2025/10/24 by Min Jang, David S. Mandell, Molly Candon · 1 voice
Medicine · Psychology · #Telemedicine and Telehealth Implementation #Digital Mental Health Interventions #COVID-19 and Mental Health
paper · doi:10.1176/appi.ps.20240292
openalex created_date 2025/10/24 · openalex publication_date 2025/10/24 · openalex updated_date 2026/07/28
OBJECTIVE: The authors aimed to examine the relationship between patient-level disparities in use of outpatient mental health care and levels of adoption of telehealth services by patients' mental health agencies during the COVID-19 pandemic. METHODS: Individuals ages <16 (N=5,383) enrolled in Medicaid in 2019 were linked to Medicaid behavioral health claims data for Philadelphia. The authors applied difference-in-differences analyses to examine the impact of mental health agencies' telehealth adoption level (categorized as low, medium, or high) on patients' mental health care use and used logistic regression to assess racial-ethnic disparities in such use (2019-2021). RESULTS: Of the sample, 15%, 64%, and 21% received services from agencies with low, medium, and high telehealth adoption, respectively. Non-Hispanic Black youths were more likely to be treated at agencies with low (vs. medium or high) telehealth adoption (p<0.001). Black youths were less likely to have used telehealth (OR=0.76) and were less likely to have received any outpatient mental health service (OR=0.77) compared with non-Hispanic White youths. After analyses were controlled for agencies' level of telehealth adoption, the odds ratios moved toward 1 and were no longer statistically significant. CONCLUSIONS: Agencies primarily treating Black youths were less likely to have adopted telehealth, and these youths received substantially less outpatient mental health care compared with White youths. Structural inequities among agencies may have driven these disparities, suggesting the need to support agencies that treat minoritized populations. Future research should explore the barriers to adopting telehealth that these agencies may have experienced, including infrastructure, resources, and organizational culture.