Social Workers' Use of Tele-Behavioral Health during COVID-19

Background and Purpose: In response to the COVID-19 pandemic, the Coronavirus Preparedness and Response Supplemental Appropriations Act and 1135 waiver authority expanded the ability for credentialed providers to utilize telehealth services, including tele-behavioral health. These regulation changes, coupled with unprecedented social, behavioral, and physical health needs, created a surge in the delivery of tele-behavioral health. Prior to COVID-19, social workers have increasingly been utilizing technology, an identified Grand Challenge to “Harness Technology for Social Good.” Yet widespread use of tele-behavioral health is limited due to financing and policy regulations that do not support the model. Evidence for tele-behavioral health exists broadly, however research on use of and training for social workers remains scant. This study measured the extent to which social workers were able to transition to tele-behavioral health during COVID-19, prior experience/education, and the barriers and facilitators experienced during this rapid change in service delivery.

Methods: An electronic survey was developed and distributed to a convenience sample of practicing social work professionals (n=585) through a national listserv. Survey creation was guided by literature, practitioner expertise, consultation from two national professional organizations, cognitive interviews (n=4) and a pilot group of social workers (n=26). The survey included closed and open-ended items and utilized a mixed-method approach. Descriptive analyses were used to depict use of tele-behavioral health and bivariate analyses assessed differences between groups. Open ended responses were analyzed using inductive thematic analysis.

Results: Participants (n=585) completed the survey in 49 states as well as D.C. and Puerto Rico. The sample was predominately white (90%), cisgender female (88%), averaged 54 years in age (SD=13.5), and had worked at their highest degree for 19 years (SD=12). Nearly 88% were licensed in their state, 65% worked in private practice, and 95% reported their organization provided mental health and/or substance use services (31%). Before COVID-19, only 28% of the sample reported using tele-behavioral health, while 34% reported their organization had tele-behavioral capabilities. Since COVID-19, 92% of respondents reported using tele-behavioral health; 95% indicated their organization now had tele-capabilities. Of those who used tele-behavioral health prior to COVID-19, average use increased from 21% to 88%. About half of respondents received training since COVID-19 whereas only 23% had received prior training. Training has been provided by employers (41%), professional organization(s) (42%), a tele-health resource center (15%), a social/program of social work (10%), or local/state/national government (7%). Most respondents indicated at least one barrier to tele-behavioral health use, with client barriers being the most common (73%). Overall, 84% of respondents intended to use tele-behavioral health beyond the pandemic.

Conclusions and Implications: COVID-19 has altered the usage of tele-behavioral health and social workers appear willing to continue providing tele-behavioral health services. Based on study findings, we propose the following recommendations: 1) Ensure parity and reimbursement for tele-behavioral health; 2) Train current and future social work social work practitioners in tele-behavioral health; 3) Provide supports to engage clients use of tele-behavioral health.