Restricted accessResearch articleFirst published online 2025-07
Telehealth-Facilitated Mental Health Care Access and Continuity for Patients Served at the Health Resources and Services Administration–Funded Health Centers
The Health Resources and Services Administration (HRSA)–funded health centers provide critical behavioral health services to historically and medically underserved individuals with complex health and social needs. As health centers rapidly expanded telehealth in response to COVID-19, the objective of the study was to assess whether telehealth use was associated with utilization and continuity within mental health care received by patients of HRSA-funded health centers.
Methods:
Cross-sectional analyses, using a nationally representative sample of adult patients with mental health needs from the 2022 Health Center Patient Survey (n = 1,044), explored associations between telehealth use and utilization of mental health services from primary care providers (PCP) and continuity of counseling services. Multivariate logistic regression models accounted for predisposing, enabling, and need factors to assess the influence of telehealth use on utilization and continuity outcomes.
Results:
After adjusting for patient-level factors, telehealth users with mental health needs had statistically significant and higher odds of receiving mental health services from a PCP at a health center compared with nontelehealth users (adjusted odds ratios [aOR] = 2.60, p < 0.001; 95% confidence interval [CI] [1.50, 4.52]). Telehealth-using patients receiving counseling services had statistically significant and higher odds of receiving all counseling services at a health center compared with nontelehealth users (aOR = 3.65, p < 0.001, 95% CI [2.04, 6.53]).
Conclusions:
Telehealth facilitates mental health care utilization and continuity for historically and medically underserved patients at health centers and can be an important tool for care management and coordination for patients with mental health needs, particularly during and following public health emergencies.
BashshurRL, ShannonGW, BashshurN, et al.The empirical evidence for telemedicine interventions in mental disorders. Telemed J E Health, 2016; 22(2):87–113; doi: 10.1089/tmj.2015.0206
3.
Uscher-PinesL, RajaP, QureshiN, et al.Use of tele-mental health in conjunction with in-person care: A qualitative exploration of implementation models. Psychiatr Serv, 2020; 71(5):419–426; doi: 10.1176/appi.ps.201900386
4.
BatastiniAB, PaprzyckiP, JonesACT, et al.Are videoconferenced mental and behavioral health services just as good as in-person? A meta-analysis of a fast-growing practice. Clin Psychol Rev, 2021; 83:101944; doi: 10.1016/j.cpr.2020.101944
5.
LombardiBM, de Saxe ZerdenL, GreenoC. Federally qualified health centers use of telehealth to deliver integrated behavioral health care during COVID-19. Community Ment Health J, 2024; 60(2):215–223; doi: 10.1007/s10597-022-01070-1
6.
ColeMB, LeeEK, DavoustM, et al.Comparison of visit rates before vs after telehealth expansion among patients with mental health diagnoses treated at federally qualified health centers. JAMA Netw Open, 2022; 5(11):e2242059; doi: 10.1001/jamanetworkopen.2022.42059
7.
MehrotraA, HuskampHA, SouzaJ, et al.Rapid growth in mental health telemedicine use among rural Medicare beneficiaries, wide variation across states. Health Aff (Millwood), 2017; 36(5):909–917; doi: 10.1377/hlthaff.2016.1461
8.
BarnettML, HuskampHA, BuschAB, et al.Trends in outpatient telemedicine utilization among rural Medicare beneficiaries, 2010 to 2019. JAMA Health Forum, 2021; 2(10):e213282; doi: 10.1001/jamahealthforum.2021.3282
9.
WilliamsC, ShangD. Telehealth usage among low-income racial and ethnic minority populations during the COVID-19 pandemic: Retrospective observational study. J Med Internet Res, 2023; 25:e43604; doi: 10.2196/43604
10.
Health Resources and Services Administration (HRSA). What is a Health Center? Rockville, MD; 2023. Available from: https://data.hrsa.gov? [Last accessed: July29, 2023].
BabeySH, PouratN, ChenX, et al.The concurrent burden of multimorbidity, mental health conditions, and severe obesity among United States health center patients. Obes Med, 2021; 24:100348; doi: 10.1016/j.obmed.2021.100348
KimJ, SheldrickRC, GallagherK, et al.Association of integrating mental health into pediatric primary care at federally qualified health centers with utilization and follow-up care. JAMA Netw Open, 2023; 6(4):e239990; doi: 10.1001/jamanetworkopen.2023.9990
15.
