Why School Mental Health Matters
Schools are uniquely situated to play an important, perhaps leading, role in the prevention and treatment of mental health disorders. Many students receive mental health services at their school: seventy percent of children receiving services get them at school. 1, 2
The school environment is often a place of protection and security for students struggling with mental health disorders.
SBHCs: The Model for Providing Mental Health Care in Schools
School-based health centers (SBHCs) provide accessible, age-appropriate primary care and evidence-based screenings to identify students that have underlying behavioral health needs – such as substance use, suicide, trauma, safety, and social determinants of health.
SBHCs address the other health care needs that often co-occur with mental health conditions. They identify treatable concerns earlier than siloed mental health services alone.3
SBHCs are set up in a way that feels safe and acceptable to students and their families, helping them access care from trusted adults early and often.
Making Schools & Classrooms Trauma-Informed
Due to the impact trauma can have on youth, the California School-Based Health Alliance works to identify best practices for trauma-informed, healing-centered, and resilience-focused work in schools and school-based health centers in California.
Trauma-Informed Services at SBHCs
Our online toolkit aims to provide resources and lessons learned on how SBHCs can increase trauma-informed practices and student resilience. Each section includes a description of the focus area, project highlights, resources from the two projects, and examples of how SBHCs and schools can implement effective practices to support students with trauma exposure.
CSHA’s Restorative, Trauma-Informed Schoolwide Assessment
The intention of the Restorative, Trauma-Informed Schoolwide Assessment is to support school leaders and staff in assessing their use of restorative, trauma-informed practices and to identify the strengths and areas of improvement for cultivating a restorative, trauma-informed school. The term restorative reflects an integration of restorative practices. Restorative practices are relational approaches used to proactively build a connected, inclusive school culture through the use of regular restorative “circles,” restorative communication strategies, and respectful and equitable approaches to conflict and discipline. A trauma-informed school is one that: Realizes the widespread impact of trauma and understands potential paths for healing and resilience; Recognizes how trauma and stress show up in leadership, staff, students, families, and others in the school community; Responds by fully integrating knowledge about trauma into policies, procedures, practices, and the overall school culture; and actively Resists Re-traumatization (adapted from SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach, 2014). Together, a restorative, trauma-informed school integrates these two approaches to promote social and educational justice and resilience for youth, their families, and school staff.
Case Study: Frick Middle School (Oakland, California)
CSHA partnered with Oakland Unified School District to support thirteen school-based health centers serving ten Oakland middle schools to increase trauma screenings and interventions, improve school culture and climate, and identify strategies to maximize Medi-Cal billing and future funding opportunities to continue these services. One of the schools in this program is Frick Impact Academy, which is shifting their school culture and climate through wellness programming. Read the full case study.
To have the greatest positive impact, school-based mental health services should be fully integrated into the everyday functioning of the school by following these best practices:
- Mental health services build from and complement a positive school climate.
- Mental health services are available to all students, especially prevention and early intervention services.
- Mental health providers work with school staff in teams, such as the Coordination of Services Team.
- Mental health providers serve as a resource to teachers and other school staff.
- School districts partner with county and community agencies to provide mental health services.
- Mental Health Services are organized into a three tier system: Universal, Targeted, and Intensive.
Districts interested in expanding or enhancing mental health services for students should ask themselves these key questions:
- What are the needs of our students, based upon data from sources such as California Healthy Kids Survey, Youth Risk Behavior Survey, suspension/expulsion data, and special education data?
- How are students involved in assessing, planning, and implementing mental health services?
- What mental health resources do we now have on campus? Do we have school-site mental health staff?
- How are current services coordinated? Are they effective?
- How are services meeting the unique cultural needs of our students?
- What do our teachers and school staff need to know to support student mental health?
- Who are our existing mental health partners? Who are potential partners?
- To what degree is the county health department invested in schools?
- Who are the principal players and leaders? Who needs to be involved in designing systems and implementing services to ensure all student needs are met?
- How do we measure success?
- How are we going to pay for and sustain services?
