Availability of Telehealth Services for Children at Mental Health Treatment Facilities

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Importance: Although the COVID-19 pandemic accelerated adoption of telehealth for mental health services, it is unclear how many, and which types, of mental health treatment facilities (MHTFs) offer telehealth mental health care to children. Objective: To quantify what percentage of MHTFs in the US offer telehealth services for children and what facility-level, state-level, and county-level factors are associated with offering any telehealth services and specifically medication management via telehealth. Design, Setting, and Participants: This cross-sectional study involved a secret shopper study of all outpatient MHTFs contained within the Substance Abuse and Mental Health Services Administration's Behavioral Health Treatment Locator, conducted from September 24, 2024, to May 12, 2025. Main Outcomes and Measures: The primary outcomes were whether MHTFs offered (1) telehealth-based behavioral services for children and (2) telehealth-based medication management for children. Multivariable logistic regressions estimated associations between facility-level and county-level characteristics and each outcome. Results: Among 5559 respondent facilities (response rate, 73.0%), 4314 (77.6%) offered treatment to children. Among children-treating facilities, 3345 (77.5%) offered telehealth services, and 2419 (56.1%) offered telehealth-based medication management. Hawaii (1 of 1 facility [100.0%]), Montana (32 of 33 facilities [97.0%]), and Colorado (79 of 85 facilities [92.9%]) had the highest rates of offering telehealth services to children, whereas Georgia (52 of 81 facilities [64.2%]), Vermont (9 of 15 facilities [60.0%]), and Alabama (25 of 46 facilities [54.3%]) had the lowest. Noncommunity mental health centers had lower odds (adjusted odds ratio [aOR], 0.36; 95% CI, 0.25-0.52) of offering telehealth for children compared with community mental health centers. Facilities that did not accept Medicaid or private insurance as a form of payment were less likely to provide medication management via telehealth (aOR, 0.46; 95% CI, 0.25-0.86) compared with facilities that accepted Medicaid as a form of payment. Public facilities had greater odds of providing telehealth-based medication management (aOR, 1.86; 95% CI, 1.20-2.88) than private for-profit facilities. Facilities in counties in the second (aOR, 0.67; 95% CI, 0.48-0.93), third (aOR, 0.66; 95% CI, 0.45-0.97), and highest (aOR, 0.67; 95% CI, 0.45-0.99) household income quartiles were less likely to offer telehealth medication management. Conclusions and Relevance: In this cross-sectional study of a sample of US MHTFs, most facilities offered telehealth services for children, but the offering varied across facility types and states. Addressing potential gaps in telehealth offering will be essential to advancing equity and ensuring that all children can benefit from emerging modalities of remote mental health care.

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