699 - Impact of COVID-19 on Primary Care Pediatrician Referrals for Developmental and Behavioral Health Concerns

Poster Number: 699
Publication Number: 699.308

Janki P. Patel, Baylor College of Medicine, Houston, TX, United States; Holly K. Harris, Baylor College of Medicine / Texas Children's Hospital, Houston, TX, United States; Robert G. Voigt, Ochsner Hospital for Children, Jefferson, LA, United States; Sonia Monteiro, Texas Children's Hospital, Houston, TX, United States

Background: The COVID-19 pandemic has had a large systemic impact, ranging from changes in economic burden and family structure to complete disruption of children’s educational and social environments.

Objective: The aim of this project was to evaluate completed primary care referrals for mental health services to determine the impact of the COVID-19 pandemic on pediatric mental health care needs and access.

Design/Methods: This study was conducted at an academic tertiary care center where all referrals for developmental or behavioral health concerns are triaged through a single referral center by social workers who are trained to review intake questionnaires and triage referrals following a specific algorithm to either psychology, psychiatry, or developmental-behavioral pediatrics. Data collection was limited to referrals from a large primary care pediatric network within the same system that were made during the months of October 2019 (pre-pandemic) and October 2020 (during the pandemic) and completed within one year of referral. Chi-square analyses were completed using SAS version 9.4.

Results: 132 patients referred in October 2019 and 225 patients referred in October 2020 completed appointments within one year of referral. Completed appointments from psychiatry and psychology referrals increased from October 2019 (N=90 [68%]) to October 2020 (N=189[84%]) (p = 0.0048), while completed appointments from developmental-behavioral pediatrics referrals did not change across the two time points. Appointment completion for more acute diagnoses (ADHD, Anxiety, Depression, Behavioral Concerns, etc.) increased from October 2019 (N=94 [71%]) to October 2020 (N=186 [83%]) (p=0.011), while appointment completion for more chronic conditions (autism, developmental delays, etc) did not change. There was an increase in completed appointments for referrals for females from October 2019 (N=46[35%]) to October 2020 (N=118 [52%]) (p=0.001) as well as an increase in completed appointments for referrals for teenagers (ages 13-18) from October 2019 (N=29[22%]) to October 2020 (N=79[35%]) (p=0.009).

Conclusion(s): Our study reveals an increase in completed appointments for referrals to psychiatry and psychology relative to developmental-behavioral pediatrics and for referrals for more acute behavioral concerns relative to more chronic developmental disabilities. Our study confirms that the COVID-19 pandemic has resulted in increased demand for acute behavioral health services, where medication or immediate psychotherapeutic intervention may be needed.