May 27, 2025 • 30 mins
New evidence shows that a one-time intervention can lead to lasting improvement in the lives of young people struggling with mental health problems. In this episode, Jessica Schleider, PhD, associate professor of Medical Social Sciences, explains how she is using this approach to scale single-session interventions (SSIs) to reach more people in need of mental health services.
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(00:04):
Today's guest says, A major driverof today's youth mental health
crisis may be the inaccessibility oftimely, effective mental health care.
Dr. Jessica Schneider aims tosolve this problem with a bold
evidence-based approach, singlesession interventions or ssis.
These are structured research-backedprograms designed to deliver
(00:26):
meaningful mental health support toyoung people in just one encounter.
Her research shows that evenone well-designed session can
lead to lasting improvements inyouth and adult mental health.
She's an associate professor ofmedical social sciences at Northwestern
University, Feinberg School ofMedicine, and the director of the
lab for scalable mental health,where she's experimenting with what
(00:48):
accessible, scalable care can look like.
We welcome her to the show today to talkabout her research and the power of a
first and only intervention, and the fightagainst the youth mental health crisis.
Welcome to the show.
Thank you so much for having me.
Well, it's wonderful to have you here, andI first want you to set the stage for us.
You've described the youth mental healthcrisis as not only a crisis of increasing
(01:13):
illness, but of inadequate access.
Talk to me about that, and what doyou think are the most important
factors driving this crisis thatwe're seeing here in America?
So this crisis is nothing new.
Although I think that the news mediaand public conception of the crisis has
really spiked since the onset of theCOVID-19 pandemic and the sudden loss
(01:36):
of access to supports that many folks,especially young people experienced
across the country in the world.
But there are really threedriving factors among many.
But three that I think are particularlyimportant in helping us understand
why this crisis has emerged.
First of all we've spent, you know,50, 60 years as a field clinical
(01:59):
psychology, psychiatry, mentalhealth research, identifying and
developing effective interventionsfor youth mental health problems.
Unfortunately.
Those interventions are broadlynot being delivered and not being
accessed by those who need them.
And today about 80% of young people withsignificant mental health needs in the
(02:21):
United States don't ever access services.
That has to do with a varietyof barriers that they face,
including provider shortages.
That's a huge one.
Yeah So there simplyaren't enough providers.
There's not enough supply tomeet the immense demand for
youth mental health support.
beyond provider shortages, a second reasonthat many youth fail to access mental
(02:45):
health support when they need and wantit is because supports aren't located
where youth can actually access them.
Most traditional evidence-based supportsor if therapies in general are located in
health systems sta freestanding clinics.
Places where youth have to activelytravel to and the logistics of
traveling and continuously paying forservices are often infeasible for many
(03:09):
families in need who are facing allsorts of logistical barriers to care.
Youth, if we, if we actually talk tothem and ask them how they'd like to
access and seek support, most of themsay, well, I just go on my phone.
Or I just go online orI talk to my friends.
So supports aren't located whereyouth are actually looking first
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and sometimes exclusively forthe support that they need.
The third reason that so manyinterventions don't have their
intended effect for youth is becausedespite our efforts to develop
multi-session interventions that lastweeks or months that are effective.
The most common number of times thatsomebody actually interfaces with any form
(03:50):
of mental health support based on nationalinsurance reimbursement data is one.
So we've spent a really long timecreating treatments that simply
don't match how people are actuallyinterfacing with healthcare.
This one single encounter coveringthis, was this a big revelation in the
mental health community that folks areonly really having this one encounter.
(04:12):
I wanna say that it was a big jointrevelation and we all realize this
together and are collectively shiftingour, our thinking and models of care.
But not so much.
This statistic is often news toaudiences I present to of my colleagues.
Despite working in the field for.
Sometimes many decades often, youknow, clinical psychologists and
(04:35):
psychiatrists are trained to treat folkswho do show up for services, right?
These are the lucky 20% of individualswho get through all of these
difficult barriers, get in the door.
And although early dropout as a,is a common concern many of these
clinicians aren't close enoughto the problem to really see the
scope of it across the nation.
(04:56):
So.
I do think it's been a bit of a blindspot for clinical psychologists who
are, of course, because that's all thatwe are exposed to, operating from the
perspective of serving those who are ableto get through all of those obstacles.
You actually published a study inJAMA Pediatrics where you found
that state parental consent lawsalso have a miserable impact on
(05:19):
whether or not teens get treatment.
What does that mean?
Talk to me about these statelaws and the significance that
this has on these barriers to
Sure.
So this is so important to ourwork right now and in shaping
how we think about what truly.
Scalable interventions need to looklike because it's not just the logistics
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and the cost of care, it's alsopolicies that make them intermittently
accessible to young people who need them.
So what we've learned throughout ourresearch with youth digital mental health
interventions and youth interventionsin general, is that we get very, very
different populations of young peopleand very different sample sizes when we.
(06:01):
Require parental consent for youthto take part in our trials, which
is standard versus when we securea waiver of the requirement.
That's typically there for parentalpermission for adolescents to self-refer
into interventions, specificallywhen we waive that requirement.
When adolescents are suddenly empoweredto choose whether or not they want to try
(06:23):
out a low intensity, safe mental healthtool that they can go through completely
on their own, we get far more diversity.
The folks coming into our studies,we get racial ethnic diversity
that is totally uncharacteristicof traditional clinical trials.
We get sexual and gender minorityparticipants that would otherwise
be excluded from care oftenbecause they're not comfortable
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asking their parents for help.
And that led us to dig intowhat is it about this single.
Change this requiring or notrequiring parental permission.
That makes a big difference.
So we started doing qualitativestudies with teens and when we asked
teens who couldn't access care fordepression, which is one of our
focus areas, what got in the way?
(07:05):
I. About 32 to 42% across multiplesamples said it was their families,
their parents not necessarily thattheir parents were declining their
requests to seek out treatment, butthat they simply weren't comfortable
going to their parents to ask for help.
And if you live in a state where aparent is required to refer their
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under 18-year-old child for treatments,and you're not comfortable going to
your parent, you are out of luck.
