Telepsychiatry Use Before and During the COVID-19 Pandemic Among Children Enrolled in Medicaid.

OBJECTIVE: This study examined telepsychiatry use among children enrolled in Medicaid before and during the COVID-19 pandemic. METHODS: A retrospective analysis was conducted of claims data from the Transformed Medicaid Statistical Information System for children (ages 3-17) with any mental health service use in 2019 (N=5,606,555) and 2020 (N=5,094,446). RESULTS: The number of children using mental health services declined by 9.1% from 2019 to 2020. Mental health services in all care settings (inpatient, outpatient, residential, emergency department, intensive outpatient/partial hospitalization) declined except for telehealth, which increased by 829.6%. In 2020, 44.5% of children using telehealth were non-Hispanic White, 16.1% were non-Hispanic Black, and 19.7% were Hispanic. Attention-deficit hyperactivity disorder, trauma, anxiety, depression, and behavior/conduct disorder were the most prevalent psychiatric diagnoses among children using telehealth services. CONCLUSIONS: Although telehealth use increased substantially in 2020, overall mental health service use declined among Medicaid-enrolled children. Telehealth may not fully address unmet mental health service needs.

Disparities in the Implementation of School-Based Mental Health Supports Among K-12 Public Schools.

OBJECTIVE: The authors sought to explore the availability of mental health supports within public schools during the COVID-19 pandemic by using survey data from a nationally representative sample of U.S. K-12 public schools collected in October-November 2021. METHODS: The prevalence of 11 school-based mental health supports was examined within the sample (N=437 schools). Chi-square tests and adjusted logistic regression models were used to identify associations between school-level characteristics and mental health supports. School characteristics included level (elementary, middle, or high school), locale (city, town, suburb, or rural area), poverty level, having a full-time school nurse, and having a school-based health center. RESULTS: Universal mental health programs were more prevalent than more individualized and group-based supports (e.g., therapy groups); however, prevalence of certain mental health supports was low among schools (e.g., only 53% implemented schoolwide trauma-informed practices). Schools having middle to high levels of poverty or located in rural areas or towns and elementary schools and schools without a health infrastructure were less likely to implement mental health supports, even after analyses were adjusted for school-level characteristics. For example, compared with low-poverty schools, mid-poverty schools had lower odds of implementing prosocial skills training for students (adjusted OR [AOR]=0.49, 95% CI=0.27-0.88) and providing confidential mental health screening (AOR=0.42, 95% CI=0.22-0.79). CONCLUSIONS: Implementation levels of school-based mental health supports leave substantial room for improvement, and numerous disparities existed by school characteristics. Higher-poverty areas, schools in rural areas or towns, and elementary schools and schools without a health infrastructure may require assistance in ensuring equitable access to mental health supports.

Availability of Outpatient Child Psychiatric Care During COVID-19: A Simulated-Patient Study in Three U.S. Cities.

OBJECTIVE: In this study, the authors sought to ascertain the availability of outpatient child psychiatric appointments in three U.S. cities. METHODS: Using a simulated-patient methodology, investigators called 322 psychiatrists who were listed in a major insurer's database for three U.S. cities, and they attempted to make appointments for a child with three payment types: Blue Cross-Blue Shield, Medicaid, and self-pay. RESULTS: Initial appointments were available 11% of the time, and it was most difficult to obtain an appointment under Medicaid coverage. Nineteen percent of phone numbers were wrong, and 25% of psychiatrists were not accepting new patients. CONCLUSIONS: These results are concerning given the current mental health crisis among youths and suggest the need for more psychiatrists, higher reimbursement rates for psychiatric services, and continued efforts to increase access to care. This study also highlights the need for insurance companies to maintain accurate information in their databases.

[Therapeutic meals in a psychiatric day hospital for children and sanitary restrictions: Institutional psychotherapy and Covid-19]. / Le repas thérapeutique en hôpital de jour de pédopsychiatrie à l'épreuve des contraintes sanitaires : thérapie institutionnelle et Covid-19.

