Use of tele-mental health in conjunction with in-person care: A qualitative exploration of implementation models

Abstract

Objective: Although use of tele-mental health services is growing, there is limited research on how tele-mental health is deployed. This project aimed to describe how health centers use tele-mental health in conjunction with in-person care. Methods: The 2018 Substance Abuse and Mental Health Services Administration Behavioral Health Treatment Services Locator database was used to identify community mental health centers and federally qualified health centers with telehealth capabilities. Maximum diversity sampling was applied to recruit health center leaders to participate in semistructured interviews. Inductive and deductive approaches were used to develop site summaries, and a matrix analysis was conducted to identify and refine themes. Results: Twenty health centers in 14 states participated. All health centers used telepsychiatry for diagnostic assessment and medication prescribing, and 10 also offered therapy via telehealth. Some health centers used their own staff to provide tele-mental health services, whereas others contracted with external providers. In most health centers, tele-mental health was used as an adjunct to in-person care. In choosing between tele-mental health and in-person care, health centers often considered patient preference, patient acuity, and insurance status or payer. Although most health centers planned to continue offering tele-mental health, participants noted drawbacks, including less patient engagement, challenges sharing information within the care team, and greater inefficiency. Conclusions: Tele-mental health is generally used as an adjunct to in-person care. The results of this study can inform policy makers and clinicians regarding the various delivery models that incorporate tele-mental health.