Methods. Three pseudo mothers (voice actresses) called eligible CMHCs and FQHCs (N=229) in Cook County, Illinois, requesting to schedule an actual MH appointment for their adolescent child who recently witnessed a traumatic event. Women of different races (White, Latina, and Black) were hired as voice actresses to understand the impact of race on access to MH care. Each agency was called twice (once using Medicaid script and once using private insurance script in random order) in the Spring and Summer of 2021, during the COVID-19 pandemic. All appointments were canceled at the end of the call. We used descriptive statistics to evaluate barriers to accessing care, length of wait time, and the availability of trauma-informed treatment. We ran a generalized linear model to assess the impact of contributing factors (e.g., race) on scheduling an appointment.
Results. Only 17% (n=78) of pseudo mothers could schedule an appointment across both waves of data collection. The primary barriers families experienced when scheduling an appointment were capacity/waitlist reasons (n=87) and an administrative requirement to switch their primary care provider (PCP) into the organization's network (n=71). The average wait time for scheduled appointments was 12 days, and 38% of agencies reported offering trauma-informed treatment. Insurance and organizational type did not predict the ability to schedule a MH appointment, but the caller's race did. The Black and Latina callers were 18% more likely to be denied an appointment than the White caller (p = .019).
Conclusion. Alarmingly, less than one in five pseudo mothers could schedule a MH appointment for their adolescent child. Appointments were primarily denied to families for administrative and capacity reasons. On a positive note, insurance type did not predict the ability to schedule an appointment, indicating agencies were just as likely to accept clients enrolled in Medicaid as private insurance. However, the caller's race did predict access, indicating discrimination may be occurring at the point of scheduling. The results of this study will inform the development of organizational-level strategies to reduce administrative requirements and enforce anti-discrimination policies.