If you ever visited the nurses’ office or had an eye exam at school as a child, you benefitted from campus healthcare initiatives. Community schools can (and should) go beyond education to serve as critical healthcare providers for students, staff, and their families. 

Unfortunately, many school districts have been forced to re-evaluate their healthcare options in recent years due to financial challenges, staffing issues, and the general volatility that accompanied the COVID-19 pandemic. 

Instead of cutting back on healthcare services, now is the time for schools to look for innovative new solutions to provide better care. By keeping the entire school community healthy, schools facilitate more successful learning for every student and a safer environment for all.  

Let’s take a look at why on-campus healthcare in schools is so vital, how it’s changed over the years, and what schools can do today to improve their healthcare options. 

The History of Healthcare in Schools

Public schools in the United States have provided some form of healthcare for over a century. Most schools started offering health education and care in the late 19th century, and many states started officially mandating that schools provide healthcare around the 1920s. 

In the decades since, school healthcare initiatives have expanded dramatically, providing essential screenings for young children, facilitating vaccinations, and promoting awareness to prevent the spread of illness. 

However, since 2020, many schools have been in survival mode. Navigating the challenging COVID-19 pandemic and resulting economic fallout has meant that many schools have needed to alter or cut back on their healthcare programs. 

During the pandemic, many schools switched to an online learning model, which also made it difficult to provide healthcare services to those in need. Although most schools have since returned to in-person learning, reinstating those healthcare services has been challenging. 

Nationwide labor shortages have made it difficult for schools to rehire staff members who previously performed these services. Additionally, many school districts across the country have seen a drop in funding. 

This is partially because COVID-19-related emergency funds have run out, but many schools have also seen drops in enrollment and therefore funding. Tighter budgets mean that schools often have to cut back to the bare minimum when it comes to healthcare. 

This lack of healthcare has real consequences for students. Many students and their families, particularly those who have lower-income backgrounds, rely on their schools for essential health screenings and basic care for illness and injury. 

It’s estimated that roughly 4.2% of children in the United States don’t have any health insurance and even families that do often rely on free in-school care options to manage costs. In other words, school healthcare isn’t just a luxury for some, but a necessity. 

Benefits of School Healthcare Initiatives

Making basic healthcare available at school results in a variety of benefits not only for students but for their families and the entire community. 

The biggest benefit is that it makes basic healthcare accessible to all students, regardless of their background or socioeconomic status. Even if students don’t have health insurance or a primary care provider, they will still get basic health screenings and checks to ensure that serious health issues don’t go untreated. 

When in-school health screenings are conducted regularly, they have the opportunity to catch physical and mental illnesses that might have otherwise gone untreated. Schools can offer screenings for everything from vision and hearing impairment to ADHD and autism. Getting these diagnoses early in life ensures that students get the support they need as they grow and develop. 

Additionally, school healthcare initiatives reduce the rate of absences related to illness or injury. When students and staff have access to preventative care and education, they’re less likely to take sick days. Fewer absences equate to more valuable time spent in the classroom and ultimately, a better education. 

On-campus healthcare has become particularly important in the wake of the COVID-19 pandemic. COVID-19 and other respiratory illnesses can spread quickly throughout any school. When schools can provide vaccinations, PPE, and treatments for highly communicable illnesses, they prevent them from spreading throughout the school and causing mass absences. 

Improving On-Campus Healthcare Initiatives

Despite the unique challenges that schools are facing, it’s more important than ever to provide healthcare options for students. Instead of tackling these challenges solo, many schools should consider bringing in an expert healthcare partner.

By working with an outside healthcare partner, schools can provide a broader range of services to students while staying within their budgets. Ideally, a healthcare partner should specialize in education and understand the unique challenges that schools face when it comes to healthcare. 

One of the biggest advantages of working with a third-party healthcare specialist is that they tend to be more cost-efficient than hiring full-time healthcare staff to work in schools. Applying for grants and other financial support can help schools stretch a tight budget even further. 

Additionally, these third parties already have the skills and the resources to offer a broad range of tests and other services. This means schools won’t have to spend extra time or money training new staff members. A healthcare partner can even provide helpful guidance on regulations in specific states to ensure that the school’s offerings are up to par. 

In-School Healthcare for Everyone

Schools play such an important role in every child’s development, and healthcare is a key part of this. By prioritizing on-campus care, schools create a better learning environment for students and support a healthier, happier community for everyone.

About Thomas Shaffer

Thomas Shaffer stands at the helm of Campus Clinic, holding the esteemed position of President. In this role, he spearheads a transformative healthcare initiative, providing school-based healthcare solutions that are revolutionizing healthcare access on campuses. With a robust professional background, Shaffer’s journey into the realm of school-based healthcare is marked by his expertise as a healthcare consultant and his dedicated service as a Board Member for a Covid Clinic.

Since its inception, Shaffer has been the driving force behind Campus Clinic, guiding the company’s mission to broaden access to healthcare services within school environments. Campus Clinic’s vision, perfectly aligned with Shaffer’s, revolves around the radical transformation of healthcare accessibility on school campuses. Under Shaffer’s leadership, the company actively engages with the community, collaborating with school districts to deliver high-quality healthcare services. His instrumental role in fostering these vital community initiatives reflects his commitment to enhancing healthcare accessibility and making a lasting impact on the lives of students. Through his dedication, Campus Clinic continues to pave the way for comprehensive and accessible healthcare within the educational landscape.

By providing scaffolding to help build psychological flexibility among young people, we can not only support good mental health for life but reduce the mounting cost of mental healthcare.  

Mental health is the defining public health crisis of our time. According to the CDC, 42% of high school students felt so sad or hopeless that they could not engage in their regular activities for at least two weeks in 2021, an increase of 50% from 2011. The amount who seriously considered suicide soared to more than one in five, a 38% increase from 2011, and one-in-10 attempted suicide, a 25% increase from 2011. That means an average classroom of 30 has three students attempting to end their lives each year.  According to Pew Research, mental health is parents’ largest concern for their children, with 40% of parents being extremely or very worried about it.

