Texas Tech telemedicine improves teens’ mental health in 24 school districts
RALLS, Texas (KXAN) — There’s something students at Ralls High School can always count on: a smiling face waiting to greet them. On this unusually chilly West Texas morning in May, high school principal Miguel Salazar stands at the double glass doors. The heels of his black square toe cowboy boots help hold one side open as dozens of teenagers walk in.
“Come on guys, check into the office,” Salazar said. “Don’t let me make you any later than you are.”
A break in the action allows Salazar to quickly glance down at his smartphone to check the time, and then he looks up and pats a couple tardy students on the back as they rush inside.
His natural, sarcastic sense of humor is how he connects best with students even when he’s pointing out a problem, and Salazar also knows all 130 of them by name. He says that’s just how it is in a rural town like Ralls, which is home to fewer than 2,000 people. It’s situated 30 miles east of Lubbock and surrounded by cotton and grain fields.
Salazar started his teaching career at the high school 15 years ago and is extremely familiar with his families. He even taught some of their parents, which means he knows a lot about their home situation and is always paying attention to how each student is feeling.
“When they’re coming in, I can almost sense that they’re having a bad day and a lot of it can just be the look on their face, how they are carrying themselves,” Salazar said.
Shay Bolm is the lone school counselor for the entire school district and splits her time between three campuses to serve more than 500 students in grades pre-kindergarten through 12. She recalls a time three years ago when two high school girls going through a traumatic experience needed more help than she could give.
“I knew this was very, very serious and it would definitely involve some doctors to get them the help that they needed,” Bolm said. “And I knew that I did not have the skills to help those girls through those things.”
Luckily, a couple of years prior Bolm had gone to some training through her district’s education service center and learned about a program called the TWITR Project, which stands for Telemedicine, Wellness, Intervention, Triage and Referral.
It’s essentially a team of mental health professionals from the Texas Tech University Health Sciences Center in Lubbock who step in to help middle and high school students at risk of hurting themselves or others at school. The team meets with students and their parents on campus, screens them and then sets up telemedicine appointments with a psychiatrist so they can talk face-to-face through a computer.
Bolm referred her first student to the program in the fall of 2014. Since then, the TWITR Project has helped about 20 Ralls middle and high school students – including the two girls she spoke about.
“These girls are in college and just doing wonderful things and moving on with their life as if nothing ever happened,” Bolm said. “And TWITR Project are the people that bridged that gap for them.”
She calls the program a godsend. An entire team of doctors coms together to discuss each child, their behaviors and meet with their parents to get their input on what they’re noticing at home.
The big picture
Ralls is one of 24 mostly rural school districts who are part of the TWITR Project. It started with ten school districts in the Lubbock area, and recently expanded to five more districts in the Amarillo area. A new contract is also in the works with the Borger Independent School District for the 2019 – 2020 school year.
The program is funded by the Office of Texas Governor Criminal Justice Division Juvenile Justice Grant Program, the Texas Health and Human Services Commission and TTUHSC matching funds. In 2018, Texas Tech received a one-year $360,885 grant from the THHSC, matched by a portion of TTUHSC funds, to begin the Amarillo expansion.
TWITR has three licensed professional counselors who travel to the campuses to hold initial meetings with students and families. They look for LPCs who have a good history with children ages 12 to 18.
The program’s success is measured by looking at a “before and after” of the following:
- student grades
- attendance and tardies
- discipline
In Ralls, Salazar said the transformation has been apparent. He’s seen student attendance improve and discipline go down.
“Before TWITR project they were a wreck. They were not able to function, they were not able to wake themselves up in the morning and get motivated to come to school, much less do anything when they’re at school,” Salazar said. “Seeing TWITR Project getting involved with their life and seeing how they can function and walk the halls … they still have bad days, but it seems they have more good days than they do bad days.”
Parents and students are required to sign consent forms to opt into the program, which also gives the LPCs access to confidential student files. Bolm said they’ve never had a parent deny the services, but one of the biggest issues is parents not following through when TWITR recommends they continue appointments long-term.
Doctors accept insurance, but families become financially responsible at that point. They also have to make the 30-minute drive into Lubbock for doctors visits. It can be difficult for a single parent. Some parents at Ralls work out of town, leaving a grandparent to take care of children during the week.
The leader of the TWITR Project, TTUHSC executive vice president of rural health Billy Philips Jr., PhD, MPH told KXAN distance is one of the biggest hurdles families face because they are serving rural communities. A parent might work 30 minutes away from their child’s campus and have trouble getting to an appointment.
“We actually didn’t have in the latter years of the program issues of students not showing up,” Philips said. “Often the kids who had the most profound problems had families who wanted the help.”
Philips said TWITR does not work with children who have disabilities or those involved in the criminal justice system because there are already mental health programs set up to help those student populations. In addition, TWITR does not have the authority to remove a child from the classroom or school. That decision is left up to school administrators.
Many people ask Philips, ‘How many shootings has your program prevented?’ He said that was never the mission.
“The purpose was to find kids with mental health issues that needed help so they didn’t get to a desperate place where they did something like that,” he said.
The future of the TWITR Project
Bolm said Ralls High School has been fortunate. She can’t recall a time when a student took their own life or others’. She looks forward to continuing the partnership with TWITR this next school year. In order for the program to work, it’s dependent on building good relationships with students so they can identify when something is off.
“Every time I see [a tragedy like the Santa Fe High School shooting] happen I think, ‘Is there anybody I’m missing? Is there anybody that I have not noticed? Who is the quiet one that maybe not as many kids are talking to? Because that’s the kid I need to zero in on, and I need to build that relationship. I need to make them feel like it’s OK to come to talk to me.”
The TWITR Project has been tasked by the Governor’s office to come up with a model that could work for schools across the state. Philips’ goal is to continue serving the 24 districts they contract with, and at the same time create a training program for educators in other districts to help them put something similar in place on their own.
He said the plan is in motion, and he will be able to share more in the coming months.