In Hong Kong, it was estimated that the incidence of autism spectrum disorder (ASD) is at 5.49 per 10,000, and the prevalence rate of ASDs is at 16.1 per 10,000 for children <15 years old. According to the government's recent mental health review, ASD was the main type of mental disorders among young children, comprising >60% of caseload of the child and adolescent services in public hospitals in 2015-2016, and the number of children with ASD seeking medical services from public hospitals had doubled between 2011 and 2016.
Generally, the government has provided various support from early diagnosis to medical intervention and education. Through allying various institutions such as child assessment center, social welfare department, and education bureau (EDB), the government aims to improve the well-being of children and adolescents through developing a holistic support system. According to the EDB, the services for children with ASD cover assessment and identification, training and intervention, family support services, home-school cooperation, cross-sector collaboration, public education, and counseling and consultation. Many of these services are in "face-to-face" format, and the waiting time to receive any assessment through certified governmental agencies is, on average, 13-19.6 months.
In January 25, 2020, the Hong Kong Government had raised the response level under the "Preparedness and Response Plan for Novel Infectious Disease of Public Health Significance (the Plan, hereafter)" to the emergency level. This plan was developed after the SARS epidemic in 2003 to allow Hong Kong to be much more prepared for future epidemics. The main goal of the plan is to ensure that a well-planned and fully integrated emergency management response can be implemented by all bureaus of the Hong Kong government with the support of the multisectors in the society.
The plan includes three response levels: alert, serious, and emergency. These response levels are based on risk assessment of the novel infectious disease that may affect Hong Kong and its health impact on the community. Emergency response level corresponds to a situation where the risk of health impact caused by the novel infection on local population in Hong Kong is high and imminent. Generally, it depicts a high risk of serious human infections caused by the novel infectious agent in Hong Kong, and serious infections may be widespread. It generally applies to situation when there is evidence or imminent risk of sustained community level outbreaks.
Accordingly, since late January, several preventive public health measures including surveillance, quarantine, social distancing, the use of face masks, and school closures have been implemented to suppress the transmission of COVID-19. On January 25, the education bureau announced the deferral of class resumption after Chinese New Year holiday for all schools, which marked the beginning of school suspension in response to the COVID-19 development in Hong Kong until further notice. Many nonurgent health care and social services were delayed or reduced.
Previous studies found that the outbreak of a novel virus was associated with the onset of psychiatric symptoms in mentally healthy individuals, exacerbated conditions of individuals with mental illness, and elevated burden for caregivers. The anxiety, fear, and stress experienced by the general public was associated with strong sense of insecurity, triggering off widespread panic buying of food and other basic necessities in at least two international cities. The prolonged closure of public services, quarantine, and impaired economic and social activities at the later stage further worsen the situation. A worry for further spread of COVID-19, distrust toward the government in their ability to contain the outbreak, anticipated economic downturn, and increased unemployment rate are associated with intensified negative emotions in the society.
Under such a problematic situation, parents had to handle multiple stressors simultaneously. Many parents struggle to secure enough resources, such as food and masks, to ensure home schooling of their children, taking care of the elderly, and going to work without contamination of their household. Limited data in the United States suggested the COVID-19 outbreak negatively affected vulnerable families more, including lower-income families and families of children with ASD.
Under the COVID-19 outbreak, families of children with ASD might face a particular difficult situation for at least three reasons. First, because of the ASD condition of their children, the parents might not be able to obtain enough tangible necessities. In particular, the closure of schools and child day-care centers shifted back the day-to-day caretaking role back to the parents while they were running here and there to fetch all kinds of daily necessities. Having limited patience and various vulnerabilities, children with ASD could not line up in the queue for long. As a result, these families often failed to get the necessities. The constant lack of resources causes stress and tension within families of children with ASD. Second, numerous research already showed that parents of children with ASD often suffered from elevated stress, lowered quality of life, and heightened psychological distress. Third, because of the rigidity nature of people with ASD, the heavily disrupted daily routine has negatively affected their well-being.
Realizing the needs of parents of children with ASD, social service professionals fight against the odds to offer continued support and services for these families. Theoretically, social service professionals underwent the processes of resiliency as service providers. Resiliency of social service professionals can be conceptualized as the dynamic process in which social service professionals work with service users in encompassing positive adaptation within the context of significant adversity. In the time of COVID-19, Hong Kong social service professionals adopted a strength-based approach to mobilize community resources and empower service users to address their needs. It is necessary to document and summarize Hong Kong social service professionals' innovation, practice wisdom, and lessons learned for at least four reasons. First, "COVID-19 is not the first virus to threaten humanity, and it will not be the last". The Hong Kong social service professionals' experiences can help to develop the practice guide and conceptual model for the future. Second, studies on social service professionals' view on the families of children with ASD under the period of COVID-19 pandemic are scarce. The document fosters the understanding of experiences of the families of children with ASD and serves as an expression of concern of academia toward these families in the time of uncertainty. Third, some service users mistakenly perceived that social service professionals might not be able to provide any kind of services in the period of COVID-19 outbreak. Our documentation helps to make social service professionals' work and the related challenges more visible and accountable. Fourth, up to date, parenting-related studies under the period of COVID-19 pandemic only present scholars' views [e.g., ]. Little is known from frontline practitioners' perspectives. The current study can address this gap.
Based on a focus group interview with the social service professionals serving families of children with ASD, the current study aims to address the following research questions:
What are the needs of families of children with ASD and other developmental issues under the period of COVID-19 pandemic?
What are the services provided to families of children with ASD and other developmental issues under the period of COVID-19 pandemic?
What are the challenges social service professionals encountered?
What are the solutions to these challenges?