To help reverse this devastating trend, healthcare systems need to shift “upstream” and focus on preclinical early intervention and prevention, as opposed to the current “downstream” reactive approach which only addresses issues after they’ve evolved into major disorders requiring acute treatment. On average, approximately 50% of lifetime mental health problems are established by age 14 and 75% are established by age 24. Unfortunately, healthcare systems globally are ignoring this reality and spending 90% of mental healthcare investments on acute mental healthcare treatment for adults, such as inpatient psychiatric care as well as hospital and emergency services.

This “downstream” approach is detrimental, inefficient, and exorbitantly expensive. It causes demand for treatment to outstrip supply and results in reactive treatment options that are condition-centric, episodic, and place-based. Healthcare systems are so heavily focused on (and overwhelmed by) the extreme instances requiring acute care that they are failing to find broader solutions to tackle the root of the problem.

We need to be proactive, shift upstream, and provide mental health support before people reach a critical breaking point. We need to support people during, not after, the 11 years it takes, on average, for initial mental illness symptoms to develop to the point of receiving traditional treatment.

Pre-clinical interventions are being vastly overlooked as the market struggles to address critically ill people. The lack of support for mental health issues until they become severe and urgent has created an enormous overlooked segment of the youth population that isn’t receiving help, but should be: the “missing middle.” This is the majority, roughly 60%-80%, of youth who are experiencing an emotional challenge, but they don’t have a mental health diagnosis, don’t think their issues are serious or ongoing enough to warrant a diagnosis and therapy, and aren’t facing an urgent crisis.

These are the young people who mask their problems, keep their heads down and just keep going. Often, they don’t recognize the severity of their struggles or don’t think medication or therapy would help, or don’t feel comfortable discussing the issue with parents or school counselors. Regardless, the “missing middle” needs far more support than they are currently getting. When left unchecked, mental health challenges often escalate and culminate into more serious problems. Prolonged exposure to stress, anxiety, and depression exacerbates each issue and increases the risk of people developing high acuity problems or having a crisis. Preventative upstream support not only builds healthier and more resilient young people, it also reduces healthcare costs by saving money on acute and chronic treatment down the line. Every $1 investment in prevention and early intervention for mental illness yields $2 to $10 in savings in healthcare costs, criminal and juvenile justice costs, and low productivity, according to a joint analysis by the National Academies of Sciences, Engineering, and Medicine.

Early intervention is particularly important because youth is the golden window of time during which environmental exposures have a pronounced impact on brain development, including the regulation of fear, stress, emotions, thoughts, and actions. We need to give young people the resources they need to build mental resilience and emotional coping skills during their early years to become healthier and higher-functioning adults.

Meeting young people where they are and where they feel comfortable

Successful upstream intervention with this generation of youth will require providing equitable access to behavioral health resources where they feel safe and comfortable. 

This means minimizing exposure to stigma by providing an anonymous digital platform where young people can privately and independently seek mental health support, which is not commonly available. In 2022, Pennsylvania began providing 150,000 students with access to Kooth’s anonymous digital mental health platform, and the user feedback demonstrated the importance of this anonymity; despite 65% of students feeling like they needed professional support, 63% did not feel comfortable speaking to friends or family about their mental wellbeing. If we want to help as many young people as possible, it’s imperative to give them equitable access to emotional health long before a diagnosis, which is generally not the case today.

It’s also imperative to make free, universally-accessible, and immediate support available 24/7. We heard time and time again from the Pennsylvania students that when they need help, they need it now – not in several weeks after they’ve obtained a diagnosis and scheduled a therapy appointment. 

The three primary reasons that Pennsylvania students are using Kooth are:

• 45% – To get mental wellbeing help that doesn’t require going to a counselor
• 59% – To get mental wellbeing help anytime/anywhere needed
• 62% – To connect with other people experiencing something similar

Finally, young people thrive when they have a sense of autonomy. We should give them the ability to address their mental health alongside their peers at their own pace – dipping into and out of a wide range of resources at their own leisure, with low commitment, minimal requirements, and no restrictions or funnels, except when people need to be referred to licensed therapy or other formal treatment. Young people need the chance to be themselves and don’t want to be commanded or controlled. We should encourage and facilitate them  to browse through and explore useful resources like therapeutic content, articles, stories from their peers, synchronous messaging and drop-in chats with mental health professionals, and forums moderated by licensed clinicians. 

Healthcare systems are very capable of providing this relevant, preventative support upstream, rather than only prioritizing acute mental healthcare treatment for adults. Society desperately needs it. 

According to the National Institute of Mental Health (NIMH,) mental health issues are costing the U.S. $467 billion per year, and they predominantly start with the youth, even though the nation’s spending on mental health does not remotely reflect that. Despite 70% of public schools reporting an increase of students who are seeking mental health services since before the COVID-19 pandemic and 76% reporting an increase in staff concerns about their students exhibiting symptoms such as depression, anxiety, and trauma, only half of school districts said they were equipped to provide needed care. As a result, the entry point for young people into the mental healthcare system is tragically often the emergency department. 

The majority of young people cannot be neglected just because their mental health challenges haven’t escalated or appeared. Instead, we must focus on enabling the youth to build psychological strength during their early years to create a more sustainable healthcare system and more importantly, a resilient, healthier, and higher-functioning population.

About Bob McCullough

Bob McCullough, PhD, is the vice president of Clinical Strategy for Kooth Digital Health. An associate professor of psychology at Missouri Baptist University and a licensed clinical social worker, Bob has extensive leadership experience in healthcare organizations including Cigna and Magellan Health, and behavioral health strategy experience at SilverCloud and ComPsych. He holds a master’s degree in social work from Washington University in St. Louis and a doctorate of philosophy from Newburgh Theological Seminary.

