as any individual who leaves their country of origin because of war, violence or persecution. Refugees have a solid fear of persecution for reasons of religion, nationality, race, or political opinion (UN-HCR, n.d.). It is reported, that by the end of 2019 the world was witnessing a record when it comes to the level of displacement (UNHCR, 2019).
As regarding migrants, according to International Organization for Migration (IOM, 2019), there is no legal or universal definition of a “migrant” term. However, this paper included under the umbrella term “vulnerable”, the migrants that are in a vulnerable situation such as children and
3 families who are unable effectively to take advantage of all the human rights and oher opportunities available in the new country they settled in. (OHCR, 2015).
2.2 Environmental influence on child development
According to Shonkoff et al. (2000), the environment and all the experiences affect multiple aspects of early human development, from the brain's developing circuitry to the child's sense of empathy. However, talking about environment in relation to vulnerable children, as they grow up in a harsh environment, with few opportunities and protective factors - they face multiple risks in their de-velopment, such as social - emotional development difficulties or behavioral problems (OECD, n.d.). Environmental factors play a very important role in modulating the brain development of a child, as vulnerable children face many psychosocial risks such as poverty, dire conditions of living, or family violence, there is an increase the odds of impaired development (Shonkoff et al., 2000).
Vulnerable parents face many stressors in their daily life that impacts the relationship with their children (Dow, 2011). One of the most consistent factors that influences the children’s de-velopment according to Shonkoff et al. (2000), are parent’s mental health, specifically psychological distress caused by economic hardship. McLoyd, (1997), highlighted the association between eco-nomic hardship, parental psychological distress, and how does this impact the children’s develop-mental outcomes. Yet, there are many other environdevelop-mental challenges that increase the family stressors in vulnerable contexts such as poor nutrition, neighbourhood conditions and other envi-ronmental hazards, that according to Shonkoff et al. (2000), can be a detrimental risk for children’s well-being throughout and beyond the childhood years.
2.3 Diathesis/Vulnerability - Stress Model
The principles of vulnerability and stress are crucial, but their true power lies in their interaction (Ingram & Luxton, 2005). The diathesis-stress model, also known as the vulnerability-stress model, is a psychological theory that aims to understand a disease or its progression as the result of an association between a predispositional vulnerability (diathesis), and stress induced by life experi-ences, (Ingram & Luxton, 2005). The model emphasize that different life experiences could interact with psychosocial vulnerabilities and can incite the development of different mental health disor-ders (Idemudia et al., 2013). The model can be used to assess anyone’s risk (Theodore, 2020).
Stress is defined as a certain event during the life of an individual, interrupts the psycho-logical equilibrium (Ranabir et al., 2011). Being exposed to a number of stressors, such as insecurity in food, shelter and safety creates high levels of stress. For vulnerable groups the stressors are often multiplied. As there are many stressors and risks among them, the model aims to underline in the
4 present paper how the interaction between a person and the psychosocial factors can lead to men-tal health problems, mainly on how different daily stressors impact the development of a child through the proximal processes (Solberg et al., 2019). The model emphasize that the stress alone does not lead to mental problems, but rather that the stressors around the person, together with the individual's vulnerability, can lead to mental issues (Groglopo, 2018).
Growing up in situations characterized with an accumulation of stressors and risk factors for positive development it is important to emphasis the additional stress that can arise from a situation such as COVID-19 pandemic along with the long-term situational factors (living in pov-erty or in an overcrowded place, having stressed parents), may be overwhelming and result in im-pacting in a negative way the developmental outcome of a child, e.g., different disorders or mala-daptation (Shonkoff et al., 2000).
2.4 Bronfenbrenner’s Bioecological Model of Human Development
The bioecological model of development was the third phase of the development of the theory elaborated by Urie Bronfenbrenner in between 1993-2006. The model aims to show how temporal and spatial contexts in relation to the individual, influence the proximal process – which is defined by Bronfenbrenner & Evans (2000), as the key factor of the development. Bronfenbrenner defined it as “an evolving theoretical system for the scientific study of human development over time” (Bronfenbrenner & Morris, 2006, p.793). This evolving system is built by four elements: process,
person, context, time (PPCT). According to Bronfenbrenner & Morris (2006), all these four elements
are simultaneously influencing the individual developmental outcome. The central element of Bronfenbrenner’s bioecological model is the proximal process. This element covers certain forms of interaction between an individual and other people or symbols and objects in his or her immediate environment (interaction parent-children; children - teacher) (Bronfenbrenner & Morris, 2006). The second element, “person”, stands for the personal and individual characteristics/genetic aspects that a person has and how these can influence any social situation. The “person” component is formed by three elements: demand (acting like an immediate stimulus, such as race, gender, age or sex), resource [can be mental and emotional (skills, experiences) or material resources (access to housing, education, or work)] and force (motivation or temperament) (Tudge et al., 2009). The third element, context involves four spheres of a person’s interaction, microsystem (the immediate environ-ment – such as the direct interaction between family-school); mesosystem (interaction between microsystems); exosystem (indirectly affecting the individual – such as the relationship between a
5 child and parent’s workplace); and macrosystem (the cultural and social context in which each indi-vidual develops) (Bronfenbrenner, 2005). The final element is time and includes micro-time (the ad-justment and continuity in the ongoing proximal process); meso-time (consistently, intensity, and periodicity across different time intervals); and macro-time (the change in the environments the de-veloping individual lives in) (Rosa et al., 2013).
As PPCT is a dynamic process, an overview upon the changes caused by the pandemic on the other systems will be presented. The model is relevant in this context, as the external environ-mental factors (e.g., the pandemic) influence the development of a child (Berns, 2006), and if the environment is changing, so is the individual.
