Proceedings of a Workshop—in Brief

Convened November 17, 2025

Digital Tools for Youth Mental Health Leadership Summit
Proceedings of a Workshop—in Brief

INTRODUCTION

As digital technologies rapidly reshape mental health care delivery, there is growing recognition of both their promise and their challenges in supporting youth well-being. In response, the Forum for Children’s Well-Being of the National Academies of Sciences, Engineering, and Medicine convened the Digital Tools for Youth Mental Health Leadership Summit¹ on November 17, 2025. This summit brought together nonprofit organizations, foundations, technology developers, health care representatives from health care systems and government agencies, researchers, educators, investors, and youth leaders to explore how digital innovations can be designed, validated, and scaled to effectively support children, adolescents, and families.

The summit featured expert presentations, case study panels, and interactive labs designed to surface actionable insights and cross-sector strategies. Youth leaders were featured throughout the day as presenters, discussants, and contributors. By focusing on evidence generation, trust building, and systems alignment while highlighting innovation and lived experience, the event helped lay groundwork for continued partnership to support children, families, and communities.

In opening remarks, David Willis, co-chair of the Forum for Children’s Well-Being, emphasized the forum’s mission to promote equitable mental, emotional, and behavioral flourishing of children and youth through evidence-based collaboration across sectors. He described the forum as a neutral space where evidence is elevated, partnerships are cultivated, and cross-sector collaboration supports real-world systems change. The summit’s focus on digital tools reflected that youth are increasingly seeking mental health support online yet face quality concerns, access barriers, and fragmented systems of care.

STATE OF THE SCIENCE: DIGITAL MENTAL HEALTH FOR YOUTH

Steven Schueller, professor of psychological science and informatics at the University of California, Irvine, opened the summit with an overview of the evidence base for digital mental health interventions. He emphasized key points that framed the day’s discussions.

Digital Mental Health Can Work

Schueller noted that over 30 years of research demonstrates that internet and mobile-based interventions can be effective in addressing mental health conditions including depression, anxiety, posttraumatic stress disorder (PTSD), and sleep disorders. Meta-analyses show effect sizes comparable to traditional gold-standard treatments, particularly when interventions include some

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form of human support (Moche et al., 2021, Pauley et al., 2023, Steubl et al., 2021). Validated tools can serve not only individuals with mild to moderate symptoms but also those with serious and persistent mental illness as adjunctive support.

The Youth Evidence Base Is Sparse

While evidence exists across age ranges, the youth-specific evidence base is considerably thinner. Meta-analyses focused on youth include far fewer randomized controlled trials (RCTs), and effect sizes tend to be smaller. For example, Schueller said that one meta-analysis found only four RCTs examining depression interventions for youth, with an effect size of 0.15. Another identified 10 studies with effect sizes ranging from 0.29 for depression to 0.59 for general mental health. Many youth-focused studies rely on single-arm designs or case studies rather than RCTs, limiting the strength of conclusions.

Youth Want These Tools

Despite limited evidence, Schueller noted that youth are actively seeking digital mental health support. According to Hopelab’s 2024 report, more than half of teens have used an app to support their mental health or well-being, most commonly for sleep, meditation, happiness, and stress reduction. Teens experiencing higher levels of depression and anxiety are even more likely to seek out these tools: 38 percent and 36 percent respectively for those with severe symptoms, compared to 6 percent and 9 percent for those without symptoms (Hopelab, 2024).

Youth described wanting tools that provide safe, judgment-free spaces; simple, convenient access; and trustworthy information. However, Schueller noted that youth often trust peers, caregivers, and community members more than academic or medical sources, highlighting challenges in ensuring quality information reaches young people.

Engagement and Quality Challenges

Digital mental health faces both engagement and quality problems. Research shows that most users abandon mental health apps within two to four weeks of download (Baumel et al., 2019). Additionally, many apps fail to incorporate evidence-based treatment elements. One study found that the majority of depression apps focused primarily on psychoeducation, neglecting proven techniques such as behavioral activation, cognitive restructuring, exposure, and problem solving.

Schueller emphasized that tools are often not designed with youth input. He shared findings from a study where middle school students cocreated ideas for mental health technology. Students wanted tools that reflected their own experiences, provided practical daily support, and addressed relationship challenges, not the adult-centered approaches commonly found in youth apps.

Continuum of Care Models

Schueller concluded by emphasizing that digital mental health should be viewed not as technology versus people, but rather as technology with people. He outlined three models along a continuum of care:

• Self-help tools: Nonconsumable interventions that can serve as on-ramps or off-ramps to care
• Therapy extenders: Blended care models that use technology alongside evidence-based psychotherapy
• Virtual care platforms: Technology-enabled delivery of therapy or interventions

He highlighted examples such as single-session interventions accessible via website, apps designed to extend cognitive-behavioral therapy for PTSD, and California’s universal digital mental health programs (BrightLife Kids for ages 0–12 and Soluna for ages 13–25). These diverse approaches, he argued, allow technology to extend therapeutic work throughout young people’s daily lives while supporting clinicians to perform the duties matching their highest training, skills, and education.

DESIGNING WITH PURPOSE, EVIDENCE, AND PARTNERSHIP

The first panel, moderated by Adrienne Stith, executive lead psychologist for science at the American Psychological Association, featured three case studies demonstrating how digital tools can be developed through authentic youth partnership and grounded in evidence.

