PolicyLab

Editor’s note: This is part of our Mental Health Awareness Month blog post series, which focuses on how COVID-19 impacts child and family behavioral health. We invite you to check back for new posts or to follow along for updates on Twitter at @PolicyLabCHOP.

On a sunny morning in May, I sat at my kitchen table, coffee in hand, waiting for my Epic app to connect. Suddenly, I saw the bright smile of my three-year old patient (I’ll call her Helena) fill the screen. “Dr. Gans! I missed you! Want to see my room?” Helena’s father had recently lost his job, and her grandmother, or “Amma,” was ill with COVID-19. As she bounded around the house, her mother smiled wearily. “Hey Dr. Gans. It’s nice to see a familiar face. She’s just not herself these days. We’re all struggling.”

Telehealth has gotten a trial by fire during the COVID-19 pandemic. For those of us working on mental health issues with patients like Helena, telemedicine visits provide a window into our patients’ homes and lives that we may not have otherwise experienced. That’s proven invaluable, as the current crisis poses increased risk for issues like depression and anxiety. With additional regulatory changes, telemedicine can continue to improve children’s mental health care long after COVID-19 has peaked.     

COVID-19’s Mental Health Impacts on Children

We can all relate to some level of emotional turmoil in recent months. As a mother, I spend these days like most parents—helping my children navigate the extraordinary upheaval in their daily lives. As a primary care pediatrician at Children’s Hospital of Philadelphia (CHOP), I see firsthand the psychological toll coronavirus is taking on my patients. Every day, I receive calls from parents, worried about changes they see in their children’s mood, sleep and behavior, seeking advice on how to help them cope amid a pandemic.

COVID-19 has created a mental health crisis in our country, one that will have a long-lasting impact on children’s emotional health and well-being. Almost half of American adults sheltering in place have reported that their psychological health is suffering. Last week, the World Health Organization, in a sobering brief on the pandemic’s mental health effects, highlighted how children and adolescents are at risk for anxiety and post-traumatic stress amid school closures, family stress, social isolation and economic challenges.

How Telemedicine Can Play a Role to Support Children and Families

Mental health is particularly important during childhood, as many psychological conditions begin during these years. Early intervention makes a difference by reducing severity of symptoms and fostering resilience. Addressing such issues early can be a challenge during the pandemic, but telemedicine offers a valuable tool to address psychosocial needs while families are at home. Many studies show it is naturally well-suited for mental health care. The American Academy of Pediatrics has advocated for its use. Furthermore, patients—and their parents—like it.

Unfortunately, adoption of telemedicine in the United States has been slow. Until recently, federal and state regulations were fairly strict. Medicare patients had to be from rural or health professional shortage areas to be eligible. Reimbursement presented a challenge, since payments for telehealth appointments were decidedly lower than for in-person visits.

The COVID-19 emergency has started to change all of this. Agencies like the Centers for Medicare & Medicaid Services have eased restraints on many of these matters. In emergency COVID-19 authorization, Congress has also lifted restrictions on geographic requirements for telehealth services and types of electronic platforms.

As regulations have relaxed, health systems and pediatric practices across the country have increasingly embraced telehealth. In my office at CHOP’s Karabots Pediatric Care Center, we are using telemedicine in ways that are meaningful for our families. During lockdown, patients have been overwhelmingly positive about its use in their care.  

My patient, Helena, has always found it hard to talk about her feelings. But via Epic, she seemed more at ease. “This is my doll, Rosie. Want to sit in my pillow fort and talk?” “Of course,” I answered. As she played, Helena said quietly “Rosie is scared that her mommy will get sick like Amma and have to go away.” In her own home, with its familiar comforts, she was open and honest. And she was able to speak candidly with her regular doctor, who has known her since birth.

I spent the rest of the visit working with Helena and her family to develop strategies—making space in her room for yoga and practicing deep breathing techniques—and coordinate care. We planned for close follow up with me and our office psychologist (through CHOP’s Healthy Minds, Healthy Kids program) on a joint videoconference.

Sustaining Telemedicine Gains Post-COVID-19

With each visit, I have seen the potential for telemedicine to address children’s mental health needs. Still, it’s unclear whether the current, COVID-19-inspired enthusiasm for telehealth will continue in the years ahead. Further research into its effect on health outcomes and treatment adherence is needed. Policies to address sustainability—including ongoing evaluation of federal and state regulations, reimbursement for telehealth services, revisions of licensure requirements and initiatives supporting broad internet access—will be required.

However, as a pediatrician, I appreciate its value. Through telemedicine, my families let me into their lives—their vulnerable moments and their joys. I miss my patients deeply and look forward to the time when they can safely have visits in the office. In the meantime, during a time of incredible isolation, telehealth offers an opportunity to be present for them, to address their mental health needs and to create a sense of connection and community. 

Anjuli S. Gans, MD, is a primary care pediatrician at CHOP’s Karabots Pediatric Care Center and a Clinical Assistant Professor of Pediatrics at the University of Pennsylvania Perelman School of Medicine.