So we, we decided to do a policy mappingstudy, which was the one that was
published in JAMA Peds late last year.
And we actually found that state levelpolicies have a measurable impact on
their own, on whether or not teenswith depression access treatment.
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mean, could this be a message to parentsas well, the results of this study?
What could parents take awayfrom this new information?
I think it's a message to everybody whocares about young people's mental health.
And I think it's a prompt andreminder for parents to proactively.
Approach these kinds of conversationswith their, with their adolescent
children in particular, butalso their younger children.
(08:13):
So they grow up knowing thatthey're able to ask for help in
the environments that they're in,and they know how to ask for help.
So modeling that early on.
Signaling acceptance of support, seekingand signaling that you're going to be
there for your child and you're goingto help them and advocate for them.
And finding the support theyneed is critical because if those
(08:33):
conversations don't happen, teensare left being uncertain and
hesitating at points of actual need.
Well, your research lab, you arereally going all in on these single
session interventions and in a recentstudy you published in the annual
review of Clinical Psychology, youconfirmed that these single session
interventions can significantlyimprove mental health outcomes.
(08:56):
So talk to me about this, your approach,what's happening right now, and.
How you're designing theseinterventions to work in your lab?
Absolutely.
So I wanna preface this bysaying that, well, two things.
First of all, I don't believe that singlesession intervention should replace
anything else that is already availablein the mental healthcare ecosystem.
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That's one of the initial questions I getfrom fellow clinicians and colleagues in
my field is, but how can you say that alltreatments should just be one session?
That's not what I'm saying at all.
I am saying that we need something like.
Single sessions and other types of lowintensity interventions to bridge the
gap, that would be totally unfillable.
(09:37):
And we know it's already unfillableby existing interventions.
So that's the first piece.
the second piece is that singlesession interventions are nothing new.
I did not invent them.
They have been practicedsince before I was born.
So the first book that was publishedon single session interventions came
out written by a clinician namedOSHA Talman an Israeli psychologist.
(09:59):
Who had been practicing singlesession therapy in his, his practice
and finding that one session wassometimes surprisingly impactful
and reduced the need for additionalcare for many of his clients.
And so we're building on a longhistory of practice based evidence.
(10:19):
As well as drawing from briefintervention research and other
neighboring fields to psychology,like social psychology and public
health, which aren't often integrated.
But those are the histories andtraditions that we're drawing
on in, in doing this work.
So it's not just us my journeyinto studying single sessions
started more than 10 years ago.
(10:41):
As a graduate student in clinicalpsychology, I got incredibly
frustrated working in you know,low resource community clinics and
seeing that many families that I was.
Treating could not come backafter the initial assessment
by no fault of their own.
And all I do in the initialassessment is ask a bunch of questions
that don't actually help them.
So I started to wonder, is theresomething I could be doing in that
first session that could help themeven if they couldn't come back?
(11:05):
So I started looking into theliterature and found there was a whole.
scope of studies on this topic, but theywere all kind of called different things,
so nobody had synthesized all of it.
And that initial meta-analysis that Ipublished in 2017 became the basis for
the work that my lab does studying whatcan be accomplished in a single session.
(11:27):
So in terms of how we think aboutdeveloping and designing single
session interventions we thinkof single session interventions,
first of all, as an umbrella term
that can include, supports thatare designed to affect some kind of
clinically meaningful change in oneencounter that can be either digital
(11:47):
and self-guided interventions.
So things completed online oron devices and things that are
provider delivered, delivered byclinicians, either lay providers,
so providers without professionaltraining or licensed professionals.
And we see the digital single sessioninterventions as bridging gaps for folks.
Who don't ever make it in the frontdoor of a mental health clinic, right?
(12:10):
Folks who are looking on social mediafor support, who can be connected with
a digital single session tool rightaway, whereas the provider delivered
single sessions, we see as more bridginggaps within healthcare systems, such
as for folks on long waiting lists fortreatment, which were a huge problem and
actually lead to deterioration if they'retoo lengthy once folks seek out help.
(12:32):
So in either case.
These single sessions are structured suchthat they promote a sense of autonomy.
The idea that, you know, youractions affect your future.
The notion of relatedness, like there'ssomebody out there who understands
and cares about you and has beenwhere you are and gotten through it.
It.
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And competence, like all of the ssisteach a really specific granular skill
that helps somebody learn better how todeal with a problem in front of them.
And those facets, autonomycompetence and relatedness.
Those are really the mechanismsof change through which a single
session encounter can help peopletake that best next step towards.
(13:18):
future that's better, that's valued.
And that's a little bit freerof their, of their symptoms.
You mentioned tools that someone cantake away from this one time encounter.
Can you gimme an example ofwhat those might look like?
What tools they couldtake out into the world?
I.
Absolutely.
These tools are also nothingnew to psychologists.
We've been studying them in longer termmulti-session interventions for decades.
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But each single session interventionessentially takes a kernel of a
longer multi-component evidence-basedtreatment and synthesize it down
to a unit, a minimally viable unitthat can still have an effect.
So one of our interventions, asan example, teaches the idea that.
What you do can shape how you feel.
(14:00):
It's extremely simple.
But what that corresponds to isthe skill in cognitive behavioral
therapy of behavioral activation.
So we help people understandthrough interactive, self-guided
exercises personal mood experimentthat we guide people through and
the creation of an action plan.
We actually show and tellthem, here is how you can take.
(14:23):
Steps to engage in activities thatyou value, that make you feel like
you, to help you support a bettermood when you're feeling stuck.
And every single person who goesthrough this behavioral activation,
SSI, which we call the A BCproject, action brings change.
They end up with a personalizedaction plan for taking valued
(14:44):
based steps in their own life tomanage their mood more effectively.
And this is one of several singlesession interventions that we've
tested in large RCTs, randomizedcontrolled trials found actually can
reduce adolescent depression even
Wow.
later compared to activecontrol conditions.
And it's available for free foranybody to use on our lab website.
(15:05):
And your lab website has a lot of tools.
I mean, how many different projectsare you piloting right now with these
digital tools?
Too many arguably.
