Beyond the Byline: Kids’ untreated psychological health requirements position long-term effects
Modern Healthcare public health press reporter Steven Ross Johnson and healthcare facility operations reporter Alex Kacik speak about how the COVID-19 pandemic compounded systemic deficiencies in behavioral health care.
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Music Credit: Coffee by Cambo
Alex Kacik: Hi and welcome back to Modern Health care’s Beyond the Byline, where we provide a behind the scenes look into our reporting. I’m your host, Alex Kacik. I write about health center operations for Modern Health care. Today, I’m talking with Steven Johnson, our public health press reporter, to go over how the pandemic is affecting kids’ mental health. Hey, Steven. Thanks for beginning.
Steven Johnson: Hey. Thank you for having me.
Alex Kacik: For many years, you’ve blogged about how the healthcare system hasn’t served folks with depression, anxiety, and other behavioral health issues. Well, I understand you have actually covered a lot on the adult side, but this is an opportunity for you to get into the pediatric side, with this really excellent special report you came out with recently on the subject. I’m questioning, how has COVID-19 intensified these systemic shortfalls?
Steven Johnson: You know, I believe in some respects, COVID has really just exacerbated a number of the longstanding gain access to problems behavioral healthcare systems had for years. Before the pandemic, you had a system where a bit more than 42% of adults who experienced a psychological health issue got treatment and practically half of children under age 17 received services. I think COVID has actually done really two things to aggravate the issue. First, it’s extended seclusion at house. It’s caused tension to lots of households. That’s manifested into increased tension in your home, which has actually led to increased rates of domestic abuse. That’s all on the further, more severe end, but then on the less extreme end, more moderate end, just a lot of household stress, which causes tension, and children exposed to that become … That affects them, particularly at more youthful ages when they’re still developing mentally.
So second, school has actually been a huge support, which I didn’t realize going into this report, how much of an aid that school, having simply a school building, where kids come in and teachers and school nurses can examine them, identify any prospective problems they may have, that’s played a big part in terms of helping to capture kids early on for emotional and psychological issues. Without that, now that schools have been closing, classes have actually relocated to online, that’s actually hurt the capability for healthcare providers to be able to supply early interventions to kids.
Alex Kacik: There’s one line in your unique report that stuck out to me, “The increasing requirement among kids for psychological health services has many afraid that without more robust support, the country deals with a tsunami of unmet needs that the health system will not recover from for years.” So we see behavioral health problems, and connected so often with chronic conditions, whether it’s stress and anxiety, depression, or what have you, have a way of intensifying underlying concerns, and I envision can not just worry your body and how you recuperate, however likewise, you’ll require more services down the road. I’m questioning, simply in regards to these untreated mental health requirements, how those can manifest in the health care system over the long term.
Steven Johnson: Well, I think you strike it precisely on that point. You hit it right on the head in regards to what’s at threat here. Having a mental health disorder typically works together with having bad health results, physical health outcomes, whether that’s brought on by establishing riskier health behaviors, like smoking cigarettes or substance abuse, or being less able to handle your chronic health conditions. Now, clearly with children it’s various, since one, typical wise they’re typically much healthier than grownups, however early on, if they start developing these conditions or psychological concerns and they go unattended, unmanaged, without treatment, in time of their advancement, that affects them to a point where it can manifest into conditions.
Many people with full fledged identified psychological health disorders don’t begin to even show symptoms until they’re about 14 years old. Many specialists believe that a lot of the indications that a kid might be having a possible issue down the roadway can be detected earlier in age, however because it’s turned into a full blown condition, then they may have fallen through the fractures. And as you stated previously, that can manifest into issues relating to physical health, where you’re using health care far more typically, and then clearly the cost of that health care increases.
Alex Kacik: It appears like we’re hitting a turning point of sorts where folks are starting to legitimize the link between psychological and physical health. And I do not understand if the health care system has actually captured up yet to use the best kind of care to deal with both these requirements. But I do seem relatively a little bit more enthusiastic that as folks recognize how important the holistic element of care is, I think of there are some best practices emerging. Do you see that recognition at least play out more amongst these health systems or suppliers that you talk with?
Steven Johnson: I believe it’s a lot more widespread in the adult care setting, instead of pediatrics. There’s been a big push for a variety of years, taking a look at trying to incorporate behavioral healthcare within the main care settings. Though there’s been a bigger push, I think there’s been a bigger push in the adult clients. Pediatrics, there are still a few companies that are doing it, however it’s not as robust as you see it in grownups. I think that systems that are including social factors, such as hardship and food insecurity, housing problems, steady real estate issues, and even the impacts of racial discrimination, as part of their mental health risk evaluations for kids, I believe that’s been useful due to the fact that it enables them to think more holistically about all possible conditions that can impact a kid’s emotional and mental development.
In doing this report, I talked with a few suppliers who are doing that. And I believe that one of the overall typical styles, even if various systems have different programs and different strategies regarding how they tackle resolving this issue, I think one overall common theme that much of them have is that they attempt to create numerous points of contact to identify a child having a mental health issue, whether it is having a collaboration with the school, whether a neighborhood company or a church, or just the moms and dads, or normally it’s a mix of all of them. However I think those type of collaborations end up being a fundamental tenant of the techniques that they employ.
