Tuesday, May 21, 2024

For the past month, New York City has been inviting teenagers to participate in one of the biggest experiments in the country aimed at helping struggling adolescents: a program offering free online therapy to all residents ages 13 to 17. The city has entered a three-year, $26 million contract with Talkspace, one of the largest digital mental health care providers. After a parent or legal guardian signs a consent form, teenagers can exchange unlimited messages with an assigned therapist and receive one 30-minute virtual therapy session each month. The rollout of the program, NYC Teenspace, on Nov. 15 took many in the city’s large mental health care community by surprise. In interviews, providers hailed the effort for having made mental health care available to teenagers who otherwise might not have had access. But many also worried about whether the limited treatment Teenspace offers will meet the needs of teenagers who have more complex issues. And some questioned why the city was partnering with a for-profit provider like Talkspace, which is the target of a class-action lawsuit filed by a former client. “Conceptually, this could be a game changer,” said C. Vaile Wright, senior director of the Office of Health Care Innovation at the American Psychological Association. “This could absolutely revolutionize access to care.” But, she added, the “devil is in the details.” It remains unclear whether digital providers can “realistically meet capacity,” and set appropriate expectations around response times and informed consent procedures, she said, “so there aren’t unintended consequences if someone is disappointed or even harmed by this model of care.” Dr. Ashwin Vasan, New York City’s health commissioner, acknowledged in an interview that the city was “taking a risk here” by embracing teletherapy at this scale. But, he added, given the alarming levels of distress among teens, the “cost of inaction is much higher.” In New York City public schools, there is one guidance counselor for every 272 students. In addition, a report released this month by the state attorney general’s office surveyed 13 health plans and found that 86 percent of the mental health providers listed as

in-network were actually “ghosts,” meaning that they were unreachable, not in-network or not accepting new patients.

”What we wanted to do was create the easiest low barrier, democratized access to help that we could,” Dr. Vasan said. “This is free of charge. It’s in the palm of your hand. We’re very much empowering the young person to be comfortable asking for help, and to do that independently of any adult, other than the initial parental consent.” So far, about 1,400 teenagers, or less than 1 percent of the more than 400,000 eligible adolescents, have signed up. At a webinar on the program this month, city parents were shown head shots of the available therapists — an array of young, dynamic faces, some with dreadlocks or hijabs. Teenspace’s smartphone sign-up page also flashed on the screen: “You get free therapy through NYC Health department!” Parents typed questions to a chat window.

“Is text therapy effective?”

”Can students remain anonymous?”

”Is this free or not?”

The arrival of Teenspace comes amid a wave of similar partnerships across the country. An analysis published this month by The Associated Press found that 16 of the largest U.S. public school districts are offering online therapy sessions. In February, Los Angeles County signed a two-year, $24 million contract with Hazel Health, which offers virtual health care to more than 160 school districts nationwide. The Los Angeles partnership will deliver teletherapy services for up to 1.3 million public school students in grades K-12.

Few areas of the country have a larger mental health work force than New York City does, and some advocates questioned the city’s decision to partner with a for-profit company at a time when city agencies are being asked to slash their budgets.

“Choosing to privatize this while simultaneously forcing deep cuts across the social sector (and beyond) does not make any sense to me,” said Matt Kudish, chief executive of the National Alliance on Mental Illness of New York City. Steven DiMarzo, president of the New York Mental Health Counselors Association, said digital platforms typically offer relatively low pay and push their employees to meet “unrealistic expectations.” He said he had heard nothing about Teenspace until a reporter contacted him, but was “concerned” about the quality of care it would provide.

Other experts questioned the level of treatment Teenspace offers adolescents.

Dr. Zachary Blumkin, senior clinical director of the Psychiatry Faculty Practice Organization at Columbia University…

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