We, I mean, the goal is to createsingle session experiences, encounters
that are accessible anywhere, anytimefor whatever problem or difficulty
(15:27):
somebody happens to be presenting with.
So we need a library of them.
To really be able to pivot so peoplecan select, that's what that problem is.
The one I resonate with thatskill is the one I need right now.
I'm gonna try this one.
And especially, you know, if time is soprecious, and especially for folks who
are not necessarily treatment seeking,who are finding these interventions
online, while they're scrolling througha social media feed, we need to make sure
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we're hitting exactly the right target.
So as a result, we're.
Testing, deploying, disseminating,implementing at least, 20 different
single session interventions in differentsettings all over the country and the
world, including primary care schoolswithin social media platforms, is just
in time supports for folks who type for,for example, suicide into the search bar.
(16:13):
So indicating that theyneed some help right away.
Through one of our nonprofit partnerships,they actually do get offered a single
session intervention in those moments.
So we're, we're trying all the thingswe can think of to figure out how to
disseminate these brief interventionsthat we have sufficient evidence for
at this point to really scale up.
And you mentioned these aregoing to people around the world.
(16:34):
Accessibility huge partof what you're doing.
These are coming to folks in their ownnative language in many cases as well.
Tell me about this undertakingand how important it is to add
that kind of cultural competencyinto what you're doing.
I.
Sure.
So we've been incredibly fortunateas we've expanded this work.
And I think because we make all of ourintervention materials freely available,
(16:56):
which is unfortunately atypical in theintervention science field colleagues
and, and, and potential collaboratorsall over the country have approach
and, and the world really have, have.
Reached out to our lab asking if theycan embark on a project, a collaboration
to culturally adapt and translatethe evidence-based digital single
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session interventions that we've built.
So we've been in incredibly lucky topartner with so many different folks and
talented individuals to do just that.
The suite of single session digitalself-guided tools for teens on our
website are now available in atleast nine different languages.
We're working on several morethat will be posted soon.
it's been a really rewarding process, notjust to build these interventions for,
(17:41):
youth living in parts of the world where.
The mental health infrastructure foryoung people is non-existent, but
getting to actually test the utility andacceptability and effectiveness of these
interventions in different languages suchsuch as Polish and Ukrainian and Arabic
and Spanish, and a host of of others.
(18:02):
But it's, it's been really excitingto see, how much this model
of providing support resonates
with what folks who are close to thedaily problems and accessibility actually
see as, as being a good solution?
Can you share some anecdotes or successstories with me of what you've heard as
a result of some of these interventions?
Absolutely.
(18:22):
So one of our team's favorite parts ofdoing this research is going through
the qualitative feedback, the writtenfeedback that we get from adolescents.
On how they respondedto our interventions.
much as I love to see the numericpoints on their depression score
go down months later, it's a littlebit more exciting to see them write
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a personal note to you that says, Ifeel understood for the first time.
Or, I feel like I can talk, I canverbalize what I'm experiencing now,
or I feel ready to ask for more help.
And that's really importanttoo, is what we see is.
Not only are the single sessioninterventions that promote, you know,
autonomy competence relatedness,helping to reduce symptoms directly,
(19:10):
but they're also supporting young people
in feeling motivated and able to askfor more support if they need it.
So the effects are, are really twofold.
I think one of the, the best ways tosee the, the impact that Teens report
having from these interventions is to goto our website and click on Project yes.
(19:31):
Project, yes stands for YouthEmpowerment and Support.
And if you click on the advice centerin Project Yes, that is actually, a
repository that we keep, because afterevery single session intervention that a
team completes, we ask them, Hey, do youwanna give advice based on what you just
learned in your own experience to others?
And if you want us to, we'll sharethat advice publicly on our project.
(19:54):
Yes.
And anonymously on our project Yes.
Website.
So you can actually scroll throughand see feedback from teens.
Across the country and across theworld on what they learned from the
interventions and what they would advisetheir peers to do in times of distress.
Which I think really speaks to theimpact that these interventions can have.
And of teens to
(20:16):
Hmm.
wanna help themselves,but help others too.
I mean, this whole project in yourlab is a really beautiful illustration
of implementation science in action.
Tell
Tell
me.
Tell me about moving your lab hereto Northwestern and the Infras
and the infrastructure here that'sallowed you to really dive into
this implementation of the research.
Absolutely.
(20:36):
So this move was just so idealfor the work and mission that we
share in, in, in so many ways.
And you know, I started the labin 2018 and spent the first.
Five years of my career at a universitythat I thoroughly enjoyed being at.
And learned pretty quickly after fiveyears of doing randomized trials and
(21:00):
effectiveness testing of do SSIS work.
We had our answer.
Yeah, they can work for somepeople in some circumstances.
They can both reduce symptoms andincrease motivation for further outreach.
And it came to this point of Ican't just keep running the same
clinical trial over and over again.
We already know the answer.
(21:21):
We really need to shift our focusfrom intervention science to
implementation science, the scienceof getting what works out there in
a systematic and sustainable manner.
To actually reduce disparities inaccess to care and implementation
science is inherently a team sport.
It is not a solo activity.
(21:42):
So I knew that our lab needed tomove to a place with a community
of implementation, scientistsdoing community partnered research.
Multi-sector research at alarge and impactful scale.
I knew I needed to begin a communitywith other folks doing digital
mental health research at a largenational scale to really move
(22:04):
the needle on population health.
And I. Northwestern was theobvious place to do that.
with the influx of experts inimplementation science and with the
Center for Behavioral InterventionTechnologies here, it's, it's a huge
hub for all of the things that ourlab tries to integrate, which is
this population health perspective,implementation and intervention science
(22:26):
and digital mental health for scale.
situating our work within thisenvironment has just allowed us to.
Really skyrocket the scope of, of our workexpand the array of community partners
we're able to meaningfully work with andreally grow towards the goal, which is to
get evidence-based tools out to everybodywho needs them at precise moments of need.
(22:49):
I would like to hear a little bit moreabout the community partners that you've
been able to work with and establish here.
Tell me about that.
Sure.
So moving to Northwestern, one of thegreat things was that I moved from a
position where a lot of my time wasspent teaching and doing clinical
supervision, which I love to anenvironment where I felt like I could
be most effective in what I'm, I feelI'm best at, which is the science I.
