Podcast Summary

Overview

Episode Title: Kari-Beth Law, MD, on Expanding Telebehavioral Health Access in Rural Appalachia
Podcast: Becker’s Healthcare Podcast
Date: February 14, 2026
Host: Ella Reuter
Guest: Dr. Carrie Beth Law, Associate Chief Medical Officer, West Virginia University Health System

This episode centers around Dr. Kari-Beth Law’s journey and leadership in expanding telebehavioral health to address serious access challenges in rural Appalachia, particularly West Virginia. Dr. Law shares the unique barriers this population faces, the operational nuts and bolts of the WVU telebehavioral health program, and how policy and data shape the present and future of virtual mental health care in rural America.

Key Discussion Points & Insights

1. Behavioral Health Landscape in Rural West Virginia

• Geography as a Barrier (02:12)
  • Mountainous, beautiful terrain also creates severe access challenges.
• Workforce Shortages
  • "65% of rural US counties have no practicing psychiatrist." (02:45, Dr. Law)
  • West Virginia: 50 of 55 counties are designated mental health professional shortage areas.
  • Very low per-capita availability of child and adolescent psychiatrists.
• Cultural & Socioeconomic Factors
  • Multigenerational poverty, high chronic illness rates, opioid epidemic legacy, and stigma.
  • "A cultural tendency to handle problems privately" (03:46, Dr. Law) results in hidden need.
  • Long travel times (up to 4 hours one way) make care inaccessible.

2. Pivotal Role of Telehealth During COVID-19

• Preexisting Telehealth Foundations (04:33)
  • WVU had prior experience with telepsychiatry, which allowed for rapid scaling.
• COVID-19 as a Catalyst
  • Virtual care became the only option when in-person services shuttered.
  • Regulatory changes (relaxed licensure, reimbursement) accelerated rollout.
• Dispelling Myths
  • Pre-pandemic assumptions "that rural patients wouldn't or couldn't use or access technology... were wrong. Patients showed up, engagement improved." (05:59, Dr. Law)
  • Virtual visits proved less disruptive, especially for families with work or transportation barriers.
• Expanding Reach & Collaboration
  • Telepsychiatry extended expertise and supported community providers.

3. Operationalizing Telebehavioral Health in Rural Settings

• Early Investments & System Approach (07:59)
  • WVU’s Mountaineer Doctor Television (MDTV) began in early 1990s; telebehavioral health piloted in 2009.
  • Used academic medical center as a "hub" extending service to community clinics, FQHCs, hospitals, ERs, schools, and eventually homes.
• Integration & Relationship Building
  • Focus on partnerships: “It was important that [local providers] felt the telebehavioral health services were integrated and not external.” (09:01, Dr. Law)
  • Worked closely with primary care, pediatricians, and community providers.
  • Emphasis on workflow, technology training, and site champions to encourage buy-in.
• Real-world Tech Barriers
  • Some families joined appointments from McDonald’s parking lots to access Wi-Fi (10:41).
  • During the pandemic, nearly all visits converted to virtual within two weeks — “pretty impressive” during a time when overdose deaths were soaring.

4. Patient Impact and Success Stories

• Clinical Outcomes (11:36)
  • Children with neurodevelopmental disorders received proper specialty care without year-long waits, enabling them to stay in school.
    • "Their parents were at their wits’ end... [telehealth] was a huge relief for the family and the patient.” (12:05, Dr. Law)
  • Adults with substance use disorders could seamlessly continue care and maintain recovery through life transitions and relocations.
    • Example: “They transitioned from inpatient consult psychiatric services to outpatient care... their child in their custody, and continue to have treatment.” (14:19)

5. Data & Measurable Outcomes

• Visit Volume & Enduring Adoption (15:27)
  • “Total [virtual] visits are still lingering a little over 50% ... about 100,000 patients per year.” (15:35)
  • For children: one third still seen virtually.
• Comparable (or Better) Outcomes
  • "Telepsychiatry produces outcomes that are comparable to in-person care... lower no-show rates and higher patient satisfaction." (16:15)
  • Internal and national data: improved access, faster first appointment, better continuity, especially for pediatric/remote patients.
  • Measured “gains in healthcare equity” reaching patients who previously had no access.

6. Policy & Reimbursement Landscape

• Crucial Policy Shifts (17:57)
  • West Virginia led in legislative changes: allowed patient’s home as originating site.
  • Medicaid and reimbursement parity plus licensure flexibility enabled rapid expansion.
  • Expanded coverage for collaborative care and behavioral integration essential for sustainability.
• Ongoing Uncertainties
  • Long-term reimbursement and online prescribing of controlled substances remain unresolved at the federal level.
  • Virtual supervision for training and licensure waivers was “hugely positive” for maintaining access and specialist support.
• Call for Policy Clarity
  • Health systems need stable, clear regulation to invest confidently in virtual care (20:54).

Memorable Quotes & Notable Moments

• On Root Causes of Access Gaps
  “When you add... multigenerational poverty, higher rates of chronic illness, the legacy of the opioid epidemic, and really a cultural tendency to handle problems privately, it becomes clear why access gaps persist.”
  — Dr. Law (03:36)

• On Dispelling Assumptions
  “There had been assumptions from some that rural patients wouldn’t or couldn’t use or access technology... many of those assumptions were wrong. Patients showed up, engagement improved, and for many families... virtual visits were easier and less disruptive."
  — Dr. Law (05:59)

• On Real-World Adaptation
  “I remember a family that would regularly drive to their local McDonald’s parking lot because that was the place locally that had WiFi and they joined their appointment from there.”
  — Dr. Law (10:41)

• On the Power of Stories
  "It's really powerful to see how that translates for patients and families."
  — Dr. Law (15:11)

• On Policy and Future Direction
  "Sustainability is going to depend upon policy alignment, on broadband investment and continued innovation. But the foundation is firmly in place... these lessons are applicable everywhere."
  — Dr. Law (22:37)

Timestamps for Key Segments

• 00:42 – Dr. Law’s personal and professional background
• 02:12 – Explaining rural West Virginia’s behavioral health landscape
• 04:33 – Telehealth’s transformation during COVID-19 and beyond
• 07:59 – Operationalizing telebehavioral health at WVU, from MDTV to present
• 11:36 – Success stories: children and adults helped by telebehavioral health
• 15:27 – Data on virtual care usage, outcomes, and equity
• 17:57 – Policy and reimbursement enablers; ongoing challenges
• 21:58 – Final practical takeaways for rural behavioral health leaders

Final Takeaways for Leaders (21:58)

• Telebehavioral health “isn’t about replacing in-person care—it's about matching the right modality to the right patient at the right time.”
• Rural systems should start with local partnerships and workforce development—don't wait for perfect conditions.
• Extending specialty expertise and supporting local providers is essential for sustainability.
• The lessons from Appalachia are relevant nationwide—rural and urban leaders alike can use these practices to mitigate workforce shortages and improve access.

This episode offers both a grounded, honest account of the complexities in rural behavioral healthcare and a hopeful, practical blueprint for leveraging telehealth to bridge deep-rooted service gaps.