Project Summary
The response to COVID-19 in the U.S. has generated a transformative shift in telehealth policies for mental
health care, including expansion of provider reimbursement, licensure portability, and permitted telehealth
platforms. Against the backdrop of COVID-19, it remains unanswered to what extent U.S. mental health
facilities have transitioned to telehealth, as well as effects on access, equity and quality of care. We propose a
longitudinal, mixed-methods evaluation of the effects of telemental health expansion on access, equity
and quality of mental health care—according to provider and patient perspectives.
First, using a secret shopper approach, we simulate the patient experience of attempting to access
telemental health services with a nationally representative sample of 1,500 mental health treatment facilities in
Years 1 and 2, creating a longitudinal repository of the evolution of service availability for a wide array of
telemental health services. Second, we will generate a unique, longitudinal secondary dataset that merges
facility-, county- and state-level characteristics to investigate key factors that predict telehealth availability
along three axes: (i) facility characteristics such as type of facility and facility management structure; (ii)
county-level socioeconomic, racial/ethnic, and geographic disparities; and (iii) state-level COVID-related
legislation. Third, following an explanatory sequential mixed-methods design, we will use responses from the
secret shopper survey to guide key informant (KI) interviews with providers at 20 facilities—stratified by
whether the facility offers telehealth services, and whether this occurred following onset of COVID-19. KI
interviews will provide key insights on provider perspectives on barriers and facilitators to telehealth, quality of
care, and feedback they have received from patients. Our three specific aims are:
Aim 1: Conduct a longitudinal secret shopper survey of 1,500 mental health treatment facilities to assess an
array of patient barriers to accessing specific telemental health services during the COVID-19 pandemic.
Aim 2: Create a national database that synthesizes facility-, county-, and state-level characteristics to
examine three sets of predictors of telemental health service availability from 2015-2022: (i) facility
characteristics—including forms of management and accepted insurance; (ii) county-level racial/ethnic,
socioeconomic, and geographic composition; and (iii) state-level COVID-19 related policies.
Aim 3: Record key facilitators and barriers to offering telemental health services, provider perspectives on
quality of care, and feedback from patients, drawing from KI interviews with a stratified sample of providers.
The proposed study will shed light on the rapidly changing landscape of telemental health services—
including with regard to access, equity and quality of care. Building from this, we will pursue an R01 in which
we link our completed dataset to claims data to examine telehealth utilization and patient-related outcomes.