Comprehensive school-based mental health increases the chance that teachers and clinicians will identify students with untreated mental health needs and avoid misdiagnoses. Students who appear to have a mental health disorder but are actually experience another challenge (e.g., family instability, severe hunger, trouble with vision) are more likely to be properly tested.
One in six children aged 2 to 8 years old, nationwide, has a diagnosed mental, behavioral, or developmental disorder. During the 2018-2019 school year, nearly 80,000 Georgia students in sixth through 12th grade reported having seriously considered attempting suicide. In Georgia, two in five children have trouble accessing the mental health treatment they need. It is evident that Georgia’s students could benefit from mental health support where they can easily access it — at school. School-based mental health programs provide a continuum of behavioral health care to students and their families, thereby mitigating transportation challenges, continuity-of-treatment issues, and, often, misbehavior within the school itself.
In 2015, Georgia’s Department of Behavioral Health and Developmental Disabilities (DBHDD) created the Georgia Apex Program (Apex), a school-based mental health pilot, to increase the availability of mental health services in Georgia’s elementary and middle schools. While a few school-based mental health programs were present in Georgia prior to Apex, the successful implementation of the pilot created a pathway for the state to scale up programs in every region by providing grants to fund clinicians’ school-based work. As of publication of this report, Apex has expanded to more than 430 schools in approximately 100 counties. As the state, philanthropy, and local districts continue to invest in such programs, understanding factors that contribute to a school-based mental health program’s success, as well as the obstacles that providers face in delivering these critical services, can make such investments most effective and help children grow healthy and strong.
This report captures the findings of, and makes recommendations based on, in-depth interviews with three long-standing school-based mental health providers in different regions of Georgia, with varied funding sources.
Never before has the need for access to mental health services been so great nor so apparent. The onset of the coronavirus pandemic brought with it not only situational circumstances lending themselves to mental health challenges, but also an amplification of mental health service obstacles that existed long before COVID-19 complicated our world. The combined impact of these factors make the release of this report, Supporting Children’s Mental Health in Georgia Schools: How Three School-Based Mental Health Providers Serve Students, all the more timely.
Generally, school-based programs are staffed with licensed and associate-level clinicians, on-site from one to five days per week. Many practitioners serve multiple schools and are funded via a blend of insurance (primarily Medicaid/PeachCare for Kids®) and private and government grants, the latter of which can be used to support nonbillable, comprehensive interventions to serve an entire school population. Leveraging insurance billing and flexible grant funding for program implementation and sustainability are key for success, as are school buy-in and provider flexibility.
Once a child is referred to a provider (most often by teachers and school counselors), clinicians obtain verbal consent from the student’s parent or guardian prior to assessment or treatment. Parents and students are required to meet with the clinician in person for the initial assessment, where written consent is then obtained. All providers in this sample deliver three-tiered system supports, in addition to services after school and over the summer. Without exception, Tier 3 interventions (e.g., individual therapy) make up the majority of their workload, followed by Tier 2 interventions (e.g., group therapy), and then by Tier 1 (e.g., teacher trainings or schoolwide activities). Of interest is the effectiveness of such comprehensive school-based mental health, which results from increased opportunities to identify students’ needs and intervening early, preventing or offsetting further decline or complications. Comprehensive programs also increase the chances that misdiagnoses are avoided, particularly for students who may initially appear to have a mental health disorder but are actually experiencing another challenge — such as family instability, lack of access to food, or vision or hearing trouble. Additionally, these providers conduct home visits, provide crisis support, and manage medication as part of their treatment. Telemedicine for treatment and medication management, as well as home delivery of medication, are employed by some as necessary to help the families they serve.
Despite far-reaching service provision and heavy caseloads, however, clinicians report that their greatest burden is paperwork — either requesting treatment authorization from insurers or completing documentation required for billing. Committed parental involvement can also be elusive, by virtue of competing family or work priorities, or simply a lack of transportation.
Barriers to success include some of the same challenges as non-school-based pediatric mental health care, namely:
Based on these findings, Voices for Georgia’s Children offers the following select recommendations for different audiences in three key areas. A comprehensive list of all recommendations can be found on pp. 25-27.
Support School-Based Mental Health Program Success through Funding and Other Means:
Grow and Protect the Qualified Workforce:
Boost Partnerships with Schools:
Our research shows that there are distinct methods providers have found effective in establishing and operating a school-based mental health program successfully. Their insight and experience may prove useful for other providers and schools as they aim to create or expand programs. Such moves have potential to dramatically improve outcomes for Georgia’s children, as school-based mental health programs increase school attendance, support a positive school climate, reduce escalation of disciplinary incidents, and provide support for families when they may not receive it elsewhere.
