Center Mental Health and Wellness for Students, Families, and Staff
In the fall of 2021, the California Department of Education, with the support of The California Partnership for the Future of Learning and the Alliance for Boys and Men of Color, organized six virtual regional forums across the state during which more than 600 students, families, community members, educators, and school and district administrators spoke about how to create equitable and thriving community schools.
One of the key themes that emerged was the urgent need to prioritize mental health services and cultures of wellness.
Students, families and school staff were struggling with stress, fear, anxiety and isolation as the pandemic continued. At the same time, forum participants emphasized that schools should prioritize mental health and a culture of wellness all the time, not just in response to the COVID-19 health crisis.
Students, families and educators expressed a tremendous need for mental health and wellness supports for everyone connected to the school community.
“We need more support for mental health for students because there’s a lot of depression and things that happen to students, especially because of what they see on social media,” said an Inland Empire parent. “Many times what students need in order to succeed academically is for someone to listen to them.”
A Southern California parent added: “With the pandemic, our kids were closed off. Our kids became antisocial and they were impacted by being isolated, like the parents. I want mental health support for parents, too, because if we are good then we will be able to better support our children.”
“There is currently a lot of hurt with everyone, students, staff, teachers,” said an Inland Empire student. “It keeps building and there is no understanding or compassion.”
Students spoke of the importance of de-stigmatizing the need for mental health care and creating a culture of wellness.. “Double down on mental health,” said one Bay Area student. “We need to do more to normalize that everyday mental health is a challenge for all people.”
A key pillar of transformative community schools–integrated mental health and wellness supports for students, families and educators–answers this urgent call to prioritize mental health and wellness in our schools.
Read on to learn more about the significant resources available to support youth mental health and wellness and best practice programs in place in schools today.
The Children and Youth Behavioral Health Initiative provides a one-time $4.4 billion investment in California’s mental health system.
Background from the report:
As part of Children and Youth Behavioral Health Initiative’s (CYBHI) commitment to building a more coordinated, youth-centered, equitable, and prevention-oriented ecosystem, the initiative commissioned 29 organizations to convene nearly 50 separate meetings in 2022, engaging more than 600 individual young people, families, and community members in sharing their insights and experiences. The goal of these sessions was to ensure that the work of rebuilding the system of support for youth mental health and wellness was guided by the lived experiences of the people it was intended to serve.
This report is a summary of that vision: a system of care designed with youth at the center. When viewed collectively, 12 calls-to-action emerged from these conversations with youth, families, and communities that describe how all of us — regardless of role — can transform systems, reimagine services, and shift thinking. It is a critical resource, intended to guide our work, as we begin the process of healing by building a new behavioral health ecosystem together.
Read the rest of the report including team discussion guides here.
Creating Circles of Support
Peer to Peer Counseling Programs
Contributors to this piece include California Children’s Trust, The Los Angeles Trust for Children’s Health, and Pomona Peer Resources.
What is Peer-to-Peer Support in Schools
Partnering with schools is key to any scalable solution to address the youth mental health crisis. Peer-to-Peer (P2P) in schools builds on cultural assets and acknowledges the importance of social influence and peer attachments in the adolescent years. It taps the evidence that young people more commonly turn to informal sources of support, including friends, for psychological needs and social-emotional support. This may subsequently lead young people to be more inclined to seek a similar-aged peer for issues around their mental health and wellbeing. 1
“Peer-to-peer programs are a great resource for young people, especially for those who feel scared to approach an adult for help. For many of us, there is a barrier that can be felt between us and someone from a different generation.” - Helen, high school student and youth mental health advocate
Why Peer-to-Peer In Schools Works
P2P programs meet youth where they are—in schools. In addition to being a natural resource for connecting with peers, schools provide a trusted and safe environment and minimize transportation barriers. Research shows that reaching children and youth in schools—with a P2P connection and/or more traditional wellness services—provides the support they need to succeed:
- Students who receive mental health services on campus report greater connection to school and more caring relationships with adults at school. 2
- Mental health treatment in schools is associated with increased access for students of color—who might otherwise go without any treatment. 3
- Students who receive mental health services on campus have lower suspension rates and get along better with peers than students who have mental health needs and do not receive school-based treatment. 4
“Peer counselors learn to listen more deeply. They are better at getting students to talk than the adults on campus, including myself.” - Sheila Balk, Peer Counseling Advisor, Pomona High School
Why We Need to Expand Peer-to-Peer in Schools
There were already signs of a youth mental health crisis before COVID. Over the past decade, California children ages 10–14 experienced a 151% increase in inpatient visits for suicide, suicidal ideation, and self-injury. 5 Behavioral health emergency room utilization for youth at Rady Children’s Hospital in San Diego increased 1,746% between 2011 and 2019. UCSF Benioff Children’s Hospital Oakland reported double the number of youth suicide attempts in the fall of 2020 than in 2019. Under-resourced and underrepresented groups have been disproportionately impacted by the mental health crisis. The suicide rate among Black youth is twice that of their white peers. 6
Making it worse, California ranks in the lowest 10% of states for providing critical early behavioral, social, and developmental screenings, and 44th in the nation in access to mental health services for children—further evidence that children and youth across California are not getting the mental health support they need.
