University of Southern California Dissertations and Theses

Mixed-method analysis for school-aged children with access and functional needs during the Covid-19 pandemic

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Mixed-method analysis for school-aged children with access and functional needs during the Covid-19 pandemic

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Content Copyright 2023 Lily Shkhyan

Mixed-Method Analysis for School-aged Children
with Access and Functional Needs during the Covid-19 Pandemic

by

Lily Shkhyan

A Thesis Presented to the
FACULTY OF THE USC KECK SCHOOL OF MEDICINE OF THE
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF SCIENCE
(APPLIED BIOSTATISTICS AND EPIDEMIOLOGY)

May 2023

ii

I dedicate this thesis to my Dad and Mom,
for always believing in me.

iii

Acknowledgments
The author acknowledges the partial financial support of the Keck
School of Medicine of USC and the Los Angeles County Department of
Public Health.
I would like to thank Dr. Rita Burke for helping me navigate my
research possibilities and giving me a position on her team to gain
firsthand experience in the research world.
I would like to thank my committee members, Dr. Myles Cockburn and
Dr. Diego Lopez, for supporting my ideas.
I would like to thank all my friends for understanding the thesis writing
process and being patient with me.
Finally, I would like to thank my family since I could not get here
without them.
iv

Table of Contents

Dedication………………………………………………………………………………………..ii
Acknowledgments……………………………………………………………………………….iii
List of Tables……………………………………………………………………………………..v
Abstract…………………………………………………………………………………...…….vii
Chapter 1: Introduction…………………………………………………………………………1
Chapter 2: Methods……………………………………………………………………………...5
Chapter 3: Results………………………………………………………………………………14
Chapter 4: Discussion…………………………………………………………………………..21
Chapter 5: Conclusion………………………………………………………………………….25
References……………………………………………………………………………………….27
Appendices………………………………………………………………………………………30
A A Survey………………………………………………………………..………. 30
A.1 Educators Survey...……………………………………………..………. 30
A.2 Caregivers Survey……………………………………………..……..…. 33

v

List of Tables

1 Themes and selected corresponding quotes from focus group participants…………………….7

2 Educator survey demographic responses………………………………………………..……..14

3 Caregiver survey demographic responses…………………………………...…………..……..15

4 Educators and caregivers Likelihood Ratio Chi-Square Results……………….……………...17

vi
Abstract

This study is a mixed-method analysis discussing the importance of disaster preparedness
for children with access and functional needs (CAFN). Children with such needs may be more
vulnerable to the effects of natural disasters and other emergencies, making it crucial for parents
and caregivers of these children to have a disaster plan in place. It is also critical for children
with access and functional needs to be included in disaster preparedness planning and practicing
these plans as they may require specialized care and assistance in an emergency. The primary
hypothesis being tested is that the association between preparedness for the COVID-19 pandemic
for children with access and functional needs is inadequate among caregivers and educators,
causing delays in social-emotional development for children with access and functional needs.
The secondary hypothesis being tested is that the association between preparedness for the
COVID-19 pandemic for children with access and functional needs is inadequate among
caregivers and educators, causing delays in academic development for children with access and
functional needs. Four caregivers and seventeen educators of children with access and functional
needs were recruited through flyers and sign-up sheets distributed in school districts within the
Greater Los Angeles Area, and focus groups were used to gather quantitative and qualitative
data. Statistical and content analysis were used to identify trends and patterns in the data. We
observed a statistically significant association between inadequate preparedness for the COVID-
19 pandemic among caregivers and educators and delays in social-emotional and academic
development for children with access and functional needs. While the study focused on disaster
preparedness during the COVID-19 pandemic, results may be generalizable to other types of
disasters or emergencies.
1
Chapter 1