Case Study 1: Mirror Journal (Child Mind Institute)

David Anderson, vice president of public engagement and education at the Child Mind Institute, presented Mirror,² a self-help journaling app launched in March 2025, and developed in partnership with the State of Califor-

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nia. Anderson emphasized that the development process deliberately avoided developers and clinician assumptions about what youth needed.

The team prioritized youth perspectives over perceived assumptions and conducted extensive youth engagement: design sessions with teens in Los Angeles, in-home interviews with families, focus groups, a large-scale survey of 1,500 teens, design teams and work with youth interns from the Youth Mental Health Academy. This research revealed that 71 percent of youth already engaged in some form of journaling and that teens experiencing depression symptoms were even more likely to journal (Youth Mental Health Academy, 2024).

Mirror is an app that offers multiple journaling modalities (audio, video, written) with both guided and unguided prompts. The app uses AI to summarize journal entries, identify themes, and index risk levels (low, medium, or high). When medium risk is detected, the app provides support resources; for high risk, it geolocates crisis services and connects users to their identified emergency contacts or services like Crisis Text Line.

Hannah Sykes, a University of California, Berkeley student and summer intern with the Child Mind Institute, described her role in developing guided journal prompts. After analyzing user feedback that demonstrated demand for prompts inviting deeper reflection rather than just creativity, she conducted a literature review of therapeutic modalities, including cognitive behavioral therapy, behavioral activation, humanistic therapy, and emotion-focused therapy. She created prompts rooted in these evidence-based approaches, organized into categories like reflection, clarity, discovery, perspective, and growth.

As of November 17, 2025, the date of this summit, Mirror has achieved 120,000 downloads, 68,000 registered users, and approximately 10,000 monthly active users since launching in March 2025. The app has facilitated over 230,000 journal entries, and the month prior to the Summit, approximately 40 percent of entries received responses that included support, with 1 in 40 users contacting support services directly from the app. Eleven users have reported that the crisis feature saved their lives.

Anderson noted that maintaining Mirror as a free resource costs approximately $1.5 million annually for user feedback integration, clinical research, and ongoing development. The organization is actively resisting pressure to monetize the app, instead seeking partnerships across school districts and states to integrate Mirror into continuums of care while keeping the app freely accessible.

Case Study 2: Sonar Mental Health

Drew Barvir, CEO of Sonar Mental Health,³ and Selinam Ayifli, a youth leader and Rutgers freshman, presented their 24/7 chat-based coaching platform that uses a human-in-the-loop approach.

Sonar provides instant access to trained, certified coaches via text, web, or app. Unlike purely artificial intelligence (AI)-driven chatbots, trained humans respond to messages 24/7, with AI tools making coaches more effective and efficient. The platform works with schools, providers, and nonprofits to coordinate care and provide insights on trends and challenges affecting student populations, with a focus on safe, scalable outcomes.

Ayifli described joining Sonar as a “changemaker” after feeling valued during the interview process. Youth cocreators built relationships with the team, engaged in both formal work sessions and informal community building, and saw their input directly influence product decisions in real time.

Ayifli specifically contributed to two major features: check-in notifications that lead with engaging questions rather than generic prompts, and a conversational tone that matches youth users’ communication styles, uses appropriate slang, and adapts emotional responsiveness to context.

Sonar sees dramatically higher engagement than typical digital apps: 30–40 percent of students engage monthly, more than 80 percent continue to engage after 30 days (compared to typical steep drop-offs), and long-term engagement stabilizes at around 40 percent of users. Barvir attributed this success directly to youth cocreation, which made the platform approachable, relatable, and contextually relevant.

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Sonar serves traditionally underserved and diverse populations, with data showing improved functional outcomes. In one rural Michigan district serving 2,000 students with a 600-to-1 student-to-counselor ratio, approximately 40 percent of middle and high school students engage with the platform. The service has helped identify previously unknown issues like racial divides and bullying, enabling school interventions. Individual cases demonstrate crisis support, care coordination, and skill-building between clinical sessions.

Case Study 3: A.S.K. (Active Minds)

Laura Horne, chief program officer at Active Minds, and Trace Terrell, a Johns Hopkins student leader and member of the Youth Leadership Council for Mental Health, presented A.S.K. (Acknowledge, Support, Keep-in-Touch),⁴ an interactive YouTube experience teaching emotional support skills.

Active Minds learned that 70 percent of young people don’t believe they have expertise to help a struggling friend. This creates a “tragic paradox” in which at the exact moment peer connection matters most, young people feel least equipped to provide it.

Developed with MTV Entertainment Studios, A.S.K. uses an interactive digital experience in a choose-your-own-adventure format. Viewers play a character who encounters a friend struggling at a coffee shop and are encouraged to make choices about how to respond. Different choices lead to different journeys, but all paths teach the same core skills: acknowledging feelings, supporting through listening rather than problem solving, and keeping in touch to maintain connection.

Youth of color and LGBTQ+ youth were centered throughout design to ensure cultural relevance and accessibility. Youth told developers they didn’t want another PSA; they wanted to practice in a low-stakes environment where mistakes don’t cost friendships. The result teaches validation and connection, not amateur therapy, making it, as Horne stated, “the stop, drop, and roll of supporting a friend.”