The provider shortage impacts traditional mental health support in schools as well, and California is far behind the country in the number of School-Based Health Centers (SBHCs) that fill the primary care and mental health gaps for students, especially those who rely on Medi-Cal, two-thirds of whom are Black or Latinx.
STUDENT-TO-STAFF RATIOS
| Recommended | National | California | |
|---|---|---|---|
| Counselor | 250-to-1 | 444-to-1 | 626-to-1 |
| Nurse | 750-to-1 | 936-to-1 | 2,410-to-1 |
| Psychologist | 700-to-1 | 1,256-to-1 | 1,041-to-1 |
| Social Worker | 259-to-1 | 2,106-to-1 | 7,308-to-1 |
Source: California Department of Education, CALPADS2020, USDOE CRCD2021
Building Blocks of a Successful Peer-to-Peer Program
After examining several best-practice programs and consulting with numerous youth leaders working to advance peer support in their schools, the following common elements were found to be a part of successful programs:
- A long-term commitment from a clinically informed adult ally with strong relationship skills
- Carefully developed and continuously updated curriculum that is co-constructed with youth and usually includes youth surveys, demographic information on students and the school community, data on youth mental health prevalence and system design, and co-development of new curriculum responsive to young people’s priorities
- Fair compensation for youth
- The school community and families adopt a youth development approach that continuously emphasizes and develops: 1) strengths and positive outcomes so young people develop the competencies, values, and connections they need for life, 2) youth as valued partners who have meaningful, decision-making roles in programs and communities, and 3) community involvement and collaboration to make the community a great place to grow up. Inclusion of social justice principles that embrace and center racism and poverty as key drivers of social and emotional challenges for youth
- Regular opportunities for training, including specific cultivation of community resources and referrals
- Strategic alliances in school administrative leadership and teaching staff
Youth Leaders Advocate for the Expansion of Peer-to-Peer
Youth have been at the forefront of the P2P movement, advocating for funding and expansion based on the positive impact they have personally experienced with the model.
In February 2022, youth advocacy leaders Sriya Chilla and Nghia Do provided expert commentary to the California State Assembly Joint Hearing for Child and Youth Behavioral Health Panel on the youth mental health crisis and the need for more relevant and accessible school-based supports, with a focus on P2P support. Their testimony sparked a $10 million effort to support eight high schools as pilot sites in California for a student P2P program.
Nghia Do
“What will the state do to incentivize and promote student-centered initiatives such as peer-to-peer so students are not just at the center of care, but are also at the center of engagement—allowing us to be the agents that help others.” - Nghia Do
Sriya Chilla
“SB 803 is a great step forward in the peer-to-peer world, but it needs to be followed up with more legislation that includes youth under 18 at the high school level. It’s our responsibility to set up the next generation with the mental health tools they need to succeed at school and in life.” - Sriya Chilla
Sriya shares more about her advocacy work and expanding P2P:
Types of Peer-to-Peer Programs and Resources
P2P in schools is an evolving model; however, there will probably never be a “one size fits all” P2P program. Every school is unique, and school teams must listen to the needs of students and families to determine what will best serve their mental wellness needs.
There are a number of factors to consider when exploring and evaluating P2P programs for your school. The table below provides a few of the primary factors to consider and offers a continuum of options for how to implement against those factors based on current program examples.
NAMI On Campus High School (NCHS)
Student-led clubs that raise mental health awareness and reduce stigma through peer-led activities and education supported with toolkits and resources. These are clubs, not support or therapy groups, and are open to all students who want to learn more for themselves or their family members, or to advocate.
The L.A. Trust Student Advisory Boards
Los Angeles Unified
year-long leadership program. Students conduct health education campaigns and navigate peers to the campus Wellness Centers run by Federally Qualified Health Centers (FQHCs) and other CBO providers.
MindOneSix
Sacramento City Unified
Collaborative work-based learning initiative focused on mental wellness. Each school has a unique CBO partner.
Madison Park Academy Mentoring
Oakland Unified
Year-long mentoring course/internship where 11th and 12th graders mentor middle school students.
