March 2022 | Ellie Sanchez
The Elementary and Secondary School Emergency Relief (ESSER) Fund represents a once-in-a-generation federal investment in public education. The following brief provides a rationale for investing ESSER funds in mental health support, outlines evidence-based school mental health strategies, and provides recommended resources for districts seeking to make high-leverage mental health investments.
Understanding the Problem
The COVID-19 pandemic led to a dramatic rise in mental health needs among young people who felt secluded or overwhelmed, lost loved ones, or encountered financial hardships. For some children, these challenges have resulted in substantial harm to their wellbeing. Data from the Centers for Disease Control and Prevention (CDC) reported that in March of 2021, 4.4 million children aged 3-17 had been diagnosed with anxiety and 1.9 million children in that age group had been diagnosed with depression (Centers for Disease Control and Prevention, 2021). This number continued to rise as school-aged children reentered brick and mortar school buildings—many reeling from racial and health-related trauma, feeling overwhelmed by the need to catch up on missed learning, and harboring concerns about shifting safety protocols in school buildings. Data shows that “between March and October of 2020, [mental health diagnoses] increased 24 percent for children ages 5 to 11, and 31 percent for kids ages 12-17” (Centers for Disease Control and Prevention, 2021).
The data is even more stark for children of color and low-income children. Many studies have shown that communities of color have faced higher rates of exposure and infection from COVID 19 and been more economically impacted. For example, in a study conducted in Massachusetts, Black and Latino populations experienced much higher rates of COVID-19 during the first five months of 2020 (Figeroa, et.al, 2020). Even before the pandemic, children of color faced significant challenges to their mental health. Self-reported suicide attempts by Black adolescents have risen by 80 percent since 1991 (Xiao et al., 2021). Many of these school-aged students mentioned racial trauma, bullying, and financial insecurity as reasons for considering suicide.
Educators and administrators across the Commonwealth recognize a need to create school communities where every student feels safe and welcome before students will be able to learn. Districts are struggling with the daily impacts of student mental health challenges, which have led to an increase in chronic absenteeism and an uptick in violent behavior on school grounds (Shoenberg, 2021). As a result, many school leaders and community stakeholders are seeking to invest federal Elementary and Secondary School Emergency Relief (ESSER) funds to strengthen mental health supports in schools.
How Districts across the Nation are Responding to Mental Health Needs School districts and state education agencies across the nation have announced a range of investments to address student mental health concerns. For instance, Wisconsin approved grants for peer-to-peer suicide prevention programs in high schools (Klein, 2021). Baltimore Public Schools provided a suite of staff training focused on mindfulness and trauma, implemented restorative practices, and developed trauma-focused cognitive behavioral therapy (CBT) programs for students with significant need (National Center on Safe and Supportive Learning Environments, 2021). In Massachusetts, many districts have identified mental health support for students and staff as their first priority in using ESSER funding (Tallman, 2021).
Research is clear on the benefit of school-based mental health systems. Most children who access mental health support do so through their schools. Given that students spend much of their time in school settings, school staff play a significant role in identifying student needs and connecting children and their families to necessary services. Though community-based providers also play a critical role in children’s mental health, financial barriers, transportation barriers, and provider capacity limit community-based providers from meeting the full demand for services in most areas.
Most schools are currently unequipped to meet the full need for services among their student population. For example, before the pandemic began only 40% of students who reported a major depressive episode received treatment in or outside of school (Substance Abuse and Mental Health Services Administration, 2019). With more students needing mental health support, the necessity to build school-based mental health systems has grown.
Building a Multitiered Approach to Mental Health Support
Building a multitiered approach to mental health support offers a sustainable, evidence-based solution to addressing students’ mental health needs. Properly structured, a tiered system builds knowledge and understanding, establishes norms or practice, coordinates staffing and services, and leverages data to maximize resources and expertise while providing all students with support regardless of their level of need. The core of this approach includes three tiers of support:
Tier 1: Mental health screening and core emotional wellness services for every student
Tier 2: Focused support for students displaying moderate signs of mental health concern. This may include small-group support for students experiencing similar challenges.
Tier 3: Intensive, individualized support for students experiencing significant mental health needs
Tiered mental health support is a component of a Multi-Tiered System of Supports (MTSS), which is a continuous improvement framework in which data-based problem solving and decision making is practiced across all levels of the educational system. MTSS systems focus on providing core academic and nonacademic support for all students, using data to identify which students need a higher level of support, and offering more intensive support for students with greater need.
