key: cord-0064580-u9lyvuzx
authors: Walters, Anne S.
title: Providing mental health services within schools: A post‐pandemic imperative
date: 2021-05-06
journal: nan
DOI: 10.1002/cbl.30550
sha: 8645a12384498483fe199311b0f4eddcf56edba0
doc_id: 64580
cord_uid: u9lyvuzx

Recent research suggests a mental health crisis for our youth of startling proportions, likely related to the stressors of the pandemic. Rates of suicidal thinking and behavior are up by 25% or more from similar periods in 2019 (Hill et al., 2020). And although emergency department (ED) visits were down in the first few months of the pandemic, the rate of children and adolescents boarding in the ED, waiting for a mental health bed, has also increased by 25%–31% (Lee et al., 2020).

R ecent research suggests a mental health crisis for our youth of startling proportions, likely related to the stressors of the pandemic. Rates of suicidal thinking and behavior are up by 25% or more from similar periods in 2019 (Hill et al., 2020) . And although emergency department (ED) visits were down in the first few months of the pandemic, the rate of children and adolescents boarding in the ED, waiting for a mental health bed, has also increased by 25%-31% (Lee et al., 2020) .

Access to mental health care for children was an issue prior to the pandemic; roughly 35%-50% of children will not receive treatment for their mental health needs (Whitney & Peterson, 2019) . This is a concern particularly as children return to in-person learning after a profoundly challenging year and moves the idea of providing mental health services in our schools from a concept to an imperative.

With barriers to treatment thought to cluster in the areas of accessibility, affordability, acceptability, and availability, schoolbased mental health treatment offers options for reaching more youth in the place where they spend substantial amounts of time each week and bypasses some of these barriers to treatment.

A bill sponsored by representatives John Katko and Grace Napolitano creates grant funding for schools across the country to partner with mental health agencies and professionals to establish comprehensive mental health services within schools.

The bill would require the Secretary of Health and Human Services to partner with the Secretary of Education, and be distributed through SAMHSA [Substance Abuse and Mental Health Services Administration] via Project Aware (Advancing Wellness and Resilience in Education). The goals of the funding are noted as: increasing awareness of mental health issues among youth; providing training for school personnel to identify and address mental health issues; connecting youth and their families to services; assessing outcomes; and disseminating best practice interventions. The bill, sponsored in six congresses so far, passed in the House in September of 2020 and was forwarded to committee for further study.

As we think about implementing services in schools, it seems feasible to layer options onto the three-tier RTI (response to intervention) system.

The philosophy behind RTI is to provide evidence-based interventions to students at increasingly intensive levels with ongoing monitoring of progress. This model has been applied to integrate intervention for both learning and behavioral issues with the recognition that difficulties in one area are both intertwined with, and influence, the other and that all instruction should be based on data.

The universal system of supports for both learning and socio-emotional developmental at the level-one tier is meant to improve outcomes for all students. At level two, often referred to as secondary support, an RTI team is charged with selecting empirically based practices to improve functioning for larger groups of students who might be struggling with accessing curriculum. Level three, or tertiary support, is aimed at meeting the needs of a small group of students who have not responded to earlier levels of support. At level three, certain core requirements must be met prior to implementing interventions (functional behavior analysis, for example), and the interventions must be individualized.

In a recent USA Today article, Franklin and Posner-Gerstenhaber (2021) call for a "mental health curriculum" in schools. They describe this curriculum as building on coping and problem-solving skills as well as self-care, implementing screenings, teaching signs of distress, and reducing stigma. They further note that only 20 states have requirements for some form of mental health curriculum and that only 16% of children receive on-site mental health assistance in school.

Applying their call to action to the three-tier system described above might result in the use of a curriculum at level one for all learners; anti-stigma interventions as well as instruction on seeking treatment without concern for repercussions among staff and/ or students.

Screenings might result in referrals to level two, with teaching of some of the skills Franklin and Posner-Gerstenhaber describe, and at level three, referrals to in-house treatment via partnerships between local education authorities and community-based agencies, with funding assistance via the grants described above and/or insurance-based billing. With the Mental Health Services for Students Act in at least its sixth iteration as students return to in-person learning, our youth need action.

In Covid's wake, we need a mandatory mental health curriculum in schools

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