In the southeastern suburbs of Denver, the Cherry Creek school system has been tackling the mental health crisis gripping students here, as in the rest of the country. Social workers and psychologists are based in schools to help. But this month, the district debuted a new option: telehealth therapy for children.
A growing number of public schools across the country are following the same path — turning to remote health care when the demand for aid has spiked and the supply of practitioners has not. To pay for it, some school districts are using federal covid relief money, as studies show rising depression, anxiety and suspected suicide attempts among adolescents.
Some of the contracts are going to private companies. Other districts are working with local health-care providers, nonprofits or state programs. In Texas, state officials recruited help from providers at medical schools, a collaboration that served more than 13,300 Texan students last school year. “It’s provided a lot of kids the support they needed,” said David Lakey, administrator and presiding officer of the Texas Child Mental Health Care Consortium.
Telehealth services more generally soared during the pandemic, as people sought to minimize in-person contact and embraced the convenience. Over almost three years of pandemic life, families and providers have grown comfortable with remote medical visits.
Federal data shows that 17 percent of public schools reported having telehealth services in the spring, with a greater concentration in rural areas and middle and high schools. Seventy percent of schools said the percentage of students seeking mental health services had increased during the pandemic.
“I don’t know one kid who wasn’t affected by this,” said Michelle Weinraub, chief health officer for 55,000-student Cherry Creek district, recalling that students lost relatives or homes during the pandemic, and many were isolated at home learning remotely.
In many schools, students may see a telehealth therapist by using an iPad or other device in a quiet office away from classmates. In Cherry Creek, they will do so from home, before or after school. Some school systems offer both options.
For schools that host the digital therapy sessions, it is not enough to simply outfit a room for appointments and send students in, said Sharon Hoover, a professor of child and adolescent psychiatry at the University of Maryland’s School of Medicine and co-director of the National Center for School Mental Health. “Most schools will need to provide staffing to support safety and privacy issues,” she said. Services are free to families in many cases, covered through school systems, government grants or insurance reimbursements.
Hoover said the trend in virtual mental health care owes partly to more providers offering remote sessions and a loosening of strict regulations that prohibit delivery and billing across state lines.
In Colorado’s Aurora Public Schools, which began to focus on mental health efforts after the 2018 school shooting in Parkland, Fla., Superintendent Rico Munn said several hundred of his students have benefited from a contract for telehealth services, including a number of children in crisis. More than 1,800 therapy sessions were held remotely last spring, thanks to federal covid relief funds. “The need was there, obviously, and it was important to be there to serve that need,” Munn said.
Virginia Garcia’s daughter was among those struggling in Aurora schools. The 17-year-old was at first distressed by family issues but while she was in treatment, a close friend was killed, her mother said. “The therapy helped a lot at that time, because the situation was terrible,” Garcia said. Her daughter began to learn strategies to help her cope with her sadness and anger and be more forthcoming with her feelings, her mother said. “I saw the change.”
Garcia said her daughter continues to work with a private therapist. Still, she was grateful when the school checked back in to see if her daughter needed more help.
According research published by the American Psychological Association, no-show rates for therapy visits for underserved families and children were significantly lower with telehealth programs than with in-person care before the pandemic. But the paper also noted some challenges unique to this format, including patients who don’t have the right tech to log in or enough privacy at home. Other research also has broadly pointed to telehealth benefits for children.
While some schools used virtual mental health services before covid-19, particularly in rural areas, researchers at the nonprofit Child Trends said the pandemic showed “proof of concept” to many more people.
The Colorado school districts in Aurora and Cherry Creek hired Hazel Health, a San Francisco-based company that started with virtual health services in schools in 2015 and expanded to mental health in May 2021.
It now has telehealth in 80 school districts, including in Florida, California, Georgia, Maryland and Hawaii; 20 other districts have signed contracts. The company said students are seen in relatively short order, and sessions are held in the familiar settings of school or home. Parent permission is required, and referrals are made by school staff or families.
Hazel Health CEO Josh Golomb said children often receive to six to 10 sessions, meeting the clinical needs of most students. For longer-term cases, Hazel connects patients to community clinicians. Some advocates have raised concerns that telehealth could mean a different practitioner from one session to the next. Hazel said children primarily keep to the same therapist.
Hazel therapists, who combined speak 10 languages, work from their homes, Golomb said. All are clinical mental health professionals who are licensed to practice in the state where their patients receive therapy.
The company plans to work with school districts to study whether Hazel’s mental health services also help reduce absenteeism, Golomb said.
Reducing absenteeism was one major incentive for Maryland’s second-largest school system, in Prince George’s County. If appointments are at school, many students will be able to return to class and miss less instruction, said Doreen Hogans, supervisor of school counseling.
Schools are already using Hazel for physical health services and will launch mental health services for high schools, middle schools and k-8 schools before winter break. Elementary schools will come sometime during or after January. Students across k-12 may request home-based telehealth.
Students will be able to go to the nurse’s office, where the nurse will find a quiet place to set the student up on an iPad with a practitioner, Hogans said. “The benefit is that the student is not going home and we can retain the student right there in school,” she said. The school system, like others around the country, has a number of vacancies in mental health-related positions, she said.
It is paid for through a $4 million federal grant, according to a spokesman for the Prince George’s County Health Department.
The big question for some districts is what to do when their federal relief money runs out in the next couple of years — whether they will find other dollars for telehealth.
correction
A previous version of this article said the Cherry Creek school system is in Denver's southwestern suburbs. It is southeast of the city. This version has been corrected.