Initial validation showed 72 percent of youth felt more prepared to support friends after using A.S.K. A comprehensive 2024 evaluation found statistically significant increases in empathy, active listening, and emotional support knowledge. Immediately after completing the experience, 4 out of 5 youth could name all three components of emotional support. High school students (ages 14–17) showed sustained improvement in empathy and active listening at two-week follow-up. At that point, 9 out of 10 felt more confident providing support and 2 out of 3 had already used A.S.K. in actual conversations.

Active Minds partnered with the Harvard T.H. Chan School of Public Health to train content creators on emotional support principles. Research showed that creator videos informed by this training significantly improved viewers’ emotional support abilities, demonstrating that the approach works not only through direct engagement but also through creator-mediated content.

Terrell described how youth cocreation shaped every aspect of digital intervention. The Youth Leadership Council created authentic responses reflecting how young people communicate when a friend is struggling and worked extensively with storyboards and mood boards to ensure the coffee shop setting remained “chill, calm and inviting.” Terrell emphasized that A.S.K. extends beyond the core YouTube experience into a broader digital ecosystem, partnering with influencers such as Solomon Thomas and the NFL, queens from RuPaul’s Drag Race, and Dr. Orna Guralnik to reach youth through channels they already use. Importantly, the team wanted A.S.K. to foster human connection beyond digital spaces, creating “A.S.K.-tivations” featuring a giant friendship bracelet that traveled to Active Minds chapters nationwide along with kits for making friendship bracelets. “I think it’s just one of many examples of how digital tools don’t have to stop online,” Terrell reflected. “They can be extended out and really [are] a great start and basis for human connection.”

Horne emphasized that A.S.K. demonstrates how technology can multiply human connection, rather than replace it. The tool is time-bound (not infinite scroll), agency-building (not passive), connection-promoting (not isolating), evidence-based (not algorithmic chaos), and free and accessible. However, she cautioned against viewing technology as a complete solution, noting that

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youth also need culturally competent care, affordable services, and real-life spaces for connection.

Panel Discussion: Stigma, Policy Barriers, and Sustainability

In response to audience questions, panelists addressed three key challenges. Regarding stigma reduction, Barvir emphasized changing language from “crisis service” to “coaching” and using relatable examples like breakups, college applications, or test stress rather than mental health diagnoses. Similarly, Anderson highlighted the importance of using terms like “emotional support” and “wellness” and being transparent about privacy protections, noting that youth are “incredibly tech savvy” about understanding how their information is used and housed. On policy barriers, Horne urged legislators to focus on “equipping and funding youth-driven ideas,” noting that practical youth-generated solutions, like mentioning the Suicide and Crisis Lifeline, #988, on student IDs, are missing from legislative conversations. Pajjuri, CEO and cofounder of Psyche Care, cautioned against “50 different sets of regulations” across states, emphasizing “simplicity and consistency” in evaluation frameworks so school districts can understand what works without adding complex assessments to their workload. Regarding sustainability, Horne acknowledged that making A.S.K. free and public on YouTube requires ongoing fundraising. many participants believe that demonstrating cost savings and preventing expensive inpatient stays or lifelong illness with comorbidities can create viable payment models through health plans and schools willing to pay for proven return on investment, emphasizing the importance of building a robust body of evidence beyond “amorphous hypothesis.”

ACTION LAB: BUILDING EVIDENCE, ACCESS, AND TRUST

Following the morning case studies, all participants engaged in small group discussions focused on actionable steps to advance digital mental health for youth. Groups addressed two guiding questions: What change in how evidence is developed, shared, or used would help ensure effective tools are trusted, funded, adopted, and sustained? And what collaboration or policy mechanism could strengthen both the evidence base and the pathway from evidence to impact within 12–18 months?

Shared Evaluation Standards

Multiple discussion groups emphasized the importance of consistent frameworks for evaluating digital tools. Many participants believe that their work would benefit from access to shared metrics representing diverse interested parties needs, such as what funders need to know and what youth and health care providers prioritize health care. Several groups suggested developing evaluation approaches that move faster than traditional RCTs while maintaining rigor, potentially modeled on emergency use authorization processes.

Groups also discussed creating consolidated information sources such as a “digital apothecary” or clearinghouse where stakeholders could find vetted tools and evaluation results. However, many participants emphasized that evaluation frameworks must balance speed with quality and avoid creating barriers that prevent innovation.

Real-World Evidence and Dosage

Several groups advocated for expanded use of real-world evidence alongside RCTs, particularly given the rapid pace of technological change. One group emphasized the importance of “dose,” or being deliberate about what level of intervention is appropriate at each point on the continuum of care. A single touchpoint might be appropriate for prevention, while more intensive engagement might be better suited for interventions with higher sensitivity. Without attention to dosage and appropriate outcomes for each level of intervention, the field cannot build the evidence base.

Local Action and Community Frameworks

Multiple groups suggested parallel design frameworks: one to set parameters for how real-world evidence should be structured to ensure consistency and trustworthiness, and another to empower communities to take responsibility for impact and scale. As one group noted, “Local communities should not be the ones to determine if a practice is safe or effective—that can be done elsewhere. But local communities and schools should be the ones responsible for actual impact.”

Youth Leadership

The voices of youth leaders remained critical throughout the discussions, youth leadership emerged as a critical element. Many participants emphasized the importance of cocreation over mere patient engagement, meeting young people where they are socially, physically, and culturally, and ensuring youth participation extends beyond token involvement to actual decision-making authority. Several groups noted the risk of placing too much burden on youth to solve systemic problems but

emphasized the importance of preparing youth for governance roles and adults for shared decision making.