At the person level, the effects of the pandemic could be felt at all three elements: demand, resource and force. From demand to force, they all have been impacted as the virus continues to spread and new restrictions being enforced all the time. Vulnerable children may be among the ones feeling the negative and considerable effects of this pandemic on a physically, mentally, and educationally level (Kazerooni et al., 2020). Confining measures implemented to reduce the spread of the virus, might have impacted the proximal process of the child, as the forms of interaction and coexistence with the immediate environment (such as the interaction between child and peers or child and teachers) have been reduced (Moura et al., 2020).
At the context level, there have been social, economic, and political measures taken by the government, impacting the immediate environment of the child or of the parent. Imposed lock-downs might constitute barriers in the direct interaction between families and their workplace or children and the school, affecting at the same time the mesosystem. The exosystem might be both challenging and favourable. Job loss among the adults might represent a key source of stress among them, but, however it can have an indirect favourable effect on their children. Because of this the parent-children interaction might occur often than before.
Time (chronosystem), has a substantial effect, especially among the vulnerable populations. While this group was already confronting challenges in the access to education, legal issue, or poor housing - throughout a year, the pandemic reshaped many aspects of their daily life. Sociohistorical events such as the COVID-19 pandemic can bring both advantages and disadvantages that can have a long-term impact on the well-being and development of an individual. Singh et al. (2015), used Bronfenbrenner’s conceptualization of macrotime, also known as the chronosystem, to
ex-6 plore how time turn changes in vulnerable micro-, meso-, and exo- structures. These develop-ments and ecological transformations in the present can have an impact on how vulnerable children develop in the future.
2.5 Rationale
The pandemic is not only a crisis itself but has created multiple crises for this vulnerable population as well. Worldwide, before the pandemic started this group encountered multiple challenges to assistance and protection, but due to the pandemic, their need might have increased as COVID-19 has shown the myriad ways in which today's social, political, economic, and civic systems strug-gle to meet the needs of vulnerable children and their families (Bhopad, 2020). As the number of refugees, migrants, and asylum-seeker is increasing according to the United Nations (2019), all the health risks and the challenges that this group is exposed to in the context of COVID-19, demon-strates the need for increased support, protection, and assistance, especially for children, as effects of a crisis can be a detrimental risk for children’s future development. A focus is laid on the last element of the Bronfenbrenner’s theory (time), as COVID-19 is a major event, it affected all the levels surrounding vulnerable children and their families. Starting from a macro-level - which began with the introduction of new movement restriction, and narrowing down its impact to the family and child level, therefore affecting the family psychological well-being which can influence the future development of a child.
3 Aim
This scoping review aims to investigate if the arisen challenges faced by vulnerable children and their families, have exacerbated in the context of COVID-19, in published research literature.
4 Research Question
The following research questions has been addressed in order to guide the study:
1. What are the challenges that have arisen among this vulnerable group due to COVID-19? 2. Has the ongoing pandemic exacerbated the challenges encountered by this population?
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5 Method
5.1 Study Design
A scoping review (ScR) was carried out to address the research questions. According to Tricco et al., (2018), a scoping review is a type of knowledge synthesis, following a systematic approach, to map shreds of evidence on a specific topic and identify main concepts, theories, sources, and knowledge gaps. Particularly, a scoping review is conducted where the research areas are complex or have not been comprehensively studied (Mays, 2001, p.194). As the COVID-19 pandemic is a recent event a scoping review fit. Additionally, a quality assessment of the selected articles was performed to minimize the bias of individual studies.
5.2 Search Strategy
The database search for this scoping review was conducted between January and February 2021, using PubMed, ScienceDirect, and Web of Science. A pre-testing of the key terms was done prior the final search in order to be properly adjusted. However, as COVID-19 is a recent event, testing the key terms on multiple databases and by visually screening the titles, many duplicates have been found. In this situation the number of databases has been reduced to three. As not so many articles meeting the inclusion criteria at the time of searching, organizational databases were used in order to extract more papers and increase the credibility of the data analysis. Additionally, searches have been conducted on WHO iris (Institutional Repository for Information Sharing) database and UNICEF (children and COVID-19 research gallery).
Prior to the final database search, a pre-testing of the key terms was conducted to see if any adjustment were needed. The terms used included Boolean operators (“AND”; “OR”), however, the searches were more open, as the exposure was already narrowing down the search strategy. Different combinations and different orders, as well as synonyms, have been used in all databases, aiming at identifying all the relevant articles related to the research questions addressed by the study. Restrictions criteria such as peer reviews and scholarly journals were applied in all the data-bases, securing that only reliable articles were included in this ScR for further analysis. The articles were chosen based the key terms such as: refugee (children OR youth OR adolescence OR kid) AND (Covid-19 OR Coronavirus OR SARS-COV-2) OR refugee family AND (Covid-19 OR Coronavirus OR
SARS-COV-2); or - migrant (children OR teenagers OR youth OR adolescence OR kid) AND (Covid-19
OR Coronavirus OR SARS-COV-2) OR migrant family AND (Covid-19 OR Coronavirus OR
8
5.3 Selection Process
In order to be able to undertake the selection process, firstly, the inclusion and exclusion criteria were established, depicted in Table 1. They were designed according to PECO (population – vulner-able children and families; exposure – COVID-19; comparator – pre- and post- pandemic, and outcome -new challenges and their exacerbation), in order to assess the association between exposure and outcome (Morgan et al., 2018). Studies were included if the focus was on COVID-19 in relation to refugee, migrant, asylum-seeker children and their families, aiming to explore the arisen challenges in the context of COVID-19. The included articles have no specific country in focus. Quantitative, qualitative, and mixed-methods studies were included in the analysis. Because of the lack of re-search conducted among this vulnerable population in the context of pandemic, grey literature such as empirical reports conducted by different organizations were selected for the data extraction and further examinations.
