Will to Wellness: Six Steps to
Reinventing Mental Health in Schools
A 6-point best practices framework for districts, states, and federal
policymakers to reinvent mental health in schools over the next five years.
policymakers to reinvent mental health in schools over the next five years.
One of the legacies of the pandemic, and the resulting youth mental health crisis, is a recognition on the part of districts that they have a critical role to play in the delivery of mental health care for our young people. However, the execution – the processes, policies, and systems – needed to deliver high-quality services remains a work in process for many districts. The below six points represent the key areas that districts, states, and federal policy makers should focus on in the next 5 years when it comes to reinventing mental health care in schools.
Six Steps to Reinventing Mental Health in Schools
Develop and implement better systems and guidelines for early identification of students with mental health challenges
Many students who experience mental health challenges may show few external symptoms, making it difficult to identify all students who need support. Districts can benefit from clinically supported tools to help better identify students experiencing mental health challenges. The earlier we identify symptoms, the quicker we can intervene and provide treatment, which can reduce the incidence rate, duration and severity of youth mental illness.
District recommendations:
- Incorporate regular mental health screenings of all students throughout the school year, following best practice guidelines for conducting such screenings.
State and federal recommendations:
- Issue guidelines and best practices for districts to conduct universal mental health screenings, with a focus on parental awareness and consent, required systems for follow up, and data and privacy considerations.
- Provide funding for districts to conduct universal mental health screenings.
Promote and incentivize consistent adherence to a best practice MTSS model
While states and districts across the country have adopted Multi-Tiered Systems of Support (MTSS) as a governing framework for school-based mental health, there is little consistency in the specifics of how this framework is implemented from state to state and district to district. Simply put, if ten districts are asked to define what MTSS “looks like” in their district in the mental health domain, it’s likely that they will have ten different answers. Districts should follow a consistent set of MTSS-aligned best practices for mental healthcare delivery,
District recommendations:
- Conduct needs assessment of current Multi-Tiered Systems of Support (MTSS) for mental health policies and practices.
- Seek guidance on therapeutic best practices for providing MTSS-aligned mental health support at various tiers.
- If internal capacity does not exist, identify and rely on trusted external partners to provide specialized expertise.
- Create an “MTSS playbook” to document how the mental health continuum should be implemented in the district.
- Provide training to educators to build awareness of the key MTSS-aligned services available in the district.
State and federal recommendations:
- Create clear and standardized definitions of best practices for each tier of the MTSS framework as they pertain to mental health.
- Create a certification program to recognize districts that have implemented mental health best practices; collect and publish data on MTSS adherence.
- Allocate funding to districts looking to create (or who have created) mental health models with MTSS-aligned best practices.
Create and implement guidelines, systems and processes for data collection and progress monitoring of school-based mental health initiatives
School-based mental health is a domain where the capture of progress monitoring data has traditionally lagged, with qualitative descriptions of student progress being more common than quantitative measures. As a result, the impact of school-based mental health initiatives is often “invisible” to most end users, including policy makers. School districts need the frameworks, tools, processes, and systems to measure the outcomes of their in-school mental health programs to demonstrate the success of programs that are working. The collection of data will allow for the longevity of in-school mental health programs as schools seek sustainable funding, as well as promote transparency and accountability for these initiatives.
District recommendations:
- Create progress monitoring guidelines and data collection frameworks aligned to key mental health outcomes.
- Create dashboards/standardized periodic reports on mental health outcomes, as well as a communications plan to share elements of this data with stakeholder groups (staff, board, community, etc.).
State and federal recommendations:
- Publish guidance for local education agencies (LEAs) on progress monitoring and data collection framework aligned to key mental health outcomes.
- Create federal and state level data infrastructure to store aggregated progress monitoring information.
- Develop federal and state dashboards to report on key mental health performance indicators.
- Provide funding for districts to create local data progress monitoring tools and processes, and to incentivize adherence to data collection best practices.
Build mental health awareness capacity among adults in our school communities
Students cannot always advocate for themselves, and it rests upon the adults in their lives (i.e., educators and parents) to recognize the signs of mental illness and help direct them to the support they need. To combat the often self-defeating constraints placed by stigma, every adult needs to know how to identify mental health warning signs and how to direct students towards the proper forums for care.
District recommendations:
- Create annual professional and parent learning plans, including defined learning objectives and a calendar of events.
- Partner with expert organizations with deep domain knowledge in building awareness of mental health-related topics.
- Ensure strong processes for progress monitoring and measuring impact.
State and federal recommendations:
- Publish and distribute guidelines and learning objectives for building mental health awareness with educators and parents.
- Create federal and state resource libraries of professional and adult learning content that can be used for awareness building.
- Determine progress monitoring plans to measure the impact of awareness building efforts.
- Provide funding for districts to implement mental health awareness building efforts.
Create sustainable funding pathways for school-based mental health initiatives
Nearly half of school administrators believe funding is a top concern when it comes to student mental health, and over 55% state that they do not have enough information on how to access available funding. Currently, funding school-based mental health initiatives can be daunting for many districts, with administrators often needing to combine funds from dozens of different sources. With many funding sources about to expire, schools need access to a simpler, more sustainable set of funding streams as well as information on how to access them in order to maintain the longevity of their school-based mental health programs.
District recommendations:
- Ensure senior district administration and finance staff are educated on the full range of options to sustainably fund mental health services.
- Monitor available mental health grants and apply for relevant opportunities where the district is eligible.
- Explore creative uses of Title I, Title II, Title IV, and IDEA funds to support mental health programs.
- Explore self-funding mental health initiatives through transition from out-of-district placements to in-district programming.
State and federal recommendations:
- Create mental health sustainability funds to ensure successful transition away from Elementary and Secondary School Emergency Relief (ESSER)-based funding.
- Create a sustainable mental health funding guide for LEAs.
- Establish permanent funding entitlement streams for mental health initiatives, with an overarching goal of simplifying how mental health initiatives are funded.
- Expand Medicaid to cover school-based mental health care for both special education and general education students.
- Adopt legislation that requires private insurance and/or Medicaid to fund school-linked mental health services according to a state-wide fee schedule (e.g., AB133 in California).
- Incentivize use of school-based mental health programs versus expensive out-of-district placements.
Ensure all students in need have access to top-tier mental health clinicians
There is a major staffing shortage of qualified mental health therapists to deliver mental health services in schools. Both parents (40%) and educators (50%) are concerned with districts having adequate staff to address student needs. Schools need specialized mental health staff who can work in a dynamic environment, respond to the varying needs of students, and provide top quality clinical support.
District recommendations:
- Partner with an agency with deep domain knowledge in hiring high-quality mental health professionals to identify, recruit, and train mental health staff members.
- Ensure the proper resources and processes are in place for providing clinical supervision to individuals working towards full licensure.
- Ensure clear therapeutic guidelines and job descriptions exist for individuals providing mental health services and/or partner with an external agency that can provide such guidelines.
State and federal recommendations:
- Offer incentives (e.g., tuition reimbursement) to increase the number of entrants into mental health-related fields.
- Launch federal and state campaigns to build awareness of job opportunities in mental health fields.
- Simplify licensure rules and increase reciprocity across state lines and across clinical licensure types (e.g., LCSW, LPC, LMFT).
- Explore the use of alternative job roles (e.g., Wellness Coaches) to extend the number of eligible mental health workforce members.
Our students deserve the best quality mental health care. While providing these services has been a priority for districts, what these services should look like and how they should be implemented has remained ambiguous. This new policy blueprint is exactly the kind of resource districts need to meet the moment.
- Marilena Guliso, Director of Student Services, Newington Public Schools