New York City Offers Free Online Therapy to Teens: Will It Work?


For the past month, New York City has been inviting teens to participate in one of the country's largest experiments aimed at helping struggling teens: a program that offers free online therapy to all residents ages 13 and up. and 17 years old.

The city has entered a three-year, $26 million contract with Talkspace, one of the largest digital mental health care providers. After a parent or legal guardian signs a consent form, teens can exchange unlimited messages with an assigned therapist and receive a 30-minute virtual therapy session each month.

He unroll program, NYC Teenspace, on November 15 took many members of the city's greater mental health care community by surprise. In interviews, providers praised the effort for making mental health care available to adolescents who otherwise would not have had access.

But many also worry whether the limited treatment Teenspace offers will meet the needs of teens who have more complex problems. And some questioned why the city was partnering with a for-profit provider like Talkspace, which is the target of a class-action lawsuit filed by a former customer.

“Conceptually, this could be a game-changer,” said C. Vaile Wright, senior director of the American Psychological Association's Office of Healthcare Innovation. “This could absolutely revolutionize access to care.”

But, he added, “the devil is in the details.” It's still unclear whether digital providers can “realistically meet capacity” and set appropriate expectations around response times and informed consent procedures, he said, “so that there aren't 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 was “taking a risk” by adopting teletherapy on this scale. But, he added, given the alarming levels of distress among adolescents, the “cost of inaction is much higher.”

In New York City public schools, there is a guidance counselor to every 272 students. Besides, a report released this month by the state attorney general's office surveyed 13 health plans and found that 86 percent of mental health providers listed as in-network were actually “ghosts,” meaning they were unreachable, not were in-network or not accepting new patients.

“What we wanted to do was create the easiest democratized, barrier access to help that we could,” Dr. Vasan said. “This is free. It's in the palm of your hand. We are empowering young people a lot. feel comfortable asking for help and do so independently of any adult, except with initial parental consent.”

So far, about 1,400 teens have enrolled, or less than 1 percent of the more than 400,000 eligible teens.

At a webinar about the program this month, city parents were shown photos of the faces of the available therapists: a variety of young, dynamic faces, some with dreadlocks or hijabs. Teenspace's smartphone registration page also appeared on the screen: “You receive free therapy through the New York City Department of 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 published this month by The Associated Press found that 16 of the largest public school districts in the U.S. offer online therapy sessions.

In February, Los Angeles County signed a two-year, $24 million contract with Hazel Health, which offers virtual healthcare to more than 160 school districts nationwide. The Los Angeles partnership will provide teletherapy services to up to 1.3 million public school students in grades K-12.

Few areas in the country have a larger mental health workforce than New York City, and some advocates questioned the city's decision to partner with a for-profit company at a time when city agencies are being asked to cut their budgets.

“Choosing to privatize this while simultaneously imposing deep cuts across the social sector (and beyond) doesn't make any sense to me,” said Matt Kudish, executive director of the National Alliance on Mental Illness in New York City.

Steven DiMarzo, president of the New York Mental Health Counselors Association, said digital platforms often offer relatively low salaries and force their employees to meet “unrealistic expectations.” He said he had not heard anything about Teenspace until a journalist contacted him, but that he was “concerned” about the quality of care he would provide.

Other experts questioned the level of treatment Teenspace offers teens.

Dr. Zachary Blumkin, senior clinical director of the Columbia University Irving Medical Center School of Psychiatry Practice Organization, praised the spirit behind the initiative as “pretty amazing.” But he said he had seen no evidence that a monthly therapy session and the exchange of text messages would offer substantial benefit for mentally ill teens.

“One concern is that this could be kind of a Band-Aid on a festering wound, and that could make things worse,” he said. As a provider who treats adolescents, he said, “this is not a level of intervention that I would feel comfortable providing.”

As teletherapy has become more prevalent in recent years, digital providers like Talkspace and BetterHelp have sometimes been criticized for care that falls short of traditional psychotherapy.

