Impact of the COVID-19 Pandemic on Child and Adolescent Mental Health Policy and Practice Implementation

Abstract

Background: The impact of the 2019 coronavirus pandemic on the mental health of millions worldwide has been well documented, but its impact on prevention and treatment of mental and behavioral health conditions is less clear. The COVID-19 pandemic also created numerous challenges and opportunities to implement health care policies and programs under conditions that are fundamentally different from what has been considered to be usual care. Methods: We conducted a qualitative study to determine the impact of the COVID-19 pandemic on implementation of evidence-based policy and practice by State Mental Health Authorities (SMHA) for prevention and treatment of mental health problems in children and adolescents. Semi-structured interviews were conducted with 29 SMHA representatives of 21 randomly selected states stratified by coronavirus positivity rate and rate of unmet services need. Data analysis with SMHA stakeholders used procedures embedded in the Rapid Assessment Procedure—Informed Community Ethnography methodology. Results: The need for services increased during the pandemic due primarily to family stress and separation from peers. States reporting an increase in demand had high coronavirus positivity and high unmet services need. The greatest impacts were reduced out-of-home services and increased use of telehealth. Barriers to telehealth services included limited access to internet and technology, family preference for face-to-face services, lack of privacy, difficulty using with young children and youth in need of substance use treatment, finding a Health Insurance Portability and Accountability Act (HIPAA)-compliant platform, training providers and clients, and reimbursement challenges. Policy changes to enable reimbursement, internet access, training, and provider licensing resulted in substantially fewer appointment cancellations or no-shows, greater family engagement, reduction in travel time, increased access for people living in remote locations, and increased provider communication and collaboration. States with high rates of coronavirus positivity and high rates of unmet need were most likely to continue use of telehealth post-pandemic. Despite these challenges, states reported successful implementation of policies designed to facilitate virtual services delivery with likely long-term changes in practice. Conclusions: Policy implementation during the pandemic provided important lessons for planning and preparedness for future public health emergencies. Successful policy implementation requires ongoing collaboration among policy makers and with providers.

The Impact of SARS-CoV-2 Infection on Youth Mental Health: A Narrative Review

“…Similar evidence has been reported by the qualitative study conducted by Palinkas and colleagues in the USA [165]: they interviewed 29 State Mental Health Authorities (SMHA) to determine the impact of the COVID-19 pandemic on the implementation of evidence-based policy and practice. The percentage of states reporting positive outcomes with telehealth implementation ranged from 80% to 100%, desire to continue the use of telehealth in the post-pandemic period ranged from 60% to 100%.…”

Public Perceptions around mHealth Applications during COVID-19 Pandemic: A Network and Sentiment Analysis of Tweets in Saudi Arabia

“…Another reason for low interactions, some studies that surveyed physicians about their perspective on telehealth during the pandemic showed that they were concerned about the following: technological barriers, diagnostic reliability, cultural and social factors, lack of face-to-face interactions, and lack of a clear telemedicine legal framework. In addition, physicians tend to use WhatsApp ® and Zoom more than the "Sehha" app [50,70,71]. Therefore, more campaigns targeting the eligibility of these mHealth apps are suggested to increase awareness about their use [23].…”

The Impact of the COVID-19 Pandemic on Mental Health Care of Children and Adolescents in Switzerland: Results of a Survey among Mental Health Care Professionals after One Year of COVID-19

“…Data from the Republic of Ireland [ 9 ] indicate that referrals to specialized child and adolescent mental health services dropped by around 10% up to August 2020 and then steadily increased up to December 2020, reaching 180% compared to previous years, with double the number of outpatient appointments compared to previous years. A recent qualitative U.S. study reported that services suspected an increased need for mental health care for children and young people during the pandemic, but that staff shortages and decreased service capacity under COVID-19 conditions made it difficult to estimate the true amount [ 10 ]. Another U.S. study analyzed admission to a child and adolescent psychiatry inpatient unit between March 2020 and January 2021 and found that 53% of admissions due to adolescent psychiatric crises were related to COVID-19 stressors, although the overall number of admissions had slightly decreased [ 11 ].…”

“…As another effect of the pandemic, the implementation of telemental health increased, although a number of barriers were identified, such as unclear funding for services, limited internet access, family/client reluctance, or problems linked to online sessions with younger children [ 10 ]. A Canadian survey of mental health professionals working in services for mentally ill children and adolescents found that 71% of respondents began to use virtual care during pandemic.…”