Date of Award

Summer 2023

Document Type

Open Access Dissertation



First Advisor

Mark D. Weist


In March 2020, the World Health Organization named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a global pandemic. While the physiological damage of COVID-19 on individuals and communities is itself immeasurable, both because variants continue to spread and because of the unpredictable nature of “long COVID,” we know even less about the long-term psychological impacts on individuals. Lockdown procedures, including school closures, were necessary to prevent transmission of the virus and to protect the most vulnerable bodies (namely, the elderly and immuno-compromised). However, the effect of the closures disproportionately resulted in psychological damage to children and adolescents. Previous studies have identified depression and anxiety, with some linking them to social isolation, as the most prevalent consequences that children and adolescents have experienced due to pandemic lockdowns and school closures. The body of literature on the pandemic’s mental health outcomes for children and adolescents is proliferating. However, most of these studies have emphasized the need to know more about the utilization and effectiveness of the mental health services provided, especially during the most critical parts of the pandemic. Mental health engagement rates before the pandemic indicated a discrepancy between the need for psychosocial services and individuals taking advantage of these services. Additionally, the shift to telemental health services during the initial lockdown, and then the continued use throughout the pandemic is indicative of the different utility of virtual psychosocial services in place prior to COVID-19. However, the field lacks a robust understanding of the various components related to the use of psychosocial services for children and adolescents. Additionally, few studies have identified potential barriers to psychosocial services, and none, to our knowledge, have analyzed the perceived effectiveness of services from the perspective of pediatric patients or their caregivers. The overall goal of this research study is to contribute to the development and adaptation of psychosocial services to support children and adolescents during COVID-19 and future global crises. Specifically, this study identifies the frequency of service use by reviewing the referral reason, attendance rates, and treatment modality for pediatric patients within a clinic. To do this, data from the Electronic Medical Record (EMR) system at the University of Florida Division of General Pediatrics Department of Pediatrics in the College of Medicine was collected at three critical time points, March-May 2019, March -May 2020 and September-November 2020. Additionally, the perceived effectiveness of psychosocial services during COVID-19 and barriers were explored. Outcomes from the study showed significant differences between referral reason, attendance rates and treatment modality at the three time-points. The outcomes highlighted notable differences with increase in internalizing concerns during lockdown, attendance rates during lockdown, and the increased use of virtual services during COVID-19. Semi-structured interviews with caregivers of pediatric patients (6-17 years old) were completed to determine the perceived effectiveness, and barriers to psychosocial services. Ten major themes emerged from the interviews, with caregivers reporting strengths related to telemental health services, but concerns with engagement with virtual services. Additionally, caregivers noted several significant barriers, including concerns related to lengths of waitlists and delay with referral. The overall goal of this research study was to contribute to the development and adaptation of psychosocial services to support children and adolescents during COVID-19 and future global crises. Future directions related to both clinical and research implications are discussed.

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