Can technology alleviate a dire shortage of mental health services for children?
Massachusetts parents will soon find out. The state’s largest insurer, Blue Cross Blue Shield of Massachusetts, is announcing Tuesday that its members now have access to an array of virtual mental health options for children and their parents, offered by a California startup.
Beginning this week, a company called Brightline, founded in 2019 and now serving just a few hundred patients in California, will become an in-network provider for Massachusetts Blue Cross, serving children ages 3 to 17 and their parents.
The move comes at a time when parents of troubled children are increasingly desperate for help. Even before the pandemic, people often waited months for appointments with mental health professionals who specialize in children. By every measure, the pandemic has intensified the stress and worsened mental health for many families, driving up demand for care.
Brightline will offer video visits with therapists, but that’s not the sole innovation. The company also deploys a suite of online resources and “coaches” who help patients stick with treatment goals and learn practical coping skills.
“We have terrific clinicians in the system in Massachusetts, but we need more and we need different models,” said Andrew Dreyfus, Blue Cross president and chief executive. “Coaching sessions and online support will act as a kind of bridge with more traditional therapeutic sessions.”
Danna Mauch, president and chief executive of the Massachusetts Association for Mental Health, an advocacy group, said she’s familiar with Brightline and Blue Cross’s plans. “It’s an excellent thing because we have a huge uptick in need,” she said.
“We need to have a broader array of supports for people than the one-on-one therapeutic encounter,” Mauch said.
The pandemic demonstrated that online therapy can work well. Forced to go virtual during the lockdown, therapists and their patients discovered they could work together just as effectively, and certainly more conveniently, through a computer or smartphone screen.
Brightline’s offerings are divided into three levels. Its “digital platform” provides guides and videos with tips from experts, interactive exercises, and the opportunity to chat online with a coach.
“Maybe for some people digital support is all they need,” said Naomi Allen, Brightline’s cofounder and chief executive. For others, she said, the digital tools can be a way “to warm up to the idea of getting coaching or therapy.”
The next level involves 30-minute virtual sessions with a “behavioral health coach.” Though not licensed clinicians, coaches have undergone training and certification in techniques to help people manage such problems as stress and anxiety, tantrums, and school struggles. They also reach out via chat messages to provide tips and trouble shooting in between therapy sessions.
The third level is called “Brightline Care”: therapy, evaluation, medication support, and speech therapy, from licensed clinicians, which include psychiatrists, advanced practice nurses, social workers, and others. All have Massachusetts licenses and are physically located in the state.
Brightline declined to specify how many licensed professionals it has recruited, saying that the number is a “moving, growing target.” But the company expects to have enough clinicians on board to serve more than 750 children in Massachusetts by the end of the year.
None will be clinicians who are already in Blue Cross’s network, Allen said. Instead, she said, the company is luring therapists who weren’t accepting insurance or who weren’t working at all, by offering flexible hours and part-time options, and handling all administrative tasks.
Blue Cross members will pay the usual copayment for such professional services, usually around $25 to $35 per visit. The other Brightline services are available for a $20 monthly fee.
Dreyfus said he does not expect Brightline “to solve the access problem in and of itself.” Last year, Blue Cross raised its payment rates for child psychiatrists, a move that increased the number of child psychiatrists in its network from 143 to 188.
“But we need different models,” Dreyfus said. “The answer to every mental health need is not necessarily more clinicians.”
Brightline won’t be able to serve every child.
It will refer to in-person care anyone in extreme crisis, those who may be a danger to themselves or others. So it won’t address the shortage of inpatient and residential treatment — at least not immediately. Allen and Dreyfus hope that by potentially intervening early, Brightline can keep problems from escalating to the crisis level.
Brightline also does not treat substance use disorders, and will refer those cases to other providers, Allen said.
Liana Shelby, a child psychologist who works with the Norfolk County juvenile court, reviewed the Brightline website at The Boston Globe’s request, and said that “the program has potential.” But she raised concerns that the people who most need the services “don’t always have access to reliable Internet and the electronic devices necessary to really utilize a platform like this one.”
Shelby said she has used telehealth for a number of years and finds it generally useful, but it has limitations. The psychologist can’t assess a child’s gait or hygiene, and may miss physical signals of distress. Her clients have sometimes become frustrated when the connection wavered and they had to repeat their responses.
Lisa Lambert, executive director of the Parent/Professional Advocacy League, which focuses on children’s mental health, said that Brightline “sounds appealing.”
“There is never a one-size-fits-all with children with mental health needs,” Lambert said. “Every few months we’re learning more and more about how to deliver therapy to children.”
Although the company is new, Allen said, Brightline is led by seasoned clinicians in child behavioral health and uses time-tested treatment protocols. It recently began providing services to employees of Blue Shield of California and is amid “late stage” talks with health plans and employers around the country, a spokeswoman said.
Massachusetts Blue Cross has been involved with the company since its earliest days. Dreyfus was previously acquainted with the other cofounder, Giovanni Colella, and had talked with him about the needs even before Brightline’s founding.
Blue Cross invested $500,000 in Brightline, which gives it a 1 percent ownership stake and a nonvoting seat on the board of directors, Dreyfus said, calling the insurer’s financial involvement merely “a vote of confidence.” Others share his confidence: Investors, including Boston Children’s Hospital and big names like GV (formerly Google Ventures), so far have kicked in nearly $100 million.
Brightline is not alone in the nascent digital mental health field for children. For example, Daybreak Health offers individual and group counseling and “well-being tools” for teens, and Enable My Child connects children with online therapists.
And Blue Cross is not alone among the state’s insurers in pursuing online options for treatment. Point32Health, the company that combines Tufts Health Plan and Harvard Pilgrim Health Care, is eying Brightline and others, but hasn’t made any decisions yet, said Emily Bailey, vice president for behavioral health and health care services.