Los Angeles County Public Schools is making an ambitious effort to offer free mental health services to its 1.3 million K-12 students, a key test of California Gov. Gavin Newsom’s sweeping $4.7 billion program to address the drug crisis. mental health of young people.
Spearheaded by the county’s Medi-Cal plans — which provide health insurance to low-income residents — in collaboration with the Office of Education and the Department of Mental Health, the Los Angeles school program relies on teletherapy services provided by Hazel Health, one of a group of companies , which emerged to address the national shortage of mental health services, which has become much worse during the covid-19 pandemic.
The teletherapy effort is one of four Los Angeles County projects that will collectively receive up to $83 million from the state’s Student Behavioral Health Incentive Program, one component of the Democratic governor’s “master plan” to address gaps in access to youth mental health care.
Los Angeles’ Hazel Health contract aims to help overburdened schools deal with the growing demand for mental health services. It promises to be a case study of both the efficacy of virtual therapy for students and the ability of faculty and administrators to effectively manage a large and sensitive program in partnership with a for-profit company.
For some educators and families in Los Angeles County, the initial results are promising.
Angela Salazar, 10, said her therapist, Hazel, has helped her feel so much better. After the fifth-grader transferred to a new school this year, Stanton Elementary in Glendora, she began having panic attacks every day.
Her mother, Rosanna Chavira, said she doesn’t know what to do — even though she’s a clinical coordinator for a company that treats mental illness — and worries she won’t be able to find an affordable therapist who accepts their insurance. After Chavira learned about Hazel, she jumped at the chance.
“For it to be free and to have a licensed professional teaching her coping skills, it just means the world,” Chavira said. “You can see the changes now.”
Salazar said she has met with her virtual therapist five times so far. One coping technique she particularly appreciates is a patting exercise: Every night before bed, she pats her eyes, cheeks, chest and knees. With each touch, she recited the same affirmation: “I am brave.”
Christine Crone, parent of seventh-grader Brady, said she has yet to see if the sessions have been effective for her son, who attends Arroyo Seco Junior High in Santa Clarita, but she knows he likes them.
“He usually struggles to be on time and prepared, but with these sessions, he always stops what he’s doing and makes sure he’s in on time,” Crone said. “He says his therapist is kind, funny and easy to talk to.”
Jennifer Moya, a mental health counselor at Martha Baldwin Elementary in Alhambra, a city east of Los Angeles, said her students like the flexibility of teletherapy, which allows them to meet with doctors anytime between 7 a.m. and 7 p.m.
“This generation of kids has grown up digital,” said Moya, who is in charge of referring students to Hazel at her school. “They love that it’s easy.”
Pablo Isais, a mental health counselor at Alhambra’s Granada Elementary School, said the services can also be a temporary measure while the student waits for an in-person appointment, which can take six to eight weeks.
“To be able to let them know that there are services available that they can access in the next week is amazing,” Moya said.
So far, at the start of the rollout, only 607 Los Angeles County students have participated in Hazel’s sessions since they were first offered in Compton in December 2022, said Alicia Garupa, superintendent of well-being and support services for the Office of Education . She acknowledged some bumps in the rollout, but said Hazel was “another tool in our toolbox.”
The state relies on for-profit enterprises
Teletherapy is playing an increasingly important role in schools across the country as educators and social workers face pressure to deal with growing mental health issues. According to an April report by Chalkbeat, 13 of the nation’s 20 largest school districts, including Los Angeles Unified, have added teletherapy since the pandemic began.
Los Angeles County’s deal with Hazell calls for the company to be paid up to $20 million by the end of 2024. In addition, Hazell can bill students for insurance.
The San Francisco-based company, founded in 2015, has raised $112.5 million from investors and has contracts in 15 different states. Other companies chasing youth mental health dollars include another San Francisco startup, Daybreak Health, which graduated from the prestigious tech incubator Y Combinator, along with BeMe, Brightline and Kooth.
California selected Brightline and Kooth for a $532 million 2024 initiative for virtual behavioral services for youth, another important component of Newsom’s master plan. There is some overlap between state and local programs, Brightline co-founder and CEO Naomi Allen acknowledged, but she said Brightline’s offerings are broader than what Hazel does in schools, with services that include everything from coaching sessions to caregivers to meditation resources.
“The state is funding free access to services for every child in the state, which is just a remarkably ambitious program,” Allen said.
However, many questions remain regarding the efficacy of teletherapy for college students. It’s also proving to be an uncertain source of cash for the companies so far: Brightline laid off 20 percent of its staff last spring, the second round of layoffs in six months.
An add-on, not a solution
Chelsea Duffer-Dunbar, who at the time worked for Los Angeles Unified as a psychiatric social worker, told KFF Health News in October that she had not yet worked with Hazel, but noted that the district requires a staff member to remain within sight of the student during their meetings and assistance if technical problems arise.
“It still takes staff time,” Duffer-Dunbar said. “My day is already so busy. I can’t imagine a threat assessment and a suicide assessment at work and then trying to find someone to participate in this therapy session with the kid and his iPad.”
Duffer-Dunbar said she wants the district to prioritize personal clinicians who are immersed in the local community, especially for younger children who have trouble engaging with teletherapy.
Duffer-Dunbar has since left the district in response to budget cuts that forced her into a more onerous role.
Hazel emphasized that teletherapy is not a one-size-fits-all solution.
“It’s an opportunity to expand access,” said Andrew Post, the company’s head of innovation.
Education and health work together
It took a complex collaboration between school districts, county agencies and the two Medi-Cal plans, LA Care Health Plan and Health Net, to create the school therapy program. Public funding rules were designed to encourage entities to work together.
“This program has helped us reach out to school districts,” said Michael Brodsky, senior medical director for community health at LA Care Health Plan. “If we can catch kids while they’re in school and get them into treatment while they’re in school, that’s good.”
Hazel primarily provides short-term individual therapy sessions with clinical social workers or other licensed counselors, 40% of whom are bilingual. They are best suited to provide temporary support to people with mild to moderate needs, such as students struggling with academic stress or starting a new school, but can also make referrals for long-term care.
The largest district enrolled in the program, Los Angeles Unified, accounts for 41 percent of the county’s students, but not all districts are ready to make that leap. Four out of 10 districts have opted not to offer Hazel’s services, which Garupa attributes in part to concerns about data sharing.
Hazel’s contract expires in December 2024, but Garupa said the Office of Education and its partners intend to maintain services until June 2025. Any extension after that will depend on results.
Sonja Smith, Garupa’s colleague, said the Office of Education will continually evaluate Hazel’s effectiveness through an annual survey, monthly impact reports and weekly meetings.
“The number of students using Hazel will obviously be a key metric,” Smith said. “Hazel’s historical utilization rate is 3% to 8%. We will assess whether these numbers are sustained, whether students are accessing care on time and whether this eases the burden on school staff and community providers.”
This article was created by KFF Health Newswhich issues California Healthlineeditorially independent service of California Health Care Foundation.
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