(23:12):
And running a team that extrabandwidth and the infrastructure at
Northwestern to support non-traditionalkinds of partnerships and research
contracts and services agreementshas given us so much freedom to
explore new types of partnershipswith different agencies and entities.
One that I'm particularly excited about isa partnership that involves many different
(23:34):
partners including in the nonprofitspace and the state government space.
Hmm.
So for this project, we're actually,our lab has a established a, a
relationship with the state of Montana,
Okay.
Which is almost entirely a federallydesignated mental healthcare provider
shortage area to disseminate singlesession digital interventions
(23:57):
across the state and create.
Basically toolkits for pediatricians,for schools, and for parents to be
able to learn about what single sessioninterventions are and offer them
sustainably in their organizations.
So for this project, we're workingwith a psychiatry clinic called
Frontier Psychiatry as well as anonprofit pediatric pri primary care
(24:21):
organization called Montana Pediatric.
We have funding from the state as wellas donors to basically deploy, test, and
sustainably implement a platform of singlesession interventions across the state.
And that platform is somethingthat we've built in collaboration
with a nonprofit partner, cocoa,
which is a digital, mental healthnonprofit company that builds basically
(24:47):
they're our, they're our tech partner.
Right.
They help us build the ssis intoan infrastructure that we as
scientists are not equipped to.
Right.
app
so it's actually a, just apublicly available website.
Yep.
and it's availablethrough Coco's interface.
And the reason it's not an app isbecause downloading something is
(25:09):
actually a barrier to access and a lot
of.
to the URL, type
Exactly, and that makes it anonymousfor teens to use too, so they don't have
to give away any personal informationin order to access the intervention.
Which we found in our focus groups withyoung people is extremely important
because they're worried about whatwill happen to their information or who
will be told that they're using this.
(25:30):
with all those partners,we're, we're working on this
mixed methods implementation,
Wow.
intervention science, large scalestatewide study where hopefully
we'll be able to see at scale, whatcan these really do when deployed
sustainably across the state.
There's been a recent Feinberg studypublished showing that there is a lack
of access to mental health care inthese rural areas, and this is a big
(25:54):
problem for teens and young adults.
Can you just talk to thata little bit as well?
A hundred percent.
And you know, one of the, another facultymember or research assistant professor
in my lab, Dr. Erica Kody this is a bigfocus of their research, is understanding
how single session interventionscan support rural populations.
they Previously did a year of theirclinical training in Alaska in a
(26:17):
super small town where really thereare no options for care and they're
bringing that passion for the work tothe single session intervention space.
So they actually let us study a year orso ago looking at whether single session
interventions could produce equitableeffects in young people in rural areas.
(26:38):
Versus urban areas in the country.
'cause we do nationwide clinical trials.
And what we found wasthat we were actually.
Coming up with an over-representationof rural teens in our studies.
So these interventions may circumventsome of the barriers to access you
know, often facing rural communities.
But they also were just as acceptableand just as effective for these young
(26:59):
people as for their urban counterpartswhich was really exciting and.
Kind of set the stage forthis partnership with Montana.
And that's one of the reasons thatthe community partnership we're
pursuing is so critical because it'snot just that we drop this preexisting
intervention suite into this, the stateand say, okay, now it, it'll just go.
(27:21):
We have to actually tailor.
The components of the interventions, thestories, the narratives that are included
in the single session interventions tomake sure that people in that community
see themselves in this platform andprogram that it's built for them.
That it's clear that we tooktheir needs into account.
And the dissemination toolkits that we'recreating for pediatricians and schools
(27:42):
have to be fit to the context that
Hmm.
and the resource limitationsthat they're up against.
So because we're partnering with MontanaYouth, Montana Providers, Montana.
Schools to build out andrefine all of these tools.
We're optimistic that what weend up with will actually be able
to sustain in their community.
There's
so many exciting things happening inyour lab right now, and in some ways
(28:03):
it feels like just the beginning.
You're just launching alot of these programs.
What is your hope for the future?
What would you like to see happen inthe next five or 10 years in your lab?
My hope for the future is that singlesession interventions are a ubiquitous
layer of support that exists in this, inthe country's mental healthcare ecosystem.
A layer of support that can.
(28:24):
Serve people as and when and whereneeds arise, such as when they first
seek out support on the internet.
Or they first call into a clinic andthey're put on a six month wait list.
They if, if they, if all clinicsjust offered single session
supports for folks waiting fortreatment, we could actually see.
population scale reductions inseverity of problems that people are
(28:48):
starting treatment with populationlevel increases in the speed
with which people could recover.
And if single session interventionswere just built into, you know,
large online platforms that.
Millions of peopleaccess every single day.
We could catch so many problemsbefore they worsen to crisis points.
And we know that once they do, it's much,much harder to treat people effectively.
(29:10):
And we increase risk exponentiallyfor outcomes like suicide.
So I wanna see a, a change in themental healthcare ecosystem where
single session interventions are just.
Something that everyone knows aboutand everyone can access as needed.
I also wanna see systems like insurancereimbursement change to accommodate
(29:32):
single session interventions.
Right now, there's no real mechanismthrough public insurance anyway,
for reimbursing for an interventionfor somebody on a waiting list, for
example, because they're technicallynot a patient yet and they haven't
gotten a diagnosis yet, so.
What code are you gonna use?
We're actually working with communityhealth agencies in the department of
mental health in Pennsylvania to testout a new temporary reimbursement code
(29:56):
for that exact purpose that we're hopefulif we can show through our pilot in the
state that single session interventionsfor folks on wait list are helpful.
We'll become permanent and maybe other
Yes.
to take it up.
think just openness to singlesession supports that needs to
change knowledge that needs to
Yeah.
and structures and systemsthat support their sustainable
implementation would need to change.
(30:17):
And hopefully our lab can bea part of all those shifts.
Thank you so much for sharing all thework that's happening in your lab and
your vision for the future as well.
We really appreciate it.
My pleasure.
Thanks so much for having me.
Thanks for listening.
