Usefulness of Telemental Health Services for Children in Foster Care in Rural Areas: Insights from Foster Parents on Facilitators and Barriers in a Southeastern State

Background and Purpose: In a southeastern state, approximately 4,000 children are in foster care on any given day. Of these children, around 35% reside in rural areas. Despite the prevalent mental and behavioral health issues, rural foster children face significant challenges in access to mental health services than their urban counterparts. Telemental health (TMH) represents a promising tool to improve access to effective mental health services in rural areas. While TMH will continue to serve as an important venue to provide mental health services and may increase foster children’s service accessibility in rural SC in the post-COVID era, there is a lack of empirical evidence regarding the perspectives of foster parents (FP) on TMH. This study seeks to explore facilitators and barriers in using TMH services for foster children as perceived by foster parents’ residing in rural areas.

Methods: We used a purposive sampling method to recruit FPs. Fourteen one-on-one interviews were conducted via Zoom with FPs in a southeastern state residing in rural areas between October 2023 and February 2024. Nine interviews were conducted for FPs with TMH experience, and five with no TMH experience. We conducted an inductive thematic analysis using NVivo 14.0 for each group of FPs. Peer debriefing and member checking were used to enhance the rigor of our results.

Results: Foster parents reported that TMH was very useful and convenient because this tool allowed continuity of care for their foster youth, offered a safe space to engage with the provider, and flexible scheduling options. We also identified several facilitators that contributed to the use of TMH services. Foster parents’ telehealth experience and familiarity, technology experiences, access to technology tools and internet, financial and social supports, and strong advocacy and support were identified as key facilitators. Furthermore, foster youth’s attitudes, foster youth’s technology literacy, having great connectivity, type of platform and device used were important for foster youth use of TMH services as perceived by FPs. Foster parents also shared several barriers, including Medicaid reimbursement policy on TMH services, lack of technology literacy and experience, type of platform and device used, type of internet carrier, connectivity issues, low-quality broadband, technical difficulties, and lack of training for using telehealth platforms. Moreover, barriers include lack of trust and rapport with the provider, privacy and confidentiality concerns, and lack of providers offering TMH services. Foster parents also frequently identified foster children’s engagement with the provider, foster’s youth placement instability, type of trauma and diagnosis, child’s inability to focus on the virtual session, as additional barriers.

Conclusions and Implications: The findings of this study will assist community based TMH providers and child welfare agency staff in eliminating barriers and promoting facilitators to using TMH services for foster children residing in rural areas of a Southeastern state, thereby enhancing their well-being. We have formulated recommendations for the public child welfare agency, TMH providers, and foster parents.