Publication date: Jul 28, 2025

Background: Many children often face gaps in crucial prevention and intervention services. Telehealth has shown promise as a delivery model well suited for mental and behavioral health. The rapid expansion of telehealth services during the COVID-19 pandemic created a timely opportunity to investigate this issue. This study is one of the first to use the 2021 and 2022 National Survey of Children’s Health data to examine nationwide patterns in children’s behavioral health service use. Methods: The analysis focused on weighted prevalence estimates for current diagnosed mental health conditions and telehealth utilization by select demographics. Crude and adjusted prevalence ratios (aPRs) were calculated using Poisson regression with robust standard errors to examine associations between each independent variable and telehealth utilization. Results: There were 50,892 children in this study. Children with common mental/behavioral conditions were more likely to use telehealth, not due to COVID-19, and adjusting for sociodemographic factors and rurality (aPRs: anxiety = 3. 12, depression = 3. 45, behavioral = 2. 83, attention-deficit/hyperactivity disorder [ADHD] = 2. 87, multiple = 3. 42; p < 0. 001). This association diminished significantly as a result of COVID-19. Finally, factors that significantly reduced the use of telehealth before COVID-19 include rurality (29%), language (17%), care coordination (54%), and a personal health care provider (7%). Conclusion: Gaps in telehealth use were identified, including rurality, insurance status, medical home, primary care provider, health care navigation support (care coordination), transportation, language, and service availability. The pandemic was not a significant factor influencing telehealth use. Targeted policies are needed to sustain the use of telehealth even after the pandemic. Tailored interventions to optimize the delivery of behavioral health services were also recommended.

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