Peer Group Connection
NE and Midwest states
Year-long, evidence-based, daily peer leadership course-for-credit initiated by CBO and taught by school faculty. High school model: 11th and/or 12th graders mentor 9th graders in small groups weekly; Middle school model: 8th graders mentor 6th graders in small groups 3 times/month.
Pomona Peer Resources Pomona Unified
year-long peer counseling class where 10th-12th grade students provide 1-on-1 support to freshmen and students referred in response to mental health needs or discipline issues.
Pomona Peer Resources
Pomona High School, Pomona CA
Pomona High School’s Peer Resources program aims to offer insight into the skills required to provide a valuable service on campus, while also focusing on self-awareness, personal power, and growth. This UC-approved “G” elective course amplifies student voice and choice and inspires critical thinking, deep listening, and empathy.
Peer Resources Advisor Sheila Balk has been leading Pomona High School’s Peer Counseling program since 1996. She describes the class as “a collaborative,” co-created with the student peer counselors. The multi-year program starts in 10th grade, with students looking at themselves more deeply and developing their listening skills. Ms. Balk shares, “The second year the kids have those ‘ah ha’ moments; 11th and 12th graders tell the 10th graders that the class gets easier the second and third years.”
Skills development is rigorous. Students spend the first semester as a peer counselor practicing in class and during 5 to 6 four-hour Saturday training sessions to hone their skills in confidentiality, active listening, emotion regulation, use of appropriate questioning, paraphrasing, and summarizing along with clarification and reflection of feelings during a client session. In addition, Peer Counselors practice how to guide others in decision-making, problem solving, managing stress, and resolving conflicts effectively. The curriculum is ever-evolving; the newest skill addition is incorporating Restorative Practices. The Peer Counseling wellness center is open daily for walk-ins, teacher or counselor referrals, and other mental health or discipline related needs.
Pomona High School peer counselors have many powerful stories about the impact of peer counseling for their student clients. Twelfth grade peer counselor Carmen Ayala shares, “Clients have told me that the things they learned and talked about in the sessions didn’t only impact their school life, but also their life at home. They didn’t expect that.”
Eleventh grade peer counselor, Jocelyn Marquez, has also experienced how peer counseling supports her clients. “Last year, I had a chance to help someone that was impactful for their life. Last year when I was talking to her she was like a caterpillar and this year she’s like a butterfly, and we’re still in relationship.”
Not only do they see the transformation in others, peer counselors also experience it for themselves. Jocelyn remembers, “I was shy and had an accent in Spanish and didn’t want to speak in front of people.” But being a peer counselor changed that perception of herself: “I realized people don’t care about how you speak, but what you’re talking about. I understand that nobody can make you feel a certain way, you choose to feel a certain way. I feel like I’ve grown in many ways — mostly in my confidence and my ability to speak in public.” Carmen adds, “Before, I was more by myself… Now, I’m very well read in terms of emotions. I’m able to regulate myself, and to support my friends, my teachers, and my family.”
“The best outcome of the pandemic was the breakdown of the mental health stigma. Students are realizing they do not have to suffer depression and anxiety alone. Since returning to in-person classes, we have seen a significant increase in clients seeking a safe space and a listening ear. We stress confidentiality, so students feel secure asking for the help they need. We do not replace professional therapists; rather we are the bridge to connecting people with more intensive services. Peer counseling is the sand that fills the cracks, so students don’t slip through while waiting for professional therapy.” - Sheila Balk, Peer Counseling Advisor
For more information, contact: Sheila Balk, Pomona Peer Resources Advisor at sheilabalk@gmail.com and (909) 519-7475
Coordination of Services Team (COST)
This backgrounder was informed by the work of Alameda County Healthy Care Services Agency Center for Healthy Schools and Communities.
Now a nationally recognized best practice, Coordination of Services Teams (COST) support students in schools and districts across the county and they continue expanding. COST, and the strength-based approach it promotes, not only increases student access to services, but enhances young people’s connection to the school and community, helping all the adults in a child’s life work collaboratively.
What Is a Coordination of Services Team?
A Coordination of Services Team (COST) constitutes a strategy for managing and integrating various learning supports and resources for students. COST teams identify and address student needs holistically and ensure that the overall system of supports works together effectively.
A COST is a multidisciplinary team of school staff and providers who:
- Create a regular forum for reviewing the needs of individual students and the school overall.
- Collaborate on linking referred students to resources and interventions.
- Support students’ academic success and healthy development.
COST uses a centralized, easy-to-use referral system so that anyone in a school community can refer or self-refer students most in need of additional supports. COST then provides a structure for school staff, administrators, and school-based providers who may normally work in separate areas to come together to discuss the strengths and needs of students who are struggling and need support. Together they develop tailored interventions that connect students to academic and social-emotional supports available in a school community.