In the context of the COVID-19 pandemic, the Pordegui children's hospital - a day psychiatric centre at Montauban hospital - first closed its doors in March 2019, like many ambulatory care facilities. As a result, the first confinement had a strong impact on the accessibility to care for particularly vulnerable patients. While the lockdown has been eased after a few weeks, the respect of hygiene rules and barrier gestures still impacts the therapeutic framework of the institution.This article aims to document reflections on the effects that the current arrangements, inherent to the pandemic health situation, seem to produce over the organization of care in psychiatric children's hospitals, using the example of therapeutic meals.The latter should not be taken for granted, even though the minimal conditions for this caring time have been reinstated. Such conditions include a repetitive, structuring and reassuring framework with schedules, collective arrangements characterized by the regular presence pattern of the caregivers and their availability, as well as feedback sessions in the form of institutional meetings. After the reopening of the center, specific phenomena that were not so identifiable during the other care times were noticed during the meals of individual and group of patients. A situational analysis was led, based on observations, experience with patients and cross-examination (institutional psychotherapy and phenomenology) in order to understand these movements and highlight what seems to be irreducible for a meal to be therapeutic.

Dispensing of psychotropic medications to Australian children and adolescents before and during the COVID-19 pandemic, 2013-2021: a retrospective cohort study.

OBJECTIVE: To determine longitudinal patterns of dispensing of antidepressant, anxiolytic, antipsychotic, psychostimulant, and hypnotic/sedative medications to children and adolescents in Australia during 2013-2021. DESIGN: Retrospective cohort study; analysis of 10% random sample of Pharmaceutical Benefits Scheme (PBS) dispensing data. PARTICIPANTS, SETTING: People aged 18 years or younger dispensed PBS-subsidised psychotropic medications in Australia, 2013-2021. MAIN OUTCOME MEASURES: Population prevalence of dispensing of psychotropic medications to children and adolescents, by psychotropic class, gender, and age group (0-6, 7-12, 13-18 years). RESULTS: The overall prevalence of psychotropic dispensing to children and adolescents was 33.8 per 1000 boys and 25.2 per 1000 girls in 2013, and 60.0 per 1000 boys and 48.3 per 1000 girls in 2021. The prevalence of psychotropic polypharmacy was 5.4 per 1000 boys and 3.7 per 1000 girls in 2013, and 10.4 per 1000 boys and 8.3 per 1000 girls in 2021. Prevalent dispensing during 2021 was highest for psychostimulants (boys, 44.0 per 1000; girls, 17.4 per 1000) and antidepressants (boys, 20.4 per 1000; girls, 33.8 per 1000). During 2021, the prevalence of dispensing was higher than predicted by extrapolation of 2013-2019 data for many classes, including antidepressants (boys: +6.1%; 95% CI, 1.1-11.1%; girls: +22.2%; 95% CI, 17.4-26.9%), and psychostimulants (boys: +14.5%; 95% CI, 8.0-21.1%; girls: +27.7%; 95% CI, 18.9-36.6%). The increases were greatest for girls aged 13-18 years (antidepressants: +20.3%; 95% CI, 16.9-23.7%; psychostimulants: +39.0%; 95% CI, 27.9-50.0%). CONCLUSIONS: The prevalence of both psychotropic dispensing and psychotropic polypharmacy for children and adolescents were twice as high in 2021 as in 2013. The reasons and appropriateness of the marked increases in psychotropic dispensing during the COVID-19 pandemic, particularly to adolescent girls, should be investigated.