Addressing Communication Gaps

Groups discussed the importance of speaking stakeholders’ languages. Private sector partners want to see connections to workforce productivity, retention, and operational continuity. Investors want clear return on investment. Clinicians want evidence of safety and effectiveness. Youth want trustworthy information from sources they actually trust—often peers and community members rather than academic institutions.

Several groups referenced the de Beaumont Foundation’s PHRASES initiative (de Beaumont Foundation, n.d.), which identified common gaps in how the private sector perceives public health. Bridging these gaps requires tailored messaging, trusted messengers, and frameworks that resonate across sectors.

SCALING WHAT WORKS ACROSS SYSTEMS

The afternoon panel, moderated by Scott Kollins, chief medical officer at Aura, featured three case studies demonstrating approaches to scaling digital mental health interventions through system partnerships.

Case Study 1: Hazel Health and Ohio Department of Behavioral Health

Andrew Post, president of Hazel Health,⁵ and Nikki Reiss, deputy director of innovation for the Ohio Department of Behavioral Health, presented their partnership delivering school-based telehealth.

Hazel Health provides behavioral and mental health services through licensed clinicians delivering care via telehealth at schools and at home through school-centered partnerships. Post emphasized that Hazel is not a silver bullet but rather supports the broader ecosystem, partnering with school districts, investors, states, and community care providers.

Ohio’s Approach

Governor Mike DeWine made behavioral health and children a campaign focus and has sustained commitment. Ohio created the SOAR (State of Ohio Action for Resiliency)⁶ grant program, bringing together 10 state departments and agencies to identify pressing needs (Ohio Department of Behavioral Health and Addiction Services, n.d.). Rather than prescribing solutions, Ohio invited partners to propose innovative approaches addressing identified needs.

Ohio identified critical needs including workforce shortages, challenges in both behavioral health and education sectors, and the goal of increasing school-based services without building brick-and-mortar facilities or duplicating local provider networks. The legislature approved funding for Hazel to serve approximately 200,000 students across 39 school districts.

The partnership between Hazel Health and SOAR became oversubscribed within two weeks of launch, which led Hazel Health to expand its services. Post highlighted key outcomes which included

• Maintaining manageable time from referral to available appointment
• High parent satisfaction with services
• Average age of 11.6 years for students receiving care—earlier than the national average of 11 years from symptom onset to treatment
• Clinical outcomes showing symptom reduction
• Impact outcomes including reduced absenteeism and behavioral disruptions
• Health care cost savings of approximately $2,800 per child per year

Reiss emphasized the value of real-time data, which enables Ohio to share information across departments, respond to acute situations, and serve diverse student populations including those in charter schools, parochial schools, and online education who are often left behind by school-based health centers.

Post acknowledged that while Hazel has demonstrated impact, scalability faces significant barriers. The model depends on multiple stakeholders: school district engagement, state support, and users who may be unaccustomed to accessing care this way. He emphasized that success requires delivering both clinical outcomes (symptom reduction) and impact in both education

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(reduced absenteeism, improved test scores) and health care (cost savings, return on investment).

Post noted that while return on investment typically takes years to demonstrate, particularly for youth interventions, elevated levels of need mean that earlier intervention can show same-year returns. Medical cost of care studies in California, for example, demonstrated approximately $3.80 saved per $1.00 spent in the first year which is unusual for prevention-focused youth interventions but reflecting the severity of unmet need.

Case Study 2: Psyche Care

Mallika Pajjuri, CEO and co-founder of Psyche Care,⁷ and Alicia Bazzano, pediatrician and emergency medicine physician at MedStar Health, presented their digital family peer support platform.

Pajjuri began by reframing the youth mental health crisis as fundamentally a family mental health crisis. More than one million children in acute distress enter emergency departments annually, but discharge home does not end their crisis. She said caregivers return to home environments not knowing how to manage daily challenges, wake up scared about what will happen with their child, and have limited access to resources and nowhere to turn while waiting for outpatient care.

Psyche Care connects parents and caregivers with certified family peer specialists who are—individuals who have lived experience navigating mental health systems. Families are engaged through community touchpoints including emergency departments, inpatient centers, and outpatient clinics. They are matched with a peer specialist and can meet via telehealth, telephone, and unlimited text messaging on a weekly basis.

The curriculum was cocreated with caregivers across the United States and includes clinical oversight from pediatricians, psychologists, and psychiatrists. Skills taught are primarily rooted in dialectical behavior therapy, focusing on helping parents manage daily challenges rather than solving clinical problems.

Psyche Care’s core theory is that parents and caregivers are the most under-supported but untapped resource in youth mental health. Research from Stony Brook University identified harsh parental discipline, disengaged parent-child relations, and severe conduct problems as significant contributors to psychiatric rehospitalization risk (Blader, 2004). By empowering parents with skills at the right time, the program aims to help families avoid readmissions and build long-term resilience.

