This case study was created as part of a series for Apolitical’s 50 States, 50 Breakthroughs, created in collaboration with the National Academy of Public Administration and Humans of Public Service.

In Montana, a combination of long distances, limited workforce, and high youth mental health needs has long made it difficult for young people to access timely support. Project YES, developed by the Lab for Scalable Mental Health, offers a new answer: free, evidence-based digital single-session interventions that any young person can access anonymously, on demand, in about 10 minutes.

Montana is now rolling out Project YES at the state level, becoming the first state in the United States to make free, evidence-based digital mental health support available to youth statewide. The work is progressing through a collaborative co-design process between the Lab for Scalable Mental Health, Montana Pediatrics, Frontier Psychiatry, Koko, and young people across the state.

The problem

Access to youth mental health care is limited almost everywhere, but Montana faces a particularly acute version of the challenge. Around 43% of Montana youth report persistent feelings of sadness or hopelessness, and the state has one of the highest adolescent suicide rates in the country. 51 of its 56 counties are federally designated mental health professional shortage areas.

The shortage of providers is only part of the picture. Across the United States, only about 20% of young people with substantial mental health needs ever access any form of treatment. Among those who do, the most common number of interactions with a professional is just one.

“What we have an evidence base for is unfortunately misaligned with the reality of on-the-ground access patterns,” says Dr. Jessica Schleider, founder of the Lab for Scalable Mental Health. Decades of research have produced multi-week, multi-month protocols for evidence-based psychotherapy, but most young people never reach a provider long enough to benefit from them.

Her lab’s mission is to close that gap by engineering brief, barrier-free interventions designed for the system that exists today, rather than waiting for the one public health leaders wish they had.

How the partnership came together

Project YES’ path into Montana began with two separate phone calls. Dr. Eric Arzubi, one of the few child and adolescent psychiatrists in the state and CEO of the telehealth practice Frontier Psychiatry, reached out to Schleider after reading her research on single-session interventions. Around the same time, the CEO of Montana Pediatrics, a statewide telehealth pediatrics organization, contacted her independently with the same idea.

It turned out the two already knew each other. In a state with so few youth mental health specialists, Montana’s small community of providers was already well connected. Schleider brought everyone into one call, and together the group began building a plan.

From there, the collaborators braided funding from the state’s Department of Public Health and Human Services with philanthropic support. This collaboration created the foundation for a statewide implementation that includes a cultural adaptation of Project YES tailored to Montana youth and linked to local resources, as well as a guide for parents and professionals across the state to help them use Project YES in schools, in clinics, and at home.

What Project YES offers

Project YES is a free online mental health resource built by and for young people. The Lab for Scalable Mental Health, working with its nonprofit tech partner Koko, co-designs each intervention with youth to make sure the resulting tools are ones young people actually want to use.

A young person visiting the site can click on any module that speaks to a problem in their life. Each module delivers a kernel of a longer evidence-based intervention, teaching a specific coping skill or strategy drawn from treatments for conditions like depression and anxiety. No diagnosis is required, and the tools are anonymous and self-guided. Each module takes about 5 to 10 minutes to complete.

Before and after each module, Project YES asks a few quick questions: how hopeful do you feel, how motivated are you to make change. This allows the team to continuously evaluate impact. At the end, young people can choose to try another module or connect with other support. In Montana, those onward resources are curated to local offerings, so a young person who wants more help can find it quickly.

Making the case for single-session interventions

Single-session interventions remain a relatively unfamiliar concept in mental health care. Schleider, a clinical psychologist by training, says she did not encounter the term once during her training. For most decision-makers, the idea of a brief digital intervention producing measurable effects is new.

The hardest part, she says, is getting into the right room with the right person at the right time. Once those conversations happen, the case for Project YES tends to make itself. After the initial investment to adapt the platform for a community, the interventions themselves cost almost nothing to deliver. Research shows impacts on depression and anxiety, increased openness to other forms of support, and broad reach for a very low marginal cost.

“Given the low barrier to entry, low stigma and low cost, it’s a pretty easy sell once we explain what these are,” she says. “I think just educating is the real barrier.”

Given the low barrier to entry, low stigma and low cost, it’s a pretty easy sell once we explain what these are. I think just educating is the real barrier.

Co-designing with Montana youth

A central component of Montana’s rollout, funded by both state and philanthropic dollars, is a formal co-design process with young people across the state. The team recruited youth through online focus group panels, gathering asynchronous and synchronous feedback on an unadapted version of Project YES.

Schleider is upfront about why that step matters. Adults, whether they are researchers, designers or clinicians, can guess what young people will want from a platform like this, but they are very likely to guess wrong. Putting the design in front of Montana teenagers early meant the lab could catch those wrong guesses before they were baked in.

