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Rise of school-based mental health: Increasingly, states are looking for ways to bring these services to students, and encourage partnerships with local providers who can deliver specialized care

by Tim Anderson ~ January 2021 ~ Stateline Midwest »
In one Cleveland suburban district, licensed psychologists are regularly visiting schools and delivering clinical levels of care to students.
Hundreds of miles away, in the southernmost part of the state, a small district is converting part of its board offices (located on the same campus as its schools) into a school-based health center. There, young people will get access to an array of services, including mental health treatment.
These are two of the more than 3,000 local initiatives across Ohio getting state support because of legislative action taken two years ago — an unprecedented, $675 million funding commitment by the state to help schools provide nonacademic, wraparound services to students.
“As much as we like to say the education system is about academics, the reality is that those issues of student wellness are tremendously important to enabling a successful academic experience,” Ohio Superintendent of Public Instruction Paolo DeMaria says.
“If children come to school hungry, or can’t see the whiteboard, or have a high level of trauma or stress, they’re not going to be in a position to be educated.”
Mental health, above all other types of eligible services, is what schools targeted for support through Ohio’s new Student Wellness and Success Fund. That choice is not surprising, DeMaria says, considering what he has heard from school administrators, teachers and parents on listening tours across the state.
And that was before the potential impacts of the COVID-19 pandemic on the mental health of people of all ages.
Across the country, “there was a ton of activity, pre-COVID, around state actions to support mental health and schools,” says Alex Mays, senior national program director for the Healthy Schools Campaign. If anything, circumstances of the past year will only heighten this activity.width="300"
“For a variety of reasons, the education sector is increasingly seeing its role as supporting the mental health of students and staff,” says Dr. Sharon Hoover, co-director of the National Center for School Mental Health. “At the same time, we see the behavioral health sector recognizing schools as an important venue for service provision. We also have more and more examples of how to structure those services and get reimbursed for them in the school setting.”
Policy options for states
Hoover points to a number of state-level, school-centered policies and investments that can help young people. One strategy is to improve mental health literacy among students.
“Just like we’d want young people to know about their physical health and nutrition as part of health education, we want them to understand mental health — how do you obtain and maintain positive mental health,” Hoover says.
Some states (New York and Virginia) have begun requiring mental health education as a part of the school curriculum, and Illinois was the first U.S. state to adopt standards for social emotional learning.
Another option for states is to set a goal or requirement for the number of school-employed psychologists, social workers, counselors and nurses per student. (The ratio in nearly all states is currently below recommended levels.)
“Those staff are critical to providing universal mental health prevention and supports in the schools, and that can reduce the needs for higher levels of care,” Hoover says. “It’s not just looking immediately at what community providers we can bring in to the school.”
Increase in school-provider partnerships
That kind of outside help, though, can be essential, especially in delivering specialized, higher-level care to students. Many of the new state-funded initiatives in Ohio, for example, involve partnerships between the schools and local providers.
Minnesota has one of the Midwest’s longest-running, comprehensive programs. Its grants for school-linked mental health services date back to 2007; they bring practitioners into the school building for direct care and treatment, assessments of student needs, and training of staff.
Separately, Minnesota has a “safe school levy,” a provision in state law that permits local districts to collect property taxes for specific purposes, including the hiring of licensed school counselors, nurses, psychologists and social workers, as well as contracting with mental health professionals.
Sen. Greg Clausen, a leading legislative advocate of school-based mental health, traces his interest in the issue back to his past experience as a school principal and administrator.
“There were a number of students where you saw the need, and there was a frustration that we didn’t have a lot of services we could provide,” Clausen says. “And then when we tried to go outside the school, it was, ‘Well, we can get you in in three months.’
“It really provided the spark that we needed to do something.”
According to Mays, who tracks state activity across the country for the Healthy Schools Campaign, Michigan has emerged as a leader in recent years on school-based mental health — for example, appropriating $31 million for schools to bring in licensed behavioral health providers and changing the state’s Medicaid program so that it can cover services for general-education students (those who don’t have an individualized education plan).
“The challenge you run into a lot is whether a state program is sustainable or whether it’s just a one-off,” Mays says. “That why I think it’s important for states to look at ways to tap into health care funding, like Medicaid.
“If these services were being provided in a hospital or a community clinic, it would be reimbursed, no questions asked. Schools should be recognized as another site of service.”
That change in Medicaid policy, she adds, is needed specifically for services being provided by school-employed staff. (Outside mental health providers already can be reimbursed.)
According to Hoover, a variety of funding streams are now available to provide for school-based mental health, including new federal grants, greater flexibility in public and private insurance plans, and programs being developed by the states themselves.
Ohio’s $675 million Student Wellness and Success Fund is a case in point.
“Maybe 10 years ago, you would have heard the argument, ‘This is not what schools ought to be about,’ ” DeMaria says. “Not anymore.”

 

Tim Anderson serves as staff liaison for the CSG Midwestern Legislative Conference Education Committee.