by Caitlin Anderson, PhD & Laura A. Shaffer, PhD, ABPP
Over the past year or so, we have been surrounded by news articles, headlines, and personal stories of youth and families struggling with their mental health. Whereas child and adolescent mental health has been a concern for many years, the COVID-19 pandemic has further highlighted and exacerbated the challenges our youth and families are facing. The crisis has not gone unnoticed. The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association declared a National Emergency in Child and Adolescent Mental Health in October 2021. Shortly thereafter, in December 2021, the U.S. Surgeon General released a Public Advisory on the Youth Mental Health Crisis.
Prior to the pandemic, children and adolescents were facing significant mental health challenges. As many as 1 in 5 children and adolescents were suffering from a mental health disorder and unfortunately, approximately 80 percent of children who needed mental health care did not receive it. Between the years 2016-2019, children’s hospital visits by 6-12 year olds for mental health care needs doubled, and there was a 60 percent increase in the rate of suicide for youth ages 10-24 from 2007 to 2018. These statistics are absolutely sobering, and the situation has only worsened over the past two years.
Youth and families faced numerous challenges during the pandemic that further impacted their mental health and socioemotional functioning. Specifically, the pandemic led to disruptions in routine, challenges with online learning, restricted peer interaction, economic strain, illness and death-related stress, caregiver mental illness, and overall increased levels of stress. As a result of these challenges, there have been notable increases in child and adolescent behavioral issues, anxiety, depression, eating disorders, substance abuse, suicide, and mental health-related emergency department visits.
Access to behavioral health resources and treatment was sorely lacking before the COVID-19 pandemic and has only worsened with the increased demands. Families are having to navigate long waitlists for services; emergency rooms are overwhelmed with youth needing inpatient care, and pediatricians are seeing an influx of pediatric patients reporting mental health concerns and families seeking help managing these symptoms. Although many children have returned to school, vaccines are widely available, and mask mandates are being lifted, we must remember that the impacts of the pandemic will be felt for years to come. Research shows us that the mental health fallout from disasters like the 911 attacks and Hurricane Katrina lasted up to ten years. We must find more ways to support our children, adolescents, and their families for decades to come.
Here at UVA Children’s, we were already working to improve pediatric behavioral health through direct clinical service, consultation, education, outreach, and scholarship. Our teams intensified these efforts over the course of the COVID-19 pandemic. Rapid transition to telehealth services afforded patients and families ongoing access to behavioral health care in the midst of so many other disruptions. The psychologists conducted their clinical services almost entirely by telehealth through the summer of 2021. Members of our team were instrumental in developing an interprofessional evaluation for Autism Spectrum Disorder so that children and families would not have to wait longer for diagnostic clarification. Approximately half of the visits to psychology and developmental pediatrics are still by telehealth.
In addition to delivering existing services in new ways, UVA Children’s expanded behavioral health services scope and volume. One new telehealth service is medication management follow up visits with developmental nurse practitioners for children and adolescents taking psychotropic medications. With funding from the Jefferson Trust, the psychologists developed telehealth group therapy programs to serve children and adolescents with anxiety, chronic pain, and behavior problems. Other growth efforts include the addition of a 5th faculty psychologist in September 2020, posting two new psychology positions to start a behavioral consult service for patients on inpatient medical units, working on proposals to expand the eating disorders and gender health programs, and planning for the new Neurodevelopmental and Behavioral Health Center at Riverside. UVA Children’s now also serves as the hub for the Western region of the Virginia Mental Health Access Project (VMAP), a statewide program to provide behavioral health consultation to pediatricians. Through all of this, our clinicians treating behavioral health concerns have been working incredibly hard in clinic, all seeing more patients and youth in much more distress than usual.
UVA Children’s efforts to improve child and adolescent behavioral health extend throughout our missions of education, scholarship, and community outreach. Our faculty have been actively involved in local, state, and national efforts to address the mental health crisis through various presentations, interviews, publications, research, and consultation. The need for child and adolescent behavioral health services far exceeds the capacity of any one entity. Through these efforts, we aim to better equip broader systems to prevent and address child and adolescent behavioral health concerns, thus improving the lives of youth and families.
For more information, please see:
Children’s Hospital Association. Focusing on Children’s Mental Health. May 2021
CDC Youth Risk Behavior Survey Data Summary & Trends Report 2009 – 2019 . October 2020.
Mental Health America. The State of Mental Health in America 2019.
Leeb RT, Bitsko RH, Radhakrishnan L, Martinez P, Njai R, Holland KM. Mental Health–Related Emergency Department Visits Among Children Aged <18 Years During the COVID-19 Pandemic — United States, January 1–October 17, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1675–1680. Available at: http://dx.doi.org/10.15585/mmwr.mm6945a3
Racine N, McArthur BA, Cooke JE, Eirich R, Zhu J, Madigan S. Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis. JAMA Pediatr. 2021 Nov 1;175(11):1142-1150. doi: 10.1001/jamapediatrics.2021.2482. PMID: 34369987; PMCID: PMC8353576.
C.S. Mott Children’s Hospital. How the Pandemic Has Impacted Teen Mental Health. March, 2021.
Virginia Chapter of the American Academy of Pediatrics. VA Pediatrician Survey: The Effects of COVID 19 on Children in Virginia. December 2020.
Filed Under: Features