What You Should Know:

– Resurgens Technology Partners, a leading software-focused private equity firm, announced its investment in Valant, a cloud-based EHR platform designed specifically for behavioral health practices.

– This partnership aims to empower both providers and patients, ultimately making the world a mentally healthier place.

Valant: A One-Stop Shop for Behavioral Health Practices

Valant offers a comprehensive solution for growing behavioral health practices, encompassing a leading cloud-based EHR, practice management tools, and more. This integrated platform caters to the ever-evolving needs of providers, streamlining administration, boosting efficiency, and ultimately, improving patient outcomes.

“With Resurgens’ support, we’ll drive Valant’s adoption and deliver better outcomes for both patients and practices,” said Valant CEO Ram Krishnan. “Their expertise and vision align perfectly with our mission to revolutionize the behavioral health landscape through our modern, purpose-built cloud platform.”

Empowering Providers, Improving Outcomes

Valant’s software streamlines clinical, administrative, and financial functions, saving providers hours on documentation, boosting revenue per claim, and reducing administrative burdens. This translates to happier practitioners, more efficient practices, and ultimately, better care for patients.

What You Should Know:

– Wysa, an AI-guided mental health platform, has partnered with MyCHN, a Federally Qualified Health Center (FQHC) with 14 locations throughout Texas.

– Wysa’s integrated solution will now offer continuous and accessible mental health care support across the care journey for patients and providers.

– Wysa’s partnership with MyCHN follows recent launches with three leading orthopedic hospitals: the Living Well Center of Washington University at St. Louis, the Hospital for Special Surgery in New York City, and the Department of Orthopedic Surgery at the University of California, San Francisco.

Value-Based Mental Health Care

Wysa’s integrated solution will provide continuous and accessible mental health care support across the care journey for patients and providers within MyCHN. The aim is to enhance provider capacity and move towards stronger outcomes in a value-based care model. The solution acts as an anonymous solution, offering brief, evidence-based interventions to provide healthcare workers with immediate access to the right tools.

Other key benefits of the integration include:

– offers clinicians and administrators better insights into patient progress enabling better outcomes and utilization.

– anonymous support to providers, helping to address the stigma and lack of access to mental health care for healthcare workers.

– integrates directly into hospitals’ existing workflows, offering triaging, supportive programs, companion tools, and an analytics dashboard for clinician insights.

This partnership is a testament to Wysa’s commitment to providing accessible and evidence-based mental health care to underserved communities.

“Accessibility poses the greatest obstacle to patients receiving mental health care today, and that issue is only exacerbated in underserved communities due to increased barriers,” said Chaitali Sinha, Senior Vice President of Healthcare and Clinical Development at Wysa. “Digital health solutions are now enabling the health care community to traverse this gap and make accessing evidence-based care simpler. We’re excited to work with health care partners like MyCHN who are dedicated to equipping patients and providers alike with innovative and accessible mental health care.” 

What You Should Know:

– Forum, a peer support group marketplace, has officially launched with $5.3M in funding from a seed round led by NextView Ventures and featuring participation from MBX Capital, Cue Ball Capital, Sahil Bloom of SRB Ventures, Romeen Sheth, Shaan Puri and City Light Capital..

– Forum connects mission-driven facilitators with individuals seeking support for various life challenges.

Virtual Support Group Marketplace Forum

The platform offers a range of support groups, covering topics like grief, loneliness, chronic conditions, substance use recovery, caregiving, relationships, and career. Each group is led by an experienced facilitator who is provided with the tools to create, manage, and grow their groups. The goal is to make peer support accessible and affordable for everyone while fostering meaningful, live, video-based connections. The platform aims to address the growing demand for peer support due to limited mental health resources and increasing loneliness issues. Forum is a solution to traditional support group models that often suffer from geographic constraints and a lack of specificity, and it provides a safe and moderated space for genuine human connections to develop. Facilitators are vetted and undergo training, and members can find groups that meet their needs and availability on the Forum website.

What You Should Know; 

– Highmark Health and Spring Health today announced their collaboration to expand the number of access points to behavioral health care by 40 percent for Highmark insurance members, including children and teens. 

– Highmark’s Mental Well-Being powered by Spring Health will offer multiple levels of support: digital capabilities for daily wellness, one-on-one care navigation, deeper clinical care through in-person or virtual therapy, medication management, and 24/7 crisis support. 

Global Mental Health Solution

Mental Well-Being is powered by Spring Health, the most comprehensive global mental health solution for employers and health plans, and provides members with access to therapy and medication management appointments in an average of three days or less. Spring Health has helped nearly 70 percent of users reliably improve their mental health, with an average time to remission of just 5.9 weeks, as shown in a peer-reviewed study published by JAMA. With Spring Health’s best-in-class technology, Mental Well-Being uses a proprietary assessment screen for acuity across more than a dozen conditions, including generalized anxiety disorder, major depressive disorder, bipolar disorder, substance use disorders, post-traumatic stress disorder (PTSD), adult attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), post-partum depression, and eating disorders. Each member is recommended a personalized care plan tailored to their assessment results. Members can book appointments with providers in real-time and filter by condition, specialty, gender, ethnicity, and language. 

“Spring Health’s precision technology is changing the mental health paradigm,” said Adam Chekroud, PhD, president and co-founder, Spring Health. “There is a false narrative that increasing access will dramatically increase cost. But third-party-validated results demonstrate that Spring Health has been successful in lowering total health plan spend per participant in the first six months of engagement, especially those with costly chronic conditions. We’re thrilled to partner with Highmark Health as they recognize that providing access to Spring Health’s Precision Mental Health services will help members develop an understanding of how to incorporate behavioral health into their personal healthcare journey in a meaningful way—with proven clinical and financial results.” 

