California Is Investing $500M in Therapy Apps for Youth. Advocates Fear It Won’t Pay Off.
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With little pomp, California launched two apps at the start of the year offering free behavioral health services to youths to help them cope with everything from living with anxiety to body acceptance.
Through their phones, young people and some caregivers can meet BrightLife Kids and Soluna coaches, some who specialize in peer support or substance use disorders, for roughly 30-minute virtual counseling sessions that are best suited to those with more mild needs, typically those without a clinical diagnosis. The apps also feature self-directed activities, such as white noise sessions, guided breathing, and videos of ocean waves to help users relax.
“We believe they’re going to have not just great impact, but wide impact across California, especially in places where maybe it’s not so easy to find an in-person behavioral health visit or the kind of coaching and supports that parents and young people need,” said Gov. Gavin Newsom’s health secretary, Mark Ghaly, during the Jan. 16 announcement.
The apps represent one of the Democratic governor’s major forays into health technology and come with four-year contracts valued at $498 million. California is believed to be the first state to offer a mental health app with free coaching to all young residents, according to the Department of Health Care Services, which operates the program.
However, the rollout has been slow. Only about 15,000 of the state’s 12.6 million children and young adults have signed up for the apps, school counselors say they’ve never heard of them, and one of the companies isn’t making its app available on Android phones until summer.
Advocates for youth question the wisdom of investing taxpayer dollars in two private companies. Social workers are concerned the companies’ coaches won’t properly identify youths who need referrals for clinical care. And the spending is drawing lawmaker scrutiny amid a state deficit pegged at as much as $73 billion.
An App for That
Newsom’s administration says the apps fill a need for young Californians and their families to access professional telehealth for free, in multiple languages, and outside of standard 9-to-5 hours. It’s part of Newsom’s sweeping $4.7 billion master plan for kids’ mental health, which was introduced in 2022 to increase access to mental health and substance use support services. In addition to launching virtual tools such as the teletherapy apps, the initiative is working to expand workforce capacity, especially in underserved areas.
“The reality is that we are rarely 6 feet away from our devices,” said Sohil Sud, director of Newsom’s Children and Youth Behavioral Health Initiative. “The question is how we can leverage technology as a resource for all California youth and families, not in place of, but in addition to, other behavioral health services that are being developed and expanded.”
The virtual platforms come amid rising depression and suicide rates among youth and a shortage of mental health providers. Nearly half of California youths from the ages of 12 to 17 report having recently struggled with mental health issues, with nearly a third experiencing serious psychological distress, according to a 2021 study by the UCLA Center for Health Policy Research. These rates are even higher for multiracial youths and those from low-income families.
But those supporting youth mental health at the local level question whether the apps will move the needle on climbing depression and suicide rates.
“It’s fair to applaud the state of California for aggressively seeking new tools,” said Alex Briscoe of California Children’s Trust, a statewide initiative that, along with more than 100 local partners, works to improve the social and emotional health of children. “We just don’t see it as fundamental. And we don’t believe the youth mental health crisis will be solved by technology projects built by a professional class who don’t share the lived experience of marginalized communities.”
The apps, BrightLife Kids and Soluna, are operated by two companies: Brightline, a 5-year-old venture capital-backed startup; and Kooth, a London-based publicly traded company that has experience in the U.K. and has also signed on some schools in Kentucky and Pennsylvania and a health plan in Illinois. In the first five months of Kooth’s Pennsylvania pilot, 6% of students who had access to the app signed up.
Brightline and Kooth represent a growing number of health tech firms seeking to profit in this space. They beat out dozens of other bidders including international consulting companies and other youth telehealth platforms that had already snapped up contracts in California.
Although the service is intended to be free with no insurance requirement, Brightline’s app, BrightLife Kids, is folded into and only accessible through the company’s main app, which asks for insurance information and directs users to paid licensed counseling options alongside the free coaching. After KFF Health News questioned why the free coaching was advertised below paid options, Brightline reordered the page so that, even if a child has high-acuity needs, free coaching shows up first.
The apps take an expansive view of behavioral health, making the tools available to all California youth under age 26 as well as caregivers of babies, toddlers, and children 12 and under. When KFF Health News asked to speak with an app user, Brightline connected a reporter with a mother whose 3-year-old daughter was learning to sleep on her own.
‘It’s Like Crickets’
Despite being months into the launch and having millions in marketing funds, the companies don’t have a definitive rollout timeline. Brightline said it hopes to have deployed teams across the state to present the tools in person by midyear. Kooth said developing a strategy to hit every school would be “the main focus for this calendar year.”
