Jason Isham recalls the high school girl as one of the first students with whom his team of tele-behavioral health clinicians worked. She shuffled around the school's halls and wasn't interacting with anyone. But Isham says the student demonstrated a "real turnaround" as she progressed through Children's Health's school-based tele-behavioral health program.
"She really seems to be a different kid now—she smiles, talks with her friends and engages with school staff," says Isham, director of the integrated behavioral health program at Children's Health in Dallas, Texas. "It's been a dramatic shift. For us, it's an illustration of the type of impact we can have on students' lives."
Rapid expansion, powerful impact
Though Children's Health's school-based tele-behavioral health program is just in its second school year of a five-year pilot period, Isham continues to see more stories like that one—and rapid expansion of the program has increased its impact. After launching in the fall of 2017 at five high schools, it has since expanded to 22 campuses across the region. All told, the program now covers more than 21,000 children, including elementary and middle school students. Since its launch, Children's Health counselors have conducted more than 400 virtual therapy sessions.
The reasons for the therapy sessions vary widely, although Isham says the most common clinical themes revolve around some manifestation of anxiety. Bullying, depression and grieving are also common themes, as is self-identity—what Isham describes as, "normal teen or adolescent angst issues, just trying to fit in and find their place in the world."
Program keys: easier access, short-term therapy
To see a therapist, a student is first referred by a school staff member, typically teachers, counselors or coaches. Prior to launching a new campus site, Children's Health trains staff members on how to identify students who might benefit from the service. From there, Children's Health conducts an assessment with the child's parents and, if applicable, creates a care plan.
The therapy sessions are 30 minutes each and take place in a private room at school. The student meets with a licensed behavioral health clinician via a secure, proprietary video-conferencing iPad app. Care plans include no more than six sessions, since "many pediatric behavioral health disorders are amenable to a short-term approach," Isham says.
Students requiring additional therapy are referred to a behavioral health professional for a more traditional therapy regimen, while case managers with the telehealth program maintain contact to chart the patient's progress.
Behavioral health presents unique challenges
Isham says the school-based tele-behavioral health program has expanded rapidly due, in part, to the success of Children's Health's medical school-based telehealth program. Behavioral health was a natural extension of the existing service, although it did come with a set of challenges for the Children's Health team, according to Isham:
- Counseling services have traditionally been provided by the schools. "Bringing an outside partner in was a culture change for many of our school districts," Isham says.
- Obtaining buy-in from schools. Asking staff to identify and initiate behavioral health referrals adds another process to their already busy schedules.
- Locating willing therapists. Most behavioral health care professionals are trained to treat patients face-to-face in an office setting. "The virtual aspect is not something that every therapist is comfortable with," Isham says. "Recruiting and training the right staff has been an important piece."
The virtual aspect of the program has been a much easier sell for the students, most of whom have grown up interacting with others over video technology. In fact, Isham says for some patients, videoconferencing provides a "psychological buffer" that makes adolescents more comfortable than they would be in face-to-face therapy. He adds that another benefit of bringing behavioral health to school campuses is providing adolescents access to help they need without having to face the stigma of going to a counselor's office.
Advice: "Don't be afraid to jump in"
Children's Health's school-based tele-behavioral health program is still a novel approach, but health systems and state governments across the country are increasingly looking at the model as a solution for adolescent behavioral health care. Isham's advice: Taking the plunge is worth facing the challenges.
"Don't be afraid to jump in," Isham says. "All the hurdles can be a little daunting, but I would say to have courage, dive in and work through the process. It can be a very rewarding experience and one that can be very impactful for your communities."
