- Brianna Lombardi, PhD Assistant Professor, Family Medicine, School of Medicine Deputy Director, Health Workforce Research Center, Cecil G. Sheps Center for Health Services Research, Research Assistant Professor, School of Social Work, University of NC
- Lisa de Saxe Zerden, PhD, Senior Associate Dean for MSW Education Associate Professor, University of North Carolina at Chapel Hill School of Social Work, Chapel Hill, NC
Background: The COVID-19 pandemic presented a significant challenge to federally qualified health centers (FQHCs) who provide comprehensive health care services, including the delivery of integrated behavioral health (IBH). FQHCs are the primary resource of behavioral health care in many communities. Tele-behavioral health dramatically increased during the pandemic due to two factors: emergency safety orders that limited in-person clinic capacity and state and federal emergency mandates that allowed for the reimbursement of services delivered through tele-health that were not previously permissible. This study aimed to explore how FQHCs adapted IBH care delivery during the pandemic. This study assessed barriers to IBH during COVID-19, as well as tele-behavioral health uptake, use, and adaptation, and goals for future use of tele-communication at FQHCs beyond COVID-19. Study design: A mixed-method study design was utilized. A web-based survey was developed and disseminated (October to December 2020) to a convenience sample of FQHC administrators in 12 states identified through HRSA’s “find a health center” website where contact information was obtained. A semi-structured interview guide was developed and used in-depth interviews were recorded via Zoom (February to April 2021). Description of population: sampled A total of 46 administrators from 10 states participated in the online survey regarding IBH and tele-behavioral health. Most responses were recorded from California (n=12; 26.1%), Kansas (n=10; 21.7%), and Pennsylvania (n=8; 17.4%). Nine interviews with FQHC administrators from six states were collected from California (n=3), Kansas (n=2), Arizona (n=1), New York (n=1), Pennsylvania (n=1), and West Virginia (n=1). Procedures and measures: FQHC administrators were contacted by email and phone to invite them to participate in the survey. The survey was deployed via Qualtrics and collected descriptive data, including FQHC location, number of clinics, and IBH model. Respondents who completed the online survey were asked to participate in a qualitative interview and those who responded affirmatively were contacted for interviews. Key results: Prior to COVID-19, 30.4% of FQHCs (n=14) delivered IBH care using tele-communication. Since COVID-19, all but two of the FQHCs surveyed used tele-communication to deliver IBH. All respondents reported patient barriers to tele-health use impacted service delivery, along with some reporting lack of reimbursement for tele-health services and concerns on HIPPA, privacy, or compliance. The following themes were identified from the qualitative interviews: tele-behavioral health worked to sustain behavioral health service delivery during COVID-19; core components of IBH were significantly impacted during COVID-19; and patient and payment barriers were a concern for long-term use of tele-behavioral health but FQHCs are hopeful and desire to continue use.
- Understand the increased need for and acceptance of tele-behavioral health services for patients in FQHC.
- Identify how having tele-IBH as an option provides equitable access to services to patients.
- Discuss potential barriers to tele-IBH in FQHC.