Please click the bell to receivenotifications about our latest
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(30:39):
up to date with our latest research
findings.
Today's guest says, A major driverof today's youth mental health
crisis may be the inaccessibility oftimely, effective mental health care.
Dr. Jessica Schneider aims tosolve this problem with a bold
evidence-based approach, singlesession interventions or ssis.
These are structured research-backedprograms designed to deliver
(00:26):
meaningful mental health support toyoung people in just one encounter.
Her research shows that evenone well-designed session can
lead to lasting improvements inyouth and adult mental health.
She's an associate professor ofmedical social sciences at Northwestern
University, Feinberg School ofMedicine, and the director of the
lab for scalable mental health,where she's experimenting with what
(00:48):
accessible, scalable care can look like.
We welcome her to the show today to talkabout her research and the power of a
first and only intervention, and the fightagainst the youth mental health crisis.
Welcome to the show.
Thank you so much for having me.
Well, it's wonderful to have you here, andI first want you to set the stage for us.
You've described the youth mental healthcrisis as not only a crisis of increasing
(01:13):
illness, but of inadequate access.
Talk to me about that, and what doyou think are the most important
factors driving this crisis thatwe're seeing here in America?
So this crisis is nothing new.
Although I think that the news mediaand public conception of the crisis has
really spiked since the onset of theCOVID-19 pandemic and the sudden loss
(01:36):
of access to supports that many folks,especially young people experienced
across the country in the world.
But there are really threedriving factors among many.
But three that I think are particularlyimportant in helping us understand
why this crisis has emerged.
First of all we've spent, you know,50, 60 years as a field clinical
(01:59):
psychology, psychiatry, mentalhealth research, identifying and
developing effective interventionsfor youth mental health problems.
Unfortunately.
Those interventions are broadlynot being delivered and not being
accessed by those who need them.
And today about 80% of young people withsignificant mental health needs in the
(02:21):
United States don't ever access services.
That has to do with a varietyof barriers that they face,
including provider shortages.
That's a huge one.
Yeah So there simplyaren't enough providers.
There's not enough supply tomeet the immense demand for
youth mental health support.
beyond provider shortages, a second reasonthat many youth fail to access mental
(02:45):
health support when they need and wantit is because supports aren't located
where youth can actually access them.
Most traditional evidence-based supportsor if therapies in general are located in
health systems sta freestanding clinics.
Places where youth have to activelytravel to and the logistics of
traveling and continuously paying forservices are often infeasible for many
(03:09):
families in need who are facing allsorts of logistical barriers to care.
Youth, if we, if we actually talk tothem and ask them how they'd like to
access and seek support, most of themsay, well, I just go on my phone.
Or I just go online orI talk to my friends.
So supports aren't located whereyouth are actually looking first
(03:29):
and sometimes exclusively forthe support that they need.
The third reason that so manyinterventions don't have their
intended effect for youth is becausedespite our efforts to develop
multi-session interventions that lastweeks or months that are effective.
The most common number of times thatsomebody actually interfaces with any form
(03:50):
of mental health support based on nationalinsurance reimbursement data is one.
So we've spent a really long timecreating treatments that simply
don't match how people are actuallyinterfacing with healthcare.
This one single encounter coveringthis, was this a big revelation in the
mental health community that folks areonly really having this one encounter.
(04:12):
I wanna say that it was a big jointrevelation and we all realize this
together and are collectively shiftingour, our thinking and models of care.
But not so much.
This statistic is often news toaudiences I present to of my colleagues.
Despite working in the field for.
Sometimes many decades often, youknow, clinical psychologists and
(04:35):
psychiatrists are trained to treat folkswho do show up for services, right?
These are the lucky 20% of individualswho get through all of these
difficult barriers, get in the door.
And although early dropout as a,is a common concern many of these
clinicians aren't close enoughto the problem to really see the
scope of it across the nation.
(04:56):
So.
I do think it's been a bit of a blindspot for clinical psychologists who
are, of course, because that's all thatwe are exposed to, operating from the
perspective of serving those who are ableto get through all of those obstacles.
You actually published a study inJAMA Pediatrics where you found
that state parental consent lawsalso have a miserable impact on
(05:19):
whether or not teens get treatment.
What does that mean?
Talk to me about these statelaws and the significance that
this has on these barriers to
Sure.
So this is so important to ourwork right now and in shaping
how we think about what truly.
Scalable interventions need to looklike because it's not just the logistics
(05:39):
and the cost of care, it's alsopolicies that make them intermittently
accessible to young people who need them.
So what we've learned throughout ourresearch with youth digital mental health
interventions and youth interventionsin general, is that we get very, very
different populations of young peopleand very different sample sizes when we.
(06:01):
Require parental consent for youthto take part in our trials, which
is standard versus when we securea waiver of the requirement.
That's typically there for parentalpermission for adolescents to self-refer
into interventions, specificallywhen we waive that requirement.
When adolescents are suddenly empoweredto choose whether or not they want to try
(06:23):
out a low intensity, safe mental healthtool that they can go through completely
on their own, we get far more diversity.
The folks coming into our studies,we get racial ethnic diversity
that is totally uncharacteristicof traditional clinical trials.
We get sexual and gender minorityparticipants that would otherwise
be excluded from care oftenbecause they're not comfortable
(06:45):
asking their parents for help.
And that led us to dig intowhat is it about this single.
Change this requiring or notrequiring parental permission.
That makes a big difference.
So we started doing qualitativestudies with teens and when we asked
teens who couldn't access care fordepression, which is one of our
focus areas, what got in the way?
(07:05):
I. About 32 to 42% across multiplesamples said it was their families,
their parents not necessarily thattheir parents were declining their
requests to seek out treatment, butthat they simply weren't comfortable
going to their parents to ask for help.
And if you live in a state where aparent is required to refer their
(07:29):
under 18-year-old child for treatments,and you're not comfortable going to
your parent, you are out of luck.
So we, we decided to do a policy mappingstudy, which was the one that was
published in JAMA Peds late last year.
And we actually found that state levelpolicies have a measurable impact on
their own, on whether or not teenswith depression access treatment.