Availability
Mental Well-Being powered by Spring Health will be available to health plan members through the My Highmark member platform. My Highmark is a digital front door to a holistic experience that guides members through individualized health journeys. By creating a pathway that suits each member’s needs and interests, it’s easier to engage in and take the right steps to manage physical, mental, and social health, which ultimately improves outcomes and overall population health.

In the current digital landscape, the impact of social media on youth mental health is becoming an increasingly pressing concern. Dr. Vivek Murthy, the U.S. Surgeon General, recently issued a call to action, urging tech companies and lawmakers to take immediate steps to safeguard the mental well-being of our children and adolescents. 

This timely request is certainly necessary, but it only scratches the surface of a complicated issue.

From my perspective as a psychologist, addiction expert, and researcher who has worked with adolescents in a clinical setting, the narrative becomes even more complex. And, as a mother of three, I’m also personally invested in the well-being of our youth in a world where social media is a ubiquitous presence. 

In joining my personal interest in these issues and my professional experience, I hope to provide a multifaceted perspective to this topic. Understanding the unique challenges faced by today’s youth is the first step toward bringing about change that can help end the mental health crisis they currently face.

What the Data Says

According to the Pew Research Center, as many as 95% of U.S. teenagers aged 13-17 report using a social media platform. This is virtually every teen in America. 

The Pew research also shows that 35% of teens say they use one of the top five platforms (YouTube, TikTok, Instagram, Snapchat, and Facebook) almost constantly. This has troubling implications, as a 2019 research study published in JAMA Psychiatry found that people who spend over three hours a day on social media are more likely to develop mental health problems. 

Digital World, Physical Harm

Many of the negative effects of youth social media use involve issues of body image and identity. This is likely because social platforms offer countless opportunities for young people to compare themselves with others. And, as a consequence, they may experience feelings of alienation when they feel they don’t meet popular standards for physical appearance.

Numerous studies have reported a correlation between social media use and body dissatisfaction, dieting behavior, and eating disorders among young people. This isn’t just a response to passive viewing of the seemingly perfect lives and bodies cascading endlessly down social media feeds; more troublingly, this is part of an active conversation as young people create and respond to content promoting disordered eating. 

Social media is also where cyberbullying happens. According to the Pew Research Center, 46% of teens aged 13-17 have been bullied or harassed online, often over their physical appearance. These online attacks can have severe psychological impacts, leading to depression, anxiety, and low self-esteem.

The Complexity of Adolescence

Adolescence has always been a challenging phase of life, with or without social media. It’s a period fraught with physiological changes, emotional turbulence, and identity formation. As CDC data shows, mental health conditions like depression and anxiety often first surface during this phase of life. The existence of these conditions isn’t just a product of social media; they’ve been long-standing challenges for adolescents. However, social media may be a factor in the record rates of youth depression and suicide we’ve seen in recent years.

Generational trauma and societal pressures compound the challenges of adolescence. Our youth are navigating an environment where the strains of academic achievement, future uncertainties, and societal expectations loom large. Research indicates that these pressures can contribute to stress, anxiety, and other mental health issues among teens. Many teens even take to social media to discuss trauma, and while this can be therapeutic, it can also have an amplifying effect on the trauma itself. 

Loneliness has also recently been highlighted by the Surgeon General as a serious harm to health and well-being in our nation, and loneliness is especially complex in young people. Loneliness can lead to both emotional and physical harm. 

Despite the many ways in which social media allows us to connect with others both near and far, the nature of those interactions can lead to more disconnection than connection. As Dr. Murthy states, “There can be an assumption that because you’re virtually connected through social media, email or text that somehow that protects you from loneliness. Sometimes it can, but not always.”

Harnessing the Positive Potential of Social Media 

Despite the issues that can arise, we must not forget that social media also has transformative potential. Social platforms can be positive places for fostering connections, encouraging empathy, and promoting social activism. For example, many young people use social media to find communities that support their interests, identities, and causes. 

However, the key is to ensure that social media usage is healthy and balanced. To do this, we need a comprehensive approach that combines education, digital literacy, mental health support, and community intervention.

The Crucial Role of Caregivers

Caregiving, especially for the youth grappling with mental health issues, requires a profound understanding of the challenges young people face and the right set of tools to address their needs. Digital tools, such as youth-oriented mental health apps, can offer round-the-clock access to resources and support; this can include self-help guides, meditation and mindfulness activities, or direct access to licensed therapists. 

Caregivers need to be equipped with knowledge about recognizing signs of mental distress, understanding the impacts of excessive social media use, and learning effective intervention strategies. This includes understanding the signs of cyberbullying, identifying changes in behavior that may indicate social media addiction, and being aware of the potential for social media to distort perceptions of reality. 

Digital literacy education for caregivers is also essential; it’s important for caregivers to understand the online environment that young patients spend so much time in. This can help caregivers provide supportive conversations about social media use, establish healthy boundaries, and introduce alternatives to online interaction.

It Really Does Take a Village

A truly effective approach to supporting youth mental health is the “It takes a village” approach, which underscores the importance of a supportive community in nurturing the well-being of young individuals. 

Schools are in a unique position to spearhead this effort by integrating mental health and digital literacy education into their curricula. Beyond education, tech companies have a crucial role to play in creating safer online environments. The Surgeon General has also urged enhanced privacy settings, effective content moderation, and tools that can promote well-being to help make social media a more constructive space for young people.

Similarly, lawmakers have a responsibility to create supportive legislative frameworks. These might include policies for stricter regulation of online content, increased public investment in youth mental health services, and legislation that promotes responsible digital behavior. Community support is another essential part of this endeavor; and this includes online communities. The presence of supportive adults and peers in a young person’s life can significantly mitigate the effects of social media. 

