COVID-19 Pandemic-Related Practices and Policies Affecting the Continuity of Behavioral Health Care Among Children With Diabetes

COVID-19 has led to substantial challenges in continuing to deliver behavioral health care to all patients, including children with chronic diseases. In the case of diabetes, maintaining strong connections among children, their families, and their care team is essential to promote and sustain daily adherence to a complex medical regimen. The purpose of this paper is to describe COVID-19 pandemic-related practices and policies affecting the continuity of behavioral health care among children with diabetes. Challenges and opportunities were encountered at the provider, patient, and family levels throughout the rapid transition period from in-person to online care to ensure continuity of services. Institutional, regional, and national policies that impacted the care team's capacity to respond swiftly to patients' changing needs were counterbalanced by those related to standards of care, education and training, and resource constraints. At the policy level, COVID-19 re-exposed a number of long-standing and complicated issues about professional licensure among behavioral health providers at the local and state levels and national long-distance practice restrictions during times of crisis. Issues of insurance reimbursement and regulations intended to protect the public may need to adapt and evolve as the practice of behavioral medicine increasingly takes place remotely, online, and over great distances. The sudden transition to telehealth instigated by COVID-19, in addition to the increasing recognition of the benefits of telehealth to favorably affect the reach and impact of traditional behavioral medicine services, offers an unprecedented opportunity to reimagine the medical home and continuity of care for children with diabetes.