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Workforce Shortages Impede Texas Push for School Teletherapy

Given skyrocketing demand for youth mental health services, Texas officials are trying to expand school-based virtual therapy options, but it's a challenge given the national shortage of mental-health professionals.

Teletherapy, psychologist online
(TNS) — Margarita Jimenez could tell her pre-teen daughter was struggling with the divorce. The girl was feeling down, crying excessively and having a hard time focusing at school. She'd lost her spunk.

Jimenez took her daughter to therapy, but as the single mother's finances tightened, she could no longer afford the expense. Another option appeared, however, when a school counselor at Bleyl Middle School in Cypress referred the seventh grader to a state-funded and school-based telehealth program called TCHATT — Texas Child Mental Health Access Through Telemedicine.

Five after-school virtual therapy sessions later, and the mother has watched her 12-year-old daughter become happier, more open and more expressive with her feelings.

"Just having that access was amazing for her," Jimenez said. "We both felt a sense of relief and calmness."

As the demand for youth mental health services skyrockets, state leaders are trying to expand the program into every Texas school district whose administrators are interested. That is an ambitious task made challenging by the national shortage of mental health professionals, said Dr. Laurel Williams, a Baylor College of Medicine professor who oversees the program.

"Every state is struggling with this — Texas isn't unique in that way — but there are not enough qualified providers in the state," she said. "That's our biggest road block."

The school-based telehealth service is among several programs run by the Texas Child Mental Health Care Consortium created in 2019 by the Texas legislature following the deadly mass shooting at a Santa Fe high school. The consortium brings together the state's largest health-related institutions to address and improve the mental health challenges among children and adolescents — and its virtual program happened to work well when the pandemic hit, Williams said.

"Even though it was incredibly difficult to start a clinical program in the middle of a pandemic, I think it allowed for us to provide services to youth and families that may have otherwise struggled even more," said Williams, medical director for the consortium's centralized operational support hub.

In the wake of the massacre at Robb Elementary in Uvalde, state officials added $5.8 million to the school-based telehealth program and tasked the consortium with offering the service to all 1,000-plus Texas school districts within the next academic year.

"We are now furiously working to try to expand," Williams said at a recent Texas House appropriations committee hearing.

More than 500 districts with 4,100 school campuses had enrolled in the program through December, according to the consortium, meaning roughly 2.7 million children — about half of all Texas students — have access to the service. The first child was referred in May 2020, and the program has since provided more than 60,000 sessions to 18,000 students.

The program is operating with a $60 million budget, according to the consortium, in addition to $59 million in American Rescue Plan Act funding that helped expand services to include group therapy, a five-session mental health and wellness training for middle school students, and services focused on substance abuse, trauma and grief.

In this legislative session, the consortium has requested nearly $173 million for the 2024-2025 biennium to help hire more workers and expand the program state-wide.

The program, which requires parental consent, is geared for neither crisis care nor long-term treatment, Williams said. Instead, the services finds a niche in between, serving children and teens with mild to moderate mental health issues through four to six virtual sessions with a therapist and/or psychiatrist. Most students get an appointment within a week or two of a referral, Williams said.

"We're really trying to be there before a crisis erupts and when a problem is more mild to moderate so that there's an opportunity to get an intervention, get an assessment, get a treatment plan," she said.

The clinicians can also help families navigate to other resources or the next point of care for more serious problems or in cases in which a child has trouble getting help through a screen, Williams said.

The goal is not to take over a school district's mental health programs, Williams said, but instead to provide support and complement the existing services. A small portion, about 300 schools, have declined the service, according to the consortium, because those campuses already had behavioral health services in place or they lacked the staff, Internet or physical space to support the program.

"We're not here to take away whatever services you may already be providing kids, we're here to fill a gap if you see a gap," Williams said.

Anxiety and depression are the top issues for which students seek treatment, Williams said, followed by anger, attention or academic issues, trauma and suicidal ideation. Elementary, middle and high school students each make up a third of the total students referred to the program.

Parent surveys show that more than half of the children served by the program were doing a lot better and a third were doing a little better after the sessions, according to the consortium.

As the state works to expand the program, several districts in the Houston area have seen success for several years. More than a dozen districts in the area are currently enrolled.

Kershal Wilson, a school guidance counselor at Grantham Academy in Aldine, has watched her students benefit from the program.

On the first day of school last year, for example, one middle school girl sought refuge in the counselor's office.

Wilson quickly realized that the student needed more help than she was equipped to provide. Instead, she connected the student and her family to virtual appointments with a therapist and psychiatrist. That level of care that may have otherwise been out of reach for the low-income family, Wilson said.

"We started to see a shift in her behavior, less anxiety on campus, less panic attacks on campus," the counselor said. "It was amazing."

Generally, the program helps remove barriers to care, including cost, transportation, school absences and long waiting lists at private providers, Wilson said.

"For parents that may not have the resources, they don't have to worry about having to travel all the way across town to bring the student to an appointment every week," she said. "It's been very convenient."

The program also offers support, education and training to counselors and other school personnel involved in the program. Wilson plans to implement some mindfulness activities that she learned at a recent training to help students cope with stress.

Priti Avantsa, the mental health and social work coordinator at Fort Bend ISD, said the state's virtual program is among several mental health services available for students. Demand for those programs has tripled every year since the pandemic, she said, and the referrals so far this school year have already surpassed last year's total count.

"Mental health has just exploded," she said. "Our kids are really struggling."

The district offers the virtual therapy program only in two high schools, Avantsa said, although the psychiatric component is available to all students.

That's because younger students typically struggle with screen-based therapy, she said, and the virtual sessions require involvement from social workers and school counselors who are often busy de-escalating crises situations on campus.

Although her school district offers a robust array of mental health services, Avantsa said, there is still a gap between the demand and the help available in schools and in the broader community, particularly for people whose primary language is not English.

"I feel like we are trying as best as we can to meet our needs, but I feel like the needs are outweighing the number of providers we have in place," she said. "And it's not for the lack of trying — they're just not available."

The slow-burning mental health crisis has been building for decades in the U.S. due to under-resourcing and stigma, Williams said, noting that she is glad to see more attention now focused on the issue.

"The youth today are driving this," she said. "They're not going to take it — they're very vocal. They don't mind sharing what's going on with them and how they're feeling."

Still, even as the stigma erodes, Williams said there are not enough mental health care providers across the state or the country.

"It is very frustrating if you're a family member and you have a child who's struggling and you're told that the wait list is nine months," she said. "We wouldn't stand for that if it was a broken leg with the bone sticking out."

The consortium has several other initiatives focused on building the workforce by training and retaining child psychiatrists and psychologists in Texas.

In Cypress, meanwhile, Jimenez works as a speech language pathologist at her daughter's middle school.

While access to mental health care is difficult for many families, she said, it's more important than ever. Kids are exposed to disasters like the pandemic, school shootings and hurricanes, plus the normal developmental challenges at their age.

"It's just a lot going on," Jimenez said. "I see it every day working in a middle school — the need is out there. It just takes an organization or a program like TCHATT to be able to give access, even if it's brief, that sometimes can mean the world."

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