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Hafeezah Muhammad’s son was six years old when he told her he wished to die. Muhammad was stunned. “My heart broke,” she says, “I didn’t see it coming.” Immediately, Muhammad began researching and contacting mental health care providers, but she came up short. She couldn’t find any excellent providers who specialized in pediatric care, accepted Medicaid and had openings for new clients.

Muhammad, who worked for a national mental health company, was already very aware of the country’s provider shortage. According to a 2022 poll from Mental Health America, 15% of youth have had at least one major depressive episode in the past year. Sixty percent of those children and teens weren’t receiving any care. Muhammad’s experience with her own son helped her understand the impacts of this crisis on individual families. In response, she quit her job and launched Youme Healthcare, which has since been rebranded as Backpack Healthcare.

Backpack Healthcare uses cutting-edge technology to address the mental health care shortage. The company, which accepts Medicaid, uses artificial intelligence (AI) to match clients to their ideal virtual provider. An AI-powered app monitors the well-being of kids and helps them develop coping strategies. Meanwhile, AI notetaking algorithms help tackle clinician burnout.

Backpack Healthcare is seeing positive impacts on both client well-being and clinician retention and satisfaction. “The work [our clinicians] are doing is incredible,” Muhammad says. And technology makes it possible.

Backpack Healthcare is at the forefront of a technological revolution within the field of counseling. From AI to virtual reality, technology is changing the way future counselors train, the path to getting licensed and the way providers run their practices. In the face of a growing provider shortage and widespread burnout, professionals say that these changes are more necessary than ever.

Broadening Access to Care

Before the COVID-19 pandemic, there were already signs that counseling was changing. Online therapy via telehealth platforms had been gaining popularity since the early 2000s. Then in the 2010s, direct-to-consumer telehealth startups expanded the reach of these services. But questions around client privacy, compliance with state licensure laws, impact on the counselor-client relationship and other concerns led to slow adoption of telehealth across the counseling community.

“In the world of behavioral health we’re often a few steps behind when it comes to technology,” says Barry Granek, LMHC, vice president of systems of care for Coordinated Behavioral Care Inc. in New York City and a private practice psychotherapist. In 2018, Granek wrote an article for Behavioral Health News calling on community-based behavioral health organizations to embrace new apps and chat platforms for communication with clients. “If we do not embrace the innovation in health care and be present to shape it, we run the risk of it happening without our input,” he said in the piece.

When lockdowns forced providers to move their practices online, Granek saw many of the tools that he wrote about in his 2018 article become widespread. That change has persisted even as normalcy returned post-pandemic. “COVID forced most of us to at least learn about virtual health,” he says.

But the growing use of telebehavioral health, on its own, doesn’t address one of the more intractable problems facing the counseling profession: not enough providers. Since the beginning of the pandemic, demand for behavioral health care has soared. In 2019, 11% of adults reported symptoms of anxiety or depression, according to the Kaiser Family Foundation. As of last year, that proportion had nearly tripled, and as of 2024, 121 million people live in a mental health provider shortage area, according to the U.S. Health Resources and Services Administration. (Read more about the workforce on page 24.)

Simplifying the Licensure Process

For many prospective counselors, the toughest obstacles to entering the workforce don’t always happen in graduate school, but immediately after, when the licensure process begins, says Carla Smith, PhD, LCSW, LMFT, chief clinical officer at Motivo Health, a company helping to solve the nation’s behavioral health crisis by supporting counselors through the licensure process.

A 2023 analysis by Motivo Health found that 57% of clinical graduates never reach licensure. “If more than half of people who get the education can’t work as an independent licensed professional, that is a significant problem,” Smith says.

The licensing process is expensive, requiring thousands of supervised clinical experience hours, which many pre-licensed counselors pay for out-of-pocket. On top of that, counselors in underserved areas may need to drive a couple of hours to meet with their supervisors. That was the case for Rachel McCrickard, LMFT, Motivo’s CEO. Living in rural Georgia, she had to drive two hours each way for clinical supervision. That experience inspired her to start Motivo Health.

Motivo Health lowers the barriers that clinicians like McCrickard face on their journey to licensure, such as cost and transportation, by providing a virtual platform for weekly clinical supervision.

The company works with both individuals seeking clinical supervision and employers looking to hire pre-licensed providers. Individuals pay $75 per supervision session with Motivo Health — making it a more affordable option to in-person supervision, Smith says. Individual clinicians can search a directory of hundreds of supervisors with diverse backgrounds. Once the clinician finds a match, a virtual dashboard tracks their progress toward licensure and organizes session notes in one place.