(07:51):
mean, could this be a message to parentsas well, the results of this study?
What could parents take awayfrom this new information?
I think it's a message to everybody whocares about young people's mental health.
And I think it's a prompt andreminder for parents to proactively.
Approach these kinds of conversationswith their, with their adolescent
children in particular, butalso their younger children.
(08:13):
So they grow up knowing thatthey're able to ask for help in
the environments that they're in,and they know how to ask for help.
So modeling that early on.
Signaling acceptance of support, seekingand signaling that you're going to be
there for your child and you're goingto help them and advocate for them.
And finding the support theyneed is critical because if those
(08:33):
conversations don't happen, teensare left being uncertain and
hesitating at points of actual need.
Well, your research lab, you arereally going all in on these single
session interventions and in a recentstudy you published in the annual
review of Clinical Psychology, youconfirmed that these single session
interventions can significantlyimprove mental health outcomes.
(08:56):
So talk to me about this, your approach,what's happening right now, and.
How you're designing theseinterventions to work in your lab?
Absolutely.
So I wanna preface this bysaying that, well, two things.
First of all, I don't believe that singlesession intervention should replace
anything else that is already availablein the mental healthcare ecosystem.
(09:16):
That's one of the initial questions I getfrom fellow clinicians and colleagues in
my field is, but how can you say that alltreatments should just be one session?
That's not what I'm saying at all.
I am saying that we need something like.
Single sessions and other types of lowintensity interventions to bridge the
gap, that would be totally unfillable.
(09:37):
And we know it's already unfillableby existing interventions.
So that's the first piece.
the second piece is that singlesession interventions are nothing new.
I did not invent them.
They have been practicedsince before I was born.
So the first book that was publishedon single session interventions came
out written by a clinician namedOSHA Talman an Israeli psychologist.
(09:59):
Who had been practicing singlesession therapy in his, his practice
and finding that one session wassometimes surprisingly impactful
and reduced the need for additionalcare for many of his clients.
And so we're building on a longhistory of practice based evidence.
(10:19):
As well as drawing from briefintervention research and other
neighboring fields to psychology,like social psychology and public
health, which aren't often integrated.
But those are the histories andtraditions that we're drawing
on in, in doing this work.
So it's not just us my journeyinto studying single sessions
started more than 10 years ago.
(10:41):
As a graduate student in clinicalpsychology, I got incredibly
frustrated working in you know,low resource community clinics and
seeing that many families that I was.
Treating could not come backafter the initial assessment
by no fault of their own.
And all I do in the initialassessment is ask a bunch of questions
that don't actually help them.
So I started to wonder, is theresomething I could be doing in that
first session that could help themeven if they couldn't come back?
(11:05):
So I started looking into theliterature and found there was a whole.
scope of studies on this topic, but theywere all kind of called different things,
so nobody had synthesized all of it.
And that initial meta-analysis that Ipublished in 2017 became the basis for
the work that my lab does studying whatcan be accomplished in a single session.
(11:27):
So in terms of how we think aboutdeveloping and designing single
session interventions we thinkof single session interventions,
first of all, as an umbrella term
that can include, supports thatare designed to affect some kind of
clinically meaningful change in oneencounter that can be either digital
(11:47):
and self-guided interventions.
So things completed online oron devices and things that are
provider delivered, delivered byclinicians, either lay providers,
so providers without professionaltraining or licensed professionals.
And we see the digital single sessioninterventions as bridging gaps for folks.
Who don't ever make it in the frontdoor of a mental health clinic, right?
(12:10):
Folks who are looking on social mediafor support, who can be connected with
a digital single session tool rightaway, whereas the provider delivered
single sessions, we see as more bridginggaps within healthcare systems, such
as for folks on long waiting lists fortreatment, which were a huge problem and
actually lead to deterioration if they'retoo lengthy once folks seek out help.
(12:32):
So in either case.
These single sessions are structured suchthat they promote a sense of autonomy.
The idea that, you know, youractions affect your future.
The notion of relatedness, like there'ssomebody out there who understands
and cares about you and has beenwhere you are and gotten through it.
It.
(12:53):
And competence, like all of the ssisteach a really specific granular skill
that helps somebody learn better how todeal with a problem in front of them.
And those facets, autonomycompetence and relatedness.
Those are really the mechanismsof change through which a single
session encounter can help peopletake that best next step towards.
(13:18):
future that's better, that's valued.
And that's a little bit freerof their, of their symptoms.
You mentioned tools that someone cantake away from this one time encounter.
Can you gimme an example ofwhat those might look like?
What tools they couldtake out into the world?
I.
Absolutely.
These tools are also nothingnew to psychologists.
We've been studying them in longer termmulti-session interventions for decades.
(13:39):
But each single session interventionessentially takes a kernel of a
longer multi-component evidence-basedtreatment and synthesize it down
to a unit, a minimally viable unitthat can still have an effect.
So one of our interventions, asan example, teaches the idea that.
What you do can shape how you feel.
(14:00):
It's extremely simple.
But what that corresponds to isthe skill in cognitive behavioral
therapy of behavioral activation.
So we help people understandthrough interactive, self-guided
exercises personal mood experimentthat we guide people through and
the creation of an action plan.
We actually show and tellthem, here is how you can take.
(14:23):
Steps to engage in activities thatyou value, that make you feel like
you, to help you support a bettermood when you're feeling stuck.
And every single person who goesthrough this behavioral activation,
SSI, which we call the A BCproject, action brings change.
They end up with a personalizedaction plan for taking valued
(14:44):
based steps in their own life tomanage their mood more effectively.
And this is one of several singlesession interventions that we've
tested in large RCTs, randomizedcontrolled trials found actually can
reduce adolescent depression even
Wow.
later compared to activecontrol conditions.
And it's available for free foranybody to use on our lab website.
(15:05):
And your lab website has a lot of tools.
I mean, how many different projectsare you piloting right now with these
digital tools?
Too many arguably.
We, I mean, the goal is to createsingle session experiences, encounters
that are accessible anywhere, anytimefor whatever problem or difficulty
(15:27):
somebody happens to be presenting with.
So we need a library of them.
