This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

As a safe, reliable point of access for Michigan kids in need of behavioral health treatment, Michigan school districts have seen particular promise in telehealth solutions. As virtual visits become more common, established community health care clinics and schools can partner to use technology to help more students get the care they need.

One prime example of a successful school-based behavioral telehealth program is the Family Medical Center of Michigan's (FMC) partnership with 20 schools in Lenawee, Monroe, and Wayne counties. FMC, a Federally Qualified Health Center, partners with schools lacking access to community health services. Since 2016, its "Someone to Talk To" school-based behavioral health program has provided teletherapy and telepsychiatry to students alongside in-person, social-worker-led therapy in the school buildings. Airport Community Schools in Monroe County has been partnering with FMC in the program for the past three years.
Airport Community Schools staff including Supt. John Krimmel (far right) confer with Family Medical Center staff including School Based Services Supervisor Meredith Gilliam (far left) and Behavioral Health Therapist Alexis Cavins (in orange shirt).
"The positive impact has been significant," says John Krimmel, Airport Community Schools superintendent. "The telehealth services have provided an additional, higher level of support that we previously did not have access to."

For all the schools FMC serves, being able to virtually connect students with therapists and psychiatrists has proven to be financially sustainable, scalable, and especially relevant for rural communities or other regions with few practicing psychiatrists or therapists.
Family Medical Center School Based Services Supervisor Meredith Gilliam at Wagar Middle School in Carleton.
"We certainly have a need in our schools that we saw with our kids," Krimmel says. "It's been just awesome to be able to provide not only the services and a seamless entry to more support services, but also to have it right here at the schools."

Fun, focused, and familiar therapy

Because FMC provides face-to-face services within the district's buildings as well as telehealth services, Krimmel notes that students are more comfortable engaging in services and parents have a higher level of trust and support for FMC. FMC also offers mental health screening services that help identify additional students who need support, and services do not end with the school year. FMC continues seeing students over the summer.
Family Medical Center Behavioral Health Therapist Alexis Cavins and School Based Services Supervisor Meredith Gilliam at Wagar Middle School in Carleton.
"We run into situations with kids and families that have a great need for more intensive mental health service support," Krimmel says. "This has allowed us to give them access."

In addition to video and audio calls, FMC's therapists engage students via virtual office settings where kids can click on a variety of activities, games, and mindfulness techniques to complement their therapy sessions.
A Family Medical Center therapist's virtual office.
"We have some really sharp and talented therapists. They created virtual offices —  really fun, colorful interactive environments on the internet where students can do exercises at home outside of the visit," says Jessica Parsil, FMC's director of behavioral health. "The teens like to be on their phones. They like technology. It's what they do."
Jessica Parsil.
Through telehealth, students also have access to a wider range of therapists and psychiatrists to serve their unique needs. A student with a specialized need can be paired with a provider who focuses on that specialty. Students who feel more comfortable either with a male or female therapist can more easily be accommodated.

"That's been another benefit — students having access to all of our therapists. We can pool all of our psychiatrists and therapists and be able to offer their services to any school," Parsil says. "The therapists have various areas of specialties. So if somebody has a diagnosis or issue in one county and the specialist that could help that patient or student is in a different county, we can still pair them up."

To share the successful program, FMC recently leveraged funding from the Michigan Health Endowment Fund to create a guide for replicating it elsewhere, including a case study and a toolkit of templates and documents. 

The case study includes information on creating the program infrastructure, offering tips on getting school board approval, selecting schools for services, obtaining U.S. Health Resources and Services Administration approval, creating staffing structure, and setting up the tech needed to support telehealth services. Information and tools are provided for all steps of program implementation, from spreading the word to evaluation.

Help at the ready when the pandemic hit

Because FMC's virtual mental health programming was already in place before pandemic-related school closures, Airport Community Schools was well prepared when it came to meeting the resulting spike in mental health issues.
Audrey Smith.
"With our services being in place, we were able to continue their therapy and had a very small dropoff. Our students were just able to continue to access their services virtually," says Audrey Smith, FMC executive vice president. "We also continued to go to the schools. For some school districts, the buildings were open and students were very comfortable seeing us at their buildings. But for the most part, we were doing that work virtually."

Parsil saw students facing more stress, fear, sleep issues, depression, and anxiety. In addition, more middle school students began vaping, abusing substances like alcohol and marijuana, and engaging in risky sexual and illegal behaviors. While social isolation was hard for all students, those living in dysfunctional home environments suffered even more.

"We are really able to look at different issues that we might not have known about had we not seen the home environment through telehealth services," Parsil says. "This really was an unintended outcome. We hadn't thought of that when we started doing remote telehealth, that we would get a glimpse of students' home lives. This has enabled us to modify treatment plans by getting into difficult and deeper issues that we might not have known."

One downside to telehealth is the potential lack of privacy for patients. Students speaking to their therapists within earshot of parents and siblings may feel uncomfortable or unable to share their thoughts and feelings.

"We do have to be aware when they are at home versus the office, and that does mean others may be able to hear," Parsil says. "Some of our students got creative, if needed. Some have a fan going to block sound. Some go out to the car and have the sessions there to make sure nobody hears. We do need to be respectful of the need to be confidential."

A vital role post-pandemic

When COVID-19 forced medical and mental health providers to shift to virtual services in the spring of 2020, Medicaid and private insurers also shifted reimbursement protocols to cover these services. As a result, Michiganders have benefited — and telehealth and telepsychiatry have proven to be extremely effective modalities for delivering health care. Some worry that payors will no longer cover virtual services to the same extent after the pandemic.

"The importance of the reimbursement for telehealth services is really key to be able to reach everybody," Parsil says. "This platform … removes some of the barriers, [such as] transportation, students and parents having to take time off work, and time out of school. It also allows a greater reach. With our psychiatry services, we are now able to provide that in all three counties. It's very important that mental health services are able to reach more people. That's the nice thing about telehealth. We have seen many positive outcomes."
 
A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Airport Community Schools photos by Christopher Slat. All other photos courtesy of the subjects.