In a pilot cohort of 30 families, Pajjuri noted that Psyche Care demonstrated remarkable engagement and outcomes:

• 100 percent session attendance—no family skipped a session
• 9.7 out of 10 rating for perceived usefulness
• 100 percent of families reported improvements in family dynamics
• Near-total reduction in emergency department visits in the year after program completion (one visit across 30 families)
• Significant reduction in intensive outpatient and day treatment use

Pajjuri outlined four major challenges to scaling caregiver-specific supports:

1. Fee-for-service versus value-based care:As a low-cost intervention with potential for high impact, it is difficult to make the upfront case to payers, especially when subclinical services are poorly reimbursed across states.
2. The wrong pocket problem:Value is created for multiple stakeholders (payers see reduced readmission, emergency departments discharge families faster), raising questions about who should pay and whether funding should be blended and braided.
3. Patient identification:State-by-state variability in who can receive family peer support services based on diagnosis or points of care precludes thousands of families from accessing support.
4. Credentialing of subclinical staff:Family peer specialist credentialing varies dramatically by state. Some states have poorly funded credentialing

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organizations with limited training offerings and no incentives to place peers in employment, making it difficult to maintain and galvanize this workforce.

Current Strategies

Given these challenges, Pajjuri noted that Psyche Care focuses on two approaches:

1. Identifying innovative billing codes:Minnesota offers behavioral health home services—a subclinical wraparound model with a $350 per engaged member per month rate. However, only outpatient mental health clinics and primary care clinics can provide this service. Psyche Care partners with clinics as essentially a staffing agency, with clinics hiring trained staff and retaining a 10–20 percent administrative fee while Psyche Care retains a services fee.
2. Demonstrating reduction in crisis services utilization:Through partnerships with organizations like the Massachusetts eHealth Institute and Ascend Rural, Psyche Care conducts validation studies documenting outcomes to build narratives for payers.

Pajjuri acknowledged this state-by-state approach is not scalable, emphasizing that caregiver supports can be highly impactful only if reimbursement systems reward family mental health approaches rather than maintaining siloed, youth-only models.

Bazzano described the emergency department as “the last stop” and “the only catchment” for families but noted it is not the best environment for mental health crises. Parents arrive in their own crisis, she said, often having had few positive interactions with their child in a long time, living in fear and conflict.

Pajurri also noted Psyche Care provides two critical elements for parents: immediate skills for positive interactions with their child, and the assurance that they are not going home alone. According to Pajjuri, this gives parents agency rather than taking it away, recreating relationships even in crisis situations. Because support comes from other parents with lived experience, it is particularly credible. From the health system perspective, Psyche Care provides several benefits:

• A solution to reduce unnecessary mental health hospitalizations
• An immediate resource (vs. months-long waitlist) that crisis teams, social workers, psychiatrists, and emergency pediatricians can offer
• Intensive training based in dialectical behavior therapy with practical scripts for what to say when a child expresses suicidal thoughts

Bazzano emphasized that as of November 2025, zero children in the program have returned to MedStar’s emergency department—notable given that many had experienced five or more prior hospitalizations.

Bazzano concluded with a plea for greater clinician involvement in developing digital solutions. Just as educators must be involved in developing educational technology, frontline clinicians must be engaged in mental health innovation. Without their voices, solutions cannot adequately address real-world implementation challenges. She drew a parallel to Psyche Care’s approach: Just as the program addresses the problem of not including parents, the digital health field benefits from including the on-ground clinicians who want to provide input.

Case Study 3: Backpack Healthcare and Maryland’s CHRC

Hafeezah Muhammad, founder and CEO of Backpack Healthcare,⁸ and Lorraine Moss, deputy director of the Children’s Health Resource Center (CHRC) of Maryland, presented their partnership delivering integrated behavioral health services.

Muhammad began with her personal story: In October 2020 her six-year-old son told her he wanted to kill himself. Despite being an executive for a national mental health company, she could not find care for him because of his disability and Medicaid coverage. Muhammad’s own research revealed that more than half of patients calling for care were on Medicaid and could not find providers. She realized that while she could afford to pay out of pocket, millions of families with insurance would never have that opportunity.

Backpack Healthcare is first a clinical services company providing virtual and in-person therapy, psychiatry, and psychological evaluations, Muhammad said. Recognizing the provider shortage, Muhammad created a residency program for master’s-level social workers and counselors. Unlike physicians who receive paid residencies, these

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professionals typically pay out of pocket for required supervision hours. Backpack partners with 11 universities, accepting students for practicum and employing them in prelicensure positions.

Backpack also developed a care companion digital tool families and youth can use between sessions to receive support and track outcomes. According to Muhammad, the company is “truly community-based,” working with pediatrician offices, hospital systems, schools, and departments of social services, bringing integrated care to multiple touchpoints in children’s lives.

The platform guides families from initial assessment through AI-powered matching with providers who have the highest compatibility. Families can access recurring therapy and psychiatry appointments, and when ready to step down from intensive services, they can use the care companion while their therapist continues to monitor in the background and respond to any escalations.

Muhammad emphasized that Backpack serves “from twinkle to wrinkle”: 60 percent of patients are children and 40 percent are adults, often because when a child is struggling, a parent is also struggling. The platform allows billing for therapy sessions with or without the patient present, enabling meaningful parent support.

When entering a new state, Backpack ensures enrollment with every insurance plan available in that market, both Medicaid and commercial plans, so that regardless of who comes to Backpack, care can be cost-efficient. Medicaid covers 100 percent of care; commercial insurance patients pay co-pays. This approach builds sustainable revenue practices enabling continued growth.

Backpack has delivered over 67,000 sessions since launch. The care companion, launched in 2024, is on track to exceed session volume through chat interactions. The platform averages 16 sessions per family given that referrals often come from inpatient facilities and foster care, representing high-acuity populations. Some families, such as twins born to parents experiencing drug addiction, have been with Backpack for four years. Average time to the first appointment is five days, with some states offering same-day access.

