With each of its 63 school buildings offering mental health services on site, Cincinnati Public Schools has committed to spreading a net of support to students in need of assistance.

Through the district’s Community Learning Center model, in which each school operates as the hub of its community, individual schools have gone through a review process and selected a private mental health provider that partners with the school, even establishing an office in the school building, says Sara Maurer, lead school psychologist. “We call on that mental health partner when we need really individualized mental health counseling, medication management, or case management.”

For the 36,000-student district, that process is part of the school system’s overall emphasis on social-emotional learning and meeting the social-emotional needs of students, says Assistant Superintendent Susan Bunte. “Certainly, a piece of that is how we support their mental health along various tiers of intervention. Other schools discuss this in terms of addressing the needs of the whole child, whether academically or on the social-emotional learning side.”

Once viewed as outside the scope of school district responsibility, student mental health and well-being is now considered an essential element of academic success. With statistics from the National Alliance on Mental Illness showing that 1 in 5 young people ages 13 to 18 have or will have a serious mental illness, half of all chronic mental illness begins by age 14 and three-quarters by age 24, providing mental health services has become an integral support offered by schools.

Identifying students who need services is a complex task, made more difficult by the stigma of mental health as well as by the very nature of some mental illness.

Indicators and Support

Relying on data collected through the district-wide Positive Behavior Interventions and Supports (PBIS) framework, school teams in Cincinnati “pay close attention to that Tier 1, universal level” and indicators including chronic absenteeism, a sudden drop in grades, unexplained discipline problems, and discipline referrals, says Maurer. “Students are systematically identified for increased behavioral supports as a first line of defense. It’s our primary means of data collection and analysis.”

A central tenet across all school buildings in the district is an open-door policy when it comes to referring a student for mental health services, Maurer says. The district does extensive training with school teams on recognizing mental health issues, but ultimately, “anyone in the school community can refer a kid for services,” she says. “Oftentimes, that is a teacher. Even more often a school psychologist, social worker, guidance counselor, but also parents and school paraprofessionals. Anyone involved in that community.”

As part of its work to provide an emotionally safe learning environment, the district this year added a button to the home page of its website where anyone in the school community can report being bullied or witnessing bullying. The district also increased teacher and student anti-bullying training. (A lawsuit filed by the parents of Gabriel Taye, a district 8-year-old who committed suicide in January 2017, alleges that Cincinnati school officials allowed and covered up bullying.)

Much like Cincinnati’s use of PBIS as an indicator that a student may need counseling interventions, North Carolina’s Charlotte-Mecklenburg Schools uses the Multi-Tiered System of Supports (MTSS) framework for school improvement as a key tool. For a student who may have had a Tier 3 behavior plan in place, and then additional other interventions, but adequate improvement hasn’t been achieved, the school “may want to add school-based mental health services in as another layer of support,” says Carrie Sargent the district’s mental health program manager.

Currently, Charlotte-Mecklenburg has school-based mental health programs in 121 of its 170 schools and regularly receives requests for the program from other district schools, Sargent says.

“I interpret that growth as a positive,” she says. “Students have always had mental health needs. We’ve always had children and adolescents who had mental health diagnoses, who weren’t receiving services, or who weren’t receiving services in a consistent manner. That’s always been the case, but it wasn’t as recognized or identified. Schools didn’t recognize their role and the role they could play in helping support mental health.”

Along with teacher, staff, and parent referrals, Charlotte-Mecklenburg also uses an extensive data portal created by the accountability department that provides an “early warning system” to identify at-risk students and highest-risk students and consider them for referrals. Chronic absenteeism, fluctuating or poor grades, frequent nurse visits, fighting, and transience are among factors considered, as is being a newcomer to the U.S. or an English learner, “at least for a period of time,” Sargent says.

Some students are identified as a result of being eligible for a Section 504 plan for a documented disability or during the creation of an Individual Education Plan (IEP), says Charlotte-Mecklenburg board trustee Ericka Ellis-Stewart, a mental health education advocate and certified trainer.

The impact of “untreated, undiagnosed, unchecked, mental health concerns is often apparent in disciplinary hearings,” Ellis-Stewart says. “Eight out of 10 times, it’s a student who has some sort of mental health challenge that hasn’t been addressed or fully addressed and has fallen off the radar.”

Early Detection

Students who do not have a safe and dependable place to call home also are often at risk for mental and behavioral health issues, says Veronica Macklin, coordinator of counselors and social workers for the Jennings School District in Missouri. As a result, “one of the things we offer automatically when filling out McKinney-Vento (Homeless Assistance Act) paperwork for a student is counseling services,” she says. “We know students who have been living in situations where regular housing has been disrupted are coming in with some kind of trauma.”