An Emotional Bias Modification for Children With Attention-Deficit/Hyperactivity Disorder: Co-design Study.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is one of the common neurodevelopment disorders. Children with ADHD typically have difficulties with emotional regulation. Previous studies have investigated the assessment for underlying emotional biases using the visual probe task. However, one of the significant limitations of the visual probe task is that it is demanding and repetitive over time. Previous studies have examined the use of gamification methods in addressing the limitations of the emotional bias visual probe task. There has also been increased recognition of the potential of participatory action research methods and how it could help to make the conceptualized interventions more relevant. OBJECTIVE: The primary aim of this study was to collate health care professionals' perspectives on the limitations of the existing visual probe task and to determine if gamification elements were viable to be incorporated into an emotional bias modification task. METHODS: A co-design workshop was conducted. Health care professionals from the Department of Development Psychiatry, Institute of Mental Health, Singapore, were invited to participate. Considering the COVID-19 pandemic and the restrictions, a web-based workshop was conducted. There were 3 main phases in the workshops. First, participants were asked to identify limitations and suggest potential methods to overcome some of the identified limitations. Second, participants were shown examples of existing gaming interventions in published literature and commercial stores. They were also asked to comment on the advantages and limitations of these interventions. Finally, participants were asked if gamification techniques would be appropriate. RESULTS: Overall, 4 health care professionals consented and participated. Several limitations were identified regarding the conventional emotional bias intervention. These included the nature of the task parameters, included stimulus set, and factors that could have an impact on the accuracy of responding to the task. After examining the existing ADHD games, participants raised concerns about the evidence base of some of the apps. They articulated that any developed ADHD game ought to identify the specific skill set that was targeted clearly. Regarding gamification strategies, participants preferred economic and performance-based gamification approaches. CONCLUSIONS: This study has managed to elucidate health care professionals' perspectives toward refining a conventional emotional bias intervention for children with ADHD. In view of the repetitiveness of the conventional task, the suggested gamification techniques might help in influencing task adherence and reduce the attrition rates.

Telehealth ROCKS at home: Pandemic transition of rural school-based to home-based telebehavioral health services

School-based telebehavioral health is one avenue to increase students' access to mental health services, especially for students who are less likely to access traditional community mental health settings due to a lack of transportation to distant sites, financial resources, and other barriers. With the shortage of child behavioral specialists in Kansas' rural and underserved communities, the Telehealth ROCKS (Regional Outreach to Communities, Kids, and Schools) program was created to address student behavioral health needs at school through telehealth. Since 2018, this program has provided approximately 1,600 mental health appointments. With public health mandates and a shift to online school, the COVID-19 pandemic led to a rapid telehealth transition from services in rural supervised school settings to direct-to-consumer services in homes. The authors describe the challenges and opportunities experienced during this transition across telebehavioral health specialties: (a) developmental/autism assessments, (b) developmental behavioral interventions to address problem behaviors, (c) child and adolescent psychological services, (d) medical complexity services, and (e) child and adolescent psychiatry. The authors then describe the overall transition from school-based to home-based services based on national Guidelines for Evidence-Based Child Telebehavioral Health domains: Patient Appropriateness, Crisis Management/Safety, and Logistics/Administrative Protocols. This experience and lessons learned can inform other school-based telemental health programs considering expansion to home-based services. The authors also discuss evolving telehealth policy and the reimbursement environment, with continued relevance due to continued COVID-19 outbreaks impacting school services and future public health emergencies affecting schools. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement This report shares lessons learned when rapidly transitioning the Telehealth ROCKS rural telebehavioral health services from the supervised school setting to the unsupervised home setting during the COVID-19 pandemic to meet escalating student behavioral health needs. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The impacts of COVID-19 pandemic on children with neurodevelopmental disorder

