Disclaimer: Moving Health Care Upstream is a collaborative effort originally co-led by Nemours Children’s Health System (Nemours) and the Center for Healthier Children, Families & Communities at the University of California- Los Angeles (UCLA). The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of Nemours Children’s, UCLA or the Moving Health Care Upstream initiative.
• Joshua Ogburn, Manager of Policy, Nemours Children’s Health
• Daniella Gratale, Director of the Office of Child Health Policy and Advocacy, Nemours Children’s Health
• Tyler Jakab, former Program and Policy Analyst, Nemours Children’s Health
A growing mental, emotional and behavioral (MEB) health crisis among children and youth has been unfolding as children and families have experienced economic, social, and emotional challenges compounded by the pandemic. While Congress and the Biden Administration have responded by making investments through COVID relief bills, including the American Rescue Plan (P.L. 117-2), federal leaders should take additional steps to holistically address the current crisis. To better understand the challenges and identify action steps, Nemours Children’s Health hosted convenings, wrote a letter to Congress in partnership with local and regional stakeholders, and developed an issue brief in partnership with Mental Health America that describes the state of MEB health among children and offers numerous federal policy recommendations.
The percentage of mental health-related emergency room (ER) visits has increased by about one quarter for children aged 5–11 and by nearly one third for those 12–17 years during the pandemic.[i] Suicidal ideation and suicide attempts among children have increased significantly in 2020 compared to 2019.[ii] More children are requiring immediate and intensive mental health treatments, hospital admissions, and longer hospital stays.[iii]
Nemours Children’s Hospital, Delaware, the only pediatric Level 1 Trauma Center in Delaware, expects to end the year with more than a 35 percent increase in the number of ER visits for children primarily reporting suicidality and intentional harm compared to 2020. It also expects to have more than a 20 percent increase in transfers from its ER to a psychiatric hospital or similar setting. Even more striking, nearly three times as many total patient days requiring a one-on-one sitter due to concerns of suicide will likely occur. These figures are but one example of a MEB crisis unfolding across the nation.
To meet this moment, we must increase investments and strengthen policies in the numerous areas outlined in the policy brief, including those described below.
Expand the workforce. Equip providers to meet children’s MEB health needs through financial incentives, such as loan repayment, and increased funding for training. These opportunities should include providers across the continuum, including specialized child behavioral health professionals, youth and family peer support specialists, and the integration of behavioral health across professions — including primary care, social work, and education — with a focus on meeting the particular needs of Black, Indigenous, and people of color (BIPOC); Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Asexual and Two-Spirit (LGBTQ+); and rural children.
Ensure access. Provide a continuum of services integrated across settings that are accessible to families by increasing reimbursement rates for children’s mental health care in Medicaid, investing in necessary care infrastructure for children, and supporting integration of mental health care into primary care, schools, and other key child-serving settings while ensuring that integrated care is sustainably funded in Medicaid.
Prioritize prevention and early intervention. Increase funding and incorporate preventive approaches in programs currently implemented by the Department of Health and Human Services, Department of Education and other agencies. To respond to the particular crisis among adolescents, the Centers for Disease Control and Prevention (CDC) should establish a coordinating center to lead a national strategy and related programming to reverse the alarming trends.
Elevate children in the federal leadership structure. Establish a White House Office on Children and Youth, a Federal Children’s Cabinet, an Interdepartmental Task Force on Child Well-Being, and a White House Conference on Building Back Better for Children and Youth.
Promote innovative payment and delivery models. Optimize MEB health across the life-course through additional Center for Medicare & Medicaid Innovation payment models that capture longer-term value and engage multiple family-serving sectors to address key issues — such as maternal depression or kindergarten readiness — and build Accountable Communities for Health for Children and Families.
The COVID-19 pandemic has underscored the need to holistically address the MEB health of children, youth, and families across the care continuum. We are at a critical inflection point for our nation’s children. We need a focused and sustained policy response to achieve a future in which all children and youth can thrive. For more information, review the full policy brief at this link.
[i]Leeb, R. T., Bitsko, R. H., Radhakrishnan, L., Martinez, P., Njai, R., & Holland, K. M. (2020). Mental health-related emergency department visits among children aged <18 years during the COVID-19 Pandemic – United States, January 1-October 17, 2020. MMWR. Morbidity and mortality weekly report, 69(45), 1675–1680. https://doi.org/10.15585/mmwr.mm6945a3
[ii]Hill, R. M., Rufino, K., Kurian, S., Saxena, J., Saxena, K., & Williams, L. (2021). Suicide ideation and attempts in a pediatric emergency department before and during COVID-19. Pediatrics, 147(3), e2020029280. https://doi.org/10.1542/peds.2020-029280
[iii]Krass, P., & Doupnik, S. K.. Equity in emergency mental health care. Pediatrics. 2021 May;147(5):e2020049843. https://pediatrics.aappublications.org/content/147/5/e2020049843