A school may have other existing systems and structures in place for different purposes such as Student Support Teams (SST), Individual Education Plan (IEP) meetings, School Attendance Review Board (SARB) process, disciplinary meetings, etc. The main difference is that a COST team triages ALL students, not only those who are diagnosed with a learning or other physical challenge
WHO IS ON A COST TEAM?
COST team members will vary by school depending on available staff resources and community partners but may include:
- School Administrators (Principal, Assistant Principal, Teacher on Special Assignment, Community School Manager)
- Attendance clerk
- School Linked Services (SLS) Coordinator, school-based mental health provider and/or county behavioral health liaison
- School Security officer
- Teacher Representatives for Student Study Team (SST), Individual Education Plan (IEP), 504
- School Counselor
- Culture and climate liaison/Multi-Tiered System of Supports (MTSS) lead
- School Health Center staff
- Family liaison
- Social workers or case managers
- After school provider
Helpful tip: Every school has “culture keepers” and staff who have developed a close rapport with students, but their role/title may differ by school. Seek out these individuals within your school campus and meet with them.
What Do COST Teams Do?
COST teams perform four major tasks:
- Identify students who need additional supports through a schoolwide referral system.
- Assess referred students and explore strengths and supports needed.
- Coordinate efforts to link referred students to appropriate supports by tracking progress and tailoring interventions over time.
- Assess learning supports and needs school-wide, make recommendations about resource allocation to the administration, and recruit new resources.
Why Start a COST?
What are the Benefits?
COST will strengthen your school’s ability to support its students holistically. Having a COST maximizes and expands available resources, increasing your school’s capacity to respond quickly and appropriately to a wide range of student needs. With this enhanced support, more students are able to stay engaged in school and ultimately graduate healthy and successful.
COST improves coordination, communication, and collaboration across providers working on behalf of students, which leads to:
- Improved capacity to tailor interventions to each student’s unique needs and strengths.
- Higher efficiency and use of limited resources.
- Increased sense of belonging and quality of services among providers on the team.
- Expanded range of universal and prevention services.
An effective COST structure builds upon a school’s Multi-Tiered System of Support and Tier 1, Tier 2, and Tier 3 services. Prior to a COST referral, a COST team member can work with a teacher or other staff member on other strategies that can support students to be successful (e.g., 1:1 convo with a student, call home to family, classroom agreements, etc.)
Why Are COST Leaders Important?
COST leaders play a critical role in contributing to a school’s culture and climate amongst students and staff. COST leaders become change leaders by:
- Bringing together a team to work in new ways.
- Challenging the team to create solutions.
- Guiding the team and setting high expectations.
- Creating a collaborative and trusting environment that supports a student-centered approach.
- COST leads often hold other responsibilities at the school site (e.g., family liaisons, social worker, community school coordinator, etc.) but it is important to have a designated COST lead responsible for moving the work forward at a school.
Helpful tip: Identifying and supporting COST “champions” at your school will help to expand the reach in the school community. Taking the time to develop relationships with staff and partners will go a long way.
Student-Centered Approach Provides More Coordinated Supports
Before COST
After COST
School-Based Health Centers (SBHC) / Wellness Centers
Currently, our public health systems are deeply fragmented and under-resourced. School-Based Health Centers (SBHCs), also referred to as Wellness Centers, play a critical role in providing mental and physical health care to California’s historically marginalized students and families of color. The national Community Preventive Services Task Force found that “school-based health centers…provide [students and families of color] with health care and health education that gives them a chance to stay in school and perform better academically, which can lift whole communities.” Schools also continue to be ground zero for the youth mental health crisis. School-Based Health Centers can allow schools to respond holistically to students’ health needs.
When school sites have School-Based Health Centers, the impact is immensely positive. California School-Based Health Alliance, a statewide nonprofit organization helping to put more health services in schools, provides the following statistics
Impact of School-Based Health Centers (SBHCs) on Health Care
- SBHCs increase access to health care.
- SBHC users are likely to use primary care — both medical and behavioral health — more consistently.
- SBHC users are more likely to have yearly dental and medical check-ups.
- SBHC users are less likely to go to the emergency room or be hospitalized.
Impact of School-Based Health Centers (SBHCs) on Academic Performance
- Research shows that SBHCs have a positive impact on absences, dropout rates, disciplinary problems and other academic outcomes.
- Students receiving SBHC mental health services improve their grades more quickly than their peers.
- States with SBHCs that serve as Medicaid providers have higher student achievement results.
States that oversee health education and health services have higher test scores and lower dropout rates.
Below are examples of how local communities are organizing to create and sustain School-Based Health Centers.
