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Racial and ethnic disparities in telemental health use among publicly insured children

Xin Hu, Ilana Graetz, Jordan Gilleland Marchak

  • 1Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Room 610, Atlanta, GA 30322.

The American Journal of Managed Care
|March 7, 2025
PubMed

Insights

The COVID-19 pandemic increased telemental health use for children. However, racial and ethnic disparities in access to these mental health services widened significantly, particularly for minority groups.

Area of Science:

  • Public health
  • Health services research
  • Mental health disparities

Background:

  • The COVID-19 pandemic dramatically increased telemental health utilization for children's mental health services.
  • Pre-existing racial and ethnic disparities in healthcare access may have been exacerbated by the shift to telemental health.

Purpose of the Study:

  • To examine racial and ethnic disparities in telemental health use among publicly insured children.
  • To compare telemental health utilization patterns before and after the onset of the COVID-19 pandemic.

Main Methods:

  • Analysis of 36,877,141 child-year observations of publicly insured children (ages 3-17) with mental health encounters from 2016-2020.
  • Multivariable linear regressions controlling for individual and county-level factors to assess changes in telemental health use by race and ethnicity before and during 2020.

Main Results:

  • Telemental health use surged from 2.74% pre-COVID-19 to 35.90% in 2020.
  • While all groups saw increased telemental health use, non-Hispanic White children experienced a larger increase (36.49 PP) compared to non-Hispanic Black (31.20 PP), Hispanic (29.71 PP), Asian (20.45 PP), and Pacific Islander children (13.80 PP).
  • Children in counties with higher proportions of Black and Hispanic populations showed lower pre-COVID-19 telemental health use and smaller increases in 2020.

Conclusions:

  • Racial and ethnic disparities in telemental health access and utilization widened post-COVID-19.
  • Further research is needed to understand the impact of telemental health on the quality of mental health care and outcomes for publicly insured children.
Abstract

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