# data[].attributes.body
Tiered approach to follow up

Resource map of school and community supports and services

Determine interventions that will be implemented for students at different levels of risk

Follow-up schedule

High risk- same day

Moderate risk- within a week

Low risk- communicate findings to staff, students, and parents within a reasonable timeframe (e.g., one month).

Processes to follow up with caregivers and school staff

Alert crisis teams and local community mental health providers to be on call in advance of screenings

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Proactive Approach to Addressing Barriers

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Proactive Approach to Addressing Barriers

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When planning for school-based screening, teams should consider potential concerns from various stakeholders, including school staff, students, families, and community partners. School screening teams should anticipate these concerns and prepare for issues that may arise.

# data[].attributes.body
Whom to screen

Pilot with a small group of students

Collect feedback from students, families and staff to inform modifications

When to screen

Consider advisory or home room time

Staff to support screening

Who will administer the screening

Provide information scripts for staff to read including potential trouble-shooting tips

# data[].attributes.body
Online vs. Pencil and Paper

Online administration

Efficient data collection and management

Paper and pencil

No technology required

May be time-consuming

Increased likelihood of errors in scoring and data entry

# data[].attributes.headline
An important decision when planning consent procedures is the type of consent, active or passive/opt-out, sought from students’ parents and legal guardians.

# data[].attributes.subject
An important decision when planning consent procedures is the type of consent, active or passive/opt-out, sought from students’ parents and legal guardians.

# data[].attributes.body
Active Consent: A student may only participate in school mental health screening if their parent gives written consent.

Passive Consent: A parent or guardian’s non- response serves as their consent to let their student participate in screening.

# data[].attributes.body
Is it reliable, valid, and evidence-based?

Is it free, or can it be purchased for a reasonable cost?

How long does it take to administer and score?

Does it come with ready access to training and technical support for staff?

Does it screen for what we want to know?

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It is imperative to clarify the goals of screening prior to selecting screening tools or communicating to those outside of the screening team about upcoming screening administration.

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It is imperative to clarify the goals of screening prior to selecting screening tools or communicating to those outside of the screening team about upcoming screening administration.

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Examples:

Screen all 6th grade students in one district for anxiety to inform who may benefit from additional support during the transition to middle school.

Screen all 9th grade students in one high school for depression, including suicidal thoughts, to improve

identification of students for counseling and inform school-wide suicide prevention efforts.

Screen all students in one district for school connectedness to identify which schools have higher rates of school connectedness and learn from their efforts to improve this in other schools.

# data[].attributes.body
Buy-in and availability of student instructional support personnel (school psychologists, school counselors, school social workers, and other school health professionals)

Administration and follow-up

Teachers and paraprofessionals

Classroom administration

Community providers

Capacity to welcome new referrals

# data[].attributes.body
Begin with a few students, and get feedback, or start with a classroom or grade and then make corrections/adjustments to the process rather than starting the screening process with an entire school or district.

# data[].attributes.body
Include students and families in informing the screening, planning, and implementation process.

Use a selection process for a screening tool that considers reliability, feasibility, cost, and fit with the goals of screening.

Share information about screening in multiple formats prior to implementation.

Inform students and families about screening procedures in advance and offer the opportunity to consent or opt out.

Roll out initial screening efforts gradually to ensure the effectiveness of all processes before scaling up.

Respond to risk of harm to self and others immediately.

Have a defined process to assess screening/assessment results that allows for triaging students to further assess the need for Tiers 2 and 3 services and supports.

Indicate the number of students:

• enrolled in school.
• formally screened in the absence of known risk factors.
• identified as being at-risk or already experiencing a mental health problem.
• referred to a mental health services following identification.

Document how many students were screened for each specific screening area: depression, suicidality, substance use, trauma, and other mental health concerns (e.g., ADHD, conduct, life satisfaction, academic engagement).

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School mental health screening is defined as the use of a systematic tool or process to identify the strengths and needs of students. Screening is conducted for all students, not just students identified as being at risk for or already displaying mental health concerns. This might involve screening an entire population, such as a school’s student body, or a smaller subset of a population, such as a specific grade level.

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Barrier: The identified need will exceed our capacity.

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Barrier: The identified need will exceed our capacity.

# data[].attributes.body
Set triaging data rules in advance

Review existing resources/capacity

Review surveillance data

Start small then adapt and scale up

# data[].attributes.body
Student assent.

Deliver a consistent message.

Share information in multiple formats.

Automated phone call/text message to all families

Information on the school website

Written notification sent in the mail

Flyers sent home with students

Forms/information sheets included as part of registration packets

Discussions with students in class and parents/caregivers at meetings

Signs displayed around the school

Script read to students prior to administration

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Challenge: Selecting a screening tool to fit goals

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Challenge: Selecting a screening tool to fit goals

# data[].attributes.body
Consider integrating data into existing data systems.

Behavior management platforms

Student information systems for academic and behavioral data

Consider electronic survey administration

Data storage and access

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Tip:  You don’t always need to create a whole new team for screening!

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Tip:  You don’t always need to create a whole new team for screening!

