Of children aged 9 to 17 in California, 21 percent have a diagnosable mental or addictive disorder that causes at least minimal impairment. Because school districts often have limited on-site counseling resources, some communities are turning to telemedicine offerings.
For instance, the Take Four program was developed to transform mental health counseling services in rural school settings through a collaborative, 3-year pilot program at six schools within the Fall River Joint Unified School District in Northeastern California. (It is called Take Four because it takes four organizations collaborating to make it work.)
In a webinar hosted by the California Telehealth Resource Center, Amanda Harris, telemedicine coordinator for the Mayers Memorial Hospital District, noted that the program was developed in response to the lack of mental health services available within the school district and community. She said that with limited access to care in the schools, it seemed logical to leverage Mayers Memorial’s existing telemedicine program to bridge the gap in access to specialty health services.
Mayers Memorial is a Critical Access Hospital located in Fall River Mills, which is a small rural area about 70 miles from Redding. The local school district is made up of six school locations in Fall River and Burney. There are two elementary schools, two high schools and two “community day” schools.
Mayers Memorial Hospital District provides outpatient telemedicine services to both the community as well as its own skilled nursing residents at two locations. Outpatient specialties include endocrinology, neurology, psychiatry and rheumatology.
There is one school psychologist for the district, serving all six locations, with approximately 1,200 students. The district also has behavior paraprofessionals, one at each site, with some additional training on behavior/mental health. They had occasional visits from the local clinic that were unbilled and ended at the end of 2018-2019 school year. The district didn’t have the budget for any other resources.
Because Harris serves as the telemedicine coordinator at the hospital, she wondered whether telemedicine could help the school district. When she talked to the hospital CEO, it turned out he had just received an e-mail about a Small Healthcare Provider Quality Improvement grant program from the Health Resources and Services Administration (HRSA). The goal is to improve the local clinic system to help them to provide services in the school district
Starting last year with the grant funding, they set out to train telemedicine site coordinators for each of the six sites. They got iPads, cases, stands and headphones for each site. A local clinic social worker sees students from one of the schools to learn best practices and get used to the telemedicine modality of service. The other five schools were served by a psychologist contracted through a company called Telemed2U.
Working through consent issues was one of the biggest challenges, Harris explained. In California, a minor 12 years of age or older may legally consent to mental health treatment or counseling on an outpatient basis if he or she, in the opinion of the attending professional person, is mature enough to participate intelligently in the outpatient services.
Navigating with the school district about if the law applies to them was a difficult conversation, Harris said. Although the State Office of Education agrees that the consent provisions under California law do apply to the districts, mandating that all districts follow is apparently more difficult than imagined.
In order to maintain the relationship with the school, the project team was forced to move forward with a consent that was approved by the superintendent. Going forward, they have distributed the consent and privacy policy forms to be included with the registration packets for the upcoming school year in order to ensure a smoother roll-out.
In the first year of the program, services were provided on the school sites from Sept. 30, 2019, through March 12, 2020, when the schools were shut down due to COVID. In the first year of the program, 59 individual students were seen and 311 consults took place.
Starting May 1, services were resumed at an outpatient telemedicine room at Mayers Memorial Hospital, and 60 consults have been done there so far.
“It shows the flexibility of telemedicine,” Harris said. “Some students had the equipment and connection to attend counseling from home and have chosen to do so.”
It was clear that services are vastly easier to attend during school hours rather than outside of school hours, she added. The parents don’t miss work, and there are no transportation or cost issues and minimal time out of class — usually only about 30 minutes. “Having the service in the school is really the best way for them to get the services they need,” Harris said.
Looking ahead to Year 2, the school district is planning to return to school as usual (plus masks and prevention steps) on Aug. 26, 2020. School counseling services will resume on site the first full week in September. “We are anticipating a large turnout, because we have a large baseline, with a lot of students waiting to see a counselor again,” she said, “plus some students have been stuck at home in negative situations for months on end and they are feeling anxiety and stress.”
Before school returns, the contracted telemedicine psychologist has offered to provide a webinar and question/answer time for staff and teachers to prepare themselves to better welcome students back into the school environment.
“Last week, the district psychologist inquired about offering the services for staff as well. Because this has been a stressful time for them,” she said. “We’re examining what this would look like and how it fits the scope of our grant project.”
