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      The Transition of Academic Mental Health Clinics to Telehealth During the COVID-19 Pandemic

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          Abstract

          Objective

          A consortium of 8 academic child and adolescent psychiatry programs in the United States and Canada examined their pivot from in-person, clinic-based services to home-based telehealth during the COVID-19 pandemic. The aims were to document the transition across diverse sites and to present recommendations for future telehealth service planning.

          Method

          Consortium sites completed a Qualtrics survey assessing site characteristics, telehealth practices, service use, and barriers to and facilitators of telehealth service delivery prior to (pre) and during the early stages of (post) the COVID-19 pandemic. The design is descriptive.

          Results

          All sites pivoted from in-person services to home-based telehealth within 2 weeks. Some sites experienced delays in conducting new intakes, and most experienced delays establishing tele−group therapy. No-show rates and use of telephony versus videoconferencing varied by site. Changes in telehealth practices (eg, documentation requirements, safety protocols) and perceived barriers to telehealth service delivery (eg, regulatory limitations, inability to bill) occurred pre−/post−COVID-19.

          Conclusion

          A rapid pivot from in-person services to home-based telehealth occurred at 8 diverse academic programs in the context of a global health crisis. To promote ongoing use of home-based telehealth during future crises and usual care, academic programs should continue documenting the successes and barriers to telehealth practice to promote equitable and sustainable telehealth service delivery in the future.

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          Most cited references7

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          Is Open Access

          Racial and ethnic disparities in SARS-CoV-2 pandemic: analysis of a COVID-19 observational registry for a diverse US metropolitan population

          Introduction Data on race and ethnic disparities for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are limited. We analysed sociodemographic factors associated with higher likelihood of SARS-CoV-2 infection and explore mediating pathways for race and ethnic disparities in the SARS-CoV-2 pandemic. Methods This is a cross-sectional analysis of the COVID-19 Surveillance and Outcomes Registry, which captures data for a large healthcare system, comprising one central tertiary care hospital, seven large community hospitals and an expansive ambulatory/emergency care network in the Greater Houston area. Nasopharyngeal samples for individuals inclusive of all ages, races, ethnicities and sex were tested for SARS-CoV-2. We analysed sociodemographic (age, sex, race, ethnicity, household income, residence population density) and comorbidity (Charlson Comorbidity Index, hypertension, diabetes, obesity) factors. Multivariable logistic regression models were fitted to provide adjusted OR (aOR) and 95% CI for likelihood of a positive SARS-CoV-2 test. Structural equation modelling (SEM) framework was used to explore three mediation pathways (low income, high population density, high comorbidity burden) for the association between non-Hispanic black (NHB) race, Hispanic ethnicity and SARS-CoV-2 infection. Results Among 20 228 tested individuals, 1551 (7.7%) tested positive. The overall mean (SD) age was 51.1 (19.0) years, 62% were females, 22% were black and 18% were Hispanic. NHB and Hispanic ethnicity were associated with lower socioeconomic status and higher population density residence. In the fully adjusted model, NHB (vs non-Hispanic white; aOR, 2.23, CI 1.90 to 2.60) and Hispanic ethnicity (vs non-Hispanic; aOR, 1.95, CI 1.72 to 2.20) had a higher likelihood of infection. Older individuals and males were also at higher risk of infection. The SEM framework demonstrated a significant indirect effect of NHB and Hispanic ethnicity on SARS-CoV-2 infection mediated via a pathway including residence in densely populated zip code. Conclusions There is strong evidence of race and ethnic disparities in the SARS-CoV-2 pandemic that are potentially mediated through unique social determinants of health.
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            Inequity and the disproportionate impact of COVID-19 on communities of color in the United States: The need for a trauma-informed social justice response.

            COVID-19 has had disproportionate contagion and fatality in Black, Latino, and Native American communities and among the poor in the United States. Toxic stress resulting from racial and social inequities have been magnified during the pandemic, with implications for poor physical and mental health and socioeconomic outcomes. It is imperative that our country focus and invest in addressing health inequities and work across sectors to build self-efficacy and long-term capacity within communities and systems of care serving the most disenfranchised, now and in the aftermath of the COVID-19 epidemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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              Clinical Update: Telepsychiatry With Children and Adolescents

              (2017)
              This Clinical Update reviews the use of telepsychiatry to deliver psychiatric, mental health, and care coordination services to children and adolescents across settings as direct service and in collaboration with primary care providers or other clinicians. The update defines terms and presents the current status of telepsychiatry as a mode of health service delivery. The update presents procedures for conducting telepsychiatry services and optimizing the clinical experience.
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                Author and article information

                Journal
                J Am Acad Child Adolesc Psychiatry
                J Am Acad Child Adolesc Psychiatry
                Journal of the American Academy of Child and Adolescent Psychiatry
                Elsevier
                0890-8567
                1527-5418
                10 June 2021
                10 June 2021
                Affiliations
                [a ]University of California, San Francisco
                [b ]University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora
                [c ]Boston Medical Center, Massachusetts
                [d ]Donald and Barbara Zucker School of Medicine at Hofstra and Northwell, Uniondale, New York
                [e ]University of Washington School of Medicine, Seattle
                [f ]NYU Langone Health, New York
                [g ]The Hospital for Sick Children, Toronto, Ontario, Canada
                [h ]University of Toronto, Ontario, Canada
                [i ]Nationwide Children’s Hospital, Columbus, Ohio
                Author notes
                []Correspondence to Marissa A. Schiel, MD, PhD, 13123 E 16 th Avenue, B130, Aurora, CO 80045
                Article
                S0890-8567(21)00367-1
                10.1016/j.jaac.2021.06.003
                8607958
                34119633
                b26e0bc6-b0cc-4c13-8ddd-8e8c65120c8c
                38; Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 3 June 2021
                Categories
                New Research

                Clinical Psychology & Psychiatry
                covid-19,telemedicine,videoconferencing,ambulatory care
                Clinical Psychology & Psychiatry
                covid-19, telemedicine, videoconferencing, ambulatory care

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