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A novel approach to counseling depressed, anxious teens: Video-chatting with therapists

A pioneering schools project connects stressed-out young people to therapists miles away via computers

Licensed mental health counselor Leslie Matilainen (seen on monitor) conducted a counseling session with 16-year-old Jerry at Ralph C. Mahar Regional High School.
Licensed mental health counselor Leslie Matilainen (seen on monitor) conducted a counseling session with 16-year-old Jerry at Ralph C. Mahar Regional High School.Pat Greenhouse/Globe Staff/Boston Globe

ORANGE — Ambling into a windowless office in his high school, Jerry plopped into a chair, cracked open a bottle of water, and casually greeted the woman whose image was on a computer screen in front of him. “How’s it going?” he said to Leslie Matilainen, a mental health counselor smiling back at him from her home computer miles away.

For the next 45 minutes, Jerry, an earnest 16-year-old junior in the Ralph C. Mahar Regional School District in Orange, alternately confided in and joked with Matilainen about his grades, the high cost of concert tickets, family issues, and his dream of attending culinary school.

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Virtual counseling visits “sounded kind of crazy" at first, Jerry said in a recent interview. “I didn’t want to talk to a computer." But nine months later, he’s found talking with Matilainen has helped ease his depression. “I feel like I went through a car wash,” he said. “My world feels different now.” (The Globe is not using Jerry’s full name to protect his privacy.)

Jerry is part of an experimental effort to address a pressing public health challenge confronting Massachusetts: how to deliver quality mental health care to all the teenagers who need it. The shortage of providers in rural areas is so severe that kids typically have to wait months to get an appointment, especially if their families are on Medicaid. Even when a therapist can be found, transportation is often an obstacle.

At Jerry’s school, and in two other rural school districts in Western Massachusetts that participate in the pioneering telehealth project, students who need mental health counseling can see a therapist via video chat on secure, school-based computers. Because the therapists can live anywhere, and neither they nor the students have to travel, therapy can usually begin just a few days after a student is identified as needing help. Parents don’t have to miss work to drive their kids to an appointment, and the amount of school students miss is kept to a minimum.

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“That’s dropped the no-show rate [compared to doctors’ office visits] to near zero,” said Maureen Donovan, the program’s manager.

Exactly how effective long-distance psychotherapy is, compared with in-person office visits, remains unclear.

Dr. David McSwain, who leads the telehealth care section of the American Academy of Pediatrics, said it’s been a “massive challenge” to determine whether virtual visits are effective for children because of a lack of large, controlled studies.

But he said that emerging information and experience where he works, at the Medical University of South Carolina, indicate that aggressive or violent children are not good candidates for virtual visits. In those cases, he said, sufficient staff or other support, such as a parent, is necessary to ensure safety.

Still, Boston Children’s Hospital has seen encouraging early results. Its Pediatric Physicians’ Organization is expanding teletherapy options after a successful two-year pilot program that delivered telepsychiatry evaluations to some 600 youngsters in the Southeastern and Western parts of the state, and in Lowell. Families made the computer-based visits at their local doctors’ offices.

“Across the state, kids are waiting six to eight months or more to see a child psychiatrist, but we were able to pretty reliably connect them with a psychiatrist at Children’s in approximately 15 days,” said program manager Jonas Bromberg.

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A survey of patients and their physicians found a 90 percent or higher satisfaction rate when they were asked about waiting times and quality of care, he said. Bromberg also said they found virtual visits typically work best for children over 12 years old.

Now the Western Massachusetts experiment aims to provide researchers with more insight. Heywood Healthcare which received a $1 million federal grant to run the three-year, school-based project, is collecting reams of data about how students are progressing.

At Jerry’s school in Orange, teletherapy is free to any student who needs it, regardless of insurance, with federal grant money plugging any gaps in coverage. (Leaders of the effort say the service wouldn’t need extra support if state lawmakers adopt pending legislation that would require insurers to spend more on mental health and to reimburse counselors at the same rate for telehealth services as they do for in-office visits.)

The video sessions aren’t designed to treat students who are suicidal or psychotic or who need intensive help. Instead, they’re meant for those experiencing mild or moderate symptoms of the most common mental illnesses, such as depression and anxiety, or who are struggling with the stress that often comes with modern teen life. Each participating school also has a full-time community health worker to coordinate with guidance counselors in identifying students who need help.

Christina Cutting, with Heywood Healthcare, is the school-based community health worker at Ralph C. Mahar Regional High School.
Christina Cutting, with Heywood Healthcare, is the school-based community health worker at Ralph C. Mahar Regional High School. Pat Greenhouse/Globe Staff

That’s important, because it means Christie Cutting, the community health worker at Mahar, is in a nearby room during the private telehealth sessions, so if a student feels overwhelmed, or the counselor senses a problem, she’s there to provide support.

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“When we have had kids who were upset, and I was not comfortable returning them to class, I was that shoulder to cry on," Cutting said.

And because students’ mental health problems often are linked to poverty, the community health workers also help the students’ families with basic needs, such as housing, insurance, heat, clothing, and food assistance.

Matilainen, the remote therapist for Mahar, previously spent 13 years counseling in schools; she said she initially hesitated to participate because she doubted long-distance therapy would be effective.

“When I was in the schools, I would play games with them during sessions, chess for older ones and arts and crafts for younger ones,” she said, "and I thought, I am not going to be able to do that, so I was reluctant.”

But she’s found that splitting the screen and watching educational or inspiring videos with students during telehealth sessions is just as effective at breaking the ice and fostering trust. And Matilainen, who spent years crisscrossing the region to treat children, said connecting via video is more efficient for her and more effective for students.

Leslie Matilainen, seen on monitor, conducted a counseling session.
Leslie Matilainen, seen on monitor, conducted a counseling session.Pat Greenhouse/Globe Staff

“The kids adjust to me more quickly because they are so used to technology," Matilainen said. To some students, she added, teletherapy feels more private than a school-based counselor. “They tell me I am not in the building to run to their teachers to tell them their business.”

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Jerry found the virtual sessions “kind of weird at first, not just isolating, but kind of awkward, being alone in the room." But “now, it feels a lot more normal.”

State Senator Julian Cyr, whose Cape Cod and Islands district grapples with severe health care shortages, included a provision in a mental health care bill filed this month for the state to try similar programs in three other public high schools.

“This is a model that’s working, and we should see if we can apply this more broadly,” said Cyr, who cochairs the Joint Committee on Mental Health, Substance Use, and Recovery.

Meanwhile, at Jerry’s school teletherapy has become so popular it has a small waiting list. Staffers who worked so hard to ensure students didn’t feel stigmatized for attending sessions are having to gently convince some, including Jerry, that they are well enough to scale back to biweekly sessions, freeing up space for others.

Jerry, who resisted traditional counseling when his parents suggested it earlier, said he looks forward to the virtual visits.

“It gives me another outlook,” he said. “I kind of feel more open about who I am."

Kay Lazar can be reached at kay.lazar@globe.com Follow her on Twitter @GlobeKayLazar.


Kay Lazar can be reached at kay.lazar@globe.com Follow her on Twitter @GlobeKayLazar.