MTSS is not new–most districts have some form of MTSS in place. In many schools, academic aspects of MTSS are stronger than the mental health components of the system. Integrating mental health supports into an existing MTSS system helps schools create a culture in which holistic student wellbeing is a shared priority. The table below provides examples of mental health supports at each tier:
All students, all levels of need
Universal screening, welcoming/inclusive classroom practices, think space/cool down corner in the classroom, explicit relationship-building strategies, peer mentoring
Some students, mild/moderate level of need
Small-group support with a counselor, referrals to community-based providers, targeted interventions (i.e. check in/check out), and accommodations
Few students, high level of need
Individual therapy, Individualized Education Program (IEP), behavior plan driven by Functional Behavior Assessment (FBA), in which school staff analyze the triggers for behaviors that interfere with a student’s education and develop targeted interventions to address the concern
The following core practices can help schools get started integrating mental health into an MTSS system:
Invest in systemic training focused on supporting every student’s mental wellbeing. A positive school climate, supportive relationships, and opportunities to build social and emotional skills serve as the foundation of a comprehensive mental health system.
Select and implement a screening tool that can be used to identify students experiencing mental health challenges–and provide follow-up services for those students.
Build a cross-functional team to identify mental health interventions at each tier and connect students to school and community-based resources.
The MA Department of Elementary of Secondary Education (DESE) is currently offering professional development for educators, administrators, and school mental health providers focused on integrating mental health into a school-based MTSS system. Find information about Thriving Minds professional development here.
Connecting Students with Individualized Mental Health Services
Through a school mental health support system, staff identify students in need of clinical mental health support. Schools can meet students’ needs through a combination of school-based and community-based mental health services.
Many schools may seek to use ESSER funds to hire mental health staff to strengthen school-based services. However, staffing shortages across sectors have made hiring difficult. Even with schools able to offer financial incentives, such as signing bonuses, the field of providers remains limited. A critical component to building an effective and responsive mental health support system is strengthening connections within the community. In schools where the demand for individualized or small-group mental health support exceeds school-based clinician capacity, schools can make referrals to community-based providers. It is important to note that community-based providers also face high demand for services. In communities facing a shortage of mental health providers, schools should consider alternative approaches including virtual services.
Methods of connecting students to outside-of-school support include:
School Staff Referrals: Conduct regular meetings to review mental health screening data and identify students in need of services. Assign a school employee to refer students and their families to a community-based or virtual provider.
Student/Family Self-Referral: Develop communications materials to ensure that all students and families know how and where to access mental health support in the community. Provide information about location of services, languages spoken, affordability, etc.
Contract with community-based providers for in-school or telehealth services: Many mental health agencies provide services in a range of locations, including schools. Through a formal contract with a community-based agency, schools can increase mental health staffing.
Resources to Get Started
Building a school-based mental health system is a large but worthwhile undertaking. Districts can begin this work by using the free resources available through the School Health Assessment and Performance Evaluation (SHAPE) System to conduct a needs assessment, map existing resources, and identify gaps in mental health support. SHAPE also offers evidence-based resources with detailed guidance on implementing mental health supports in schools, along with a bank of no-cost screening tools appropriate for a variety of purposes and audiences.
In addition, the Massachusetts School Mental Health Consortium has created a checklist for district-level mental health support planning. This checklist can help your district take stock of current initiatives and identify where investment is necessary to improve mental health services for all students.
School mental health systems are essential to ensuring that students experiencing the traumatic effects of the pandemic receive the care they need. By building a multitiered system of mental health support to identify and respond to all students’ needs, school and district leaders can help create the conditions for all students to learn. In building a school mental health system, it is vital to understand that certain communities disproportionately experience poor mental health outcomes. These communities include LGBTQ+ students, students with disabilities, Black, Indigenous, and Latinx/e students, and lower-income students (MA Department of Public Health, 2021). School districts must actively seek to understand the interests and needs of these populations of students, including by listening to the students and their families, while developing systems of support.
