Millions of adults experiencing mental illness or substance use disorders are unable to access the care they need. For example, in 2016, the estimated number of individuals 12 years and older in need of substance use treatment was 21 million; however, only 3.8 million received treatment in the last year. The gap in treatment shines light on barriers individuals face when accessing care. These barriers include: lack of access to transportation for rural consumers of behavioral health care, workforce shortages and maldistribution, and a lack of specialty services contribute to difficulties in access for those who need care.

Previous findings suggest that telebehavioral health care can help overcome challenges in accessing behavioral health services and may reduce the existing treatment gap; however, adoption of telehealth by behavioral health providers has lagged behind primary care and other physical health providers. During the COVID-19 pandemic, there has been a rapid expansion in the use of telebehavioral health services. This swift transition of services presents challenges and adaptations for both clinicians and clients.

This study will explore the perception of quality of services from the providers’ perspectives to identify factors that impact perceived quality and satisfaction of telebehavioral services by collecting and analyzing data to address the following research topics/themes: 1) environmental scan of current research, literature, and other publications on providers’ perception of the quality of telebehavioral health care delivery and factors that influence their satisfaction; 2) a survey to examine factors of provider and client satisfaction in use of telebehavioral health. (e.g., technology utilized, programs utilized, ease of use/transition to Telebehavioral health, comfort of use, privacy, access); and 3) up to nine key informant interviews to better understand factors that influence telebehavioral health quality.



Overall, telebehavioral health services were well received. Of those surveyed, 89.4% of administrative staff, 83.5% of providers, and 82.8% of clients reported their experiences with these services during COVID-19 as all positive or mostly positive.

Specific barriers and facilitators exist both within and between groups, with common threads being lack of travel and related costs as a facilitator, while lack of private space, lack of stable or adequate technology, and uncertainty over future regulation requirements and reimbursement remained common barriers. A particular benefit of telebehavioral health noted by providers and administrative staff was the increased access to new and underserved populations, with lower barriers to care for these groups. In order to ensure adequate access to care exists for all those in need, future policy action should continue to explore ways to help ameliorate the already severe workforce shortages in the behavioral health space.

Efforts should also be made to ensure that the lowered barriers to treatment and increased access for clients resulting from the expansion of telebehavioral health and other factors remain as low as possible. Long-term solutions, regulatory guidance, and reassurance of the continuation of fair financial reimbursement will be essential aspects to both ensuring access to clients while also protecting and expanding the behavioral health care workforce to address the current severe shortages.


Matt St. Pierre, MS
Yoon Hyung Choi, PhD
Emma Amoako, MPH
Lindsi DeSorrento, MPH
Caitlyn Wayment, MPH
Victoria Schoebel, MPH
Jessica Buche MPH, MA