193 - Reduced Disruption in Psychotherapy Visits among Children & Adolescents Following the Transition to Virtual Care

Publication Number: 193.6510

Robert B. Penfold, Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States; Rebecca Rossom, HealthPartners, Minneapolis, MN, United States

Background: Many health systems transitioned to virtual mental healthcare delivery following the onset of the COVID-19 pandemic. Little is known about changes in the continuity of psychotherapy following broad adoption of virtual care.

Objective: This study aimed to examine disruption in psychotherapy among children and adolescents before and after the rapid shift to virtual mental health care induced by the onset of the COVID-19 pandemic in the United States.

Design/Methods: This retrospective study used electronic health record and insurance claims data from three U.S. health systems. The sample included 13,656 children and 12,634 adolescents with mental health conditions who were members of the health systems’ affiliated health plans and attended at least two psychotherapy visits from June 14, 2019, through December 15, 2020. Data were subdivided into two 9-month periods (before vs. after COVID-19 onset, defined in this study as March 14, 2020). Psychotherapy visits were measured via health records and categorized as in person or virtual. Disruption was defined as a gap of ≥45 days between visits. Mixed-effects logistic regression analyses controlled for pre-onset utilization intensity, demographic characteristics (age, gender, race/ethnicity, rurality, income, education), and psychiatric diagnoses.

Results: Visits in the pre-onset period were almost exclusively in person (99.5%), whereas over half of visits in the post-onset period were virtual (53.6%). Approximately 35% of psychotherapy visits were followed by a disruption ≥ 45 days in the pre-onset period, compared with only 17.4% in the post-onset period. Disruption remained lower during the post-onset period compared to the pre-onset period (adjusted OR = 0.45) after adjustment for visit type, mental health, and sociodemographic factors. The magnitude of the difference in disruption between periods was related to number of visits in the pre-onset era, age, gender, race/ethnicity, rurality, and mental health diagnostic group.

Conclusion(s): This study found reduced population-level disruptions in psychotherapy after transition to virtual mental health care following COVID-19 onset. These data support the continued availability of virtual psychotherapy for children and adolescents.