When the COVID-19 pandemic began to sweep across the United States, volume in the emergency department (ED) at Children’s of Alabama in Birmingham began to plunge.

Jesse “Tobias” Martinez, Jr., MD, a psychiatrist and medical director of the Psychiatric Intake Response Center (PIRC), a unit that operates within the Children’s of Alabama ED, fielded calls from families in need of mental health resources. Concurrently, he helped assess patients who presented with mental health concerns. A few weeks into the pandemic, a different picture began to emerge.

“As schools were closing and children were at home, some of the first cases that we had coming in were children suffering with autism, developmental delays, and intellectual disabilities,” Martinez explains. “In talking with the families, it was because [these children] lost that structured environment. They lost the opportunity to go to a school or a program for a certain amount of the day ... it has been very difficult for those patients and their families.”

ED providers, as well as mental health therapists in the PIRC, witnessed a lot of caregiver burnout, Martinez observes. “Children with autism can sometimes be difficult for families to work with [outside] that structured environment that their school or a program provides,” he says. “Some of the families were lost in how to appropriately mange or work with their child at home. The Zoom or video education that schools were trying to provide did not really work for a lot of these patients.”

As a result, the Children’s of Alabama ED began to see more patients presenting with an acute psychiatric crisis. Now, several months into the pandemic, the ED is seeing more patients who feel socially isolated and upset.

“There is a high level of anxiety happening to the patients as well as the families,” observes Cynthia Jones, MA, LPC-S, NCC, CRC, director of the PIRC. “We are seeing that more than normal.”

To protect patients and staff, the hospital has instituted a policy requiring all patients and caregivers to wear a mask, except for children younger than age 2 years, Martinez reports.

“We have several main entrances where people in the community — and even all of our clinicians and staff — come into the hospital. They are all screened daily [at these locations] with COVID screening questions and a temperature check. Then, they are provided with an ID sticker saying they have been screened for that day,” he explains. “Another thing we have done in the ED is we have limited the number of visitors to only one caregiver with the patient.”