American Institutes for Research. (n.d.). Implementation. Center on Multi-Tiered Systems of Support. Retrieved December 17, 2021, from https://mtss4success.org/implementation
Centers for Disease Control and Prevention. (2021, March 22). Data and statistics on children's Mental Health. Centers for Disease Control and Prevention. Retrieved December 17, 2021, from https://www.cdc.gov/childrensmentalhealth/data.html
Colorado Department of Education . (n.d.). Multi-tiered system of supports (MTSS). CDE. Retrieved December 17, 2021, from https://www.cde.state.co.us/mtss
Ed Trust. (2020, October 15). School counselors matter. The Education Trust. Retrieved December 17, 2021, from https://edtrust.org/resource/school-counselors-matter/
Editorial Board. (2021, November 10). An outbreak of violence in schools? - The Boston Globe. BostonGlobe.com. Retrieved December 17, 2021, from https://www.bostonglobe.com/2021/11/10/opinion/an-outbreak-violence-schools/?et_rid=690633199&s_campaign=todaysheadlines%3Anewsletter
Editorial Board. (2021, September 17). Schools must meet students' mental health needs - The Boston Globe. BostonGlobe.com. Retrieved December 17, 2021, from https://www.bostonglobe.com/2021/09/17/opinion/schools-must-meet-students-mental-health-needs/
Figueroa, J. F., RK, W., Al., E., DA, L., H, B., BD, S., K, K., M, C., RW, B., S, R., EG, P.-H., B, R., JF, F., SR, K., JA, D. R., M, W. H., CW, Y., WF, O., NS, K., … Reitsma, M. B. (2020, August 27). Community-level factors associated with racial and ethnic disparities in covid-19 rates in Massachusetts: Health Affairs Journal. Health Affairs. Retrieved March 23, 2022, from https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.01040#:~:text=We%20performed%20a%20cross%2Dsectional,point%20increase%20in%20the%20Latino
Klein, A. (2021, October 20). Children, teens are in a 'mental health state of emergency,' child health-care groups warn. Education Week. Retrieved December 17, 2021, from https://www.edweek.org/leadership/children-teens-are-in-a-mental-health-state-of-emergency-child-health-care-groups-warn/2021/10?utm_source=nl&utm_medium=eml&utm_campaign=eu&M=64182617&U=1265601&UUID=d8c252224e2ee21f6e0065dbb80e0ea1
MA Department of Public Health . (n.d.). Covid-19 community impact survey. Mass.gov. Retrieved December 17, 2021, from https://www.mass.gov/info-details/covid-19-community-impact-survey
Massachusetts Department of Elementary and Secondary Education. (n.d.). Multi-tiered system of support (MTSS). Multi-Tiered System of Support (MTSS) - Systems for Student Success Office. Retrieved December 17, 2021, from https://www.doe.mass.edu/sfss/mtss/
Methuen Public Schools. (n.d.). Methuen Comprehensive School Mental Health System (CSMHS) Resource Page. MPS. Retrieved December 17, 2021, from http://www.methuen.k12.ma.us/departments/special-education/guidance/dese-annual-report-resource-page
National Center on Safe and Supportive Learning Environments. (2021, April). Implementing School Mental Health supports: Best practices ... National Center on Safe and Supportive Learning Environments. Retrieved March 23, 2022, from https://safesupportivelearning.ed.gov/sites/default/files/13-ImpSchMnHlthSprtBtPrt-508_0.pdf
National Center for School Mental Health. (n.d.). SHAPE System. The SHAPE System. Retrieved December 17, 2021, from https://www.theshapesystem.com/
Tallman, K. (2021, October 19). Here's how New Bedford residents want the school district to spend $74m in Esser Funds. The Standard-Times. Retrieved December 17, 2021, from https://www.southcoasttoday.com/story/news/education/2021/10/19/new-bedford-residents-input-expected-esser-funds-mental-health-support-staff-forefronts-education/8473573002/
Xiao, Y. (2021, June 14). Temporal trends in suicidal ideation and attempts among us adolescents by sex and race/ethnicity. JAMA Network Open. Retrieved December 17, 2021, from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780949
Yale School of Medicine. (2020, September 3). Health notes: People of color suffer disproportionate impact of covid-19 pandemic. Yale School of Medicine. Retrieved December 17, 2021, from https://medicine.yale.edu/news-article/health-notes-people-of-color-suffer-disproportionate-impact-of-covid-19-pandemic/