Student Mental Health: Planning for the Post COVID-19 World
by Duncan Young, CEO, Effective School Solutions
The COVID-19 crisis is fundamentally changing many aspects of education. One key area that will be transformed — and elevated in importance — is the area of student mental health. The focus on student mental health, and particularly the use of the school environment as the “front line” for mental health care delivery, has already been on the rise in recent years as the incidence rate of student mental health challenges has increased. Districts have increasingly shifted their thinking on mental health support to view it not just as a medical need to be solved by the healthcare system, but as a foundational element of educating the whole child. The COVID-19 crisis has made student mental health challenges like anxiety and depression an even greater priority as students have been separated from familiar environments, routines, and services. Here are some key points that need to be front of mind for how districts plan for mental health support as our country begins the gradual shift to the post-COVID-19 era.
Student mental health was already a huge challenge for districts- this crisis will exacerbate it
The statistics around the mental health of young people in the last decade are sobering, with the National Alliance on Mental Illness reporting that 1 in 5 students suffer from a mental health condition, and the American Psychological Association stating that mental health challenges like anxiety, depression, and suicidality have risen almost 50% among young people during this time period. Unfortunately, the COVID-19 crisis is likely to increase the incidence and severity of student mental health challenges. During this time of extended school closure, educators are reporting a rise in depression and anxiety related to a number of stressors. These include academic stressors (challenges with management of unstructured time, lack of motivation, challenges connecting with teachers), family stressors (parent/child conflict and sibling conflict that comes from being in close proximity to one another), social isolation (particularly for students who rely on a support group of peers and friends in school) and simply worry about them or their loved ones getting COVID-19. Says Rui Dionisio, Superintendent of Verona (NJ) Public Schools, “Most notable [about the closure] is the significance of the lack of consistent and physical face-to-face time which cannot be discounted. Loneliness at the hands of isolation due to this public health crisis has the potential to worsen conditions for students who have struggled with trauma and mental health challenges, such as anxiety and depression in the past.”
In many ways, the crisis has the potential to create a form of “ambient trauma” which could very well lead students with existing mental health conditions to struggle even more. There is extensive research relating the number of “adverse childhood experiences” (ACEs) that a student experiences to the number of social and emotional challenges they experience later in life (e.g. mental health challenges, substance abuse issues, etc.) It may be that the COVID-19 crisis serves as a sort of “universal ACE” for young people today. As districts inevitably get to the point where schools re-open, they should be aware of a potential up-tick in student mental health issues such as school avoidance and increased anxiety.
Focus on creating a continuum
The key best practice that has emerged around school-based mental health in recent years has been the shift from a “random acts of therapy” approach (one in which mental health consists of a series of well-intentioned but disconnected efforts in the school environment) to one in which mental health supports are aligned around a continuum of care. For example, we advise districts to align their mental health efforts around a Response to Intervention (RTI) Framework for Mental Health, consisting of three tiers ranging from Tier 1 universal supports (high quality SEL curriculum, universal mental health-related professional development for educators), to Tier 2 moderate intensity interventions, to Tier 3 intensive in-school mental health programming for students with more severe challenges. All of this should be supported by a universal mental health screener which can serve as an early identification system for potential challenges. Bottom line, for districts that have already taken steps to build a true in-school mental health continuum, stay the course. For districts who have been considering the move to a more comprehensive approach, the mental health landscape coming out of the crisis will make this even more of a moral imperative.
When it comes to mental health care delivery, plan for a “blended” model
One thing demonstrated by the COVID-19 crisis is that even if schools are closed, student mental health challenges do not go away. It’s been vital during this time for districts to provide virtual or remote means of delivering mental health, counseling, and therapeutic services. Federal and most state guidance has now raised the stakes on this by reminding districts that they must make a “best effort” to deliver these services, many of which are required under a student’s Individualized Education Plan (IEP). Just as importantly, most districts have concluded that providing continuity of service is simply the right thing for at-risk students, given the isolation and disruption caused by this crisis. Moving forward, as districts build out their mental health continuum it is now essential to have a “blended” mental health care model that utilizes in-person services, but which also has a virtual component that provides continuity of services if school closures happen again in the future. And with many reports predicting that COVID-19 could return in the fall, the capability for virtual delivery of mental health supports will be key over the long-term. As an example of virtual delivery in action, at ESS we shifted the delivery of our in-person services to virtual delivery when the COVID-19 crisis occurred in mid-March. Our typical delivery model of individual, group, and family therapy was replaced with a sequence of frequent virtual therapeutic check-ins for both individual students and their parents. Of course, a virtual component has some benefits above and beyond its role as a “back up plan” for in-person services, given the comfort of young people with technology and its ability to traverse the home/school divide. However, districts are wrestling with numerous questions about how best to prepare for the delivery of mental health care services going forward. Says Mary Forde, Chief Pupil Personnel Services Officer in Greenwich (CT) Public Schools, “I don’t know of any public-school staff who are trained in providing remote/tele-therapy, and our contract language with outside providers has not been descriptive as to the use of and expectation of these tools. How is professional liability impacted? What does clinical supervision entail? What should the options be when remote therapy is not working? These are all questions we need to answer.”
Find ways to self-fund mental health initiatives
The COVID-19 crisis will have a profound effect on district budgets. While in the short-term districts may have surplus funds due to the fact that many planned services weren’t delivered this school year, in the longer term there will be more uncertainty as sales tax revenues, property tax revenues, and other non-federal sources of school funding decrease. While the recently passed $2 trillion stimulus bill will help in the form of education stabilization aid provided to states, it’s unlikely it will address the entire gap. Despite this, it’s imperative that districts continue to be creative to find ways to fund both targeted and more universal mental health initiatives. The good news is there is often inefficiency in the delivery of mental health care in school districts, and thus building a mental health continuum can often be self-funded by reducing those inefficiencies. A good example of such an inefficiency is the cost incurred by districts each year on sending students with mental health challenges to specialized private facilities and schools outside of the district. While this is the right clinical solution for many students, there are thousands of students who could be retained in (or returned to) and supported in their home district if the appropriate mental health services existed in school. And since the cost of sending a student out of district is often 6 to 8 times the cost of providing the same support in-school, creating in-house mental health programs can be a great way for districts to create a surplus that can be used to build an entire mental health continuum.
In summary, the COVID-19 crisis will create an even more urgent student mental health crisis in our country moving forward. Districts should begin planning now for how they can best support student mental health needs when school closures inevitably end.