“It’s a big state — 58 counties,” Bob McCullough of Kooth said. “It’ll take us a while to get to all of them.”
So far BrightLife Kids is available only on Apple phones. Brightline said it’s aiming to launch the Android version over the summer.
“Nobody’s really done anything like this at this magnitude, I think, in the U.S. before,” said Naomi Allen, a co-founder and the CEO of Brightline. “We’re very much in the early innings. We’re already learning a lot.”
The contracts, obtained by KFF Health News through a records request, show the companies operating the two apps could earn as much as $498 million through the contract term, which ends in June 2027, months after Newsom is set to leave office. And the state is spending hundreds of millions more on Newsom’s virtual behavioral health strategy. The state said it aims to make the apps available long-term, depending on usage.
The state said 15,000 people signed up in the first three months. When KFF Health News asked how many of those users actively engaged with the app, it declined to say, noting that data would be released this summer.
KFF Health News reached out to nearly a dozen California mental health professionals and youths. None of them were aware of the apps.
“I’m not hearing anything,” said Loretta Whitson, executive director of the California Association of School Counselors. “It’s like crickets.”
Whitson said she doesn’t think the apps are on “anyone’s” radar in schools, and she doesn’t know of any schools that are actively advertising them. Brightline will be presenting its tool to the counselor association in May, but Whitson said the company didn’t reach out to plan the meeting; she did.
Concern Over Referrals
Whitson isn’t comfortable promoting the apps just yet. Although both companies said they have a clinical team on staff to assist, Whitson said she’s concerned that the coaches, who aren’t all licensed therapists, won’t have the training to detect when users need more help and refer them to clinical care.
This sentiment was echoed by other school-based social workers, who also noted the apps’ duplicative nature — in some counties, like Los Angeles, youths can access free virtual counseling sessions through Hazel Health, a for-profit company. Nonprofits, too, have entered this space. For example, Teen Line, a peer-to-peer hotline operated by Southern California-based Didi Hirsch Mental Health Services, is free nationwide.
While the state is also funneling money to the schools as part of Newsom’s master plan, students and school-based mental health professionals voiced confusion at the large app investment when, in many school districts, few in-person counseling roles exist, and in some cases are dwindling.
Kelly Merchant, a student at College of the Desert in Palm Desert, noted that it can be hard to access in-person therapy at her school. She believes the community college, which has about 15,000 students, has only one full-time counselor and one part-time bilingual counselor. She and several students interviewed by KFF Health News said they appreciated having engaging content on their phone and the ability to speak to a coach, but all said they’d prefer in-person therapy.
“There are a lot of people who are seeking therapy, and people close to me that I know. But their insurances are taking forever, and they’re on the waitlist,” Merchant said. “And, like, you’re seeing all these people struggle.”
Fiscal conservatives question whether the money could be spent more effectively, like to bolster county efforts and existing youth behavioral health programs.
Republican state Sen. Roger Niello, vice chair of the Senate Budget and Fiscal Review Committee, noted that California is forecasted to face deficits for the next three years, and taxpayer watchdogs worry the apps might cost even more in the long run.
“What starts as a small financial commitment can become uncontrollable expenses down the road,” said Susan Shelley of the Howard Jarvis Taxpayers Association.
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Rest For The Restless (Legs)
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Any tips for dealing with restless legs syndrome?❞
As a neurological disorder (Willis-Ekbom Disease, as it is also called
by almost nobody outside of academia), there’s a lot that’s not known about its pathology, but we do know that looking after one’s nerves can help a lot.This means:
- Avoid alcohol, as this is bad for everything, including nerves
- See also: How To Reduce Or Quit Alcohol
- Don’t smoke, as this is bad for everything, including nerves
- Do exercise those restless legs! It may sound funny, but in seriousness, movement promotes nerve health
- See also: Walking… Better.
- Take care of your blood sugars, because diabetic neuropathy can also cause this
- See also: 10 Ways To Balance Blood Sugars
- Massage your legs, and enjoy a hot bath/shower
You can also take into account the measures recommended for dealing with peripheral neuropathy, e.g:
Peripheral Neuropathy: How To Avoid It, Manage It, Treat It
There are also medication options for RLS; most of them are dopamine agonists, so if you want to try something yourself before going the pharmaceutical route, then things that improve your dopamine levels will probably be a worth checking out. In the category of supplements, you might enjoy:
NALT: The Dopamine Precursor And More
Take care! And… Want something answered here? Send us your questions!
