Widening Racial Disparities During COVID-19 Telemedicine Transition: A Study of Child Mental Health Services at Two Large Children's Hospitals

J. Corey Williams, Molly Ball, Nora Roscoe, Jenna Harowitz, Rebekah J. Hobbs, Harshini N. Raman, Molly K. Seltzer, Lan Chi Vo, Consuelo C. Cagande, Aaron F. Alexander-Bloch, David C. Glahn, Leela Morrow

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Objective: To examine whether racial disparities in access to pediatric mental health care were affected during the COVID-19 telemedicine transition at both The Children's Hospital of Philadelphia (CHOP) and Boston Children's Hospital (BCH). Method: Electronic health records were queried for all unique outpatient visits from a pre-pandemic period in 2019 and a within-pandemic period in 2020. Changes in the proportion of patients were compared based on insurance status, clinic location, and racial identification. Hypotheses were tested via logistic regression analyses. Results: At CHOP, from 2019 to 2020, the proportion of racially minoritized patients significantly declined within a 1-month period from 62% to 51%, whereas the proportion of White-identifying patients increased from 38% to 49% (β = 0.47; z = 3.60; p =.0003), after controlling for insurance status and clinic location. At BCH, the proportion of racially minoritized patients significantly declined within a longer 6-month period between 2019 and 2020, from 62% to 59%, whereas the proportion of White-identifying patients increased from 38% to 41% (β = 0.13; z = 2.8; p = .006), after controlling for insurance status. Conclusion: At CHOP and BCH, the COVID-19 telemedicine transition exacerbated pre-existing racial disparities in pediatric mental health services. Our findings suggest that racially minoritized patients receiving services in urban areas may be particularly at risk for losing access when telemedicine is implemented. Although there are limitations to this racial dichotomization, examining differences between White and racially minoritized patients can highlight ways in which White-identifying individuals have disproportionately received enhanced access to healthcare resources.

Original languageEnglish
Pages (from-to)447-456
Number of pages10
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume62
Issue number4
DOIs
StatePublished - Apr 2023
Externally publishedYes

Keywords

  • pandemic
  • pediatrics
  • psychiatry
  • racial disparities
  • telehealth

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