Rates of pediatric behavioral health conditions have skyrocketed in the wake of the COVID-19 pandemic.
As a result, the federal government has poured hundreds of millions of dollars into pediatric mental health services. Last year, the Biden administration pledged nearly $300 million to expand mental health services in schools, for instance.
Still, addressing the youth behavioral health crisis will likely be a multi-pronged approach that includes in-school services, primary care interventions, and wrap-around outpatient and digital services. More availability in acute care settings will also be critical, industry insiders told Behavioral Health Business.
“I think everyone’s trying to solve this from different angles, but the fact of the matter is, we have far too few resources and therapists to meet the demand,” Natalie Schneider, CEO of Fort Health, told BHB.
Fort Health provides pediatric telehealth services. The New York-based company recently raised $9 million in funding.
Recent CDC data revealed that 57% of teen girls and 29% of teen boys reported feeling persistently sad or hopeless in 2021. LGBQ+ teens were particularly impacted by behavioral health conditions, with more than half experiencing poor mental health and 22% attempting suicide in the previous year.
A focus on prevention
Schools have been the focus of federal funding and many provider partnerships. Historically, schools have struggled to meet the behavioral health needs of their students.
The National Association of School Psychologists recommends a ratio of one psychologist to every 500 students. However, only 8% of districts meet this recommendation, according to reporting from Education Week.
Although federal funding may be temporary, many in the industry anticipate that the boost could help give schools the right resources. It could also allow the education system to set up long-term programs for addressing youth mental health.
“There’s always that question of sustainability. The hope is that these funds, although a temporary boost, allow for things like increased salaries, new service lines and expanded service areas,” Rola Aamar, director of behavioral health solutions at Relias, told BHB. “In some sense, that may be just a temporary boost, but the hope is once some of these critical areas are established, it will open pathways for sustainability so that behavioral health organizations can implement practices that will sustain the service lines through reimbursement.”
Relias is a health care-focused firm that helps organizations train direct care teams. It also has a platform that tracks performance metrics.
As a result, many providers are looking to partner with schools to help tackle access issues and provide children services in schools and after school.
“Part of the solution is increasing funding. Part of the solution is schools partnering with third-party innovative companies like Brightline,” Naomi Allen, CEO of Brightline Health, told BHB. “We’ve begun exploring direct partnerships with schools by offering services directly to students as an extension of resources for families, when the school-sponsored resources are not enough. So we’re definitely seeing schools kind of hit the wall in terms of what they’re able to service.”
Brightline is a virtual pediatric behavioral health provider. It has raised about $212 million in funding.
Brightline isn’t the only youth-focused behavioral health provider teaming up with schools. In February, telehealth company Hazel Health inked a deal with the Los Angeles County Office of Education, LA Care Health Plan, Health Net and the LA County Department of Mental Health to offer students free access to behavioral health services.
Another way schools and behavioral health organizations are trying to promote mental wellbeing is through peer-training programs. For example, Relias has partnered with the National Council for Mental Wellbeing on a new peer-training program.
“Within the last couple of years, they’ve rolled out the Mental Health First Aid for youth and teens, and they’re seeing a lot of adoption in schools to help children and teenagers learn the signs of a mental health situation, how to ask questions, and how to help their peers find the resources and support they need,” Aamar said.
Beyond the school yard
Schools aren’t the only institutions that need to be involved in youth prevention efforts. There is also an opportunity for pediatricians to take an active role in screening and referring children to services.
“The new guidance from the U.S Prevention Task Force is screening for pediatric anxiety at the age of 8,” Allen said. “But the reality is, many pediatricians either don’t have the time to do effective screening or if they screen, they don’t have a place to then send those kids because there is such a dearth of clinicians. I do think there’s a real need for us to disrupt that and create better tools and resources and incentives for screening, but then also create really smooth referrals and workflows so that those pediatrician identified kids have a place to go.”
While there is still a lot of work to be done, the end goal for better prevention services is an integrated process between schools, third parties and medical practices, sources told BHB.
“We hear about it a lot from our clients that there is this growing desire to create a better streamlined referral process,” Aamar said. “Not just referrals from medical providers to behavioral health providers, but also from schools to behavioral health providers. With everything that has happened over the past couple of years, this referral process is still in development for a lot of providers and organizations. It will take significant coordination and effort to get off the ground.”
Addressing kids in crisis
While federal dollars and attention have gone to pediatric behavioral health prevention programs, there is still a large need for supporting children in crisis.
Over the last decade, children with behavioral health conditions are experiencing a longer length of stay in the emergency department. Research from the American Academy of Pediatrics found that the rate of prolonged length of stay for pediatric behavioral health patients increased from 16.3% in 2005 to 24.5% in 2016.
And wait times have only increased after the pandemic.
As a result, there has been an uptick in children’s hospitals across the country adding new inpatient mental health units. For example, in 2022, Children’s Minnesota, Texas Children’s and University of North Carolina Health all announced plans to open new inpatient units or facilities.
And while many of these children need more than outpatient services, not all need inpatient hospitalization.
This has given rise to the emergence of new intensive outpatient programs (IOP) for children and teens. In addition to a new inpatient unit, Texas Children’s is adding a number of preventative services including an IOP.
“One of the biggest things that we’ve noticed in our community is a lack of care for kids that are presenting with intermediate needs,” Dr. Karin Price, chief of psychology at Texas Children’s Hospital and an associate professor of pediatrics at Baylor College of Medicine, told BHB.”
Texas Children’s is a non-profit health system. It has several research institutes, community hospitals and a children’s health plan.
“We’ve got our emergency centers where kids can come in and get assessed, we’ve got some good outpatient care where kids can get their care,” Price continued. “But if we think about kids that might be presenting with a crisis, but who don’t need a psychiatric inpatient hospitalization, we have a significant gap there in thinking about where those kids could go.”
This type of program is typically three days a week for four to five hours a day, which allows kids to go to school and be at home with their families.
These types of programs also offer a step-down option for children who were in an inpatient program.
“The interventions that are happening within these intensive programs are really evidence based,” Price said. “Meaning that we are teaching kids skills that they need to cope with the difficulties that they are having or that we anticipate they might have, and engaging their families as well.”
Companies featured in this article:
