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Association of California School Administrators
Association of California School Administrators
Elements of consideration
Developing your school’s mental wellness program
By Sheri Stevens Parker, Aimee Garcia and Mark LeNoir | November | December 2022
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The Centers for Disease Control and Prevention estimates that in any given year, one out of every five children experiences a mental disorder. A report in the Journal of the American Medical Association indicates that half of the children with a treatable mental health disorder do not receive treatment from a qualified mental health professional. Childhood traumas such as physical, emotional or sexual abuse can be the underlying cause of many mental health disorders, and early intervention is critical to a child’s overall development. A 2009 ABC News brief reported on a study by the CDC, which shows that children who experience a significant amount of trauma, can have their life-expectancy shortened by almost 20 years.
The reasons for not obtaining treatment are varied and range from a lack of accessible resources to an inability to pay. According to the National Alliance on Mental Illness, “school-based and school-linked mental health services reduce barriers to youth and families getting needed treatment and supports, especially for communities of color and other underserved communities.” Given the number of children with a mental health diagnosis and the need for accessible and affordable treatment, it makes perfect sense to provide mental health services in schools. Val Verde Unified School District recognizes and values the benefits of providing mental health services for all students and has incorporated these services into their Multi-Tiered System of Support.
Val Verde Unified School District has invested in a robust mental health program for all students. The district currently employs a total of thirty-one therapists, four supervisors and ten student interns who provide tiered mental health services for students and families within the district. Val Verde has roughly 19,000 students, is a majority-minority district and the mental health staff employed by the district are reflective of the students and families they serve. As a result, students and their parents are able to receive culturally competent and affirming care, which increases the likelihood that they will stay in treatment longer and have better outcomes (Georgetown University, 2022).
In the following paragraphs, we will briefly outline important elements of Val Verde’s mental wellness supports, describe lessons the school district has learned and share nuggets that other districts may benefit from, especially considering the increased funding that are available for these types of supports. What is important to point out is that there is no one-size-fits-all formula for staffing and programmatic emphasis when it comes to creating your individualized school district’s Multi-Tiered Systems of Support. Each school district has its own unique demographics, internal and community resources and other variables that make up its local context and in turn influence its individual needs.
As a result, there may be other elements not mentioned in this article which may prove to be successful in another school setting. There are numerous things to consider when putting together your comprehensive supports for student well-being; however, we would like for you to reflect on some items that will assist in helping you create a stronger system of student support.
Goals
Before you start investing in your mental wellness program with the addition of staff and other valuable resources, we strongly suggest making time with your district leadership to first establish goals for the program. In Val Verde, we started first with our Board of Education through presentations, study sessions and weekly updates. One of the board goals in Val Verde is to provide a whole child approach to education which considers our students’ mental, social, and physical well-being. Tied to our district’s board goals are specific measures in how we will measure our implementation of our support programs.
Utilization of data
Since the COVID-19 pandemic, mental health crises have been on the rise. A report from the American Psychological Association indicates that: “From March 2020 to October 2020, mental health-related emergency department visits increased 24 percent for children ages 5 to 11 and 31 percent for those ages 12 to 17 compared with 2019 emergency department visits…” (Abramson, 2022).
A significant increase in crises and the need for Tier 2 and Tier 3 mental health services was also seen in Val Verde. During the 2019-2020 school year, there were 265 referrals for Tier 3 services; 90 referrals were for depression; 98 for anxiety; and 21 for self-harm. Referrals during the 2020-2021 school year more than doubled. There was a total of 552 referrals; 179 of those were for depression; 110 for anxiety; and 109 for self-harm. In 2021, in response to the increased need for services, the district increased its use of outside resources. Students and families were provided with referrals to community-based mental health services, while substance use and sexual harassment intervention and prevention services were brought in-house to support the schools.
As a result of the monitoring of this data, the district was able to adjust and responded in a way that the students received the comprehensive support that they needed. These actions would not have been guided without the use of data. When building your student support programs, it is important to harness the power of data. Whether it be data from surveys, attendance, academic achievement, discipline or the tracking of services provided to students, you will want to make sure that you are collecting this vital information as you go. Determining what sources of data you will collect as you build your program is crucial in determining the effectiveness of your programs and when to take decisive action.
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In addition to the types of data, remember to look for baseline data before you start your intervention so that you can determine if you are making progress on your goals. As you identify your sources of data, calendar when you will be collecting this information so that it stays at the center of your attention and becomes part of your team’s collaboration time. As school years pass, this information will become more meaningful and valuable with time.
To date, the district has used multiple assessments to evaluate the success of its programs. Data from an online platform named SHAPE and from Panorama Surveys, AERIES student information system and other internal data-collection sources have all been utilized. The district is still reviewing its sources of data information and recognizes the importance of standardization to ensure that it is accurate and reliable.
Integrate your mental wellness program into your multi-tiered systems of support As Val Verde worked to put its student mental wellness support program in place, an emphasis was placed on a systems approach. The student mental wellness program would integrate into the district’s overall Multi-Tiered Systems of Support. The district had already begun its work with Positive Behavioral Interventions and Supports as a framework used to support students’ academic, behavioral and mental health. When used with fidelity, PBIS helps create a learning environment in which students and teachers can thrive.
In Val Verde, Tier 1 mental health supports focus on mental wellness for all students and serve as the building blocks for Tier 2 and Tier 3 supports. Social work interns are mostly responsible for Tier 1 mental health interventions which include morning check-ins, school-wide mental health education lessons and classroom-based social-emotional learning for all students. Classroom lessons range from general topics such as “how to be a buddy, not a bully,” to more serious topics such as “how to help a friend who is experiencing depression or feeling suicidal.” Tier 1 interventions aid in creating a positive school climate, teaching mental health literacy and increasing social-emotional learning. Tier 1 interventions are available to all students and can also be implemented by teachers, counselors and administrators.
In response to the district’s need to decrease disproportionate discipline, and to provide additional Tier 2 supports, Val Verde hired 14 additional therapists at the beginning of the 2021-2022 school year. The therapists received specialized training in restorative practices and provide early interventions and support for students who have been identified as at-risk due to problems such as truancy; peer conflict; substance use; and lower levels of depression and anxiety.
Tier 2 interventions include proactive circles, restorative conferences, substance abuse education, anger management and self-esteem groups. The Tier 2 therapists also provide professional development for staff, assist with check-in/check-out and collaborate with the PBIS teams on their campuses to ensure fidelity with tiered interventions. When necessary, the Tier 2 therapists provide crisis management services and assist with making referrals to Tier 3 mental health services.
Students who are experiencing significant distress and impairment in their social or academic functioning are eligible for Tier 3 mental health services. Individuals receiving Tier 3 services benefit from a variety of interventions including individual, group and family counseling. To identify their behavioral health needs, students undergo an Educationally Related Mental Health Services assessment. Therapists use information from the assessment, along with feedback from students, parents and school staff to determine the specific interventions that will be used with each student. The frequency and duration of appointments are as varied as the student’s receiving services, as each treatment plan is individually developed to meet the specific mental health needs of each student.
Professional development is important
Onboarding new therapists and training them in an evidenced-based practice, developing and implementing a new program and incorporating them into an existing team of mental health professionals can be a challenge. To ensure fidelity with implementation, documentation and consistency of services, mental wellness staff participate in weekly team meetings. They use this time to provide feedback about challenges at each of their sites and to share the successes they have been experiencing with students. The weekly meetings also help to build camaraderie amongst the new staff and allow the team an opportunity to continue to make modifications as they design the new program. The process has been exciting, despite it being a challenging time for all staff supporting our students.
Like many other employers, we’re searching for ways to allow more working from home when possible and reducing the punishing night work expectations for our high school administrators.
The need to provide the team with an opportunity for their own self-care became quite evident. To provide staff with an opportunity to address their own wellness and to help strengthen additional cohesion amongst newly hired therapists, the district sponsored a two-day planning and reflection time for all mental health therapists. They were provided breakfast and lunch on both days; participated in yoga and nature hikes; and interacted with one another during a series of team-building exercises. The time together far exceeded the expectations of the administrators. At the end of the second day, tears were shed, relationships were strengthened and the entire staff walked away as one solid team.
Dedicating space to your program
Another challenge to increased mental health services has been finding adequate, confidential space for therapists to meet with students. As with many districts, schools are already challenged with finding space for teachers, counselors and administrators. An increase in mental health staff provided a challenge for school administrators, as well as therapists who were seeking space free from intrusions. The district has made room for more spaces and constructed new offices to meet the needs of its internal and external stakeholders. The expansion has provided an opportunity for several schools to capitalize on the addition of a wellness center which, in many cases, is housed within the same space as the offices for the Tier 2 therapists. The wellness centers offer a calm, safe space for students and staff to decompress if they are experiencing symptoms of anxiety or simply having a challenging day. The wellness centers also offer specialized groups, school-based and community resources and opportunities for mindfulness activities.
