Due to school closures and shelter-in-place orders, nonprofit providers of mental health services cannot easily connect with children and families in person.
As a result, the last few months have seen the beginnings of an unprecedented change in practices to technology-enabled modalities for providing services — and a break with a culture of practice that has historically focused on in-person, 50-minute appointments.
While undoubtedly it is a different experience when we can’t sit down face-to-face, new services and strategies are enabled by a variety of technology platforms that eliminate logistical and transportation barriers and approaches to care that bring out flexibility and creativity. There are already extraordinary stories of saving children’s lives by providing immediate access to services in the home via phone or video, rather than waiting for children to show up at a clinic.
The transition to technology-enabled support for children’s mental health and well-being presents a number of compelling possibilities: continuity of service for children who move around due to poverty, being in foster care, or living in migrant families; better cultural matching, as any therapist anywhere can be matched with any child in need; service delivered outside of traditional hours, and without the need to commute across town in California traffic. But it’s only one part of the adaptation and the transformation that the current moment might bring about.
Over the past few months we have seen unprecedented change and tremendous challenge for both those doing the work and those paying for it. The federal and state governments have offered guidance that has supported the transition to contracts that pay for telemedicine. But in California’s county-administered system, changes have to be implemented by 58 distinct county safety net systems with widely divergent administrative depth and capacity. Contracts have to be rewritten; regulations, policy, and practice have to be changed—all while nonprofits are transforming their administration under conditions of uncertainty, and clinicians are working to transform their daily practice and respond to overwhelming need. It will take tremendous effort over the coming weeks and months both to stabilize the capacity we already have and to ensure our providers can stay solvent while providing virtual services.
Beyond making face-to-face and technology enabled modalities equivalent, we can change our reimbursement systems to expand who can provide care — for example, by expanding access to trained peer providers that have lived experience and working via social models centered on mutuality. We want to ensure that support is available where children currently live, learn, and play — namely in schools that currently serve as a child’s mental health center.
To support this kind of expansion and practice transformation, we must change the underlying reimbursement and financing models that continue to drive both the culture and reality of what children and their families experience. Much of this was possible before; new waivers and rule flexibilities granted at the federal and state level in response to this crisis will facilitate experimentation and innovation. And when we are able to fully reengage with building the future mental health care model for children, we’ll have both the knowledge and the tools we need to transform the way we support children’s social, emotional, and behavioral health. We must work together to make this transformation a reality.