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<!DOCTYPE html>
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<title></title>
<meta name="description" content="" />
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<body>
<main class="step-container">
<p>
There are few aspects of New Yorkers’ lives that have not been touched
by COVID-19. As our city, state, and country continue to grapple with
how to help families recover from this crisis, we must not overlook the
impact of COVID-19 on children’s behavioral health. Without adequate
support for children struggling with mental health challenges and
substance use disorders, too many children will face the long-term
impacts of unmet behavioral health needs.
</p>
<p>
Even prior to COVID-19, New York had a children’s behavioral
healthcrisis. In 2016, suicide was the
<a href="https://apps.health.ny.gov/public/tabvis/PHIG_Public/lcd/reports/#state" target="_blank">second
leading cause of death</a>
for New York children age 15-19, and the third leading cause of death
for children age 5-14.
</p>
<div class="graph-wrapper">
<p>
In 2016, suicide was:
</p>
<div class="cause-of-death-flexbox">
<div class="cause-of-death-container">
<p>
<span>2<sup>nd</sup></span> leading cause of death among children
age 15 to 19
</p>
</div>
<div class="cause-of-death-container">
<p>
<span>3<sup>rd</sup></span> leading cause of death among children
age 5 to 14
</p>
</div>
</div>
<p class="table-note">
Source:
<a href="https://apps.health.ny.gov/public/tabvis/PHIG_Public/lcd/reports/#state" target="_blank">New
York State Department of Health</a>
</p>
</div>
<p>
54.5% of children ages 3 through 17 with a
diagnosed mental/behavioral condition in New York
<a href="https://www.childhealthdata.org/browse/survey/results?q=5427&r=34" target="_blank">
did not get the treatment they need </a>, including 55% of young people <a href="https://www.mhanational.org/issues/mental-health-america-access-care-data" target="_blank">with major depression.</a>
</p>
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<p>
of children with a mental/behavioral condition who needed treatment
or counseling did not receive it in the past year.
</p>
<p class="table-note">
Source:<a href="https://www.childhealthdata.org/browse/survey/results?q=5427&r=34"
target="_blank">National Survey of Children's Health</a>
</p>
</div>
</div>
<p>
Access to care challenges have been in part driven by inadequate
provider capacity. For example, in New York, there are only
<a href="https://pediatrics.aappublications.org/content/144/6/e20191576/tab-article-info" target="_blank"> two child psychiatrists for every 10,000 children </a>. Families face barriers accessing care regardless of whether they need outpatient care, intensive inpatient services, or community support
services. These challenges are even harder for families in rural areas
or those in need of bilingual services.
</p>
<p>
With the arrival of COVID-19, the need for behavioral health services
has skyrocketed. The National Alliance on Mental Illness of NYC has reported a
<a href="https://www.thecity.nyc/2020/7/16/21327408/black-mental-health-specialists-weathering-waves-of-trauma"
target="_blank">60% increase in calls</a> to their hotline since mid-March.
<a href="https://www.smartcitiesdive.com/news/covid-19-is-amplifying-anxiety-depression-in-largest-us-metro-areas/581845/"
target="_blank">Census survey data from July 2020</a>
found that 62% of New York residents reported feeling anxiety for at
least several days, while 55% experienced depression. New York’s youth are seeing a spike in reported symptoms of anxiety and/or depression that are consistently higher than other age groups. From June to July, almost half of all youth aged 18 to 24 living in the New York Metropolitan Statistcal Area (MSA) reported symptoms of anxiety and/or depression.
</p>
<div class="graph-wrapper line-chart-wrapper">
<h3>Reported Symptoms of Anxiety and/or Depression, by Age Group in the New York (MSA)</h3>
<svg></svg>
<div class="legend-wrapper">
<i></i><span></span><i></i><span></span><i></i><span></span><i></i><span></span><i></i><span></span>
</div>
<div class="tooltip"></div>
<p class="table-note">Source: CCC’s analysis of the U.S. Census Bureau’s Household Pulse Survey collected from April to July 2020.</p>
</div>
<p>
Importantly, the effects of this pandemic can be even more pronounced
for children and adolescents. Extensive research on adverse childhood
experiences tells us that the kinds of trauma caused by COVID-19 –
including economic and housing insecurity, disruptions in mental health care, and loss of
loved ones – have long-lasting repercussions across the health and
wellbeing of children as they become adults. Though hospitals saw a
temporary decline in psychiatric patients during the height of COVID,
doctors are seeing a
<a href="http://www.centernyc.org/news-center/2020/6/9/kids-and-covid-19-a-mental-health-crisis-looms"
target="_blank">growing number of young people </a>come to hospitals with dangerous psychiatric
emergencies, and fear that
conditions will only worsen without an adequate response.