To really be able to pivot so peoplecan select, that's what that problem is.
The one I resonate with thatskill is the one I need right now.
I'm gonna try this one.
And especially, you know, if time is soprecious, and especially for folks who
are not necessarily treatment seeking,who are finding these interventions
online, while they're scrolling througha social media feed, we need to make sure
(15:50):
we're hitting exactly the right target.
So as a result, we're.
Testing, deploying, disseminating,implementing at least, 20 different
single session interventions in differentsettings all over the country and the
world, including primary care schoolswithin social media platforms, is just
in time supports for folks who type for,for example, suicide into the search bar.
(16:13):
So indicating that theyneed some help right away.
Through one of our nonprofit partnerships,they actually do get offered a single
session intervention in those moments.
So we're, we're trying all the thingswe can think of to figure out how to
disseminate these brief interventionsthat we have sufficient evidence for
at this point to really scale up.
And you mentioned these aregoing to people around the world.
(16:34):
Accessibility huge partof what you're doing.
These are coming to folks in their ownnative language in many cases as well.
Tell me about this undertakingand how important it is to add
that kind of cultural competencyinto what you're doing.
I.
Sure.
So we've been incredibly fortunateas we've expanded this work.
And I think because we make all of ourintervention materials freely available,
(16:56):
which is unfortunately atypical in theintervention science field colleagues
and, and, and potential collaboratorsall over the country have approach
and, and the world really have, have.
Reached out to our lab asking if theycan embark on a project, a collaboration
to culturally adapt and translatethe evidence-based digital single
(17:17):
session interventions that we've built.
So we've been in incredibly lucky topartner with so many different folks and
talented individuals to do just that.
The suite of single session digitalself-guided tools for teens on our
website are now available in atleast nine different languages.
We're working on several morethat will be posted soon.
it's been a really rewarding process, notjust to build these interventions for,
(17:41):
youth living in parts of the world where.
The mental health infrastructure foryoung people is non-existent, but
getting to actually test the utility andacceptability and effectiveness of these
interventions in different languages suchsuch as Polish and Ukrainian and Arabic
and Spanish, and a host of of others.
(18:02):
But it's, it's been really excitingto see, how much this model
of providing support resonates
with what folks who are close to thedaily problems and accessibility actually
see as, as being a good solution?
Can you share some anecdotes or successstories with me of what you've heard as
a result of some of these interventions?
Absolutely.
(18:22):
So one of our team's favorite parts ofdoing this research is going through
the qualitative feedback, the writtenfeedback that we get from adolescents.
On how they respondedto our interventions.
much as I love to see the numericpoints on their depression score
go down months later, it's a littlebit more exciting to see them write
(18:46):
a personal note to you that says, Ifeel understood for the first time.
Or, I feel like I can talk, I canverbalize what I'm experiencing now,
or I feel ready to ask for more help.
And that's really importanttoo, is what we see is.
Not only are the single sessioninterventions that promote, you know,
autonomy competence relatedness,helping to reduce symptoms directly,
(19:10):
but they're also supporting young people
in feeling motivated and able to askfor more support if they need it.
So the effects are, are really twofold.
I think one of the, the best ways tosee the, the impact that Teens report
having from these interventions is to goto our website and click on Project yes.
(19:31):
Project, yes stands for YouthEmpowerment and Support.
And if you click on the advice centerin Project Yes, that is actually, a
repository that we keep, because afterevery single session intervention that a
team completes, we ask them, Hey, do youwanna give advice based on what you just
learned in your own experience to others?
And if you want us to, we'll sharethat advice publicly on our project.
(19:54):
Yes.
And anonymously on our project Yes.
Website.
So you can actually scroll throughand see feedback from teens.
Across the country and across theworld on what they learned from the
interventions and what they would advisetheir peers to do in times of distress.
Which I think really speaks to theimpact that these interventions can have.
And of teens to
(20:16):
Hmm.
wanna help themselves,but help others too.
I mean, this whole project in yourlab is a really beautiful illustration
of implementation science in action.
Tell
Tell
me.
Tell me about moving your lab hereto Northwestern and the Infras
and the infrastructure here that'sallowed you to really dive into
this implementation of the research.
Absolutely.
(20:36):
So this move was just so idealfor the work and mission that we
share in, in, in so many ways.
And you know, I started the labin 2018 and spent the first.
Five years of my career at a universitythat I thoroughly enjoyed being at.
And learned pretty quickly after fiveyears of doing randomized trials and
(21:00):
effectiveness testing of do SSIS work.
We had our answer.
Yeah, they can work for somepeople in some circumstances.
They can both reduce symptoms andincrease motivation for further outreach.
And it came to this point of Ican't just keep running the same
clinical trial over and over again.
We already know the answer.
(21:21):
We really need to shift our focusfrom intervention science to
implementation science, the scienceof getting what works out there in
a systematic and sustainable manner.
To actually reduce disparities inaccess to care and implementation
science is inherently a team sport.
It is not a solo activity.
(21:42):
So I knew that our lab needed tomove to a place with a community
of implementation, scientistsdoing community partnered research.
Multi-sector research at alarge and impactful scale.
I knew I needed to begin a communitywith other folks doing digital
mental health research at a largenational scale to really move
(22:04):
the needle on population health.
And I. Northwestern was theobvious place to do that.
with the influx of experts inimplementation science and with the
Center for Behavioral InterventionTechnologies here, it's, it's a huge
hub for all of the things that ourlab tries to integrate, which is
this population health perspective,implementation and intervention science
(22:26):
and digital mental health for scale.
situating our work within thisenvironment has just allowed us to.
Really skyrocket the scope of, of our workexpand the array of community partners
we're able to meaningfully work with andreally grow towards the goal, which is to
get evidence-based tools out to everybodywho needs them at precise moments of need.
(22:49):
I would like to hear a little bit moreabout the community partners that you've
been able to work with and establish here.
Tell me about that.
Sure.
So moving to Northwestern, one of thegreat things was that I moved from a
position where a lot of my time wasspent teaching and doing clinical
supervision, which I love to anenvironment where I felt like I could
be most effective in what I'm, I feelI'm best at, which is the science I.