A Comprehensive Approach to a Complex Problem

The issue of social media and youth mental health is not a one-dimensional problem. It’s a multifaceted challenge, intertwined with broader societal issues and generational narratives. It calls for a comprehensive approach that recognizes these complexities, fosters community support, and places education at its core.

As we navigate this new digital era, it is our collective responsibility to ensure that our young people are equipped with the resilience and skills to thrive, both online and off.

About Lindsay Oberleitner

Lindsay Oberleitner, Ph.D., is a clinical psychologist who has worked at the intersection of addiction, trauma, and chronic health conditions. Lindsay is SimplePractice’s Education Director. Before joining SimplePractice, she worked as an Assistant Professor at Oakland University William Beaumont School of Medicine, Yale University School of Medicine, and Western Connecticut State University. She also served as Associate Director of the Yale Forensic Drug Diversion Clinic, where she worked to increase access to care and recovery for underserved populations and advance equitable and inclusive treatment through a community engagement approach.

What You Should Know:

– Cartwheel, a platform helping schools tackle the student mental health crisis by delivering affordable, evidence-based telehealth services with no waitlist raises $20M in Series A funding led by Menlo Ventures. Reach Capital joined the round, as did earlier investors General Catalyst, BoxGroup and Able Partners.

– The funding will allow Cartwheel to expand mental health services to hundreds of thousands of new students in current service areas, as well as school districts in new states.

Evidence-Based Mental Health Support

Founded in 2022, Cartwheel has quickly become a trusted mental health partner to schools. The founding team, which includes Chief Medical Officer, Juliana Chen, MD, a board-certified child, adolescent, and adult psychiatrist, had collectively spent decades working in schools and community mental health clinics and felt the need for stronger school-community partnership to improve accessibility, quality, and financial sustainability of mental health care.

Today, when a school district partners with Cartwheel, school counselors can refer students for clinical mental health services with no waitlists. Cartwheel’s in-house team of licensed clinicians delivers evidence-based telehealth services, including 1-1 therapy, group therapy, parent guidance, and medication support – all as an in-network benefit covered by the family’s insurance. Operating year-round, Cartwheel allows students to see a licensed clinician at home or at school and during evenings, weekends, school breaks, and summers.

“By combining funding from school districts and health insurers, we’ve helped superintendents ensure the long-term financial sustainability of these services,” added Daniel Tartakovsky, Co-Founder and COO of Cartwheel and previously a mental health policy advisor to the U.S. Surgeon General. “We believe our model will become a blueprint for districts across the country on how to build a long-term school-community partnership, especially as school budgets tighten with the expiration of federal COVID relief dollars.”

Throughout care, Cartwheel works hand-in-hand with school staff and families to ensure the student is appropriately supported. A clinically licensed Program Manager supports school administrators on student cases, parent engagement, and staff training throughout the year; and bilingual Care Coordinators help families with scheduling, insurance, and referrals for additional services. Parents can also schedule weekly guidance sessions with a licensed clinician to discuss ways to support their child, even if their child isn’t interested in therapy themselves. Parents can also join educational workshops on timely mental health topics, ranging from school avoidance to social media use.

In a society where so many want more—more money, more time off, more adventure—few stop to question the logic of insatiably wanting “more.” Perhaps, no place does the consequence of wanting more negatively impact people than with healthcare treatments. Medication use, for example, shows clear dose-response curves, where over-use can have fatal consequences; negative consequences and death also can result from too much chemotherapy, radiation, antibiotic use, or complications from unnecessary surgical procedures. Within behavioral healthcare, negative outcomes have been across all populations and treatment interventions. Patients receiving cognitive behavioral therapy, for example, who fail to show significant change within an expected number of sessions have an incredibly low likelihood of achieving clinical behavior change making further therapy a misallocation of resources and potentially harmful if it prevents the patient from finding a more effective treatment. As a result, medical and behavioral health treatments often have well-defined standards of care that outline minimum and maximum levels of treatment to optimize effectiveness, with one exception -autism spectrum disorder (ASD). Here’s why stakeholders need to figure it out… 

The prevalence of autism has continuously risen over the past 20 years along with a continued shortage of Board Certified Behavior Analysts (BCBA) to provide Applied Behavior Analysis (ABA) treatment, the only evidence-based, empirically proven therapy for ASD. In a rush to meet the resulting access issues, the elephant in the room that people look past, however, is the lack of standardization and high variability for recommending treatment intensity individuals with autism clinically need. The result is a system where treatment recommendations can range from focused to comprehensive, from 5-to-40 hours per week, and for between 18 months to 5 years—often under the assumption that more hours will always translate to more progress. But is the old adage that “more is better” uniquely applicable to ABA? 

There is not a “one size fits all” approach within ABA and it’s important to consider various factors which may lead to some undesirable effects that comprehensive treatment may have on families. Recommendations of 30+ hours/week pose a lengthy list of flags, questions and concerns including the financial impact on the family, coordination of care and transition planning.  Having a therapist in your home for several hours every day is seen by many as an intrusion of privacy. It also takes away precious time for other social/community involvement, reduces a parent’s ability to work, and can lead to the deterioration of parent-sibling and marital/couple relationships. Children receiving ABA in clinics have added impact from the time driving back and forth, limited parental insight into what their child does all day, and their treatment gains may not generalize to other environments. In short, therapy-life balance is important for the child in treatment, their parents, and their siblings. 

More controversially, several pieces of evidence suggest some autistic individuals have better treatment outcomes with fewer hours directly contradicting the “more is better” assumption from above. The key component here is that treatment recommendations are individualized relative to each patient’s baseline skill levels (skillset prior to receiving treatment) and target skills that the providers believe to be most important to improving the child’s quality of life. For example, if the goal is to optimally increase communication skills, comprehensive services may be the answer. If the goal is to reduce general ASD symptom severity and parental stress, more ABA may not be the answer. Finally, research examining dose-response relationships suggests the duration of treatment has a stronger impact than intensity on outcomes (here’s another example for adaptive skills, motor skills, and executive functioning). 