</p>
<p>
Furthermore, with the transition to distance learning, many children
have lost a source of stability and routine, and may experience feelings
of social
<a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2764730" target="_blank">isolation and
anxiety</a>. Many LGBTQ students may face heightened challenges if they live in
unsupportive families and have lost their in-person connection to a more
affirming school community. Additionally, the shuttering of schools has
impaired the ability to identify and connect or maintain continuity of
student’s access to clinical services. The importance of schools as a
setting through which to receive clinical services is clear; a national
study from the National Survey of Drug Use and Health (NSDUH) found that
more than 13% of adolescents received some form of mental health
services in a school setting in the
<a href="https://www.ncbi.nlm.nih.gov/books/NBK362074/" target="_blank">previous 12 months</a>.
Additionally, 35% of adolescents who receive any mental health
services
<a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/josh.12753" target="_blank">receive them
exclusively from school settings</a>.
</p>
<div class="graph-wrapper single-data-point">
<p></p>
<div class="cause-of-death-flexbox">
<div class="cause-of-death-container">
<p>
<span>35<sup>%</sup></span> of adolescents who receive any mental
health services receive them exclusively from school settings.
</p>
<p class="table-note">
Source:
<a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/josh.12753" target="_blank">Journal of
School Health</a>
</p>
</div>
</div>
</div>
<p>
Like all other aspects of this pandemic, the mental toll of COVID-19 has
fallen disproportionately on those already most marginalized. The health
and economic impacts of COVID-19 have been felt most strongly in
working-class immigrant neighborhoods, and among Black and brown
communities that have faced
<a href="https://citylimits.org/2020/07/28/study-huge-racial-skews-mean-poverty-doesnt-explain-covid-death-risk/?mc_cid=464e0cb516&mc_eid=936c00a681; https://documentedny.com/2020/07/29/new-york-latinos-were-hit-hardest-by-the-pandemic-why/"
target="_blank">historic and institutional inequities</a>. Extensive research indicates that household
economic hardships can
contribute to
<a href="https://www.nber.org/papers/w22459.pdf" target="_blank">
decreased mental wellbeing and increased rates of certain mental
disorders and suicidal behaviors</a>. With the added strains of job loss, loss of loved ones, housing
instability, food insecurity, and a host of other instabilities, more
and more children have been placed at risk of poor mental health.
</p>
<p>
Compounding the impact of COVID-19 are the harms of institutional
anti-Blackness and police violence that children are coping with in
the wake of the killing of George Floyd and the police’s violent
reaction to protests. Even prior to this crisis,
<a href="https://people.com/human-interest/voices-against-racism-black-youth-suicide-dr-michael-lindsey/"
target="_blank">
we were beginning to see a rise in suicide among Black youth </a>. The factors driving this spike –
including job loss and economic
insecurity, lack of access to mental health resources, and the toxic
stress of racism –
<a href="https://www.nytimes.com/2020/06/29/parenting/coronavirus-black-children-inequality.html"
target="_blank">have all been heightened during this crisis</a>. NYC Well saw a nearly
<a href=" https://www.thecity.nyc/2020/7/16/21327408/black-mental-health-specialists-weathering-waves-of-trauma"
target="_blank">
10% surge in calls during the week following George Floyd’s death </a>, on top of increase in calls from
pandemic. The systemic racism and
anti-Blackness students experience in their communities, schools, and
daily lives is a second pandemic that must be addressed.
</p>
<h2>
Responses from State and Federal Governments
</h2>
<div class="graph-wrapper pull-quote">
<p>
</p>
</div>
<p>
Americans stand at a precipice, with many of the federal COVID-19 relief
benefits – such as unemployment insurance, cash payments, and federal
eviction protections – having expired at the end of July. Yet Congress
remains gridlocked, with Senate Republicans resisting the passage of a
comprehensive COVID relief package that mirrors the HEROES Act proposed
by the House. Without additional financial support, even more families
and their children will suffer the psychological and emotional harms of
economic distress, on top of anxieties related to isolation, loss of
loved ones, and widespread uncertainty.
