Addressing the growing mental health crisis in pediatrics

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A growing mental health crisis among children and adolescents has currently placed pediatric health care physicians and other family practice clinicians on the front lines of a battle they often aren’t prepared to fight. According to the National Survey of Children’s Health, nearly two-thirds of adolescents aged 12 to 17 with a diagnosed mental or behavioral health condition had difficulty accessing treatment in 2023 — a 35% increase since 2018.

The demand for early mental health screening and intervention has never been greater, but logistical and systemic challenges make it difficult for many care providers to deliver the kind of care their young patients need.

The challenge of Medicaid unwinding in Colorado

For us at Every Child Pediatrics, a nonprofit serving nearly 24,000 underserved children across Colorado, this challenge has been further compounded by the state’s Medicaid unwinding process. The unwinding caused more than 187,000 Colorado children to lose health coverage between May 2023 and January 2024.

During the COVID-19 pandemic, states were required to keep people enrolled in Medicaid without reviewing their eligibility. When that emergency provision ended, millions of children across the United States lost their Medicaid coverage due to administrative errors and procedural barriers. Colorado was among the states with the highest rates of disenrollment. In fact, nearly 7,000 of our Every Child Pediatrics patients have lost their Medicaid coverage.

Laura Luzietti, MD, MBA
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Ultimately, physicians across the state report seeing a lot of patients without insurance coming in only when they absolutely need something. This means many children are missing critical preventive care, including developmental screenings and mental health assessments. The long-term impact of missing early intervention opportunities is profound, particularly for children with undiagnosed behavioral health needs.

Many children who once had access to vital mental health services are now falling through the cracks. Families who cannot afford out-of-pocket costs for assessments and treatment may delay care until crises emerge, putting additional strain on emergency rooms ill-equipped for pediatric behavioral health crises.

The need for early mental health screening

Challenges pediatric facilities face in providing mental health services include the following:

• Time-intensive processes: Administering and analyzing multiple screeners disrupts workflows and increases wait times.
• Stigma and miscommunication: Patients or families may resist discussing mental health issues due to fear of judgment.
• Inconsistent use: Practices may not universally apply assessments, leading to missed opportunities for early diagnosis.
• Delayed interventions: Without proactive systems in place, critical conditions often remain undiagnosed or untreated.

Even for insured patients, timely identification of mental health concerns remains a challenge. Pediatricians often serve as the first point of contact for families navigating behavioral health concerns, but time constraints and administrative burdens make consistent screening difficult. A 20-minute visit is often not enough to conduct thorough developmental and mental health assessments while also addressing routine pediatric care.

To bridge this gap, Every Child Pediatrics has prioritized mental health screenings as part of its standard pediatric workflow. By integrating automated screening tools into patient intake processes, the organization is working to help ensure that no child with potential behavioral health concerns goes undetected.

Leveraging technology to improve access

Technology is playing a vital role in helping overwhelmed pediatric practices manage the increasing demand for mental health assessments. Digital screening tools allow families to complete mental health questionnaires before their appointments, ensuring that providers receive critical insights up front.

We’ve had great success using an automated screening solution from Yosi Health that helps us flag high-risk patients early. While such screening tools aren’t a replacement for clinical judgment, they can serve as a powerful tool to help us ensure no child slips through the cracks. By reducing administrative burdens on providers, these tools free up valuable time for meaningful discussions with families about next steps, referrals and treatment options.

What needs to change

Every Child Pediatrics’ experience spotlights the urgent need for systemic reforms that protect children from unnecessary coverage losses and ensure access to essential mental health services. While technology and workflow innovations can help bridge some of the gaps, broader policy changes are needed to safeguard continuous care for vulnerable pediatric populations.

We need to address both the short-term challenges, like ensuring children who lost Medicaid coverage get re-enrolled, and the long-term need for better mental health integration in primary care. Clinicians can’t do this alone, but with the right tools and support, they can make a difference in the lives of thousands of children who need our help.

As the demand for pediatric mental health care continues to rise, solutions that combine early screening, proactive intervention and policy reform will be essential in ensuring every child gets the care they deserve.

Laura Luzietti, MD, MBA, is executive director of Every Child Pediatrics, based in Thornton, Colorado. She joined the team in 2009 as a pediatrician, became medical director in 2017 and was named executive director in 2020. She oversees all operations, business functions, finances and delivery of clinical services, and continues to care for patients at ECP’s Denver Clinic.