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By Anthony Sossong, MD
Pediatric hospitalizations dropped across nearly all conditions in the past year—but that doesn’t mean children’s health needs decreased. That’s particularly true in behavioral health, where hospitalizations from self-harm remained consistent among children.
Nearly half of parents in a recent national poll reported that their children exhibited a new or worsening mental health condition during the pandemic. As a result, psychologists reported a 30% rise in demand for services for kids under the age of 13 during the pandemic, according to American Psychological Association (APA) data. Among teens, demand for psychiatric services increased 16%, APA data shows.
Their needs are more acute than ever. Among teens, researchers found a sharp spike in behavioral health-related conditions such as major depression, generalized anxiety disorder, adjustment disorder, self-harm and substance abuse since before the pandemic, with a 334% increase in self harm among 13- to 18-year-olds in the Northeast alone.
Yet parents struggle to gain access to child psychiatrists and psychologists who can treat their children’s mental health needs. Nationally, parents struggle to find available appointments with mental health specialists for their children. It’s not uncommon to encounter long waitlists for care, if the option of a waitlist is offered at all. Not only has the need for behavioral health services increased, but the U.S. also faces a significant shortage of child psychiatrist. In fact, 70% of U.S. counties don’t have one at all.
In this environment, child psychiatrists have become medicine’s new “unicorns:” highly desirable but hard to get.
How can healthcare providers and health plans ensure children get the behavioral health resources they need in the most appropriate setting? A recent study by Nemours Children’s Health and Amwell points to the potential for organizations to leverage virtual care to bridge gaps in access, especially in counties where in-person resources do not exist.
No. 1: Become an enabler for telebehavioral health. Among 2,000 parents surveyed by Nemours Children’s Health and Amwell, more than one in four say they don’t use telehealth because they have never been offered this service. Strikingly, 12% have never heard of telehealth, despite the dramatic increase in use of virtual care during the COVID-19 pandemic. It’s a sign of the critical need for providers and health plans to educate parents on availability of virtual behavioral health services not only as a vehicle for care, but also as a way to obtain high-quality mental health services for their children on an ongoing basis.
One way to enable telebehavioral health is to encourage pediatricians to introduce parents to virtual options for meeting their child’s mental health needs. Parents respect their pediatrician’s advice, and they are more likely to try alternative avenues for high-quality care when they receive recommendations from their child’s physician.
No. 2: Emphasize the positive impact of telehealth in eliminating logistical challenges to children’s mental health care. Just one out five children with a mental, emotional or behavioral disorder receive care from a specialized provider. Before the pandemic, some parents faced challenges due to a lack of local resources for treating their child’s needs. In these instances, parents either traveled lengthy distances for care, all while juggling responsibilities at work and home, or struggled to help their children at home.
The expansion of virtual health capabilities helped eliminate these barriers to care, helping to save time and money that otherwise would be spent traveling to and from healthcare appointments. It also provides new options for children who have health or mobility problems, lack transportation or live too far away from behavioral health specialists to regularly seek care. One often unanticipated benefit for parents is increased opportunity for family participation in care. Telehealth can have an unexpectedly positive effect on family dynamics by helping to balance caregiving responsibilities. For instance, nearly half of fathers interviewed by Nemours and Amwell say telehealth could help them become more involved in medical appointments, a benefit that could help shift household division of labor. By communicating the potential benefits of telehealth for children’s behavioral health needs, healthcare providers and health plans can help promote increased use of virtual mental health care for children.
No. 3: Identify technology barriers to care and seek creative ways to resolve them. For 32% of parents who face adverse social determinants of health, lack of required technology gets in the way of their ability to leverage telehealth for their children’s health needs, the Nemours/Amwell survey found. Healthcare organizations and health plans must work to ease this barrier for high-risk children to ensure equitable, long-term access to child psychiatrists and other mental health professionals for children. For example, at IU Health, based in Indianapolis, leaders built virtual kiosks for mental health services in 100 primary care offices across the state of Indiana. It’s an approach that helps individuals of all economic backgrounds conveniently access much-needed care in a trusted location. Health plans also may find value in providing vulnerable patients with devices that help them connect with behavioral health providers, whether via scheduled visits or on demand.
No. 4: Eliminate reimbursement barriers to care. Sixty-four percent of parents say coverage of virtual care by their health plan is “essential” or “extremely important” to their future use of telehealth, the survey found. This is especially true in families that face adverse social determinants of health. Certainly, federal waivers and state flexibilities that expanded access to telehealth during the pandemic fueled adoption of virtual care services. Now, health plans must consider: “How can we continue to harness telehealth to meet the needs of medically or socially vulnerable populations—including children with behavioral health needs?” Given that half of all families that grapple with social determinants of health such as an inability to pay for medical appointments still use telehealth, easing access to telehealth by ensuring telehealth is a covered benefit is vital to supporting better health outcomes for children.
The Stakes Are High
The COVID-19 pandemic put a spotlight on telehealth’s potential to meet children’s healthcare needs, with 72% of parents saying they would use or have used telehealth to obtain care for their children, according to the Nemours/Amwell survey. But supporting equitable access to care—including telebehavioral health services—requires providers and health plans to actively promote availability of these services virtually. It also demands a close look at the barriers that limit access to mental health services for children and creative strategies for overcoming these obstacles to care. By rethinking how healthcare organizations connect families with virtual options for mental health care, leaders can make a dramatic impact on mental health outcomes for children during the pandemic and beyond.
Anthony Sossong, MD, is chief medical director, behavioral health for Amwell.