</p>
<p>
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act)
included
<a href=" https://www.psychiatry.org/newsroom/news-releases/apa-praises-mental-health-provisions-in-covid-19-stimulus-aid-package"
target="_blank">several provisions specific to behavioral health</a>, including $4 billion for community
health centers and $425 million
for Certified Community Behavioral Health Clinics, suicide prevention
programs, and mental health and substance use disorder emergency grants.
New York was the recipient of a four-year,
<a href="https://apps.cio.ny.gov/apps/mediaContact/public/view.cfm?parm=D12842E2-FED1-7C73-BE813118D1F179C7&backButton"
target="_blank">$12 million award from SAMSHA</a>
to help local providers better coordinate services for children with
serious emotional disturbances and their families.
</p>
<p>
As important as this funding has been, it only begins to scratch the
surface of the need, and there has been insufficient attention to the
specific behavioral health needs of children and adolescents.
</p>
<p>
CCC joined national advocates in pushing for a $38.5 billion investment
for providers of mental health and addiction treatment services,
advocating that at least 25% of those funds be dedicated to children’s
needs. This is part of a broader push, in recognition that if we do not
also address the stressors facing families – child care, unemployment,
primary healthcare access, food insecurity – mental health will suffer.
</p>
<p>
At the state level, New York faced harsh budget realities even prior to
the COVID-19 pandemic. Despite the threat of cuts to children’s
behavioral health services, advocates successfully pushed the state to
preserve children’s behavioral health, and even restore a proposed 1.5%
cut to Children and Family Treatment and Support Services. This has
proved even more important than anticipated, as it meant New York
entered this crisis without a severely damaged infrastructure for
children’s behavioral health.
</p>
<p>
New York has also taken important steps in implementing telehealth
services, with state agencies moving quickly to ensure new flexibilities
in access to telehealth services. An important legislative change now
allows audio-only and video-only telehealth services in Medicaid and
CHIP, which has helped expand opportunities to connect with patients.
</p>
<div class="graph-wrapper pull-quote">
<p>
</p>
</div>
<p>
At the same time, New York’s dire economic and budget reality, threatens
the stability of the children’s behavioral health system, among other
systems. The state is facing $14 billion in revenue shortfalls, with
great uncertainty regarding how much the federal government will invest
in state relief. New York is currently withholding some of the funds
intended to support local treatment providers, and
<a href="https://www.timestelegram.com/news/20200719/how-covid-19-is-creating-mental-health-pandemic"
target="_blank">
is cutting funding for some behavioral health services by 20% </a>. The State also announced a proposed
1.5% cut to children’s Home and
Community Based Services (HCBS), which are intended to help meet the
mental health needs of children in their homes and communities and
prevent the need for institutional levels of care. The threat of
additional cuts places the state’s behavioral health infrastructure and
ability to serve children at risk.
</p>
<h2>
Priorities for Recovery
</h2>
<p>
Budget decisions made at the federal level will directly impact the
state’s budget, which will in turn impact New York City’s budget. As our
state and federal governments consider how to address the behavioral
health crisis among young people and prevent long-term harm, there are
key areas that must be addressed.
</p>
<h2 class="priorities">
Protect and Invest in Children’s Behavioral Health
</h2>
<p>
At its core, we cannot ensure the wellbeing of children if our state and
federal governments take a short-sighted approach to children’s mental
health. Targeted investments are needed in children’s behavioral health
services. Investments are also needed in the foundations of recovery and
promotion of wellbeing – housing, nutrition, financial assistance,
unemployment insurance – that support family and household stability and
protect children from the stressors that can drive poor mental health.
</p>
<p>
As a start,
<a
href="https://www.cccnewyork.org/actions/tell-the-u-s-senate-to-pass-legislation-to-help-struggling-families/">
Congress must pass comprehensive stimulus legislation to help
struggling families </a>. Without this assistance, families in New York and across the country
face long term hardship and resulting trauma.
</p>
<div class="graph-wrapper pull-quote">
<p>
</p>
</div>
<p>
At the state level, New York must continue to protect and invest in the
children’s behavioral health infrastructure. Only by investing in
children now can we avoid the long-term repercussions of trauma and
unmet mental health needs. Those families most impacted by the economic
downturn, illness, and loss are those most in need of behavioral health
supports for their children. We strongly support the State’s efforts to
draw down additional federal funding. We also recognize that by
protecting and strengthening state investments, we can reduce
hospitalizations and emergency room visits, and prevent the emergence of
more complex needs among children that are harder to address later in
life. New York must resist any proposed cuts to children’s behavioral
health care, including the proposed 1.5% rate cut to HCBS services.
