School-Based Mental Health Services for Students in Remote, In-Person and Blended Learning

by Tim Peerenboom, School Psychology Consultant on Student Services, Prevention and Wellness Team

Prior to school closures due to the COVID-19 pandemic, increasing evidence was making two things clear.  First, is that Wisconsin students are in crisis.  According to the 2019 Youth Risk Behavior Survey (YRBS), nearly 60% of high school students reported experiencing depression, anxiety, self-harm, or suicidal ideation.  Second, is that schools are uniquely positioned and thus increasingly being relied upon to provide mental health services for school-aged youth.  It is reasonable to assume that school closures have exacerbated the symptoms experienced by many students already facing mental health challenges.  It is also reasonable to anticipate that the number of students who experience depression, anxiety, self-harm, suicidal ideation or other mental health challenges has increased.  The need for equitable, high quality, proactive, and responsive mental health services within an equitable multilevel system of support already existed prior to the pandemic.  What has changed is the ways in which we must provide school-based mental health services.  

Educational leaders must be prepared to support their school-based mental health service providers in implementing mental health services in an equitable, flexible, efficient, and effective manner.  School-based mental health service providers responded and adapted quickly in response to school closures to meet students’ immediate mental health needs.  Now, school leaders must assess the needs of their school-based mental health service providers to ensure they have the competence and confidence to provide mental health services in new and innovative ways.  This may include providing the professional development time and resources to learn new skills, as well as to plan and implement virtual, in person and blended mental health service models.  

Local Education Agencies (LEAs) and school based mental health providers now have additional considerations for providing services, but also new opportunities to provide quality services for students.  The Department of Public Instruction’s Education Forward guidance encourages LEAs to consider multiple potential scenarios for educating and supporting students as they prepare and implement their reopening plans. The COVID-19 pandemic has shined a spotlight on the mental health needs of students and the inequities that exist in our systems and structures of service provision.  In response, we have an opportunity to remove the systemic barriers that perpetuate inequities and address those needs in new, more efficient and effective ways.                   

Because this article is focused on the topic of mental health service provision, it will not address the broad challenges and inequities in our systems in general.  For example, some individual LEAs will continue to face challenges in providing equitable access to the technology resources needed to implement virtual or blended learning.  Additionally, it must be noted that the conditions of the COVID-19 pandemic continue to evolve at the national, state and local levels.  Thus, LEAs must adjust as new information related to the pandemic is released, local communities respond and new policies are created.  Regardless of the changing conditions or what instructional model individual LEAs adopt, the remainder of this article offers considerations and resources to support LEAs in planning and providing efficient, effective and adaptable school based mental health services in remote, in-person and blended learning environments.  

As LEAs move toward providing more services and supports virtually, it is important to recognize that the vast majority of the students we serve spend much of their time in online environments.  It is equally important to recognize that school based mental health service providers may not.  This presents an interesting dichotomy.  On one hand, students who are well versed in the utilization of technology to interact with others are often not vigilant about ensuring the safety, privacy and confidentiality of themselves or others online.  On the other hand, school based mental health providers who are committed to online safety, privacy and confidentiality may have legitimate concerns about their ability to provide services virtually.  Several prominent national professional organizations provide recommendations, guidance, and professional development for the provision of teleservices (commonly referred to as telehealth). 

In general, mental health services can be legally and ethically provided virtually by implementing some basic precautions.  The US Department of Education provides many resources regarding these precautions.  DPI has developed teleservice guidance for mental health services, such as individual and small group counseling, social skills instruction or social emotional learning support if provided as a related service identified in an Individual Education Program.  Recommendations for ethical practices are also more straightforward and simpler than many may fear.  The school leader’s role in this is to ensure their school based mental health staff members have the ability to provide virtual services.  This may include providing funding and resources to purchase appropriate virtual platforms and to work with their staff to provide virtual services in accordance with the recommendations of their professional organizations and the US Department of Education. 

In addition to the legal and ethical considerations, there are also potential practical barriers that may be encountered by school based mental health service providers.  The National Association of School Psychologists (NASP) offers practical considerations for Virtual Service Delivery.  The American School Counselor Association and American Psychological Association have published recorded webinars addressing the topic of providing virtual services.  These organizations, and many others, continue to provide support, guidance and professional guidance regarding providing mental health services to students.  School and district leaders, in recognizing the strong link between mental health and wellness to academic success, as well as the impact of the pandemic on students, must consider the professional development needs of their staff members to best support them.  Fortunately, many of these organizations are providing resources free of charge, leaving the main consideration for leaders being the allocation of resources such as staff member time to engage in professional development, then to plan and implement the strategies and practices that will have the greatest positive impact on their local schools and communities.                 

Whether your district plans to provide educational services in-person, virtually or a combination of the two, the “reopening” process must be built upon a foundation of the mental health and wellness of students, staff, and community.  Every community has been greatly impacted by the COVID-19 pandemic. School-based mental health service providers will be vital in helping schools and community in mitigating these negative impacts.  They will play a prominent role in implementing the activities and systems for supporting all students, starting with addressing the immediate needs of the school and community.  A good place to start is a two part webinar series on supporting student trauma and grief, entitled “When School Starts Back,” presented by Dr. David Shonfeld of the National Center for School Crisis and Bereavement. The two-part webinars are linked below: 

1. Helping Students and Yourself Cope with Crisis During a Pandemic
2. Supporting Grieving Students During a Pandemic 

As our support of students continues to evolve in response to the pandemic during this time of uncertainty, it is vital that school leaders support their staff members who directly and indirectly serve students.  The pandemic has not only impacted students.  Staff members have experienced increased levels of stress, trauma and loss.  Ensuring a system that supports staff mental health and wellness, such as Compassion Resilience practices, will be a key component in adequately meeting the mental health needs of students.

Finally, it is important to recognize that one of the major barriers to providing efficient and effective school-based mental health services for students is the shortage of available school-based mental health providers.  For this reason, another key focus for school leaders is to support the creation or improve upon the Mental Health Referral Pathways system.  The current pandemic, in addition to the already existing challenges in supporting student mental health and wellness, requires strong communication and collaboration at the community level.  Referral Pathways offers a roadmap for providing students with the supports they need when they need them. 

School closures resulting from the COVID-19 pandemic have highlighted and exacerbated existing challenges and inequities in the provision of school-based mental health services.  The pandemic has created new challenges and additional potential barriers to eliminating inequities in meeting the mental health needs of students. However, it has also provided an opportunity to directly address these challenges.  Educators have had to adapt quickly to new ways of instructing and supporting students, staff, and communities.  National and state-level organizations, communities, LEAs and individuals throughout the educational system have responded to the pandemic by innovating and collaborating in unprecedented ways.  As the pandemic continues to impact students and their families, school leaders and school-based mental health service providers have an opportunity to continue to innovate, build partnerships, learn and improve equitable practices to best serve students.  In this moment in history, it is our collective moral and ethical responsibility to seize that opportunity to ensure that every student has what they need to learn when they need it.  And it starts with mental health and wellness services.

If your team is looking for support on school-based mental health supports, the Comprehensive School Mental Health Academy is designed to equip leaders with easy-to-access resources, tools, and application examples so that relevant, local action can be thoughtfully implemented and monitored.