The full effect of COVID-19 on children's behavioral health likely won't be known for some time. But even before the pandemic, pediatric behavioral health was a national crisis, with 1 in 5 children living with a mental illness and suicide the second leading cause of death for children 10 and older. The pandemic propelled the country into a crisis within a crisis. As a result of COVID-19, behavioral health care providers had to pivot to address needs.
Personalized behavioral health services
From 2011 to 2015, more than 13 million youth ages 6 to 24 turned to the emergency department (ED) for a psychiatric concern, according to a 2019 report in Pediatrics. While EDs should always be an option for young people in crisis, they may not be the best care solution because they are not outfitted to meet the specific needs of this population.
Recognizing the need for more personalized behavioral health services and programming, Nationwide Children's Hospital opened the doors to its Big Lots Behavioral Health Pavilion in March 2020–just days before COVID-19 prompted widespread shutdowns.
The Behavioral Health Pavilion integrates acute behavioral health services with intensive outpatient programs and research. One of the features is the Psychiatric Crisis Department, an ED for behavioral health. The department allows staff to evaluate, treat, refer or admit children in a more patient-friendly environment. It also provides more time for evaluation and triaging children to the appropriate level of care.
With the number of crisis assessments for mental health concerns up by almost 15% in the second half of 2020 compared to 2019, David Axelson, M.D., chief of the Department of Psychiatry and Big Lots Behavioral Health Services at Nationwide Children's, says it's hard to imagine what the last year would have been like without the addition of the pavilion and its clinics. Throughout 2020, the Psychiatric Crisis Department had approximately 4,600 visits, which took significant pressure off the hospital's main ED and greatly improved care. Most of the kids evaluated within the Psychiatric Crisis Department were connected to an appropriate level of care that did not include inpatient admission.
Pivoting during a pandemic
When the pandemic first hit, many people were uncomfortable visiting the hospital or other health care settings. To help bridge the gap, Nationwide Children's pivoted to telehealth for outpatient care. They conducted more than 160,000 behavioral health telehealth visits from March 16 to December 31, 2020–51% of all hospital-wide telehealth visits in that timeframe.
"The rapid expansion of telehealth at Nationwide Children's has transformed the way we deliver services to improve access and expand capacity," says Ujjwal Ramtekkar, M.D., medical director of Telehealth and Virtual Care. We are able to leverage telehealth to connect with children in their homes, schools or primary care offices to overcome the barriers related to social determinants of health."
Virtual care became integral to providing prevention programs, a key area of focus even before the pandemic. School-based therapy and parenting offerings shifted to an online format, placing additional emphasis on helping parents and educators deal with the pandemic.
"Our community work is intentionally designed to support local providers and agencies to address more mental health conditions at less intensive levels, rather than refer to us," Axelson says. "We're also hoping that our comprehensive community approach will reduce ED use for crisis patients and reduce readmissions."
Public education is another important pillar to Nationwide Children's behavioral health efforts. In 2018, the hospital started the On Our Sleeves campaign to break stigmas and educate families and advocates about children's behavioral health. During the pandemic, education resources were tailored to support parents with coping strategies, such as starting conversations, routines and working from home.