PettsRA, LewisRK, BrooksK, et al.Examining patient and provider experiences with integrated care at a community health clinic. J Behav Health Serv Res, 2022; 49(1):32–49; doi: 10.1007/s11414-021-09764-2
16.
KoehlerAN, SudanoLE, IpE, et al.Patient experience of an integrated care model in a family practice clinic & FQHC. Int J Psychiatry Med, 2020; 55(5):357–365; doi: 10.1177/0091217420951059
17.
LinCC, DievlerA, RobbinsC, et al.Telehealth in health centers: Key adoption factors, barriers, and opportunities. Health Aff (Millwood), 2018; 37(12):1967–1974; doi: 10.1377/hlthaff.2018.05125
18.
AntonioMG, WilliamsonA, KameswaranV, et al.Targeting patients’ cognitive load for telehealth video visits through student-delivered helping sessions at a United States federally qualified health center: Equity-focused, mixed methods pilot intervention study. J Med Internet Res, 2023; 25:e42586; doi: 10.2196/42586
19.
BerryCA, KwokL, MassarR, et al.Patients’ perspectives on the shift to telemedicine in primary and behavioral health care during the COVID-19 pandemic. J Gen Intern Med, 2022; 37(16):4248–4256; doi: 10.1007/s11606-022-07827-4
20.
Uscher-PinesL, AroraN, JonesM, et al.Experiences of health centers in implementing telehealth visits for underserved patients during the COVID-19 pandemic: Results from the connected care accelerator initiative. Rand Health Q, 2022; 9(4):2.
21.
HellsternRB, RobinsonWD. The impact of COVID-19 and telehealth services on attrition rates in psychotherapy. Contemp Fam Ther, 2023:1–12; doi: 10.1007/s10591-023-09661-0
22.
Health Resources and Services Administration (HRSA). 2022 Health Center Patient Survey Data File User’s Manual. Bureau of Primary Health Care: Rockville, MD; 2023.
23.
RadezJ, ReardonT, CreswellC, et al.Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. Eur Child Adolesc Psychiatry, 2021; 30(2):183–211; doi: 10.1007/s00787-019-01469-4
24.
AndersenR, NewmanJF. Societal and individual determinants of medical care utilization in the United States. Milbank Quarterly, 2005; 83(4); doi: 10.1111/j.1468-0009.2005.00428.x
25.
AndersenJA, FelixHC, SuD, et al.Factors associated with Arkansans’ first use of telehealth during the COVID-19 pandemic. Int J Telemed Appl, 2022; 2022:5953027; doi: 10.1155/2022/5953027
26.
NarcisseMR, AndersenJA, FelixHC, et al.Factors associated with telehealth use among adults in the United States: Findings from the 2020 National Health Interview Survey. J Telemed Telecare, 2024; 30(6):993–1004; doi: 10.1177/1357633X221113192
27.
BhuyanSS, LuN, ChandakA, et al.Use of mobile health applications for health-seeking behavior among US adults. J Med Syst, 2016; 40(6):153; doi: 10.1007/s10916-016-0492-7
28.
IottB, DoanTT. Provision of telemental health before and after COVID-19 onset. Am J Manag Care, 2023; 29(3):118–123; doi: 10.3776/5/ajmc.2023.89326
29.
HartS, CampbellC, DivineH, et al.Telehealth diabetes services for non-English speaking patients. J Am Pharm Assoc (2003), 2022; 62(4):1394–1399; doi: 10.1016/j.japh.2022.03.009
30.
PayánDD, FrehnJL, GarciaL, et al.Telemedicine implementation and use in community health centers during COVID-19: Clinic personnel and patient perspectives. SSM Qual Res Health, 2022; 2:100054; doi: 10.1016/j.ssmqr.2022.100054
31.
ColeM. Disparities in telehealth use during COVID‐19 across federally qualified health centers: Findings from national survey data. Health Serv Res, 2021; 56(S2):29–30; doi: 10.1111/1475-6773.13759
32.
FortneyJC, HeagertyPJ, BauerAM, et al.Study to Promote Innovation in Rural Integrated Telepsychiatry (SPIRIT): Rationale and design of a randomized comparative effectiveness trial of managing complex psychiatric disorders in rural primary care clinics. Contemp Clin Trials, 2020; 90:105873; doi: 10.1016/j.cct.2019.105873
33.
HowrenMB, CastagnaN, KatzPR. Openness to use of telehealth during and after the COVID-19 pandemic in a sample of rural older adults in a federally qualified health center. J Am Med Dir Assoc, 2021; 22(9):1856–1857; doi: 10.1016/j.jamda.2021.06.028
34.
