By Jennifer Fernandez
Key takeaways
- Early survey data from nearly 300 North Carolina schools shows that staff at schools that offer behavioral telehealth are reporting reductions in student behavioral challenges and disruptions compared with schools without the service.
- Access gaps are still a challenge, with about a third of schools reporting students wait longer than a month to get behavioral telehealth services after referral.
- Researchers at UNC Chapel Hill’s Sheps Center are working to move beyond staff perceptions toward concrete student-level data on attendance and disciplinary outcomes so they can better measure the true impact of school-based behavioral telehealth.
At North Carolina schools that provide behavioral health care remotely, teachers and school staff say they’re seeing an impact on students’ behavioral challenges.
The new data comes from initial responses to a survey by researchers at the Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill. They are working with the Collaborative for the Advancement of School Telehealth, formerly the Carolina School-Based Telehealth Learning Collaborative, to collect data on the impact of school-based telehealth programs that are focused on behavioral issues.
The researchers started collecting data and surveying participating schools in October 2025. Since data collection has just started, there’s not a lot of information to compare.
However, staff indicate that adding behavioral telehealth services has already had some impact, researchers told collaborative members during a May 15 meeting in Greensboro.
The difference in responses between schools with and without behavioral telehealth services was compelling statistically on the survey questions exploring:
- whether telehealth reduces behavioral issues and disruptions,
- whether it impacts behavioral challenges,
- whether it improves attendance and student health in general, and
- whether it increases health care access in general for students and families.
“I was a school teacher,” researcher Emily Hutchens said at a presentation to collaborative members. “Moving the needle at all on behavioral challenges at a school perception level is tremendous.”
About the school telehealth collaborative
The Collaborative for the Advancement of School Telehealth, also known as CAST, is made up of 20 partners — hospital systems, university programs and health agencies — from North Carolina, South Carolina and Virginia. They hold conferences twice a year to discuss best practices and share updates.
Previous CAST meetings have included updates on the expansion of behavioral telehealth, but the May 15 meeting was the first one solely focused on the topic.
CAST members also heard presentations on the value of universal screening, Novant Health’s telepsychiatry program and Atrium Health’s efforts to add behavioral telehealth in Georgia. The keynote address focused on how the continued siloing of behavioral health affects overall care.
‘New wave’
School-based telehealth has been around in North Carolina for years, but the number of programs rose across the state during the COVID-19 pandemic.
Once kids returned to in-person learning, many of the telehealth efforts petered out, Hutchens said, “whereas behavioral telehealth is now riding this new wave.”
Health advocates say that school-based telehealth care cuts down on absenteeism, ensures that students receive routine care that they might not otherwise get, and can even boost test scores.
John Jenkins, medical director of Cone Health School-Based Care and the telehealth collaborative’s program leader, has told NC Health News that about 90 percent of students in Cone’s program return to their classrooms the same day.
Missing too much school not only puts students at risk of dropping out, it also puts them at risk for unhealthy behaviors, such as alcohol and drug use, and poor long-term health outcomes, according to the American Academy of Pediatrics. Not graduating high school is associated with increased mortality risk or lower life expectancy, research shows.
Behavioral telehealth programs like Improving Adolescent Child health Through Telepsychiatry in NC report improvement with depression, anxiety issues and attention deficit hyperactivity disorder.
Yet broader data on the impact of behavioral telehealth has not been available. The Sheps Center team’s work represents the first time some of this data has been collected in a systematic way across North Carolina, Hutchens told collaborative members.
The Sheps Center was tapped by the state to evaluate the impact of behavioral telehealth at schools that added the service with support from state dollars. About a dozen schools got funds to hire staff, buy software or upgrade space to house a program as part of the General Assembly’s historic $1 billion investment in mental health in 2023.
The Sheps Center researchers decided to widen the pool to include as many schools as possible, Hutchens said. Working with the collaborative, nearly 300 schools have taken part in the survey so far, she said.
Still collecting data
Along with asking staff and teachers about their perceptions, the researchers collected baseline data on telehealth services.
They found that at schools participating in behavioral telehealth, 46 percent have a physician and 39 percent have a nurse available every school day. Psychologists were available daily through telehealth for 36 percent of schools, while 23 percent had daily access to a counselor.
About a third of schools reported that students get behavioral services within a week of referral. However, another third reported it took longer than a month.
“This is a huge area where we’re going to dig in on the qualitative work, because every agency has a different answer for why this is,” Hutchens said.
Answers for what causes the delay ranged from waiting for parental consent to only having a telepresenter available every two weeks to having too many students needing services.
“The challenges are truly unique,” Hutchens said. “Challenges of culture, challenges of parental consent, of school acceptability, just of a physical space that is private.”
Data collection will continue over the summer. In the fall, they’ll conduct follow-up surveys to see if there are any changes, Faith Albertson, another Sheps Center researcher, told collaborative members at the meeting.
“Eventually we’re going to work with [the Department of Public Instruction] to get some sort of student-level data,” Hutchens told NC Health News. “Because right now what we have is perceptions from the survey, and what we want to achieve is … tangible impacts on attendance, disciplinary action, that sort of thing.”
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