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Objectives: The objective of this presentation is to describe the effects of the COVID-19 pandemic on a group of community clinics in the San Francisco Bay Area. Methods: Bay Area Clinical Associates (BACA) serves the majority of the San Francisco Bay Area and provides outpatient and intensive outpatient (IOP) services. BACA employs a multidisciplinary team of mental health practitioners (child and adolescent psychiatrists, psychologists, therapists, and trainees) in 3 different physical locations. Although BACA has been delivering telehealth services for years, insurance restrictions and provider attitudes restricted widespread adoption until COVID-19. COVID-19 impacted all aspects of care, including appointment requests, care modalities, the agency's financial stability, and provider attitudes on working via telemedicine vs in a physical office. Data relative to each of these topics were reviewed. Service requests were analyzed by reviewing the online form submitted to request services. Financial data were reviewed on a weekly basis, and provider attitudes were presented from an anonymous survey staff completed at the end of each month. Results: The first mention of COVID-19 was on March 23, 2020. The highest percentage of appointment requests with mention of the pandemic was during the week of April 27th when 9 out of 55 (16.4%) requests included mention of COVID-19. Overall, between March 23rd and May 31st, 32/378 (8.5%) of the appointment requests mentioned the pandemic. Financial data showed that compared to the week of March 9th, billed charges fell 31% during the week of March 16th, gradually recovered to 94% of pre-COVID levels during the week of April 20th, and then have been gradually declining to 74% for the week of May 25th. The staff survey given at the end of May revealed that even if shelter-inplace restrictions were lifted, 27/42 of staff respondents (64.3%) preferred to continue to work from home, and that only 5/42 (11.8%) were willing to come into the clinic to run groups even with proper social distancing. Conclusions: In the 13 years that BACA has been operating, there has never been an event that had such a wide-ranging impact on patients, clinicians, and operations. Maintaining fiscal viability while providing much needed services requires innovation around care models for child and adolescent psychiatry.

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of COVID-19 patients without and with an MHD was 5.36% vs 6.82% (p < 0.05). After adjustment for age, regression analysis showed that the relative risk of mortality was 29% (relative risk [RR] ¼ 1.29; 95% CI, 1.1-1.6; p ¼ 0.001) in COVID-19 patients with an MHD compared to those without. Finally, the mortality rate in African American COVID-19 patients was significantly higher (6.72% and 7.6% without and with an MHD, respectively) as compared to other ethnicities. The age-adjusted regression analysis showed that the RR of mortality was 35% (RR ¼ 1.35; 95% CI, 1.25-2.67; p ¼ 0.01) in African American COVID-19 patients with and without MHD, compared to the corresponding groups with other ethnicities. Conclusions: The findings of this study reveal an increased risk of mortality in COVID-19 patients across all ages, which is significantly higher in those with an MHD. Furthermore, the mortality rate was disproportionately higher in African Americans compared to the other ethnicities. In children and adolescents, COVID-19 and its related mortality, while uncommon, are still present.

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