Using School-Based Telehealth to Boost Mental Health Access in LA County

March 28, 2023 - The youth mental health crisis in America has worsened considerably in the past decade, particularly following the onset of the COVID-19 pandemic. A recently announced telehealth partnership aims to combat the problem by bringing mental and behavioral health services to Los Angeles County public schools.

In 2021, the proportion of mental health-related emergency department visits increased by 24 percent among children aged 5 to 11 years and 31 percent among 12- to 17-year-olds, according to data from the Centers for Disease Control and Prevention.

Additionally, a survey conducted among students of the LA Unified School District the same year showed that about half (51 percent) reported that they were at least a little worried about their mental health.

"In early 2021, we were eight or nine months into COVID, kids were having incredible and rising levels of stress," said Michael Brodsky, MD, senior director of behavioral health and social services at L.A. Care Health Plan, in a phone interview. "There was social isolation because schools were closed. Then, there was not only the COVID pandemic, which caused fear but also waves of illness and loss for many students. Also, the twin pandemic of systemic racism, which, as you recall, became very prominent in those years — but of course, it had been there all along, particularly in communities of color."

To stem the rising tide of mental health issues, a group of county agencies and healthcare stakeholders launched the telehealth partnership in LA County with the goal of expanding access to virtual mental healthcare for the 1.3 million students across the county's K-12 public schools.

HOW THE PARTNERSHIP WILL WORK

Launched in early February, the partnership brings together the LA County Office of Education (LACOE), L.A. Care Health Plan, Health Net, the LA County Department of Mental Health, and Hazel Health.

The county's local education agencies (LEAs), or school districts, can choose to participate in the virtual mental health program, said Van Nguyen, LACOE's public information officer, in an email. Once they have decided to participate, LACOE and Hazel Health will work with the school district or LEA to provide more information, such as how parents can enroll their children.

Students who sign up can be referred for a mental health intake and assessment by a school counselor, social worker, or parent/guardian. Students may also choose to self-refer, Nguyen noted.

Hazel Health's family resource managers then work with the students and their families to schedule virtual appointments with a therapist for short-term therapy sessions. Students can attend the virtual sessions at school during school hours or at home.

"This partnership allows us to build a longer-term infrastructure to ensure that students' needs are being met," said Nguyen.

L.A. Care Health Plan, a public health plan in LA County, and Health Net, a Centene Corp. subsidiary, are providing up to $24 million to cover the services for all LEAs who choose to participate over two years.

"Health Net views its role as a critical partner in addressing the youth mental health crisis in LA County, partnering with state, county, and community-based organizations to ensure that young people have access to mental health services," said Beatriz Lopez, senior public relations manager at Health Net, in an email.

The Department of Health Care Services' Student Behavioral Health Incentive Program (SBHIP), authorized by California Gov. Gavin Newsom, will also provide funding for the school-based telemental healthcare program.

OVERCOMING DEPLOYMENT CHALLENGES

The partnership has been years in the making. The health plans got involved after the state of California announced in 2021 an opportunity for payers to work more closely with schools to help students with mental health and substance abuse issues.

"We saw, with the start of Covid, we saw great increases in the use of telehealth for people to obtain psychotherapy or to contact a psychiatrist or to get counseling either on a short-term or long-term basis," said L.A. Care's Brodsky. "It seemed like a good opportunity. We started thinking about telehealth fairly early in 2022."

After the school-based telehealth project received state approval, the health plans began working with LACOE, the LA County Department of Mental Health, and Hazel Health to identify school districts willing to implement the virtual mental health services.

Currently, Los Angeles Unified School District and Compton Unified School District have decided to participate in the initiative.

"With unprecedented levels of trauma and stressors facing our students, the need for timely and effective mental health support has never been greater," said Los Angeles Unified School District Superintendent Alberto M. Carvalho in a press release announcing the partnership.

But, as the initiative rolls out across the public schools, the partners have noted several barriers they must break down to make the implementation successful. One such barrier is technology access.

"For example, if we're going to have people connect via a video therapy session on a tablet, we probably need to purchase the tablets, and we need to make sure that there's an internet connection that can sustain high-quality video transmission," said Brodsky.

Part of the funding provided by the health plans and SBHIP will go towards purchasing the technology and internet bandwidth needed, he added.

Another potential barrier is ensuring the student population's diverse needs are met. This is where Hazel Health comes in, as the school-based telehealth provider has experience working with communities of color.

"Hazel Health aligns the hiring of therapists to the demographics of its partner districts and [is] committed to connecting students to therapists who reflect and understand diverse populations," said LACOE's Nguyen.

Other decisions that will be made alongside the schools involved include the timing of the sessions. Brodsky stated that the therapy sessions would ideally be set up such that they do not interrupt schoolwork unless necessary.

SCHOOL-BASED TELEMENTAL HEALTHCARE'S BENEFITS

Though discussions around mental health have become more transparent recently, the partners involved in the telehealth project hope that by bringing expanded access to schools, they can help further curb any negative association with seeking mental healthcare.

"We've seen the devastating impact of COVID-19 on students," said Nguyen. "We know our children are anxious and depressed, and many are not seeking treatment. By offering a telehealth option for students, we hope to reduce the stigma of seeking help for mental health."

Not only that, but school-based telemental healthcare can also help children get quicker access to care, which could "reduce both staff and student absenteeism, improve morale, and even boost test scores," Nguyen added.

Further, unresolved mental health needs among students can result in an enormous societal cost, Brodsky noted. For instance, the Los Angeles Unified School District includes more than half a million students. According to Brodsky, approximately 7,000 mental health crisis calls came from the district in 2019.

"If you just think about that means every weekday — there are only 180 school days in a school year. That's like dozens of those [crisis calls] a day," he said. "To me, it's a testament to how much distress students are living with."

While the initiative's primary goal is to provide prompt access to mental healthcare in schools, it also aims to expand access for those who may face socioeconomic barriers to care, such as transportation issues or parents who cannot afford to take time off work, by offering therapy services at convenient locations for children.

"This model of care offers a greater level of access to healthcare than ever before, particularly for students from economically disadvantaged families," said Health Net's Lopez.

The initiative's partners plan to work with local healthcare agencies to expand care access even further for children who may need more intensive care.

"We've made some arrangements to try to enhance those workflows and to make those handoffs as smooth as they can be," Brodsky said.

Addressing the youth mental health crisis will require the healthcare industry to join forces with the community in various ways. This partnership is just one example of how stakeholders from within and outside the industry can collaborate to expand much-needed access to pediatric mental healthcare.