Introduction

Disaster preparedness is creating plans and taking action to prepare for potential
emergencies and disasters. Disaster preparedness for children with access and functional needs
(CAFN) is an important issue, as these children may be more vulnerable to the effects of natural
disasters and other emergencies. The World Health Organization estimates that between 93
million and 150 million children under the age of 14 years worldwide have a disability, which
includes long-term physical, mental, intellectual, or sensory impairments that may interact with
various barriers and hinder their full and effective participation in society on an equal basis with
others. Examples of children with access and functional needs include those with physical
disabilities, developmental delays, or chronic medical conditions. Preparing for disasters in
advance can be a matter of life or death for some children with access and functional needs, as it
can help ensure that they are safe and secure during and after an emergency. One of the critical
components of disaster preparedness for CAFN is for parents and caregivers of CAFN to have a
disaster plan in place. This plan should include detailed information about contacting family
members, caregivers, or medical providers in the event of an emergency, and the child's needs,
such as medical information, communication needs, and special equipment requirements.
The child and their family must practice the emergency plan regularly to ensure everyone
knows what to do in an emergency. It is crucial for CAFNs to be included in disaster
preparedness planning and practicing these plans because they may require specialized care and
assistance in an emergency. For example, a child who uses a wheelchair may need to evacuate a
building differently than a child who does not use a wheelchair. In addition, CAFN may require
2
specialized equipment or medication during a disaster, which must be considered during
planning.
Another crucial element of disaster preparedness for CAFN involves ensuring that
emergency personnel and other first responders possess the knowledge and training to cater to
CAFN's unique requirements. This may involve supplying specialized equipment or
communication tools and preparing for engagement with and support of CAFN individuals. It is
also vital to establish backup plans for potential electricity shortages, transportation disturbances,
and other emergencies that could affect CAFN communities. By implementing these measures
and addressing the distinct needs of CAFN, societies can enhance their comprehensive disaster
preparedness and reaction strategies.
The preparedness of families with CAFN during disasters is an important topic. These
individuals are more vulnerable and have additional requirements that might not be addressed
during an emergency. In recent years, there has been a surge in studies concentrating on disaster
preparedness among CAFNs; earlier research emphasizes the necessity for families to establish a
communication strategy (Chin et al., 2020; Dosa et al., 2012; Lee et al., 2014). Nonetheless,
there is a gap in the literature concerning the consequences of preparedness amidst the COVID-
19 pandemic. Although some research has investigated family experiences with CAFN during
the pandemic (Kang et al., 2021), only a few have specifically examined the role in lessening the
pandemic's impact on CAFN. This is crucial because the COVID-19 pandemic has introduced
unique challenges for individuals with AFN, such as interruptions in medical services and
heightened social isolation (Kang et al., 2021). Examining CAFN disaster readiness is essential
to guarantee that these individuals can remain secure and healthy during and following
emergencies. By comprehending the difficulties that families with CAFN encounter and
3
pinpointing practical approaches for disaster preparedness, we can work towards alleviating the
adverse effects of emergencies and fostering the well-being of these individuals.
It is crucial to prioritize disaster preparedness for CAFN, as they typically face higher
vulnerability and might have distinct requirements to be considered in emergencies. By
incorporating CAFN into the planning stages and ensuring their specific needs are
acknowledged, families and communities can contribute to the safety and well-being of these
children during emergencies. Furthermore, it is vital to recognize that the COVID-19 pandemic
has introduced unprecedented challenges concerning disaster preparedness for CAFN. For
instance, numerous families have had to modify their emergency strategies to accommodate the
pandemic's consequences, such as interruptions in medical services and heightened social
isolation (Kang et al., 2021). The pandemic has also emphasized the significance of
communication and information dissemination during disasters, as families might need to stay
updated on changes in healthcare availability and other critical services (Chin et al., 2020). To
guarantee preparedness throughout the pandemic, it is essential to evaluate and rehearse
emergency procedures with all participants, including CAFN. Doing so can help ensure everyone
understands what is anticipated and how to respond in a crisis, decreasing anxiety and stress
while improving outcomes for everyone involved. Additionally, by examining and rehearsing
plans, families can pinpoint any shortcomings or obstacles that must be addressed to ensure
CAFNs remain secure and properly cared for during the pandemic. The primary hypothesis being
tested is: Association between preparedness for the COVID-19 pandemic for children with
access and functional needs is inadequate among caregivers and educators, causing delays in
social-emotional development for children with access and functional needs. The secondary
hypothesis being tested is: Association between preparedness for the COVID-19 pandemic for
4
children with access and functional needs is inadequate among caregivers and educators, causing
delays in academic development for children with access and functional needs.