Moss described Maryland’s innovative approach to school-based mental health. In 2021 the Maryland General Assembly passed the Blueprint for Maryland’s Future, a comprehensive education reform bill. As the bill approached passage, legislators heard from teachers that they could not help children learn if mental health challenges reduced capacity to learn.

In response, the legislature created CHRC, a $100 million annual fund to support behavioral health in schools. The CHRC’s legislative mandate is intentionally worded so that supports must be coordinated in the community and through partnerships. The focus is on local partnerships meeting students’ holistic needs across all tiers of multitiered systems of support, including substance use and family supports, from pre-K through 12th grade.

The CHRC works with Maryland’s 24 jurisdictions (23 counties plus Baltimore City), with each county serving as a school district. The organization develops community supports partnerships, of which there are currently seven covering 12 jurisdictions, with more anticipated. Local behavioral health authorities or local management boards conduct needs assessments and asset mapping in collaboration with schools.

While developing system-wide infrastructure, the CHRC began making resources available immediately through more than 100 service provider organizations. These include traditional local mental health clinicians with improved school access, community organizations providing Tier 1 or Tier 2 supports, and digital providers like Backpack and Hazel Health.

Each partnership has a governance board including the school system, local health department, and other key stakeholders, deliberately breaking down silos. Grantees report that while they previously claimed to work together, the CHRC structure forced true collaboration.

The CHRC brings providers together monthly for mandatory technical assistance calls and office hours, creating a learning community where providers share challenges and solutions across counties. Moss emphasized that providers do not feel they are in competition, they make referrals to each other and coordinate services, with one group offering family services while another provides individual therapy.

Moss noted that approximately 75 percent of grantees from the CHRC’s other programs (two-to-three-year

seed funding) are able to continue after grants end, often by maximizing Medicaid and commercial insurance billing. The CHRC encourages all grantees to bill Medicaid and commercial insurance first, serving as a “funder of last resort.” The organization has brought on consultants to help grantees understand billing codes and optimize all possible Medicaid and commercial reimbursement.

For the resource center specifically, the ten-year funding commitment from the Blueprint legislation provides stability, though Maryland faces budget challenges requiring annual vigilance. The organization’s sustainability plan centers on demonstrating results to make budget cuts difficult to justify.

Muhammad highlighted one of the most significant barriers to national scale: Medicaid credentialing. While commercial insurance like Aetna allows a single national contract covering all 50 states, Medicaid operates state by state. Each state requires a separate Medicaid ID and enrollment with all insurances contracted with that state—a process Muhammad compared to navigating Europe, where “every state is a different language.”

Additionally, every county within a state operates differently, requiring significant ground-level learning. Backpack addresses this by beginning the Medicaid credentialing process approximately two years before entering a state. Even with this planning, achieving value-based care contracts that provide enhanced payments for outcomes took three years of demonstrating data and results.

Muhammad emphasized that solving the behavioral health crisis requires an entire ecosystem. Even with every partner working together, significant work remains. She called for more states to follow Ohio and Maryland’s examples in making public–private partnerships and innovation a priority, particularly for programs like Psyche Care that address critical gaps but face reimbursement challenges.

Moss highlighted the importance of local partnership and collaboration, noting that Maryland’s model of developing comprehensive mental health approaches through community-driven partnerships at scale appears unique nationally. She emphasized that digital tools bring scalability but grounding them in communities with strong partnerships and integration with other providers creates the most impactful experiences.

Question-and-Answer Session

The discussion session opened with a probing question about scalability challenges, prompting panelists to reflect on both their successes and ongoing obstacles. Post acknowledged that while his organization has successfully built a scalable network of diverse, multilingual clinicians and mastered collaborative embedding within school systems, operational logistics remain problematic, coordinating hundreds of thousands of visits while managing the complexities of pulling children from class or ensuring caregiver availability continues to create inefficiencies. Pajjuri highlighted her organization’s success in engaging caregivers through intentionally designed touchpoints for family peer support yet expressed concern about demonstrating value and accountability when multiple community-based supports are involved and attribution becomes unclear. Muhammad addressed the complexity of Medicaid credentialing, explaining that unlike commercial insurance with national contracts, Medicaid requires state-by-state and even county-by-county navigation, necessitating on-the-ground teams and multiyear lead times before entering new markets.

When asked to define scalability, panelists offered varying perspectives: Muhammad described it as rapid access regardless of jurisdiction; Pajjuri framed it as replicable community engagement across diverse implementation settings; and Andrew defined it as ensuring every child has equitable access to quality care. On prevention, Pajjuri noted that caregiver stigma often prevents proactive help-seeking, finding that crisis moments create engagement opportunities that build trust for longer-term preventative work, while Post discussed the potential of harnessing fragmented youth data for early intervention while acknowledging ethical risks. Addressing the challenge of “death by pilot” Reiss stressed the necessity of embedding sustainability plans and measurable outcomes from the outset, arguing that pilots should be allowed to fail if data doesn’t support continuation. Moss described her organization’s approach of requiring upfront sustainability plans in grant applications and maximizing Medicaid reimbursement, while candidly

noting their strategy is to “show results and make it real hard for our budget to get cut.”

ACTION LAB: SCALING ACCESS AND SUSTAINABILITY

Following the afternoon case studies, attendees engaged in a second round of small group discussions focused on actionable steps to scale effective digital mental health tools. Groups addressed two guiding questions: What system or policy shift is most important to make effective tools broadly accessible, especially for underserved populations? And what collaborative steps could organizations in the room take within the next year to move that shift forward?

