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Research Study Proposal

Molly E. Tuttle

The University of North Carolina at Pembroke

SWK 3910-800-S22: Understanding Social Research

Dr. Tamara Estes Savage

May 1, 2022
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Introduction

Mental health conditions and illnesses have always existed among humanity. For

centuries prior, mental illness was often associated as a side effect of physical illnesses such as

disease and infection common of the time or related to religion, or lack thereof (Clark et al.,

2017). Little regard has been given to the mental health and well-being of children in our society

because sadly it is often dismissed as “children being children” or even children being

“dramatic” or “attention-seeking” (Ross, 2018). With the rise of the internet, cyberbullies, and

youth suicide, the time is now to improve access to mental health services for children and

adolescents (Kwan et al., 2020). The focus of my study is aimed at identifying the effect that the

COVID-19 pandemic has had on increased anxiety and depression diagnoses in children in the

United States.

Background of the Social Problem and Client Population

On March 11, 2020, The World Health Organization formally declared COVID-19 a

pandemic (CDC, 2021). Just four days later, the United States began to shut down as a

preventative measure to prevent the spread of COVID-19, starting with the largest school system

in the United States, New York City public schools (CDC, 2021). It was at this point that all

sense of normality was gone for everyone. For children in foster care, COVID-19 lockdowns and

restrictions came with increased isolation, postponed therapy sessions, limited visitation with

biological parents (if any at all), delayed reunification, increased stress levels, and of course,

aging out did not stop (Goldberg et al., 2021). Unlike many of their peers who have “normal”

upbringings, foster children are in foster care for a variety of reasons including physical abuse,

sexual abuse, emotional abuse, and neglect which can come in forms such as starvation, filth,

and unsafe housing (Papovich, 2019).

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Obtaining specific data on mental health diagnoses in children in the United States is

impossible because of the number of children who remain undiagnosed or have not had their

diagnosis reported and added to statistical information. However, the CDC has a strong estimate

of the number of children in the United States that have confirmed mental disorders (CDC,

2022). Specifically focusing on anxiety and depression as they relate the closest to the COVID-

19 pandemic topic, the CDC reported for the years 2016-2019, an estimated six million children

had attention deficit hyperactivity disorder or ADHD, and an estimated 2.7 million children ages

3-17 had depression (CDC, 2022). Of the millions of children diagnosed with anxiety and/or

depression, up to 80 percent of children in foster care have mental health diagnoses compared to

20 percent of the general population (NCSL, 2019). According to the Child Welfare Information

Gateway (2021), there were “an estimated 423,997 children in foster care as of September 30,

2019” (p.4). Although commonly assumed that minority children make up the majority

percentage of foster care children, 44 percent of children in foster care in 2019 were White,

followed by 23 percent being Black or African American and 21 percent being Hispanic (Child

Welfare Information Gateway, 2021, p.9).

Fortunately for children and families, there is some financial relief for mental health

services. In 2021 as part of the American Rescue Plan, $9.2 million was allocated by the federal

government to tackle the mental health crisis in the United States (SAMHSA, 2022). On March

9, 2022, the United States Department of Health and Human Services (HHS) Substance Abuse

and Mental Health Services Administration (SAMHSA) announced an additional $35 million in

funding to expand community mental health services and strengthen suicide prevention programs

for American children and young adults (SAMHSA, 2022). The new funding goes to grant

programs to improve school-based mental health programs and services, mental health services
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for college students, tribal youth suicide prevention, support for families and caregivers who are

raising children with serious emotional disturbances, identify youth and young adults at risk for

psychosis, and identify wellness policies that improve black youth mental health and suicide

prevention (SAMHSA, 2022).

Literature Review

The purpose of this literature review is to research, review, and gain knowledge regarding

the topic of COVID-19 and the effects it has had on the mental health of children and children in

foster care. The two common themes that I found throughout my ten selected peer-reviewed

scholarly articles are changes in children's mental health due to the COVID-19 pandemic and

how COVID-19 has affected children in foster care.