5
Chapter 2
Methods
A mixed-methods approach was used in this study involving caregivers and educators of
CAFN. Participants were recruited through flyers and sign-up sheets distributed in school
districts in the Greater Los Angeles area.
Questionnaires were distributed to participants to gather quantitative data. The
questionnaires included demographic information and questions related to the participant's
experiences, mental and emotional well-being, and expectations for the future. The
questionnaires used in this study were designed to assess the participants' perceived stress levels
and pandemic-related mental health concerns. The Perceived Stress Scale (PSS) was used to
evaluate the degree to which participants felt that their life circumstances were overwhelming
and unmanageable (Cohen et al., 1983). This widely-used instrument has been validated in
numerous studies and has demonstrated good reliability and validity in various populations
(Cohen & Williamson, 1988; Lee, 2012). Various Pandemic mental health Questionnaires
(COPAQ) were used to gather data on anxiety, depression, and overall mental well-being during
the COVID-19 pandemic. The COPAQ has been validated in previous studies and has
demonstrated good reliability and validity for assessing mental health during pandemics and
other crises (Wang et al., 2020; Xiong et al., 2020). These questionnaires were carefully
developed to ensure that they were clear, concise, and targeted specific areas of interest, making
them effective practical tools to use in focus group settings.
Participants were asked to complete questionnaires before each focus group. Focus
groups were conducted to gather qualitative data. The focus groups were held in schools within
each school district. A focus group guide was used to guide the discussion to ensure consistency
6
and structure in data collection. Focus groups were conducted in-person and virtually and lasted
approximately an hour, during which participants were asked open-ended questions about their
experiences with disaster preparedness. Prior to data collection, Institutional Review Board
(IRB) approval was obtained to ensure the ethical treatment of research participants. Participants
were given the opportunity to express their feelings about the preparedness among themselves,
the school, and the district, and their responses were recorded for further analysis.
Teachers/educators were allowed to discuss the academic standing of their students with AFN
and their requirements in future disasters to be more prepared.
Data collected from the questionnaires were analyzed using statistical analysis (SAS) to
identify trends in participants' responses. Data were collected from the focus groups by
anonymous audio recording during each focus group session. The audio recordings were
converted into transcription files. The files were analyzed using a content analysis approach
(ATLAS.ti) to identify patterns and themes. The data were coded into thirty-five code categories
and analyzed to determine overarching themes, key findings, and conclusions.
For the primary hypothesis, the independent variable is the level of preparedness for the
COVID-19 pandemic for children with access and functional needs among caregivers and
educators. The dependent variable is the social-emotional development of children with access
and functional needs. For the secondary hypothesis, the independent variable is the level of
preparedness for the COVID-19 pandemic for children with access and functional needs among
caregivers and educators. The dependent variable is the academic development of children with
access and functional needs.
For the educators, the primary independent variable was measured by taking various
questions from the survey to create an average of each response per answer and analyzing
7
themes from the transcription files (Table 1) to find how prepared participants felt. The primary
dependent variable was measured by analyzing themes from the transcription files and the
average answers to the specific survey question, "Are you concerned about your student's social-
emotional well-being?" The secondary independent variable was measured by taking various
questions from the survey to create an average of each response per answer and analyzing
themes from the transcription files (Table 1) to find how prepared participants felt. The
secondary dependent variable was measured by analyzing themes from the transcription files and
the average answers to the specific survey question, "Are you concerned about your student’s
academic state?"
For the caregivers, the primary independent variable was measured by taking various
questions from the survey to create an average of each response per answer and analyzing
themes from the transcription files (Table 1) to find how prepared participants felt. The primary
dependent variable was measured by analyzing themes from the transcription files and the
average answers based on the two specific survey questions: “During the Covid-19 pandemic, I
noticed my CHILD: Progress in social development” and “During the Covid-19 pandemic I
noticed my CHILD: Progress in emotional development.” The secondary independent variable
was measured by taking various questions from the survey to create an average of each response
per answer and analyzing themes from the transcription files (Table 1) to find how prepared
participants felt. The secondary dependent variable was measured by analyzing themes from the
transcription files and the average answers to the specific survey question, " During the Covid-19
pandemic, I noticed my CHILD: Progress in academic development."

Table 1. Themes and corresponding quotes
Theme Subtheme Number Quotes
8
Academic
Standing
Recovery after Online
Learning
1
It's going to take a little
bit more work to get
[the students] to be
where they need to be.
2
…kids are having
struggles and they will
continue to have
struggles…
3
There’s a gap for so
many students…
Academic Decline
4
We've got more kids in
intervention than we
have had before.
5
[Student] is now two
years behind in math -
two years.
6
They couldn't sit, they
couldn't grab a pencil.
They didn't know what
to do with the paper.
7
…there's a lot of
regression. I teach math
and chemistry, and my
math students for
algebra one, just the
basics, I just felt like I
had to start from the
beginning.
8
I saw the regression that
my students had, so I
was like I need
something that's more
basic for them.
Academic Resources
9
We only get one
instructional aid. And,
sometimes if they don't
show up, we don't get
subs for them.
10
once the District offered
the hotspot stuff, that
was a lot better. That's
what they relied on.
11
I feel like I could use
that extra adult, because
I have some students
that require, like
9
consume a full adult.
So, there's a lot of
instructional time lost,
because I have to deal
with it.
Preparedness
Educators Preparedness
12
…but that was stuff that
we lost because we
weren't really prepared.
13
Still that was
exhausting, exhausting.
It wasn't two years at
home. It was two years
of learning, completely
new skills, being able to
do something
completely different,
dealing with everything,
dealing with families.
14
Set it up and it was all
neat, and teachers was
like we're just
struggling.
15
A lot of us ended up
using our own laptop,
because it was just more
so robust, or getting
extra screens, so you
can be doing multiple
things at the same time.
A lot of us actually had
to do that. The ones that
don't have that ability,
or even tech savvy, may
do with whatever they
are able to, and that's
why I'm quite sure the
quality of instruction
varies from person to
person and depending
on how tech savvy you
are, what kind of
equipment you have, so
it wasn't straight across
the board.
Caregiver Preparedness
16
...for us parents...no one
knew this was coming.
10
17
But there was no
training for her to know
how to navigate through
Canvas.
18
It was like pretty much
we know now how to
prepare for an
earthquake. We know.
We know that hands
down. No one knew
how to prepare for this.
So then that's where the
struggle came in.
Educator/Caregiver
Relationships
Relationship with District
19
You got to help
ourselves, because the
District ... For me, the
District is a million
miles away, because
they just don't care in
my opinion. They really
don't.
20
I think the
implementation, yeah,
everything looks great
on paper, but when it
came to implementation
and the logistic of it all,
it just wasn't carried out
as what we thought it
should be, and it was so
disappointing, nerve
wrecking, and it felt like
our concerns were not
generally being heard.
21
So I just think that if we
could have consistency
and I know that, that's
hard as things change
all the time, but just
continuing to try to keep
it consistent as possible
for us would be great.
Relationship with
Caregivers
22
I feel like people don't
trust education even
more than they didn't
11
trust it before, now they
really don't trust it,
23
…the parents are angry,
especially from what I
hear.
24
Constant change -
unhappy parents
because students had
difficulties with
transitioning from one
structure to another
Relationship with Teachers
25
Now there are teachers
who refuse to work with
you, who are just like...
I had one teacher who's
like, "I don't deal with
those type of kid, those
type of people."
26
I'm reaching out to the
teachers. I'm emailing.
No one is saying
anything back to me.
27
The teacher doesn't
even follow any of the
things, any of the
accommodations, any of
the modifications, any
of the hours of goals
that you put in.
Social/Emotional
Standing
Anxiety
28
I notice a lot of kids are
getting anxiety, anxiety
now that we're back to
class.
29
...but socially, [the
student] just couldn't get
on. And she was so
nervous about getting
on and being with
people and I don't know
them.
30
Yes, some kids are
having struggles and
they will continue to
have struggles…
12
Behaviors
31
It's like because we
were stuck in places for
so long without that
exposure to the outside
world that it's like we
forgot how to act
around people,
especially students
forgot.
32
they had lost their
minds and didn't know
that they were supposed
to be being appropriate
at school.
33
I think for everybody,
and then to come back
and then to have so
much emotional stress is
hard.
34
And then having kids
come back that hadn't
been in places. Kids that
had anxiety have had
more anxiety. Kids that
had behaviors had more
behaviors, kids that
were low were lower.
Social Skills
35
...when you're talking
about social cues, those
were some of the issues
that we had.
36
I think there're more
behaviors. They can't
get along, with each
other as the main thing.
37
…and the social
emotional too. I see a
lot of them do have their
friendships, that I see,
that are growing, but
some of them are a lot
more reserved

