A Quasi-Experiment to Evaluate the Effectiveness of Telebehavioral versus In-Person Counseling in Rural Texas

Abstract

Introduction: Rural residents experience mental health disparities when compared to urban communities due to complex factors. Telehealth is one way to bridge the gap, but existing research on telebehavioral health effectiveness is sparse for rural communities, especially when comparing telehealth to in person services.

Methods: To investigate if telebehavioral health outcomes were similar to traditional in-person counseling, evaluators designed a quasi-experiment to detect differences in behavioral health outcomes between a group of rural residents who received services via video conference or telephone and a second group who received in-person services.

Results: Regarding depression outcomes, PHQ9 scores were higher than the clinical level at baseline (in-person: 11.39, telehealth: 13.22) and decreased over time. Scores for the in-person group, on average, fell below clinical level at 8 weeks and telehealth groups scores, on average fell below clinical level at 12 weeks. Similarly, regarding anxiety outcomes, both groups started above the clinical level for GAD7 scores at baseline (in-person: 10.00, telehealth: 12.34). On average, scores for the in-person group dropped below the clinical level at 4 weeks while scores for the telehealth group, on average, dropped below the clinical level at 8 weeks or later.

Discussion: This study provides evidence in support of telebehavioral health services, specifically in reference to depression and anxiety concerns. Both telehealth and in-person groups showed improvement in terms of having positive rates of overall improvement, low occurrence of reliable deterioration, and a growth model showing scores starting above the clinical level and falling across treatment. This study supports the conclusion that telebehavioral health services can be reliable used to treat depression and anxiety, similar to in person care.