Improving behavioral health care access in rural school districts in Washington

In the past decade, the number of young people experiencing persistent feelings of sadness, suicidal thoughts and behaviors has been steadily increasing.¹ The prevalence of anxiety, depression, behavioral problems and suicide has increased at a faster rate for young people living in rural communities.^2,3 This geographical disparity reflects a lower level of access to behavioral health care in rural areas.

While about 64% of all U.S. counties have at least one mental health facility that serves young people, this figure drops to 30% within rural counties. Additionally, only 3% of rural mental health facilities provide suicide prevention services for young people. In Washington State, the average ratio of mental health providers to residents in urban counties is 224:1 while the average ratio in rural counties stands at 470:1.^5,6

UnitedHealthcare is dedicated to supporting community-led solutions that meet local needs. In collaboration with Advocates for Community Health (ACH), UnitedHealthcare is empowering Federally Qualified Health Centers (FQHCs) to drive local change.⁷ This commitment includes the Community Health Entrepreneur Challenge, a program providing two years of financial and technical support to bring an innovative approach to address challenges facing local communities.

Columbia Basin Health Association (CBHA) is an FQHC serving rural Central Washington. In response to the increasing rates of youth experiencing mental health challenges, CBHA wanted to help students have better access to behavioral health care in the community and reached out to local school districts. In June 2022, CBHA began exploring solutions to improve behavioral health care access in collaboration with Othello School District administration.  

CBHA developed an innovative hybrid telehealth model that enables students to book appointments, both in-person or virtual, through a HIPAA-compliant chatbot. The chatbot interacts with students and parents to facilitate scheduling and obtain consent forms when needed. It also offers an option to connect students with a 24/7 crisis support line for immediate help. This solution streamlines processes for students and families who previously had to navigate barriers related to completing forms, coordinating schedules and arranging transportation to appointments.

In the initial phase of the program, launched in 2022, students accessed these services by scanning a QR code using a tablet located in a school nurse or counselor’s office. With support from the Community Health Entrepreneur Challenge, CBHA is expanding the program to students’ personal devices, allowing them to book or attend appointments from a personal phone, tablet or laptop.

Going forward, the program aims to:

• Increase youth behavioral health care access within rural communities to reduce depression, anxiety and suicidal ideation.
• Reduce stigma associated with behavioral health to encourage more students to seek help.
• Increase early detection of behavioral health concerns within local school districts to avoid the onset or progression of youth mental illness. 

CBHA is looking ahead to expand these efforts to even more local schools, removing barriers to drive more equitable access to behavioral health care. UnitedHealthcare is dedicated to supporting organizations that bring innovative solutions to drive local change. Through CBHA’s hybrid telehealth model, more students are able to access the behavioral health care they need.