Telehealth Service Provision in Integrated Settings: Strengths and Challenges

Background: Telehealth has caused tremendous impacts on behavioral health service provision and outcomes. Telehealth services improve cost efficiencies, offer flexibility in provider schedules, and reduce readmissions (Langabeer et al., 2017). Telehealth provision has been critical during COVID-19 by maintaining service provision while preventing virus spread (Smith et al., 2020). Research suggests that telehealth services provide comparable quality of care and clinical outcomes to traditional services (Donelan et al., 2019). Telehealth may also help decrease the disparities in healthcare utilization among racially and economically disadvantaged populations. Among Medicaid beneficiaries, telehealth use was higher among beneficiaries with severe mental illness, living in rural nonadjacent counties, or in mental health professional shortage areas (Talbot et al., 2020). However, there is not enough discussion on the strengths and challenges of telehealth implementation from the practitioners’ perspective.

Methods: In 2022, we conducted one-hour focus group interviews with 17 student trainees in the “Behavioral Health Workforce Education and Training Program” supported by the Health Resources and Services Administration. Participants interned in integrated health settings from health professional shortage areas (HPSAs) to provide behavioral health services. We solicited participants’ experiences providing telehealth, focusing on the perceived strengths and challenges of telehealth service provisions in HPSAs. Interviews were recorded and analyzed using thematic analysis (Braun & Clarke, 2012).

Results: Trainee participants reported that telehealth promotes service accessibility for clients living with physical limitations, disabilities, and health problems, clients living in remote areas with limited transportation options, children and adolescents whose caregivers were not available to provide transportation, and clients who need interpreters. On the other hand, lack of computers and internet access, low computer skills, and comfort levels with technology were barriers to telehealth. Trainee participants also reported that telehealth might compromise client engagement partly because of providers’ difficulties in reading body language and partly because of client characteristics (e.g., children with attentional difficulties). More importantly, trainee participants reported that they experienced extreme stress and uncertainty when delivering telehealth for clients in crisis due to the absence of protocols. When working with clients having suicidal ideations or facing domestic violence, trainee participants were often unsure about clients’ safety and practitioners’ responsibilities. Clients were also more likely to cancel appointments for telehealth. Finally, the method of delivery impacts telehealth service provision; telehealth via phone was perceived to be more distracting than video conference. Clients called in, lying on the bed, from grocery stores, or not focusing on the service they were receiving.

Conclusions and Implications: Trainee participants reported that telehealth is a promising direction for integrated health care due to its potential to reduce health care disparities among racially and socioeconomically disadvantaged populations. There is a critical need to improve telehealth service provision. For example, health professionals should develop telehealth training to enhance client engagement and develop practitioners’ cultural competency, as well as establish regulations and protocols for providing telehealth services. In addition, policy and technical support are needed to expand access to telehealth, such as broadband, Wi-Fi, and telehealth platforms, for both service providers and recipients.