California is investing $500 million in therapy apps for youth. Advocates fear it won’t pay. – California Healthline

With little fanfare, California launched two apps earlier this year that offer free behavioral health services to young people to help them deal with everything from living with anxiety to body acceptance.

Through their phones, youth and some caregivers can meet BrightLife Kids and Soluna coaches, some specializing in peer support or substance use disorders, for approximately 30-minute virtual counseling sessions that are tailored better to those with milder needs, usually those without a clinical diagnosis. The apps also include self-directed activities such as white noise sessions, guided breathing and ocean wave videos to help users relax.

We think they will have not just a big impact, but a broad impact in California, especially in places where it might not be as easy to find an in-person behavioral health visit or the kind of training and support that parents and youth need. , Gov. Gavin Newsoms health secretary Mark Ghaly said during the Jan. 16 announcement.

The apps represent one of the Democratic governors’ major forays into health technology and come with four-year contracts valued at $498 million. California is believed to be the first state to offer a mental health app with free coaching to all young residents, according to the Department of Health Care Services, which runs the program.

However, rollout has been slow. Only about 15,000 of the states’ 12.6 million children and young adults have signed up for the apps, school counselors say they’ve never heard of them, and one company doesn’t make its app available on Android phones until in summer.

Youth advocates are questioning the wisdom of investing taxpayer money in two private companies. Social workers are concerned that company trainers are not correctly identifying young people who need referrals for clinical care. And the spending is drawing scrutiny from lawmakers amid a state deficit pegged at as much as $73 billion.

An app for that

The Newsoms administration says the apps fill a need for young Californians and their families to access professional telehealth for free, in multiple languages, and outside of the standard 9 to 5 hours. It’s part of Newsom’s $4.7 billion Children’s Mental Health Master Plan, which was introduced in 2022 to increase access to mental health and substance use support services. In addition to launching virtual tools such as teletherapy apps, the initiative is working to expand workforce capacity, especially in underserved areas.

The reality is, we’re rarely more than 6 feet away from our devices, said Sohil Sud, director of Newsom’s Child and Youth Behavioral Health Initiative. The question is how we can leverage technology as a resource for all California youth and families, not in place of other behavioral health services that are being developed and expanded, but in addition to them.

The virtual platforms come amid rising rates of depression and suicide among young people and a shortage of mental health providers. Nearly half of California youth ages 12 to 17 report having recently struggled with mental health problems, and nearly a third have experienced serious psychological distress, according to a 2021 study by the Center for Health Policy Research at the UCLA. These rates are even higher for multiracial youth and those from low-income families.

But local youth mental health advocates wonder if the apps will move the needle on rising rates of depression and suicide.

It’s fair to applaud the state of California for aggressively pursuing new tools, said Alex Briscoe of the California Childrens Trust, a state initiative that, along with more than 100 local partners, works to improve children’s social and emotional health. We just don’t see it as fundamental. And we do not believe that the mental health crisis of young people will be solved by technological projects built by a professional class that does not share the lived experience of marginalized communities.

The apps, BrightLife Kids and Soluna, are operated by two companies: Brightline, a 5-year-old venture-backed startup; and Kooth, a publicly traded London-based company that has experience in the UK and has also signed on some schools in Kentucky and Pennsylvania and a health plan in Illinois. In the first five months of the Kooths Pennsylvania pilot, 6% of students who had access to the app signed up.

Brightline and Kooth represent a growing number of health technology companies looking to capitalize on this space. They beat dozens of other bidders, including international consulting firms and other youth telehealth platforms that had already hired in California.

Although the service is intended to be free with no insurance requirement, the Brightlines app, BrightLife Kids, is integrated and only accessible through the company’s main app, which asks for insurance information and directs users to paid licensed counseling options along with free coaching. After California Healthline questioned why free training was advertised below paid options, Brightline rearranged the page so that even if a child has high-acuity needs, free training appears first.

