Protecting Mental Health During a Pandemic

Posted on Sep 22, 2020

Jennifer Katzenstein, Ph.D., ABPP-CN, is co-director of the Center for Behavioral Health at Johns Hopkins All Children’s
Jennifer Katzenstein, Ph.D., ABPP-CN, is co-director of the Center for Behavioral Health at Johns Hopkins All Children’s. Providers in the Center for Behavioral Health have been using telemedicine to see patients during the COVID-19 pandemic.

When the COVID-19 pandemic began to affect the United States earlier this year, behavioral health providers at Johns Hopkins All Children’s Hospital had to rethink how they cared for patients in an era of physical distancing. The result: virtual visits that are drawing rave reviews from providers and families alike.

The COVID-19 pandemic presents a twofold challenge — behavioral health needs that existed before the crisis remain, and new ones that may arise. Children and teens are more likely than other groups to be affected by the stress of a situation such as the pandemic, according to the Centers for Disease Control and Prevention. Missing spending time with friends or frustration about having to spend a lot of time at home can lead to anxiety, depression or difficulty sleeping.

The Center for Behavioral Health at Johns Hopkins All Children’s is an invaluable resource for children and teens, and its providers are reaching their patients in a new way.

“The COVID-19 pandemic makes mental health essential,” says Jennifer Katzenstein, Ph.D., ABPP-CN, director of psychology and neuropsychology and co-director of the Center for Behavioral Health at Johns Hopkins All Children’s. “When COVID-19 hit, we recognized an opportunity to use telemedicine to provide mental health services in a safe, physically distant way. We know from emerging literature that telemedicine has similar efficacy to an inperson session for many types of patients.”

Distance Caring

Telemedicine allows patients and their families to see a Johns Hopkins All Children’s behavioral health provider via video using a computer, tablet or smartphone. Few of the providers used telemedicine before the COVID-19 pandemic, but they embraced it and quickly adapted. The team fully pivoted to telemedicine on March 26, and since then, nearly 30 providers have used video visits for a variety of behavioral services, including:

  • Medication and pain management
  • Consultation
  • Family support
  • Diabetes adherence management
  • Neuropsychological testing
  • Patient management training on handling disruptive or destructive behaviors such as tantrums
  • Anxiety and depression

The need is great: Throughout the spring, patient volume was up 20% to 30% compared with last year, with most visits taking place via video. Providers continue to see patients who are at risk of self-harm or are having suicidal thoughts in clinic, where a variety of safety measures are in place to help prevent the spread of the coronavirus.

Families appreciate the convenience and safety of telemedicine, but those aren’t its only benefits.

“Several of my colleagues have observed some teenagers are more open with them when using telemedicine, perhaps because they’re in an environment where they feel comfortable and are accustomed to using technology,” Katzenstein says. “During telemedicine visits with younger children, we may get more information about behaviors that parents are seeing at home because the children are in their home and don’t feel like they have to be on their best behavior, as they would in the office.”

Striving to Improve Telemedicine

Providers with the Center for Behavioral Health at Johns Hopkins All Children’s Hospital are conducting quality improvement work to enhance the efficiency and effectiveness of behavioral health telemedicine services — and that stands to benefit children far beyond Florida.

Earlier this year, before the Center for Behavioral Health began offering telemedicine, pediatric psychologists William Frye, Ph.D., and Lauren Gardner, Ph.D., led an effort to survey their colleagues regarding concerns about and confidence in telemedicine. A follow-up survey, three weeks after telemedicine services began, sought to gauge how providers’ feelings about telemedicine had changed.

“We wanted to see what barriers to telemedicine still existed after we started offering it, as well as learn more about what predicts provider confidence in telemedicine and what other sites could do to optimize the shift to telemedicine,” Katzenstein says. “We’ve shared lots of documentation with other children’s hospitals, especially related to neuropsychological and psychological testing, because this is an opportunity to show efficiency in our work, to show how screening evaluations can be helpful in deciding who needs more significant intervention or testing, and then be able to disseminate that to other places to share some of the great work we’re doing to help reduce costs.”

Weekly meetings occur to discuss telemedicine policies and procedures for patient testing and screening, and how to standardize patient data collection.

This story first appeared in For the Kids magazine. Telemedicine services represent an estimated $500,000 investment in the mental health of children throughout the Tampa Bay region. Visit to support these and other Johns Hopkins All Children’s services.

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