The COVID-19 pandemic has changed the ways in which society interacts. Attending meetings, doctor's visits and spending time with friends and family have all transitioned to virtual platforms. This abrupt shift into the virtual world has also been strongly felt in the field of pediatric mental health.
A pediatric mental health crisis
Experts predicted a mental health crisis would follow the COVID-19 health crisis. Shortly after the pandemic hit the United States and stay-at-home orders were put into place, some pediatric mental health providers began to witness a surge in the acuity of mental health concerns including:
- Social isolation that has resulted in youth experiencing more depressive symptoms.
- Fears of the pandemic have worsened anxieties.
- Changes in family dynamics has caused more behavioral problems.
The ability to access high-quality mental health services has never been more critical.
The need for virtual mental health services
In early March, the Outpatient Psychiatry Clinic at Children's Hospital Colorado was averaging 500 clinic visits per week. Once the pandemic hit the state, families became worried about attending appointments in-person and volumes dropped to 140 clinic visits per week. The general Partial Hospitalization Program (PHP) program volumes also experienced a drop from approximately 150 visits in early March, to roughly 50 visits in late March.
Clinical leadership in the ambulatory division of the Pediatric Mental Health Institute at Children's Hospital Colorado recognized the emergence of this mental health crisis and transformed clinical services into virtual formats so patients and families could continue to receive support.
Outpatient psychiatry clinic
The outpatient clinic provides individual, family and group therapy, as well as medication management, to pediatric patients with a broad range of emotional and behavioral difficulties and their families. Prior to the pandemic, legal regulations and lack of insurance reimbursement were significant barriers to being able to offer outpatient telehealth services. In response to the national public health emergency, states and payors loosened requirements, making it easier to provide telehealth services.
Within a two-week timeframe, the outpatient clinic transitioned to providing all mental health services through a telehealth format and began to see typical volumes. The clinic also developed telehealth group-based services for youth or their parents on topics such as anxiety, mood concerns and parenting during the pandemic.
General partial hospitalization program
The hospital's general PHP program provides intensive multi-disciplinary mental health treatment for youth with more severe psychiatric difficulties (e.g., suicidality, self-harm, severe depression, anxiety and behavior challenges) that are impairing their functioning at home, school or in the community. Due to the group-based nature of this program, social distancing restrictions required discontinuing the provision of in-person care to this high-risk population beginning in mid-March.
To be able to continue supporting this patient population and divert them from possible admission to an inpatient level of care, the leadership team developed a telehealth PHP for teens with anxiety and/or depression. Although outpatient telehealth services are more commonplace, pediatric PHP virtual curriculums are nonexistent.
The multi-disciplinary team collaborated and successfully offered virtual PHP services based on a modified version of an evidence-based curriculum based on Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents that included:
- Individual/family sessions
- Group therapy sessions, skills based and experiential
- Parent group therapy sessions
- Medication management sessions
The future of telehealth services
As stay-at-home orders have been lifted and social distancing guidelines have loosened, the hospital is slowly returning to business as usual. However, certain elements of clinical care continue to be affected by the pandemic including:
- Health screenings of all individuals who come into the building.
- The need to socially distance in the waiting room and therapy rooms.
- Requiring all patients, families and providers to wear masks.
- Some families do not feel comfortable coming in for in-person visits.
- Some families cannot come in for in-person visits due to family members at high-risk.
Despite these challenges, reactivation efforts in the hospital have focused on supporting families in returning to in-person appointments. These efforts are motivated, in part, by the expectation that emergency telehealth regulations will be expiring this summer. An unanticipated benefit of the pandemic has been the increase in the use of telehealth services, which has improved patient access to critical mental health services.
Efforts must be made to prevent losing this progress in the coming months and ensure that state and federal legislation, as well as payor reimbursement, do not resume being barriers to providing telehealth mental health services.