Mental Health Emergency Department Visits by Children Before and During the COVID-19 Pandemic

ObjectivesTo describe pediatric mental health emergency department (ED) visit rates and visit characteristics before and during the COVID-19 pandemic.MethodsWe conducted a cross-sectional study of ED visits by children 5–17 years old with a primary mental health diagnosis from March 2018 to February 2021 at a 10-hospital health system and a children's hospital in the Chicago area. We compared demographic and clinical characteristics of children with mental health ED visits before and during the pandemic. We conducted an interrupted time series analysis to determine changes in visit rates.ResultsWe identified 8,127 pediatric mental health ED visits (58.5% female, 54.3% White, Not Hispanic/Latino and 42.4% age 13–15). During the pandemic, visits for suicide or self-injury increased 6.69% (95% CI 4.73, 8.65), and visits for disruptive, impulse control, conduct disorders increased 1.94% (95% CI 0.85, 3.03). Mental health ED visits by children with existing mental health diagnoses increased 2.29% (95% CI 0.34, 4.25). Mental health ED visits that resulted in medical admission increased 4.32% (95% CI 3.11, 5.53). The proportion of mental health ED visits at community hospitals increased by 5.49% (95% CI 3.31, 7.67). Mental health ED visit rates increased at the onset of the pandemic (adjusted incidence rate ratio [aIRR] 1.27, 95% CI 1.06, 1.50), followed by a monthly increase thereafter (aIRR 1.04, 95% CI 1.02, 1.06).ConclusionMental health ED visit rates by children increased during the COVID-19 pandemic. Changes in mental health ED visit characteristics during the pandemic may inform interventions to improve children's mental health.     

Trends in Pediatric Primary Care Visits During the Coronavirus Disease of 2019 Pandemic

ObjectiveMonths after the declaration of the coronavirus disease of 2019 (COVID-19) national emergency, visits among children remained suppressed for unclear reasons, which we sought to understand by examining child visit rates.MethodsUsing de-identified claims data for children <18 years old from OptumLabs® Data Warehouse, a large commercial claims database, we compared monthly primary care visit and vaccination rates from January–October 2020 to January–October 2018 and 2019. Visit rates were analyzed by visit reason and by the month after (eg, month +1) the COVID-19 public health emergency declaration using a series of child-level Poisson regression models.ResultsThere were 3.4, 3.4, and 3.1 million children in 2018, 2019, and 2020 cohorts, respectively. Compared to the same months in prior years, primary care visits in 2020 were 60% lower in month +1 (incidence rate ratio [IRR] 0.40, 99% confidence interval [CI] 0.40–0.40) and 17% lower in month +7 (IRR 0.83, 99% CI 0.83–0.83). Preventive visit rates were 53% lower in month +1 (IRR 0.47, 99% CI 0.47–0.47), but 8% higher than prior years in month +7 (IRR 1.08, 99% CI 1.08–1.08). Monthly rates of vaccine administration followed a similar pattern. Problem-focused visits remained 31% lower in month +7 (IRR 0.69, 99% CI 0.68–0.69), with notably fewer infection-related visits (acute respiratory tract infections IRR 0.37, 99% CI 0.36–0.37; gastroenteritis IRR 0.20, 99% CI 0.20–0.20).ConclusionSeven months after the COVID-19 emergency declaration, receipt of pediatric care remained suppressed due to fewer problem-focused visits, with notably fewer infection-related visits. By October 2020, rates of preventive visits and vaccination exceeded rates in prior years.     

Supporting Children Experiencing Family Violence During the COVID-19 Pandemic: IPV and CPS Provider Perspectives

ObjectivesChildren experiencing family violence (child abuse and neglect and exposure to intimate partner violence) are at a particularly elevated risk for compounding challenges during the COVID-19 pandemic. In this study, we interviewed intimate partner violence (IPV) advocates, child protective services (CPS) caseworkers, and IPV and CPS administrators on the needs of children experiencing family violence during the pandemic.MethodsWe conducted semistructured interviews with IPV advocates, CPS caseworkers, and IPV and CPS administrators. Recruitment occurred through emails to national and state listservs, networks of the study team, and word of mouth. Interviews were completed through Zoom, took 45 to 60 minutes and were audio recorded. We used a mixed deductive-inductive content analysis approach.ResultsFifty-nine IPV advocates, 35 IPV administrators, 21 CPS workers and 16 CPS administrators participated in this study. Four themes emerged from this work. Participants discussed the role of social isolation, school closures, and distance learning on children experiencing family violence. They also noted child custody and visitation challenges, particularly in the context of abusive partners using custody to control IPV survivors and limitations to virtual visitation more broadly. Compounding challenges were described for children from marginalized communities due to structural-level inequities. Collaboration was discussed by participants from both IPV and CPS sectors.ConclusionThis study is one of the first to describe the way the COVID-19 pandemic has impacted children experiencing family violence. Future studies should triangulate these results with children, families, and other child-serving providers     

