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

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% (b = 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% (b = 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 ser-vices. Our findings suggest that racially minoritized patients receiving services in urban areas may be particularly at risk for losing access when tele-medicine 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.

Automated summary

This study examines the racial disparities in access to pediatric mental health care during the COVID-19 telemedicine transition at The Children's Hospital of Philadelphia (CHOP) and Boston Children's Hospital (BCH). The findings indicate that the transition to telemedicine exacerbates pre-existing racial disparities, leading to a decrease in access for racially minoritized patients and an increase in access for White-identifying patients.