Policy effects of the expansion of telehealth under 1135 waivers on intentions to seek counseling services: Difference-in-difference (DiD) analysis

Practicing counselors swiftly shifted to telehealth after insurance payers changed their policy to cover telehealth counseling under the expansion of telehealth with 1135 waivers, which has led to concerns over the policy effects on clients’ continuing counseling service-seeking intentions. To determine if this shift to telehealth was associated with a change in clients’ counseling service-seeking intentions while adjusting for unmeasured confounders and time trends, we performed a difference-in-difference analysis (a quasi-experimental design) to compare changes between the client (treated) and non-client (control) groups through a large national sample of emerging adults (N = 52,237). The study findings indicated that the shift to telehealth was not associated with a change in clients’ counseling service-seeking intentions, providing support for the utility of telehealth counseling. Implications of these findings should be considered when assessing the merit of telehealth counseling to inform public policies and counseling practice in the post-pandemic era.