Table 1. Inclusion – Exclusion Criteria
Inclusion Exclusion
Population
-Refugee, vulnerable migrants, asylum-seeker, aged 0-18 or families with at least one child
-Voluntary migrants, seasonal migrant, in-ternal migrant, migrant worker, families without children
Exposure
-COVID-19, Coronavirus, Sars-cov-2, Covid
-Not specifically limited in time to 2019-2021 (e.g., the period of COVID-19 Pandemic)
Comparator
-Pre- and post- pandemic challanges - Studies only focusing on pre- pandemic challanges
Outcome
-Covid-19 Challenges/ barriers/ difficul-ties/ issues /problems/ limitations
-Studies that are not exploring the exacer-bation/ new challenges arisen due to COVID-19
Others
-Published in English, empirical grey
litera-ture, open access (full text access) - If the results mix groups/ not presented separately for each group (e.g., children with elderly)
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5.4 Screening procedure
Articles collected from PubMed, ScienceDirect and Web of Science and WHO iris (Institutional Repository for Information Sharing) database were imported in the program Rayyan QCR (Ouz-zani et al., 2016). A flow diagram of scoping review screening procedure, following Prisma Frame-work (2009), is presented in Figure 1.
Figure 1. Flowchart of selection process – following Prisma framework
Records identified through da-tabase searching (n = 468) Scr ee ning Include d E ligibilit y Ide nt ifica tio
n Additional records identified
through other sources (n = 24)
Number of duplicates removed (n = 63)
Records screened based on title and abstract
(n = 429)
Records excluded for having wrong popula-tion, exposure or
out-come (n = 378) Full-text articles
as-sessed for eligibility (n = 51)
Full-text articles ex-cluded for wrong study design,
popula-tion or mixed (n=44) results (n =44) Studies included in narrative synthesis (n = 7)
10 5.4.1 Screening process - Title and abstract level
There were (n=492) publications identified initially in data bases and other sources. A title – ab-stract screening of the identified (n=468) articles imported from the database and (n=24) from the additional sources has been conducted. A total of (n=378) articles have been excluded, the most common reason for the exclusion being the wrong population such as migrant workers or internal migrants; wrong study design such as reports or essays, or the data was not looking at pre- or post- COVID-19 effects on the focused population.
5.4.2 Screening process - Full text
A total of (n=51) articles have been assessed to see whether they met the inclusion-exclusion cri-teria in the full-text screening. Here, (n=44) articles were excluded, (n=14) due to the wrong study design, (n=24) wrong population and (n=6) for having mixed results (e.g. the group the results are not presented separately for each group, such as children with elderly). The articles that did not present the results separately for the vulnerable group, were excluded as they did not let the re-viewer distinguish in detail the main relevant aspects. Therefore, the final sample consisted of seven articles, out of which two were considered grey literature as they were extracted from WHO and UNICEF own databases
5.5 Data Extraction
Data were extracted following an extraction protocol displayed in the Appendix B. Moreover, pre-and post-ppre-andemic challenges were identified in the included studies pre-and extracted in order to examine the differences between them. The main parts from the discussion, together with the conclusion and limitations of each article were extracted as well to create a better understanding of the themes and how they can be aligned with the conceptual framework. While examining the articles, main themes have been distinguished and divided in the results section.
5.6 Quality Assessment
In order to evaluate the quality and internal validity of the articles, as well as reduce the bias, mul-tiple critical review appraisal tools have been used and adapted by the author (Jasson et al., 2011). The quality assessment of the publications used for the data extraction was carried out through different instruments depending on the methodology of each paper (displayed Appendix C). The reason for choosing different instruments was to assess the different study designs each publication had: quantitative study (n=2), qualitative study (n=2), mixed-methods studies (n=3). The selection of the instruments was done by convenience, focusing on specific aspects of each study (e.g., the quantitative tool for cross-sectional studies assessed the exposure and outcome, both being relevant
11 for the included studies). The articles were then classified based on their degree of quality. Each item from each tool used was scored from 0 – 2 points, where 0 constituted “No”; 1 - “Can’t tell” and 2 - “Yes”. See Table 2 for the overview of the articles and Appendix D for a justification of the quality assessment. . In Table 2 quality assessment is reported while Appendix D justifies the quality of the included publications, (n=3) articles had high quality, which mean that they maximized the relevance, originality, generalizability, and significance of the results (Maggio et al., 2016). (n=3) articles had medium quality, and (n=1) publication had low quality indicating that it might have an impact on the validity of the findings (Møller et al., 2018).
For the publications using mixed methods (III; IV; VI) the tool used to assess their quality was Mixed Methods Appraisal Tool ([MMAT], Pluye et al., 2009). The instrument had a range from 0- 23 points. Article III had a total of 23 points, therefore considered as having high quality, article IV a total of 19 points – having a medium quality, and publication VI had a total of 12 points – being rated as having a low quality.
The quantitative and qualitative publications were rated as “high quality” if six or more of the assessment criteria were answered with “Yes”, moderate quality was determined if four or five items were answered with “Yes”, and poor quality resulted if three or less were answered in the affirmative.