“The goal of these platforms is scale,” said Livia Garofalo, a researcher at the nonprofit research institute Data & Society, who studies telehealth. “That's his problem; we need to expand it. And in the process there are compromises that both the therapist and the client must accept.”

In March, a school administrator, Naomi Weizman, filed a lawsuit class action lawsuit v. Talkspace in federal court in California, charging that the company “creates the false impression that Talkspace has a large enough network of therapists to meet demand” and then unilaterally enrolls customers in payment plans that renew automatically.

A motion was filed by Talkspace to dismiss the class claims in the lawsuit. 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 stop the platform's subscription plan.

John Reilly, Talkspace's chief legal officer, said Monday that the allegations in the complaint were not accurate. “We work to connect members with providers as quickly as possible and are typically connected to a therapist within a day or two,” he added.

Dr. Vasan said the city “went through a long and fairly detailed due diligence” when considering digital providers, and opted for 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 “within hours.” Talkspace is also “an incredibly affordable and affordable platform,” he added.

Dr Vasan said the health department hoped to analyze and update the service as it grew, adding therapists if necessary and streamlining referrals for teenagers who need more intensive services.

“We can make those adjustments over time,” Dr. Vasan said. “And this will be a rigorous learning that we are going to experience. And I just want to reiterate that last point: I wish I knew all the answers beforehand, but I think the cost of inaction is greater.”

After teens verify that they are between 13 and 17 years old, they must provide the email address of a parent and, with rare exceptions, their parent or guardian must sign and return a consent form. After checking inThey can use the platform's self-guided exercises or opt for therapy.

Teens share their current problem and preference for provider gender, and will then be matched with one of Talkspace's New York State-licensed therapists, who number about 500.

Right now, only 40 percent identify as teen care specialists, but a company spokesperson said training in the specialty, led by a Talkspace doctor, is offered to any therapist who is part of the Teenspace program. .

In addition to the monthly video session, clients can send an unlimited 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 business hours, “depending on the teen's cadence and preference,” a Talkspace spokesperson said.

Providers cannot prescribe medications. “The essence of this program is therapy,” Dr. Cohen said. He declined to disclose the metrics outlined in NYC Teenspace's contract, but said “one of the benchmarks is getting teens to use it.”

Teens who are in crisis should call 988 or other helpline instead of using the app. As an added precaution, the company uses artificial intelligence to scan text conversations for signs that a client is at risk of self-harm and then alerts the therapist, who decides what to do next.

Talkspace ran into financial trouble after going public in 2021, but its business-to-business revenue, which stems from partnerships with cities and companies, has been a bright spot in its financial reports.

In 2020, Hillary Schieve, mayor of Reno, Nevada, announced a one-year, $1.3 million contract with Talkspace to provide free care to citizens. The use was relatively low – about 3,100 of the city's approximately 250,000 residents used the service – and the city did not renew contract.

In an interview, Ms. Schieve said she was satisfied with the mental health services provided to people, but disappointed by the company's efforts to promote the service.

“They failed miserably there,” he said, adding that he would recommend cities partner with digital providers that pay the platforms based on the number of customers served.

“I don't think they get their money's worth, although I hope they do,” said Ms. Schieve, who, as president of the U.S. Conference of Mayors, has made mental health an area of ​​focus. “I want cities to be cautious when working in this space.”

When asked about the promotion in Reno, Dr. Cohen, CEO of Talkspace, responded that “we would all have liked to see better utilization.” He added that in New York City “we are focusing a significant amount of our efforts right now on getting the word out.”

Ms. Garofalo, a telehealth researcher, said the quality of the experience at Teenspace is particularly crucial because, in many cases, it will be a young person's first encounter with mental health care.

“This is your chance to convince someone that you need help or would benefit from talking to someone,” he said. “What if case management needs to be involved? “It is a monumental task that they have set themselves.”

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