Coordination of services
As the district’s MTSS continues to grow, redefining roles and responsibilities has been critical. We have learned that sometimes adding too many resources results in mild chaos, with stakeholders being unclear about who is responsible for a particular intervention, or even how to refer a student for needed services. At the onset, some students experienced a duplication of services because initially, the district did not have a clear coordination of services that integrated the work of both internal and external partners. The district has utilized administrative meetings as well as multi-departmental collaborations and professional development time to answer questions and clarify roles. These meetings have proved to be beneficial for all parties, as it has helped to clearly define which students are being targeted for services; how often services will be provided; and better utilization of resources.
Make time to celebrate
Forming a systemic approach can be challenging. It is important that during the creation and implementation of your own system to share information on the successes with your board of education, school sites and community. In Val Verde, we provide weekly updates to our board on the utilization of services, provide presentations to our community, and celebrate when we get acknowledged for our efforts. Some of this acknowledgement takes the form of presentations at conferences, being mentioned in articles, and being acknowledged for state recognitions, such as the California Department of Education Pivotal Practices Award and the California PBIS Coalition Award. All these things provide feedback on goals, acknowledgement of services and motivation to continue the work.
Although the implementation of restorative practices is still new to the district, the data show great promise. Early numbers indicate that suspensions and expulsions in the district are trending downward, which is exactly what the district had hoped for. The suspension rate for African American students dipped from a high of 10.7 percent in the 2018-2019 school year to a low of 7.3 percent in the 2021-2022 academic year. The district is optimistic about the trends and each week shares its data with the school board. This fall, a team of supervisors and directors will present what the district has learned and share its outcomes at the Student Mental Wellness Conference in San Diego.
In time, Val Verde will be able to determine if its investment in mental health services as part of its MTSS has paid off. Improved and increased data collection will unveil the benefits, if any, of mental health interventions on the academic performance of its students. In the meantime, efforts to provide culturally responsive interventions to serve all students will continue at every level — from the district to the classroom.
References
Abramson, A. (2022, January 1). Children’s mental health is in crisis: As pandemic stressors continue, kids’ mental health needs to be addressed in schools. American Psychological Association. https://www.apa.org/monitor/2022/01/special-childrens-mental-health#:~:text=As%20the%20United%20States%20approaches,facing%20a%20mental%20health%20crisis.
Brownstein, J. (2009, October 5). Childhood trauma may shorten life by 20 years. ABC News: https://abcnews.go.com/Health/MindMoodNews/cdc-study-childhood-trauma-shorten-life-20-years/story?id=8758968#:~:text=Researchers%20say%20study%20shows%20childhood%20trauma%20is%20a%20lifelong%20battle.&text=Oct.,average%2C%20almost%2020%20years%20shorter.
California Department of Education: Definition of Multi-Tiered System of Support: Retrieved from: https://www.cde.ca.gov/ci/cr/ri/mtsscomprti2.asp
Centers for Disease Control and Prevention. (2009, April 19). Children’s mental health: Improving Children’s Behavioral Health. https://www.cdc.gov/childrensmentalhealth/features/child-mental-health.html
Georgetown University McCourt School of Public Policy. (n.d.). Cultural competence in healthcare. Is it important for people with chronic conditions? https://hpi.georgetown.edu/cultural/. Retrieved 8/20/22.
International Institute for Restorative Practices. (n.d.). https://www.iirp.edu/
National Alliance on Mental Illness. (n.d.) Mental health in schools. Where we stand. https://www.nami.org/Advocacy/Policy-Priorities/Improving-Health/Mental-Health-in-Schools Retrieved 8/20/22.
Positive Behavioral Interventions and Supports. (n.d.) What is PBIS https://www.pbis.org/pbis/what-is-pbis. Retrieved 8/20/22.
Whitney, D.G. & Peterson, M.D. (2019, February 11). US national and state-level prevalence of mental health disorders and disparities of mental health care use in children. The Journal of the American Medical Association. 173(4):389-391. doi:10.1001/jamapediatrics.2018.5399 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2724377
Sheri Stevens Parker, Aimee Garcia and Mark LeNoir work in the Val Verde Unified School District.
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