Guest Op-Ed: Behavioral Health Needs of Families

By Robert P. Franks

The impact of COVID-19 is being felt by everyone. We have been confronted with a time where our usual structures and supports have been replaced with a new reality. For children and families who have been dealing with mental-health issues, the challenges presented by the crisis have the potential to be even more daunting.

There is an inherent irony resulting from our current stay-at-home situation. Families who typically are caught up in the routine of work, school, sports and other activities have commonly bemoaned the lack of quality family time. There never seemed to be enough hours in the days to keep up with our busy schedules. That dynamic has certainly changed. It is an adjustment most of us welcomed at first, but as the days wear on we are confronted with new, unexpected challenges resulting from being under the same roof 24/7 for an extended period.  We now sometimes yearn for the relentless routines that before had seemed so burdensome.

We are learning that home isolation can have a more profound effect on children dealing with behavioral health issues and the families that care for them. The usual experiences that help buffer, protect and support our children are no longer available. We have come to a new appreciation for teachers, healthcare providers, day care providers, therapists and friends who routinely have supported the most vulnerable. This lack of access to their usual support system can exacerbate symptoms of anxiety, depression, traumatic stress, ADHD and behavior problems.

Parents now often serve as the sole source of support for their children, resulting in a recipe for a high-stress family environment. In addition to facing the concerns we all share over employment, housing, isolation, security and at times being able to put food on the table, parents in this situation may also be facing serious concerns about the health and wellbeing of their children and whether they are capable and equipped to meet their needs.

How many times have we recently heard of the new-found respect for teachers developed by parents who have joined the home-school movement by necessity?  Now, imagine the additional challenge of trying to educate a child with special education or behavioral health needs. These complex challenges of this pandemic will likely affect vulnerable families for months and years to come and create behavioral health needs for a cohort of children and families we have not seen in decades.

There is also significant concern for children who are living in an at-risk home environment. While the reports of child maltreatment have actually decreased during this pandemic, it is likely that it is because our children’s safety net no longer is in place. Pediatricians, teachers, behavioral health providers, child welfare workers and day care providers who are usually the first to notice the signs of child abuse and neglect are no longer in direct contact with the families they typically serve. Many of us who have worked in this field for many years expect that rates of maltreatment are being grossly underreported and that the current cohort of vulnerable children and families are at risk of negative sequelae for years to come

The good news is that many of our behavioral health providers are being creative in their approach to serving families and have transitioned their services to telehealth platforms. While not always ideal, centers like ours are providing children and families with virtual access to services in their homes. It is incumbent upon our systems of care to ensure that all families have access to such care during this time and in the future, and that we break down any payment or reimbursement issues that can be barriers to quality care. 

We have seen early signs that telehealth services can actually work better for some families who are now able to access the care they need from the safety of their own homes.  As behavioral health providers continue to find new ways to support children and families using virtual technologies, on a larger scale, this crisis is providing a whole new paradigm for how we think about providing mental-health services.

As we slowly transition out of the current crisis, we must ensure that addressing the emergent and growing behavioral health needs of families is one of our top priorities. It is also clear that nonprofits, especially those that serve children and families experiencing mental-health challenges, will need the increased support of both the public and private sectors in order to address needs that will almost assuredly be greater in number and scope as a result of this pandemic. The future of a generation of children and families will be dependent on our collective response.

Robert P. Franks, Ph.D., is president and chief executive officer of Judge Baker Children’s Center, a Boston-based agency providing children and families with mental-health services since 1917.

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