From Pandemic to Progression: An Educational Framework for the Implementation of Virtual Mental Healthcare for Children and Youth as a Response to COVID-19

Doan, Bridget T.; Yang, Yue; Romanchych, Erin; Grewal, Seena; Pignatiello, Tony; Bryden, Pier; Kulkarni, Chetana

doi:10.1007/s10879-020-09478-0

Cited by 16 publications

(24 citation statements)

References 10 publications

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“…Programs rapidly pivoted to home-based telehealth practice to continue providing care for their patients, while following site and state/province recommendations to shelter at home at the start of the pandemic. This rapid transition created new stressors for providers and families, 14 including coping with stressors related to sheltering at home, managing home schooling, and, for some individuals, sharing devices and Internet bandwidth. Each program paved its own way to delivering home-based telehealth services in the context of local regulatory requirements, reimbursement environment, hospital resources, patient clinical needs, and patient and provider receptivity.…”

Section: Discussionmentioning

confidence: 99%

The Transition of Academic Mental Health Clinics to Telehealth During the COVID-19 Pandemic

Folk

Schiel

Oblath

et al. 2022

Journal of the American Academy of Child & Adolescent Psych

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Objective: A consortium of 8 academic child and adolescent psychiatry programs in the United States and Canada examined their pivot from inperson, clinic-based services to home-based telehealth during the COVID-19 pandemic. The aims were to document the transition across diverse sites and to present recommendations for future telehealth service planning. Method: Consortium sites completed a Qualtrics survey assessing site characteristics, telehealth practices, service use, and barriers to and facilitators of telehealth service delivery prior to (pre) and during the early stages of (post) the COVID-19 pandemic. The design is descriptive. Results: All sites pivoted from in-person services to home-based telehealth within 2 weeks. Some sites experienced delays in conducting new intakes, and most experienced delays establishing teleÀgroup therapy. No-show rates and use of telephony versus videoconferencing varied by site. Changes in telehealth practices (eg, documentation requirements, safety protocols) and perceived barriers to telehealth service delivery (eg, regulatory limitations, inability to bill) occurred preÀ/postÀCOVID-19. Conclusion: A rapid pivot from in-person services to home-based telehealth occurred at 8 diverse academic programs in the context of a global health crisis. To promote ongoing use of home-based telehealth during future crises and usual care, academic programs should continue documenting the successes and barriers to telehealth practice to promote equitable and sustainable telehealth service delivery in the future.

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Section: Discussionmentioning

confidence: 99%

The Transition of Academic Mental Health Clinics to Telehealth During the COVID-19 Pandemic

Folk

Schiel

Oblath

et al. 2022

Journal of the American Academy of Child & Adolescent Psych

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“…As the COVID-19 pandemic evolves, access to mental health care for children and adolescents will become increasingly important and will stimulate the field to utilize innovations in mental health care delivery during the crisis and beyond. 24,25 While physical distancing measures have mandated the rapid uptake of tele-mental health services use during the pandemic, 26,27 an iterative approach is warranted for its implementation and evaluation with broad system-level considerations in order to ensure access matches the current and changing needs of the population. Furthermore, child and youth mental health services have long been under-resourced, 28 with many accessing the mental health care system for the first time in the ED.…”

Section: Discussionmentioning

confidence: 99%

Health System-Level Evaluation of Tele-Mental Health Services Among Children and Adolescents in Ontario, Canada

et al. 2021

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Objective To describe the characteristics of children and adolescents receiving tele-mental health services in Ontario, Canada and examine access to a psychiatrist, in-person or via tele-mental health services, following a mental health and addictions (MHA)-related emergency department (ED) visit or hospitalization. Method Using linked health and administrative data, we described two cohorts: (1) children and adolescents (1–18 years) who used a provincial tele-mental health programme from January 1, 2013 to March 31, 2017, comparing their MHA-related service use (outpatient, ED, hospitalization) in the 1 year prior to and the 1 year following initial consultation; (2) children and adolescents with high mental health service needs, defined as those with an incident MHA-related ED visit or hospitalization between January 1, 2013 and December 31, 2016, examining their 1-year follow-up with telemedicine and other health care utilization. Results In the first cohort, 7,216 children and adolescents (mean age 11.8 [±3.8] years) received tele-mental health services. The proportion of MHA-related ED visits [15.1% pre vs. 12.6% post (test statistic 23.57, P < 0.001)] or hospitalizations [10.2% pre vs. 8.7% post (test statistic 11.96, P < 0.001)] declined in the year following tele-mental health consultation, while local psychiatry visits increased [8.4% pre vs. 17.0% post (test statistic 298.69, P < 0.001)]. In the second cohort ( n = 84,033), only 1.5% received tele-mental health services, 40.7% saw a psychiatrist in-person, and 32.5% received no MHA-related outpatient care in follow-up. Conclusions Tele-mental health services were rarely used in Ontario, even among high-needs children and adolescents, despite their association with increased access to care and less need for acute mental health care.

