Therapists' perspectives on access to telemental health among Medicaid-enrolled youth.

Abstract

The COVID-19 pandemic exacerbated risk for poor mental health (MH) outcomes among youth from low-income families and propelled a shift to telemental health. Yet, little is known about barriers to and facilitators of MH care access when services are delivered via synchronous telehealth to Medicaid-enrolled youth. Between December 2020 and March 2021, we conducted in-depth interviews with 19 therapists from a large safety-net organization who served Medicaid-enrolled youth (< 18 years of age) to elucidate their perspectives on barriers to and facilitators of access to telemental health services among this population. We conducted a thematic content analysis, guided by the 5 dimensions of health care access identified by Fortney and colleagues: geographical, temporal, digital, cultural (including acceptability of services), and financial access. Therapists noted that when components of digital access are met (ie, access to hardware and software, connectivity, and technological literacy), then telehealth could facilitate temporal access and eliminate geographic barriers; elimination of these barriers was particularly beneficial for youth in rural and hard-to-reach communities. Notably, many families depended on smartphones for telemental health access, and many youth depended on their caregiver's smartphone. When considering acceptability of services, some youth preferred in-person services, whereas other youth (especially some teenagers with high technological literacy) had a preference for telemental health. Our results highlight the need for flexibility in reimbursement policies that allows providers to optimize MH care access by offering telehealth delivered via telephone and video as well as in-person services, depending on the needs and preferences of youth and families.