This guide is intended to support local education agencies (LEAs) and county behavioral health departments (BHDs) as they seek to partner to deliver comprehensive, high-quality school mental health services. The goal of this resource is to create a library of helpful resources and organize tools around critical topics and challenges. The guide includes information about planning & partnerships, staffing, funding, coordination, and legal concerns. The guide is meant to provide specific, applicable resources to address the needs of partners to further the growth of school mental health partnerships.
National Center for School Mental Health
This center at the University of Maryland provides user-friendly resources and information for diverse stakeholders interested in advancing school mental health within their own school, community, city, state, or nation. Resources include a summary of evidence-based practices, literature review of school mental health research and data points, and a report on linking school mental health with PBIS.
Behavioral Health: Adolescent Provider Toolkit
The Behavioral Health: Adolescent Provider Toolkit was created by the Adolescent Health Working Group (AHWG). Developed by and for health care providers, it addresses common adolescent mental health and substance use issues. It is available for free download; hard-copies can be ordered for $15. AHWG also offers additional provider toolkits on trauma and resilience, sexual health, general adolescent health and minor consent.
Cognitive Behavioral Intervention for Trauma in Schools
The Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program is a school-based, group and individual intervention. It is designed to reduce symptoms of post-traumatic stress disorder (PTSD), depression, and behavioral problems, and to improve functioning, grades and attendance, peer and parent support, and coping skills. The CBITS website includes a wide variety of free resources, including everything you need to implement CBITS in your school.
The ACEs Aware site provides training for conducting the ACEs screener and resources for increasing trauma informed services.
National Child Traumatic Stress Network
The National Child Traumatic Stress Network (NCTSN) provides information on the wide variety of types of trauma, as well as resources and tools for diverse audiences, including educators and health care professionals. It contains a database of evidence based treatments for children and adolescents to treat trauma.
Mental Health Technology Transfer Center
The Mental Health Technology Transfer Center (MHTTC) provides training and resources for mental health professionals including school mental health. The National American Indian and Alaska Native MHTTC and the National Hispanic and Latino MHTTC offer resources and training on culturally competent practices for mental health practitioners.
Eliminating Barriers to Learning through the Early Identification of Student Mental Health Issues
The Eliminating Barriers to Learning (EBL) initiative is an innovative collaboration between the California Department of Education, Placer County Office of Education, and Kognito Interactive. Based on a training series developed by the federal Substance Abuse and Mental Health Services Administration (SAMHSA), California’s EBL uses a train-the-trainer model. A school- or district-based team of educators attends an in-person workshop and then uses an online training simulation to develop the skills necessary to support their colleagues in better identifying and responding to student mental health needs.
A Practical Guide for Crisis Response in Our Schools
This guide, from the American Academy of Experts in Traumatic Stress, provides information and tools for effectively managing school-based crises. The guide can be ordered for $26.95, but select resources are available for free.
Resources for Dealing with Traumatic Events in Schools
The Center for School Mental Health at the University of Maryland School of Medicine put together a list of resources that will help schools respond to a traumatic campus event.
Coping With Grief After Community Violence
This Substance Abuse and Mental Health Services Administration (SAMHSA) factsheet offers tips for coping with grief after community violence.
Know the Signs
Know the Signs is a statewide suicide prevention social marketing campaign built on three key messages: Know the signs. Find the words. Reach out. This campaign is intended to educate Californians to recognize the warning signs of suicide, find the words to have a direct conversation with someone in crisis, and find professional help and resources.
Substance Abuse Mental Health Services Administration (SAMHSA) toolkit
SAMHSA provides a free resource, Preventing Suicide: A Toolkit for High Schools, that assists high schools and school districts in designing and implementing strategies to prevent suicide and promote behavioral health. Includes tools to implement a multi-faceted suicide prevention program that responds to the needs and cultures of students.
LA County Youth Suicide Prevention Project
The Los Angeles County Youth Suicide Prevention Project provides school administrators, staff, parents, and students with up-to-date information about the prevention, intervention, and postvention of suicide among our youth. Their website offers a rich set of resources for providers, school staff, parents, and students.
Youth Suicide Prevention
This list of resources, compiled by the California Department of Education, provides school districts with youth suicide prevention resources, including the Youth Suicide Prevention School-Based Guide.