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- Avoid alcohol, as this is bad for everything, including nerves
Own Your Past Change Your Future – by Dr. John Delony
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This one is exactly what it says on the cover. It’s reminiscent in its premise of the more clinically-presented Tell Yourself A Better Lie (an excellent book, which we reviewed previously) but this time presented in a much more casual fashion.
Dr. Delony favors focusing on telling stories, and indeed this book contains many anecdotes. But also he bids the reader to examine our own stories—those we tell ourselves about ourselves, our past, people around us, and so forth.
To call those things “stories” may create a knee-jerk response of feeling like it is an accusation of dishonesty, but rather, it is acknowledging that experiences are subjective, and our framing of narratives can vary.
As for reframing things and taking control, his five-step-plan for doing such is:
- Acknowledge reality
- Get connected
- Change your thoughts
- Change your actions
- Seek redemption
…which each get a chapter devoted to them in the book.
You may notice that these are very similar to some of the steps in 12-step programs, and also some religious groups and/or self-improvement groups. In other words, this may not be the most original approach, but it is a tried-and-tested one.
Bottom line: if you feel like your life needs an overhaul, but don’t want to wade through a bunch of psychology to do it, then this book could be it for you.
Click here to check out Own Your Past To Change Your Future, and do just that!
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Body Language (In The Real World)
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Forget What You Think You Know About Body Language
…unless it’s about a specific person whose habits and mannerisms you know intimately, in which case, you probably have enough personal data stored up to actually recognize patterns à la “when my spouse does this, then…”, and probably do know what’s going on.
For everyone else… our body language can be as unique as our idiolect
What’s an idiolect? It’s any one given person’s way of speaking/writing, in their natural state (i.e. without having to adjust their style for some reason, for example in a public-facing role at work, where style often becomes much narrower and more consciously-chosen).
Extreme example first
To give an extreme example of how non-verbal communication can be very different than a person thinks, there’s an anecdote floating around the web of someone whose non-verbal autistic kid would, when he liked someone who was visiting the house, hide their shoes when they were about to leave, to cause them to stay longer. Then one day some relative visited and when she suggested that she “should be going sometime soon”, he hurried to bring her her shoes. She left, happy that the kid liked her (he did not).
The above misunderstanding happened because the visitor had the previous life experience of “a person who brings me things is being helpful, and if they do it of their own free will, it’s because they like me”.
In other words…
Generalizations are often sound… In general
…which does not help us when dealing with individuals, which as it turns out, everyone is.
Clenched fists = tense and angry… Except when it’s just what’s comfortable for someone, or they have circulation issues, or this, or that, or the other.
Pacing = agitated… Except when it’s just someone who finds the body in motion more comfortable
Relaxed arms and hands = at ease and unthreatening… Unless it’s a practitioner of various martial arts for whom that is their default ready-for-action state.
Folded arms = closed-off, cold, distant… Or it was just somewhere to put one’s hands.
Lack of eye contact = deceitful, hiding something… Unless it’s actually for any one of a wide number of reasons, which brings us to our next section:
A liar’s “tells”
Again, if you know someone intimately and know what signs are associated with deceit in them, then great, that’s a thing you know. But for people in general…
A lot of what is repeated about “how to know if someone is lying” has seeped into public consciousness from “what police use to justify their belief that someone is lying”.
This is why many of the traditional “this person is lying” signs are based around behaviors that show up when in fact “this person is afraid, under pressure, and talking to an authority figure who has the power to ruin their life”:
Research on Non-verbal Signs of Lies and Deceit: A Blind Alley
But what about eye-accessing cues? They have science to them, right?
For any unfamiliar: this is about the theory that when we are accessing different parts of our mind (such as memory or creativity, thus truthfulness or lying), our eyes move one way or another according to what faculty we’re accessing.
Does it work? No
But, if you carefully calibrate it for a specific person, such as by asking them questions along the lines of “describe your front door” or “describe your ideal holiday”, to see which ways they look for recall or creativity… Then also no:
The Eyes Don’t Have It: Lie Detection and Neuro-Linguistic Programming
How can we know what non-verbal communication means, then?
With strangers? We can’t, simply. It’s on us to be open-minded, with a healthy balance of optimism and wariness.
With people we know? We can build up a picture over time, learn the person’s patterns. Best of all, we can ask them. In the moment, and in general.
For more on optimizing interpersonal communication, check out:
Save Time With Better Communication
…and the flipside of that:
The Problem With Active Listening (And How To Do It Better)
Take care!
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Team’s Personal Health Practices Disagreements?
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You’ve Got Questions? We’ve Got Answers!
Q: I’m curious how much of these things you actually use yourselves, and are there any disagreements in the team? In a lot of places things can get pretty heated when it’s paleo vs vegan / health benefits of tea/coffee vs caffeine-abstainers / you need this much sleep vs rise and grinders, etc?