Reimbursement as Central Challenge

Reimbursement emerged as the dominant theme across nearly all groups. Many participants identified opportunities for

• State and system-wide incentives across the continuum from prevention to acute care (Barvir)
• Expanded scope of what is reimbursable, particularly for mental health prevention and subclinical services (Pajjuri)
• New reimbursement structures that prioritize prevention and good outcomes rather than persistent treatment of chronic disorders (Post)
• Addressing fragmentation across states and between commercial and Medicaid plans (Muhammad)

Multiple groups discussed the difficulty of developing new payment mechanisms even when health systems have strong incentives and willingness to invest. One group emphasized the importance of “incentivizing prevention and building outcomes measurement demonstrating value across different stakeholders.”

Bundling and Value-Based Care Innovations

Several groups explored specific reimbursement innovations:

• Bundling codes, particularly with Medicaid, as demonstrated by Psyche Care (Pajjuri)
• Introducing value-based care into platforms and plans for more holistic approaches (Muhammad)
• Diversified funding that blends (combines funding streams together) and braids (coordinates separate funding streams) different sources (Reiss)
• Developing shared evaluation frameworks that can generate buy-in for implementing reimbursement structures prioritizing prevention and outcomes (Moss)

One group noted the importance of demonstrating value through avoided costs, comparative savings, and creation of new revenue, while acknowledging that not all value can be easily monetized.

State-Level Action and Hub-and-Spoke Models

Multiple groups called for legislative leadership to define standards of care for youth mental health requiring reimbursable services across the spectrum of intervention. Several groups expressed enthusiasm for “hub- and-spoke” models like those in Maryland and New Jersey, which make services reimbursable from the top down while leaving service procurement and selection to communities that can best serve their needs.

Groups emphasized the value of state-level convenings, bringing together state Medicaid leaders, mental health leaders, and education leaders to share lessons and find strategies for fragmented systems. One group suggested National Governors Association collaborations or shared research across sites as mechanisms for this work.

Workforce Development

Several groups focused on workforce as both a barrier and an opportunity:

• Standards around training, certification, career ladders, and reciprocity for bachelor’s-level behavioral health specialists and peer-to-peer and parent-to-parent support across state lines (Muhammad)
• Residency programs like those developed by Backpack Healthcare (Reiss)
• Making the value of digital tools self-evident to frontline practitioners (Bazzano)
• Competencies for practice that evolve to include digital tools as core foundational skills (Anderson)

One group gave “a massive plus-one” to the residency program idea, seeing it as addressing both workforce shortages and sustainability challenges.

Procurement and School Support

Multiple groups discussed supporting schools in selection and procurement processes. The Children’s Hospital Association is developing a model with four components that schools and education departments can use when evaluating tools, incorporating benchmarks for efficacy, safety, and caregiver and student voices. One group noted that procurement panels often include the same people who evaluate educational technology and emphasized the importance of incorporating clinical voices into decision making about clinical interventions.

Barriers to Virtual Care

One group identified specific barriers to virtual care that were temporarily lifted during COVID but have since returned, creating obstacles to access:

• Geographic restrictions on whether families are physically within state lines during virtual sessions (Muhammad)
• Limitations on group visits conducted virtually (Reiss)
• Interstate practice barriers for licensed professionals (Bazzano)
• Restrictions on reimbursement for telehealth services that were previously covered under emergency provisions (Moss)

These obstacles were characterized by the working groups as “potentially low hanging fruit” for policy interventions, since the infrastructure and evidence for effectiveness already exist from the pandemic period.

Data Sharing and Integration

Multiple groups discussed the complexity of demonstrating impact when benefits accrue to different systems than those providing or funding services. For example, school-based mental health interventions may reduce healthcare costs, but schools struggle to access healthcare use data to demonstrate this value.

Avenues for increased access to these data included

• Working with National Governors Association or other groups to facilitate cross-system data sharing (Reiss)
• Addressing data barriers that prevent connecting interventions to outcomes in other sectors (Moss)
• Developing common data infrastructure that allows tracking of impact across education, healthcare, justice, and other systems (Anderson)
• Creating mechanisms for aggregate reporting that protect privacy while demonstrating population-level impact (Pajjuri)

One group emphasized that “the benefits are often to a different system than the system you’re working in, and how complex it is to get data from those other systems.”

Intentional and Targeted Funding

Several groups emphasized that “the money doesn’t need to be huge, but it does need to be intentional,” and underscored that using data to support decisions about where funding should go, who receives it, why, and when. Even modest funding can be highly effective when deployed strategically based on evidence and community needs.

Groups also discussed the importance of distinguishing between innovation funding for pilots and sustainable funding for proven approaches. As one participant noted, “Scale problems are solvable” but require moving beyond “death by pilot” to long-term commitments.

Youth Advocacy and Matchmaking

One group identified a gap and opportunity for youth advocacy groups to coalesce and have “a matchmaker that helps them come together.” While individual youth leaders and organizations exist, better coordination and support for youth-led advocacy could amplify impact and ensure youth voices shape policy and funding decisions.

Community of Practice for Pilots

Several groups suggested creating communities of practice for organizations developing pilots, particularly those that may not be data-savvy but want to integrate good metrics and planning from the start. This would provide resources, technical assistance, and shared learning to improve the quality and evaluability of innovations.

