Editor’s note: This is the third of three stories on school-based mental health treatment in Minnesota. Here are links to Part 1 and Part 2.
It may be that no one knows more about school-based mental health than Nancy Lever. As executive director of the University of Maryland’s National Center for School Mental Health, she’s dedicated her career to supporting and advancing efforts in schools around the country, allowing her a bird’s-eye view of how the most successful programs work.
Minnesota, with its long history of supporting school-based mental health, is a national leader in the work, as this series has shown, with kids in the majority of the state’s public schools having access to care.
Different schools and districts have taken individualized approaches, but whatever the specific model, Lever has found that the most effective programs all have a few things in common.
The first, and perhaps the most important, Lever said, is a strong sense of partnership between school staff and members of the community. “The whole point of school-based mental health is it’s a wonderful model where people work together to create a system to make sure all youth mental health needs are being met,” she said. “The most successful models are going to have some level of family-school-community collaboration.”
Successful school-based mental health programs also acknowledge the central role played by existing school staff, even when community-based partners are brought in to provide additional mental health services for students, Lever said. This helps to build buy-in and integration and to keep programs running smoothly. “School employees — staff, social workers, school psychologists, counselors — are, to me, at the center of these programs.”
Then there are the teachers, whose collaboration with mental health programs is also essential. Classroom teachers often have the most interaction with students, and because of this they are able to observe behavioral changes that may indicate developing mental health concerns. Schools with effective mental health programs, Lever said, have developed an environment in which teachers feel comfortable reaching out to and collaborating with mental health staff, and building connections to parents.
“You want to be in a system that when you ask, ‘Who makes the most referrals?’ most often it is the educators, because they are at the front line,” Lever said. “They are the ones who are going to notice the kids who need the help.”
While including these elements in a school-based mental health program is essential for success, Lever said this still leaves room for innovation and adaptation to meet the unique needs of a community.
“It’s not a cookie-cutter approach,” she said, pointing to the Los Angeles Unified School District, which has, over the years, “done a lot of good work around trauma.” In Colorado, she said, school-based mental health has been supported by funds gained from marijuana taxes. Wisconsin’s program is supported by “strong leaders from their public instruction department,” Lever said, and Massachusetts “had a local champion who did amazing work.”
In Minnesota, Mark Sander, Hennepin County’s director of school mental health, has been one of those local champions. Decades ago, he cut his teeth as a post-doctoral fellow at the National Center for School Mental Health, working closely with founder and then-director Mark Weist. When he moved to Minnesota in 2003, Sander said he “stumbled into” an opportunity to start the school-based mental health program in Minneapolis and later in Hennepin County.
Related: Researchers measure fewer suicide attempts after school-based mental health implemented in Hennepin County
He brought what he learned in Maryland and adapted it to fit the needs of the state and the children who attend its public schools. That included creating a funding model in Minnesota that captured potential funding from students’ health insurance and made sure clinicians could be paid for time they spent in schools doing work beyond one-on-one counseling — an essential element that he and his colleagues believed was missing from some grant funding for school-based mental health.
“I wanted to make sure there is protected time for clinicians to take time to chat with teachers, and understand the schools and be part of the culture,” Sander said.
This 360-view, combined with an emphasis on building a holistic culture that embeds mental health providers in the inner workings of schools, helped the state to create a highly regarded school-based mental health program that has been emulated by other states, Weist said. “Minnesota is one of the leaders in the nation on this work.”
Baltimore: Here for good
School-based mental health providers in Baltimore work hard to make their presence known.
“In our model, we advertise widely,” said Jennifer Lease, a school-based mental health provider at the city’s Thomas Jefferson Elementary/Middle School. “Throughout the year, members of our administrative staff are continually asking us, ‘How are you getting yourself out there? How are you making sure that everyone knows who you are?’”
With those questions in mind, Lease said that she and her colleagues in the school use a range of approaches to remind everyone — from students to teachers to parents to staff — that they are there to provide mental health support. “We’re doing classroom presentations with every class in the school. We’re posting on the social media platforms with QR codes that people can use to refer themselves to us. We’re holding events focused on mental health. We’re trying to get that message spread far and wide.”
This emphasis on establishing a presence in the school is a response, in part, Lease said, to larger societal concerns about young people’s mental health.