For employers, Motivo smooths out the laborious process of matching pre-licensed clinicians to supervisors by ensuring that virtual supervision is compliant with state and federal regulations and handling supervisor turnover, should it occur. After partnering with Motivo, Pinnacle Treatment Centers, a national network of mental health care centers offering treatment for addiction, saw clinician retention increase by 8%. Within a year, they were able to hire 32 new counselors — a 4% increase in their staff.

“Employers are also struggling with a workforce shortage,” Smith says. “To be able to expand their provider types to pre-licensed clinicians who are under Motivo’s supervision, they are better able to serve their communities.”

Backpack Healthcare is also lowering barriers to licensure. The company has developed a residency program, in which newly graduated clinicians can gain experience and supervision while earning a paycheck. The residents are an integral part of Backpack Healthcare, making up 65% of the company’s clinicians, Muhammad says.

“We’re making sure that the 57% who would otherwise drop out before licensure aren’t dropping out,” Muhammad says.

Streamlining Provider Practices

Technology is also playing an important role in the way established providers run their practices, helping them spend less time on administrative tasks and more time with clients. Granek has found AI note-taking tools particularly helpful. With client consent, he uses the tools to automatically transcribe their sessions.

With the click of a button, he can transform those transcripts into a progress note or care plan, he says. Not only does this technology save time, sometimes it even improves the care he offers patients. “The AI does a really good job writing well-crafted progress notes with nuance,” Granek says. “Sometimes it actually picks up on things that I may not have in session.”

Before employing these tools, Granek was careful to vet them for potential data privacy issues, even speaking directly with several of the companies offering AI transcription for behavioral health care. The companies reported that they had no access to client data and that recordings and transcripts are never used to train AI models.

Granek sees AI note-taking tools as a potential way to both provide better care to clients and reduce provider burnout. “Now I have more time to do actual work,” he says. “I can see more clients or at least focus on other things that benefit my practice.”

Backpack Healthcare has found success with similar technology. One clinician reported that before the company adopted AI administrative tools, she was spending 15 minutes between each session writing progress notes. Now, she spends five minutes editing and 10 going for a walk. “She can recalibrate for her next session,” Muhammad says.

Websites such as Alma and Headway can further reduce administrative burden. These services provide insurance support, caseload management and professional development to private practices. They also connect potential clients to counselors who meet their needs with a provider search engine tool and streamline the intake process with automated paperwork and assessments.

“Until recently, this technology didn’t really exist for therapists,” Granek says. “It’s small, but it saves time and is one less headache.”

Entering a Virtual Reality

Imagine strapping on a pair of virtual reality (VR) goggles alongside your client and stepping into a virtual world together. In this space, the client can explore their anxieties and triggers, practice real-world interactions and confront phobias, all without leaving the safety of the office.

The technology is already here. At community behavioral health centers, for example, VR is being used to help people work through post-traumatic stress following natural disasters. Meanwhile, researchers are exploring using VR as a tool to help young people on the autism spectrum develop life skills, such as navigating sensory triggers. Panagiotis Markopoulos, PhD, the counseling program director at Upper Iowa University, developed one of these VR environments — a simulation that exposes clients to loud noises and flashing lights as a form of desensitization therapy.

Some professionals are imagining how VR could transform counselor education and supervision. Michelle E. Wade, EdD, LPC, is developing a VR tool that would allow counseling students to practice skills on virtual clients. AI would allow these clients to “hear” the student in training and offer tailored responses.

“The program would be able to adapt to the student and their skill level, as well as any biases,” says Wade, an assistant professor of counselor education at the University of New Orleans. The program, which is a collaboration between Wade and colleagues in the computer science department, is in the early stages of development. Wade is still consulting tech developers and applying for grants. But the idea isn’t far-fetched; similar modules already exist in the world of social work education.

Four years after it was founded, Muhammad is seeing the positive impacts of Backpack Healthcare, on both clients and clinicians. The company has an 87% clinician retention rate, she says.

Meanwhile, 77% of Backpack Healthcare’s clients demonstrate a drop in their GAD-7 score, which reflects symptoms of generalized anxiety disorder. And, Muhammad says, 70% show a drop in their PHQ-9 score, which reflects symptoms of major depression.

Muhammad is proud of Backpack Healthcare — the satisfaction she sees in employees and the improvement she sees in the kids who seek care with them. With a willingness to embrace innovation, she sees the challenges counseling faces today, from clinician burnout to increasing demand for care, as surmountable. “No one company or organization can do it by themselves,” she says. “But as a collective, all of us working together can make it happen.”