Disaster Mental Health
Evidence-Based Youth Services Through the Pandemic: Using Technology and Behavioral Therapies to Support Community Need and Enhance Access to Care
Suh Jung "Rylee" Park, B.A.
Ph.D. Student
University of Missouri-Columbia
Columbia, Missouri
Siena Tugendrajch, M.A.
Doctoral Candidate/Clinical Intern
University of Missouri-Columbia
Webster, New York
Evelyn Cho, Ph.D.
Postdoctoral Fellow
Harvard University
Cambridge, Massachusetts
Erika M. Waller, Ph.D.
Associate Teaching Professor
University of Missouri
Columbia, Missouri
Jenna Strawhun, Ph.D.
Psychologist
University of Missouri
COLUMBIA, Missouri
Kristin M. Hawley, Ph.D.
Associate Professor
University of Missouri-Columbia
Columbia, Missouri
Debora J. Bell, Ph.D.
Professor
University of Missouri
Columbia, Missouri
The COVID-19 pandemic created unprecedented increases in emotional and behavioral distress as youth and families faced health concerns and substantial changes to school, work, and social contacts (e.g., Xiong et al., 2020). Pandemic-related school and mental health agency closures also created challenges in usual routes of access to mental health care. As transition to telehealth-delivered mental health services allowed many families to access much-needed care, it is critical that behavioral scientists and service providers evaluate the impact of such services. The current study addresses three important questions about the impact of telehealth behavioral therapy services during the pandemic: (1) Who did telehealth services reach (e.g., to what extent were telehealth services associated with restriction or diversification in client demographics) as compared to pre-COVID-19? (2) How did service utilization patterns change for telehealth services (e.g., average number of sessions, rates of premature termination) as compared to pre-COVID-19? (3) How did client outcomes compare to pre-COVID-19 services (e.g., was telehealth during the high stress of the pandemic associated with lower improvement)?
We examined data collected as part of a youth services program at a university-based community-serving clinic in the Midwest. The clinic provided an array of evidence-based behavioral therapies to address common youth concerns (e.g., anxiety, depression, challenging behaviors, school performance and interpersonal concerns), as well as acute COVID-19 related distress during the pandemic. We compare demographics (age, gender, race, ethnicity, income), service utilization (average number of sessions, treatment completion vs. premature termination), and clinical outcomes (diagnostic status, symptom severity, adaptive functioning) for 2-19 year old clients served in the two years prior to the pandemic (n=398; 2018-2019) and the two years of the pandemic (n=374; 2020-2021). Preliminary analyses indicate that compared to pre-pandemic, clients receiving telehealth after the start of the pandemic were somewhat more likely to be female, Hispanic, and in middle or high school vs. elementary aged, perhaps reflecting an increased focus on emotional concerns during the pandemic (more frequently reported by girls and older youth). Clients receiving telehealth were somewhat more racially diverse than immediately pre-pandemic (2019), but less likely to fall below 200% of the federal poverty line, suggesting that telehealth may have reduced race/ethnicity-related but not income-related barriers to care. Compared to pre-pandemic, clients’ diagnostic improvement was greatly reduced during the pandemic, with only a minority of clients showing diagnostic remission or recovery. Improvements in symptom severity and adaptive functioning were also lower during the first year of the pandemic (2020), but were comparable to pre-pandemic levels in 2021. Results have important implications for understanding access to care and clinical outcomes during emergencies such as the COVID-19 pandemic.