Objective: In this study, we aimed to evaluate the impact of Covid-19 pandemic on children with neurodevelopmental disorders through Tele-Medicine system. Method: Children aged between 7-18 years old with neurodevelopmental disorders were evaluated. On the routine control visit day, they and their parents were called by phone via the Tele-Medicine system and a questionnaire prepared by the researchers was applied to evaluate the compliance process to the pandemic. The disease severity of the cases was evaluated by the Clinical Global Impression Scale. Results: In our study, 17.6% of the cases were girls and 82.4% were boys. The average age is 11.66 +/- 3.46 years. In this study 51% of the cases were diagnosed with Autism Spectrum Disorder;47.1% with Intellectual Disability and 17.6% with Special Learning Disorder. The comorbidity of Attention Deficit and Hyperactivity Disorder was found to be 49%. Increased anxiety is reported by 25.5% of the cases, appetite and nutritional problems by %37.3 and sleep pattern changes by 62.7%. Pre-pandemic score of Clinical Global Impression Scale was evaluated as 3.82 +/- 0.81, and the score during the pandemic as 4.09+/-0.87. Discussion: It was found that, in the early period of the Covid-19 pandemic, the most common problems of the cases with neurodevelopmental disorder were the sleep pattern changes, appetite and nutritional problems and increased anxiety. It is thought that our findings will guide psychosocial support interventions for children and adolescents with developmental problems during the pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Turkish) Amac: COVID19 pandemisinin, norogelisimsel bozuklugu olan cocuklar uzerine olan etkisinin Tele-Tip uygulamasi ile degerlendirilmesi amaclanmistir. Yontem: Calismada, norogelisimsel bozukluk tanisi olan 7-18 yas araligindaki cocuk ve gencler degerlendirilmistir. Randevu tarihlerinde Tele-Tip Sistemi kapsaminda telefonla aranip kendileri ve ebeveynleriyle gorusulmus, pandemiye uyum surecini degerlendirmek amaciyla arastirmacilarin hazirladigi anket uygulanmistir. Pandemi oncesi ve sonrasi hastalik siddeti Klinik Global Izlenim Olcegi ile degerlendirilmistir. Bulgular: Degerlendirilen 51 olgunun %17.6'si kiz, %82.4'u erkektir. Yas ortalamasi 11.66 +/- 3.46 yildir. Calismaya alinan olgularin %51'i Otizm Spektrum Bozuklugu;%47.1'i Zihinsel Yetersizlik;%17.6'si Ozel Ogrenme Bozuklugu tanisi ile izlenmektedir. Dikkat Eksikligi ve Hiperaktivite Bozuklugu komorbiditesi %49 olarak saptanmistir. Olgularin %25.5'i kaygi artisi, %37.3'u istah ve beslenme duzeni degisikligi, %62.7'si uyku degisikligi bildirmistir. Olgularin pandemi oncesi Klinik Global Izlenim Olcegi puani 3.82+/-0.81, pandemi surecindeki puani 4.09+/-0.87 olarak degerlendirilmistir. Sonuc: Covid-19 pandemisinin erken doneminde, norogelisimsel bozukluk tanisi ile izlemde olan cocuk ve genclerin en sik uyku duzeni degisiklikleri, istah ve beslenme sorunlari ve kaygi artisi saptanmistir. Bulgularimizin pandemi surecinde gelisimsel sorunlari olan cocuk ve genclere yonelik gelistirilecek psikososyal destek mudahalelerine yol gosterici olacagi dusunulmustur. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Emerging challenges in child psychiatry practices in the post-pandemic era

Following the Covid pandemic, there are various changes in the presentation and management of childhood psychiatric disorders. The introduction of telepsychiatry for delivering therapies has its own merits and demerits. However, as a consequence of the lack of one-on-one therapy and regular consultation with a child psychiatrist which is essential for the management of neurodevelopmental disorders, detrimental effects in terms of an increase in symptoms and behavioral problems were observed. Increased identification of cases of neurodevelopmental disorders especially ADHD and autism has escalated the burden on caregivers and treating professionals. These all need to be addressed in the post-pandemic situation calling for novel approaches for better service delivery on part of the psychiatrist in advising home-based therapies rather than depending on therapy centers. Due to the disruption of routine schooling during Covid pandemic, children are facing problems in adjusting to regular school postpandemic, especially children belonging to younger age groups. Most of these children are presenting with multiple somatic complaints to avoid attending school leading to a decline in scholastic performance. Other factors such as changing schools and increased screen time have an additive role in school refusal. These are the major factors that affected most school-going children. This scenario has been increasing and has to be tackled by employing a multidisciplinary approach involving psychiatrists, psychologists, parents and school authorities. Several studies demonstrate that early identification of the problem of school refusal and an early reintroduction to school has a good prognosis. Electronic gadget usage is on the rising trend bringing about its own set of challenges including internet addiction and gaming disorders. Psychiatrists should address these problems delicately, understanding the child's point of view which may require out-of-the-box approaches.

