Child mental and behavioral health services during the COVID-19 pandemic: Trends and implications for service outcomes during telehealth expansion

Transportation to/from care is a significant barrier to healthcare access and utilization. The novel coronavirus pandemic prompted a widespread expansion of telehealth service delivery throughout much of 2020. We used propensity score matching to generate two comparison groups of children served in a large public mental and behavioral health system between (1) April-December 2019 (pre-pandemic; n=2,794), and (2) between April-December 2020 (during the COVID-19 pandemic, n=2,794), followed by longitudinal linear mixed-effects modelling to explore the relationship between caregiver transportation needs and child-level outcomes. Our analyses indicated a statistically significant association between the resolution of caregiver's transportation needs and children's clinical improvement in the 2019 (pre-pandemic) sample; there was no such association found in the 2020 (pandemic) sample. Our findings suggest that the use of telehealth may mitigate the effect of caregiver transportation needs on child-level clinical outcomes.

Barriers to Healthcare Access and Utilization among Urban Syrian Refugees in Turkey

Turkey currently hosts 3.6 million registered Syrian refugees, most of which reside in urban centres. Urban refugees in Turkey face significant challenges in accessing the healthcare to which they are entitled under international and Turkish law. This literature review seeks to provide a holistic overview of the major barriers refugees face in accessing adequate healthcare. Language forms the single greatest obstacle despite efforts to provide services staffed by Arabic speakers. Poverty exacerbated by lack of employment, unhygienic living conditions, and the COVID-19 pandemic also play significant roles. Above all, hostile Turkish public sentiment towards refugees motivates restrictive government policies and discourages aid. Potential means by which this situation may be addressed include prompt address of the financial hardships brought on by COVID-19, permitting NGOs to evaluate the effectiveness of migrant health centres, and the resumption of refugee registration in key provinces.

Reduced Pediatric Urgent Asthma Utilization and Exacerbations During the COVID-19 Pandemic

Background and Objectives: The COVID-19 pandemic has had a profound impact on healthcare access and utilization, which could have important implications for children with chronic diseases, including asthma. We sought to evaluate changes in healthcare utilization and outcomes in children with asthma during the COVID-19 pandemic. Methods: We used electronic health records data to evaluate healthcare use and asthma outcomes in 3,959 children and adolescents, 5-17 years of age, with a prior diagnosis of asthma who had a history of well child visits and encounters within the healthcare system. We assessed all-cause healthcare encounters and asthma exacerbations in the 12-months preceding the start of the COVID-19 pandemic (March 1, 2019-February 29, 2020) and the first 12-months of the pandemic (March 1, 2020-February 28, 2021). Results: All-cause healthcare encounters decreased significantly during the pandemic compared to the preceding year, including well child visits (48.1% during the pandemic vs. 66.6% in the prior year; p < 0.01), emergency department visits (9.7% vs. 21.0%; p < 0.01), and inpatient admissions (1.6% vs. 2.5%; p < 0.01), though there was over a 100-fold increase in telehealth encounters. Asthma exacerbations that required treatment with systemic steroids also decreased (127 vs. 504 exacerbations; p < 0.01). Race/ethnicity was not associated with changes in healthcare utilization or asthma outcomes. Conclusion: The COVID-19 pandemic corresponded to dramatic shifts in healthcare utilization, including increased telehealth use and improved outcomes among children with asthma. Social distancing measures may have also reduced asthma trigger exposure.