Two articles collected qualitative data (V, I). Second instrument used to assess the quality was CASP (2017). Article V had a moderate quality as five items were rated with “Yes”. Article I was rated high because eight out of ten items were rated with “Yes” (justification of quality assess-ment is depicted in Appendix D). Both articles seemed to have selected a qualitative design that was suitable for their aim and offered consistent statement of the research results. The researcher's influence and ethical concerns were also clearly stated in both studies. However, the article with a moderate quality did not reported why the selected participants were appropriate to provide access to the type of knowledge sought by the study (CASP, 2017).
The quality of publications using a quantitative study design (II, VII), was assessed by using the NIH Quality Assessment Tool for Cross-Sectional Studies (2014). The quality was rated high for an article (II) since seven out of 14 items were rated with “Yes” and moderate for the second one (VII) as five items were rated with “Yes”. The moderate article lacked sample size justification, and the timeframe of collecting the data was not sufficient so that one could reasonably expect to see an association between exposure and outcome.
12 The quantitative and qualitative publications were rated as “high quality” if six or more of the assessment criteria were answered with “Yes”, moderate quality was determined if four or five items were answered with “Yes”, and poor quality resulted if three or less were answered in the affirmative. As the initial number included in this ScR was relatively small, none of the articles were excluded due to low quality.
5.7 Ethical considerations
In this scoping review, the ethical consideration were carefully rated within the quality as-sessment. It was ensured that ethical priciples were followed in the included studies such as: ob-taining the informed consent, participants were treated equally (the moral, religious and political aspects were considered), traumatizing or sensitive aspects were avoided, and the anonymity and privacy were respected (Clark-Kazak, 2017). The investigations carried out among vulnerable groups, they require additional diligence in order to ensure respect for and concern for the well-being of the participants (Seagle et al., 2020). Articles number I, II, III, IV, V and VII, (see Table 2 for information regarding the authors), reported that they have received ethical approvals from the ethics committee. There was only one article (article VI), that did not directly report an ethical approval.
5.8 Data Analysis
The information extracted under data extraction, was split as before, and after pandemic. After-wards, an identification number was assigned to each publication (displayed in Table 3.). Henceforth instead of referencing the articles, the number assigned will be used. The present study has an inductive approach towards the content of the included publication. To answer the first research question, an overview of the challenges that have arisen due to COVID-19 were displayed in Table
3. To highlight the new challenges that have arisen among this group, the pre-existed ones
identi-fied in the included studies have been also illustrated in Table 3. To answer the second research question, both pre- and post-data was analysed in order determine if they intensified in the context of COVID-19.
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6 Results
6.1 Overview of the results
Seven articles were included in the analysis and were suitable to answer the research questions addressed by this study, which aimed to look into the challenges that had arisen among this vul-nerable group due to COVID-19 and explore if they exacerbated in the context of COVID-19. A total of 14 challenges were identified.
All of the articles explored how COVID-19 has impacted vulnerable children and their families, by looking at both pre- and post- pandemic. Only one article (VI) looked at some positive aspects that this group faced before the pandemic. Regarding the aim of the studies, four articles investigated the impact of pandemic (II; V; VI; VII), one article (IV) focused more on what has changed in the social determinants of health (SDOH) during COVID-19, one article (I), examined both the challenges and what needs to be done to mitigate these difficulties times of crisis (See
Table 2)
There are several challenges reported by the population in focus as a consequence of the pandemic. However, the pre-pandemic ones that were presented in the included publications were identified as well, in order to examine if the participants reported them as getting worse (they are marked with an “o”). The post-pandemic ones are marked with an “x” and the exacerbation of the challenges are marked with an “Y” (displayed in Table 3). To get an insight on what has been in-tensified in, the challenges were analysed and synthesized in themes: 6.3. Pre-pandemic challenges; 6.4. Post-pandemic challenges and 6.5. Exacerbation of the challenges.
6.2 Characteristics of the participants
There were (n=3) articles in which the level of report was made both by parents and children, (n=3) reported by parents and (n=1) reported by children. Minimum age of the participants was 8-year-old, and the maximum age was above 45 years. However, the results for all the study were presented separately for each group, therefore meeting the inclusion criteria. The level of report is displayed in Table 2.
15 * - low quality, ** - medium quality, *** - high quality, , MX- mixed-methods, QL- qualitative, QN - quantitative
Study No.
Author Country Title Level of report
Family Child
Study Design
QAS
I Banati et al. Ethiopia
Lebanon Ivory Coast
Intersecting Vulnerabilities: The Impacts of COVID-19 on the Psycho-emotional Lives of Young People in Low- and Middle-Income Countries
x
QL ***
II Feinberg et al. USA Public health crisis in the refugee community: little change
in social determinants of health preserve health disparities. x
QN ***
III Guglielmi et al. Bangladesh Exploring the impacts of COVID-19 on Rohingya
adoles-cents in Cox’s Bazar: A mixed-methods study x
MX ***
IV Masumbuko et al. Democratic
Republic of Congo
Prevention of COVID-19 in Internally Displaced Persons Camps in War-Torn North Kivu, Democratic Republic of the Congo: A Mixed-Methods Study.
x x MX ** V Munajed Al D., & Ekren, E. Turkey Lebanon
Exploring the impact of multidimensional refugee vulnera-bility on distancing as a protective measure against COVID-19: The case of Syrian refugees in Lebanon and Turkey.
x
QN **
VI Save The Children
(UNICEF database)
Kenya Impact of COVID-19 on Protection and Education Among
Children in Dadaab Refugee Camp. x x
MX *
VII World Health
Organization
Worldwide ApartTogether survey: preliminary overview of refugees and
migrants self-reported impact of COVID-19. x x
QN **
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Table 3. Challenges pre- and post- COVID-19
Challenges I II III IV V VI VII
Overcrowding and quality of shelter o Y Y o
Access to healthcare o o o x o Hygiene measures x Economic issues Y Y x x o x Y Access to education x x x Psychological effects x Y Y x x Y Food insecurity x x x x Sources of information x x x Violence x Y x o Freedom of movement x x x Discrimination x Y Child labour x x Access to services x x x Child marriage x x
o= pre-pandemic; x= post-pandemic; Y= both pre- and post- with the mention that they have exacerbated due to COVID-19
6.3 Pre-pandemic challenges
A total of three pre-pandemic challenges were identified in the included publication. Access to healthcare was reported in four studies due to lack of insurance (II), limited health services (III), English proficiency (IV), or financial constrains (VII) (see Table 3).