Table 1. Themes and selected corresponding quotes from focus group participants.

13
The data met the assumptions of normality and equal variances; therefore, to test the
hypothesis the primary and secondary hypotheses, a statistical test that compares means between
two or more groups was used. The statistical analysis used for hypothesis testing was a
Likelihood Ratio Chi-Square test because the independent and dependent variables were
categorical, and the sample size was small.

14
Chapter 3
Results
The educator survey found that all 17 participants were female (Table 2). The
participants' average was found to be 43 years old ± 12 years (Table 2). Lastly, seven
participants identified as white, another seven participants identified and Hispanic/Latino, one
participant identified as Asian and Asian Pacific Islander, one participant identified as Asian, and
one participant identified as American Indian (Table 2).
Table 2. Educators Demographics
Average Age (years) 43 (SD 12)
Gender 17 Female

N Percent
Ethnicity Hispanic/Latino 7 41.18
White 7 41.18
Black 0 0
Asian 1 5.88
Asian Pacific Islander 0 0
American Indian 1 5.88
Other 0 0
More than one 1 5.88

Table 2. Educator survey response for age, gender, household size demographic.

The caregiver survey found that all four participants were female (Table 3). The
participants' average was found to be 43 years old ± 5 years (Table 3). One participant was a
college graduate, while the other three participants had some college education (Table 3). One
participant identified as Black and Hispanic/Latino, two identified as Hispanic/Latino, and one
identified as Black (Table 3). Regarding household income, one caregiver reported a lower
income bracket of less than $14,100; two reported a middle-income bracket of $14,101-$53,700,
and one reported a higher income bracket of $85,501-$163,300 (Table 3). Lastly, one of the
15
participants reported living in an apartment with a five-person household count; three
participants reported living in a house with household counts of three, four, and five, respectively
(Table 3).
Table 3. Caregivers Demographics
Average Age (years) 43 (SD 5)
Gender 4 Female
Average # Household Members 4.24 (SD 1)
N Percent
Ethnicity
Hispanic/Latino 2 50
White 0 0
Black 1 25
Asian 0 0
Asian Pacific Islander 0 0
American Indian 0 0
Other 0 0
More than one 1 25
Income
<$14,100 1 25
$14,101-$53,700 2 50
$53,701-$85,500 0 0
$85,501-$163,300 1 25
Residence
House 3 75
Apartment 1 25
Other 0 0
Education
Less than high school 0 0
High school graduate 0 0
Some college 3 75
College graduate 1 25
Post-graduate 0 0
Diagnosis
Takes daily medications (insulin,
prescription pills, etc.) 1 25
Requires “as needed”
medications(asthma inhalers,
nebulizers, etc.) 0 0
Uses a home ventilator 0 0
Uses a wheelchair 0 0
16
Uses a gastrostomy tube (G-tube) for
feedings 0 0
Multiple responses represent my
child's medical needs 0 0
None of the above 3 75

Table 3. Caregiver survey response for age, gender, household size, ethnicity, household
income, residence type, education level, and diagnosis demographic

