Partnering with Schools to Promote and Improve Mental Wellness in Youth

There continues to be a mental health crisis in youth. It is crucial communities work together to raise awareness and identify mental health issues in youth early. Educating families, expanding screening for mental health conditions, improving access and capacity for care, and ensuring evidence-based interventions and treatments are available to all youth are all important in a comprehensive approach to meeting the current needs of our youth.

Families, schools, pediatricians, health care organizations and community stakeholders all have a role to play in supporting youth for mental wellness. For many years, mental health was not considered an important component of health and wellness. We already had a mental health crisis in youth before the pandemic, and throughout the pandemic, it was declared a national emergency by the government, hospital organizations, advocacy organizations such as the American Academy of Pediatrics, schools, and parents.

Efforts over the past few years have gained momentum, including the expansion of payments and services by health plans, expansion of models by telemedicine providers, digital tools using artificial intelligence and the CMS expansions that include the ability to be paid for services where youth spend most of their time, at school. However, the workforce still cannot meet the demand.

We continue to have lots of work to do finding solutions to improve prevention efforts, early intervention and using treatments that ensure realizable and sustainable outcomes.

We know that mental wellness has a direct effect on school performance, school attendance, optimal learning, disciplinary actions, social integration, and graduation rates to name a few.

Recent data has shown more than 40% increase in students having feelings of sadness and hopelessness through the pandemic. Suicide rates continue to rise among 10–18-year-olds, and over 20% of students have considered suicide. Black, indigenous and students of color have had significant increases in mental health issues and often are referred to juvenile justice systems rather than to behavioral health programs. These students are also more likely to be suspended.

Schools have run out of the capacity to meet the students’ needs, which now is affecting both their learning and overall wellness. Traditional approaches at school allowed for students to receive services that met certain conditions that interfered with their learning (Individual Education Plans-IEP). Many students with mental health issues do not meet these requirements and often have great difficulty accessing services in the community. Lack of healthcare benefits, stigma, lack of parental ability to get them care, avoidance of care to not miss school time, families themselves have mental health issues, and lack of a coordinated system for care and support are all playing a role in students not receiving the care they need and deserve.

Schools can work within their communities and partner to innovate, collaborate, and develop solutions that can begin to meet the demands of their students. The federal and state governments have funded grants and additional district funding to meet some of these needs. However, these are not available to all schools and students.

Many schools do not have the workforce to implement a grant model and find staff to support it. CMS has expanded funding so that Medicaid members can receive services delivered in schools, but not all states have applied for it.

Some schools have mental health services provided within a school-based health center, but very few schools have these clinics on-site.

Community partnerships and collaborations are critical to meeting the mental health needs of youth in school. Every community may have unique circumstances regarding funding, workforce, and the diversity of student needs for care. Some ways that partnerships and collaborations can occur require thought leaders from the school, parent organizations, community, and academic centers to meet in identifying the need and creating pathways for care that can be delivered at school, in the community and access to higher level resources for youth in crisis.

PM Pediatric Care has become a community partner working with many school districts to innovate and provide mental health services to students through its’ school partnerships.

Offerings include four tiers of care that include: education, screening, and professional development; evaluation and brief intervention (6 sessions to identify issues and provide intervention and, if needed, referral for ongoing care); a crisis consultation and on-demand visit service available to schools every school day for students with escalated behaviors and psychiatric evaluations required by the school for complex medical-behavioral students. Care is provided by pediatric experts and follows measurement and evidence-based care. These partnerships also include our ability to provide ongoing care outside of school when needed, referrals for escalated circumstances, wraparound services that are communicated with both the school and medical home, telehealth, and on-site appointments available that can be accessed until 8 p.m. and Saturdays. These services are funded by grants, district funding and hopefully soon by expansion of Medicaid in schools and access to our community programs covered by health insurance.

We all have a responsibility to meet the needs of our youth, and there are many ways to participate.

Building partnerships and recognizing our youth spend most of their time at school just makes sense to meet students where they are and have comfort. Trusted relationships at school have proven to be one of the best indicators of a student’s success.