COVID-19 Effects on Children’s Mental Health

The greatest impact on the mental health of children during the COVID-19 pandemic was

school closures because it was such a traumatic disruption to children’s everyday lives (Bartek et

al., 2021). Americans were initially told “two weeks to flatten the curve,” so children and

teachers had no idea they would need to prepare to say goodbye for much longer. Globally, 91

percent of the student population was affected negatively by the disruption of their day-to-day

lives by the removal of in-person educational learning (Bartek et al., 2021). As many learned that

COVID-19 was not going away in two weeks or even two months, everyone, including children

found ways to adapt their everyday life to the “new normal” such as virtual learning (Dvorsky et

al., 2021). However, virtual learning presented its own unique set of challenges that included

lack of access to quality internet service, access to computers to attend virtual school, lack of

assistance and supervision to complete schoolwork, and effectively learning the material being

presented because of the lack of hands-on experience (Bartek et al., 2021). Close to home in
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rural Appalachia, 87 percent of students did not receive the recommended amount of remote

learning (McFayden et al., 2021). While the educational results of the effects of the COVID-19

pandemic are still unfolding, it is likely that recovering from nearly two years of inadequate

learning or in some cases, a total absence of learning will prove to be far greater of a challenge to

overcome than the effects of COVID-19 on mental health (McFayden et al., 2021).

Beyond the educational aspect of school, as many as three million children receive

mental health services through school or a school-based program and they were greatly impacted

when those resources were no longer available (Bartek et al., 2021). Through many of the events

that took place during the strictest part of the COVID-19 pandemic such as stay-at-home orders,

mask mandates, and attendance restrictions on gatherings, came resiliency and adaptability

(Dvorsky et al., 2021). Additionally, with school closures came increased food insecurity for

many children in the United States (Spencer et al., 2021). Increased food insecurity combined

with increased financial difficulties for families due to the massive amount of job layoffs as a

direct result of stay-at-home orders, led to an increase in psychiatric problems such as

hyperactivity, aggression, anxiety, and higher rates of attempted suicide (Spencer et al., 2021).

On the contrary, some children reported positive feelings toward the pandemic restrictions

because it allowed for more time with their families (Spencer et al., 2021). To continue

combatting the effects COVID-19 has had on children, medical providers recommend holistic

care, psychosocial interventions such as counseling, maintaining a daily routine, healthy eating,

adequate, quality sleep, and validation of feelings (Bartek et al., 2021).

Prior to the start of COVID-19, the Centers for Disease Control and Prevention (CDC)

found that out of 1 in 5 children who had a mental disorder, only 20 percent received care from a

mental health provider (Abramson, 2022). From March to October 2020, mental health-related
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visits to the emergency room had increased by 24 percent for children ages 5 to 11 and 31

percent for children ages 12 to 17 compared to 2019 emergency room visit data (Abramson,

2022). After 29 studies were conducted among 80,879 youth globally, the data shows that after

one year of the COVID-19 pandemic, childhood depression was increased by 25.2 percent and

anxiety was increased by 20.5 percent (Racine et al., 2021). Compared to pre-pandemic

estimates, childhood anxiety and depression symptoms doubled during the COVID-19 pandemic

with increased symptoms being most prevalent in girls and older adolescents (Racine et al.,

2021). Additional effects of the COVID-19 pandemic on children include boredom, loneliness,

hopelessness, isolation, increased risk of cyberbullying and increased anxious and depressive

symptoms (Bartek et al., 2021).