The ask and answer: Individualize treatment tailored to optimize ABA effectiveness for each child! No more blanket business models at 35 hours/week for every child. No more requesting excessive hours “just in case” of cancellations and school vacations. No more requesting hours to substitute for school enrollment. Instead, services should be outcome-based and guided by clinically validated data to drive hours of recommendations and treatment to best meet individual goals. Providers have good intentions but also have conflicts of interest. Let’s use patient characteristics, goals, skill sets, and historical data on how ABA actually improves the lives of each unique client to determine precise, individualized treatment intensity recommendations that optimize outcomes and pay providers accordingly. Examples of how this can be done already exist here, and here, and here. All it takes for all individuals with autism to benefit is to start questioning the assumption that “more is always better.”

About Dana D’Ambrosio, MS, BCBA, LBA

Dana D’Ambrosio leads Clinical Development for RethinkFutures. She is a New York state-licensed and Board-Certified Behavior Analyst. She brings over a decade of clinical knowledge, with experience spanning from direct patient care in various treatment settings to utilization and care management within the payor realm. She specializes in the creation and enhancement of technology solutions utilized by providers and health plans, to ensure best practice, high quality, coordinated care and streamlined review processes for all parties. 

What You Should Know:

– Banner Health forms a strategic partnership with Phoenix-based evolvedMD to place mental-health providers at Banner’s primary-care clinics, making it easier for people to receive mental health services they may need.

– The integration of mental health services in primary-care settings will be phased in at Banner Medical Group sites throughout metro Phoenix, starting in the East Valley at Banner’s East Mesa and Queen Creek locations.

– Under the program, a licensed behavioral therapist works with the patient’s primary care providers to provide mental health expertise, psychiatric consultation, ongoing clinical support, case management and insurance support and navigation.

What You Should Know: 

– Headspace, a comprehensive digital mental healthcare provider, and Castell, Intermountain’s value-based care subsidiary, have signed a value-based care (VBC) mental health partnership designed to improve health outcomes through a personalized care experience for members.

– The VBC mental health partnership will provide members with access to Headspace’s clinical offerings including their self-guided content, behavioral health coaching, and therapy in an outcomes-based payment model. This is a notable expansion of VBC for Headspace and is Castell’s first and only digital mental health provider in their network.  

Addressing the Growing Mental Health Crisis

The collaboration between Castell and Headspace aims to address the growing mental health crisis by engaging patients – wherever they may be on their mental health care journey – with robust behavioral health care offerings. The partnership will integrate Headspace’s offerings into Castell’s value-based model of care, which aims to improve clinical outcomes at a population level while reducing costs across the healthcare continuum.

Refer Eligible Members to Behavioral Health Coaching & Therapy

The partnership will allow Castell to refer eligible members directly to Headspace for behavioral health coaching and therapy. Those members will then have access to a team of behavioral health coaches, who respond to outreach in two minutes or less and provide care in the moment of need. Headspace’s coaches help to build coping skills and manage day-to-day stressors, and its licensed therapists are trained in a variety of clinical specialties and treatment modalities for more acute clinical care. Headspace’s care model is built to meet people where they are in the care spectrum and allows members to step up to higher levels of care or adjust over time, as their needs and preferences evolve.

“Our goal with patients is to help them have the most holistic view of their health. Being able to better address and integrate a patient’s mental health status is critical to treating the whole person and elevating the quality of care they receive,” said Jay Zerwekh, CEO of Castell. “We are thrilled to partner with Headspace to give patients access to behavioral health coaching and tools that can be tailored to meet their individual needs.”

Far too often, substance use disorder (SUD) is viewed as an “acute condition,” one that can be “cured” with short-term treatment, such as a week-long stay in a detox facility. This could not be further from the truth. The failure to understand the science behind addiction leads individuals who are undertreated or inappropriately treated to return to use again and again.

SUD is not a moral failing. It is not a behavioral issue. It is not a choice. The leading health organizations around the world agree―based on a multitude of scientific research―SUD is a chronic brain disease rife with biological underpinnings. As such, the genetic component of SUD should not be a surprise. If you have addiction in your family, you are approximately 50% more likely to be affected, too.

SUD can be managed very successfully―and for a lifetime―if individuals in treatment, in need of treatment, and in recovery (along with their loved ones) fully understand the need to manage it as a chronic disease. When individuals harbor misconceptions about what addiction is, they may not seek treatment, they may not seek the right treatment, or they may not continue in treatment. Self-detox is not a viable option and, in some cases, can be fatal.

When viewed as a behavioral issue or a choice, there is a stigma surrounding SUD that can prevent individuals in need of treatment from seeking care. According to the 2021 National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), 46.3 million Americans are struggling with substance use disorders, but only a small fraction—6%—receive treatment.

For those who do seek treatment, many expect SUD to be remedied with a “one and done” approach, which is not realistic. Individuals in recovery then internalize that thinking and let their guard down, assuming it is not necessary to continue daily practices that support long-term recovery. The National Institutes of Health reports the relapse rate for SUD is between 40 and 60%.

In addition to understanding recovery is a long-term process, we must also recognize that clinical treatment alone is not enough. Individuals with SUD need ongoing psychosocial support from their families, their communities, and their employers. Recovering from addiction requires rewiring and retraining the brain, and it takes hard work and a significant amount of effort. Acknowledging this better serves patients and families going through the early stages of recovery, as well as in managing this disease long-term.

In the ideal world, unhealthy substance use would be identified early on, and intervention by a family member or healthcare provider would be delivered with compassion and without judgment. Too often the opposite is true, and when people seek medical or mental healthcare, they do not feel cared for.

