Sutter Health Launches Behavioral Health Tool to Support Young People

Scout by Sutter Health combines downloadable information with human nonclinical guides to help young people with anxiety, depression, and stress.

Sutter Health has launched a digitally driven tool matched with nonclinical guides to support youth and young adults who are struggling with anxiety, depression, and stress.

Access to behavioral health services is a challenge for many people afflicted with mental illness. In 2016, about 16.5% of school-aged children had been diagnosed with a mental health disorder. During the coronavirus pandemic, a larger than average share (56%) of people between 18 and 24 have reported symptoms of anxiety and/or depressive disorder.

Scout by Sutter Health was launched as a pilot program in July 2020. The program was launched at scale in April 2021. Scout is a 12-week, nonclinical program targeted at youth and young adults aged 12 to 26.

"Scout is a nonclinical tool—it is not a substitute for treatment. Rather, Scout is a tool to build youth and caregiver resilience. It helps youth manage their symptoms and helps them in their everyday lives in managing a variety of life challenges while they are having depression, anxiety, or stress," says Larry Marx, MD, director of integrated care for the mental health and addiction team at Sutter Health.

Pediatricians or clinicians working with young people and/or their families can refer patients or caregivers to Scout if there are concerns around stress, anxiety, or depression. 

Scout has four primary elements:

1. Weekly virtual screenings

After young people enroll in Scout, they are screened weekly for anxiety and depression, says Vandana Pant, MA, director of strategic initiatives for the health design and innovation team at Sutter Health. "For a young person who uses Scout, they sign up, then they receive weekly screeners. Those weekly screeners are based on evidence-based tools that measure both anxiety and depression—the GAD-7 and PHQ-9. Based on the young person's responses to the screeners every week, they receive personalized content."

The screeners rate a young person's symptoms from mild, to moderate, to severe. When a rating reaches the moderate level, the young person automatically gets outreach from a nonclinical guide. Reaching out to a clinician is recommended for additional support, she says. "We are very conscious of directing young people back into care if their scores are showing that they are at a level that may require clinical care. That provides a safety net."

2. Digital modules of educational and supportive materials

Downloadable information that Scout provides falls into two categories: young people received personalized information based on responses to the screeners, and young people and their caregivers receive standard digital information modules on a weekly basis.

The standard digital information modules can be educational about anxiety and depression or address other topics such as communication skills, Pant says.

"When a caregiver signs up for Scout, the main difference is that the young person has a highly personalized experience with the screeners. If you sign up as a caregiver such as a parent, modules are sent out on a weekly basis that parallel the modules that the young people receive. For example, if a young person receives an educational module on anxiety, their caregiver will receive the same module of content. For the caregiver, the goal is to build resilience through building knowledge," she says.

An example of personalized information is making it age-specific, Pant says.

"A lot of people in their early 20s are in the workforce, and we have tools that are valid for that age group like isolation at work, communication with peers, living successfully with roommates, managing finances, and the stress of dating. So, there is a host of content that is not necessarily clinical but addresses things that form the basis of people's everyday anxieties. On the younger end of the spectrum, we have content modules that address things like talking with friends about mental health, having a healthy diet, tips for getting to bed on time, and tips for settling the mind," she says.

3. Exercises

Scout has been designed to not be directive or prescriptive. For example, exercises linked to the information modules provide options for young people, Marx says.

"As the youth or the young adult goes through the different modules, there is a variety of different exercises that they can choose to participate in. There are no dictates or prescribing in the tool—there are just helpful suggestions. If someone decides to do one of the exercises, Scout checks on how they feel after the exercise to give some insight into whether a particular practice improves overall well-being. Because Scout is not a clinical tool, youth can pick and choose exercises or material that are going to be meaningful to them. There is no monitoring of what material or exercise has been used, so young people are completely autonomous," he says.

4. Nonclinical guides

A unique aspect of Scout is the use of nonclinical guides provided by Boston-based Docent Health to engage young people, Pant says.

"The core of the program and what really differentiates it is that we support the experience that young people go through for 12 weeks with nonclinical guides. Docent Health provides the nonclinical guides—they essentially guide the experience. For example, in addition to my weekly screener, I can text additional concerns. In that case, a Docent guide will step in and give a personalized response. That boosts the support because young people know that they can reach out if they want to," she says.

The nonclinical guides play a key role in Scout, Pant says. "Once you are enrolled in the program, you receive the screeners in an automated way, but you are welcomed into the program by a nonclinical guide. That nonclinical guide also keeps checking in with you through the course of the program. The nonclinical guide is also available via text as a source of support and engagement."

Sutter Health decided to include a human touch in Scout because of design-stage feedback from young people and the project's youth advisory group, she says. "Across the board, from age 12 to 26 and in the youth advisory group, we heard that one of the key challenges that young people face when they are feeling depressed or anxious is that they feel isolated. We responded to that need for human connection by creating a program that had an opportunity for nonclinical, human guide support."

Measuring Scout's impact

Sutter Health and Docent Health created a dashboard for Scout that has metrics on the population health and individual level.

On the population health level, week-over-week aggregate scores on the anxiety and depression screeners measure whether participants are trending in a positive or negative direction.

Engagement level is also measured week over week. Engagement is measured by how many people are completing the screeners and how many people are texting the nonclinical guides.

So far, the numbers look good, Pant says. "We have had about 510 users over the past three months: 40% of them are caregivers and 60% of them are young people. On an aggregate basis, we have seen a 1.7% improvement in anxiety scores; so, week-over-week, we are seeing improvement in anxiety at the population health level. About 95% of the users say they are finding the modules meaningful."

Related: How Providers Can Continue to Support Mental Health Services Post-Pandemic