Summer is over and a new school year is kicking off. New school supplies, reconnecting with classmates and an opportunity to start fresh are among the things that kids look forward to as they ready themselves. But for plenty of students – and by plenty, I mean one in five – there are underlying mental health concerns that have gone unaddressed and may even be triggered by the thought of a new school year.

Personal stories from Lady Gaga to Demi Lovato remind us that most adults facing mental health and substance use issues began their initial struggles as teenagers, or even earlier in life. In fact, more than half of mental health symptoms emerge by age 14. While the behavioral health system spends the bulk of its dollars on the most chronically ill adults, we are missing out on the opportunity to save the next generation through the expansion of, and funding for, school-based mental health services.

Adverse childhood experiences (ACEs) have now been well-documented as connected directly to long-term, chronic health issues that result in high costs for treatment in both physical and behavioral health systems. Studies such as the CDC-Kaiser Permanente study of 13,000 adults have found a strong relationship between the number of ACEs in a person’s life and their overall physical health as an adult. Given that we have this knowledge, the need for early screening for trauma, developmental issues and overall mental health needs is critical to the long-term health of this next generation.

School-based mental health services can provide three tiered approaches to intervention:

• Tier One: Introduce a universal “whole-school” approach that supports awareness, peer supports, teacher consultation and creating a trauma-informed environment at schools that helps students feel safe.
• Tier Two: Use interventions that identify and serve students who may show signs of needing more supports that may include support groups, individualized supports or consultation with teachers to develop classroom techniques that will engage and support these students to reduce anxiety, depression or behavior issues.
• Tier Three: For students who are assessed as needing more intensive services like individual therapy, family therapy or individualized behavioral supports, an intervention may be needed. These students are often at risk of suspension or expulsion, referral to special education or may struggle with chronic absenteeism related to their behavioral health issues.

In spite of the expansion of enrollment in Medicaid in many states, as well as parity laws and the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) entitlement spelled out in federal laws and regulations, children and youth are still likely to lack access to much-needed mental health and substance use services when and where they are most likely to take advantage of them. What can we do to increase access to these services and supports where children and youth are?

1. Commit to school-based mental health services as a best practice. Each state must consider how it can use the EPSDT benefit to meet students’ behavioral health needs and work to expand services into schools through partnerships between school districts, behavioral health authorities or managed care organizations and private nonprofit partners. CMS and SAMHSA agree and have developed guidance for states on integrating services in schools.
2. Strengthen partnerships between nonprofit behavioral health organizations, districts and charter schools and behavioral health authorities. Using braided funding available through Medicaid, managed care organizations, education and other state-specific funding, a full array of school-based mental health interventions can be made available. The savings resulting in increased daily attendance funds, reduced juvenile justice and child welfare costs and reduced crisis interventions for youth whose mental health needs have not been identified and treated early, will significantly outweigh the costs of programs.
3. Invest in Youth Mental Health First Aid and evidence-based screening tools to identify behavioral health needs early, then address them through Tier One and Tier Two supports. Training teachers and other school staff in Youth Mental Health First Aid will help to reduce stigma in the school environment and help students get referred for services when they need them.

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