Environmental Scan of Public Health Directives During COVID-19: A View Through the Lens of Children With Complex Care Needs and Their Families

Background: The COVID-19 pandemic shaped childhood globally. The experiences of vulnerable children in Canada’s Maritime provinces reveal important lessons about equity, resilience, and the unintended consequences of public health directives. Public health restrictions were enacted in the early days of COVID-19. At-risk populations such as children with complex care needs (CCN) were among those most impacted by health system changes due to COVID-19. To better understand how COVID-19 public health measures impacted children with CCN who were highly susceptible to the virus and associated disruptions, we conducted an environmental scan to map changes in COVID-19 public health directives and services impacting children with CCN. Methods: We systematically retrieved government news releases communicating new or changing COVID-19 public health directives published March 1, 2020-March 31, 2022. All directives and service changes in the health and education sectors were included. Directives were divided into 13 categories co-developed with parent and decision-maker partners, and we identified whether directives included support measures relevant to children with CCN. Results: The environmental scan revealed that children with CCN were largely overlooked in COVID-19 directives across the Maritime provinces. We identified 699 public health directives and services changes. Fewer than 2.2% of COVID-19 directives explicitly referenced children with CCN, with most guidance focusing on general social restrictions, vaccinations, and education/daycare. Mental health and well-being were also rarely addressed (13 directives). Conclusion: The Maritimes’ predominately rural and geographically dispersed population exacerbates the inequities experienced by children with CCN, offering insights relevant to other regions about the unintended consequences of broad public health policies delivered to heterogeneous populations. Examining this data through the lens of children with CCN and their families can inform recommendations to better support this vulnerable population in future public health emergencies.