The effects of COVID-19 pandemic on early childhood care systems in Hawaii in 2020.

The COVID-19 pandemic caused many effects on the referrals to and the work of governmental agencies working with young children. This article describes the impact on the use of early childhood evaluations and services in the State of Hawaii. We looked at several nonpublic data sets from the Hawaii Department of Health and Department of Human Services, comparing the rates of early intervention referrals, lead level screening, childhood immunizations, and child welfare referrals in 2019 and 2020. We also describe effects on the work processes in various early childhood programs from the COVID-19 stay-at-home and work mandates. There was a decrease in rates of referrals to early intervention and child welfare services. There was less lead level screening being done, and childhood immunization rates dropped. Some of these issues stem from clinicians not seeing children whose families were worried about bringing their children for routine appointments. These clinicians do a lot of the developmental and lead screening, and much of the immunizations for children. Home visiting programs were interrupted as they could not do in-person screenings of families. Therefore, they could not easily identify families that benefit from the support of a trained home visitor. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) could not do anemia checks or measurements on children's growth. With ongoing COVID-19 issues in the State of Hawaii, remedies are required given ongoing effects on clinician offices practices and childhood program processes.