While it may take many years for society to fully understand and identify SUD as the chronic condition it is, there is a particular treatment component―one that too few are providing or utilizing―that we can leverage immediately to support more individuals in their recovery journey. That component is the integration of peer support into every level of care.

The presence of peers throughout the recovery journey―peers who have overcome SUD and mental health challenges themselves and can inspire hope, offer compassion, and provide guidance along the way―is a complete gamechanger. This manner of support, especially during the most challenging moments, can mean the difference between recovery and return to use. The outcomes, which are clinically evident, are extraordinary.

It is frequently touted that “connection is the opposite of addiction.” And that feeling of connectedness is essential to long-term recovery. My hope is to build greater awareness and implementation of this peer support component in our collective mission to combat our country’s SUD crisis, and to ensure every individual has access to the tools needed to achieve lifelong recovery.

About Hans Morefield

Hans Morefield is Chief Executive Officer at CHESS Health, proudly leading a team that brings innovative and evidence-based solutions for addiction management and behavioral health to healthcare providers, health plans, and the public sector. CHESS Health’s platforms help get more patients into treatment for substance use disorder, increase adherence to treatment plans, reduce the rate and severity of relapses, and lower the total cost of care. Prior to joining CHESS Health in 2017, Morefield served as Vice President of 

Population Health and Care Coordination at Experian, where he led the team delivering the successful CareCertainty Platform to ACOs, health plans, and risk-bearing health systems nationwide. He previously served as Senior Vice President of Strategic Development at SCI Solutions, responsible for product management and strategic partnerships. Morefield earned his BA from Kalamazoo College, where he has served on the Board of Trustees for over 15 years. He also serves as a volunteer on the Community Relations Committee for Stepping Stones, the Historic Home of AA and Al-Anon Founders Bill and Lois Wilson.

As behavioral health claim volumes continue to increase, there’s a growing need for health plans to be vigilant in spotting fraud, waste and abuse. Today, the complexity and cost of these schemes necessitate a proactive, preventative approach.

Nearly four out of five psychologists say they are seeing increased volumes of patients experiencing anxiety, while two out of three reported an increase in symptom severity in 2022, an American Psychological Association survey shows. High volumes, combined with new modes of care delivery approved during the pandemic such as audio-only services for behavioral health, make these services especially vulnerable to fraud, waste and abuse by bad actors.

Some health plans—typically larger plans with greater resources—have large in-house special investigations units with the expertise to review behavioral health claims data for suspicious activity. One investigation detected more than 40 dates of service for which a provider billed more than eight hours of services a day, often on consecutive days, including major holidays such as Thanksgiving, Christmas and New Year’s Day. A closer look at the documentation revealed inconsistencies in the member’s identity, age, gender, health history and sexual orientation. These were signs that services might not have been provided or that records were being cloned, with either scenario leading to inappropriate payment. Without this investigation, the health plan could have overspent as much as $115,000 annually on just one provider’s claims.

But not every plan has access to a large SIU to combat fraud, waste and abuse in behavioral health. That’s why knowing how to decrease the risk of inappropriate claim payment—preferably before the claim is paid—is an important step toward improving payment integrity.

Behavioral Health Schemes Are Increasing

The potential for lost revenue is high in an environment like the one health plans found themselves in during the COVID-19 pandemic when the need for services like behavioral health dramatically increased, but opportunities for in-person care suddenly shrank. 

The relaxations in telehealth delivery that occurred during the pandemic, for example, created additional avenues for bad actors to exploit members who badly needed mental healthcare. Suddenly, Medicare members could access behavioral health via telehealth using audio-only communication platforms, from the point of the first visit. They could also access care via telehealth from providers across state lines, whether in their homes or in rural health clinics or federally qualified health centers. Many of these changes became permanent for Medicare, such as enabling beneficiaries to receive behavioral telehealth services in their home. Others have recently been extended for several months beyond the expiration of the COVID-19 public health emergency (PHE), such as flexibilities that enable providers to prescribe controlled medications via telehealth. 

Individual psychotherapy sessions are another area that is ripe for fraud, waste and abuse. Among claims processed by Cotiviti, 60-minute individual therapy sessions comprised nearly two-thirds of behavioral health procedure codes in 2022. One example of potential waste and abuse is when a higher-than-average percentage of claims are billed as 60-minute sessions compared with a provider’s peers, warranting a closer look. Then there’s applied behavior analysis services for people with autism, an area where disreputable providers have submitted false claims, upcoded claims, or billed for one-on-one therapy rather than a group session. In one instance, the U.S. Attorney’s office recovered more than $2 million from an autism therapy provider for false claims. 

Yet many plans are hesitant to pursue suspected issues with behavioral health claims. There is a tendency to treat these claims more sensitively than other types of claims, partly due to fears of upsetting members who need mental health care and partly due to a lack of in-house expertise—from clinicians to coders—to review these claims. Moreover, patients who are most often targeted in these schemes include those least likely to review or understand their claims—such as the elderly—as well as those who suffer from addiction and those whose claims are fully covered by insurance.   

Detecting Behavioral Health Schemes Faster

When behavioral health claims look suspicious or outright wrong, the right defense helps plans protect themselves as well as their members—and prevents these cases from continuing to proliferate. Here are ways health plans can shore up efforts to prevent and detect behavioral health fraud, waste and abuse.

