Wraparound Blog

Research Supports Expanding Telehealth for Systems of Care: What Does Your Experience Say?

October 17, 2021 | Janet Walker

The COVID-19 pandemic in the United States created a public health emergency that led to an unexpected and enormous increase in the use of telehealth strategies to deliver behavioral health services. As the pandemic ebbs, temporary emergency policies expanding the use of telehealth will expire. Now, policymakers and other stakeholders are considering the extent to which policies expanding telehealth should be made permanent. Without proactive efforts, it’s likely that options for using telehealth in systems of care will be significantly reduced.

Instead of retreating from telehealth in systems of care, research evidence suggests we should be focused on figuring out the best ways to expand it further. This is particularly important given existing workforce shortages. Shortages were already acute in public mental health systems prior to the pandemic, and they are currently at crisis levels in many parts of the country. Given the positive findings from research, it seems like a bad idea to reduce use of a technology that has been shown to have the potential to make mental health services more efficient, equitable and effective.

The paragraphs below provide a summary of the research evidence and expert consensus in support of continuing to expand the use of telehealth strategies in systems of care for youth, young adults, children and families. But research studies paint only part of the picture. We invite you to share your experiences and opinions on telehealth in this short NWI telehealth survey. We’ll let you know what we find out!

Prior to the pandemic, a number of systematic reviews of available research compared telehealth with in-person visits. Systematic reviews are a formal way to combine findings from multiple studies on the same topic, and to draw conclusions about what the studies say when taken as a group. Recent systematic reviews of telehealth research are based on as many as 1,500 individual studies. These reviews have found telehealth to be at least as effective as in-person visits, with one review saying that “Telehealth interventions produce positive outcomes… for psychotherapy as part of behavioral health,” and another review saying that “Studies examining telemental health services generally found that outcomes did not differ significantly from in-person intervention.” Another systematic review focused specifically on telehealth for family mental health services, and found that family therapy outcomes for “child behavioural problems… showed equivalent outcomes in telehealth and face-to-face therapy.”

During the pandemic, the shift to telehealth was in many cases unplanned and somewhat chaotic; however, expert consensus and emerging research conclude that the forced experiment with telehealth was generally successful. For example, one study found that “… the no-show rate of telehealth visits during the COVID-19 pandemic was… lower than both the no-show rate for in-office visits and a pre-pandemic in-office no-show rate,” while satisfaction was similar. A study of a first-episode of psychosis program found that “The no-show rate during the shelter-at-home period was 28 percent, compared to 32 percent the previous year.”

This year, as the pandemic passed the one-year mark, SAMHSA released an expert consensus report endorsing telehealth, saying “Telehealth is effective across the continuum of care for SMI [serious mental illness] and SUD [substance use disorders], including screening and assessment, treatments, including pharmacotherapy, medication management, and behavioral therapies, case management, recovery supports, and crisis services.” Similarly, a 2021 policy brief from the Child Health and Development Institute of Connecticut focused on delivery of behavioral health services for children and families. The policy brief concludes that research “has shown telemedicine to generally be as effective as in-person psychotherapy for a range of diagnoses modalities, and for children, adolescents, and adults.”

The Connecticut policy brief also noted that telehealth “has reduced or eliminated common barriers to care such as non-emergency medical transportation, two-parent work schedules, lack of child care options, and the stigma that can be associated with visiting a behavioral health clinic. Support of telemedicine is grounded in its powerful potential to promote better and more equitable access, engagement, and outcomes, particularly among traditionally underserved populations.” Other studies assess the benefits of telehealth for behavioral health services similarly, focusing on its potential to address barriers related to transportation, poverty and stigma. Further, telehealth can expand access to providers with particular areas of expertise and success in working with populations that are underserved and/or that are less likely to be engaged in services.

The potential drawbacks of telehealth for behavioral health participants are well known, and include lack of access to high-speed internet, lack of appropriate devices, and difficulty finding private space to participate in telehealth services. Additionally, more research is needed to explore in detail best practices for telehealth at the policy level, as well as at the organizational and individual provider levels. Yet even with these challenges remaining, it seems clear that telehealth should remain widely available as an option while research continues to explore its enormous potential to improve systems of care.

Share your opinions and experiences providing or receiving services/supports via telehealth by taking the 3-minute NWI telehealth survey.