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Comment & Response
November 23, 2020

Coronavirus Disease 2019 and Effects of School Closure for Children and Their Families—Reply

Author Affiliations
  • 1Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
  • 2Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
  • 3Well Being Trust, Oakland, California
JAMA Pediatr. 2021;175(2):211-212. doi:10.1001/jamapediatrics.2020.3598

In Reply Coronavirus disease 2019 (COVID-19) continues to highlight the critical importance of addressing mental health in children and adolescents and the foundational role of schools. In our Viewpoint,1 we highlighted 3 policy areas that deserved attention.

In response, Graves et al astutely point out that without broadband infrastructure and accessibility, many rural youths will miss out on the opportunity to benefit from much needed telehealth mental health services. Most of the United States has access to broadband services, but major gaps remain in rural areas.2 We wholeheartedly agree that this should be a focus. Telehealth financing and regulation are important, and we encourage policy makers to make the changes to telehealth services from the Emergency Order permanent while working to expand these provisions for other commercial health plans. It is vital that children and their families can access quality mental health care through whatever remote modality is available to them. To facilitate this, telehealth services should be covered and paid at the same level as face-to-face visits, and the quality and outcomes from these telehealth services should be tracked. State Medicaid programs can take the lead here because they cover a large share of children and mental health services. But we should also invest in broadband expansion to ensure rural and other underserved communities have equitable access to mental health care.

Poletti and Raballo also respond and correctly describe the ways that quarantines and school closings negatively affect children and their families. They make a critical point about school closings: that there is a need to invest in and implement interventions to reduce long-lasting effects of prolonged school closures.

Beyond what we describe here, policy makers should prioritize 2 other areas for action. First, support frontline Medicaid clinicians who provide most mental health services in this country. A survey of mental health clinicians shows that many mental health clinics and community-based services are at risk of closing without financial help.3 With the expected increased demand for services, there needs to be a system in place for those seeking care. Second, policy makers and community leaders need to engage with and listen to youths while crafting COVID-19 response, recovery, and redesign plans. We need to listen to diverse youth voices for their take on the problems and solutions.4

Unfortunately, we currently lack representative data on how COVID-19 is affecting youth mental health in the United States. However, nonrepresentative data suggests that serious problems exist. For example, a survey commissioned by 4-H, the national youth development organization, found that 64% of teenagers surveyed believed that COVID-19 will have a lasting effect on their generation’s mental health.5 From changes in social interactions to educational achievement to accessing much-needed mental health services, life for millions of children and adolescents has changed almost overnight. The ripple effects of these changes could negatively affect this generation for years to come if we do not begin to invest in policies and programs that can make a difference now.

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Article Information

Corresponding Author: Ezra Golberstein, PhD, Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE, MMC 729, Minneapolis, MN 55455 (egolber@umn.edu).

Published Online: November 23, 2020. doi:10.1001/jamapediatrics.2020.3598

Conflict of Interest Disclosures: None reported.

Golberstein  E, Wen  H, Miller  BF.  Coronavirus disease 2019 (COVID-19) and mental health for children and adolescents.   JAMA Pediatr. 2020;174(9):819-820. doi:10.1001/jamapediatrics.2020.1456PubMedGoogle Scholar
Perrin  A. Digital gap between rural and nonrural America persists. Published 2019. Accessed June 20, 2020. https://www.pewresearch.org/fact-tank/2019/05/31/digital-gap-between-rural-and-nonrural-america-persists/
Behavioral health crisis in America getting worse as COVID-19 forces community behavioral health care organizations to cut back. Press Release. April 16, 2020.
Dougherty  D, LeBlanc  N, Armstrong  P, Kanani  NS, Wittenberg  R, Cope  E.  Advancing Teen Flourishing: Moving Policy Upstream. Well Being Trust;2020.
National 4-H Council. 4-H youth mental health survey. Accessed June 20, 2020. https://4-h.org/about/research/#!healthy-living