Two pieces of feedback stood out. The first was about language. Teens told the team they hated the term “single-session interventions.” “They were like, that sounds too clinical. I would never do that. What even does that mean?” Schleider recalls. On Project YES, the interventions are now called “mini courses.”

The second was about length. The original interventions developed by the lab were 15 to 20 minutes long, which felt short to a clinical psychologist but unrealistic to a teenager. Schleider laughs recalling the team’s reaction: “That was distressing because 20 minutes to a clinical psychologist is already really short.”

The team responded by running clinical trials comparing 20 minute, 10 minute, and 5 minute versions of the same intervention. They found that the effect on depression two months later was consistent across lengths. The active ingredients were a concrete action plan, peer stories, and a small dose of psychoeducation to help young people understand what they were experiencing. Project YES modules are now between 5 and 10 minutes.

Feedback also shaped how the modules are described, the flow a user moves through, and the fact that the tools are anonymous. The entire concept of the platform, Schleider notes, was inspired by what youth were asking for: something they could access on their own, before they felt comfortable asking for help, that was immediate, brief, and gave them an action step.

Results and signals of success

Project YES has now reached more than 150,000 young people through a mix of clinical trials and partnerships with platforms, nonprofits, county, and state governments. Koko, the lab’s technology partner, has helped surface Project YES modules through online platforms such as TikTok, Discord, and Character.ai, offering support to young people struggling, such as those searching for terms related to suicide or self-harm.

Roughly 25,000 of those young people have been reached through formal clinical trials published in scientific journals. Those trials have shown that Project YES modules can reduce symptoms of depression and anxiety up to three months later. For interventions that last between 5 and 20 minutes, and often reach young people who would not otherwise access care, that is a meaningful result.

Impact data from more than 5,500 adolescents who have engaged with Project YES in other settings shows consistent reductions in hopelessness and self-hate and increases in agency, regardless of which module a young person chooses.

With the evidence base established, the Montana work is now focused on a different question: how to embed single-session interventions into the systems of care young people already touch. The status quo, Schleider argues, is not enough on its own, and the next stage of the work is about finding sustainable implementation pathways rather than running more efficacy trials.

Alongside the platform itself, the team is developing a Project YES dissemination toolkit for providers, teachers, and parents. The goal is to help pediatricians, school staff, and caregivers understand what single-session interventions are and how to offer them within the settings where young people naturally seek care. Creating something that works, Schleider is quick to point out, is only half the task: the other half is doing the unglamorous work of embedding it in people’s day-to-day lives.

Roughly 25,000 of those young people have been reached through formal clinical trials published in scientific journals. Those trials have shown that Project YES modules can reduce symptoms of depression and anxiety up to three months later.

Challenges

Schleider, who is trained as both an intervention and implementation scientist, is clear-eyed about the gap between designing something that works and actually getting it to the people who need it. In her view, implementation is significantly harder than creating an effective intervention in the first place.

The central challenge for Montana’s rollout, she says, is making sure the perspectives of people from all walks of life are represented in how the platform is adapted and disseminated. Without that, community-embedded initiatives risk reinforcing the same disparities they set out to bridge, prioritizing voices that have historically been heard while overlooking the young people who are most often left out of the system. For Project YES to meet its goal, the people who have been systematically excluded from existing systems of support need a genuine hand in shaping this one.

Advice for other governments

The Montana experience offers several lessons for governments and health systems interested in expanding youth mental health access, especially in rural or workforce-constrained settings.

First, take the education step seriously. Single-session interventions are not widely understood, even among clinicians. Once decision-makers understand what they are and what the evidence shows, the value proposition tends to speak for itself. The bottleneck is getting into the right conversations in the first place.

Second, start with the people already doing the work. Project YES arrived in Montana because two local clinicians independently sought it out and then worked together to bring it to the attention of the state’s Department of Public Health and Human Services. Partnering with trusted local providers who leveraged pre-existing relationships gave the initiative credibility and reach that an outside organization could not have achieved alone.

Third, co-design is not a finishing touch. The most consequential design decisions in Project YES, from what the modules are called to how long they are, came from young people themselves. Adult assumptions about what teenagers want, or how short is short enough, tend to be wrong.

Fourth, plan for dissemination from the start. A working intervention is only half the job. Embedding it in the schools, clinics, and online spaces where young people already are requires a parallel investment in the toolkits, training, and partnerships that make adoption possible.

Looking ahead

Montana’s rollout is the first example of a state-level public-private-academic partnership for digital single-session mental health support in the United States. The Lab for Scalable Mental Health is in conversation with other states and is running a similar countywide initiative in Indiana, where foundation funding is supporting co-design, large-scale deployment, and cost-effectiveness evaluation.

If the Montana model holds, it offers something rare in youth mental health: a way to deliver evidence-based support to large numbers of young people quickly, cheaply, and in a form they actually want to use, without waiting for the workforce or the wider system to catch up.