Sunday, April 6, 2025
4/6/2025
State Telehealth Policies and Mental Care for Children in Underserved Areas - PROJECT SUMMARY/ABSTRACT Unmet need for child mental health services is a persistent and pressing public health problem in the US. One of the key drivers of the unmet need is health workforce shortage, which has been exacerbated during the COVID-19 pandemic. This exacerbation has occurred against the backdrop of rising mental disorders among children, leading to the national emergency in child mental health declared by multiple specialty organizations. At the same time, the pandemic has also stimulated innovations, including the widespread adoption of telehealth, which has been promoted by recent government policies. Although telehealth has long been advocated for improving health care access for vulnerable populations, such as children living in mental health professional shortage areas (MHPSAs), no study to date has examined how the recent dramatic growth of telehealth affects mental health care availability and utilization for children in MHPSAs. Furthermore, amid the rapid transition to telehealth during the pandemic, some experts have been concerned with disparities in telehealth access and utilization and called for further research on the equitable development of telehealth. In response to that call, this proposed project aims to draw lessons about telehealth adoption during the pandemic to inform future telehealth policies. As a comprehensive evaluation of state telehealth policies on licensure, insurance coverage, and reimbursement, the proposed project has three aims: (1) mental health treatment facility (MHTF) level analyses to assess how changes in state telehealth policies affect disparities in mental health service availability for children from before to during the pandemic, (2) child level analyses to evaluate how changes in state telehealth policies affect disparities in mental care access, utilization, and spending among children from before to during the pandemic, and (3) qualitative interviews with medical directors at MHTFs to understand their experiences using telehealth to serve children as well as facilitators and barriers that they have identified for expanding telehealth in MHPSAs. For each aim, we will analyze two types of disparities—by area of residence (e.g., MHPSAs vs. non- shortage areas), and by child socio-demographic characteristic (e.g., race/ethnicity). Examining these disparities is crucial given the concern about digital health equity during the pandemic. To examine the aims, we will analyze quantitative data from both primary and secondary sources, including our unique longitudinal survey of nearly all MHTFs in the US. We will also collect complementary qualitative data through interviews with medical directors at MHTFs. The proposed study is both timely and important, as state policymakers are considering actions to revise their telehealth policies. The study findings will help them identify policies that have (or haven’t) been successful in expanding telehealth services for children with mental disorders—especially those who live in MHPSAs—to inform subsequent policy decisions.
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