Problems with playground bullies began for Maria Ishoo’s daughter in elementary school. The girls got together and called him “fat” and “ugly”. The children tripped over him and pushed him. The California mom watched as her typically cheerful second grader retreated to his bedroom and spent his afternoons curled up in bed.
For Valerie Aguirre’s daughter in Hawaii, middle school “friend drama” turned 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 teenagers.
At least 16 of the 20 largest U.S. public school districts now offer online therapy sessions to reach millions of students, according to an analysis by The Associated Press. Schools in these districts alone have signed provider contracts worth more than $70 million.
The growth reflects a new business emerging from America’s youth mental health crisis that has proven so lucrative that venture capitalists are funding a new breed of school teletherapy companies. Some experts express concern about the quality of care provided by fast-growing technology companies.
As schools grapple with a shortage of in-person practitioners, educators say teletherapy is working for many children and filling a major need. Access to therapy has been made easier, especially for rural schools and low-income students. Schools allow students to connect with online counselors during school hours or while away from home.
“This is how we can prevent people from falling off the cliff,” said Ishoo, a mother of two who lives in Lancaster, California.
Ishoo remembers standing in front of the sophomore’s bedroom door last year and wishing he could reach her. “What’s the problem?” the mother would ask. The answer made her heart heavy: “NOTHING, mother.”
Last spring, the school district started a teletherapy program, and she enrolled her daughter. During 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 told her daughter: You are responsible for your own emotions. Don’t give this control to anyone else.
“He learned that it was okay to ask for help and that sometimes everyone needs extra help,” Ishoo said.
The 13,000-student school system, like many other systems, has counselors and psychologists on staff, but it’s not enough to meet the need, said Trish Wilson, counselor coordinator for the Lancaster district.
The district’s therapists are overloaded with caseloads, making it impossible to refer students to urgent care, she said. However, students can schedule a virtual session within a few days.
“Our preference is to provide face-to-face therapy to our students. Frankly, that’s not always possible,” said Wilson, whose district has referred more than 325 students to more than 800 sessions since the online therapy program launched.
In interviews, students and their parents said that they turned to teletherapy after struggling with emotions such as sadness, loneliness, academic stress and anxiety. For many, returning to in-person school after distance learning has been traumatic. Friendships were broken, social skills deteriorated, and anger flared more easily.
As experts warn that rates of depression, anxiety and suicide in teens are alarming, many are using federal pandemic relief money and schools are footing the bill. Many school districts sign contracts with private companies. Others work with local health care providers, nonprofit organizations or government programs.
Mental health professionals welcome the extra support but are wary of potential dangers. First, school counselors and psychologists are increasingly difficult to recruit, and competition from telehealth providers isn’t helping.
“We have 44 vacant counselor positions, and telehealth is definitely impacting our ability to fill them,” said Doreen Hogans, superintendent of school counseling in Prince George’s County, Maryland. Hogans estimates that 20 percent of counselors who leave school take teletherapy jobs that offer more flexible work hours.
Kevin Dahill-Fuchel, executive director of Counseling in Schools, a nonprofit that helps support traditional, in-person mental health services in schools, said the companies’ rapid growth raises questions about therapists’ qualifications, experience with children and privacy protocols. .
“I want to hear how all the other bases are covered while providing these youth with access to telehealth,” she said.
One of the largest providers, San Francisco-based Hazel Health, started with telemedicine health services in schools in 2016 and expanded into mental health in May 2021, CEO Josh Golomb said. There are currently more than 300 clinicians providing teletherapy in more than 150 school districts in 15 states.
Rapid expansion means 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 for two years.
Other clients include Hawaii, which paid Hazel nearly $4 million over three years to work in public schools, and Clark County schools in the Las Vegas area, which forked out $3.25 million for teletherapy Hazel provided. Miami-Dade, Prince George’s and Houston school districts have also partnered with Hazel.
Despite the huge contracts, Golomb said Hazel remains focused on ensuring child welfare outweighs the bottom line.
“We have the mentality of a non-profit company, but we use the private sector mechanism to reach as many children as possible,” Golomb said. Hazel raised $51.5 million in venture capital financing in 2022, accelerating its growth. “Are there any concerns about any compromise in quality? The responsive answer is no.
Other providers are also entering this space. In November, New York City launched a free telehealth therapy service for teens to help eliminate barriers to access, said Ashwin Vasan, the city’s health commissioner. New York is paying $26 million over three years to startup TalkSpace for a service that lets teens ages 13 to 17 download an app and connect with licensed therapists by phone, video or text.
Unlike other cities, New York offers services to all youth, whether they are enrolled in private, public or home schools.
“I hope this will really normalize and democratize our youth’s access to mental health care,” Vasan said.
Most referrals in Hawaii come from schools in rural or remote areas. Fern Yoshida, who oversees teletherapy for the state education department, said student clients have increased sharply on Maui since the deadly wildfires in August. So far this fall, students have had 2,047 teletherapy visits; This means a threefold increase compared to the same period last year.
One of them was the daughter of Valerie Aguirre; Last year, in sixth grade, a disagreement with two of her friends turned physical when one of the girls slapped her daughter in the face. Aguirre suggested her daughter try teletherapy. After two months of online therapy, Aguirre said she “felt better” and realized that everyone makes mistakes and friendships can be mended.
In California, Ishoo says her daughter, now in third grade, is passing on wisdom to her sister, who started kindergarten this year.
“He walks his little sister to class and tells her everything will be okay. He is a different person. He’s older and wiser. “He reassures his sister,” Ishoo said. “I heard him 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. AP is solely responsible for all content.