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Federally Qualified Health Centers (FQHCs) are a safety net for low-income individuals needing mental and/or physical health care. The COVID-19 pandemic required FQHCs (and other health organizations) to pivot rapidly to telehealth. In theory, telehealth services can expand access to needed care. The COVID-19 pandemic provides a natural opportunity to "test" this assumption. We compared sociodemographic differences in patients accessing behavioral health services pre-and peri-COVID-19 at an FQHC. We also investigated potential patient sociodemographic disparities in telebehavioral health service use during the first year of the COVID-19 pandemic. Data were collected from a single FQHC (13 sites, 4 integrated primary care medical clinics) in the southern United States. Participants included 5,190 patients (69.2% female, 59.7% persons of color) attending a total of 16,474 behavioral health sessions across 2 years (one pre-and one peri-COVID-19). Before the COVID-19 pandemic, 100% of behavioral health visits were conducted in person. During the pandemic, nearly half of behavioral health visits were conducted via telehealth. Telehealth visits were most frequently attended by adults, non-Latinx Whites, women, and people making ≤200% of the federal poverty level. A combination of in-person and telehealth service delivery models should be used by FQHCs to maximize access to care for different demographic groups. FQHCs should consider key factors (e.g., access, ableism, technology facility, and language) to increase patients' ability to take advantage of telehealth services where available. Impact StatementThe COVID-19 pandemic offered an opportunity to test whether telehealth services could expand patient access to behavioral health care. We found some demographic groups frequently used telehealth services but key barriers to access remained for other groups. We encourage readers, policymakers, and directors of primary care behavioral health clinics to consider factors such as access, ableism, technology facility, and language to increase patients' telehealth service use.

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The current study provides psychometric support for the use of the Children’s Attributional Style Interview-II (CASI-II) to assess attributional style for positive and negative events with young adolescents. The paper-and-pencil version of the CASI-II was administered to a sample of 546 seventh- and eighth-grade students attending a Midwest suburban middle school (50% women, 54% white, 22% Hispanic, 10% Asian American, and 14% other). A multilevel confirmatory factor analysis demonstrated a factor structure consistent with attributional style theory and evidence for internal consistency reliability and temporal stability. Construct and convergent validity were strong. Dimensional subscale scores as well as composite scores for both positive and negative events showed adequate reliability and strong validity evidence. These results offer confidence for testing theory-driven predictions related to attributional style for both positive and negative events, as well as specific attributional dimensional patterns, using the CASI-II.