COVID-19 and Foster Care

Although foster care is intended to be temporary, COVID-19 significantly impacted

reunification between children and their biological families due to restricted in-person visits

because of social distancing restrictions (Goldberg et al., 2021). Delayed visitation often meant

delayed reunification (Goldberg et al., 2021). Mentally, foster children fared worse because of

prolonged reunification combined with the initial trauma and stress associated with being

removed from their homes and being placed into foster care (Goldberg et al., 2021). Whereas

most children in the United States were able to shelter in place with their families, foster children

were left to rely on foster parents who were essentially strangers or group homes during the most

isolating, uncertain, and lonely times in their life (Ruff & Linville, 2021). Additionally, support

services and systems typically available to foster children were also impacted because of

COVID-19 restrictions (Goldberg et al., 2021). Additional factors that affected children in foster

care were caseworker turnover which led to increased instability and trust between children and
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the system and court closures (Goldberg et al., 2021). As everything seemed to be a domino

effect in the world of foster care, one thing led to another thing which led to another thing, and

with so many jobs forced to work from home, the court system was another factor that worked

against foster children (Whitt-Woosley et al., 2021). Court closures resulted in case backlogs and

delayed reunification and the recommendations for solutions included reviewing submissions

prior to rescheduled court dates to ensure the hearing is meaningful and productive, insinuating

that not all court hearings are productive in some way or another (Whitt-Woosley et al., 2021).

Research Question(s)/Hypothesis

The COVID-19 pandemic placed many barriers to the adequate access children so

desperately needed to combat their trauma. Web meetings like Zoom replaced in-person

meetings for health safety reasons but failed to take into consideration young children, special

needs children, and those with limited access to technology (Goldberg et al., 2021). My research

problem is trying to statistically figure out what increased percentage of mental health diagnoses

have occurred since COVID started, if any, specifically in foster children. My research questions

include, how does the mental health of children in foster care differ from pre covid to now

(2021)? and how does the mental health of children in foster care differ from pre covid to now

(2021) in rural settings? Scientifically, what is the increased percentage of mental health

diagnoses in 2021 compared to 2019? My hypothesis is children, specifically, foster children, are

more likely to have had increased mental health diagnoses in anxiety and depression due to

increased instability in life brought on by the global COVID-19 pandemic. My variables of

interest include resiliency, access to therapy and/or treatment, anxiety, depression, rural setting,

and foster care. My independent variable is COVID-19 and my dependent variable is increases in

anxiety and depression symptoms.

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Defining, Operationalizing Variables & Measurement of Variables

Resiliency is defined as “an ability to recover from or adjust easily to adversity or

change.” (Merriam-Webster, 2022). Access means “permission, liberty, or ability to enter,

approach, or pass to and from a place or to approach or communicate with a person or thing.”

(Merriam-Webster, 2022). A medical definition of anxiety states it is “an abnormal and

overwhelming sense of apprehension and fear often marked by physical signs such as increased

pulse rate and sweating, by doubt concerning the reality and nature of the threat, and by self-

doubt about one’s capacity to cope with it.” (Merriam-Webster, 2022). Depression is defined as

“a state of feeling sad.” (Merriam-Webster, 2022). The Health Resources and Services

Administration (2017) states that the United States Census Bureau does not define “rural” but

considers it to be an area not within an urban area and with less than 50,000 people (Health

Resources & Services Administration, 2017). A foster child is “a child raised by someone who is

not its natural or adoptive parent.” (Dictionary.com, 2022).

For my selected variables of access to therapy, rural setting, and foster care, the variables

will be measured nominally through a brief demographic questionnaire because they are simple

yes or no subjects that help categorize data results. For my variables of resiliency, anxiety, and

depression, the variables can be measured ordinally and I would use the Revised Children’s

Anxiety and Depression Scale (RSCADS). RCADS is a 47-item questionnaire available for

children ages 8 to 18 that measures symptoms of depression and anxiety and helps to screen for

disorders such as generalized anxiety disorder, obsessive-compulsive disorder, social phobia, and

major depressive disorder (NovoPsych, 2021).