Since the sample-size assumption of the Pearson Chi-square test has been violated, the
Likelihood Ratio Chi-Square test was used for both the primary and secondary hypotheses. The
Likelihood Ratio Chi-Square test is based on the likelihood of the observed data under two
different models, the null model and the alternative model. The null model assumes that the two
variables are independent, while the alternative model allows for some form of dependence
between the two variables. The test statistic is calculated as the difference between the log-
likelihoods of the two models, multiplied by negative two. The Likelihood Ratio Chi-Square test
is more powerful than the Chi-squared test and is appropriate when the sample size is smaller
and the expected frequencies in each cell are less than five (Agresti 2002). The assumptions of
the Likelihood Ratio Chi-Square test were tested to determine the eligibility of the test. The
assumptions were as follows: the observations in the sample were all independent, the sample
size of each cell frequency was less than five, the variables were all categorical, and no cell had a
frequency less than one.
For the primary hypothesis, the educators and caregivers were assessed separately. The
Likelihood Ratio Chi-Square p-value for the primary hypothesis amongst educators is .0197
(Table 4); since this value is less than the significance level of .05, we reject the null hypothesis
and conclude that there is an association between the inadequate preparedness for the COVID-19
pandemic among caregivers and educators and delay in the social-emotional development of
children with access and functional needs because the results are statistically significant. The
17
Likelihood Ratio Chi-Square p-value for the primary hypothesis amongst caregivers is .0339
(Table 4); since this value is less than the significance level of .05, we reject the null hypothesis
and conclude that there is an association between the inadequate preparedness for the COVID-19
pandemic among caregivers and educators and delay in the social-emotional development of
children with access and functional needs because the results are statistically significant.
Table 4. Likelihood Ratio Chi-Square Results
Development Type Focus Group P-Value
Academic Development
Educators 0.0197
Caregivers 0.0339
Social-emotional Development
Educators 0.0095
Caregivers 0.0185

Table 4. Educators Likelihood Ratio Chi-Square Results for COVID-19 Preparedness and
Social-emotional Development. These data show that the mean of Preparedness among
caregivers and educators is statistically significantly associated with Social-emotional
development amongst Children with Access and Functional needs (p = .0197). Family
Likelihood Ratio Chi-Square Results for COVID-19 Preparedness and Academic Development.
These data show that the mean of Preparedness among caregivers and educators is statistically
significantly associated with Social-emotional development amongst Children with Access and
Functional needs (p = .0339). Educators Likelihood Ratio Chi-Square Results for COVID-19
Preparedness and Social-emotional Development. These data show that the mean of
Preparedness among caregivers and educators is statistically significantly associated with
academic development amongst Children with Access and Functional needs (p = .0095). Family
Likelihood Ratio Chi-Square Results for COVID-19 Preparedness and Social-emotional
Development. These data show that the mean of Preparedness among caregivers and educators is
statistically significantly associated with academic development amongst Children with Access
and Functional needs (p = .0185).

While coding the transcriptions for the primary hypothesis, it was found among
caregivers and educators that the overall preparedness for online learning and other factors
associated with COVID-19 is low. Educators explained the effects of quarantine, stating, “It's
like because we were stuck in places for so long without that exposure to the outside world that
it's like we forgot how to act around people, especially students forgot” (Educators Focus
Group). Parents went as far as saying their children were having issues with common forms of
18
non-verbal communication, describing, “…like when you're talking about social cues, those were
some of the issues that [the students] had” (Caregiver Focus Group). Caregivers and educators
consistently agreed that this caused a decline in their AFN children's social-emotional
progression between all school districts measured in the Greater Los Angeles Area (Figure 1).
For the secondary hypothesis, the educators and caregivers were assessed separately. The
Likelihood Ratio Chi-Square p-value for the secondary hypothesis amongst educators is .0095
(Table 4); since this value is less than the significance level of .05, we reject the null hypothesis
and conclude that there is an association between the level of preparedness for the COVID-19
pandemic for children with access and functional needs among educators and academic
development for children with access and functional needs because the results are statistically
significant. The Likelihood Ratio Chi-Square p-value for the secondary hypothesis amongst
caregivers is .0185 (Table 4); since this value is less than the significance level of .05, we reject
the null hypothesis and conclude that there is an association between the level of preparedness

19

Figure 1. Concept Map for code consistency among the all the school focus groups were
conducted with.
20

for the COVID-19 pandemic for children with access and functional needs among caregivers and
academic development for children with access and functional needs because the results are
statistically significant.
While coding the transcriptions for the secondary hypothesis, it was found among
caregivers and educators that the overall preparedness for online learning and other factors
related to COVID-19 is low. Educators felt very strongly about the gaps in students' education,
sharing, “…there's a lot of regression. I teach math and chemistry, and my math students for
algebra one, just the basics; I just felt like I had to start from the beginning…”(Educator Focus
Group). However, some teachers explained that it was not just the material but also the basics,
describing, “They couldn't sit, they couldn't grab a pencil. They didn't know what to do with the
paper. Just basic, basic pre-learning skills they came without” (Educator Focus Group). Parents
agreed there was an academic decline but advocated for their students, describing, “…it's not
necessarily about a gap. It's the team that you can possibly be working with that is not offering,
or even letting you know what the issues are” (Caregiver Focus Group). Caregivers and
educators consistently agreed that this caused a decline in their AFN children's academic
progression between all school districts measured in the Greater Los Angeles Area (Figure 1).

