Study Limitations, Future Research Directions on Telemental Health Disparities Among Children

In the final part of this interview with The American Journal of Managed Care® (AJMC®), Xin Hu, PhD, MSPH, assistant professor at Emory University School of Medicine, discusses the limitations that may have impacted the findings of her study, "Racial and Ethnic Disparities in Telemental Health Use Among Publicly Insured Children," published in the March 2025 AJMC issue.

She also suggests areas for further research based on both the findings and limitations.

Watch parts 1 and 2 to explore Hu's study further.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

What were the key limitations of your study? How might they have impacted your findings?

There are a few limitations of our study. Although we have very comprehensive nationwide Medicaid data, the data quality varies across different states, including the completeness of some study variables. Following prior studies that also use this data source, in our analysis, we conducted several sensitivity analyses among subsets of states that had higher quality data. It's very reassuring that we found pretty consistent results in the sensitivity analysis.

Another limitation is that administrative data only capture children with a documented mental health diagnosis, and who sought care within the Medicaid system. This means that we could not assess children with unmet medical needs who were underdiagnosed or untreated.

What additional research is needed to address the disparities in telemental health access and utilization?

Many important questions remain to be addressed in future research. With limited mental health provider availability and their limited capacity to take on new patients during COVID-19, much of the telehealth expansion may have focused on maintaining the continuity of care for existing patients rather than engaging the new patients.

For future research, it's very important to understand whether the difference in telemental health uptake among new vs existing patients is different and how that also differs across social demographic subgroups.

Our study used data only up to 2020. Given that the telehealth landscape has evolved pretty rapidly in recent years, future monitoring is still needed to track the telemental health use over time. Future research should also understand how this new care modality affects mental health care quality and outcomes, and how this affects different patient subgroups differently.