Sampling
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For my proposed study, I have found that probability sampling is the best course of action

for gathering data because I need statistical information on a specific population; the specific

population being children in foster care. The subtype of probability sampling that I would use is

simple random sampling. For example, if I am trying to gather statistical information on children

ages 8-17 in a specific area, I’ll use Laurinburg for this example, and I use simple random

sampling, which means that all children in Laurinburg between ages 8 and 17 have an equal

chance of being selected. Of all available children between ages 8 and 17 in Laurinburg, I would

then randomly select 500 qualifying children to survey about anxiety and depression. The

probability that a selected child has anxiety and/or depression is 50/50, either they do, or they

don’t, but that is what probability sampling is about, random selection. The limitation of my

chosen sampling plan would be obtaining access to the information, specifically for foster

children, and finding willing participants. Since the population I would be testing are under 18

years of age, they are considered minors and I would need parental or guardian consent due to

HIPAA regulations. The Health Insurance Portability and Accountability Act of 1996, also

known as HIPPA, is a federal law that requires the protection of a patient’s health information

from being released without the patient’s permission (Centers for Disease Control and

Prevention, 2018).

To recruit participants for my study, I would contact all pediatric doctor offices within a

25-mile radius of Laurinburg, seeking permission to place a flyer requesting participants for a

confidential, educational research study regarding mental health. Since I work for Social

Services, I am aware that many families choose Purcell Clinic to take their children to in

Laurinburg and that would be my primary focus. After I contact all local doctor offices, I would

then contact therapists in Scotland County and present them with the same request as I did for
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the doctor’s offices. Despite Scotland County’s population size, I am confident that I could find

500 parents and children willing to participate in an educational research study. The only criteria

for the recruitment of participants are that they must be between the ages of 7 and 17. No other

criteria are required because of the simple random sampling method I would be using. The

ethical issues I may run into with this research study are informed consent and maintaining

confidentiality because of the use of children for the research and general concerns their parents

may have.

Research Design

The research design that will fit best for determining if the COVID-19 pandemic has

caused an increase in mental health diagnoses in children is the quantitative research design. This

research design will fit best because I am trying to obtain statistical information or data

collection. While there are three types of research designs that I could utilize, descriptive,

correlational, and explanatory, I would choose to use the explanatory research design. The

explanatory research design is used to explore events or topics that have not previously been

researched or are well explained (Team Leverage Edu, 2021). There is some research and

statistical information currently available about how the COVID-19 pandemic has affected

mental health in humans, but it is not a substantial amount. This is because the COVID-19

pandemic is still active, and it will take many more years to research and understand the true

effects the COVID-19 pandemic has had on humanity.

The research I am trying to gather is how the COVID-19 pandemic has affected mental

health in children so far. The reason I say so far is that there is a decent amount of information

available for 2020 and 2021 thanks to sources such as the internet, social media, and people

willing to speak out about their experiences. The advantage of the explanatory research design is
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that it essentially lays the groundwork for future research (Team Leverage Edu, 2021). The

disadvantage is that the results are often inconclusive because the research is conducted on new

topics that have little to no prior research (Team Leverage Edu, 2021). Since children are the sole

focus of the proposed research study, the threat to internal validity could be parents, friends, and

social media. Some adolescents may not answer questions or participate in studies related to

mental health truthfully for fear of being stigmatized and would rather keep quiet to fit in among

their peers rather than be a part of a statistic (Keller et al., 2019). In rare cases, some parents

fabricate false illnesses for their children to seek attention, also known as Munchausen by proxy,

which could be an additional threat to internal validity (Monroe, 2018).

The three general threats to external validity or people, place, and time (M.K, 2020). In

my proposed research study in the year 2022, the primary threat to external validity is time. Now

that children are safely able to attend school in person and be surrounded by their peers, their

anxiety and depression symptoms may have decreased or even disappeared. Social isolation is

what increases symptoms of anxiety and depression in children in the first place (Vestal, 2021).

