Abstract
<title>Abstract</title> <p>Background: The COVID-19 pandemic led to widespread disruptions in schooling, health services, and daily routines, with disproportionate effects on families of children receiving mental health care for pre-existing conditions. While prior studies have documented increased stress, mental health problems and service disruptions, less is known about how these experiences evolved over time and how families adapted to prolonged uncertainty. This study aimed to examine longitudinal changes in parental experiences during the first year of the pandemic. Methods: A qualitative longitudinal design was used. Parents of children receiving mental health services participated in semi-structured interviews conducted at two time points during the first year of the pandemic. Thematic analysis was performed separately for each time point. Themes were then compared across time to examine patterns of change. An analytic mapping of themes was conducted to derive higher-order longitudinal components capturing shared variation across domains. Results: Four distinct longitudinal components were identified. First, children’s mental health shifted from heterogeneous early responses to more consistently deteriorating trajectories over time. Second, parental coping evolved from primarily individual, home-based strategies toward increasing reliance on external supports as demands intensified and initial strategies proved insufficient. Third, institutions such as schools and mental health services emerged as structuring determinants of family functioning, with variations in access, responsiveness, and coordination shaping stability and caregiving burden. Fourth, parents’ accounts reflected growing uncertainty and erosion of trust in institutional systems, driven by inconsistent policies, shifting recommendations, and difficulty anticipating future conditions. Together, these components illustrate interacting changes across child functioning, family adaptation, institutional context, and the informational environment. Conclusions: Parental experiences during the pandemic were characterized by dynamic and interrelated changes across child functioning, coping strategies, institutional contexts, and trust. Findings highlight the central role of stable, coordinated, and transparent institutional support in sustaining family functioning during prolonged crises. Trial registration: Not applicable.</p>