Student Union
Lacking Counselors, US Schools Turn to Booming Business of Online Therapy
Trouble with playground bullies started for Maria Ishoo's daughter in elementary school. Girls ganged up, calling her "fat" and "ugly." Boys tripped and pushed her. The California mother watched her typically bubbly second-grader retreat into her bedroom and spend afternoons curled up in bed.
For Valerie Aguirre's daughter in Hawaii, a spate of middle school "friend drama" escalated into violence and online bullying that left the 12-year-old feeling disconnected and lonely.
Both children received help through telehealth therapy, a service that schools around the country are offering in response to soaring mental health struggles among American youth.
Now at least 16 of the 20 largest U.S. public school districts are offering online therapy sessions to reach millions of students, according to an analysis by The Associated Press. In those districts alone, schools have signed provider contracts worth more than $70 million.
The growth reflects a booming new business born from America's youth mental health crisis, which has proven so lucrative that venture capitalists are funding a new crop of school teletherapy companies. Some experts raise concerns about the quality of care offered by fast-growing tech companies.
As schools cope with shortages of in-person practitioners, however, educators say teletherapy works for many kids, and it's meeting a massive need. For rural schools and lower-income students in particular, it has made therapy easier to access. Schools let students connect with online counselors during the school day or after hours from home.
"This is how we can prevent people from falling through the cracks," said Ishoo, a mother of two in Lancaster, California.
Ishoo recalls standing at her second-grader's bedroom door last year and wishing she could get through to her. "What's wrong?" the mother would ask. The response made her heart heavy: "It's NOTHING, Mom."
Last spring, her school district launched a teletherapy program and she signed up her daughter. During a month of weekly sessions, the girl logged in from her bedroom and opened up to a therapist who gave her coping tools and breathing techniques to reduce anxiety. The therapist told her daughter: You are in charge of your own emotions. Don't give anyone else that control.
"She learned that it's OK to ask for help, and sometimes everyone needs some extra help," Ishoo said.
The 13,000-student school system, like so many others, has counselors and psychologists on staff, but not enough to meet the need, said Trish Wilson, the Lancaster district's coordinator of counselors.
Therapists in the area have full caseloads, making it impossible to refer students for immediate care, she said. But students can schedule a virtual session within days.
"Our preference is to provide our students in-person therapy. Obviously, that's not always possible," said Wilson, whose district has referred more than 325 students to over 800 sessions since launching the online therapy program.
Students and their parents said in interviews they turned to teletherapy after struggling with feelings of sadness, loneliness, academic stress and anxiety. For many, the transition back to in-person school after distance learning was traumatic. Friendships had fractured, social skills deteriorated and tempers flared more easily.
Schools are footing the bill, many of them using federal pandemic relief money as experts have warned of alarming rates of youth depression, anxiety and suicide. Many school districts are signing contracts with private companies. Others are working with local health care providers, nonprofits or state programs.
Mental health experts welcome the extra support but caution about potential pitfalls. For one, it's getting harder to hire school counselors and psychologists, and competition with telehealth providers isn't helping.
"We have 44 counselor vacancies, and telehealth definitely impacts our ability to fill them," said Doreen Hogans, supervisor of school counseling in Prince George's County, Maryland. Hogans estimates 20% of school counselors who left have taken teletherapy jobs, which offer more flexible hours.
The rapid growth of the companies raises questions about the qualifications of the therapists, their experience with children and privacy protocols, said Kevin Dahill-Fuchel, executive director of Counseling in Schools, a nonprofit that helps schools bolster traditional, in-person mental health services.
"As we give these young people access to telehealth, I want to hear how all these other bases are covered," he said.
One of the biggest providers, San Francisco-based Hazel Health, started with telemedicine health services in schools in 2016 and expanded to mental health in May 2021, CEO Josh Golomb said. It now employs more than 300 clinicians providing teletherapy in over 150 school districts in 15 states.
The rapid expansions mean millions of dollars in revenue for Hazel. This year, the company signed a $24 million contract with Los Angeles County to offer teletherapy services to 1.3 million students for two years.
Other clients include Hawaii, which is paying Hazel nearly $4 million over three years to work with its public schools, and Clark County schools in the Las Vegas area, which have allocated $3.25 million for Hazel-provided teletherapy. The districts of Miami-Dade, Prince George's and Houston schools also have partnered with Hazel.
Despite the giant contracts, Golomb said Hazel is focused on ensuring child welfare outweighs the bottom line.
"We have the ethos of a nonprofit company but we're using a private-sector mechanism to reach as many kids as we can," Golomb said. Hazel raised $51.5 million in venture capital funding in 2022 that fueled its expansion. "Do we have any concerns about any compromise in quality? The resounding answer is no."
Other providers are getting into the space. In November, New York City launched a free telehealth therapy service for teens to help eliminate barriers to access, said Ashwin Vasan, the city's health commissioner. New York is paying the startup TalkSpace $26 million over three years for a service allowing teens aged 13 to 17 to download an app and connect with licensed therapists by phone, video or text.
Unlike other cities, New York is offering the service to all teens, whether enrolled in private, public or home schools, or not in school at all.
"I truly hope this normalizes and democratizes access to mental health care for our young people," Vasan said.
Many of Hawaii's referrals come from schools in rural or remote areas. Student clients have increased sharply in Maui since the deadly August wildfires, said Fern Yoshida, who oversees teletherapy for the state education department. So far this fall, students have logged 2,047 teletherapy visits, a three-fold increase from the same period last year.