Because a sizeable percentage of the district’s 3,000 students live in poverty, increasing their exposure to the depression, anxiety, and stress that can hinder a student’s school success, the district has put in place a multitude of wrap-around supports (from laundry facilities to homeless shelters, to mental health and counseling services) to assist them.

“From the very moment of enrollment, we do a needs survey that asks what prior issues, situations, or ailments require supports,” says Superintendent Art McCoy. Through weekly meetings with each school-based care team and monthly districtwide meetings with administrators and an array of outside professionals, including 10 mental health providers, “we try to cover all the bases,” he says.

Changes to school registration forms in Florida school districts this year also attempt to uncover past mental health conditions. A new regulation requires that school districts ask parents registering their children for the first time whether the child has ever been referred for mental health services. The registration form addition is part of the Marjory Stoneman Douglas High School Public Safety Act passed by the Florida Legislature following the Feb. 14 mass shooting.

In a statement, Andrea Messina, executive director of the Florida School Boards Association, noted that while the language in the legislation “passed in an effort to increase early intervention for students by using collaborative services, families and school districts have definitely expressed concerns regarding student data privacy.”

In Cincinnati, where district schools contract with outside partners to provide mental health treatment, “parents can consent to what information they are comfortable sharing with school staff,” Mauer says. “There are many times parents do not want their child’s mental health diagnosis information from their treatment plan shared, and that’s perfectly acceptable and is honored. It’s confidential information.”

But the district typically finds “improved outcomes” for kids when there is collaboration between the mental health treatment provided by outside therapists and the educational and behavioral supports provided during the school day, Bunte says.

Universal Screening

A growing number of schools are turning to universal mental health screening to identify students who are at risk for problems ranging from aggression to social isolation. Newton County School System in Georgia does not conduct a mental health screening of all students, but some district teachers have used the Social, Academic and Emotional Behavior Risk Screener, or SAEBRS tool, to identify students who may benefit from additional behavioral supports, says Adrienne Boisson, the PBIS coordinator for the 20,000-student district.

“The rating comes back identifying the student as a low-risk, slightly elevated risk or elevated rate,” Boisson says. “It doesn’t mean that every student who is not low-risk gets services, but it lets you know to look at other factors affecting this student and see if he might benefit from some of our Tier 2 and Tier 3 services.”

As part of the Signs of Suicide Prevention Program piloted in several Charlotte-Mecklenburg schools, a brief screening tool is used to identify at-risk students, Sargent says. A positive screening will lead to follow-up with staff and, where necessary, further evaluation by a mental health professional. The district is discussing the possible expanded use of screening tools, she says.

Boisson, who also serves as the Project Aware (Advancing Wellness and Resilience Education) director for Newton County, works with a school team to identify students in need of mental health services and help connect families to support services for their children. Funded through federal grants by the Substance Abuse and Mental Health Services Administration, Project Aware aims to promote youth mental health awareness among schools and communities across the country.

Another goal of the project is “reducing the stigma associated with mental illness and increasing mental health conversations,” Boisson says.

It was with that objective that she and her Project Aware team last year launched a mental wellness film series to encourage family conversations about mental health and mental wellness. “We felt like we were doing a good job reaching school staff, and we were able to inform and get programming out to students,” she says, “but we really wanted to reach parents, deal with the taboo, and get conversations going.”

Half of the six-film, 2018-19 series features family films such as Horton Hears a Who!, which emphasize themes of positive self-esteem, self-respect, and how to handle bullying. Parent-child art projects, book giveaways, and other activities are included as part of the event.

The other half of the film series features documentaries and is aimed at middle school and high students, parents, teachers, and other adults. One film, Mind/Game: The Unquiet Journey of Chamique Holdsclaw, tells the story of the former WNBA player who battled bipolar disorder and depression and went on to become an advocate for mental health awareness.

“We know that if our kids are struggling with a mental illness and no one talks about it or if the people they know and trust say disparaging things about those with a diagnosis, that will make young people less willing to open up and get the help they need,” Boisson says.

Open and Honest

Encouraging open and honest conversations is one practice that educators say can make a difference for students in need of mental health counseling. Other suggestions:

Ensure that mental health partners become part of the school culture and meet with school staff on a regular basis to discuss not only progress on cases that they can discuss, but also to figure out who in the school can help kids get the care that they need, Maurer says.

Help county and state funding agencies understand that funding for student mental health services is a high priority. Collect data to make data-informed decisions. Determine what are the issues in your district. How is it impacting educational outcomes? Look at ratios in your school system for school psychologists and social workers, Ellis-Stewart says. How does that compare to national standards?

Build capacity so that staff members feel confident that they can respond to crisis situations, know district protocol, and have proper resources for families, Boisson says.

Encourage teacher and staff mental wellness and self-care. We are asking teachers and staff to care for our precious cargo, but if they aren’t mentally well, that’s a challenge,” says Ellis-Stewart.