Sustaining tiered mental health options and collaborations

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Association of California School Administrators

Sustaining tiered mental health options and collaborations

Collaboration to positively impact the lives of at-risk youth

By Aaron Benton and Veronica Coates | November | December 2022

From a very young age, Jake moved through multiple group homes and foster placements before enrolling as an 8th grader in a 65-student school district within Butte County, 90 minutes north of Sacramento. Like many group home students, nonpublic school (NPS) was indicated on Jake’s Individualized Education Plan, and placement was arranged for him to attend BASES Learning Center, a Butte County SELPA-operated school authorized by the county office of education.

“When Jake came to us, he wouldn’t interact, and he had attempted suicide,” recalls Melanie Quave, BASES principal. “He hid under his hoodie all day making little eye contact, he easily got into fights, and there was absolutely no touching.”

A relationship-based program, BASES uses a “ball as life” approach to student needs, and all staff serve as coaches who build safety and trust as they keep students like Jake focused on their progress toward “home base,” or attendance at their home school. The program was created in 2019 by the Butte County SELPA governing board of superintendents who decided the region needed a local option similar to nonpublic school that would avoid two-hour, one-way bus rides to Sacramento. The program employs specialized staff including a mental health clinician, a part-time board-certified behavior analyst, and two registered behavior technicians, all of whom were paid for in part by state and federal funds for Educationally Related Mental Health Services, or ERMHS.

“Jake made it back to his high school this year, after posting a 79 percent batting average all year last year,” reports Quave. “He’s removed the hoodie and he smiles more often. He separated himself from instigators and helped out in our school kitchen. On his own, he would approach others to give hugs, which is huge for him. He was even honored by the Rotary Club.”

Jake is just one success story. Similar student stories speak to the power of the coordination that occurs behind the scenes to ensure the delivery of high-quality, innovative, intensive mental health services to students with disabilities and their families.

Student mental health services and support is typically provided within a Multi-Tiered System of Support framework in schools and districts. Tier 1 generally consists of universal supports for all students such as schoolwide behavioral and mental health curriculum and interventions. Tier 2 includes short-term, targeted interventions for a subset of students who require support groups, individual counseling, or referrals to community-based organizations. Tier 3 is reserved for students needing the type of longer-term interventions, indicated pursuant to an IEP, that often focus on significant trauma and acute crisis.

It has been a little over a decade since the California Legislature passed Assembly Bill 114, which repealed the state mandate on special education partnerships between school districts and county mental health agencies, leaving school districts solely responsible for ensuring that students with disabilities receive these intensive tier 3 services, which often include ERMHS. Over this time, Local Education Agencies, SELPAs, and county offices of education have provided seamless and steady leadership in the collaborative development of appropriate ERMHS programming for students across California.

Effective programs in Central and Coastal California

The Santa Barbara County SELPA Wrap-Around Services Team supports students and their families in a model conceived and developed by the leadership and joint powers authority board members of the SELPA. The purpose was to build and staff a WRAP team that could provide consistent service and avoid contracts with outside entities, typically at significantly greater costs. The model they created is now accessible to any of the 25 LEAs in Santa Barbara County SELPA. The typical student referred to the team exhibits school avoidance or a lack of school success due to social-emotional challenges, and is eligible for special education under the category of emotional disturbance. The WRAP Youth Support Specialist works directly with the student while the WRAP Facilitator supports the family connected to the student.

“Our most vulnerable students deserve to receive research-based and high-quality services consistently, and partnership across our LEAs allows us to provide just that,” explains Ray Avila, Santa Barbara County SELPA executive director. The SBC SELPA staff has also developed an innovative “G.R.O.W.” program, a therapeutic wellness model with 18 classrooms throughout the county on various K-12 campuses. Designed using evidence-based research in education, child development, trauma, behavior, psychology and interpersonal biology, G.R.O.W. classroom teacher and paraprofessional teams receive support from mental health staff and behavior specialists in an arrangement made possible by pooling regionalized ERMHS dollars.

