Can The BIG Act Give School-Based Telehealth a National Platform?

July 01, 2019 - An innovative telehealth program developed in Texas that extends telemental health services into schools could be headed for the national stage, thanks to a bill now before Congress.

Introduced last week, the Behavioral Intervention Guidelines (BIG) Act (HR 3539) would, if passed, compel the Health and Human Services Department to work with other government agencies, including the Departments of Education, Justice and Homeland Security, “to develop best practices for the proper use and implementation of behavioral intervention programs.”

One of the bill’s sponsors is Michael C. Burgess, MD (R-TX), whose home state has been pushing to improve school-based access to mental health services in the wake of the Feb. 14, 2018 massacre at Marjorie Stoneman Douglas High School in Parkland, Fla., and the May 18, 2018 massacre of eight students and two teachers at Santa Fe High School, near San Antonio.

“School safety is imperative in ensuring American children can succeed throughout the course of their education,” Burgess said in a press release announcing the bill. “By connecting experts who develop and implement behavioral intervention programs to the Department of Health and Human Services and other federal agencies, the BIG Act will help to spread best practices throughout the country. I commend Texas Tech University Health Sciences Center for establishing a project to increase access to mental health services in schools and for contributing to the efforts in Texas to boost school safety.”

That project is the Telemedicine Wellness, Intervention, Triage and Referral (TWITR) program, launched in 2012 in the wake of the Sandy Hook Elementary School massacre and the Aurora, Colo. theater shooting. It uses telemedicine to help school officials screen and treat students in need of behavioral health counseling.

“As a mental health screening program, the project successfully utilizes modern technology to offer staff training and student services through the use of telemedicine,” Dr. Tedd L. Mitchell, Texas Tech University System Chancellor and TTUHSC President, added in the release. “This legislation is an important step to provide schools with information and resources to help support the mental health needs of their students.”

A statewide expansion of the program was a key part of Texas Gov. Greg Abbott’s 2018 plan to improve school safety and mental health resources, as well as recent state legislation to create a statewide telehealth network for school-based mental health services.

“Since the TWITR Project’s launch, more than 400 students have been referred to the program, of which 200 students were screened for anxiety, depression, loneliness, isolation — and screened for whether they were prone to violence or violent thoughts,” Abbott said in his 2018 plan. “Those screenings led to psychiatric appointments and, sometimes, immediate hospitalizations and arrests for planning violent incidents like shootings. In four years, the program has resulted in 25 students being removed from school, 44 placed in alternative schools, and 38 admitted to a hospital.”

“The effectiveness of the project is also demonstrated by improvements in student outcomes, decreases in truancy referrals, and fewer discipline referrals in schools,” he added. “A 37 percent reduction in truancy and discipline referrals has been seen for students receiving TWITR services.”

Burgess’ bill is co-sponsored by Reps. Drew Ferguson (R-GA), Jimmy Panetta (D-CA) and Joe Kennedy (D-MA).

According to Ferguson, the bill would expand a program created in 2008 following the 2007 Virginia Tech massacre that killed 32 people. It led to the creation of The National Behavioral Intervention Team Association (NaBITA), which aims to design student interventions that catch behavioral health issues before they reach a crisis stage.