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6.4 Post-pandemic challenges
A total of seven new challenges are addressed due to COVID-19 (see Table 3). Some of them (n=6), can be considered to be economic challenges: freedom of movement (n= 3), food insecurity (n=4), child marriage (n=2), child labor (n=2), access to education (n=3), and hygiene measures (n=1), while some (n=2), can be considered to be organizational challenges: access to services (n = 3), sources of information (n= 3).
6.4.1 Economic challenges
A total of six challenges can be seen as economic challenges. Economic challenges that are empha-sized are freedom of movement (n= 3), food insecurity (n=4), child marriage (n=2), child labor (n=2), access to education (n=3), and hygiene measures (n=1). They were emphasized in six studies and they link to each other.
Freedom of movement due to the COVID-19 regulations was presented in three studies. A focus is set on access to the labor market as the family members are not allowed to move outside the camp in order to work (IV; V). There are multiple concerns about the impossibility of family reunification (V), child protection actors, or other humanitarian workers aiming to support the well-being of the families, unable to enter the camps (V; VI).
The freedom of movement and lockdowns were reasons for food insecurity in two studies, and a way of escaping unwanted early marriages in another. Study II and V outlined the food insecurity, as a consequence of the lockdown which does not allow families receive food from outside the camp. The COVID-19 lockdown was a way of escaping unwanted marriages, therefore constituting a facilitator among girls in one publication (I). However, the main reason for an in-crease in child marriage outlined in two studies, was economic issues caused by the movement restriction, therefore being a way of coping with the financial hardship caused by the pandemic (I; VI).
The pressing economic challenges have deprioritized the access to education, and it can be identified in three studies. Access to online learning (I; V), lack support from teachers, weak public provision in terms of learning materials (I), financial insufficiency (V), and engaging in other house-hold duties (VI), have significantly disrupted the education. Positive aspects such as the caregiver’s support while learning at home, in particular reading with children, leading and guiding them through activities, have been reported among some participants (VI).
18 School closure was a reason for child labour and child marriage in two studies and food insecurity in one study. Involvement in work among children occurred because of the disruption of the education, that has reshaped the responsibilities of the family and added pressure on the young people contribution to domestic or agricultural labour (I). Among girls, school closure was a challenge as they had to get married rather aggravate the economic situation of their families (VI). As regards food insecurity, school closures resulted in the loss of school meals (I).
Nevertheless, lack of financial means was the main reason in prevention of the virus, child labour and food instability in three publication. Lack of soap, lack of water in the camps and im-possibility to afford cleaning products, were crucial in protection from the virus (IV). Concerning child labour, the caregivers’ difficulties in meeting the basic needs for the whole family, resulted in sending their children to work (VI), and it was presented as a coping strategy for parents, and for the children in meeting the household’s necessities during the pandemic. Regarding the food insta-bility, high demand and low availability of food resulted in increasing the food prices and inability to afford it (III).
6.4.2 Organizational challenges
A total of two new issues are considered organizational challenges. Access to services was reported in three studies by cause of the lockdown and movement restrictions. Across families, COVID-19 prevention measures limited the access to different services such as social protection, employment or health (I). Access to legal documentation such as residency paperwork has been impracticable due to the imposed prohibitions (V). Among young mothers, the pandemic has made the access to counselling or access to sexual and reproductive health impossible as the services were closed (VI). Sources of information aiming to raise awareness about the risks of COVID-19 are re-ported in three studies (II; III; V). Lack of connection to technology (II), such as prolonged inter-net shutdown (III), lockdowns that forbid the volunteers to enter the camps (III), have created gaps in the information flow among this group. However, contrary to the previous two studies, study V focuses on the accurate NGO and governmental health campaigns that succeed in inform-ing the household members.
6.5 Exacerbation of the challenges
Five areas worsened in the context of the pandemic (See Table 3). They were all reported pre- post- and after pandemic, but they had intensified in this context. Overcrowding, violence and economic issues were reported in three studies prior COVID-19, however they exacerbated in this context.
19 The intensified challenges are: economic issues (n=3), overcrowding (n=2), violence (n=1), psy-chological issues (n=3), and discrimination (n=1).
Regarding of the exacerbation of the economic issues, there is one study that reports this issue prior the pandemic, three post pandemic, and three studies indicating exacerbations. Before pandemic only few economic opportunities were reported (V) while during the pandemic lack of economic resources were illustrated through the paid work that has stopped due to the lockdown (III; IV; VI). When talking about exacerbation, job loss and unemployment stress (I), skipping food and other needs in order to afford the housing (I; II, VII), unpaid work or sent home without payments (VII), were factors related to the economic problems that because of the fallout of the pandemic have highly intensified. Financial insecurity (II) was amplified especially among boys that were being compelled to engage in risky and exploitative work (I). Lack of financial support was associated in all three studies with the inability to provide the household members the access to basic needs, such as, education (I), food (II), health care in case of COVID-19 symptoms or the access to sexual and reproductive health (VII).
