State Telehealth Policies and Mental Care for Children in Underserved Areas - 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 public health emergency between January 2020 and May 2023. 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. The public health emergency 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, some experts have been concerned with imbalance in telehealth access and utilization and called for further research on the balanced development of telehealth. In response to that call, this proposed project aims to draw lessons about telehealth adoption during the public health emergency 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 differences in mental health service availability for children, (2) child level analyses to evaluate how changes in state telehealth policies affect differences in mental care access, utilization, and spending among children, 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 differences—by area of residence (e.g., MHPSAs vs. non-shortage areas), and by child socio-demographic characteristic (e.g., race/ethnicity). Examining these differences is crucial given the concern about digital health differences during the emergency. 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.
