Study: Therapists serving Medicaid patients, couples and families less likely to continue teletherapy


Therapists serving patients from lower socioeconomic status groups, as well as couples and families, are less likely to continue teletherapy after the COVID-19 pandemic, according to a study published in JMIR.

The study surveyed mental health professionals currently using telehealth between January and April last year about their practices, experiences moving to and using teletherapy, and their clients’ characteristics. A total of 114 therapists from 27 states responded, with less than half reporting having used telehealth before the pandemic.

Researchers found therapists who had a higher percentage of patients from rural areas, younger and older clients, patients on Medicare, and clients with marginalized gender and religious identities were more likely to continue using teletherapy post-pandemic.

“Findings from the study suggest that while some groups of clients are more likely to continue to receive benefits of teletherapy, vulnerable groups such as those in lower socioeconomic conditions, Medicaid beneficiaries and those who seek couple and family therapy may be less likely to be served by it,” the study’s authors wrote. 

“These differences point to a need to address factors driving telehealth care disparities such as access to technology, housing and childcare issues, as well as the need for continued training for licensed professionals.”


Researchers noted more studies with diverse samples are necessary, since it’s possible that participants self-selected to take part and that their experiences may not apply to all therapists nationwide. 

But they argue that their study highlights potential structural barriers to teletherapy access for already disadvantaged groups. Since Medicaid and Medicare coverage for teletherapy started at the same time, it’s possible Medicaid clients don’t have resources like technology or internet access or the programs aren’t supporting the modality at state and local levels. 

Researchers suggest therapists working with couples and families may need more training to effectively use teletherapy with their clients, and that de-escalating conflict and managing multiple clients may be more difficult when working virtually. 

“Given that the pandemic has disproportionately impacted those who are under-resourced, decreased teletherapy usage with those with lower socioeconomic status suggests that unless structural issues of accessibility are addressed, vulnerable groups may be left behind,” they wrote.


Though telehealth use has declined from pandemic highs, mental health diagnoses still make up the largest percentage of telehealth claim lines, according to FAIR Health’s Monthly Telehealth Regional Tracker

Other studies and reports have noted potential disparities in virtual care use. The National Committee for Quality Assurance released a white paper last month that detailed challenges to optimal telehealth care, including a lack of broadband access, resources to overcome socioeconomic barriers and tools for people with learning, intellectual, physical and cognitive disabilities.


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