Students for Wellness Centers
Inland Congregations United for Change (ICUC)
Inland Congregations United for Change (ICUC) is a faith-based non-profit community organization serving San Bernardino and Riverside counties. ICUC empowers people of faith to transform and revitalize the Inland Empire by working in the civic arena for the common good. Since 2015, ICUC youth leaders have been leading a campaign to reimagine school safety and invest in student mental health and wellness in schools in San Bernardino City Unified School District.
Breaking the School to Prison Pipeline
Photo Credit: Inland Congregations United for Change (ICUC)
ICUC’s campaign for student wellness centers began during the 2014 Yes on Proposition 47 campaign. Proposition 47 was a ballot measure passed by voters that redirected hundreds of millions of dollars a year away from prisons and into programs that prevent crime, including TK-12 education, victim services, mental health services, and substance abuse rehabilitation.
ICUC youth leaders who were deeply engaged in the Yes on Prop 47 campaign saw the connection between Prop 47 and what was happening in their schools, and realized they could have an impact on their district. They started to organize to end the School to Prison Pipeline in San Bernardino City Unified School District (SBCUSD) by working together with Congregations Organized for Prophetic Engagement (COPE) and Youth Action Project (YAP) to reduce suspensions in SBCUSD based on a policy around willful defiance that was disproportionately impacting Black and Brown students and pushing them towards incarceration.
In 2015-2016, ICUC also worked alongside COPE to pass the “Reducing Student Citations and Arrests” Board Policy and won. The policy put a moratorium on giving students citations for things like Day-Time Curfew Loitering and Loitering in a Public Place. This meant that students would no longer receive citations that could be added to their permanent records and follow young people for years to come.
Mental Health/Wellness & the Campaign to Reimagine School Safety
Photo Credit: PInland Congregations United for Change (ICUC).
2018 Student Walkouts in Support of Mental Wellness Centers
ICUC leaders realized it wasn’t enough to get rid of punitive policies. They also had to advocate for more resources that would proactively address the conditions that lead to creating real safety.
ICUC youth leaders decided to transition into focusing on mental health because they saw themselves and their peers struggling mentally and emotionally in isolation — without adult support or a safe space at school. Students felt they wouldn’t be able to achieve their dreams if they weren’t capable of being fully present emotionally at school.
“There have been plenty of times when I have seen other students crying at school and have felt the need to offer them comfort myself. I hear the same thing over and over again, they are feeling stress, anxiety, just overwhelmed with all the pressures of being a student, and have nowhere to turn to for support. It is rare to hear a student that feels comfortable enough to reach out to a teacher or counselor on campus.”
—Senior at Cajon High School and a youth leader with ICUC
In 2016, ICUC youth leaders conducted focus groups with about 120 youth and young adults. The most prominent theme — by far — was the lack of access to mental healthcare.
Based on their findings, in 2017, youth leaders began to organize for increased mental health and wellness supports for students. ICUC youth held their first Mental Health action and invited school board members to make commitments to prioritize student mental health and to join youth in learning about possible solutions to close the gap in resources.
They advocated for the expansion of the Heart Team, the district-wide team made up of therapists and nurses that provide services to students. This led to an increase in the number of therapists on the Heart Team from one to three.
Additionally, following the Mental health action, school board member Abigail Medina joined a team of ICUC youth leaders on a research trip to Sacramento, where they learned how school-based health centers could make mental health services directly available for students on their campuses from the California School-Based Health Alliance. Later that year, the SBCUSD applied for and was granted funding to pilot a school-based health center at one of the continuation high schools in the district.
The district began to plan what the school-based health center would look like. However, students felt like the district wasn’t practicing meaningful student engagement in the design process. Then, in 2018, as students were advocating to have a seat at the table, the tragic shooting at Marjory Stoneman Douglas High School in
Parkland, Florida rattled the country and catapulted March for Our Lives into a nationwide movement that made its way to ICUC youth leaders.
As the conversation around gun control and student safety unfolded nationally, ICUC leaders identified the disconnect between what they had been saying for years and what local leaders saw as the solution. ICUC youth continued to lift the need to invest more funding in resources for students, while local leaders were driven by the national narrative and pushed for a continued police presence at their schools, leading to a culture of criminalizing students of color. As youth across the country stood up for their safety, ICUC leaders in San Bernardino led 800 students across 5 different high schools to participate in a walkout to make it clear that students across the district needed mental health resources readily accessible to them in order to process the ongoing trauma of school shootings. This advocacy led to the district finally opening up the first School-Based Wellness Center at Sierra High School in 2019 and announcing that a second one would be opened at Pacific High School.