A: We are indeed genuinely enthusiastic about health and productivity, and that definitely includes our own! We may or may not all do everything, but between us, we probably have it all covered. As for disagreements, we’ve not done a survey, but if you take an evidence-based approach, any conflict will tend to be minimized. Plus, sometimes you can have the best of both!
- You could have a vegan paleo diet (you’d better love coconut if you do, though!
- There is decaffeinated coffee and tea (your taste may vary)
- You can get plenty of sleep and rise early (so long as an “early to bed, early to rise” schedule suits you!)
Interesting note: humans are social creatures on an evolutionary level. Evolution has resulted in half of us being “night owls” and the other half “morning larks”, the better to keep each other safe while sleeping. Alas, modern life doesn’t always allow us to have the sleep schedule that’d suit each of us best individually!
Have a question you’d like answered? Reply to this email, or use the feedback widget at the bottom! We always love to hear from you
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Hummus vs Guacamole – Which is Healthier?
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Our Verdict
When comparing hummus to guacamole, we picked the guacamole.
Why?
First up, let’s assume that the standards are comparable, for example that both have been made with simple whole foods. The hummus is mostly chickpeas with tahini and a little olive oil and some seasoning; the guacamole is mostly avocado with a little lime juice and some seasoning.
In terms of macronutrients, hummus has slightly more protein and fiber, 2x the carbohydrates (but they are healthy carbs), and usually slightly less fat (but the fats are healthy in both cases).
In terms of micronutrients, the hummus is rich in iron and B vitamins, and the guacamole is rich in potassium, magnesium, vitamins C, E, and K.
So far, it’s pretty much tied. What else is there to consider?
We picked the guacamole because some of its nutrients (especially the potassium, magnesium, and vitamin K) are more common deficiencies in most people’s diets than iron and B vitamins. So, on average, it’s probably the one with the nutrients that you need more of at any given time.
So, it was very very close, and it came down to the above as the deciding factor.
However!
- If you like one and not the other? Eat that one; it’s good.
- If you like both but feel like eating one of them in particular? Eat that one; your body is probably needing those nutrients more right now.
- If you are catering for a group of people? Serve both!
- If you are catering for just yourself and would enjoy both? Serve both! There’s nobody to stop you!
Want to read more?
You might like: Avocado Oil vs Olive Oil – Which is Healthier?
Enjoy!
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16 Overlooked Autistic Traits In Women
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We hear a lot about “autism moms”, but Taylor Heaton is an autistic mom, diagnosed as an adult, and she has insights to share about overlooked autistic traits in women.
The Traits
- Difficulty navigating romantic relationships: often due to misreading signs
- Difficulty understanding things: including the above, but mostly: difficulty understanding subtext, when people leave things as “surely obvious”. Autistic women are likely to be aware of the possible meanings, but unsure which it might be, and may well guess wrongly.
- Masking: one of the reasons for the gender disparity in diagnosis is that autistic women are often better at “masking”, that is to say, making a conscious effort to blend in to allistic society—often as a result of being more societally pressured to do so.
- Honesty: often to a fault
- Copy and paste: related to masking, this is about consciously mirroring others in an effort to put them at ease and be accepted
- Being labelled sensitive and/or gifted: usually this comes at a young age, but the resultant different treatment can have a lifetime effect
- Secret stims: again related to masking, and again for the same reasons that displaying autistic symptoms is often treated worse in women, autistic women’s stims tend to be more subtle.
- Written communication: autistic women are often more comfortable with the written word than the spoken
- Leadership: autistic women will often gravitate to leadership roles, partly as a survival mechanism
- Gaslighting: oneself, e.g. “If this person did this without that, then I can to” (without taking into account that maybe the circumstances are different, or maybe they actually did lean on crutches that you didn’t know were there, etc).
- Inner dialogue: rich inner dialogue, but unable to express it outwardly—often because of the sheer volume of thoughts per second.
- Fewer female friends: often few friends overall, for that matter, but there’s often a gender imbalance towards male friends, or where there isn’t, towards more masculine friends at least.
- Feeling different: often a matter of feeling one does not meet standard expectations in some fashion
- School: autistic women are often academically successful
- Special interests: often more “socially accepted” interests than autistic men’s.
- Flirting: autistic women are often unsure how to flirt or what to do about it, which can result in simple directness instead
For more details on all of these, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Related reading:
You might like a main feature of ours from not long back:
Miss Diagnosis: Anxiety, ADHD, & Women
Take care!
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