Overcrowded was a challenge reported in two studies prior pandemic due to dire condi-tions of living (V), and household size (I). The exacerbation of this issue was illustrated through poor housing conditions that had worsened due to a high number of family member being at home, as a consequence of movement restrictions (IV), and lack of job opportunities (II).
Prior pandemic violence was portrayed through sexual and domestic aggression among children and women (VII), while post-pandemic the economic pressures caused by unemployment (IV), disproportionately impacted the young population in the camps (I; IV). However, overcrowd-ing, limited access to safe space and the decision to close the protection services intensified the cases of gender-based violence presented in one study (III). This worsened mostly among young married women and children as all the household members spend most of their time at home.
Psychological issues are also mixed (being present pre- post- and have worsened). While three studies identified during COVID-19 fear of restrictions (VI, I), closure of schools (VI), and the difficulties adapting to the online teaching methods (I) as post- pandemic challenges, three studies recognized that higher degrees of stress, hopeless, sleeplessness (II; VII), moderate-to-severe depression (III), or substance use due to greater level of anxiety (VII) were made more se-vere, therefore exacerbating in the context of pandemic.
20 Discrimination was reported in two publications. Disease transmission, as well as the back-ground of each family (I), were highlighted in the findings as challenges in the access to labour market throughout the pandemic. However, the origin of this population along with the fear that they might spread the disease outside the camps while seeking for jobs, are experiences of perceived discrimination, stigmatization and xenophobia that had worsen due to the ongoing pandemic (VII).
7 Discussion
There have been (n=14) challenges identified in seven articles included in the present review. A total of seven new areas are emphasized in the aftermath of a pandemic, and five areas seem to experience a worsening situation. The studies with high quality (n=3) emphasized that the ability to access resources worsened the pre-existing health disparities within vulnerable population and provided a glimpse of the dire conditions under which they survive, leaving them more vulnerable under the COVID-19. Low quality studies (n=1) emphasized the regulations imposed as leading to an increase in child and gender-based violence. All findings from the seven included publica-tions are going in the same direction, underscoring the significantly heightened vulnerabilities faced by the population in focus in the context of the pandemic. The present scoping review aimed to investigate if the arisen challenges faced by vulnerable children and their families, have exacerbated in the context of COVID-19, in published research literature.
7.1 Reflections on the findings
Even though some of the studies present each challenge separately, the interconnection between them is crucial and can have a great impact on the child’s development. Data shows that many challenges have occurred among vulnerable children and their families since COVID-19 hit the world. Child labour, child marriage, access to education, food insecurity, freedom of movement or lack of information are just some out of all the new issues that have occurred. An interesting aspect is how the economic difficulties along with the freedom of movement- two new issues that arisen due to COVID-19, had a great impact on some other challenges. Food insecurity became a major problem both due to the inability to move outside the camp to purchase it, increased prices and incapacity to afford it caused by job losses and school closure, all increasing the stress level of the family. The findings are in line with Elsahoryi et al., (2020), which reports that the monthly income below the poverty line, together with the quarantine measures were significantly associated with food insecurity and high levels of stress. Before the pandemic, school represented an important source of food for the vulnerable ones. According to Drennen et al. (2019), food insecurity can be
21 devastating among children. It is associated with developmental risks, behavioral problems, hospi-talizations and poor overall health.
Access to education is interconnected with the economic challenges. Many children re-ported the financial insecurity as deprioritizing factor in the access to online resources. The rela-tionship between these two issues is consistent with You (2020), which stated that financial chal-lenges encountered by this population during the pandemic will increase the learning deprivation gap. Prior pandemic, access to school was the most valuable place to facilitate the development of the vulnerable children, by playing a vital part in their integration, not only for the education but also for their social and emotional development (Fazel & Stein, 2002). As the school have closed the focus from education has been shifted on economic situation of the family, child marriage and child labour have increased in this context and were considered to be ways of saving the family from poverty. The results are in agreement with UNICEF (2020), which reported that that loss of household income during the pandemic has increased the early marriage and the child labor. How-ever, child labour represents a risk in the social development of a child, as they cannot build positive relationships with the peers or spend time with the family members, which can lead to insecure adults at risk of developing such emotional issues (International Labour Rights, 2011). Girls that are getting married at a younger age are more liklely to suffer from depression as they are at higher risk of domestic violence and early pregnancies and it forces them out of education, which can lead to an intergenerational transmission of poverty (Oyortey et al. 2003; Person et al. 2015).
Regarding the exacerbation of the challenges, these are the psychological, overcrowding, discrimination and violence. According to the present results, the economic issues (the most com-mon exacerbated challenge due to COVID-19), are strongly related with the psychological issues faced by families and their children. Higher rates of unemployment lead to an increase level of anxiety and stress, in most of the cases due to the fear of not affording to pay the rent or feed the household members. The results are supported by Foad et al. (2021), and Brooks et al. (2020), which stated that economic deterioration and financial insecurity caused by COVID-19, played a fundamental role in increasing the experiences of distress already existed in these families prior the pandemic. Shonkoff et al. (2000, p. 280,) reported that financial hardship may compromise the relationship between the parent and the child by creating “tension and hostility as well as reducing warmth and supportiveness in the home”.
In addition, the overcrowding and violence issues were presented as being related in two included studies only, however the correlation between these two is critical. All the studies that
22 reported overcrowding as an exacerbated challenge in the context of the pandemic, referred to it as a result of high rates of unemployment job-losses or the imposed lockdown measures. According to the extant literature living in an overcrowded place can lead to less responsive parenting due to stress, and it indirectly impacts the child behavioural problems. (Caldwell and Bradley 1984; Evans et al. 2001).
