America’s unprecedented and still evolving response to COVID-19 can and should be focused on mitigating the spread of the virus and its impact on vulnerable populations.
In order to protect these vulnerable populations, including older adults and those with underlying health conditions, one of many actions local governments have taken is the closing of schools to help flatten the contagion curve and slow the spread of the disease. This strategy feels reasonable and appropriate given what we are up against.
California has roughly 1,000 schools—and 670 of them are now closed, which affects 95 percent of the state’s 6 million children in public schools.
And while this bold and unprecedented action is necessary and appropriate in the face of the pandemic, it is critical that we carefully manage the impact on our vulnerable children and the mental health clinicians who serve them. While we fully recognize there’s a lot to worry about, there are some steps counties and states can—and should—take now to mitigate the collateral damage of school closures. We must protect the social and emotional health of our children.
Even before COVID-19, schools were already on the front lines of an epidemiological crisis. Between 2006 and 2016, twice as many children were seen in emergency departments in California for serious self-injury, a 104 percent increase. And the number of days Californian children spent in the hospital for mental health treatment was up 50 percent. Most shocking of all is that youth suicide rates continue to rise—they increased 87 percent between 2007 and 2017.
These alarming trends were already occuring before the recent school closures, which will isolate children from their social networks and the treatment services they are federally entitled to under Medicaid and the Individuals with Disabilities Education Act. We predict that most mental health systems that serve children will see between a 20 and 50 percent decline in outpatient capacity with the closure of schools, but at the same time, social isolation practices and fear will exacerbate mental health conditions and challenges.
State and federal guidance on the pandemic, while welcome and important, only matters if counties act on it. Counties run local safety nets, and if they do not act swiftly and agressively, children will suffer. The fragile and overburdened safety net that many jurisdictions have been able to put together will be collateral damage to the pandemic if we do not take these steps:
- Allow children in need of mental health support to access services without in person meetings by adopting the policy to deem all patient and client contact “equivalent,” an already existing option that will remove barriers to technology enabled services.
- Guarantee full-cost reimbursement to providers who rely on patient visits and interactions so we do not lose our capacity in this critical time when clinicians may be facing either self or imposed quarantines.
The state also has a very important role to play. California must increase and direct federal resources to support our children’s mental health. We must ensure that our underfunded and fragile children’s mental health system does not get further eroded in the pandemic.
In response to the March 13 federal emergency declaration, California is developing its 1135 waiver applications this week, the required mechanism by which states can secure relief for the pandemic response. Beyond this immediate application, we implore the state to explore all potential federal waiver opportunities to increase resources for our children’s wellbeing.
In California, 6 out of 10 children are covered by Medicaid, and before this emergency, the state was in the process of renegotiating two key federal waivers relevant to children’s mental health. It should be noted that when several states were faced with the emergency caused by Hurricane Katrina, the Centers for Medicare & Medicaid Services under President George W. Bush waived the budget neutrality calculation for 1115 waivers, allowing for more resources. We encourage the state to use this opportunity and this precedent to expand the scope of these negotiations.
Together, these actions will allow counties and clinicians to ensure that the children who are isolated during this crisis still have access to care.
Finally, and most importantly, we urge families and providers to tap the increasingly available virtual network of resources. Reach out. While there are no easy answers, there are good resources that are increasingly available online. Most forms of technology enabled treatment have been approved and are available, so there are options even if your child’s school is closed or you cannot travel.
Let’s consider all facets of this crisis and make sure that we do not lose sight of the mental health services our children need.
Alex Briscoe is principal of the California Children’s Trust and the former director of the Alameda County Health Care Services Agency. Benjamin F. Miller is the chief strategy officer of the Well Being Trust.