Pioneering project in Oregon could help youth mental health crisis

Lisa Jarvis

Last year saw a flood of grim headlines about children’s mental health. Children and teens in the U.S. are struggling with higher rates of depression and anxiety. Suicide and eating disorder rates are on the rise. But now there’s reason for hope: An ambitious experiment in Oregon may point the way to a new solution.

Much of the last two years has been spent trying to analyze the root cause of the alarming statistics, rather than debating what to do about them, although there has been some positive change. New guidelines recommending widespread screening for childhood anxiety and depression were a good start. So was the Biden administration’s investment in helping better connect families with behavioral and health services. And several states have expanded educator training and improved access to telehealth.

But none of them can fully address a fundamental problem: the number of children who need help outnumbers the number of mental health providers available. The pediatric mental health workforce has not expanded despite ever-increasing demand. A 2019 study that used data from the National Survey of Child Health found that about half of children with a mental disorder did not receive treatment. The shortage is probably even greater now.

“We need to try something new—something that’s radically different from what we’ve been doing, that clearly isn’t working,” child clinical psychologist Katie McLaughlin told me.

This is where the Oregon experiment fits in. McLaughlin recently left Harvard to be executive director of the Ballmer Institute for Child Behavioral Health, which launched at the University of Oregon in 2022 with the goal of rapidly expanding the workforce by creating a new type of mental health provider. The venture was made possible by a $425 million gift from Connie and Steve Ballmer (the latter of Microsoft fame).

The bachelor’s level position, called a child behavioral health specialist, will work in the community to identify struggling children and offer brief and early interventions to help them.

During the last two years of college, students enrolled at Ballmer will receive intensive, hands-on training in evidence-based interventions. They will gain experience first in elementary and middle schools in the Portland area, and could later choose to be embedded in pediatricians’ offices, community centers, or preschools. When they’re done, they’ll be ready to go out into the field.

These students will not replace school counselors or psychiatrists who have graduate degrees. But in an ideal world, brief interventions could prevent some children from needing more intensive resources, freeing up those with advanced degrees to focus on those who need them most.

There’s good reason to believe the Oregon experiment will work. The UK pioneered the highly successful ‘low intensity’ mental health workforce as part of a 2008 plan to expand access to services. Part of that effort included the creation of a new type of provider called a “Psychological Wellbeing Practitioner” that offers brief interventions to struggling adults. Those who do not benefit are directed to more intensive therapy. An analysis found the program had a major impact on reducing levels of depression and anxiety in the UK.

So the model is good, but the Oregon experiment still has a lot to prove. McLaughlin will need to present solid evidence that her students are having a positive impact on children—but gathering that evidence shouldn’t take long. The first group starts in classrooms next fall. McLaughlin says anyone who interacts with a Ballmer student — whether a child, parent, school administrator or pediatrician — will receive an iPad to offer feedback on the experience, allowing for a quick assessment of whether the child or family is satisfied with their experience and over time whether the services provided really improve the children’s mental health.

The Ballmer Institute is essentially creating a new profession that involves some practical challenges. The first hurdle was cleared in late 2022, when the state Higher Education Commission approved the program. Next is to work with policymakers to establish standards for certification as a child behavioral health professional, as well as to determine the type of services such a professional will be eligible to provide. And then there is convincing insurers, including state Medicaid programs, that the care provided by these new professionals is worth paying for.

But if this experiment works, other institutions may consider adopting the new degree, in theory helping establish a new layer of support for children across the country.

The cost of Ballmer’s experiment cannot be overlooked. Not every institution will get more than $400 million to try to fix the mental health crisis. But if Ballmer can show the concept works, it shouldn’t be too hard for others to follow suit. The cost of the status quo is too high to ignore.

Lisa Jarvis is a Bloomberg Opinion columnist covering the biotech, healthcare and pharmaceutical industries. She was previously the executive editor of Chemical and Engineering News.

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