Had this same proposed research study been conducted in the fall of 2020 or even the spring of

2021, the results may be much different than they are now. Additionally, because foster care is

meant to be temporary, people, place, and time are all valid threats to external validity.

Data Collection

The data collection method that I would utilize for my proposed research study is a

survey, specifically the Revised Child Anxiety and Depression Scale – Child, also known as

RCADS-Child. RCADS-Child is a 47-item questionnaire that asks children about their thoughts

and feelings and uses a scale of 0-3 for answers (NovoPsych, 2021). 0 = never, 1 = sometimes, 2

= often, and 3 = always (NovoPsych, 2021). The RSCADS-Child questionnaire screens for high
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prevalence disorders such as social phobia, generalized anxiety disorder, and major depressive

disorder (NovoPsych, 2021). The information I want to obtain overall is to find how many new

anxiety and depression diagnoses have occurred since the COVID-19 restrictions began in the

United States in March of 2020. Because I do not have the proper tools or resources to obtain

this information on a national level, I would need to do it on a local level. I would work with

local pediatric doctor offices specifically but, would not exclude the opportunity to utilize local

therapists the hospital, and social services to try to gather statistics on mental health diagnoses in

children before the COVID-19 pandemic began; so, I can compare data for 2020 and 2021.

Using the RCADS-Child questionnaire is important for research because many healthcare

providers may not use it, so it will supply new additional information not only for myself but

also to increase knowledge for healthcare providers. The questionnaire would be presented with

a cover sheet which would allow the participant, or their parent/guardian if the adult had to

record the answers for the participant, to indicate their age only. There would be additional

options for first name, sex, and race to be identified if the participant chose to disclose that

information. I would also include a few questions not related to the RCADS-Child questionnaire

to aid with the results and potentially help healthcare providers should they request the results

from my research. My questions can be answered with a “yes” or a “no” and are listed in order.

After the COVID-19 lockdown restrictions began, did you feel or notice a change in your

behavior or mood such as increased sadness, loneliness, increased anxiousness, or increased

tiredness? Did you experience any of these symptoms before? Did you have a formal diagnosis

of anxiety or depression before COVID-19 began? Would you agree that COVID-19 restrictions

had a negative effect on your mental health? Have you noticed any changes or improvements in
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yourself with COVID-19 restrictions lifting and your ability to attend school in person and see

your friends and peers?

Ethical considerations that should be considered when collecting data include avoiding

causing emotional harm, remaining neutral and unbiased, avoiding convenience sampling, being

respectful of time, always seeking permission, obtaining informed consent, and protecting data

results (North Jersey Health Collaborative, 2014). When collecting data, it is important to protect

confidential information, even if the information does not have names to identify the subjects.

Therefore, any information that I would obtain and have in my possession would be placed in a

container that can have a lock or password on it.

Conclusion

To conclude, the importance of researching the effects of COVID-19 so far on mental

health diagnoses, specifically anxiety and depression, is to keep the momentum going regarding

research on these topics. There is still little information available because understanding the

effects is still new and ongoing. While I was able to identify through research some statistical

information already available about increased anxiety and depression diagnoses in children, I

feel that I laid the groundwork for additional, ongoing research, specifically for my local

community using the RCADS-Child questionnaire. This type of research is crucial to the social

work community for two reasons. One reason is so that new social workers know what to expect

when entering the field and working with children, specifically children in foster care. The

second reason is to help advocate for funding for mental health resources for children as they

continue to recover from the changes brought on by the COVID-19 pandemic and restrictions.

