When it comes to child and adolescent access to mental health services, Texas ranks last in the nation. Recent state legislation is attempting to change that, and Children's Health in Dallas is at the forefront of those initiatives. At the 2020 Behavioral Health Summit, Sue Schell, M.A., vice president and clinical director of Behavioral Health at Children's Health described the institution's involvement in the Texas Child Health Access Through Telemedicine (TCHATT) program.
TCHATT brings tele-mental health services to 55 school campuses with several goals:
- Provide early intervention.
- Decrease stigma associated with mental illness.
- Improve access to behavioral health services.
- Reduce the demand on limited resources in hospitals and primary care practices.
- Enhance resilience for kids with behavioral health challenges.
Through TCHATT, each participating school receives a device that connects a student with an off-site provider. Teachers are given mental health first aid training—provided by hospital staff—to identify students who could need behavioral health services and help stabilize classroom disruptions. Originally, the program started with kids in high school and each year younger students have been added.
How the tele-mental health program works
Anyone in the school can identify a child who would benefit from the program, but the school counselor is Children's Health's direct contact. Counselors work with parents to let them know what's going on and ask them to consent to being contacted by Children's Health staff within two business days. At the initial contact with families, Children's Health doesn't discuss insurance or payment. If a child does need a psychiatrist, Children's Health helps set up appointments and follow-up.
Visits are 30 minutes and conducted virtually through the hospital-provided device while the child is at school. Schell says parents can be brought in but that doesn't happen very often—students enjoy having their own time with the psychologist. All appointments are documented in Children's Health's electronic health record, not in the telehealth platform.
According to Schell, not all students with behavioral health disorders are appropriate for TCHATT. It is not a crisis program—students with imminent risk will be referred elsewhere for immediate assistance. For students who are deemed to be good candidates for the program, however, Schell and her team identified positive outcomes for ages 10 and up.
Engaging with students
So far, 215 students have been referred to TCHATT and there's a 96% engagement rate for those patients. Students have an average of 5.4 visits, with a total average of eight contact points with the student and family, including follow-up calls.
Part of the program is self-assessments—each student is asked to set a goal and rate themselves on a 10-point scale. Participating students have shown goal improvement, and TCHATT has a 98% satisfaction rate. The next data point that Schell is hoping to collect is how the program has affected school attendance.
Initially, Children's Health based its physician-to-student ratio on its already established medical home program where one physician could handle 12,000 to 15,000 patients. After starting TCHATT, Schell says it was clear one physician could manage more students due to the additional resources available when a child is in school. Children's Health now uses a ratio of one physician to 30,000 students.
TCHATT received additional funding at the start of 2020. Students can now receive up to four free appointments. Schell says this may cause more students to take advantage of TCHATT, which could change the physician-to-student ratio.
For now, TCHATT is funded through the 2021 academic year and 110 campuses over a nine-county area will be added.