7.2 The Bioecological and Diathesis-stress model
The present paper rooted its focus on how the changes in time and in the environment along with the exacerbation of the vulnerabilities, have incited stress at family – which might lead to long-term changes in the children’s social emotional functioning and development (Grantham-McGregor et al., 2007). Using the PPCT model (Bronfenbrenner & Morris, 2006), and the Diath-esis-stress theory (Ingram & Luxton, 2005), we can see the impacts on processes, such as the par-ent-child interaction, the niches available, as schools are closed, and children need to work or even marry. Mainly, it is pointed out how the processes and the environment are major sources of stress in times of crisis. Arguably, the scarcity of resources and isolation also reduced the focus on positive developmental and effective proximal processes (interaction between child and peers, teachers or protection services).
On the child level, COVID-19 has completely changed the context in which they live. The lockdown and movement restrictions were aversive and challenging, disrupting their routines and limiting the child- environment interaction. Children are missing out many opportunities to play, due to the confinement, therefore not getting the cognitive and social stimulation they usually got while interacting with the peers, which may lead to a delay in their social skills (Rafanelli, 2021). Cacioppo et al. (2006), examined that social isolation and decreased social networks are linked to the well-being of a children, and can lead to psychological challenges such as anxiety and depres-sion, issues raised by the participants from the included studies. The pandemic has reshaped the interactions between the individuals. While before COVID-19, children used to spend time with the peers or at school, these aspects lay now on parents as they have to play the role of a teacher or a peer, therefore remaining the only reference point. According to Browne (2020), children development in the context of the pandemic is influenced both by the proximal processes (rela-tionship with the family), and by distal factors (social disruptions caused by the pandemic). All the environmental stressors within the family affected the interpersonal relationships with the child, impacting the key component of the development – the proximal process. As the parents leave now in fear and stress due to the economic issues, the positive parenting behaviour decreased
23 (Morelli, 2020). Parent-child relationship is critical in the child’s development, and it can lead to lower social competence, behavioural problems or poor psychological health (Lewallen, 2015).
On the household level, given the economic hardship, parents were facing an increased in the daily stressors, representing a risk to their well-being (Schneider et al., 2015; Brooks-Gunn et al., 2013). In line with Brown (2020), with the tremendous challenges that families face during the COVID-19 pandemic, good family leadership—characterized by nurturing, support, and protec-tion—is critical. However, in times where the environment and time play a significant role in dis-tressing the family, this becomes tenuous. Under the viewpoint of the diathesis-stress model (In-gram & Luxton, 2005), when the environmental stressors get alongside with the vulnerability of the individual, the emotional resources are drained increasing the risk of mental health problems (Vetter et al., 2008). In time, all these stressors will be associated with poor parent-child relationship and poor child psychological adjustment (Patterson, 2016).
Financial hardship that lead to food insecurity served as a major stressor and had an impact on the quality of child-parent interaction, resulting in an increase in child labor, child marriage and even in violence. According to Conger & Elder (1994), parental distress (in this context anxiety and depression), arisen from financial stressors lead to negative behaviors, and can have a detri-mental impact on child development outcomes (Newland et al., 2013). Moreover, the financial stressors along with the lack of social support and access to different services due to the lockdown, have reshaped the family routines. As stated by Moura et al., (2020), decreasing the personal inter-action leads to the exacerbation of coexistence in the family microsystems and therefore change the influences of the mesosystem—the interrelationship between different microsystems. In this context, school closure along with family confined at home, has converted the household environ-ment into a work environenviron-ment. Children’s studies altered routines and tasks, which changed the configuration of proximal processes in this environment. On a positive note, vulnerable children from Kenya reported the caregiver’s support while learning at home, in particular reading with them, leading and guiding them through activities, therefore playing a key role in supporting their development in these times (Save The Children, 2020). In these circumstances, parents’ wellbeing can serve as a conduit for the social disruptions, and according to Conger et al. (1994), it can infiltrate the family functioning through changes in parent-child relationship.
The national policies and restrictions had a major effect on the community level. Access to essential services such as social protection, labour market, or information has been impacted by the movement restrictions and regulations. As vulnerable children and their families are unable to
24 fulfill legal requirements or access visa processes, many were left stranded in the host countries (Smith, 2020). Therefore, family reunification has been made impossible, food insecurity has highly increased, shelters have been overcrowded due to the inability to work, and the families got into a difficult situation, as they are unable to fulfill legal requirements or access visa processes. All these organizational challanges were a great factor in increasing the stress of the community and more-over, the fear of deportation (IOM, 2020). An interesting aspect was how the focus from the access to healthcare (an issue presented more before the pandemic that after), has been shifted to the need of accessing social services during the pandemic. This might have been due to the movement re-strictions that confined all family members at home, increasing the overcrowding which led to gender-based violence and child abuse. According to UNICEF (2021), lockdown measures height-ened the household tension and added many stressors on the women and children which would recognize signs of abuse, therefore being in need of protection from the social services. During crisis such as the ongoing pandemic, the limited contact with the support networks leave children much more vulnerable and their future will be undermined if they do not have equitable access to the support and services they need (UNICEF, 2021).
