COVID-19 impacts on children under 5 in temporary accommodation-co-developing solutions from lockdown to the recovery phase-A mixed-methods study

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Coronavirus disease 2019 (COVID-19) has and will have huge direct health and economic implications as highlighted by the media, but there are and likely will be also a myriad of significant indirect health, social, and educational consequences for children and families. These impacts will likely be most keenly felt on the most vulnerable of CYP - such as those experiencing homelessness while living in temporary or insecure accommodation. Specifically, homeless children under age five (under5s) are not only at greater risk of exposure and transmission of COVID due to overcrowding in substandard housing, but also immediate and long-term impacts on growth, optimal health, and brain development. The COVID-19 pandemic could result in a number of further waves of increased infection incidence and last for 18 months or longer. The longevity and periodicity of the pandemic will therefore not have only short-term impacts but long-term for some children extending across most of their infant life with some children even being born into this pandemic. The Children's Commissioner suggested that there could be more than 210,000 homeless children in temporary accommodation or 'sofa surfing,' and approximately 585,000 who either are homeless or at risk of becoming homeless in England alone.The purpose of this study is to determine the barriers attributed to the COVID-19 pandemic and our associated health services and societal response, experienced by parents of under5s living in temporary accommodation nationally for themselves and their children. First, we will explore perceptions around access to health care services, such as seeking medical review in response to common childhood assessments (e.g. fever, diarrhoea, respiratory symptoms, accidents). Second, we will explore parent/carer perceived ability to support their child in achieving their optimal health outcomes (e.g. nutrition, vaccination uptake, overall wellbeing, growth, reaching full developmental milestones). We will also co-develop an information toolkit with the parents of this vulnerable population and front line (health and social care) workers to address their short-term and long-term needs once the lockdown period ends and there is an effort to return to "normalcy" while at the same time, there is a need to learn from these current experiences in preparation for a possible Winter resurgence of COVID-19, for any future epidemics or pandemics but also to rapidly address the health challenges that these children have encountered during this pandemic.