Approaches of patients to health care before and during the COVID-19 pandemic

Aim: In the present study, the aim is to determine the approaches of patients to healthcare services before and during the pandemic by comparing the rates of outpatient admissions and hospitalizations to Selcuk University Medical Faculty Hospital throughout the present study. Material(s) and Method(s): The present study is a retrospective, descriptive study. Patients diagnosed with COVID were admitted to Selcuk University Medical Faculty Hospital on March 5, 2020. During the pandemic, no patients diagnosed with COVID were admitted to the adult cardiology, neurology, internal medicine, psychiatry, emergency, general surgery and pediatric emergency, pediatric psychiatry, pediatrics and pediatric surgery polyclinics and services. Hence, these clinics were included in the study. In the study, patients' data who applied to the relevant clinics of Selcuk University Medical Faculty Hospital or were hospitalized in the relevant clinics, including the years 2019, 2020 and 2021, were examined as pre-pandemic (2019) and pandemic period (2020, 2021) quarterly. The parameters of the present study were the pre-pandemic and pandemic period. The data obtained in the study were evaluated with descriptive statistics (as frequency and percentage). Result(s): In the first year of the pandemic, it was determined that both the number of outpatient clinic referrals and hospitalizations to the relevant clinics decreased significantly. Although the impact of epidemic diseases, emerging throughout human history has decreased, the risk they carry is systematically exaggerated, and the fears of the public fueled constantly by the media. Discussion(s): Unfortunately, this fear in society was also reflected in hospital admissions. Therefore, to manage medical services correctly during pandemics, planned and organized psychosocial support services are needed to preserve the mental health of the community as well as to enable appropriate medical interventions.Copyright © 2023, Derman Medical Publishing. All rights reserved.

Pilot Study of the MAP Curriculum for Psychotherapy Competencies in Child and Adolescent Psychiatry.

OBJECTIVE: This pilot study aimed to evaluate the relevance, feasibility, acceptability, and instructional efficacy of the Managing and Adapting Practice (MAP) curriculum for enhancing the teaching of psychotherapy to child and adolescent psychiatry (CAP) fellows. MAP is a system of resources and decision models that supports practitioners in selecting and implementing psychotherapeutic interventions for children and adolescents. The MAP curriculum includes modules to guide education about psychotherapeutic procedures (e.g., behavioral activation) common in evidence-based treatments for an array of childhood problems and to support development of competencies in assessment, treatment planning, and reflective practice. METHODS: Curriculum coding was used to examine the relevance of MAP's core components to the skills articulated in the Accreditation Council for Graduate Medical Education (ACGME) CAP milestones. Feasibility, acceptability, and learning outcomes were examined after delivery of the MAP curriculum to 12 CAP fellows at two sites, with instructional features tailored according to faculty preferences and training program structure. RESULTS: Coding suggested that the MAP curriculum was relevant to 95% of the 21 ACGME CAP training subcompetencies. Feasibility was indicated by the successful delivery of 100% of the planned MAP curriculum across the two sites. Acceptability was supported by positive feedback from the CAP fellows, and psychotherapy knowledge increased significantly. Finally, case review scores (mean±SD=2.21±0.15) showed positive posttraining application of MAP to two patients and exceeded scores achieved by other samples of mental health professionals. CONCLUSIONS: This pilot study demonstrated the potential for the MAP curriculum to support CAP education. MAP's versatility as a curriculum supports broader adoption, with continuing rigorous empirical evaluation.

Experiences of parents of children with psychiatric disorder from Covid-19 pandemic and its related quarantine: A qualitative study.

Introduction: Owing to the considerable mortality caused by Covid-19, different countries have made some decisions for dealing with this virus, one of which was quarantine. It was shown that a range of behavioral and emotional changes may exacerbate in children while staying more at home, and parents may then experience these positive or negative behavioral changes. The present study was conducted to examine the experiences of families with children with psychiatric disorders in a psychiatric outpatient clinic in Iran. Method: The phenomenological method, which is a qualitative approach, was used in this study. The population was the parents of children with psychiatric disorders referred to the pediatric psychiatric clinic of Imam Hossein Hospital. Sampling was purposeful, which continued until data saturation. Finally, the number of included participants reached 14. As well, the Colaizzi method was used for data analysis. Results: The results of this study included 12 secondary codes and 10 tertiary codes, which were divided into three main thematic groups as follows: effective factors for improving behavior, effective factors for worsening behavior, and affective factors on creating a new behavior during quarantine. Conclusion: In conclusion, quarantine, social restrictions, closure of schools, and online classes can affect the mental health status of children and adolescents in different ways, especially in children with a history of psychiatric disorders.

