Lacking counselors, US schools turn to the booming business of online therapy
Maria Ishoo's daughter's problems with playground bullies started in primary school. Girls gathered together and called her 'fat' and 'ugly'. Boys tripped and pushed her. The California mom watched her typically bubbly second-grader retreat to her bedroom and spend afternoons curled up in bed.
For Valerie Aguirre's daughter in Hawaii, a wave of “friend drama” in high school escalated into violence and online bullying, leaving the 12-year-old feeling disconnected and alone.
Both children received help through telehealth therapy, a service that schools across the country are offering in response to rising mental health issues among American youth.
Now at least 16 of the 20 largest U.S. public school districts are offering online therapy sessions to reach millions of students, according to an analysis by The Associated Press. In those districts alone, schools have signed vendor contracts worth more than $70 million.
The growth reflects a booming new business emerging from America's youth mental health crisis, which has proven so lucrative that venture capitalists are funding a new crop of school teletherapy companies. Some experts are raising concerns about the quality of care provided by fast-growing technology companies.
However, as schools face a shortage of in-person practitioners, educators say teletherapy works for many children and fills a huge need. It has made therapy more accessible, especially for rural schools and lower-income students. Schools allow students to connect with online tutors during the school day or outside office hours.
“This is how we can keep people from falling through the cracks,” said Ishoo, a mother of two in Lancaster, California.
Ishoo remembers standing at her second-grader's bedroom door last year and wishing she could get through to her. “What is wrong?” the mother would ask. The answer made her heart heavy: “It's NOTHING, Mom.”
Last spring, her school district launched a teletherapy program and enrolled her daughter. Over a month of weekly sessions, the girl logged in from her bedroom and opened up to a therapist who gave her coping tools and breathing techniques to reduce anxiety. The therapist said to her daughter: You are the boss of your own emotions. Don't give anyone else that control.
“She learned that it's okay to ask for help, and that everyone needs a little extra help sometimes,” Ishoo said.
The 13,000-student school system, like many others, employs counselors and psychologists, but not enough to meet the need, said Trish Wilson, the Lancaster district's counselor coordinator.
Therapists in the region have a full caseload, making it impossible to refer students for immediate care, she said. But students can schedule a virtual session within days.
“Our preference is to provide personal therapy to our students. That's obviously not always possible,” said Wilson, whose district has referred more than 325 students to more than 800 sessions since launching the online therapy program.
Students and their parents said in interviews that they turned to teletherapy after struggling with feelings of sadness, loneliness, academic stress and anxiety. For many, the transition to in-person schooling after distance learning was traumatic. Friendships were broken, social skills had deteriorated and tempers flared more easily.
Schools are footing the bill, many using federal money for pandemic relief, as experts have warned of alarming rates of depression, anxiety and suicide among young people. Many school districts sign contracts with private companies. Others partner with local health care providers, nonprofits or state programs.
Mental health experts welcome the extra support, but are cautious about potential pitfalls. First, it's becoming increasingly difficult to hire school counselors and psychologists, and competition with telehealth providers isn't helping.
“We have 44 counselor positions open, and telehealth is certainly impacting our ability to fill them,” said Doreen Hogans, supervisor of school counseling in Prince George's County, Maryland. Hogans estimates that 20% of school counselors who left have taken teletherapy jobs, which offer more flexible hours.
The companies' rapid growth raises questions about the therapists' qualifications, their experience with children and privacy protocols, said Kevin Dahill-Fuchel, executive director of Counseling in Schools, a nonprofit that helps schools ditch traditional, in-person mental health care. strengthen. .
“As we get these young people access to telehealth, I want to hear how all these other bases are covered,” he said.
One of the largest providers, San Francisco-based Hazel Health, started providing telemedicine health services in schools in 2016 and expanded into mental health services in May 2021, according to CEO Josh Golomb. There are now more than 300 physicians providing teletherapy in more than 150 school districts in 15 states.
The rapid expansions mean millions of dollars in revenue for Hazel. This year, the company signed a $24 million contract with Los Angeles County to provide teletherapy services to 1.3 million students over two years.
Other clients include Hawaii, which is paying Hazel nearly $4 million over three years to work with its public schools, and Clark County schools in the Las Vegas area, which has allocated $3.25 million for Hazel-delivered teletherapy . The Miami-Dade, Prince George's and Houston school districts are also working with Hazel.
Despite the massive contracts, Golomb says Hazel is focused on ensuring that the well-being of children outweighs the bottom line.
“We have the ethos of a nonprofit, but we use a private sector mechanism to reach as many children as possible,” Golomb said. Hazel has raised $51.5 million in venture capital funding in 2022, fueling its expansion. “Are we concerned about any compromises in quality? The resounding answer is no.”
Other providers are entering the space. In November, New York City launched a free telehealth therapy service for teens to help remove access barriers, said Ashwin Vasan, the city's health commissioner. New York will pay the startup TalkSpace $26 million over three years for a service that allows teens ages 13 to 17 to download an app and connect with licensed therapists by phone, video or text message.
Unlike other cities, New York offers the service to all teens, regardless of whether they are enrolled in private, public, or home schools, or not in school at all.
“I really hope this normalizes and democratizes access to mental health care for our youth,” Vasan said.
Many of the referrals in Hawaii come from schools in rural or remote areas. The number of students in Maui has increased sharply since August's deadly wildfires, said Fern Yoshida, who oversees teletherapy for the state education department. So far this fall, students have logged 2,047 teletherapy visits, a threefold increase over the same period last year.
One of them was the daughter of Valerie Aguirre, whose argument with two friends turned physical in sixth grade last year when one of the girls punched her daughter in the face. Aguirre suggested her daughter try teletherapy. After two months of online therapy, “she felt better,” Aguirre said, realizing that everyone makes mistakes and that friendships can be repaired.
In California, Ishoo says her daughter, now in third grade, is passing on wisdom to her sister, who started kindergarten this year.
“She brings her sister to class and tells her everything will be fine. She's a different person. She is older and wiser. She reassures her sister,” Ishoo said. “I heard her say, 'If kids are mean to you, just ignore them.'”
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Associated Press data reporter Sharon Lurye contributed.
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The Associated Press education team receives support from the Carnegie Corporation of New York. The AP is solely responsible for all content.