21
Chapter 4
Discussion

The study assessed the association between the level of preparedness for the COVID-19
pandemic among caregivers and educators of children with access and functional needs and the
social-emotional and academic development of the children. The Likelihood Ratio Chi-Square
test was used to analyze data collected from surveys completed by caregivers and educators
because the sample size assumption for the Pearson Chi-square test was violated, making the
Likelihood Ratio Chi-Square test more appropriate for this analysis. The results showed a
statistically significant association between inadequate preparedness for the pandemic and delays
in social-emotional and academic development among children with access and functional needs.
This means that the more prepared caregivers and educators are for disasters such as the COVID-
19 pandemic, the less impacted the CAFN social-emotional and academic development is in all
school districts measured in the Greater Los Angeles Area for this study.
The current study's findings are consistent with existing literature that has demonstrated
the negative impact of the COVID-19 pandemic on the academic and social-emotional
development of children, particularly those with access and functional needs (AFN). Studies
have shown that school closures and the shift to online learning have resulted in learning loss and
decreased socialization opportunities for children with disabilities (Holanda et al., 2021;
Tøssebro et al., 2021). The results of this study suggest that the level of preparedness for the
COVID-19 pandemic among educators and caregivers plays a crucial role in mitigating these
negative impacts on AFN children's development. The findings also align with previous research
that has identified the importance of caregiver involvement in the education of children with
disabilities (Jackson et al., 2019). The current study found a significant association between the
22
preparedness of caregivers and the academic and social-emotional development of AFN children,
highlighting the need for increased support and resources for caregivers in navigating online
learning during the pandemic. Overall, the current study adds to the growing body of literature
on the impact of the COVID-19 pandemic on the development of CAFN and emphasizes the
importance of preparedness and support for caregivers and educators in mitigating these adverse
effects.
The unexpected finding from the focus groups with educators and caregivers of CAFN
was the negative impact of the COVID-19 pandemic on the relationships between districts,
teachers, and caregivers, with consistent findings, for all school districts that there was a lack of
trust emerging because of lack of communication throughout the transition into online learning.
This finding is unexpected because the literature suggests that strong partnerships between
families and educators are essential for children with disabilities to succeed academically and
socially (Henderson et al., 2002). The unexpected finding of deteriorating connections among
school districts, teachers, and caregivers of CAFN during the COVID-19 pandemic is
consequential for various reasons (Wang et al., 2020). It emphasizes the necessity for robust
collaborations between family members and educators, which are essential for the scholastic and
social achievement of CAFN (Henderson et al., 2002). Weakened relationships may lead to
ineffective student assistance, impacting their emotional health and capacity to handle challenges
(Kaffenberger, 2006). Furthermore, efficient communication is crucial for identifying and
implementing suitable accommodations and adjustments for CAFN (Friend & Cook, 2013). Poor
trust and communication can impede their educational progress (Adams & Christenson, 2000).
This finding also highlights the susceptibility of relationships during crises (Wang et al., 2020),
encouraging schools and districts to create more robust systems and procedures. This
23
information can guide policymakers in allocating resources, training, and support systems that
enable improved communication and collaboration between teachers and caregivers (Epstein et
al., 2009). Finally, the finding emphasizes the importance of professional development
opportunities that concentrate on communication and collaboration with caregivers of CAFN
(Brown et al., 2014). By comprehending the importance of this finding, all parties involved can
collaborate on developing strategies that preserve and fortify these relationships during crises
and beyond, guaranteeing the most favorable outcomes for CAFN (Henderson et al., 2002). The
pandemic has brought significant changes to the educational system, including the rapid shift to
online learning, which has likely disrupted communication and collaboration between families
and educators. This unexpected finding highlights the importance of maintaining and
strengthening relationships between families and educators during times of crisis. Future
research should investigate strategies for promoting effective partnerships between families and
educators during crises such as pandemics.
There are several limitations to this study. First, the study had a small sample size of only
17 female educators and four female caregivers. This sample size may not represent the entire
population and may limit the generalizability of the study. Second, the homogeneity of the
sample, the educator and caregiver sample only consisted of female participants, and the
majority of the participants identified as white or Hispanic/Latino. This lack of diversity may
limit the study's ability to make conclusions about the experiences of educators or caregivers
from other racial or ethnic backgrounds. Third, limited geographic location since the study was
conducted in only three school districts, which may limit the generalizability of the findings to
other geographic regions. Another limitation is the limited socioeconomic diversity among the
caregivers because the income brackets reported showed only one participant in a lower-income
24
bracket and one in a higher-income bracket. This lack of diversity in income may limit the
study's ability to make conclusions about caregivers' experiences in different socioeconomic
groups. Next, the limited education level diversity since all caregivers had at least some college
education, with only one participant being a college graduate. This lack of diversity in education
levels may limit the study's ability to make conclusions about caregivers' experiences with
different levels of education. Lastly, the survey was self-reported data which may be subject to
social desirability bias, where participants may provide answers they believe are more socially
acceptable rather than their actual experiences or opinion.

