Without counselors, US schools grapple with the booming business of online therapy

Trouble with playground bullies began for Maria Ishoo’s daughter in primary school. Girls were joking, calling her “fat” and “ugly”. Boys hit her and pushed her. The California mother watched as the second grader usually escapes into her bedroom and spends the evening curled up in bed.

For Valerie Aguirre’s daughter in Hawaii, middle school “friend drama” escalated into violence and online bullying that left the 12-year-old disconnected and lonely.

​​​​The two children received help through telehealth therapy, a service that schools across the country are offering in response to growing mental health struggles among America’s youth.

Now at least 16 of the 20 largest public school districts in the US 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 supplier contracts worth more than $70 million.

The booming new business growth born out of America’s youth mental health crisis has proven so lucrative that venture capitalists are funding a new crop of school teletherapy companies. Some experts raise concerns about the quality of care provided by fast-growing technology companies.

As schools deal with a shortage of in-person practitioners, however, educators say teletherapy works for many kids, and is meeting a huge need. For rural schools and low-income students in particular, access to therapy is easier. Schools allow students to contact counselors online during the school day or after hours from home.

“This is how we can prevent people from falling through the cracks,” said Ishoo, a mother of two in Lancaster, California.

Ishoo remembers standing at the door of her second-grade bedroom last year, wishing she could get through. “What’s wrong?” the mother would ask. The response made her heart heavy: “There is NOTHING, Mom.”

Last spring, her school district launched a teletherapy program and signed her daughter up. 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 in control of your own emotions. Do not give that control to anyone else.

“She’s learned that it’s okay to ask for help, and sometimes everyone needs a little extra help,” Ishoo said.

The 13,000-student school system, like many others, has counselors and psychologists on staff, but not enough to meet the need, said Trish Wilson, Lancaster district counselor coordinator.

Therapists in the district have full caseloads, making it impossible to refer students to immediate care, she said. But students can schedule a virtual session within days.

“Our choice is to provide personal therapy to our students. Of course, 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.

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 back to in-person school after distance learning was traumatic. Friendships faded, social skills deteriorated and moods flared up more easily.

Schools are footing the bill, many of them using federal pandemic relief money as experts warn of alarming rates of youth depression, anxiety and suicide. Many school districts are signing contracts with private companies. Others are working with local health care providers, nonprofit or state programs.

Mental health experts welcome the extra support but warn of potential pitfalls. For one, school counselors and psychologists are getting harder to hire, and competition from telehealth providers isn’t helping.

“We have 44 counselor vacancies, and telehealth definitely affects our ability to fill them,” said Doreen Hogans, school counseling supervisor in Prince George’s County, Maryland. Hogans estimates that 20% of school counselors who left took teletherapy jobs, which offer more flexible hours.

The companies’ rapid growth raises questions about therapists’ qualifications, experience with children and privacy protocols, said Kevin Dahill-Fuchel, executive director of Counseling in Schools, a nonprofit that helps schools bolster traditional, in-person mental health services. .

“As we give 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, began telemedicine health services in schools in 2016 and expanded to mental health in May 2021, CEO Josh Golomb said. It now employs more than 300 clinicians who provide teletherapy in more than 150 school districts in 15 states.

The rapid increase means millions of dollars in revenue for Coll. This year, the company signed a $24 million contract with Los Angeles County to offer teletherapy services to 1.3 million students for 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 have allocated $3.25 million for teletherapy provided by Hazel. The Miami-Dade, Prince George’s and Houston school districts also partnered with Hazel.

Despite the huge odds, Golomb said Hazel is focused on making sure children’s welfare is above the bottom line.

“We have the ethos of a non-profit company but we’re using a mechanism from the private sector to reach as many kids as we can,” said Golomb. Hazel raised $51.5 million in venture capital funding in 2022 fueling its expansion. “Are we concerned about any quality compromise? The overwhelming answer is no.”

Other providers are entering the space. In November, New York City launched a free telehealth therapy service for teens to help break down barriers to access, said Ashwin Vasan, the city’s health commissioner. New York is paying startup TalkSpace $26 million over three years for a service that lets teens between the ages of 13 and 17 download an app and connect with licensed therapists by phone, video or text.

Unlike other cities, New York is offering the service to all teenagers, whether they are enrolled in private, public or home schools, or not in school at all.

“I hope this will normalize and democratize access to mental health care for our young people,” Vasan said.

Many of the referrals from Hawaii come from schools in rural or remote areas. Student clients in Maui have increased dramatically 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, triple the same period last year.

One of them was the daughter of Valerie Aguirre, who turned criminal last year with two friends in the sixth grade, when one of the girls hit her daughter in the face. Aguirre suggested her daughter try teletherapy. After two months of online therapy, she “felt better,” Aguirre said, understanding that everyone makes mistakes and that friendships can heal.

In California, Ishoo says her daughter, now in third grade, is imparting wisdom to her sister, who started kindergarten this year.

“She walks her little sister to class and tells her everything will be okay. She is a different person. She is older and wiser. She comforts her sister,” Ishoo said. “I heard her say, ‘If kids are disrespecting you, ignore them.'”


Associated Press data reporter Sharon Lurye contributed.


Associated Press education staff is supported by the Carnegie Corporation of New York. The AP is solely responsible for all matters.

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