Promoting Equity in Behavioral Telehealth

Promoting Equity in Behavioral Telehealth

A three-pronged approach enhances telehealth services for underserved communities.
Mother and son speak to doctor with telemedicine.

The COVID-19 pandemic rapidly accelerated the use of telehealth services, but recent research shows inequities in telehealth access for underserved populations may have increased during the COVID era. When leaders at Children’s Wisconsin dug into their own data, they found a substantial divide affecting Latino families. In the first quarter of 2022, nearly 37% of all behavioral health visits were conducted via telehealth. Yet, only 20% of Latino patients with Spanish as their primary language used those services. When factoring in patients with government-provided medical insurance coverage, the number of video visits dipped to 18%.

To address this gap, Children’s Wisconsin launched the Enhancing Telehealth Readiness (EnTeR) Project. Striving to increase behavioral telehealth access for the Latino community, the EnTeR Project focuses on three primary categories of barriers to care: service system, community dynamics, and individual-based.

Overcoming service system barriers

The EnTeR Project launched in conjunction with the rollout of Children's Wisconsin’s Spanish-language patient portal. To further address language barriers, the hospital trained behavioral health providers to incorporate interpreters into telehealth visits and adapt visits to accommodate the Latino community. For example, providers learned techniques to accommodate family members or religious leaders who accompany the patients during video sessions. In developing this educational component, the EnTeR project team was careful to not assume what was important to their Latino patients and families.

“My expertise is in behavioral telehealth; I’m not an expert on various cultures,” said Kristin Kroll, PhD, a pediatric psychologist formerly with Children’s Wisconsin.  “We gathered a lot of research from the true experts in the field and then spoke with our families and cultural experts from within our communities locally as we pieced this together.” 

Reducing community barriers

The project’s second strategy focused on increasing awareness of behavioral health in general and the role of telehealth within the Latino community. They developed resources for patients and their families, including informational sheets and a video for its website — available in Spanish as well as English — providing basic information on behavioral telehealth. The EnTeR project team relied on published research to address issues specific to the Latino community, including misconceptions about behavioral telehealth treatment, concerns around privacy and confidentiality, and immigration status. The team collaborated closely with leaders in the local Latino community to help raise awareness of these educational resources available to patients and their families.

Reducing individual barriers

The EnTeR project worked to improve telehealth access and utilization by providing Wi-Fi-enabled devices and/or data plans to qualified patients and their families to use for telehealth services. To be eligible, patients must:

  • Have a behavioral health appointment scheduled within the next six months.
  • Live in Wisconsin and self-identify as Latino or Hispanic.
  • Be enrolled in the Children’s Wisconsin patient portal.
  • Have logistical barriers limiting their access to care.

Project promotes flexibility

The EnTeR team is still analyzing the data to assess the impact of the interventions, but the training was well received by her colleagues — and essential. “You have to be able to adapt. There are evidence-based protocols, but those have to be flexible to what the patient needs,” Kroll said. “Learning how to provide care to families from completely different cultures who are facing barriers that most therapists haven’t faced in their own lives requires extra time and training to provide the best treatment for that patient.”

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