The non-profit Teen Line connects teens who may be struggling and want to talk with other teens via phone, text and email through an App.
Healing the Hurt: Trauma-Informed Approaches to the Health of Boys and Men of Color
This brief provides an overview of the research on trauma, its disproportionate prevalence among boys and men of color, and its impact on a wide variety of short- and long-term outcomes. It also describes what is meant by a trauma-informed approach and suggests specific ways in which organizations can ensure that they can better meet their clients needs through trauma-informed services.
Wisconsin Department of Public Instruction, Trauma-Sensitive Schools Toolkit
This comprehensive resource includes a trauma-sensitive schools assessment and checklist; sample teacher in-service presentation; and webcasts, videos and online articles to learn more about trauma.
The Heart of Learning & Teaching: Compassion, Resiliency, & Academic Success
A compassionate teaching and trauma-informed schools guide developed by partners Washington State with specific strategies for teachers and classrooms.
The Sanctuary Model
The Sanctuary Model is a theory-based, evidence-supported model that provides a clear and structured approach to creating an organizational culture that facilitates the delivery of trauma-informed services. The Sanctuary Model offers resources and trainings that can be applied in a wide variety of settings, including health clinics and schools.
An Annotated Bibliography of Research Literature
The Center for Health and Health Care in Schools provides a downloadable annotated bibliography of empirical studies from 2001 to 2013 that reviews the impact of school-connected behavioral and emotional interventions on student academic performance.
Using Coordinated School Health to Promote Mental Health for All Students
This white paper, from the national School-Based Health Alliance (formerly the National Assembly for School-Based Health Centers), defines the scope of mental health services in schools, highlights the growing body of literature finding a connection between health, mental health, and academic success, and presents Coordinated School Health as a sustainable way to promote mental health.
Mental Health Presentations for High School Students
National Alliance on Mental Illness (NAMI) California is a grass roots organization of families and individuals whose lives have been affected by serious mental illness. NAMI California has 71 local affiliates and represents 19,000 people to the California Legislature and Governor on mental illness issues. NAMI offers a free one-hour presentation for high school students on mental illness and recovery that includes a review of common mental illnesses, including their symptoms, and a personal testimony on recovery by a NAMI member. To schedule a presentation for your campus or school-based health center, contact Holly Davison via email.
This guide provides SBHCs run by federally qualified health centers (FQHCs) in California tools to maximize the reimbursement to which they are entitled in providing critically needed mental health care to eligible students. It is for use by FQHCs that operate or plan to operate SBHCs in California.
Watch a recording of our 2021 conference workshop on billing advice.
There are many different ways that schools can knit together resources to address the mental health needs of students. Make public funding work for you and maximize your return on investment in mental health with the strategies presented in this toolkit.
The California School-Based Health Alliance (CSHA) has a new guide for 2022 to assist in local planning and strategy that shows local education agencies (LEAs) and partners how they can braid together new state funding opportunities – including the Student Behavioral Health Incentive Program (SBHIP) and the Behavioral Health Continuum Infrastructure Program (BHCIP) – to support new school-based health centers (SBHCs) or expand and improve existing SBHCs.
(1) California School Health Centers Association, Integrated Trauma-Informed Mental Health Care to Support Boys and Young Men of Color: Recommendations for School-Based Health Centers, October 2013.
(2) Hurwitz, Laura and Weston, Karen, Using Coordinated School Health to Promote Mental Health for All Students, National Assembly on School-Based Care, July 2010.
(3) Chris Kjolhede, April C. Lee, Cheryl Duncan De Pinto, Sonja C. O’Leary, Marti Baum, Nathaniel Savio Beers, Sara Moran Bode, Erica J. Gibson, Peter Gorski, Viju Jacob, Marian Larkin, Ryan Christopher, Heidi Schumacher; COUNCIL ON SCHOOL HEALTH, School-Based Health Centers and Pediatric Practice. Pediatrics October 2021; 148 (4): e2021053758. 10.1542/peds.2021-053758.
We offer technical assistance consulting hours for organizations that are members of the California School-Based Health Alliance. You can learn more about membership and join right here on our website!