</p>
<h2 class="priorities">
Make Telehealth Flexibilities Permanent, and Ensure Equitable Access to
Telehealth Services
</h2>
<div class="graph-wrapper pull-quote">
<p>
</p>
</div>
<p>
New flexibilities to provide telehealth services have been a lifeline
for many children and families, allowing them to stay connected to the
critical health and behavioral health supports they need. However, thus
far many of these flexibilities are temporary and tied to the
declaration of a state of emergency. Particularly given the uncertainty
of the future, it is critical that many of these regulatory
flexibilities become permanent fixtures. Additionally, New York must
reimburse telehealth visits at the same level as comparable in-person
visits to maximize options for children and families.
</p>
<p>
As important as telehealth is, we must also acknowledge its potential
role in exacerbating inequities in telehealth access, and that
telehealth is not in itself a silver bullet to long-standing capacity
challenges.
<a
href="https://www.cccnewyork.org/blog/new-york-citys-digital-divide-500000-nyc-households-have-no-internet-access-when-it-is-more-important-than-ever-before/">
Too many families still lack access to reliable broadband or internet
to access services </a>, and the digital divide disproportionately impacts low income
communities and communities of color. For those that have experienced a
racially discriminatory healthcare system, teleservices may not feel
like a safe alternative to in-person care. Telehealth can also pose
challenges for very young children, children with disabilities, families
who lack privacy, and families who speak languages other than English.
</p>
<p>
For these reasons and more, New York must work carefully to ensure
equitable access to telehealth services. This means prioritizing the
needs of children and families and respecting their choices regarding
how they want services delivered. It also means addressing the digital
divide and ensuring all families have access to the devices and internet
connectivity they need. In developing a new statewide plan for
telehealth, careful attention must be paid to those patients most likely
to be left behind, and how to ensure they receive the care they need.
</p>
<h2 class="priorities">
Support the Behavioral Health Needs of Students
</h2>
<p>
Though students engaged in remote learning throughout the spring, their
need for school-based services has not faded. Great uncertainty remains
over how children’s next school year will look, but schools will remain
an important site – whether physical or virtual – for connecting
children to emotional and behavioral supports.
</p>
<p>
Many students may have new behavioral health needs that are not easy to
identify. It is therefore essential that educators have the training
they need on trauma-responsive care. Students suffer when schools lack
the tools to respond to trauma and instead respond with punishment,
emergency medical services, and police involvement. Fortunately, models
exist for how to engage students, families, and educators in whole
school approaches that center healing and help support all students,
including those who have experienced trauma. Though each school or
school district has unique needs, some models worth considering include
the
<a
href="https://www.legalservicesnyc.org/what-we-do/practice-areas-and-projects/access-to-education/community-roadmap-to-healing-centered-schools">Bronx
Healing-Centered Schools Community Roadmap</a>; the Schenectady City School District’s
<a href="https://dailygazette.com/article/2018/01/01/more-schenectady-families-opt-for-diversion-over-suspension"
target="_blank">cultural broker model</a>, and
<a href="https://www1.nyc.gov/assets/sclt/downloads/pdf/SCLT_Report_7-21-16.pdf" target="_blank">
the proposed Mental Health Continuum in New York City </a>.
</p>
<div class="graph-wrapper pull-quote">
<p>
</p>
</div>
<p>
At the same time, New York must also strengthen schools’ access to
clinical and community-based services. Though no longer providing all
services on site, during the pandemic, many Article 31 School Based
Mental Health clinics have found ways to identify and connect with
students who have increased need. Community-based behavioral health
providers are also critically important when schools have limited access
to on-site mental health resources or staff. New Child and Family
Treatment and Support Services (CFTSS) provide family-focused,
community-based services designed to prevent the need for more intensive
services later in life. These services can reach more children if they
are integrated into education settings, and if they are made available
to children outside of Medicaid, including children in the Child Health
Plus program. Despite budget restrictions, New York cannot afford to be
short-sighted by scaling back on existing school-based behavioral health
resources; in fact, now is the time to invest more in the student
supports so they can thrive social emotionally and academically.
</p>
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