Improving population health through single-session interventions

[Related: The essentials of single-session interventions]

SSIs are structured programs that intentionally—and that’s key—involve a single visit, encounter, or interaction with a clinic, provider, or program. There’s no built-in assumption that people can or will return for additional sessions, as there is in most psychotherapies, which helps instill the belief that meaningful change is possible in one session.

Another important facet of SSIs: They are an as-needed, on-demand mode of support. Any SSI is a standalone opportunity for change, but there’s no expectation that one session will be enough, and there’s no cap on how many SSIs you can have.

They can be human-delivered (by licensed professionals or lay providers) or self-guided, and they can exist either within or outside of health care systems, which makes them super flexible in terms of scalability.

Fortunately, this isn’t just a nice idea. Decades of study and hundreds of clinical trials show that this approach can actually work. Our lab just published an umbrella reviewopens in new window in the Annual Review of Clinical Psychology that looked at 415 clinical trials of SSIs across 24 systematic reviews. Of those, 20 reviews supported a clinically meaningful positive effect of SSIs for a host of mental health outcomes, from depression and anxiety symptoms to better engagement with mental health support services.

Shortly after I started my lab, The Atlanticopens in new window and Voxopens in new window wrote about our digital SSIs for youth. Many parents reached out to ask us how to access the interventions—and my honest answer was: “Nowhere.” (Like most academics, our lab lacked the infrastructure or resources to focus on distributing these publicly.) That caused a reckoning. Most of the time, intervention scientists create and test these interventions, then publish on them, and that’s where it ends. That didn’t sit right with me.

So, without any grant funding, our lab decided to make our interventions free. We created a website with publicly available links to Qualtrics surveys that contained our interventions, all of which had been through clinical trials. Anybody can access these single-session, self-guided tools, which are now available in nine languages, anonymously and for free. Users can anonymously provide us with pre- and post-data, so we can continue to improve our SSIs.

Teens who complete Project Yes also have the opportunity to give advice to other teens on how to cope with mental health difficulties, based on what they learn in the program and their own lived experience. With their permission, we post their responses online in our Advice Centeropens in new window.

We just released an impact reportopens in new window based on anonymous pre- and post-data from 5,500 adolescents who have completed Project Yes. No matter what interventions they chose (such as a behavioral activation exercise or a session on growth mindset), youth reported reductions in hopelessness and self-hate and increases in agency. This was true across cultures and settings. We’ve published on Project Yes delivered through primary care settings, social media platforms, and schools in San Antonio, Texas, as well as with Lebanese youth and Syrian refugees.

All of this work was very exciting—and it also alerted us that we needed to evolve. What we’ve learned is that partnerships outside of academia are essential because academics don’t have the infrastructure to be the implementers ourselves. We realized we needed to collaborate with an organization with the resources and expertise to make Project Yes consumer-ready and scalable.

The partnership that’s really spurred the evolution of Project Yes is with Koko, a digital mental health nonprofit that identifies online distress through social media and routes youth to timely support. For example, when a user searches for “suicide” or “depression” on TikTok or Tumblr, Koko offers them real-time resources and connects them with crisis supports.

We have now embedded our SSIs into Koko as just-in-time supports for people looking for mental health information or help through social media platforms. Our research shows the tools perform well in this context, both in reducing hopelessness and in increasing uptake of crisis resources.

There was also a growing demand from our community partners, including city, county, and state government agencies, for a more scalable way to deliver Project Yes. We worked with Koko to build Project Yes 2.0. Like the original, it’s an online platform of evidence-based SSIs, but in addition to providing immediate support, we can also connect youth with local resources for follow-up. It’s very easy to access through a QR code, WhatsApp chat, social media platform, or website—with no login required, which we found removes a barrier for many teens.

In Montana, we’re working with the State Department of Public Health and local organizations to deploy this new and improved Project Yes as a free resource for all kids across the state. Together with Montana teens, we’re adapting the program to fit their context. We’re also working with providers and parents to figure out how best to disseminate it. We’ll evaluate both the clinical impact of Project Yes at the state level and the effectiveness of our dissemination strategies.

SSIs can play multiple roles in the larger tapestry of mental health supports, which are great and need to remain as they are—and aren’t enough. Project Yes and similar digital SSIs are a terrific option for folks seeking care outside formal health care systems, for instance, on social media platforms, which are the first and often only help-seeking touch point for many young people.

Embedding digital SSIs means we can offer something evidence-based through existing channels, when the alternative for many people would be no support at all—or something unregulated and harmful, like using ChatGPT as a therapist.

We also do a lot of work in our lab around training providers to deliver SSIs. That can help us reach people stuck on long waiting lists for services, or folks in primary care systems who can benefit from care on the spot, for instance, from a nurse practitioner.

Providers can also offer SSIs universally in schools, making them directly accessible to students. Our qualitative research with young people has shown that the biggest barrier teens face isn’t cost or stigma—it’s their parents. For that reason, it’s important to center youth autonomy and ensure these tools are initially accessible with or without parental involvement.

The goal is not for SSIs to be standalone resources, but to use them as pathways to the best next step, whatever that looks like for an individual based on their needs and what’s available.