25
Chapter 5
Conclusion

This study highlights the importance of preparedness for the COVID-19 pandemic for
CAFN and its impact on their development. The study found a significant association between
the inadequate preparedness for the COVID-19 pandemic for CAFN among educators and
caregivers and delays in the social-emotional and academic development of children with access
and functional needs. The Likelihood Ratio Chi-Square p-values were less than the .05
significance level for both the primary and secondary hypotheses amongst educators and
caregivers, indicating that the results are statistically significant. The overall preparedness for
online learning and other factors pertaining to COVID-19 was low, and caregivers and educators
consistently agreed that this caused a decline in their AFN children's social-emotional and
academic progression. These results suggest that educators and caregivers must be better
equipped to handle the challenges of online learning and pandemic-related disruptions to ensure
the optimal development of AFN children. The findings of this study have important
implications for policy and practice in the education and healthcare sectors. Efforts must be
made to improve preparedness and support for caregivers and educators of AFN children.
Several steps can be taken to better prepare families and schools for future challenges
related to online learning and pandemic-related disruptions. Schools and caregivers should
prioritize ongoing training and professional development to ensure they have the necessary skills
and knowledge to support the learning and development of CAFN. This training could include
assistive technology, accessible teaching methods, and emergency preparedness planning.
Schools and families should work together to develop and test emergency preparedness
plans tailored to the needs of AFN children. These plans should include specific strategies for
26
ensuring that children can continue to receive the support and services they need during a
disruption, such as access to technology, telehealth services, and medication management.
Schools and caregivers should prioritize open and frequent communication with families
of AFN children to ensure that their needs are met and provide ongoing support during
disruption. This can include regular check-ins, virtual support groups, and access to resources
and information about available services and supports. By taking these steps, families and
schools can work together to ensure that AFN children receive the support they need to thrive
during challenging times.

27
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30
Appendices
A A Survey
A.1 Educators Survey

What is your age (in years)?
Your answer

What is your gender?
Male
Female
Prefer not to say

What is your ethnicity (select all that apply)?
Hispanic/Latino
White
Black
Asian
Other:

Please answer the following questions about teaching during the COVID-19 pandemic:

Very Satisfied
Satisfied
Neutral
Dissatisfied
Very dissatisfied

How satisfied are you with the current learning model at your school?

How satisfied are you with the frequency of communication from school leadership/district
leadership?

How satisfied are you with the instruction you provide in the current learning model?

How satisfied are you with students’ academic growth right now?

How satisfied are you with students’ social-emotional well-being right now?

How satisfied are you with students’ participation level in class(virtual, hybrid, in-person)?

How satisfied are you with your ability to build relationships with your students right now?

31
Student concerns:
Very concerned
Concerned
Neutral
Not concerned

Are you concerned about your student's academic state?

Are you concerned about your student's behavior in the classroom?

Are you concerned about your student's social-emotional well-being?

Please answer the following questions about school resources and performance:

Yes
No
Prefer not to say
Does not apply
Unsure

Do you believe your school has helped resolve challenges related to COVID-19 so far?

Do you believe there is a difference in performance after distance learning?

Was it difficult for you to implement and follow the COVID-related safety measures and
protocols?

Did your school provide mental health resources?

Do you believe the school provided the best possible learning model for children with special
needs?

Do you feel like your opinions were heard and valued by the school?

Please answer the following question about COVID-19 safety:

Yes
No
Does not apply
Prefer not to say

Do you find yourself feeling anxious about transitioning back to in-person learning?

Do you believe you have enough training on COVID-19 safety?

Do you have fears about being exposed to COVID-19?
32

Are you eligible to get vaccinated?

Are you worried about your ability to keep students masked?

Are you vaccinated?
Yes, I am vaccinated.
No, I am not vaccinated, but I plan to get vaccinated
No, I am not vaccinated, and I do not wish to get vaccinated

If you selected that you wish not to get vaccinated in the previous question, please select all that
apply to you:
It is against my personal beliefs
It is against my religion
Do not trust the safety of the vaccine
Prefer to wait
Believe the vaccine will harm my health
Other:

33
A.2 Caregivers Survey

What is your age (in years)?
Your answer

What is your gender?
Male
Female
Prefer not to say

What is your ethnicity? (Select all that apply)
Hispanic/Latino
White
Black
Asian
Other:

What is your household income (per year)?
<$14,100
$14,101-$53,700
$53,701-$85,500
$85,501-$163,300

What is your residence type?
House
Apartment
Other
What is the number of people living in the household (including self)?
Your answer

What is your educational level?
Less than high school
High school
Graduate
Some college
College
Graduate
Post-Graduate

Please select the response that best represents your child’s medical needs:
Takes daily medications (insulin, prescription pills, etc.)
Requires “as needed” medications (asthma inhalers, nebulizers, etc.)
Uses a home ventilator
Uses a wheelchair
Uses a gastrostomy tube (G-tube) for feedings
Multiple responses represent my child’s medical needs
34
None of the above

What is the medical diagnosis of your child?
Your answer

Do you have extra medication for family members with a chronic medical conditions? If yes, for
how many days for each family member?
Your answer