State and federal ERMHS funding was originally intended to be used for intensive tier 2 and tier 3 mental health interventions and services. The Legislature granted flexibility in 2019 to use ERMHS funds for tier 1 universal mental health and behavior support. These funds have since been expended almost entirely to continue to provide these intensive tier 2 and tier 3 mental health supports specifically for students with an IEP. The use of these funds is determined locally by each SELPA’s governing board of superintendents of boards of education.

This past June, Gov. Gavin Newsom signed into law Senate Bill 181, which would require that beginning in the 2023-24 school year, state and federal ERMHS dollars, currently allocated to SELPAs and distributed according to their locally adopted allocation plans, be allocated directly to LEAs instead. This has caused considerable concern among special education and mental health advocates who believe these funding shifts will unnecessarily complicate the provision of ERMHS programs, erode service quality and coordination, and ultimately prevent many students from accessing ERMHS altogether.

Tulare County SELPA has a well-established, strong collaborative partnership with Tulare County Health and Human Services, whereby they receive reimbursement for services provided to students with mental health services on their IEPs who are covered by Medi-Cal, which represents approximately 76 percent of youth served. In the last year, Tulare County SELPA served more than 650 students across Tulare County. Nearly half of those students live in rural communities with considerable obstacles to accessing community mental health care. Tulare County uses ERMHS funds to employ mental health clinicians who are registered with the California Board of Behavioral Services in a variety of categories (LCSW, ACSW, LMFT, AMFT, LPCC, APCC), as well as bachelor’s and associate level professionals with specialized training in building skills associated with mental health and wellness. The mental health clinicians provide evidence-based treatments to address mental health concerns that are signiﬁcantly interfering with a student’s ability to beneﬁt from their education.

Students served by Tulare County SELPA under a contract with the Tulare County Department of Mental Health signiﬁcantly beneﬁt from having a “one-stop shop” for comprehensive mental health care, including ERMHS services. Tulare County is realizing the benefits of its collaborative program in the form of a reduction in out-of-home nonpublic school placements as well.

“In an effort to minimize out-of-home placement and subsequent trauma to the student and family system, we have used ERMHS funds to support a robust continuum of educationally related mental health support to ensure all students receive the care they need within their community,” explains Tammy Bradford, assistant superintendent of Special Services and SELPA.

Dynamic ERMHS collaborations in Southeast California

One of the largest mental health collaboratives in California exists within the Desert/Mountain SELPA coverage area, where a memorandum of understanding exists between the SELPA and the Desert/Mountain Children’s Center for the SELPA to provide tiered mental health services and ERMHS to more than 2,000 children annually across their 15 LEAs. The Desert/Mountain SELPA is uniquely equipped to meet their region’s mental health services goals as they have been the primary school-based mental health provider in the over 200 schools in the Desert/Mountain SELPA region providing for both larger districts as well as the smaller districts in extremely rural areas.

The SELPA and D/MCC developed a strong collaborative relationship with the San Bernardino County Department of Behavioral Health and held contracts over the years starting in 2003. “We use our ERMHS dollars to provide a portion of the contract match that draws down Medi-Cal EPSDT dollars, allowing us to offer more mental health programs and services to children and families in need of a variety of social-emotional and mental health services,” explains Linda Llamas, director of the Desert/Mountain Children’s Center.

The superintendents of each LEA have long supported this SELPA and D/MCC agreement to provide ERMHS services within their districts and use the braided funding method to maximize specialized mental health services for children and families in need. For this geographically large and rural region, it is especially imperative to continue this model of care as the behavioral health needs of children continue to rise due to the COVID-19 pandemic.

ERMHS dollars are also used to conduct comprehensive residential assessments and case management for special education students who may need a higher level of care. On average, the Desert/Mountain SELPA has eight to 12 students in these residential placements per year. SELPA case managers support LEAs with their responsibilities for monitoring these students, typically traveling outside of California up to four times per year to ensure that students are physically well, emotionally supported, and educationally getting back on track. ERMHS case managers attend IEPs and communicate frequently with the facility, the LEA, the parents, and the students.