(23:12):
And running a team that extrabandwidth and the infrastructure at
Northwestern to support non-traditionalkinds of partnerships and research
contracts and services agreementshas given us so much freedom to
explore new types of partnershipswith different agencies and entities.
One that I'm particularly excited about isa partnership that involves many different
(23:34):
partners including in the nonprofitspace and the state government space.
Hmm.
So for this project, we're actually,our lab has a established a, a
relationship with the state of Montana,
Okay.
Which is almost entirely a federallydesignated mental healthcare provider
shortage area to disseminate singlesession digital interventions
(23:57):
across the state and create.
Basically toolkits for pediatricians,for schools, and for parents to be
able to learn about what single sessioninterventions are and offer them
sustainably in their organizations.
So for this project, we're workingwith a psychiatry clinic called
Frontier Psychiatry as well as anonprofit pediatric pri primary care
(24:21):
organization called Montana Pediatric.
We have funding from the state as wellas donors to basically deploy, test, and
sustainably implement a platform of singlesession interventions across the state.
And that platform is somethingthat we've built in collaboration
with a nonprofit partner, cocoa,
which is a digital, mental healthnonprofit company that builds basically
(24:47):
they're our, they're our tech partner.
Right.
They help us build the ssis intoan infrastructure that we as
scientists are not equipped to.
Right.
app
so it's actually a, just apublicly available website.
Yep.
and it's availablethrough Coco's interface.
And the reason it's not an app isbecause downloading something is
(25:09):
actually a barrier to access and a lot
of.
to the URL, type
Exactly, and that makes it anonymousfor teens to use too, so they don't have
to give away any personal informationin order to access the intervention.
Which we found in our focus groups withyoung people is extremely important
because they're worried about whatwill happen to their information or who
will be told that they're using this.
(25:30):
with all those partners,we're, we're working on this
mixed methods implementation,
Wow.
intervention science, large scalestatewide study where hopefully
we'll be able to see at scale, whatcan these really do when deployed
sustainably across the state.
There's been a recent Feinberg studypublished showing that there is a lack
of access to mental health care inthese rural areas, and this is a big
(25:54):
problem for teens and young adults.
Can you just talk to thata little bit as well?
A hundred percent.
And you know, one of the, another facultymember or research assistant professor
in my lab, Dr. Erica Kody this is a bigfocus of their research, is understanding
how single session interventionscan support rural populations.
they Previously did a year of theirclinical training in Alaska in a
(26:17):
super small town where really thereare no options for care and they're
bringing that passion for the work tothe single session intervention space.
So they actually let us study a year orso ago looking at whether single session
interventions could produce equitableeffects in young people in rural areas.
(26:38):
Versus urban areas in the country.
'cause we do nationwide clinical trials.
And what we found wasthat we were actually.
Coming up with an over-representationof rural teens in our studies.
So these interventions may circumventsome of the barriers to access you
know, often facing rural communities.
But they also were just as acceptableand just as effective for these young
(26:59):
people as for their urban counterpartswhich was really exciting and.
Kind of set the stage forthis partnership with Montana.
And that's one of the reasons thatthe community partnership we're
pursuing is so critical because it'snot just that we drop this preexisting
intervention suite into this, the stateand say, okay, now it, it'll just go.
(27:21):
We have to actually tailor.
The components of the interventions, thestories, the narratives that are included
in the single session interventions tomake sure that people in that community
see themselves in this platform andprogram that it's built for them.
That it's clear that we tooktheir needs into account.
And the dissemination toolkits that we'recreating for pediatricians and schools
(27:42):
have to be fit to the context that
Hmm.
and the resource limitationsthat they're up against.
So because we're partnering with MontanaYouth, Montana Providers, Montana.
Schools to build out andrefine all of these tools.
We're optimistic that what weend up with will actually be able
to sustain in their community.
There's
so many exciting things happening inyour lab right now, and in some ways
(28:03):
it feels like just the beginning.
You're just launching alot of these programs.
What is your hope for the future?
What would you like to see happen inthe next five or 10 years in your lab?
My hope for the future is that singlesession interventions are a ubiquitous
layer of support that exists in this, inthe country's mental healthcare ecosystem.
A layer of support that can.
(28:24):
Serve people as and when and whereneeds arise, such as when they first
seek out support on the internet.
Or they first call into a clinic andthey're put on a six month wait list.
They if, if they, if all clinicsjust offered single session
supports for folks waiting fortreatment, we could actually see.
population scale reductions inseverity of problems that people are
(28:48):
starting treatment with populationlevel increases in the speed
with which people could recover.
And if single session interventionswere just built into, you know,
large online platforms that.
Millions of peopleaccess every single day.
We could catch so many problemsbefore they worsen to crisis points.
And we know that once they do, it's much,much harder to treat people effectively.
(29:10):
And we increase risk exponentiallyfor outcomes like suicide.
So I wanna see a, a change in themental healthcare ecosystem where
single session interventions are just.
Something that everyone knows aboutand everyone can access as needed.
I also wanna see systems like insurancereimbursement change to accommodate
(29:32):
single session interventions.
Right now, there's no real mechanismthrough public insurance anyway,
for reimbursing for an interventionfor somebody on a waiting list, for
example, because they're technicallynot a patient yet and they haven't
gotten a diagnosis yet, so.
What code are you gonna use?
We're actually working with communityhealth agencies in the department of
mental health in Pennsylvania to testout a new temporary reimbursement code
(29:56):
for that exact purpose that we're hopefulif we can show through our pilot in the
state that single session interventionsfor folks on wait list are helpful.
We'll become permanent and maybe other
Yes.
to take it up.
think just openness to singlesession supports that needs to
change knowledge that needs to
Yeah.
and structures and systemsthat support their sustainable
implementation would need to change.
(30:17):
And hopefully our lab can bea part of all those shifts.
Thank you so much for sharing all thework that's happening in your lab and
your vision for the future as well.
We really appreciate it.
My pleasure.
Thanks so much for having me.
Thanks for listening.
Please click the bell to receivenotifications about our latest
episodes and follow us on socialmedia at NU Feinberg Med to stay
(30:39):
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