Texas’ Push For School Teletherapy Hindered By Shortage Of Workforce

Margarita Jimenez saw that her preteen daughter was having trouble adjusting to the divorce. The girl was depressed, sobbing, and struggling to concentrate in class. She was no longer spunky.

Jimenez took her kid to treatment, but as her circumstances became more precarious, she was no longer able to cover the cost. The seventh grader was introduced to TCHATT, or Texas Child Mental Health Access Through Telemedicine, a state-funded and school-based telehealth program, by a school counselor at Cypress’ Bleyl Middle School.

The mother has seen her 12-year-old daughter improve in happiness, openness, and emotional expression following five after-school virtual therapy sessions.

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

State leaders are attempting to bring the program to every Texas school district whose administrators are interested as the demand for juvenile mental health care soars.

According to Dr. Laurel Williams, a professor at the Baylor College of Medicine who oversees the program, that is a difficult assignment made more difficult by the lack of mental health specialists in the country.

“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 roadblock.”

The Texas Child Mental Health Care Consortium was established in 2019 by the Texas legislature in response to the horrific mass shooting at a Santa Fe high school. It runs several services, including the school-based telehealth service.
Its virtual program just so happened to operate effectively when the pandemic came, according to Williams. The consortium brings together the state’s top health-related institutions to address and enhance the mental health difficulties among children and adolescents.

“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,” Williams, the consortium’s centralized operational support hub’s medical director, stated.

Following the shooting at Robb Elementary in Uvalde, state officials increased the school-based telehealth program’s budget by $5.8 million and gave the consortium the responsibility of providing the service to all of Texas’ more than 1,000 school districts by the start of the next school year.

“We are now furiously working to try to expand,”  Williams stated during a recent meeting of the Texas House appropriations committee.

The consortium reported that more than 500 districts with 4,100 school campuses had participated in the program by December, giving 2.7 million children—about half of Texas’s students—access to the service. Since its initial referral in May 2020, the program has delivered over 60,000 sessions to 18,000 students.

The consortium reports a $60 million budget and $59 million in American Rescue Plan Act financing that expanded programs to include group therapy, a five-session mental health and wellness training for middle school children, and treatments for substance misuse, trauma, and sorrow.

Texas' Push For School Teletherapy Hindered By Shortage Of Workforce

In the legislative session, the consortium requested roughly $173 million for the 2024-2025 biennium to hire more personnel and expand the program statewide.

Williams said the program, which requires parental consent, is neither crisis nor long-term. Instead, therapists and psychiatrists provide four to six virtual sessions to children and teens with mild to moderate mental health difficulties. Williams said most pupils are seen within a week or two following referral.

“We’re trying to be there before a crisis erupts and when a problem is milder to moderate so that there’s an opportunity to get an intervention, get an assessment, get a treatment plan,” she said.

Williams said clinicians can also help families find additional services or the next level of treatment for more significant issues or when a child has trouble seeking help online.

Williams said the idea is to enhance and complement school districts’ mental health programs, not take them over. The consortium reports that roughly 300 schools have denied the service because they already had behavioral health services or lacked manpower, Internet, or 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.

Williams said kids seek treatment most often for anxiety, sadness, anger, attention or academic challenges, trauma, and suicidal ideation. Thirds of program referrals are elementary, middle, and high school children.

According to consortium polls, more than half of the program’s youngsters did better and a third did better after the sessions.

Houston districts have had success for years as the state expands the program. Enrolled districts include almost a dozen. The program has helped Aldine’s Grantham Academy guidance counselor Kershaw Wilson’s kids.

One middle school girl hid in the counselor’s office on the first day of school last year.

Wilson quickly knew the pupil needed more aid than she could supply. She connected the student and family to virtual therapy and psychiatrist appointments. Wilson claimed the low-income family could not afford that level of care.

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

Wilson said the program reduces expenses, transportation, school absences, and private provider waiting lists.

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

Counselors and other program staff receive assistance, education, and training. Wilson will use mindfulness techniques from a recent session to assist pupils to manage stress.

Fort Bend ISD’s mental health and social work coordinator, Priti Avantsa, said the state’s virtual program is one of several student mental health services. She said demand for those programs has quadrupled every year since the epidemic, and this school year’s referrals have already topped last year’s.

“Mental health has just exploded,” she said. “Our kids are struggling.”

Avantsa said just two high schools offer virtual therapy, but all pupils have access to psychiatry. She said younger adolescents struggle with screen-based therapy, and social workers and school counselors are often busily de-escalating campus tensions.

Avanti said her school district offers a wide range of mental health services, but there is still a gap between need and the treatment offered in schools and the community, especially for non-English speakers.

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

Williams said she is delighted to see a greater emphasis on the U.S.’s decades-long mental health epidemic owing to under-resourcing and stigma.

“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.”

Williams said there are not enough mental health care providers in the state or country, even as stigma decreases.

“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.”

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The consortium includes various programs to train and retain Texas child psychiatrists and psychologists. Jimenez is a speech-language pathologist at her daughter’s middle school in Cypress.

She said mental health care is more vital than ever, yet many families struggle to get it. Youngsters face pandemics, school shootings, hurricanes, and common developmental challenges.

“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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