Finally, as does all research, the effects of COVID-19 will lay groundwork for future pandemics

and conceivably better prepare everyone for what to expect and how to react.
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References

Abramson, A. (2022, January 1). Children’s Mental Health is in Crisis. Apa.org.

https://www.apa.org/monitor/2022/01/special-childrens-mental-health

Bartek, N., Peck, J. L., Garzon, D., & VanCleve, S. (2021). Addressing the Clinical Impact of

COVID-19 on Pediatric Mental Health. Journal of Pediatric Health Care, 35(4), 377–

386. https://doi.org/10.1016/j.pedhc.2021.03.006

CDC. (2021, August 4). CDC Museum COVID-19 Timeline. Centers for Disease Control and

Prevention; CDC. https://www.cdc.gov/museum/timeline/covid19.html

CDC. (2022, March 4). Data and Statistics on Children’s Mental Health. Centers for Disease

Control and Prevention; CDC. https://www.cdc.gov/childrensmentalhealth/data.html

Centers for Disease Control and Prevention. (2018, September 14). Health insurance portability

and accountability act of 1996 (HIPAA). Centers for Disease Control and Prevention.

https://www.cdc.gov/phlp/publications/topic/hipaa.html

Child Welfare Information Gateway. (2021). Foster Care Statistics - Child Welfare Information

Gateway. Www.childwelfare.gov. https://www.childwelfare.gov/topics/systemwide/

statistics/foster-care/

Clark, L. A., Cuthbert, B., Lewis-Fernández, R., Narrow, W. E., & Reed, G. M. (2017). Three

Approaches to Understanding and Classifying Mental Disorder: ICD-11, DSM-5, and the

National Institute of Mental Health’s Research Domain Criteria (RDoC). Psychological

Science in the Public Interest, 18(2), 72–145. https://doi.org/10.1177/1529100617727266

‌Dictionary.com. (2022). Definition of foster child | Dictionary.com. Www.dictionary.com.

https://www.dictionary.com/browse/foster-child
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Dvorsky, M. R., Breaux, R., Cusick, C. N., Fredrick, J. W., Green, C., Steinberg, A., Langberg,

J. M., Sciberras, E., & Becker, S. P. (2021). Coping with COVID-19: Longitudinal

Impact of the Pandemic on Adjustment and Links with Coping for Adolescents with and

without ADHD. Research on Child and Adolescent Psychopathology, 50, 605–619.

https://doi.org/10.1007/s10802-021-00857-2

Font, S. (2020, July 29). The Impact of the COVID-19 Pandemic on Children in Foster Care |

SSRI COVID-19 Resources. Covid19.Ssri.psu.edu.

https://covid19.ssri.psu.edu/articles/impact-covid-19-pandemic-children-foster-care

Goldberg, A. E., Brodzinsky, D., Singer, J., & Crozier, P. (2021). The impact of COVID-19 on

child welfare-involved families: Implications for parent-child reunification and child

welfare professionals. Developmental Child Welfare, 251610322110452.

https://doi.org/10.1177/25161032211045257

Health Resources & Services Administration. (2017, April 28). Defining Rural Population |

Official website of the U.S. Health Resources & Services Administration. Hrsa.gov.

https://www.hrsa.gov/rural-health/about-us/definition/index.html

Keller, S., McNeill, V., Honea, J., & Paulson Miller, L. (2019). A Look at Culture and Stigma of

Suicide: Textual Analysis of Community Theatre Performances. International Journal of

Environmental Research and Public Health, 16(3), 352.

https://doi.org/10.3390/ijerph16030352

Kwan, I., Dickson, K., Richardson, M., MacDowall, W., Burchett, H., Stansfield, C., Brunton,

G., Sutcliffe, K., & Thomas, J. (2020). Cyberbullying and Children and Young People’s

Mental Health: A Systematic Map of Systematic Reviews. Cyberpsychology, Behavior,

and Social Networking, 23(2), 72–82. https://doi.org/10.1089/cyber.2019.0370

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Merriam-Webster. (2022). Merriam-Webster Dictionary. Merriam-Webster.com.

https://www.merriam-webster.com/

M.K, W. (2020, March 10). The Research Methods Knowledge Base. Conjointly.com;

Conjoint.ly. https://conjointly.com/kb/external-validity/

McFayden, T. C., Breaux, R., Bertollo, J. R., Cummings, K., & Ollendick, T. H. (2021).