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“…Parents might have been hesitant to access primary care settings during periods of lockdown due to fears of contracting the virus or public messaging discouraging in-person service access, aside from cases of emergencies ( 35 ). In relation to online service delivery, concerns of confidentiality of sessions, privacy of client information, and clinician competency and training in online service provision also have the potential to impact the uptake of these services during this time ( 80 – 83 ).…”

Section: Discussionmentioning

confidence: 99%

“…Considering that families in these neighborhoods are at the greatest risk for exposure to pandemic-related stressors ( 42 , 43 ), this decline likely does not reflect a decline in need for such services within these communities. While many mental health agencies shifted to online service delivery during the pandemic ( 80 ), this mode of service delivery may not be accessible to all families, especially those living in low-income neighborhoods who might not have access to the tools and technology required for online assessments ( 42 , 84 ). For example, children living within families with lower incomes are disproportionately less likely to have access to internet at home, and more than one device per household, for the use of online services ( 80 , 84 ).…”

Section: Discussionmentioning

confidence: 99%

“…While many mental health agencies shifted to online service delivery during the pandemic ( 80 ), this mode of service delivery may not be accessible to all families, especially those living in low-income neighborhoods who might not have access to the tools and technology required for online assessments ( 42 , 84 ). For example, children living within families with lower incomes are disproportionately less likely to have access to internet at home, and more than one device per household, for the use of online services ( 80 , 84 ). Moreover, considering that areas with the highest levels of material deprivation (e.g., educational attainment, income, and housing) in Ontario experienced disproportionately higher rates of transmission ( 85 ), it is also possible that families within lower income neighborhoods were more hesitant to send their children back to school during the second wave ( 86 , 87 ).…”

Section: Discussionmentioning

confidence: 99%

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Following the Epidemic Waves: Child and Youth Mental Health Assessments in Ontario Through Multiple Pandemic Waves

et al. 2021

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Emerging studies across the globe are reporting the impact of COVID-19 and its related virus containment measures, such as school closures and social distancing, on the mental health presentations and service utilization of children and youth during the early stages of lockdowns in their respective countries. However, there remains a need for studies which examine the impact of COVID-19 on children and youth's mental health needs and service utilization across multiple waves of the pandemic. The present study used data from 35,162 interRAI Child and Youth Mental Health (ChYMH) assessments across 53 participating mental health agencies in Ontario, Canada, to assess the mental health presentations and referral trends of children and youth across the first two waves of the COVID-19 pandemic in the province. Wave 1 consisted of data from March to June 2020, with Wave 2 consisting of data from September 2020 to January 2021. Data from each wave were compared to each other and to the equivalent period one year prior. While assessment volumes declined during both pandemic waves, during the second wave, child and youth assessments in low-income neighborhoods declined more than those within high-income neighborhoods. There were changes in family stressors noted in both waves. Notably, the proportion of children exposed to domestic violence and recent parental stressors increased in both waves of the pandemic, whereas there were decreases noted in the proportion of parents expressing feelings of distress, anger, or depression and reporting recent family involvement with child protection services. When comparing the two waves, while depressive symptoms and recent self-injurious attempts were more prevalent in the second wave of the pandemic when compared to the first, a decrease was noted in the prevalence of disruptive/aggressive behaviors and risk of injury to others from Wave 1 to Wave 2. These findings highlight the multifaceted impact of multiple pandemic waves on children and youth's mental health needs and underscore the need for future research into factors impacting children and youth's access to mental health agencies during this time.

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From Pandemic to Progression: An Educational Framework for the Implementation of Virtual Mental Healthcare for Children and Youth as a Response to COVID-19

Cited by 16 publications

References 10 publications

The Transition of Academic Mental Health Clinics to Telehealth During the COVID-19 Pandemic

The Transition of Academic Mental Health Clinics to Telehealth During the COVID-19 Pandemic

Health System-Level Evaluation of Tele-Mental Health Services Among Children and Adolescents in Ontario, Canada

Following the Epidemic Waves: Child and Youth Mental Health Assessments in Ontario Through Multiple Pandemic Waves

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