Pediatric Primary Care Perspectives of Mental Health Services Delivery during the COVID-19 Pandemic

Abstract

Due to a national shortage of child and adolescent psychiatrists, pediatric primary care providers (PCPs) are often responsible for the screening, evaluation, and treatment of mental health disorders. COVID-19 pandemic stay-at-home orders decreased access to mental health care and increased behavioral and emotional difficulties in children and adolescents. Despite increased demand upon clinicians, little is known about mental health care delivery in the pediatric primary care setting during the pandemic. This focus group study explored the experiences of pediatric PCPs and clinical staff delivering mental health care during the pandemic. Transcripts from nine focus groups with San Francisco Bay Area primary care practices between April and August 2020 were analyzed using a thematic analysis approach. Providers expressed challenges at the patient-, provider-, and system-levels. Many providers reported increased patient mental health symptomatology during the pandemic, which was often intertwined with patients’ social determinants of health. Clinicians discussed the burden of the pandemic their own wellness, and how the rapid shift to telehealth primary care and mental health services seemed to hinder the availability and effectiveness of many resources. The findings from this study can inform the creation of new supports for PCPs and clinical staff providing mental health care.

Using human-centered design to develop and implement a pediatric mental health care access program

“…Given that the HCD process is iterative, we have cycled back through earlier phases to design new solutions as we expanded geographically. For example, we conducted a series of focus groups from April to August 2020 with PCPs from 11 practice sites contributing insights and feedback to further develop CAPP’s programmatic offerings ( 9 ). We discovered that clinician burnout prohibited engagement with CAPP services.…”

“…More than ever, pediatric primary care providers (PCP) play a critical role in meeting youth mental health needs ( 9 ). PCPs often have a longitudinal relationship with patients and therefore are in a unique position to apply chronic care principles ( 10 ) to mental health problems.…”

“…A shortage of mental health specialists has long been a challenge for healthcare systems nationwide (4)(5)(6) and was further exacerbated during the coronavirus disease 2019 (COVID-19) pandemic, when school-based mental health services were shuttered, and youth were socially isolated (7,8). More than ever, pediatric primary care providers (PCP) play a critical role in meeting youth mental health needs (9). PCPs often have a longitudinal relationship with patients and therefore are in a unique position to apply chronic care principles (10) to mental health problems.…”

Children and young people’s consultation rates for psychosocial problems between 2016 and 2021 in the Netherlands

“…The COVID-19 pandemic may have increased the importance of GPs in managing psychosocial problems of CYP (e.g. because of restricted access to specialised mental health services) [ 13 ].…”