On a context level the time had a great impact on the society. National and local laws and regulations imposed such as lockdowns, border closure, physical distancing, limited mobility, and access to social networks have disrupted aspects of the life, vulnerable families usually rely on to overcome challenges (International Journal of Refugee Law, 2020). The regulations have signifi-cantly changed the physical interaction with other people, which can have repercussions on a prox-imal process since there is no more engagement between individuals. However, lockdowns are essential measures during outbreaks, yet they can have a substantial and far-reaching psychological impact on the population. Among vulnerable adults, the duration of the confinement played an important role in the feelings of stress, mood disorders or anxiety (Garcia & Flores, 2020), which in time may predispose the parents to a higher risk of negative responses or reactions, impacting directly the well-being of their children (Yakushko et al., 2008).
7.3 Methodological Issues and limitations
In order to minimize the bias of a review, scoping reviews are usually conducted by multiple researchers in a longer period of time (Jesson et al., 2017). Because the time limits, there was no opportunity for a second reviewer to assess the included articles. Therefore, the screening of all included articles was made by one reviewer only. According to Higgins & Green (2006), a second
25 reviewer can reduce the possible errors throughout the process of the review and more likely reli-able results are reported. Data analysis was performed also by one researcher which might have increased the risk of bias, as according to Boell & Cecez- Kecmanovic (2014), researcher’s pre-understanding of the explored area might influence the analysis of the findings.
The issue of time had an impact on the searching process. There are many articles based on this new topic that are being published daily, which made the database search ending, difficult. Since the searches have been ended, many new articles related to present study have been pub-lished.
Finally, since the research synthesis was not comprehensive enough due to the restricted time frame, it is likely that some research related to answering research questions might have been over-looked and not included in the present study. Another aspect was the inclusion criteria limited to the English language only, and not including the mother tongue of the researcher. Related research may have been published in other European languages as well, but it was not included in this study. It is a common approach to include refugees, asylum-seekers and vulnerable migrants under the umbrella term “vulnerable” as they share common social risk factors (e.g., Waite et al., 2014; Pacquiao, 2008). However, the term “vunerable” might be considered broad as it includes elderly people, homeless or medical patients as well (Aday, 1994). It is crucial to consider this aspect and the results of the present study should be interpreted with caution, as they only can be generalized for the included population only.
7.4 Practical Implication
Given the results in relation to previous research, it is very important to focus on vulnerable chil-dren and their families as COVID-19 has exacerbated the psychological, economic, overcrowding, violence, and discrimination issues – which is demonstrated by foregoing studies as having a great impact on children development. Future interventions should consider frameworks such as the Bioecological model (Bronfenbrenner & Morris, 2006), in order to assess and address the family and children’s needs on all levels, and safeguard their basic rights. Starting from a community level (macrolevel), programs should try to focus on providing access to multiple services, as according to the findings of this present paper, due to the pandemic access to protection services, legal ser-vices or sexual and reproductive health among young mothers was impossible because of the ina-bility to move. On a family level, interventions should try to strengthen the mental health and psychological well-being of the family. Parental stress should be considered as it has highly in-creased in the times of COVID-19, and it has been demonstrated that it can lead to lower social
26 competence, behavioral problems, or poor psychological health of the child (Lewallen, 2015). Nar-rowing the programs down to the individual level, strategies in combating and preventing child labor and child marriage through better access to education should be highly considered.
8 Conclusion and future research
This paper has highlighted the new challenges that occurred post-pandemic and how COVID-19 has exacerbated the pre-existing ones for vulnerable children and their families. As the findings are showing, COVID-19’s disease burden is higher in vulnerable contexts such as refugee, migrants or asylum-seekers, due to the living conditions, high risks jobs, and poor access to services. For this group, COVID-19’s impact manifested through economic hardship, that had a great impact on all the challenges, therefore increasing the overall stress of the population. The data underscored the food insecurity as a major area that has worsened due to the school closures and loss of jobs. Major overcrowdings due to the imposed lockdown alongside with economic situation of the family heightened the exposure to violence especially among women and children. Stress and anxiety about the future has highly intensified among parents, becoming a risk in the children develop-mental outcomes. School closures lead to child marriage and increased the child labour. Both early marriage as well as child labour were ways of saving the family from poverty. Yet, studies are showing that the boys involved in work might suffer from depression ( Aransiola & Justus, 2018) On the other hand, early marriage among girls forces them out of education, which can lead to an intergenerational transmission of poverty (Oyortey et al. 2003). The paper has also revealed that discrimination increased among vulnerable children and their families, as they were perceived of transmitting the disease. Although efforts to control the virus’s spread remain critical, the negative effects on vulnerables, must be addressed and identified in order to avoid the risk of more chal-lenges getting exacerbated, and mitigate the impact of the pandemic in order to reduce the parental stress and improve the well-being of the future generations.
Based on the results of this present study, there are several implications for future research. The paper suggests that there is a need of including vulnerable children and their families in inclu-sive policy responses in order to “build back better” (Banati et al., 2020). It is crucial to expand the research and evidences collected worldwide in order to understand how COVID-19 has worsened the living condition among vulnerables and prevent them for deteriorating and increase the pov-erty. The “negative cascade” that arisen from the alteration of social life caused by the pandemic, can be disrupted at multiple junctures through “research, policy, advocacy, and lobbying” (Browne, 2020). Future research could also focus on studying how governments and different organizations
27 can implement prevention strategies in combating discrimination, violence, and other challenges that have intensified. As all of the difficulties encountered by these families are directly impacting the children’s development and well-being, these problems should be given sufficient considera-tion. Although, there is an opportunity and a pressing need to create and adopt new services, and safety lines for children and families, the pandemic's repercussions continue and will be felt far into the future, continuing to increase the poverty (Oyortey et al. 2003). That is why the actions should be taken now, in order to protect the ones who are the most vulnerable in the context of a crisis (Cheng et al., 2020).
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