As 2019 was coming to an end, Sierra High School opened the first School Based Wellness Center in San Bernardino. Unfortunately, the pandemic began soon after, schools moved into distance learning, and the center closed temporarily.
Then, in May of 2020, ICUC youth learned of the devastating murder of George Floyd. ICUC’s work around the impact of police brutality and the criminalization of Black and Brown youth in their schools intensified in response. While some members of the community were arguing that having a police presence in schools created safety, ICUC student leaders surveyed about 500 of their peers across 5 high schools to learn more about what students said would make them feel safe. Through this survey, they learned that the top 3 things that make students feel safe at school were:
- Having a positive relationship with a teacher/staff on campus
- Knowing there are mental health resources available to them at their school (e.g., therapists/social emotional counselors)
- Having safe physical spaces where they can go if they are in need of somewhere to safely ground themselves before heading to class (e.g. calming rooms)
The results of the survey and listening with their peers further cemented the case students had been making all along, that in order for students to really be successful, their mental health needs to be a priority.
As months turned into years and the pandemic continued, the need for mental health resources intensified. ICUC leaders began to see how COVID-19 increased anxiety and depression in youth.
“…As an only child, it was hard for me to find someone to talk to and I did not want to burden my mom since she was dealing with my dad being hospitalized due to COVID19. I know many other youth experienced similar situations like myself.” - Leo, ICUC Youth Leader
In 2021, as federal funding began to roll into communities, ICUC leaders held an action to engage board members around ensuring that some of this funding be allocated to mental health support for students. They urged for the allocation of ESSER II and ESSER III funds toward the immediate creation of Wellness Centers on every high school campus. They conducted research with the California Children's Trust and applied their learnings to educating district leaders about how they could use Medi-Cal billing to create sustainable funding to support the wellness centers. Such funding could be used for construction projects, including bringing existing facilities up to code, as well as providing mental health services and supports.
ICUC Reimagining School Safety Research Report, April 30th, 2022 (PDF)
The youth leaders created a budget that estimated how much it would cost to establish and maintain Wellness Centers at all 5 SBCUSD high schools and urged school board members to allocate approximately $11 million of the $219 million left in unassigned ESSER II and ESSER III funds towards their development. Unfortunately, board members did not approve the funding for the Wellness Centers. However, thanks to the unwavering advocacy of ICUC leaders, the district went on to allocate a total of $3,264,500 from ESSER III funds towards providing social-emotional and mental health support for students.
Additionally, following the research and advocacy by ICUC leaders and staff, the district began the process of expanding its role in the Medi-Cal billing process to include billing for services provided under nursing, mental health, and counseling to general education students.
They have created a LEA-BOP (Local Education Agency - Billing Option Program) Collaborative and invited ICUC to be one of the founding members. In a letter to ICUC, SBCUSD stated that the “purpose of the Collaborative group is to participate in the decision making reinvestment of funds obtained through Medi-Cal reimbursement and to provide an important voice in deciding how the funds generated get reinvested into school children and their families. These funds will supplement nursing, mental health and counseling services already in place.”
Today, ICUC youth leaders are continuing to hold the district accountable to ensure that student needs and voices are at the forefront of district decision-making. ICUC students have joined with family leaders to build the unity and power needed to realize their collective vision for their schools. Students and families are also partnering with educators to ensure that they are all fully engaged in school and district decision-making for strong implementation of California's new Community Schools Partnership Program (CCSPP).
Student and family leaders see the CCSPP as an opportunity to support creating and sustaining wellness centers as a key component of the racially just, relationship-centered community schools they have envisioned for so many years.
ICUC youth leaders won’t stop organizing until all students get access to the mental health and wellness supports and resources they deserve.
Additional Resources from other School-Based Health Center Initiatives
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- Wellness Centers Now! Resolution:
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- Roosevelt Modernization Project:
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- Roosevelt High School Upgrades ‘Must’ Include Wellness Center (2015)
- Commentary: Honor yesterday’s Roosevelt High School heroes by giving today’s students the modern high school they deserve (May 2018)
- Los Angeles Unified’s Theodore Roosevelt Senior High School Campus Cuts Ribbon to the Comprehensive Modernization of New Gymnasium and Classroom Building (2021)
- Sylvia Mendez Wellness Center Campaign:
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Long-Term Resources for Sustaining Mental Health & Wellness: How to Leverage Partnerships and Funding
California Children’s Trust , an initiative to achieve health equity and healthy development for California’s children, youth, and families
California Children’s Trust (CCT) is a coalition-supported 5-year initiative to reimagine how California finances, defines, administers and delivers children’s mental health supports and services. Equity + Justice are at the center of CCT’s beliefs, actions, and strategy for change. CCT’s belief statement lays out our vision for a transformed behavioral health system.
