Introduction: Due to the COVID-19 pandemic and prompted by recent federal and state policy shifts impacting behavioral health care delivery, the use of telebehavioral health has rapidly increased. This qualitative study describes behavioral health provider perspectives on the use of telebehavioral health before and during the pandemic and how policy changes impacted access to and utilization of behavioral health services in Michigan. Materials and Methods: A convenience sample of 31 licensed and nonlicensed behavioral health providers operating in Michigan participated in semi-structured interviews between July and August 2020. Interviews were audio-recorded, transcribed, and analyzed by using inductive methods. Results: The thematic analysis resulted in four overarching themes: (1) increased access to care; (2) maintenance of quality of care; (3) minimal privacy concerns; and (4) client and provider satisfaction. Discussion: During and post-pandemic, providers need flexibility to determine whether in-person or telebehavioral health services, including audio-only, best meet client needs. Providers identified several populations for which telebehavioral health was less accessible: clients with serious mental illness and substance use disorder, those with no broadband Internet access, children, and older adults. Additional training in telebehavioral health service provision can positively impact quality of care. Conclusion: Policies that support reimbursement parity and expand provider use of telebehavioral health services should be maintained after the COVID-19 pandemic ends to avoid imposing barriers to accessing behavioral health care barriers post-pandemic.
Gender-diverse individuals (those whose gender and/or sex differ from societal expectations, such as trans or genderqueer) face stigma and discrimination, which can translate into negative health outcomes. Resilience describes the process of overcoming adversity that can mitigate these negative effects. Previous work has focused on trans individuals only or measured resilience without first exploring subjective understandings. Purpose: We sought to explore subjective perceptions of resilience among gender-diverse individuals. Methods: This qualitative study uses longitudinal photo-elicited interviews (in which participants' photos prompt interview discussion) with 21 gender diverse individuals (35 total interviews or a 66% retention rate). Interviews were separated by 6 months and transcripts were analyzed using Dedoose software, with each coded twice by separate coders. Results: Participants' strategies to foster resilience included proactive approaches at both the internal and external levels and distracting/temporary approaches. Two themes, flexibility and awareness, emerged as central facets of resilience trajectories. Flexibility took several forms and was intrinsic to cognitive processes, as well as coping choices, and sought through mental training techniques, such as meditation. Participants demonstrated high levels of awareness by incorporating trauma and health outcomes in gender-diverse populations within their narratives, and through the recognition of the unhelpful aspect of avoidant strategies in building resilience. Conclusions: The diverse ways that individuals perceive their own resilience have implications for resilience research in this group and have the potential to inform the development of strength-based interventions tailored to gender-diverse individuals. Public health interventions targeting resilience have the potential to break the pathway linking adversity to ill health among gender-diverse individuals, thereby reducing health disparities in this group.
Research Objective To understand the impact of state and federal policy changes during the COVID‐19 pandemic on use and effectiveness of telebehavioral health based on provider experience, Study Design Between July and August 2020, researchers conducted one‐hour interviews with 31 Michigan‐based behavioral health providers from 15 counties. These semi‐structured interviews included the following topics: (1) Experience with telebehavioral health prior to, and during, the pandemic, (2) Changes in cost of, access to, and quality of care between in‐person and telebehavioral health services, and (3) Telebehavioral health's impact on providers and clients. The interviews were recorded, transcribed, and later analyzed with Dedoose™ software to identify common themes between responses. Population Studied Interviewees included a psychiatrist, psychologists, registered nurses, clinical social workers, mental health counselors, substance use disorder counselors, applied behavior analysts, and peer support specialists. Principal Findings Telebehavioral health provision increased during the pandemic, with all interviewees reporting providing telebehavioral health services ‐ 19 for the first time. All interviewees agreed that newly‐enacted state and federal policies made it legally and financially viable to continue safely providing services during the pandemic. Fourteen interviewees reported increased job satisfaction and decreased feelings of burnout. No interviewees reported a breach of health data as a result of using non‐public facing audio‐visual communications. Overall, interviewees agreed telebehavioral health services were at least as effective as in‐person services. Clients with certain conditions (social anxiety, post‐traumatic stress disorder) seemed to respond better to telebehavioral health services. Clients with other conditions (substance use disorder, developmental disabilities) responded less favorably. Thirty interviewees reported clients were satisfied with telebehavioral health services, with some clients preferring them over in‐person services. Twenty‐eight reported telebehavioral health reduced or removed barriers that would have otherwise prevented these clients from receiving care, such as the need to arrange for transportation, childcare, or time off from work. This resulted in decreased no‐show rates and more regular contact between providers and clients. Access to care for geographically isolated populations increased when audio‐only telebehavioral health was authorized; these populations used to have to travel further for care, and often lacked high‐speed internet and internet‐connected devices necessary for audio‐visual telehealth services. Conclusions Despite telebehavioral health's effectiveness and widespread client approval, interviewees expressed that their current work with telehealth was only possible because of recent policy changes. Should those policies revert back, providers may not be able to continue to provide these services. For some clients, such as those who are geographically iso...
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