During the COVID-19 pandemic, I have noticed my CHILD has felt stressed or burdened a lot
by:
Strongly disagree
Disagree
Neutral
Agree
Strongly Agree
Our current living accommodation

Online school lessons

Increased conflicts with family/friends

Concerns for personal safety

Concerns for the safety of family members or friends

Fears of what the future will bring

Maintaining social contacts

Reduced contact with people outside of the household

During the Covid-19 pandemic, I noticed my CHILD:

Strongly disagree
Disagree
Neutral
Agree
Strongly agree

Progress in academic development

Progress in social development

Progress in emotional development

35
Act out more often

Stop doing their work

Pursuing new hobbies/interests

Smiling more often

Being happy about additional time spent with family

During the COVID-19 pandemic, I have noticed I have felt stressed or burdened a lot by:

Strongly disagree
Disagree
Neutral
Agree
Strongly Agree

Our current living accommodation

Childcare

Being responsible for online school lessons

Balancing work and family responsibilities

Worries about my health

Worries about not being able to get medical care

Increased conflicts with people close to me

Financial worries

Uncertainties regarding my job, training place, studies, or school

Concerns for the safety of family members or friends

Uncertainties about the future

Reduced contact with people outside my household

Since the start of the COVID-19 pandemic I...

Strongly disagree
Disagree
36
Neutral
Agree
Strongly agree

Have had the opportunity to retreat to a private place

Have maintained my social contacts (telephone, visits, or video chats)

Have focused on my inner strengths, resources, abilities, and talents

Have acknowledged the COVID-19 pandemic as a reality

Have been happy about the increased time spent with family

Have strengthened the relationships in my household

Have found new hobbies, activities, or interests which make me happy

The COVID-19 Pandemic has brought me/my family...

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

Anxiety

Closer together

Depression

Fear

Insecurities

Loneliness

Opportunities to spend more time as a family

Panic

Peace of mind

Please answer the following questions about how your child's school:

37
Yes
No
Does not apply
Prefer not to answer

Did you find the communication from your child’s school this school year helpful?

Was the communication from the school about COVID-related safety measures and protocols
clear?

Do you find it difficult to get in contact with someone at your child’s school?

Do you feel comfortable communicating with your child’s school?

Do you feel the school values your opinions?

Are you pleased with the level of COVID-related safety measures and protocols in your child’s
school to keep students healthy?

Did the school allow you to choose how the child is attending (in-person, remote, or a mix of
both)?

Are you worried about your child getting sick?

Is your child eligible to receive the vaccine?

Do you feel comfortable vaccinating your child?
Is everyone in your family who is eligible to get the vaccine vaccinated?

Are you comfortable with your child wearing a mask at school?

Did your child's school provide services for your child (Example: Speech therapy)?

How satisfied were you with the way distance learning was carried out at your child’s school
during the COVID-19 pandemic?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very dissatisfied

How confident were you in your ability to support your child's education during distance
learning?
Very confident
Confident
Neutral
38
Unconfident
Very unconfident

Is there anything else you would like us to know about your child's healthcare needs/mental
health?
Your answer

Abstract (if available)

Abstract This study is a mixed-method analysis discussing the importance of disaster preparedness for children with access and functional needs (CAFN). Children with such needs may be more vulnerable to the effects of natural disasters and other emergencies, making it crucial for parents and caregivers of these children to have a disaster plan in place. It is also critical for children with access and functional needs to be included in disaster preparedness planning and practicing these plans as they may require specialized care and assistance in an emergency. The primary hypothesis being tested is that the association between preparedness for the COVID-19 pandemic for children with access and functional needs is inadequate among caregivers and educators, causing delays in social-emotional development for children with access and functional needs. The secondary hypothesis being tested is that the association between preparedness for the COVID-19 pandemic for children with access and functional needs is inadequate among caregivers and educators, causing delays in academic development for children with access and functional needs. Four caregivers and seventeen educators of children with access and functional needs were recruited through flyers and sign-up sheets distributed in school districts within the Greater Los Angeles Area, and focus groups were used to gather quantitative and qualitative data. Statistical and content analysis were used to identify trends and patterns in the data. We observed a statistically significant association between inadequate preparedness for the COVID-19 pandemic among caregivers and educators and delays in social-emotional and academic development for children with access and functional needs. While the study focused on disaster preparedness during the COVID-19 pandemic, results may be generalizable to other types of disasters or emergencies.

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Asset Metadata

Creator Shkhyan, Lily (author)

Core Title Mixed-method analysis for school-aged children with access and functional needs during the Covid-19 pandemic

School Keck School of Medicine

Degree Master of Science

Degree Program Applied Biostatistics and Epidemiology

Degree Conferral Date 2023-05

Publication Date 03/31/2023

Defense Date 03/31/2023

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag academic development,access needs,Children,COVID-19,disaster preparedness,emergencies,emergency assistance,functional needs,OAI-PMH Harvest,pandemic,social-emotional development,specialized care

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Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Burke, Rita (committee chair), Cockburn, Myles (committee member), Lopez, Diego (committee member)

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