The Trust’s Framework for Solutions simplifies the immense complexity of reinventing California’s approach to children’s healthy development, by focusing on three core strategies:
- Maximize funding
- Expand access and participation
- Reinvent systems
These three strategies are centered on Equity + Justice, recognizing that if we don’t address root causes, including structural and systemic racism, we cannot achieve, sustain, nor scale our vision of health equity and healthy development for California’s children, youth, and families.
As a 5-year initiative, CCT plans to sunset its work in December 2024. More information about CCT’s history and impact can be found here.
Centering Schools at Scale in Response to the Youth Mental Health Crisis
Even before COVID-19, there was a youth mental health crisis. The global pandemic created further isolation, anxiety, and stress, and exacerbated and deepened equity divides. Schools have always played an essential role in supporting the well-being of our young people and connecting children, youth, and their families to essential community services and supports. This became even more evident during the isolation of the pandemic. As a safe and familiar space, families and students actually rely on schools for connections to—and often the delivery of—essential healthcare for their physical, mental, and behavioral well-being. These school connections to health are often more relevant and effective than the current diagnosis driven medical model which data shows as insufficient to support and heal our children and youth. Even though 96% of children are enrolled in a health plan with a defined mental health benefit—far too few children access care through their health plans.
Since its founding, CCT has worked at the intersection of public health and public education to ensure that schools are a critical part of any solution to address the youth mental health crisis at scale. However, historically, California schools have been woefully under-resourced and are ill-equipped to respond to the social, emotional and mental health needs on their own; schools need resources, partners, and funding to provide the school-based supports our children and youth deserve.
In August 2020, CCT published the Practical Guide for Financing Social, Emotional and Mental Health in Schools to create a road map for school district leaders interested in exploring partnerships and accessing Medi-Cal to meet the social, emotional, and mental health needs of students in schools. CCT also started collaborating with over a dozen school districts and county offices of education across the state to advise them on how to build partnerships and maximize revenue to expand programming.
California’s unprecedented investment in children and youth
In 2021, in response to the growing crisis, state lawmakers heeded the call and prioritized multi-billion dollar investments and cross-sector initiatives in health and education to support the well-being of California’s children and youth. The $4.4 billion investment in Children and Youth Behavioral Health Initiative (CYBHI) and the $4.1 billion California Community Schools Partnership Program (CCSPP) create exciting opportunities for schools to reimagine where and how schools reach young people with the supports they need to learn and thrive. These investments were a welcome addition to already significant federal funds through the Elementary and Secondary School Emergency Relief Fund (ESSER) I, II, and III (combined $23.4 billion) and a boost in the state’s Expanded Learning Opportunities Program (~$4 billion ongoing).
In recent years, in large part due to the influx of funding, school districts across the state launched hundreds, if not thousands, of new programs aimed at supporting the social, emotional and mental health of our young people. While the additional funding provides welcome resources for schools, much of it is for short-term or “one-time” use. As a result, schools and districts have the responsibility—and burden—to figure out how to secure funding to sustain programming once the one-time funding runs out.
Medi-Cal is an untapped resource for ONGOING funding in schools.
Medicaid, known in California as Medi-Cal, can and should be a strategic tool used to support and expand social, emotional, and mental health services in schools at scale and address complex trauma that students from under-resourced communities are facing. Despite the known shortcomings—restrictive, administratively burdensome, clinical—California’s Medi-Cal program is slowly changing and should be seen as an important tool for school districts to access the ongoing funding schools need and deserve to support students. Nationally, Medicaid is the third largest federal funding source in schools after Title I and the Individuals with Disabilities Education Act (IDEA). In California, Medi-Cal funded services have the potential to grow significantly in schools, due in part to historic underinvestment of school social, emotional, and physical healthcare for students.
There are three primary Medi-Cal revenue streams for schools. CCT calls them the “Big Three” Medi-Cal Payors in Schools:
- Managed Care Plans, MCPs, are licensed health plans contracted by the state and include public health plans and private health plans. Every county has at least one MCP which can be found here. Historically, managed care plans have not worked closely with schools, but this is changing. District leaders can explore ongoing contractual funding partnerships with their local managed care plans to co-locate services on sites. MCPs are the most promising new payor of health services in schools.
- County Mental Health Plans, MHPs, also called County Behavioral Health Departments or County Health Authorities, manage the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for children with higher acuity medical needs. MHPs also control Prop 63/Mental Health Services Act funds which can be used to pay for a variety of mental health services in schools. Currently, MHPs are the most common Medi-Cal financed school-based health service and often contract with community-based providers.
