Disrupted Behavioral Health Routines for Children During a Public Health Crisis
A Mixed-Methods Study of Digital Technology’s Role in Children's Virtual Care
Problem: The COVID-19 pandemic caused a global disruption of daily routines. Children with behavioral disabilities were particularly impacted, losing access to critical face-to-face behavioral health services (e.g., therapy, special education). In response, providers and families worked to reconstruct these routine services, primarily with digital technology.
Methods: In April-July 2020, Olivia conducted a mixed-methods study with parents of children with behavioral disabilities. Using a six-week survey study followed by semi-structured interviews, we identified which (and how) behavioral health routines were disrupted, how care teams recovered these services, and what roles digital technology played in these processes.
Findings:
The recovery of children's behavioral health services was delayed, resulting in negative consequences for the children.
The stoppage of services undermined in-person care coordination mechanisms, necessitating parents and providers to reconfigure their communication processes virtually.
This digital communication led to the digital reconstruction or replacement of some services, but not most.
Video conferencing was overstimulating for many children with behavioral needs, and most recovered services required parental involvement.
These findings have substantial implications for the design of digital technology to increase usability by (and supports for) children with disabilities, and enable resilient care routines that could help withstand the impact of future disruption.
Key Insights for Inclusive Digital Design
Usability Adjustments: Redesign telehealth technologies to minimize stimulation and make children more comfortable. This includes setting default mute for participants and enabling a speaker view in video calls, coupled with options for personalized settings adjustments, or virtual check-in's on whether the tech setup is working for the child.
Direct and Embedded Support: Enhance digital technology to provide both spontaneous and scheduled one-on-one support for children and parents. Integrate features like in-app scheduling for ease of access to care providers.
Structuring with Artifacts: Use visual schedules and engaging tools to help children adhere to behavioral routines. Apply gamification principles where appropriate to reward positive behaviors and maintain consistency in routines.
Key Insights for Care Delivery
Blended Care Model: Encourage routine incorporation of telehealth alongside face-to-face sessions to prepare for potential disruptions. Provide parents with role clarity and involvement opportunities to ensure continuous and competent care.
Parent Training: Integrate comprehensive training modules for parents within digital platforms. This prepares them for effective participation in their children’s care process, making service routines more resilient to disruptions.
Digital Communication Channels: Maintain continuous, flexible digital communication channels between parents and providers for adaptive care coordination. Ensure these systems facilitate burst communication, are easy to use, and support service iteration as needed. Implement efficient digital coordination mechanisms that can substitute in-person coordination in the event of service disruptions, allowing for seamless transition and minimal impact on children’s well-being.
Protocol Revisions and Collaborative Documents: Develop and maintain collaborative platforms for real-time updates and shared access, emphasizing clarity in roles, tasks, and service delivery methods.
Insurance Coverage for Parent Training: Advocate for policy changes that enable parent training to be included in clinical coding and billing systems. Ensure that parents can receive the necessary training to assist with their children’s care without facing financial barriers.
Service Delivery Continuity: Establish a robust recovery plan to swiftly restore or replace children's health services in times of disruption. Aim to minimize the lag in service restoration to protect children's progress and well-being.