Racial and ethnic disparities in telemental health use among publicly insured children.

Objectives: The COVID-19 pandemic propelled telemental health utilization among children seeking mental health (MH) services. We examined racial and ethnic disparities in telemental health use among publicly insured children before and following COVID-19.

Methods: We identified 36,877,141 child-year observations among publicly insured children aged 3 to 17 years with MH-related encounters in a given year from 2016 to 2020. Multivariable linear regressions controlling for individual- and county-level confounders estimated changes in telemental health use before (2016-2019) and following the pandemic (2020) and how these changes differed by individual- and county-level race and ethnicity.

Results: The percentage of publicly insured children using telemental health increased from 2.74% pre-COVID-19 to 35.90% in 2020. Among non-Hispanic White children, 3.41% used telemental health care pre-COVID-19, which increased by 36.49 percentage points (PP) in 2020. Non-Hispanic Black children had a lower percentage of telemental health use (2.50%) pre-COVID-19, which increased by 31.20 PP in 2020, resulting in a 5.39 PP smaller increase than non-Hispanic White children (P < .001). Similarly, Hispanic, non-Hispanic Asian, and non-Hispanic Pacific Islander children had 6.19 PP, 15.45 PP, and 12.10 PP smaller increases in telemental health use in 2020 compared with non-Hispanic White children (all P < .001). Moreover, children in counties with the highest (vs lowest) quartiles of non-Hispanic Black and Hispanic populations had lower pre-COVID-19 telemental health use and smaller increases in 2020 (all P < .001).

Conclusions: Racial and ethnic disparities in telemental health use widened following COVID-19. Future research should evaluate how telemental health use impacted MH care quality and outcomes among publicly insured children.