BowerM, OlsenN, PeachN, et al.Feasibility of telehealth counselling pilot for people experiencing homelessness and/or complex needs: During COVID-19 and beyond. Health Promot J Austr, 2023; 34(4):889–894; doi: 10.1002/hpja.717
35.
DeLaCruz-JironEJ, HahnLM, DonahueAL, et al.Telemental health for the homeless population: Lessons learned when leveraging care. Curr Psychiatry Rep, 2023; 25(1):1–6; doi: 10.1007/s11920-022-01400-w
36.
LalS, EliasS, SieuV, et al.Use of technology to provide mental health services to youth experiencing homelessness: A scoping review protocol. BMJ Open, 2022; 12(9):e061313; doi: 10.1136/bmjopen-2022-061313
37.
Lebrun-HarrisLA, BaggettTP, JenkinsDM, et al.Health status and health care experiences among homeless patients in federally supported health centers: Findings from the 2009 patient survey. Health Serv Res, 2013; 48(3):992–1017; doi: 10.1111/1475-6773.12009
38.
AdepojuOE, TranL, AgwunchaR, et al.Associations between patient- and provider level factors, and telemedicine use in family medicine clinics. J Am Board Fam Med, 2022; 35(3):457–464; doi: 10.3122/jabfm.2022.03.210416
39.
StataCorp LLC. Stata survey data reference manual: Release 18. College Station, Texas; 2023. Available from: https://www.stata.com/manuals/svy.pdf [Last accessed: July31, 2023].
40.
BedmarMA, Bennasar-VenyM, Artigas-LelongB, et al.Health and access to healthcare in homeless people: Protocol for a mixed-methods study. Medicine (Baltimore), 2022; 101(7):e28816; doi: 10.1097/md.0000000000028816
41.
DaviesA, WoodLJ. Homeless health care: Meeting the challenges of providing primary care. Med J Aust, 2018; 209(5):230–234; doi: 10.5694/mja17.01264
42.
KyankoKA, CurryLA, KeeneDE, et al.Does primary care fill the gap in access to specialty mental health care? A mixed methods study. J Gen Intern Med, 2022; 37(7):1641–1647; doi: 10.1007/s11606-021-07260-z
43.
AinslieM, BrunetteMF, CapozzoliM. Treatment interruptions and telemedicine utilization in serious mental illness: Retrospective longitudinal claims analysis. JMIR Ment Health, 2022; 9(3):e33092; doi: 10.2196/33092
44.
AdepojuOE, ValdezMR. Trends in mental health utilization before and during the COVID-19 pandemic: Federally qualified health centers as a case study. Popul Health Manag, 2023; 26(3):143–148; doi: 10.1089/pop.2023.0006
McGarity-PalmerR, SawA, SunM, et al.Mental health needs among Asian and Asian American adults during the COVID-19 pandemic. Public Health Rep, 2023; 138(3):535–545; doi: 10.1177/00333549231156566
48.
KustersIS, AmspokerAB, FrosioK, et al.Rural-Urban disparities in video telehealth use during rapid mental health care virtualization among American Indian/Alaska native veterans. JAMA Psychiatry, 2023; 80(10):1055–1060; doi: 10.1001/jamapsychiatry.2023.2285
49.
DaySC, CaloudasA, FrosioK, et al.Culturally centered implementation of video telehealth for rural native veterans. Telemed J E Health, 2023; 29(12):1870–1877; doi: 10.1089/tmj.2022.0506
50.
DhinsaJ, Roman-UrrestarazuA, van KesselR, et al.Understanding predictors of mental health and substance use treatment utilization among US adults: A repeated cross-sectional study. Glob Epidemiol, 2023; 5:100109; doi: 10.1016/j.gloepi.2023.100109
51.
PouratN, LuC, ChenX, et al.Staffing transformation following patient-centered medical home recognition among health resources & services administration-funded health centers. Health Care Manage Rev, 2023; 48(2):150–160; doi: 10.1097/hmr.0000000000000362
52.
McBainRK, SchulerMS, QureshiN, et al.Expansion of telehealth availability for mental health care after state-level policy changes from 2019 to 2022. JAMA Netw Open, 2023; 6(6):e2318045-e2318045; doi: 10.1001/jamanetworkopen.2023.18045
Center for Connected Health Policy. State Telehealth Laws and Medicaid Program Policies Summary Report, Spring 2023. The National Telehealth Policy Resource Center: Sacramento, CA; 2023.
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