The D/MCC and SELPA are understandably concerned that potential changes to ERMHS funding could lead to a disruption in current services and impact the quality of care, causing some children to fall through the cracks.

Accessible ERMHS services for small LEAs and rural California

Small LEAs and rural parts of California benefit greatly from the efficiencies and economies of scale provided through ERMHS collaborations. Shannon Ross from Douglas City Elementary School District in Trinity County SELPA is one of more than 270 school district superintendent/principals in California. Wearing so many hats in the organization, she is grateful for the teamwork and regionalized support her district can access.

“I am sometimes the custodian, the ball monitor, you name it, you have to do it all,” she shares. “Here in Trinity County, we’re just really limited and it’s difficult to find staff. Mental health services through the SELPA have been a huge resource for us and we have worked to connect students to therapists on and off-site, and we can have a school counselor support us each week.”

In the Fresno County SELPA, counseling and behavior support services in programs for students with emotional disturbance are funded entirely through state and federal ERMHS funds. The funds are used to employ a team of ERMHS school psychologists who provide intensive counseling to individual students in LEA programs who require a higher level of mental health support. These dollars also support the SELPA’s behavior intervention team that assists LEA IEP teams with their most behaviorally challenged students through consultation, assisting in developing behavior intervention plans, conducting functional behavioral assessments, and providing coaching and modeling for school staff on implementing behavior strategies. “This regional coordination enables us to truly meet the needs of all our students, so those in rural and remote areas of Fresno County have the same access to quality mental health and behavior services,” notes Trina Frazier, assistant superintendent of Special Education and SELPA.

Access to quality mental health services is critical in places like Tehama County, just a few minutes south of Shasta, where their small and sparse SELPA pools federal and state ERMHS funds to provide a full continuum of school-based mental health services. Tehama County SELPA comprises 14 LEAs, most very small, and one of which is a one-room K-8 district unto itself. Service delivery is based on need, not the size of the school district in which a student happens to reside. Teamwork, economies of scale, and coordination of shared resources allow them to, in addition to the typical array of services, expand their continuum to include parent/family counseling, consultation and coaching to LEA staff, and transitional support for students entering or returning from a nonpublic school setting.

Recently, one of the smallest districts in Tehama County placed a student in a Residential Treatment Center due to severe depression and multiple suicide attempts. The ERMHS Team provided continuity of care with the student while enrolled at the RTC, encouraged transition activities, and ensured the parent received the counseling, support and agency linkages for a smooth transition back into the home and school environment in their community. “The pooling of ERMHS resources allowed us to provide fiscal support to this very small district,” notes Todd Brose, superintendent of Red Bluff Joint Union High School District and chair of the Tehama County SELPA Governing Board. “Without this allocation model, the placement would have caused catastrophic fiscal distress for the LEA.” With their supportive service model and fiscal support from the SELPA, this placement was successful. But, more importantly, the transition back to the home community was successful, as the student only required an intensive RTC placement for less than a year.

Since developing this comprehensive model, Tehama County SELPA has decreased both nonpublic school and residential placements, currently having no RTC placements and a very limited number of NPS placements. They serve approximately 100 students and families in their community and expend more of the dollars than they receive with commitment from the SELPA governing board made up of LEA superintendents. They have also started a partnership with their county office on their general education school-based mental health and wellness program, and they have dreams to build even more of a continuum of care for all their students.

Critical Educationally Related Mental Health Services are delivered daily through established partnerships and consortium models all across California, ensuring access for youth with some of the most complex mental health needs that significantly impact their ability to benefit from their education. Moving forward, educational leaders and agency partners work together to preserve dynamic and effective ERMHS programming that is provided to students with disabilities while continuing statewide efforts to enhance tiered mental health supports for all students in need.

Aaron Benton is the director of the Butte County SELPA, and Veronica Coates is the assistant superintendent of special education and SELPA for the Tehama County SELPA.