Comparison of Children Hospitalized With Seasonal Versus Pandemic Influenza A, 2004-2009

BACKGROUND: The extent to which pandemic H1N1 influenza (pH1N1) differed from seasonal influenza remains uncertain. METHODS: By using active surveillance data collected by the Immunization Monitoring Program, Active at 12 Canadian pediatric hospitals, we compared characteristics of hospitalized children with pH1N1 with those with seasonal influenza A. We compared demographics, underlying health status, ICU admission, and mortality during both pandemic waves versus the 2004/2005 through the 2008/2009 seasons; influenza-related complications and hospitalization duration during pH1N1 wave 1 versus the 2004/2005 through the 2008/2009 seasons; and presenting signs and symptoms during both pH1N1 waves versus the 2006/2007 through the 2008/2009 seasons. RESULTS: We identified 1265 pH1N1 cases (351 in wave 1, 914 in wave 2) and 1319 seasonal influenza A cases (816 from 2006/2007 through 2008/2009). Median ages were 4.8 (pH1N1) and 1.7 years (seasonal influenza A); P < .0001. Preexisting asthma was overrepresented in pH1N1 relative to seasonal influenza A (13.8% vs 5.5%; adjusted P < .0001). Symptoms more often associated with pH1N1 wave 1 versus seasonal influenza A were cough, headache, and gastrointestinal symptoms (adjusted P < .01 for each symptom). pH1N1 wave 1 cases were more likely to have radiologically confirmed pneumonia (adjusted odds ratio = 2.1; 95% confidence interval = 1.1-3.8) and longer median length of hospital stay (4 vs 3 days; adjusted P = .003) than seasonal influenza A. Proportions of children requiring intensive care and deaths in both pH1N1 waves (14.6% and 0.6%, respectively) were not significantly different from the seasonal influenza A group (12.7% and 0.5%, respectively). CONCLUSIONS: pH1N1 in children differed from seasonal influenza A in risk factors, clinical presentation, and length of hospital stay, but not ICU admission or mortality.     

Provider Perspectives on Telehealth Services for Children With Autism Spectrum Disorder During the Coronavirus Disease 2019 Pandemic

ObjectiveThe purpose of the current study was to explore provider perspectives on the strengths and challenges of telehealth services (e.g., behavioral interventions, physical, speech, and occupational therapy, medication management) for children with autism spectrum disorder during coronavirus disease 2019 related shutdowns.MethodsFrom September 2020 to May 2021, we conducted qualitative interviews with 35 providers across multiple disciplines from 17 sites in the Autism Care Network. Qualitative data were analyzed using a framework approach and common themes were identified.ResultsProviders across clinical disciplines identified strengths of the virtual model, such as its flexibility and the opportunity it provided to see children in their home environment. They also indicated that some interventions worked better virtually than others, and that there were several factors that impacted their success. Respondents were generally satisfied providing parent-mediated interventions but expressed mixed satisfaction in using telehealth for direct-to-patient care.ConclusionsResults suggest that telehealth services for children with autism spectrum disorder could be a helpful tool in decreasing barriers and improving service delivery, especially when tailored to the individual needs of the patient. More research is needed on the factors contributing to its success in order to eventually inform clinical guidelines regarding the prioritization of children seen for in-person visits.     

Planning for Virtual Interviews: Residency Recruitment During a Pandemic

Recent directives from The Coalition for Physician Accountability, Association of Pediatric Program Directors, Council on Medical Student Education in Pediatrics, and Association of Medical School Pediatric Department Chairs recommend virtual recruitment for graduate medical education (GME) programs this year. Driven by concerns for safety, equity and financial pressures, virtual interviewing will require a thoughtful approach to achieve the desired goals of recruitment. Drawing on the fields of communication and human resources management, we examine the potential effects of web-based interviews on communication through the lens of several communication theories: media richness, media naturalness, and signaling. We then review the literature on virtual interviews in GME training programs. Finally, we will provide best practices compiled from the literature