1. Become well-versed on the changes in behavioral health service delivery that will become permanent. This includes knowing which telehealth flexibilities continue to be extended following the expiration of PHE—and in what circumstances. This will help in educating providers, members and staff on what has changed in the plan’s coverage of remote behavioral health services. It will also position payers to take the first steps toward optimizing prepay claim editing.
2. Take a proactive approach to data mining, looking for trends in behavioral health spending. Examine trends in behavioral health spending prior to the pandemic and compare them to the types of claims the health plan is seeing now. Look at providers that are rendering much of their services in a telehealth setting and that are expanding their geographic coverage area. This data offers a basis for flagging providers that warrant immediate investigation.
3. Go beyond a traditional outlier analysis. Outlier analysis can position plans to pick the low-hanging fruit, such as providers who are billing extremely high volumes. But with these schemes becoming more sophisticated, health plans should also examine trends such as clustering—when a group of providers in a geographic area provides similarly high volumes of behavioral health services. They should also compare providers’ activity levels to those of their peers, regionally and nationally. Doing so can help pinpoint providers that are flying under the radar and merit a second look. Today, the addition of artificial intelligence algorithms and machine learning is assisting health plans in moving from retroactive, “pay-and-chase” review toward early detection of inappropriate claims.
4. Adopt a collaborative approach to front-line detection of suspicious claims. For small and medium-sized plans in particular, talking with other plans about the trends they are seeing in the same geographic area can uncover regional trends that deserve greater focus. This gives health plans a better basis for determining where to devote resources for strengthening prevention and recovery. It also increases staff productivity by empowering them to catch bad billing behaviors before payment is made.
5. Add prepay and postpay integrity solutions to your revenue integrity toolkit. This not only enables plans to detect behavioral health schemes faster, but also positions them to use the learnings from their investigations to optimize prepay claim editing moving forward.

Prevention Starts with a Change in Mindset

The sophistication of behavioral health billing schemes calls for health plans to let go of their fear of pushing back on behavioral health claims and arm themselves with actionable data and expert guidance. Such an approach empowers plans to more effectively detect and analyze suspicious claims, catch red flags and follow up on potential patterns of abuse, protecting vulnerable members.

About Erin Rutzler

Erin Rutzler is vice president of fraud, waste and abuse for Cotiviti. As vice president of fraud, waste, and abuse (FWA), Erin is responsible for the oversight and strategic direction of Cotiviti’s FWA solution suite. In her role, Erin has been integral in the development of Cotiviti’s FWA solutions over the past eight years. Serving as the company’s primary subject matter expert in investigations and FWA for compliance, client training, sales, and marketing activities, she regularly represents the company at industry conferences such as the National Health Care Anti-Fraud Association’s (NHCAA) Annual Training Conference (ATC).

What You Should Know: 

• Artificial intelligence (AI)-powered mental health screening pioneer Aiberry (pronounced “I” + “berry”) unveiled a new version of the Aiberry platform specifically designed to meet the needs of corporate wellness platform users. 
• Easily integrated with all leading corporate wellness platforms, Aiberry uses an AI-powered therapeutic assistant, “Botberry,” to conduct a conversation to detect mental health disorders by analyzing what is being said, the speech patterns being used and even subtle changes in facial expressions. New analytics capabilities introduced as part of the Aiberry corporate wellness platform enable corporate wellness program administrators to track utilization of the platform as well as employee wellness over time.

Platform Expansion into Corporate Wellness

Aiberry for corporate wellness builds on a solid foundation of use in clinical settings including leading national recovery centers. These facilities have seen assessment accuracy and patient well-being improve measurably since the platform was implemented. Futures Recovery Healthcare found that the percentage of clients receiving an official diagnosis for a depressive disorder rose from 24% to 46% after Aiberry implementation, due to the system’s ability to detect depression in cases in which completion of self-reporting forms such as the Patient Health Questionnaire (PHQ-9), currently the gold standard, did not. Futures found Aiberry to be more sensitive than traditional screening methods, as 45% of clients who scored in the severe range for depression on initial Aiberry assessment scored only “moderate” or “mild” when completing the PHQ-9.

“The expansion of the Aiberry platform into corporate wellness brings the benefits of AI-powered mental health assessment to a critical population, American workers, which is massively underserved by currently-available behavioral health resources,” said Aiberry Co-Founder and Co-CEO Linda Chung. “This delivers on our mission to offer objective, reliable, and scalable solutions via the power of AI, making behavioral healthcare accessible to all, and helps bring our vision, to empower patients and providers with the tools to effectively and efficiently assess behavioral health, to reality.”

What You Should Know: 

• Today, Affect Therapeutics – a McLean, VA-based company reimagining alcohol and drug addiction treatment with smartphone apps that put an integrated treatment program into the pocket of its members raises $16M in Series A funding led by ARTIS Ventures. The funding also included additional participation from previous investors AlleyCorp and CityLight, as well as new investments from LifeArc Ventures, Samsung Next, and What If Ventures. 
• Founded in 2020, Affect Therapeutics offers clinically intensive treatment that is all-digital, accessible, and cost-effective.

Supporting Entire Recovery Journey

Affect has established a scientifically-proven program that supports the entire recovery journey, and is the first company to reward healthy behavior with financial incentives, known as contingency management, to drive motivation resulting in increased retention and more durable sobriety. This is coupled with counseling, medical oversight, and case management, delivering a comprehensive program based on decades of research. Affect has already treated thousands of patients with results that are proven to be twice as effective as traditional treatment models by key metrics insurance and medical partners value most. More importantly, these outcomes change peoples’ lives and lead them to manage the chronic disease of addiction into lasting remission.

In its short time in market, Affect has already treated thousands of patients with results that are proven to be twice as effective as traditional treatment models by key metrics insurance and medical partners value most. More importantly, these outcomes change peoples’ lives and lead them to manage the chronic disease of addiction into lasting remission. 

Availability

Affect currently holds outpatient treatment licenses in 20 states and aims to serve a majority of the U.S. population by the end of 2023. The company partners with the largest health insurance payers in the country, including UnitedHealthcare, Aetna, Humana, Molina, and Centene. The company plans to use the funding to advance their program initiatives in more states, as well as engineering innovation in its platform. The Affect app is free to download on the Google Play Store or Apple App Store.