Related: Princeton school-based initiative is Minnesota’s first Teen Mental Health First Aid program
“Everybody is really being encouraged to make sure the people know about these services, especially after some feedback in the past that particularly centered on the topic of children’s mental health in the news, with a lot of doom and gloom about how things are getting so much worse. And then there were children who were saying, ‘I didn’t know there was a therapist at my school,’ or, ‘I didn’t know how to access those supports.’”
Lease, employed by the University of Maryland School Mental Health Program and contracted to work with students at Thomas Jefferson, said she and her colleagues don’t want to fade into the background. “We put a lot of focus and attention toward making sure people know how to find us, know who we are, that we’re integrated into the school community, even though we are technically not school-system employees.”
For school-based mental health providers, especially those who, like Lease and her colleagues, are employed by community-based partner agencies, getting out there and establishing yourself as an essential part of the school community is key. If the goal is to reach all kids who need mental health services, this approach is a proven winner.
“We try to be seen as members of the school community, and really for those relationships, because it allows people to know how to find us and how to access services,” Lease said. “It reduces stigma if we’re seen as another member of the school community, whether you are a parent coming to pick a kid up from school, or a kid just swinging by our office.”
Maryland’s school-based mental health program has a long history, said Nikita Parson, associate director and trainee coordinator at the University of Maryland’s School Mental Health Program. As far back as 1989, staff in school-based health centers began noticing rising numbers of students complaining of physical ailments, including, Parson recalled, “somatic symptoms like headaches and stomachaches.” After taking a deeper look, school staff determined that the issues students were talking about were, she explained, “more social-emotional related for those kiddos rather than physical.”
Health center staff made referrals for visits with mental health providers, but the follow-up rate was low, Parson said. Barriers like a lack of reliable transportation, childcare needs for other siblings and stigma within their community kept families from getting kids to the appointments.
In response, a team from the University of Maryland, led then by Weist, helped to expand mental health services in Baltimore’s school-based health centers. The idea was that if kids could get the mental health care they needed at school, they were far more likely to get parental support and show up for appointments, Parson explained. The model was built on the idea that rather than asking school employees like psychologists, social workers and guidance counselors to take on more responsibility for mental health care, schools would contract with credentialed community-based providers to come into the school and provide mental health care for students there.
Lever said the approach of boosting mental health care services in the schools rather than relying on outside locations was key to the program’s success. “If you want to work with children, you have to go where they are,” she said.
‘When it’s done well, it works.‘
If Baltimore’s visible, integrated approach to school-based mental health seems similar to Minnesota’s approach, that’s not an accident, Sander said. Many of the leaders of the school-based mental health movement in the United States, himself included, have worked together to develop models that can best serve students who would otherwise lack access. Their programs’ approaches mirror one another.
“There’s a reason school-based mental health often operates that way,” Sander said. “That’s because when it’s done well, it works.” It’s not a cut-and-paste approach, he said, because the needs are unique in each school district. But at the core, most successful school-based mental health programs lean heavily into the model that was developed in the late 1980s by Weist and his colleagues at the University of Maryland and successfully put into practice in states like Minnesota.
Just as in Baltimore, Sander said that an intentional integration of mental health clinicians in the school ecosystem in Minnesota has helped to normalize the idea of seeking mental health care. That support has been evident since the programs were founded in the state nearly 25 years ago.
Support for school-based mental health grew organically, Sander said, as children and adults around the state began to see the benefits of easy access to care. In the state Legislature, lawmakers from across the political spectrum, driven by personal experience and constituent requests, began to approve funding for these programs.
It got to the point where legislators wanted to make sure that school mental health was available in every county in the state, Sander said. Voters told their elected officials that they wanted these services available for their children, and the programs grew. Lawmakers, he said, “all wanted to make sure they had school mental health in their district. It took off in a good way, and it’s just grown from there.” Today, Minnesota’s school-based mental health programs are funded by a combination of private and public insurance as well as $20 million in state funding.
Lever can’t help but feel heartened by the state’s support for school-based mental health programs.
“I love what Minnesota’s doing,” she said. “They were part of our national quality initiative. We gave them some background, and they just took it and ran with it and brought it to a higher level. It’s a real accomplishment that truly benefits all the children of the state.”
This article was published with support from the Solutions Journalism Network’s HEAL Fellowship.
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