Telemental Health Services Improved Access to Mental Health Treatment for Publicly Insured Children with Depression During the COVID 19 Pandemic

A new study published in JAMA Network Open and led by researchers at the Rollins School of Public Health and Emory University School of Medicine found that publicly insured children with depression who received treatment via telemental health in 2020 were significantly more likely to receive any mental health visit and at least four mental health visits compared to those in clinic-only settings.  Four mental health visits is a conservative threshold used in prior studies because research has shown that brief interventions can improve depressive symptoms within four sessions. 

Researchers  analyzed claims data for nearly 800,000 publicly insured children and adolescents (ages 3–17) across 41 states and Washington, D.C., from 2016 through 2020. The study examined trends in care delivery before and during the COVID-19 pandemic and compared mental health treatment across settings.

“In recent years, mental health service delivery for children has changed substantially, with increases in telehealth, school-based services, and in-home care. Our team wanted to examine how these changes were associated with mental health care received among publicly insured children with depression,” says lead author Janet Cummings, PhD, professor of health policy and management at Rollins. 

Rates of depression have been rising among children, and in 2023, nearly four in 10 children in the United States were covered by public insurance programs such as Medicaid.     

What the Researchers Found

• The share of publicly insured children with depression receiving telehealth rose from 4.5% pre-pandemic to 49.8% in 2020, while clinic-only (in-person) care declined from 76.8% to 43.1%.
• The share of the sample who received any mental health services in school settings (but did not receive telehealth)   also declined from 7.3% pre-pandemic to 2.6% in 2020.
• In 2020, publicly insured children with depression that received any mental health care via telehealth or in school settings were more likely to have at least four mental health visits than those who received clinic-only care.

In this study, the greater likelihood of receiving at least four mental health visits with telemental health reflects its advantage in lowering access barriers. “Telemental health services were an important mechanism for maintaining depression treatment among publicly insured children and adolescents in 2020 and show promise in reducing access barriers such as distance to care, transportation availability, and family schedules,” says Cummings. “Ensuring continued access may help support timely mental health care.”