Therapists' Perspectives on Access to Telemental Health Among Medicaid-Enrolled Youth

OBJECTIVE: The COVID-19 pandemic exacerbated risk for poor mental health (MH) outcomes among youth from lowincome 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. STUDY DESIGN: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.