COVID-19 and Mental Health Care Delivery: A Digital Divide Exists for Youth With Inadequate Access to the Internet

Although recent policy changes during the coronavirus disease 2019 (COVID-19) pandemic have minimized spread of by allowing health care providers to deliver via telehealth transmission,1Centers for Disease ControlUsing expand access essential services COVID-19 pandemic.June 10, 2020https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.htmlGoogle Scholar this has resulted in gaps people who lack reliable (or any) internet and/or computers. While a large majority youth United States access, about 14% youths ages 6–17 live homes without internet, and 17% 3–18 computers; these percentages translate approximately 11 million internet.2USA Facts. 4.4 households with children don't consistent computers online learning pandemic.September 28, 2020https://usafacts.org/articles/internet-access-students-at-home/Google Even 91% smartphones, video interruption or poor audio/video can occur owing broadband inadequate cellular service.3Rideout V. Robb M.B. The commonsense census: Media use tweens teens.2019https://www.commonsensemedia.org/sites/default/files/uploads/research/2019-census-8-to-18-full-report-updated.pdfGoogle Failing consider needs subgroups marginalizes them—both inconspicuously intensely—subsequently widening pediatric mental disparities. Youth at risk disparities service delivery computers, low-income rural areas. Disparities are further widened when ethnic racially diverse groups considered terms delivering interventions. These not only more likely experience health4American Psychiatric AssociationMental disparities: Diverse populations.2017https://www.psychiatry.org/psychiatrists/cultural-competency/education/mental-health-factsGoogle but also receive poorer quality treated.5Hostetter M. Klein S. In focus: Reducing racial confronting racism.September 27, 2018https://www.commonwealthfund.org/publications/newsletter-article/2018/sep/focus-reducing-racial-disparities-health-care-confrontingGoogle Longitudinal studies indicated multiple social factors involving adolescents lower socioeconomic status as report higher rates unmet negative consequences (eg, deprivation) that profoundly affect their development. Further, audio interfere communication alliance building between patients. Despite fact much may continue be delivered restrictions, data sparse regarding effectiveness other interventions treatment conditions. For there appears no research available development innovative ways provide young minorities time is preferred venue many people. Research thus urgently needed takes into consideration long-term effects youth, particularly from disadvantaged backgrounds. Black patients historically reported being less satisfied services, they than White peers,6Pierce R.P. Stevermer J.J. onset public emergency.J Telemed Telecare. 2020; 9: 368-371https://doi.org/10.1177/1357633X20963893Crossref Scopus (103) Google Scholar,7Serper Nunes F. Ahmad N. Roberts D. Metz D.C. Mehta S.J. Positive early patient clinician telemedicine an academic gastroenterology practice pandemic.Gastroenterology. 159: 1589-1591https://doi.org/10.1053/j.gastro.2020.06.034Abstract Full Text PDF PubMed (53) express concerns related physical absence clinicians—justifiable apprehensions given historical experiences community had system. Pilot should therefore patients' barriers develop culturally sensitive address them. Employing training workers (CHWs) could enhance cultural sensitivity determinants create access. CHWs trusted communities serve play role improving They do require competency training, share similar lived others communities. reason, typically great success helping overcome acting bridges care, been integral assisting arranging medication developing guides individuals limited English proficiency navigate visits.8Peretz P.J. Islam Matiz L.A. Community COVID-19—addressing times crisis beyond.N Engl J Med. 383: e108https://doi.org/10.1056/NEJMp2022641Crossref (76) To close gap organizations employing assist getting connected need. Finally, achieve favorable outcomes, multifaceted approach warranted considers initiatives, targeted approaches, Mental users families must empowered fundamentally involved within Health administrators researchers how disproportionately affected economic pandemic, such unemployment. insurance, collaborative model utilizes telephonic used either alternative supplement services. example, remote consultations psychiatric managers primary clinic were implemented several programs throughout state Washington Integration Program (MHIP). Using model, patient's plan pays telephone consultation consultant business hours needed. Another example solution insurance Schizophrenia Foundation (SCARF) Telepsychiatry Puddukottai (STEP) program India. program, pay base fee per month ($12 USD) mobile bus room pharmacy.9Mental Innovation NetworkSCARF telepsychiatry Puddukottai.2021https://www.mhinnovation.net/innovations/scarf-tele-psychiatry-puddukottai-stepGoogle connects enter (the laptop provided on service). When complete visits, pharmacy onboard fills medications ordered. no-cost some spaces libraries, fast food chains, school parking lots), sites expose them health-related issues, inability maintain distancing privacy, confidentiality, security. Moreover, find challenging face-to-face encounters disengage treatment. Online treat conditions, yet exclude smartphones service. National Institutes prioritizing addresses those insurance. Incentives small grants models new increase connectivity neighborhoods where businesses San Francisco, California, hubs local recreation centers parks, community-based agencies, libraries allow distance learning.10San Francisco Department Children, Youth, FamiliesCommunity initiative.2021https://www.dcyf.org/careGoogle Such assessment poor) Future efforts involvement partners (including churches access) exploration beliefs perspectives seeking care. Targeted approaches investigate patient-reported even both clinicians optimal technology connectivity. It important identify specific problems improvement user issues logging on) user-friendly guidelines functionality troubleshoot common visual connectivity). encompass examining clinician-implicit bias perceptions various racial, ethnic, gender, age, diversity groups. policies developed mandate companies reimburse Wi-Fi device sent appointments providers. clinics, federal funding include ability apply hot spots reach Until especially minority will left out fast-paced technological occurring U.S. healthcare settings, undoubtedly result deteriorating outcomes. critical concern, outcomes adolescence adulthood.