COVID-19 remote learning experiences of youth with neurodevelopmental disorders in

rural Appalachia. Journal of Rural Mental Health, 45(2), 72–85.

https://doi.org/10.1037/rmh0000171

Monroe, J. (2018, July 23). The Facts About Munchausen by Proxy... Newport Academy;

Newport Academy.

https://www.newportacademy.com/resources/mental-health/munchausen-by-proxy-

syndrome/

NCSL. (2019, November 1). Mental Health and Foster Care. Ncsl.org.

https://www.ncsl.org/research/human-services/mental-health-and-foster-care.aspx

North Jersey Health Collaborative. (2014). Ethical Considerations in Data Collection.

https://www.njhealthmatters.org/content/sites/njhc/Ethical_Considerations_in_Data_Coll

ection.pdf

NovoPsych. (2021, March 1). Revised Child Anxiety and Depression Scale – Child (RCADS-

Child). NovoPsych. https://novopsych.com.au/assessments/child/revised-child-anxiety-

and-depression-scale-child-rcads-child/

Papovich, C. (2019, July 10). Trauma & Children in Foster Care: A Comprehensive Overview.

Concordia St. Paul. https://www.csp.edu/publication/trauma-children-in-foster-care-a-

comprehensive-overview/
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Racine, N., McArthur, B. A., Cooke, J. E., Eirich, R., Zhu, J., & Madigan, S. (2021). Global

prevalence of depressive and anxiety symptoms in children and adolescents during

COVID-19. JAMA Pediatrics, 175(11), 1142–1150.

https://doi.org/10.1001/jamapediatrics.2021.2482

Ross, S. L. (2018, December 6). Please, Don’t React; Respond | NAMI: National Alliance on

Mental Illness. Www.nami.org. https://www.nami.org/Blogs/NAMI-Blog/December-

2018/Please-Don-t-React-Respond

Ruff, S. C., & Linville, D. (2021). Experiences of young adults with a history of foster care

during COVID-19. Children and Youth Services Review, 121, 105836.

https://doi.org/10.1016/j.childyouth.2020.105836

SAMHSA. (2022, March 9). HHS Announces Nearly $35 Million To Strengthen Mental Health

Support for Children and Young Adults. Www.samhsa.gov.

https://www.samhsa.gov/newsroom/press-announcements/20220309/hhs-announces-35-

million-strengthen-mental-health

Spencer, A. E., Oblath, R., Dayal, R., Loubeau, J. K., Lejeune, J., Sikov, J.,

Savage, M., Posse, C., Jain, S., Zolli, N., Baul, T. D., Ladino, V., Ji, C., Kabrt, J.,

Mousad, L., Rabin, M., Murphy, J. M., & Garg, A. (2021). Changes in psychosocial

functioning among urban, school-age children during the COVID-19 pandemic. Child

and Adolescent Psychiatry and Mental Health, 15(1). https://doi.org/10.1186/s13034-

021-00419-w

Sokoloff, W. C., Krief, W. I., Giusto, K. A., Mohaimin, T., Murphy-Hockett, C., Rocker, J., &

Williamson, K. A. (2021). Pediatric emergency department utilization during the

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COVID-19 pandemic in New York City. The American Journal of Emergency Medicine,

45, 100–104. https://doi.org/10.1016/j.ajem.2021.02.029

Team Leverage Edu. (2021, November 17). Research Design. Leverage Edu.

https://leverageedu.com/blog/research-design/

Whitt-Woosley, A., Sprang, G., & Eslinger, J. (2021). Foster care during the COVID-19

pandemic: A qualitative analysis of caregiver and professional experiences. Child Abuse

& Neglect, 124. https://doi.org/10.1016/j.chiabu.2021.105444