- Local Education Agency Billing Options Program (LEA BOP) or School-based Medi-Cal Administrative Activities program (SMAA) allows districts to bill the State directly for eligible services to be reimbursed by Medi-Cal. The program is small overall (~$130 million annually). In comparison, MHPs and MCPs currently spend ~$2 billion combined on children’s behavioral health through Medi-Cal, with MCPs having the potential (and responsibility) to spend much more. Recent changes have expanded the program to include general education students as well as students with Individual Education Plans (IEPs).
Medi-Cal resources should be seen as a critical component of a comprehensive district-wide strategy and approach to supporting students’ healthy development and healing-centered community schools.
A Shifting Landscape of Payors in Schools…
The Children and Youth Behavioral Health Initiative (CYBHI) ushered in several new and exciting opportunities to fundamentally shift how social-emotional and mental health services will be financed and delivered in schools.
- Wellness Coaches - CYBHI provides funding and authority to broaden the definition of who can deliver Medi-Cal funded mental health services in schools by developing a new position, Wellness Coaches. This position does not require an advanced degree (a barrier for many qualified individuals) and creates an opportunity for schools to hire (and pay for) more culturally-rooted healers and practitioners who better reflect the demographics of our students.
- Student Behavioral Health Incentive Program - SBHIP allocates $400 million to encourage the development of a partnership between local managed care plans, county offices of education, and school districts. The funds are distributed to the managed care plan to work with the county offices of education and priority school districts to identify which “targeted interventions” SBHIP will cover in schools. The SBHIP project plans were submitted to the Department of Health Care Services in December 2022 and notifications of approval went out in Spring 2023. Funding from the program lasts for two years in 2024 and 2025.
- School-Linked Partnership and Capacity Grants - $400 million will be available for school districts, agencies, and community organizations to apply for grants to build partnerships, capacity, and infrastructure to support ongoing behavioral health services in schools. Check the CYBHI website for more information to apply.
- Evidence-Based and Community Defined Grants Program - $429 million is available to scale programs to improve access to prevention, early intervention, and resiliency/recovery services, especially for BIPOC and LGBTQIA+ youth. There are six competitive grant rounds including a focus in the areas of youth driven programs, early intervention, and community-defined evidence programs and practices. The remaining requests for applications are expected to be released in Summer and Fall 2023.
- Statewide All-Payer Fee Schedule - Beginning in January 2024, schools will have “Essential Community Provider” status. This means that schools will automatically be considered “in network” providers for ALL health plans; commercial, public and private health plans will be responsible for paying claims for mental health and substance abuse treatment services provided at or near school campuses. This is likely to translate to increased revenue for school districts billing for services because the rate of reimbursement through the fee schedule is expected to be higher than the current rates through the BOP/SMAA. Additionally, commercial plans will now be required to pay for services that were previously only required for Medi-Cal qualifying students. As a result, many more students will be covered. This change will be a fundamental shift and take a couple of years to roll out. As a start, school districts can begin to set up the infrastructure to start collecting insurance information from all students to assist in billing.
The landscape is rapidly changing and many of these reform initiatives are still in process, however there is no doubt that we are seeing some of the biggest structural changes in the children’s behavioral health landscape in decades. CCT is tracking critical funding opportunities for schools and translating the complex Medi-Cal landscape into more tangible action steps for school districts wishing to secure long-term partnerships and funding to support the social, emotional, and mental health of our young people.
The work is ongoing and there is no one-size-fit-all approach to building a sustainable model of funding. CCT is working to change this by empowering school districts, county agencies, community-based organizations, and partners with the resources and tools to understand these complex changes. Our best advice to school districts and advocates is to continue to prioritize social, emotional and mental health in schools, creatively blend and braid resources, and develop cross-sector collaborations in support of young people.
“The future of mental health looks much less like a 50 minute therapy session and much more like culturally rooted mutual aid and peer-to-peer support.” Alex Briscoe, Principal, California Children's Trust
Below are some tools and stories that can help support school communities and districts to develop local strategies for leveraging these funding opportunities.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8049263/
- Susan Stone et al., “The Relationship Between Use of School-Based Health Centers and Student-Reported School Assets,” Journal of Adolescent Health. Published online July 10, 2013
- Snowden, L. R., & Yamada, A. (2005). Cultural differences in access to care. Annual Review of Clinical Psychology
- Strolin-Goltzman, J. The Relationship between School-Based Health Centers and the Learning Environment. Journal of School Health
- Annual Report on Health Care for Children and Youth in the United States: National Estimates of Cost, Utilization and Expenditures for Children With Mental Health Conditions, November 2014
- https://jamanetwork.com/journals/jamapediatrics/fullarticle/2680952