Retrospective and comparative study about the impact of the health crisis on the activity of a pedopsychiatric emergency unit

Objectives: The aim of this retrospective study was to question the psychological consequences of the health crisis in a pediatric population, through an analysis of the variations in the activity data of a pedopsychiatric emergency consultation service. Material(s) and Method(s): The present study is a retrospective and comparative epidemiological study based on an analysis of activity data from a pedopsychiatric emergency consultation at the Lille University Hospital center collected over the period contemporary of the social restriction measures of March 17th, 2020 to May 19th, 2021 as well as those collected after the lifting of these measures from May 19th, 2021 to May 31st, 2022 by comparing them to the activity on this same service over the equivalent periods between January 1st, 2017 and March 17th, 2020. Comparisons centered around the three confinement periods were also carried out. Any patient between 0 and 18 years old taken care of in this emergency consultation was included in this study. Result(s): A significant increase in drug prescriptions and consultations for suicidal ideations was observed during, but also at a distance from social restriction measures. The first confinement was marked by a significant drop in the number of consultations and a significant increase in the drafting of child protection documents. Discussion(s): These results were therefore in favor of an increase in suicidality in the pediatric population during and after the lifting of social restriction measures, as well as an increase in situations relating to child protection during the first confinement. The significant increase in discordant discharge drug prescriptions with the more modest increase in hospitalizations foreshadowed a mismatch between needs and hospitalization capacity. Conclusion(s): An impact of the health crisis could therefore be observed on the activity of a pedopsychiatric emergency consultation during, but also after the lifting of social restriction measures. This raises the importance of not limiting research to periods of confinement, as well as the question of the reversibility of the variations observed for the generation considered. Copyright © 2022 Elsevier Masson SAS

Alone (together): becoming a parent in the pandemic

This paper draws on the author's own experience of becoming a parent during the Covid-19 pandemic as a starting point from which to explore, and consider, how the experience of new parenthood was profoundly affected by the unusual and challenging circumstances created by the pandemic. Using a psychoanalytic lens, the author considers the legacy effects of Covid-19 restrictions and the atmosphere of heightened anxiety and danger, on the families who welcomed their first child in 2020 or 2021. The paper brings into focus the simultaneous experience of increased isolation and the withdrawal of support that would ordinarily be offered to new parents, along with the increased opportunities for closeness and early bonding this might bring, and considers how these factors might interrelate. It considers the changes to fatherhood that the pandemic created, and examines the benefits as well as pitfalls of the unusual circumstances brought about by successive lockdowns in the UK. The paper also explores the role that child psychotherapy has, as a profession, to examine and understand this experience for new parents and children born in the pandemic. Copyright © 2023 Association of Child Psychotherapists.

Geographic Trends in Pediatric Psychotropic Medication Dispensing Before and After the Start of the COVID-19 Pandemic.

OBJECTIVE: This study examined trends and geographic variability in dispensing of prescription psychotropic medications to U.S. youths before and after the start of the COVID-19 pandemic. METHODS: Using national data on prescription medication dispensing, the authors performed a cross-sectional study examining the monthly percent change in psychotropic medications dispensed (total N=95,639,975) to youths (ages 5-18 years) in 2020 versus 2019, across medication classes and geographic regions. RESULTS: For many medications, more were dispensed in March 2020 than in March 2019 and fewer in April-May 2020 versus April-May 2019. Stimulants had the largest decline: -26.4% in May 2020 versus May 2019. The magnitude of the monthly percent change varied by region. CONCLUSIONS: Fewer psychotropic medications were dispensed to U.S. youths after the start of the COVID-19 pandemic compared with 2019. Although some medication classes rebounded to prepandemic dispensing levels by September 2020, dispensing varied by class and region.