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Team:

School administrators and staff

Community

Students

Family

# data[].attributes.body
Support a Multi-tiered System of Supports (MTSS)

Inform Prevention and Early Intervention Strategies

Identify concerns specific to certain grades or classrooms

Identify students with highest well-being

Identify students at risk for a mental illness or harm to self or others

Make economically sound decisions

Improve Access to Mental Health Supports

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Barrier: Our community doesn’t like the idea.

# data[].attributes.subject
Barrier: Our community doesn’t like the idea.

# data[].attributes.body
Involve multiple stakeholders in planning

Use existing community and parent forums

Start by screening for resilience and strengths

Start small then adapt and scale up

# data[].attributes.headline
Challenge: Compliance with applicable laws, policies, and guidelines around consent for screening

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Challenge: Compliance with applicable laws, policies, and guidelines around consent for screening

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Alternatives to Exclusionary Discipline

Exclusionary discipline policies, such as suspensions or expulsions, can have long-term negative consequences on youth (e.g. school dropout and involvement in the juvenile justice system) and school climate ( White House Report: The Continuing Need To Rethink Discipline; HHS and U.S. DoE Policy Statement on Exclusionary Discipline). Although federal data demonstrate steady declines in suspensions and expulsions, data indicate that students of color and students with disabilities continue to be disproportionately suspended or expelled.

Several states have addressed the negative consequences and disparities related to exclusionary discipline by enacting policies that direct schools and districts to eliminate or reduce punitive discipline practices and/or implement restorative practices.

Sources: Data retrieved via an extensive independent review by the NCSMH and supplemented by additional sources, including:

National Association of State Boards of Education (NASBE). (2020). State Policy Database: Alternatives to Exclusionary Discipline. Retrieved from: https://statepolicies.nasbe.org/health/categories/social-and-emotional-climate/alternatives-exclusionary-discipline

Education Commission of the States. (2018). School Discipline: Are there non-punitive approaches outlined as alternatives to suspension or expulsion? Retrieved from: http://ecs.force.com/mbdata/MBQuest2RTanw?rep=SD1804

All 50 states and the District of Columbia have either anti-bullying laws, regulations, model policies, or a combination of all three. These require districts to engage in bullying prevention and to respond when bullying occurs. Although it is necessary to address bullying, there is concern regarding the reliance on punitive responses to bullying. Punitive discipline practices do not reduce incidents of bullying and do not address harm.

The links in the map lead to state pages on stopbullying.gov, a site hosted by the US Department of Health and Human Services. In addition to describing the laws, policies, and common components, each state page provides link to the policy itself.

The information in the map was originally collected and compiled by several federal government agencies, including U.S. Department of Education (DoE), Department of Health and Human Services (HHS), and Department of Justice (DOJ).

U.S. Department of Health and Human Services. (2018). Laws, Policies, & Regulations | StopBullying.gov. https://www.stopbullying.gov/resources/laws

Culturally Responsive Teaching

Students, their families, and their communities thrive when school staff celebrate and integrate the societal contributions of people from different cultures in the classroom. According to the National Childhood Traumatic Stress Network (NCTSN), multicultural recognition in education increases personal meaning of classroom content, elevates student-teacher relationships, improves academic success, and enhances students' sense of belonging at school. Recognizing and honoring the experiences of diverse people reduces disenfranchisement among communities that are marginalized. The New America's report on culturally responsive teaching (CRT) notes that "the majority of states do not yet provide a description of CRT that is clear or comprehensive enough to support teachers in developing and strengthening their CRT practice throughout their careers." The map below provides access to state professional teaching standards that incorporate aspects of CRT.

The information in this map was originally compiled New America.

Muñiz, J. Culturally responsive teaching: A 50-state survey of teaching standards. New America. https://www.newamerica.org/education-policy/reports/culturally-responsive-teaching/

Every Student Succeeds Act (Chronic Absenteeism and School Climate)

One of the most significant components of the Every Student Succeeds Act (ESSA) is the requirement that states include multiple measures in their accountability systems. In addition to academic indicators (academic achievement, academic growth, graduation rate, and progress in achieving English language proficiency (ELP)), states must select at least one indicator of "school quality or student success" such as:

Rates of chronic absenteeism

College and career readiness

Student or educator engagement

Student access to and completion of advanced coursework

School climate

States have the flexibility to select multiple "school quality or student success" indicators and to use multiple measures within each indicator.

Expanded Medicaid Coverage in Schools

In 2014, the Center for Medicare and Medicaid Services (CMS) reversed the Free Care Rule, which restricted schools from getting reimbursement for services provided to Medicaid-enrolled students without an Individualized Education Plan (IEP). The reversal permits states to allow school districts to bill Medicaid for school-based health services, including mental health services, provided to all Medicaid-enrolled children, not just those with an IEP. To expand this eligibility, states need to take action, typically through modification of state Medicaid plans. For more information on school Medicaid, please visit the Healthy Students, Promising Futures webpage, a Healthy Schools Campaign program.

The map below displays states that have leveraged the policy reversal by expanding Medicaid coverage in schools, states that are in the process, and states that have not yet taken action.

This information was originally compiled by the Healthy Schools Campaign through their Healthy Students, Promising Futures program.

