Schools across the country are seeing an increase in the number of students dealing with mental health challenges amid a waning, but still ongoing, pandemic.
Some school districts are hiring more staff to respond to the need; others are having trouble doing so.
About 12 percent of students attend schools in districts that don’t have a psychologist at all, and just 8 percent attend schools with the recommended one psychologist to 500 students ratio. The counselor-to-student ratios are only a little bit better with just 14 percent of students attending schools with the recommended ratio of one counselor per 250 students. The need is higher in districts serving more students of color.
What are cash-strapped and overwhelmed school districts to do amid this mental health crisis?
The Cherry Creek School District in Greenwood Village, Colo., has hired more staff, increased partnerships with health agencies and hospitals, and contracted with an online provider to provide therapy for students.
But the most unorthodox thing the district is doing is building a mental health day-treatment center, in partnership with a local hospital and university to ensure that students struggling with issues such as severe anxiety, depression, substance abuse, and eating disorders can get care as soon as possible.
While their efforts still don’t meet the full extent of the need, district leaders there hope their efforts can provide a few lessons for districts struggling to respond to a crisis moment for adults and students.
“You really do have to think outside the box,” said Tony Poole, assistant superintendent of special populations. “If we have a system that’s just not working, what can you do? What can you do to get kids more support?”
Take an inventory of current services and programs
One of the first things districts can do is take a top to bottom look at the services and personnel that already exist to support mental health. Is it enough? Where are they falling short? What does the community (students, families, teachers, and principals) have to say about the needs and whether and how they are being addressed?
Dr. Bruno Anthony, a professor of child psychiatry at the University of Colorado Anschutz Medical Campus, who is working with the Cherry Creek school district on the mental health day-treatment center, said he always suggests an inventory for school districts.
“You look very carefully at what your needs are,” Dr. Anthony said. “You look very carefully at what you have in place already, and then you look to see, across the country, what the experts say is really the way to go about getting those needs met.”
That’s one of the ways that Cherry Creek officials have scaled up resources over the years, particularly during the pandemic era.
The district hired this year a social-emotional learning coordinator to focus more on prevention efforts, including to work on universal mental health supports, suicide-prevention and social-emotional learning curricula, and building stronger culture and communities, according to Steve Nederveld, the district’s mental health director.
Cherry Creek also assembled a mental health task force, made up of students, parents, principals, teachers, district administrators, community members, and other stakeholders, to ask about changes that could be made to better serve students and their mental health needs. Many of the new programs the district is implementing this year grew from the taskforce, Nederveld said.
“The main thing we heard was more prevention, more support in schools, that counselors and mental health providers were stretched so thin, that they felt they needed more of those two resources,” he said. “And that when they needed mental health support outside of schools, it was hard to provide those services.”
The district’s foundation created a relief fund to help students access mental health services outside of their parents’ insurance networks. A new partnership with Hazel Health, an online health company that provides physical and mental health supports, will offer tele-therapy for students in 6th through 12th grades, at no cost to students within 24 hours of students contacting the company. About half of the clinicians at Hazel are people of color and between 30 and 40 percent are bilingual in Spanish and English. About half of the students in Cherry Creek are students of color.
That’s critical, he said.
“It’s always been a challenge to find therapists or mental health professionals that kind of connect with our students as much as I think the Hazel Health clinicians might, given the fact that there’s such diverse employee group,” Nederveld said.
Consult the experts
Dr. K. Ron-Li Liaw, Children’s Hospital Colorado’s mental health-in-chief, who is also working on the mental health day-treatment program with the district, said that before they started their school-based strategy they reached out to Sharon Hoover, the co-director of the National Center for School Mental Health, which is based at the University of Maryland.
Check with the experts for evidence-based approaches and advice, Dr. Liaw said.
The center’s website and experts have a ton of resources to help districts get their arms around the rising need and to tailor mental health supports to students.
The organization has “everything from how to build a multi-tiered system of support to how to do a district-wide assessment of your mental health supports and need,” Dr. Liaw said.
There’s also free educational online modules for districts.
Partner with local hospitals and health services
Contact local children’s hospitals to find out whether it’s possible to collaborate on a treatment center like the one Cherry Creek is building or whether the hospitals can share resources by bringing in counselors, psychiatrists, and psychologists to supplement the mental health staff already available in schools, Poole said.
“If I were a superintendent in a school district and I was desperate for mental health supports for my kids, I’d start reaching out to all the CEOs of the hospitals in my area and ask them if they want to partner and look into creative ways to partner and provide services to kids and families,” Poole said.
Cherry Creek has also partnered with Aurora Mental Health Center and AllHealth Network Colorado for therapy services. It’s now working with HealthONE, a state healthcare provider for the first time this year, with the goal of ultimately ensuring that there’s a full-time or part-time school-based therapist in every school building.
Think about building a pipeline
While school districts are facing a crisis right now, Poole urged districts to think about the future and their role in building a workforce of social workers, psychologists, counselors, and other mental healthcare professionals.
Over the past few decades, school districts have started grow-your-own programs to encourage students to become teachers.
A similar line of thinking should apply to mental health support staff, he said.
“We have to start working with our own kids in growing our own,” Poole said. “Do you want to grow up and be a psychiatrist? Do you want to grow up to be a psychologist and be a licensed clinical social worker? Let’s get you in some classes about that.’ Let’s look at this as a career pathway. ... Psychologists, licensed clinical social workers, speech language pathologists, occupational therapists—we are dying for these people.”
Focus on early intervention and prevention
Given that students spend about eight hours a day in schools, districts must prioritize early-intervention and prevention programs, Nederveld said.
“If we don’t have mental health supports in a building to assess, to screen, to provide support, to provide referrals to outside community mental health resources, I don’t know where else students can identify and connect to the services if it weren’t for schools,” he said.
That includes improving school climate and culture, ensuring that students have a trusted adult in the building they can go to if they have a problem, conducting threat assessments and suicide risk assessments, and training teachers to know what to look for to spot students in distress and support them.
A new coordinator of social-emotional learning, for example, will oversee hiring and professional development around mental health support, determine the services that need to be put in place, and oversee the safety curriculum.
But the district expects its mental health staff to be part of the teaching and learning side of things as well.
“So having our building and mental health staff push into classrooms to teach some of those social-emotional lessons or support that is probably beyond the scope of what most people think of when they think of mental health,” Nederveld said. “They think that only certain students need crisis support or mental health treatment—which is true—but we would say all of our students need to learn how to grow their capacity on a social emotional level.”
It’s also piloting twice-a-year universal screeners in eight of its 67 schools on social-emotional competencies. Part of the survey will ask students about whether they have a trusted adult on staff they can speak to if they have a problem.
“That will be an effort that we think can help us identify which students we need to pay a little bit more attention to if they are not connected to an adult in the building,” he said. “How can we build those relationships?”