29.4 Challenges and Adaptation in Child Crisis Triage and Intervention Delivery Across California Before and During the COVID-19 Pandemic

ObjectivesThe objective is to describe real-time barriers to and facilitators of youth crisis triage and intervention programs before and over the course of the COVID-19 pandemic.MethodsAmong 6 school-based and 8 county-based child crisis triage and intervention programs funded by the California Mental Health Services Act, 76 semi-structured interviews were conducted at 6-month intervals with program leads and staff at county-based programs (n = 44) and school-based programs (n = 32). The time period for qualitative interviews spanned 9 months prior to and up to 18 months after COVID-19–related school closures. The Consolidated Framework for Implementation Research informed the interview guides and qualitative data analyses.ResultsPrograms reported dynamic changes in client and community needs, including increased clinical acuity, variability in program utilization, and emerging demand for support for basic needs, grief and loss, and socialization. Early barriers to care related to school closures, including reduced access to students and virtual fatigue, were replaced by challenges managing the “tsunami” of youth mental health needs once schools reopened in person. Associated barriers to care included staff turnover and increased staff and provider strain due to the pandemic, which were further compounded by pandemic-related workforce disruptions. Facilitators to care included program adaptability and rapid uptake of innovative solutions, even as the pandemic eroded organizational resilience. While collaboration with external agencies remained a facilitator of care, programs reported variable impacts on those partnerships as the pandemic progressed.ConclusionsThe ongoing evolution of the COVID-19 pandemic led to shifting barriers to care that were partially mitigated by the adaptability and innovation of highly strained organizations and providers. Future research is needed to further trace these shifts in care delivery over time and to identify additional contextual factors that influence implementation.CC, SII ObjectivesThe objective is to describe real-time barriers to and facilitators of youth crisis triage and intervention programs before and over the course of the COVID-19 pandemic. The objective is to describe real-time barriers to and facilitators of youth crisis triage and intervention programs before and over the course of the COVID-19 pandemic. MethodsAmong 6 school-based and 8 county-based child crisis triage and intervention programs funded by the California Mental Health Services Act, 76 semi-structured interviews were conducted at 6-month intervals with program leads and staff at county-based programs (n = 44) and school-based programs (n = 32). The time period for qualitative interviews spanned 9 months prior to and up to 18 months after COVID-19–related school closures. The Consolidated Framework for Implementation Research informed the interview guides and qualitative data analyses. Among 6 school-based and 8 county-based child crisis triage and intervention programs funded by the California Mental Health Services Act, 76 semi-structured interviews were conducted at 6-month intervals with program leads and staff at county-based programs (n = 44) and school-based programs (n = 32). The time period for qualitative interviews spanned 9 months prior to and up to 18 months after COVID-19–related school closures. The Consolidated Framework for Implementation Research informed the interview guides and qualitative data analyses. ResultsPrograms reported dynamic changes in client and community needs, including increased clinical acuity, variability in program utilization, and emerging demand for support for basic needs, grief and loss, and socialization. Early barriers to care related to school closures, including reduced access to students and virtual fatigue, were replaced by challenges managing the “tsunami” of youth mental health needs once schools reopened in person. Associated barriers to care included staff turnover and increased staff and provider strain due to the pandemic, which were further compounded by pandemic-related workforce disruptions. Facilitators to care included program adaptability and rapid uptake of innovative solutions, even as the pandemic eroded organizational resilience. While collaboration with external agencies remained a facilitator of care, programs reported variable impacts on those partnerships as the pandemic progressed. Programs reported dynamic changes in client and community needs, including increased clinical acuity, variability in program utilization, and emerging demand for support for basic needs, grief and loss, and socialization. Early barriers to care related to school closures, including reduced access to students and virtual fatigue, were replaced by challenges managing the “tsunami” of youth mental health needs once schools reopened in person. Associated barriers to care included staff turnover and increased staff and provider strain due to the pandemic, which were further compounded by pandemic-related workforce disruptions. Facilitators to care included program adaptability and rapid uptake of innovative solutions, even as the pandemic eroded organizational resilience. While collaboration with external agencies remained a facilitator of care, programs reported variable impacts on those partnerships as the pandemic progressed. ConclusionsThe ongoing evolution of the COVID-19 pandemic led to shifting barriers to care that were partially mitigated by the adaptability and innovation of highly strained organizations and providers. Future research is needed to further trace these shifts in care delivery over time and to identify additional contextual factors that influence implementation.CC, SII The ongoing evolution of the COVID-19 pandemic led to shifting barriers to care that were partially mitigated by the adaptability and innovation of highly strained organizations and providers. Future research is needed to further trace these shifts in care delivery over time and to identify additional contextual factors that influence implementation.