Addressing Noncompliance and Building Grassroots Support

One participant noted their success addressing insurance noncompliance with mental health parity laws in Georgia, emphasizing that regulatory agencies benefit from grassroots support from community constituencies. Digital health stakeholders should translate information for community members who can advocate with legislators and regulators, rather than keeping knowledge solely among organizations with technical expertise.

Prevention and Upstream Investment

While most discussion focused on treatment and crisis response, several groups emphasized the importance of prevention and upstream investment. One group mentioned the challenge of making the case for investments in preventing harm that may never materialize, which is a common difficulty with pay-for-success models.

However, groups also acknowledged that current elevated levels of need mean prevention can show returns more quickly than historically expected. One participant suggested that investments in belonging and connection, grounded in vital conditions frameworks, could demonstrate measurable gains when coordinated across multiple sectors simultaneously.

CONCLUSION

The Digital Tools for Youth Mental Health Leadership Summit demonstrated both the tremendous promise and significant challenges of digital innovation in youth mental health. Summit attendees heard compelling examples of tools that are engaging youth, supporting families, demonstrating impact, and beginning to scale. They also discussed persistent barriers including fragmented reimbursement, limited evidence for youth-specific interventions, workforce shortages, and misaligned incentives across sectors.

Several key insights emerged. First, youth cocreation is not optional; it is essential to developing tools that youth will use and that will meet their needs (Horne, Terrell, Sykes, Ayifli). Second, evidence must balance rigor with speed, incorporating real-world data and appropriate attention to so-called “dosage” while maintaining quality standards (Schueller, multiple action lab groups).

Third, technology works best when it enhances rather than replaces human connection, whether through therapy extenders, peer support, or family engagement (Horn, Schueller, Pajjuri, Bazzano, Post, Terrell).

Fourth, scaling requires systems thinking and cross-sector collaboration (Post, Reiss, Moss). The most successful examples (e.g., Ohio’s SOAR program, Maryland’s CHRC, California’s universal digital mental health) involved sustained leadership commitment, multi-agency coordination, and integration with existing care systems. Fifth, sustainability must be designed from the beginning, with realistic revenue models, evidence of value to multiple stakeholders, and pathways from pilot to permanent funding (Anderson, Reiss, Pajjuri, Horne).

The action labs enumerated numerous concrete steps organizations could take within 12–18 months, from developing shared evaluation frameworks to creating communities of practice, from state-level Medicaid leader convenings to school procurement support tools. Summit attendees were provided with both inspiration from innovations already under way and clear-eyed recognition of work remaining.

As Muhammad reflected, solving the behavioral health crisis “takes a whole entire ecosystem.” No single tool, organization, or sector can address youth mental health alone. But by working together with youth and families at the center, evidence as a guide, and commitment to reaching all young people the field can make meaningful progress.

The summit concluded with recognition that the risks of inaction outweigh the risks of experimentation. As one participant noted, “We don’t need to agree on everything, but what we’re doing now isn’t good enough.” Digital tools, designed well and implemented thoughtfully within supportive systems, offer pathways to reach more young people, earlier, with effective support. Realizing that potential requires continued collaboration, innovation, and commitment to ensuring that every young person regardless of geography, insurance, language, or circumstance has access to the mental health support they need to flourish.

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DISCLAIMER This Proceedings of a Workshop—in Brief was prepared by Molly Dorries as a factual summary of what occurred at the workshop. The statements made are those of the rapporteur or individual workshop participants and do not necessarily represent the views of all workshop participants; the planning committee; or the National Academies of Sciences, Engineering, and Medicine.

PLANNING COMMITTEE David Willis (Co-Chair), Georgetown University Thrive Center for Children; Leslie R. Walker (Co-Chair), University of Washington and Seattle Children’s Hospital; Deana Around Him, Child Trends; April Joy Damian, Johns Hopkins Bloomberg School of Public Health; Tyler Norris, Federal Reserve Bank of New York. The National Academies’ planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. Responsibility for the final content rests entirely with the rapporteur and the National Academies.

REVIEWERS To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Workshop—in Brief was reviewed by Kyle MacDonald, ETR and Columbia University Mailman School of Public Health; and Megan Coder, Society for Digital Mental Health (SDMH). Kirsten Sampson Snyder, National Academies of Sciences, Engineering, and Medicine, served as the review monitor.

SPONSORS This workshop was supported by contracts between the National Academy of Sciences and Centers of Disease Control (75D30121D11240/75D30124F00044) and the Health Resources and Services Administration (75R60221D00002/75R60223F34007). Additional support came from the American Academy of Pediatrics, Children’s Hospital Association, Family Voices, Global Alliance for Behavioral Health and Social Justice, Society for Child and Family Policy and Practice, and the Society of Clinical Child and Adolescent Psychology. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

STAFF Molly Dorries, Amanda Grigg, Anthony Mann

SUGGESTED CITATION National Academies of Sciences, Engineering, and Medicine. 2026. Digital Tools for Youth Mental Health Leadership Summit: Proceedings of a Workshop—in Brief. Washington, DC: National Academies Press. https://doi.org/10.17226/29366.

For additional information regarding the workshop, visit https://www.nationalacademies.org/our-work/forum-for-childrens-well-being-promoting-cognitive-affective-and-behavioral-health-for-children-and-youth.

Copyright 2026 by the National Academy of Sciences. All rights reserved.