Our kid’s behavioral health is in crisis. Here’s how to fix it — Part 2
By Naomi Allen
By Naomi Allen
A 50% increase in emergency room visits due to suicide attempts among teen girls. A 72% rise in behavioral health emergency department visits at Children’s Hospital Colorado. A 300% increase in emergency admissions at a children’s hospital in Florida. These are just some of the dire statistics emerging from our current crisis in pediatric behavioral health.
According to experts, the situation is about to get much worse. Children’s hospitals around the country have declared a state of emergency and our already strained healthcare system is about to witness a tsunami of pediatric behavioral health needs.
In my last note, I discussed the four major shortcomings of traditional pediatric behavioral health care that created our current crisis. Today, I want to focus on the solutions.
Here are the five steps we must take to stem the tide and and ensure our kids have access to high-quality, affordable behavioral health care:
1. Increase access by scaling virtual care and lower acuity, lower stigma options
In any given year, nearly one in five children experience a behavioral health disorder, yet only about 20% of them receive the care they need. Why don’t the rest get help? Many families simply don’t live anywhere near a pediatric-trained, licensed clinician. In fact, a whopping 70% of U.S. counties — most with lower income and education levels — have no child psychiatrists at all.
Solving this access problem will require scaling both clinical care and lower acuity, lower stigma options — like coaching and self-guided content — to support early interventions. Today’s highly trained coaches paired with digital resources can help families manage tantrums, lower stress and anxiety, address sleep issues, and much more — preventing small everyday challenges from spiraling into big ones like anxiety disorders or major depression.
Coaching and content can also provide much-needed transitions from higher-acuity care to maintenance-level support. For children who no longer require clinical care but still need ongoing support, a step-down model is a much-needed option.
2. Make these options affordable by making them a covered benefit
In a recent survey we conducted, a remarkable 41% of working parents and caregivers said they had to pause or stop obtaining pediatric behavioral health care due to unaffordable costs. This is consistent with research that shows families are 10 times more likely to go out-of-network for pediatric behavioral health care than primary care. As a result, the vast majority of pediatric behavioral health visits are going completely unnoticed by employers and health plans — and families are bearing the costs.
We must make behavioral health care more affordable for families, and that starts with health plans bringing these options in-network and employers making them a covered benefit for their workforce. By removing cost as a barrier to care, we can ensure our kids can access the care and resources they need to stay healthy.
3. Implement measurement-based care
Today, few providers use clinically-validated measures to track progress against high-quality, evidence-based protocols. Why not? Most providers aren’t in network with health plans and have no system in place to track progress. The minority of providers that are in-network are not reimbursed by health plans for tracking progress — and thus have little incentive to perform that extra work.
We must make measuring clinical outcomes the norm. Validated tools like the Clinical Global Impression – Improvement scale (CGI-I) and the Patient-Reported Outcomes Measurement Information System (PROMIS) scale already exist. We can use technology to drive adoption of these tools to help clinicians calibrate appropriate treatment programs and make it easy for parents and caregivers to quickly understand how their child’s care is progressing.
Given validated clinical outcomes, health plans will be more willing to provide higher reimbursement rates for providers, which will in turn encourage them to go in-network — making high-quality care more affordable and accessible for families. Tracking outcomes will also make it easier to figure out when a child is ready to step down from care, making room for other families in need.
4. Train parents and caregivers to support kids through dyadic care
Many pediatric behavioral health programs don’t involve parents and caregivers at all. Often the adults in the child’s life aren’t told what outcomes or signs of progress to look for — let alone how they themselves could participate in the child’s care.
Yet pediatric behavioral health care is proven to be three times more likely to be effective when parents and caregivers are trained to support their children and involved in the treatment process. By involving the whole family in the care model, we have the potential to triple the impact we can have on the pediatric behavioral health crisis.
5. Assemble multidisciplinary care teams
Among children with behavioral health needs, comorbidities are common. For example, 27% of children with attention deficit/hyperactivity disorder (ADHD) also have a conduct disorder, and 18% of children with ADHD also suffer from an anxiety disorder.
Caring for children requires a multifaceted approach. One child may need occupational therapy to address developmental delays, as well as psychotherapy for mood disorders, as well as medication management for ADHD. To properly care for multiple diagnoses, children need multidisciplinary care teams — with team members that coordinate with each other to provide a unified treatment plan. These teams can help families better navigate care, triaging their needs to reduce the trial and error often involved in the process of seeking care today.
The news today is dire, but we can create a brighter future. Now is not the time for temporary band-aids or partial fixes. We need to completely rethink the way we deliver pediatric behavioral health care in this country. By harmonizing the solutions outlined above into a unified system of care, we can create a new model for pediatric behavioral health that increases access, reduces costs, and improves quality. Without any one of these solutions, the whole system falls apart.
At Brightline, we’re excited to see so many policymakers, payers, and employers embracing the benefits of pediatric behavioral health support. By working together to find a solution, our families can all start living happier, healthier, and more fulfilling lives.
Naomi Allen is the co-founder and CEO of Brightline.