New York City Offers Teens Free Online Therapy: Will It Work?
This past month, New York City invited teens to participate in one of the nation’s largest experiments aimed at helping struggling adolescents: a program that offers free online therapy to all residents ages 13 to 17.
The city is one three-year, $26 million contract with Talkspace, one of the largest digital mental health providers. After a parent or legal guardian signs a consent form, teens can exchange unlimited messages with an assigned therapist and receive one 30-minute virtual therapy session each month.
The unroll of the program, NYC Teenspace, on November 15 surprised many in the city’s large mental health community. In interviews, providers praised efforts to make mental health care available to teens who might not otherwise have had access.
But many also worried whether the limited treatment Teenspace offers will meet the needs of teens with more complex issues. And some wondered why the city would partner with a profitable 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 processes, she said, “so that there are no 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 “took a risk here” by embracing teletherapy on this scale. But, he added, given the alarming levels of distress among teens, the “cost of inaction is much higher.”
New York City public schools have one guidance counselor every 272 students. In addition, a report Released this month by the Attorney General’s Office, it examined 13 health plans and found that 86 percent of in-network mental health providers were actually “ghosts,” meaning they were inaccessible, out-of-network or not accepting new patients.
“What we wanted to do was create the simplest, most accessible, democratized access to help that we could,” said Dr. Vasan. “This is free. It sits in the palm of your hand. We give the young people a lot of power to be comfortable asking for help, and to do so independently of any adult other than initial parental consent.”
So far, about 1,400 teens, or less than 1 percent of the more than 400,000 eligible adolescents, have signed up.
During a webinar scheduled for this month, city parents were shown headshots of the available therapists — a series of young, dynamic faces, some with dreadlocks or hijabs. Teenspace’s smartphone sign-up page also flashed on the screen: “You’ll get free therapy through NYC Health!”
Parents typed questions into a chat window.
“Is text therapy effective?”
“Can students remain anonymous?”
“Is this free or not?”
Teenspace’s arrival comes amid a wave of similar partnerships across the country. An analysis A release 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 contract worth $24 million with Hazel Health, which provides virtual health care to more than 160 school districts across the country. The Los Angeles-based partnership will provide teletherapy services to up to 1.3 million public school students in grades K-12.
Few parts of the country have a larger mental health workforce than New York City, and some advocates are questioning the city’s decision to partner with a for-profit company at a time when city agencies are being asked to tighten their budgets to lower.
“Choosing to privatize this while making deep cuts in the social sector (and beyond) makes no sense to me,” said Matt Kudish, CEO 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 tend to offer relatively low wages and push their workers to meet “unrealistic expectations.” He said he hadn’t heard 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 provides adolescents.
Dr. Zachary Blumkin, senior clinical director of the Psychiatry Faculty Practice Organization at Columbia University Irving Medical Center, called the mind behind the initiative “pretty amazing.” But he said he had seen no evidence that a monthly therapy session and text message exchanges would provide a substantial benefit for teens with mental illness.
“One concern is that this could be like a band-aid for a gushing wound, and that could make things worse,” he said. As a provider who treats adolescents, he said, “This is not the level of intervention that I would feel comfortable providing.”
As teletherapy has become more common in recent years, digital providers like Talkspace and BetterHelp have sometimes been criticized for care that falls short of traditional psychotherapy.
“The whole point of these platforms is scale,” said Livia Garofalo, a researcher at the nonprofit research institute Data & Society, who studies telehealth. “That’s their jam; we need to scale it up. And there are compromises that both the therapist and the client must accept.”
In March, a school administrator, Naomi Weizman, filed an application class action lawsuit against Talkspace in a California federal court, alleging that the company “creates the false impression that Talkspace has a network of therapists large enough to meet demand,” and then unilaterally enrolls clients in auto-renewal payment plans .
A motion by Talkspace to dismiss the class claims in the lawsuit was denied last week. The judge in the case, P. Casey Pitts, dismissed two elements of Ms. Weizman’s claims, including a request for an injunction that would halt the platform’s subscription plan.
John Reilly, Talkspace’s chief legal officer, said Monday that the allegations in the claim were incorrect. “We do our best to connect members with healthcare providers as quickly as possible, and they are typically connected with a therapist within one to two days,” he added.
Dr. Vasan said the city “underwent a long and fairly detailed due diligence” when considering digital providers, and chose Talkspace in part because of its size and focus on New York.
Dr. Jon R. Cohen, CEO of Talkspace, said the company stood out because it is based in New York City and could connect teens with a therapist “in hours.” Talkspace is also “an incredibly low-cost, affordable platform,” he added.
Dr. Vasan said the health department expected to analyze and update the service as it grows, adding therapists as needed and streamlining referrals for teens who need more intensive services.
“We can make these adjustments over time,” said Dr. Vasan. “And this will be a rigorous learning process that we will undergo. And I just want to reiterate that last point: I wish I knew all the answers in advance, but I think the cost of inaction is greater.
After teens verify that they are between the ages of 13 and 17, they must provide a parent’s email address and, except in rare exceptions, their parents or guardians must sign and return a consent form. After to enrolthey can use the platform’s self-guided exercises, or opt for therapy.
The teens share their problem and their preference for provider gender, and are then paired with one of Talkspace’s New York State-licensed therapists, who number approximately 500.
Currently, only 40 percent identify as youth care specialists, but a company spokesperson said training in the specialty, led by a Talkspace physician, is offered to every therapist who is part of the Teenspace program.
In addition to the monthly video session, clients can send any number of text, audio, or video messages to their therapist, but the response will not be immediate. Typically, providers communicate at least once or twice a day during their work hours, “depending on the teen’s cadence and preference,” according to a Talkspace spokesperson.
The providers cannot prescribe medications. “The essence of this program is therapy,” said Dr. Cohen. He declined to disclose the statistics outlined in the NYC Teenspace contract, but said that “one of the benchmarks is getting teens to use it.”
Teenagers in crisis are told to call 988 or another helpline instead of using the app. As an extra precaution, the company uses artificial intelligence to scan text conversations for indications that a client is at risk of self-harm. The company then alerts the therapist, who decides what to do next.
Talkspace struggled financially after going public in 2021, but its business-to-business revenue, which comes from partnerships with both cities and companies, has been a bright spot in the market. financial reports.
In 2020, Hillary Schieve, the mayor of Reno, Nev., announced a one-year, $1.3 million contract with Talkspace to provide free healthcare to citizens. Use wax relatively low – about 3,100 of the city’s approximately 250,000 residents used the service – and the city did not renew the contract.
In an interview, Ms. Schieve said she was satisfied with the mental health care provided to individuals, but disappointed with the company’s efforts to promote the service.
“They failed there quite miserably,” she said, adding that she would advise cities that partner with digital providers to pay platforms based on the number of customers served.
“I don’t think they’re getting their money’s worth, although I hope so,” said Ms. Schieve, who has made mental health an area of focus as president of the U.S. Conference of Mayors. “I want cities to be careful as they work in this space.”
When asked about the promotion in Reno, Dr. Cohen, CEO of Talkspace, said that “we all would have liked to see better use.” He added that in New York City “we are currently focusing a significant portion of our efforts on getting the message out.”
Ms. Garofalo, the telehealth researcher, said the quality of the experience on Teenspace is particularly crucial because in many cases it will be a young person’s first encounter with mental health services.
“This is your chance to convince someone that they need help or would benefit from talking to someone,” she said. “What if case management needs to be involved? It is a monumental task they have set themselves.”