Treatment - Other
Treating youth in a global pandemic: Service patterns in public mental health care before and during COVID-19
Kalyn L. Holmes, M.A.
Graduate Research Assistant
University of Hawai’i at Manoa
Honolulu, Hawaii
Puanani J. Hee, Ph.D.
Clinical Data Director
State of Hawai'i, Dept of Health, Child & Adolescent Mental Health Division
Lihue, Hawaii
Trina E. Orimoto, Ph.D.
Clinical Psychologist
University of Hawai’i at Manoa
Honolulu, Hawaii
David S. Jackson, Ph.D.
Research & Evaluation Specialist
University of Hawai’i at Manoa
Honolulu, Hawaii
Max Sender, B.S.
Data Analyst
Hawaii Department of Health, Child and Adolescent Mental Health Division
Honolulu, Hawaii
Scott K. Shimabukuro, ABPP, Ph.D.
Acting Division Administrator
Hawaii Department of Health, Child and Adolescent Mental Health Division
Honolulu, Hawaii
Charles W. Mueller, Ph.D.
Professor
University of Hawai’i at Manoa
Honolulu, Hawaii
The COVID-19 pandemic has led to considerable life disruption for young people, bringing with it concerns regarding mental health impacts, treatment utilization, and clinical outcomes. National research has found increases in suicidal ideation, self-harm, depression, and anxiety in youth (Jefsen et al., 2020; Loades et al., 2020). Access to mental health services during and after the pandemic will be essential for youth and family wellbeing. To prepare for the wave of youth and families seeking services post-COVID and during future disasters, a deeper understanding of mental health systems during the pandemic is needed. The aims of this project are to report on youth enrollment, initial impairment, and treatment progress patterns before and during COVID-19 as well as describe pandemic related adaptions to services in a public mental health care system.
Enrollment and clinical data were collected from a statewide system which provides mental health services for thousands of youths and their families with serious emotional and behavioral challenges from July 2019 to February 2021. This included measures of functional impairment (care-coordinator report using the Child and Adolescent Functional Assessment Scale; CAFAS; Hodges & Kim, 2000) and problem severity (youth and caregiver reports using the Ohio Scales Problem-severity Total Score; Ogles et al., 2001). A subsample of families was also queried regarding telehealth services.
Initial review of enrollment numbers showed a drop in cases (33% decrease in applications from July 2019 to June 2020, relative to the same period the prior year), related to fewer new treatment referrals. The trend in the number of youths actively receiving services continued downward throughout the first year of the pandemic. In comparing fiscal years 2019 and 2020, average functional impairment scores (CAFAS; 92.3 to 93.5) and initial levels of emotional and behavioral problems (Ohio Scale; 30.0 to 29.5 parent report and 23.4 to 23.3 youth report) did not considerably change after COVID-19 onset. Improvement over time on both the CAFAS and caregiver reported Ohio Scale Problem Score were relatively comparable before and during the pandemic. The system of care under study implemented telehealth quickly by providing HIPAA compliant Zoom accounts to staff and contracted providers. Youth (57.7% and 56.2%, respectively) and caregivers (68% and 70.2%, respectively) reported similar rates of satisfaction with telehealth services provided in 2020 and 2021.
Lower service utilization during presumed increased community need suggests that some families who could benefit from services may not be receiving them. Given that those referred and enrolled in the system during the pandemic were at similar levels of severity, it might be that those experiencing more impairment were also those not accessing or unable to access services. This suggests a heightened need for novel approaches for increasing accessibility to and knowledge of available services including ways to ensure consistent access to care when typical pathways to treatment are unavailable. These factors will be especially important as we prepare for a potential increase in treatment need related to the current pandemic and future global emergencies.