Telehealth to the rescue for childrenā€™s mental health during COVID

As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread far and wide after its emergence in China, restrictions on social interactions, travel, leisure activities, and business interactions led to significant difficulties with meeting people in-person for the purpose of healthcare, unless for emergencies. Elective treatments, for example, were mostly postponed.

A new study published on the preprint server medRxiv* concludes that the lack of transportation led to impairments in child mental health services. However, the advent of telehealth services was found to reduce the negative correlation between caregiver transport and clinical outcomes in children.

Study: Child Mental and Behavioral Health Services During The COVID-19 Pandemic: Trends and Implications for Service Outcomes During Telehealth Expansion. Image Credit: VH-studio / Shutterstock.com

Background

In the United States, the non-pharmaceutical measures that were used to contain the spread of the SARS-CoV-2 severely impacted in-person visits with physicians and other healthcare providers. This led to a shift towards remote consultation, or telehealth, irrespective of the type of facility.

Across the spectrum of federal, state, and private insurance providers, telehealth coverage increased as policy shifts occurred. Telehealth technology underwent a fast expansion of use and, as a result, thousands of patients experienced its benefits in gaining access to healthcare without the risk of contracting the virus.

In the U.S., almost one in five children have a diagnosis of mental, behavioral, or developmental ill-health. Since the pandemic began, this population has seen an increasing number of mental health concerns; however, many caregivers from low-income or rural settings have found it difficult to access their healthcare providers.

It is estimated that almost a tenth of children from poor families, which is defined as those with an annual household income less than $50,000, miss key medical visits because they have no transportation even though, in some cases, insurance coverage was present. The long-term outcome for these patients is worse than for those who do not face transportation problems.

Earlier reports showed that telehealth coverage also varies by racial and ethnic backgrounds. Extensive research has also been done on the use of telehealth technology by older adults within long-term care facilities and in large hospitals.

The current study seeks to examine the deployment of telehealth in relation to patient outcomes in the U.S. among children served by public mental and behavioral healthcare facilities. Notably, many of these children have more than one problem relating to medical or psychosocial issues.

Study findings

The authors of the current preprint used data from the Idaho Child and Adolescent Needs and Strengths (CANS), which is a detailed behavioral evaluation for children that is the most widely used such tool for young people in the U.S. It is used initially and then at intervals of 90 days, and includes over 80 items across six domains.

The study shows that from April 1 to December 31, 2020, the number of CANS assessments declined by two-fold compared to the same period in 2019. Transportation problems were reported to be unresolved in more cases by the caregivers; however, the frequency of assessment increased.

Among individual groups, the number of registrations for girls, Whites, and Asians increased over this period.

In the pre-pandemic period, providing a solution to the problem of transport was linked to improved function among children in need. Specifically, childrenā€™s needs were being met 5% better. Children were functioning better, behaving better with better emotional regulation, and building new strengths.

Conversely, during the pandemic, this association was lacking. Moreover, pandemic-period improvements in strength and behavior-emotional domains were only half of those in the preceding period. This pattern agrees with that of several other healthcare delivery systems in the U.S.

Implications

The authors demonstrate that telehealth services reduced the impact of the shortfall in transportation facilities for caregivers. This was reflected in the improvement in clinical outcomes in children being treated at public facilities for mental and behavioral health.

ā€œOverall treatment effects did not significantly differ pre- and during pandemic, indicating that the care provided was of measurable value to children served during the pandemic.ā€

In fact, the Idaho Office of the Governor released data showing that telehealth service delivery had gone up 40-fold. Further research will be needed to understand the background in which these findings were obtained.

However, it seems clear that telehealth is here to stay. Doctors, scientists, and patients agree on the need to establish this option as a permanent one, and on the high satisfaction index reported by patients and providers. However, this does not excuse the lack of transportation for certain patient populations.

ā€œOne such systems-level change may be supporting and advocating for the continued use of telehealth for clients with transportation needs as a bridge to support service delivery while also working towards the resolution of transportation needs.ā€

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information

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