One of them was Valerie Aguirre's daughter, whose fallout with two friends turned physical last year in sixth grade, when one of the girls slapped her daughter in the face. Aguirre suggested her daughter try teletherapy. After two months of online therapy, "she felt better," Aguirre said, with a realization that everyone makes mistakes and friendships can be mended.
In California, Ishoo says her daughter, now in third grade, is relaying wisdom to her sister, who started kindergarten this year.
"She walks her little sister to class and tells her everything will be OK. She's a different person. She's older and wiser. She reassures her sister," Ishoo said. "I heard her say, 'If kids are being mean to you, just ignore them.'"
See all News Updates of the Day
- By VOA News
International students have options to pay for grad school
U.S. News & World Report tackles the challenges of paying for grad school as an international student with this story giving tips on paying for school. Read the full story here. (August 2024)
- By Tracy Liu
Economics, tensions blamed for Chinese students shifting from US to Australia, Britain
U.S. universities are welcoming international students as the academic year begins. But while the total number of foreign students is steadily growing, the top sending country, China, is showing signs of leveling out or shrinking.
Industry analysts say the negative trend is mainly due to higher costs amid China’s struggling economy, with a growing number of students going to less expensive countries like Australia and Britain, and tense ties between Washington and Beijing.
The number of foreign students studying in the U.S. in 2022-23 passed 1 million for the first time since the COVID pandemic, said Open Doors, an information resource on international students and scholars.
While the U.S. saw a nearly 12% total increase year-on-year for that period, the number of international students from China, its top source, fell by 0.2% to 289,526.
That’s 600 fewer students than the 2021-22 academic year, when their numbers dropped by nearly 9%. The COVID pandemic saw Chinese student numbers drop in 2020-21 by nearly 15%, in line with the world total drop.
While it’s not yet clear if the drop is a leveling out or a fluctuating decline, analysts say China’s struggling economy and the high cost of studying in the U.S. are the main reasons for the fall in student numbers.
Vincent Chen, a Chinese study abroad consultant based in Shanghai, said although most of his clients are still interested in studying in the U.S., there is a clear downward trend, while applicants for Anglophone universities in Australia and Britain have been increasing.
"If you just want to go abroad, a one-year master's degree in the U.K. is much cheaper,” Chen said. “Many people can't afford to study in the U.S., so they have to settle for the next best thing."
Data from the nonprofit U.S. group College Board Research shows that in the 2023-24 academic year, the average tuition and fees for a U.S. private college four-year education increased 4% to $41,540 compared with the previous academic year.
The British Council said three to four years of undergraduate tuition in Britain starts as low as $15,000.
The number of Chinese students in Britain was 154,260 in 2022-23, according to the U.K. Higher Education Statistics Agency, HESA, up from 121,145 in the 2018/19 academic year.
Australia’s Home Affairs office said in the 2023-24 program year, China was the top source foreign country for new student visa grants at 43,389, up slightly (1.5%) from the previous year.
Chen said Chinese state media's negative portrayal of the United States and concerns about discrimination have also contributed to the shift.
Bruce Zhang, a Chinese citizen who received his master's degree in Europe after studying in China, told VOA Mandarin he had such an incident occur to him after he was admitted to a U.S. university’s Ph.D. program.
When he entered Boston's Logan International Airport last year, Zhang said customs officers questioned him for more than an hour about his research, and if it had any links to the military, and took his computer and mobile phone for examination.
"Fortunately, I had heard that U.S. customs might be stringent in inspecting Chinese students, so I had relatively few study-related data and documents on my personal computer," he said.
Zhang was allowed to enter the U.S. for his studies in materials science, but the questioning left him so rattled that he has encouraged other Chinese to study elsewhere.
Cui Kai, a study abroad consultant in Massachusetts told VOA Mandarin that experiences like Zhang’s or worse happen for a reason.
"Students who were questioned or their visas were revoked at the customs are usually those who completed their undergraduate studies in China and come to the U.S. for a master's or doctoral degree in a sensitive major," said Cui.
Former President Donald Trump signed Proclamation 10043 in June 2020, prohibiting visas for any Chinese student who “has been employed by, studied at, or conducted research at or on behalf of, an entity in the PRC that implements or supports the PRC's “military-civil fusion strategy.”
The U.S. says China has been using students and scholars to gain access to key technology and, under Proclamation 10043, revoked more than 1,000 visas issued to Chinese nationals and has denied thousands more.
Critics say the policy is costly to the U.S. and is encouraging Chinese students to look to European and other universities.
Adrianna Zhang contributed to this report.
- By VOA News
Duolingo report details the reality of Gen Z international students
A report by Duolingo takes a look at the experiences of Gen Z international students studying in the U.S., Australia and the U.K, The Pie reports.
The report, the site says, debunks "characterizations of them as 'tech-obsessed, attention-deficit and self-centered'" and highlights "their emerging role in shaping global politics and economics."
Read the full story here. (August 2024)
- By VOA News
School with the lowest costs for international students
U.S. News & World Report crunched the numbers and came up with a list of 20 U.S. colleges and universities with annual total costs at or below $20,184. Check out these best bargains for international students here. (August 2024)
- By VOA News
How to make the most of schools' international student services
U.S. colleges and universities offer a variety of services for international students.
U.S. News & World Report takes a look at them and details how to best use them. Read the article here. (June 2024)