Alex Kacik: Let’s talk about access for a second and after that possibly we can enter into repayment, but you talked with a couple families, among which, they were having a hard time to get therapy for several of their kids during the pandemic, another one who is a partner and mother and had actually gone through a major traumatic occasion with her other half and after that stressed about her 8 month old. I’m wondering, what did you discover from them as they tried to get services for their kids? Were they readily available, and were there barriers to gain access to?
Steven Johnson: I think the one crucial takeaway that I obtained from both talking with Emily Hangen and Jennifer Pannone was just the pure sense of desperation that parents must be feeling today as they seek assistance for not just themselves, but their families, and finding that there was few to no options available right now. Even if they do whatever right, even if they have everything that they need in terms of they have resources, they have insurance protection, they’re qualified to get this kind of care, and yet due to the fact that there’s such a backlog for individuals who are just like them, who need those services, they either discover themselves not able to access a readily available provider or being put on a waiting list for months.
It creates a system where you discover yourself jumping through one hoop, then you find that there’s another hoop and there’s another hoop. So once you jump through the preliminary hoop of, alright, even accepting that, fine, I might have an issue that I need assistance to attend to, that’s one. And believe me, I’m not decreasing that. That’s a huge difficulty for lots of people to get rid of. Simply admitting there’s a problem is extremely essential, an essential primary step.
As soon as you surpass that, then trying to access a behavioral healthcare professional when there is just purely no one available, people are saying that, “Hey, we’re not taking on brand-new patients,” that’s another hurdle you have actually got to leap over. You have actually got to discover somebody who’s even taking clients. Then as soon as you do that, you’ve got to discover someone who takes your particular brand name of insurance coverage. And then once you get past that, if you’re fortunate sufficient to get past that, well, initially you might have to wait. And then after you wait, then you might have to determine a way to come up with the money out of your own pocket, even with insurance coverage considered, to be able to pay for the services that you’re getting. So it creates a system where it actually incentivizes people to quit a great deal of times or to postpone care.
Alex Kacik: And the Health care Expense Institute adds some information, simply taking a look at the claims information and the reimbursement rates for psychological health services, and I think this is mostly for adults, but enrollees in private strategies spent more expense because they headed out of network for mental health services more than six times as frequently as for other types of services. So this is a genuine concern here. And I imagine, I believe there were some waivers associated with terms of payment parity. I know payment parity, I understand there’s some state laws including that when it comes to telehealth. I’m wondering if you enter into, you know, we’re seeing scarcities especially for experts, so I envision the pediatric side, specifically, in backwoods and simply areas that aren’t highly populated.
So do you believe telehealth can fill deep space in some of these access concerns, but likewise, is it sustainable from a repayment viewpoint? Do you think that there’s the monetary incentives that would allow these care gaps to be filled through that medium?Steven Johnson
: In other words, in a word, no, right now. Telehealth has definitely been valuable throughout this time in terms of increasing the number of patients a professional can see, in addition to expanding the geographical scope in which they can offer services. So people in more rural parts of the country can get telehealth therapy from someone out of state, particularly if they reside in an area where there is a shortage of pediatric behavioral health care experts. And you mentioned the shortages in terms of the labor force, you see that on the adult end. It’s particularly bad in pediatrics.
So any issues with lacks you see on adult behavioral health care [inaudible], just multiply that by two or 3 when it pertains to pediatrics. I believe that a few of the regulative modifications that were made during the general public health emergency situation, as a result of the public health emergency situation, have actually been positive in regards to incentivizing. There’s more modifications that require to be made. I believe the 2 tests for telehealth in terms of what it has the ability to do, in terms of providing greater gain access to, is going to be when the pandemic ends and you have individuals that are more positive or feeling much better about going into the health center or into the care setting face to face.
With that being stated, the quintessential problem still exists, which is a scarcity, just a total scarcity of providers, even with telehealth. Telehealth assists in a sense that it assists to help those service providers that exist, I guess widen the scope of their services, to spread them a little more thin, for absence of a better term, however the problem still exists that there’s simply inadequate service providers. The workforce is just inadequate in terms of its numbers to meet the level of need that’s needed.
I believe one of the important things that struck me in doing the report the most was when I talked with Dr. Ken Duckworth at the National Alliance for Mental Illness, who stated bluntly, “It takes 8 years to make a social worker. It just took approximately 8 months to produce this mental healthcare pandemic.” So the issue is one that was years in the making. And it’s likely going to take that long, if not longer, to solve it.
Alex Kacik: I ‘d be interested to hear, too, if you follow up with some of those households down the road to see how they’re doing and see if they have actually had the ability to get the help they need for their kids and for themselves.
Well, hi, can’t thank you enough, Steven, for this work. It’s so important, and we appreciate you and all you do. And thanks for coming on with me. I actually, truly thank you so much.
Steven Johnson: Oh, thank you.
Alex Kacik: Thank you all for listening. If you ‘d like to subscribe and support our work, there’s a link in the show notes. You can sign up for Beyond the Byline wherever you listen to your podcasts and you can stay gotten in touch with our work by following Steven and I and Modern Health Care on Twitter and LinkedIn. We appreciate your assistance.
Published at Thu, 08 Apr 2021 10:00:00 +0000