Breaking down the barriers for teens seeking help

Texting, for some, has become the new phone call.  For others, texting is what they grew up with.  Adolescents today oftentimes feel more comfortable talking through a text message or online chat, and professionals in the Joplin, Missouri area have recognized this not as a roadblock, but as an opportunity.

Ozark Center, the behavioral health division of Freeman Health System, has partnered with Joplin Schools to offer more than 5,000 students a service called SchoolMessenger Talk About It.  This product is a free, 24-hour communication service that allows students to confidentially reach out for help using their cell phone or computer.

Vice President of Clinical Services, Vicky Mieseler, says that the administrative staff began discussing this option within a week of the 2011 tornado that hit Joplin.  She recalls that they met with several federal officials from FEMA and health and senior services, and their challenge for Ozark was “for us to come up with a way to meet the needs of teens, tweens and adolescents where they feel most comfortable.”

“There’s a lot of barriers to seeking crisis counseling by that age group,” Mieseler explains.  “They oftentimes don’t feel comfortable making the phone call.”  Also, she says that the fact that they are still being parented also plays a factor in these situations. 

The process began by contacting two companies that had similar products.  Eventually, the group decided to go with Talk About It in part because it had experience in which Ozark saw value. 

“They had put together a very similar plan in Mississippi following the [Hurricane] Katrina disaster,” Mieseler explains. “We felt like it could really meet our needs.”  Also, in Talk About It’s proposal it mentioned ties with the schools, the department of mental health, and the mental health provider, and Ozark felt that the way the program was packaged met their needs.   

Funding for the program

After searching for funding for over a year to support the project, Joplin Tornado First Respond Fund stepped forward and provided funding for the first year.  “The Missouri Foundation for Mental Health did a grant application for us after that and agreed to pick up the remaining six years.  So that funding allows us to have a license to use this product for seven years,” says Mieseler.     

“There’s no real continuity to buying a bunch of cell phones to use for texting so the program takes the student’s text, converts it to an email, and sends it to our computers.  We respond back in an email format, the program converts it back into a text, and it goes to the child’s phone as a text.  It works well for business because there’s no way we could manage that many phones texting out,” she explains.

Besides this conversion process, Mieseler says the license also provides Ozark with “the fact that you have 24/7 assistance if there’s technical glitches.  Kids have access to people who can help them log in and other things like that.”

The other piece of this service is that the students can not only text crisis counselors at Ozark Center, but they can also text the principal at their school, the assistant principal, or their school counselors. 

She says that this helps them to address a multitude of issues, including bullying.  “It’s an anonymous text so it allows the kids to have the freedom to report things that they might not otherwise report, fearing retaliation,” she comments. 

Additionally, it allows students to text into their principal ideas for the next themed Friday, or to vote for Homecoming court.  The idea here is to use the service often so that the students are very comfortable with it if they should need it for something serious, explains Mieseler.    

Promoting the service to the students

Although any of the 7,500 child enrolled in Joplin Schools can access the texting product, Mieseler says they targeted fourth grade and up through their marketing plan.  To do this, they held assemblies in the middle schools and used some videos from Talk About It that students produced in various area across the country.  These short videos about bullying, “mean girls,” depression, stress, and family issues were used to demonstrate what the product was and why it was being implemented.  Additionally, there were posters placed throughout the buildings with tear-off sheets they could take with them and each student was given their own card that talks about how to use the system online, and as a text, and serves as a space where they can write their user id and password hint. 

For the high school students, they viewed a video that was streamed into their communication arts classes. After viewing, the teachers would have a conversation with the students about the product.  “We really want the school to own the product and share it with the students through them, so we didn’t really have any involvement in the marketing of the product,” Mieseler remarks.

The assembly in Joplin Schools was held on Nov. 16.  The week before that, Ozark was busy getting information out to the kids about this soon-to-be program.  Between the day of the assembly and Nov. 19, Mieseler says they received 200 text messages.  Only three were mental health related but the others were school issues.  She admits that some of them could’ve been the students just “testing the system” and “seeing if the principal would really respond.”  But in any case, she says “it’s great that they were using it.”

