Impact of the COVID-19 Pandemic on Child and Adolescent Mental Health Policy and Practice Implementation

Lawrence A. Palinkas, Jessenia De Leon, Erika Salinas, Sonali Chu, Katharine Hunter, Timothy M. Marshall, Eric Tadehara, Christopher M. Strnad, Jonathan Purtle, Sarah McCue Horwitz, Mary M. McKay and Kimberly E. Hoagwood
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Lawrence A. Palinkas: Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA
Jessenia De Leon: Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA
Erika Salinas: Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA
Sonali Chu: Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA
Katharine Hunter: Office of Child and Family Services, Virginia Department of Behavioral Health and Developmental Services, Richmond, VA 23218, USA
Timothy M. Marshall: Office of Community Mental Health, Connecticut Department of Children and Families, Hartford, CT 06103, USA
Eric Tadehara: Utah Department of Human Services, Substance Abuse and Mental Health, Salt Lake City, UT 84116, USA
Christopher M. Strnad: Office of Children’s Behavioral Health, Department of Children, Youth and Families, Providence, RI 02903, USA
Jonathan Purtle: Department of Health Management & Policy, Drexel University Dornsife School of Public Health, Philadelphia, PA 19104, USA
Sarah McCue Horwitz: Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY 10016, USA
Mary M. McKay: George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63130, USA
Kimberly E. Hoagwood: Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY 10016, USA

IJERPH, 2021, vol. 18, issue 18, 1-21

Abstract: Background: The impact of the 2019 coronavirus pandemic on the mental health of millions worldwide has been well documented, but its impact on prevention and treatment of mental and behavioral health conditions is less clear. The COVID-19 pandemic also created numerous challenges and opportunities to implement health care policies and programs under conditions that are fundamentally different from what has been considered to be usual care. Methods: We conducted a qualitative study to determine the impact of the COVID-19 pandemic on implementation of evidence-based policy and practice by State Mental Health Authorities (SMHA) for prevention and treatment of mental health problems in children and adolescents. Semi-structured interviews were conducted with 29 SMHA representatives of 21 randomly selected states stratified by coronavirus positivity rate and rate of unmet services need. Data analysis with SMHA stakeholders used procedures embedded in the Rapid Assessment Procedure—Informed Community Ethnography methodology. Results: The need for services increased during the pandemic due primarily to family stress and separation from peers. States reporting an increase in demand had high coronavirus positivity and high unmet services need. The greatest impacts were reduced out-of-home services and increased use of telehealth. Barriers to telehealth services included limited access to internet and technology, family preference for face-to-face services, lack of privacy, difficulty using with young children and youth in need of substance use treatment, finding a Health Insurance Portability and Accountability Act (HIPAA)-compliant platform, training providers and clients, and reimbursement challenges. Policy changes to enable reimbursement, internet access, training, and provider licensing resulted in substantially fewer appointment cancellations or no-shows, greater family engagement, reduction in travel time, increased access for people living in remote locations, and increased provider communication and collaboration. States with high rates of coronavirus positivity and high rates of unmet need were most likely to continue use of telehealth post-pandemic. Despite these challenges, states reported successful implementation of policies designed to facilitate virtual services delivery with likely long-term changes in practice. Conclusions: Policy implementation during the pandemic provided important lessons for planning and preparedness for future public health emergencies. Successful policy implementation requires ongoing collaboration among policy makers and with providers.

Keywords: COVID-19; mental health services; children and adolescents; telehealth; policy; implementation (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (2)

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