Access to and Provision of Child and Youth Behavioral Health Services in the Rural and Urban U.S.

Research center:
Project funded:
September 2022
Anticipated completion date:
June 2024

Rural counties have a lower per capita supply of behavioral health providers, including psychologists, psychiatrists, and psychiatric nurse practitioners (NPs), than urban counties. About 10% of all U.S. children and adolescents live in a county with no child psychiatrists or with inadequate broadband to access telepsychiatry. This percentage jumps to half (51.1%) in rural counties. Medicaid data from 2013-2014 show that rural youth are more than twice as likely to be prescribed a new psychotropic medication by a primary care nurse practitioner than by a psychiatrist. As the child and adolescent psychiatrist workforces age (44.2% are 55 years of age or older), understanding the geographic distribution of the behavioral health workforce and services they provide to children and adolescents, particularly in rural areas, is vital to ensure adequate and equitable access to care.

To address these gaps in knowledge we will answer the following research questions:

  1. What is the prevalence of behavioral health conditions including depression, anxiety, and substance use disorder(s) among children and youth in rural and urban places? What is the prevalence of treatment for these conditions?
  2. How is the child and youth behavioral health workforce distributed across rural versus urban areas of the country?
  3. What is the current distribution of clinicians with a Drug Enforcement Agency (DEA) waiver to prescribe buprenorphine for opioid use disorder (OUD)?
  4. What behavioral health services do patients 0-17 years and 18-24 years of age receive for mood disorders and OUD in rural versus urban areas of the U.S.?
    1. Who is the workforce (e.g., physicians, NPs, behavioral health professionals) providing behavioral health treatment for rural versus urban youth?
    2. How far do rural versus urban youth travel to receive treatment for mood disorders and OUD?
    3. What percent of rural versus urban youth with OUD receive medication treatment for their opioid use disorder (MOUD)?
    4. What proportion of rural versus urban youth patients in counties with and without DEA-waivered provider(s) receive MOUD?
  5. Which states reimburse marriage and family therapists, clinical psychologists, and clinical social workers to provide behavioral health care for youth? Which states have licensure compact agreements and for which types of behavioral health providers?