The text message format

For the students, there is a certain format that these messages are sent in.  They all send the message to the same 5-digit number, and in that they list: a topic, someone’s name (or crisis counselor), and then their message which could be something such as, “I need help,” or “I need to talk to someone.”  With this format, the software system can recognize the recipient of the message, and send it to the correct computer.

Besides receiving messages, Mieseler explains that messages can also be pushed out. “During mental health month, we might push out information about depression in children, or stress.  In tornado season in the spring, we can push out messages about relaxation and stress reduction.  It might be a text that says, ‘Stress reduction: take three deep breaths five times today,’” she says.

In order to collect the phone numbers of the student population, Mieseler says it was a data dump that took five minutes or less to complete.  When the project gets expanded out to the community (which is included in their future goals), community members will have the opportunity to go to the website and register for the service.

Anonymity to an extent

Also included in the license fee is the opportunity to run different reports that will provide information about the topics addressed, male versus female, age groups, and school versus non-school issues.  Mieseler says this will provide “all sorts of information to help us recognize where the kids are in their second year of recovery [since the tornado].” 

To the students, their messages are anonymous because when it shows up on the recipient’s computer, they don’t know right away who sent it.  However, in the system they are identified by their student number. This is how the reports are able to be calculated and also to serve as a precautionary measure.  “In a critical situation we can identify that child, or at least the child that should be associated with that phone,” Mieseler explains.  “And we can also run a program to locate that phone if there were an emergency.” 

She says this aspect of it is the biggest concern when implementing a text program for mental health.  “It’s great, but what if it’s too late?   We always worry about things like that and we do have a lot of safeguards ready for our staff if the time comes.”

She says that the hospital works closely with the police department because of its role in mental health and emergency services. “They’re pretty excited about the opportunity too,” she comments about the police department, “and I think it will educate our kids more than they’ve ever been on what’s happening with them and mental health issues in their lives.” 

No additional staff needed

Mieseler says that no additional staff was hired for the purpose of this program because they had already had a 24/7 mental health hotline in place for many years.  Immediately following the tornado in 2011, she explains that extra staff was needed at that time and then they kept those extra staff members on because the call volume to that center had remained twice what it was pre-tornado. 

There are two crisis counselors on duty at any given moment throughout the day or night. During the day, she explains, there is an additional supervisor and coordinator in the building “so they could have four functioning at once if they had to.” 

Additionally, that team also consists of a mobile response team which she explains as “a team that works at home until they’re dispatched out to a mental health emergency.”  There is one mobile responder on duty at all times.  

For example, Mieseler explains that if a child says, “I’m very depressed, I think I want to die,” the team would talk to that child about calling them from that phone first, and then ease them into getting their parents involved and do an assessment.  “But to keep things calm for that child, we don’t necessarily want them to come into the office and make a big deal of it so we will send a counselor to their home, and do an assessment at home with the child and the parents where its more comfortable and convenient,” she says.

Working together

One issue that Ozark does not work with is adolescent substance abuse; however, it has a partner in the community that does.  Mieseler explains that the two organizations have a memorandum of understanding that allows them to work together very cleanly.   Similarly, Ozark is also a long-term partner with the local domestic violence shelter.   

“There’s nothing faster when you’re in a difficult, violent situation than texting.  A phone call is one thing and cell phones were great at the time for that purpose, but texting is safer, and so that’s why we’re going to bring them into the fold,” she says of the applicability of the technology to the domestic violence shelter.

On these sensitive issues, Mieseler says the counselors know enough about it to talk to the students about it but ultimately if it’s a treatment issue, Ozark will connect them with one of the partners.

“We’ve learned in this community following the tornado that you can’t do it all and you have to work together.  We were pretty collaborative before, but we’re even more so now,” she admits.

“I think it’s really important in the behavioral health field that we constantly push ourselves to think outside the box and look at unique and creative opportunities that break down barriers for people accessing our care,” she says.  “This is one of those products that was going to help us break down the barrier for teens, but in the process we have to look at HIPAA and compliance and all those issues that are still very important to us and very much needed in the field.  So you kind of have to balance the need of the community and what you can do legally, comfortably and safely.”