Assessing Access to Trauma-Informed Outpatient Mental Health Services for Adolescents: A Mystery Shopper Study

Objective: The authors aimed to examine how access to trauma -informed mental health services in safety -net health centers varies by insurance type and race -ethnicity of the care seeker. Methods: In this mystery shopper study, three women (White, Latina, and Black voice actresses) called community mental health centers (CMHCs) and federally qualified health centers (FQHCs) (N =229) in Cook County, Illinois, posing as mothers requesting a mental health appointment for their traumatized adolescent child. Each health center was called twice-once in the spring and once in the summer of 2021-with alternating insurance types reported (Medicaid or private insurance). Ability to schedule an appointment, barriers to access, wait times, and availability of trauma -specific treatment were assessed. Results: Callers could schedule an appointment in only 17% (N =78 of 451) of contacts. Reasons for appointment denial varied by organization type: the primary reasons for denial were capacity constraints (67%) at CMHCs and administrative requirements to switch to in -network primary care providers (62%) at FQHCs. Insurance and organization type did not predict successful appointment scheduling. NonWhite callers were significantly less likely (incidence rate ratio =1.18) to be offered an appointment than the White caller (p =0.019). The average wait time was 12 days; CMHCs had significantly shorter wait times than FQHCs (p =0.019). Only 38% of schedulers reported that their health center offered trauma -informed therapy. Conclusions: Fewer than one in five contacts resulted in a mental health appointment, and an apparent bias against non-White callers raises concern that racial discrimination may occur during scheduling. For equitable access to care, antidiscrimination policies should be implemented.