The apps take a broad view of behavioral health, making the tools available to all California youth under the age of 26, as well as caregivers of infants, toddlers, and children 12 and under. When California Healthline asked to speak with a user of the app, Brightline connected a reporter with a mother whose 3-year-old daughter was learning to sleep on her own.

It’s like crickets

Despite being months from launch and having millions in marketing funds, the companies don’t have a definitive release schedule. Brightline said it hopes to have teams deployed across the state to introduce the tools in person by mid-year. Kooth said developing a strategy to hit every school would be the main goal this calendar year.

It’s a big 58-county state, said Kooth’s Bob McCullough. It will take us a while to get to all of them.

BrightLife Kids is currently only available on Apple phones. Brightline said it aims to release the Android version during the summer.

I don’t think anyone has done anything like this of this magnitude before, I think in the United States, said Brightline co-founder and CEO Naomi Allen. They were very early innings. We were already learning a lot.

The contracts, obtained by California Healthline through a records request, show the companies operating the two apps could earn up to $498 million over the term of the contract, which ends in June 2027, months after Newsom leaves the position And the state is spending hundreds of millions more on Newsoms’ virtual behavioral health strategy. The state said it intends to make the apps available over the long term, depending on usage.

The state said 15,000 people signed up in the first three months. When asked by California Healthline how many of those users have actively engaged with the app, he declined to say, noting that the data will be released this summer.

California Healthline reached out to nearly a dozen mental health professionals and youth across California. None of them were aware of the apps.

I’m not hearing anything, said Loretta Whitson, executive director of the California School Counselors Association. It’s like crickets.

Whitson said he doesn’t think the apps are on anyone’s radar at schools, and he doesn’t know of any schools actively advertising them. Brightline will present its tool to the adviser association in May, but Whitson said the company has not reached out to schedule the meeting; she did

Kelly Merchant, a student at College of the Desert in Palm Desert, and Allen Pahl, a recent graduate, say they like Solunas’ engaging content and the ability to talk to a coach outside of 9-5 hours. None of the youth interviewed by California Healthline had not heard of the app before.(Molly Castle Work/KFF Health News)

Concern for references

Whitson still isn’t comfortable promoting apps. While both companies said they have a clinical team to help, Whitson said she worries that the trainers, who are not all licensed therapists, lack the training to spot when users need more help and refer them to the ‘clinical care.

That sentiment was echoed by other school social workers, who also noted the duplicative nature of applications in some counties, including Los Angeles, where youth can access free virtual counseling sessions through Hazel Health , a for-profit company. Non-profit organizations have also entered this space. For example, Teen Line, a peer-to-peer hotline operated by Southern California-based Didi Hirsch Mental Health Services, is free nationwide.

Although the state is also funneling money to schools as part of Newsom’s master plan, students and school mental health professionals expressed confusion over the heavy investment in apps when, in many school districts , there are few face-to-face counseling functions and in some cases they are decreasing.

Kelly Merchant, a student at College of the Desert in Palm Desert, noted that in-person therapy can be difficult to access at her school. She believes the community college, which has about 15,000 students, only has one full-time counselor and one part-time bilingual counselor. She and several students interviewed by California Healthline said they liked having engaging content on their phone and the ability to talk to a coach, but all said they would prefer face-to-face therapy.

There are many people who are seeking therapy and people close to me that I know. But their insurance takes forever and they’re on a waiting list, Merchant said. And, like, you’re seeing all these people fighting.

Fiscal conservatives question whether the money could be spent more effectively, such as bolstering county efforts and existing youth behavioral health programs.

Republican state Sen. Roger Niello, vice chairman of the Senate Budget and Fiscal Review Committee, noted that California is projected to face deficits for the next three years, and tax officials fear the applications could cost even more so in the long run.

What starts as a small financial commitment can turn into unmanageable expenses down the road, said Susan Shelley of the Howard Jarvis Taxpayers Association.

[Correction: This article was revised at 5:55 p.m. PT on April 26, 2024,
to correct details about the BrightLife Kids app for Android.]

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