Partnering with and effectively engaging families is critical to the success of comprehensive school mental health systems. The map below displays states that have a policy directing districts to develop or implement plans, policies, or programs related to family engagement in schools.

The information in this map was compiled by the National Association of State Boards of Education.

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SHAPE - School Health Assessment and Performance Evaluation

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Alternatives to Exclusionary Discipline Exclusionary discipline policies, such as suspensions or expulsions, can have long-term negative consequences on youth (e.g. school dropout and involvement in the juvenile justice system) and school climate ( White House Report: The Continuing Need To Rethink Discipline; HHS and U.S. DoE Policy Statement on Exclusionary Discipline).

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Challenge: Making Data Systems Decisions

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Challenge: Making Data Systems Decisions

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•Gather input from several groups:

Focus groups

Parent/staff meetings

Feedback cards

•Strategize how your goals fit in with other initiatives or goals in your school/district

•Consider how students are currently being identified for MH services and the implications for service provision.

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Resource: Best Practices In Universal Screening For Social, Emotional, And Behavioral Outcomes: An Implementation Guide

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Resource: Best Practices In Universal Screening For Social, Emotional, And Behavioral Outcomes: An Implementation Guide

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BEST PRACTICES IN UNIVERSAL SCREENING FOR SOCIAL, EMOTIONAL, AND BEHAVIORAL OUTCOMES- AN IMPLEMENTATION GUIDE

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Challenge: Understand why & how to screen at the student, classroom, school, district, state, parent, community levels.

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Challenge: Understand why & how to screen at the student, classroom, school, district, state, parent, community levels.

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Barrier: Obtaining consent from parents will exceed our capacity.

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Barrier: Obtaining consent from parents will exceed our capacity.

# data[].attributes.body
Use passive consent and opt-out procedures

Share a consistent message in multiple formats

Engage parents in developing your message

Start small then adapt and scale up

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Resource: UCSB Universal Complete Mental WellnessScreening Via Student Self-Report

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Resource: UCSB Universal Complete Mental WellnessScreening Via Student Self-Report

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Universal Complete Mental Wellness Screening Via Student Self

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Resource: Student Information Systems Issue Brief

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Resource: Student Information Systems Issue Brief

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•Complex stress related to poverty, immigration, language barriers

•Cultural beliefs about mental health and how concerns should be addressed

•Marginalized and underserved groups

•Screening more acceptable across cultural groups when strengths-based

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Resource: School Mental Health Screening Playbook: Best Practices and Tips from the Field

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Resource: School Mental Health Screening Playbook: Best Practices and Tips from the Field

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School Mental Health Screening Playbook- Best Practices and Tips from the Field

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Resource: School Mental Health Quality Guide: Screening

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Resource: School Mental Health Quality Guide: Screening

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School Mental Health Quality Guide- Screening

# data[].attributes.headline
Barrier: What will we screen for? Lack of clarity on screening goals

# data[].attributes.subject
Barrier: What will we screen for? Lack of clarity on screening goals

# data[].attributes.body
Obtain input on key focus areas to start with

Consider different measures by grade levels, schools, etc

Use the SHAPE Screening and Assessment Library

Start small then adapt and scale up

# data[].attributes.body
Data can support justification for mental health screening.

Surveillance Data:

Using a tool or process employed with an entire*population, such as a school’s student body, to gather anonymous information about school and student strengths and needs.

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Resource: Module 4: Screening Best Practices

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Resource: Module 4: Screening Best Practices

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Challenge: Managing screenings without overloading staff or students

# data[].attributes.subject
Challenge: Managing screenings without overloading staff or students

# data[].attributes.headline
Resource: Nine Elements of Effective School Community Partnerships to Address Student Mental Health,Physical Health, and Overall Wellness

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Resource: Nine Elements of Effective School Community Partnerships to Address Student Mental Health,Physical Health, and Overall Wellness

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Nine Elements of Effective School Community Partnerships to Address Student Mental Health, Physical Health, and Overall Wellness

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Resource: NCSMH Multi-Disciplinary School Mental Health Team Roles and Functions Template

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Resource: NCSMH Multi-Disciplinary School Mental Health Team Roles and Functions Template

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Multi-Disciplinary School Mental Health Team Roles and Functions Template

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Resource: Youth Risk Behavior Surveillance System

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Resource: Youth Risk Behavior Surveillance System

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The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of health-related behaviors that contribute to the leading causes of death and disability among youth and adults, including-

Behaviors that contribute to unintentional injuries and violence

Sexual behaviors related to unintended pregnancy and sexually transmitted diseases, including HIV infection

Alcohol and other drug use

Tobacco use

Unhealthy dietary behaviors

Inadequate physical activity

YRBSS also measures the prevalence of obesity and asthma and other health-related behaviors plus sexual identity and sex of sexual contacts.

YRBSS is a system of surveys. It includes 1) a national school-based survey conducted by CDC and state, territorial, tribal, and 2) local surveys conducted by state, territorial, and local education and health agencies and tribal governments.

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YRBSS | Youth Risk Behavior Surveillance System | Data | Adolescent and School Health | CDC

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The Youth Risk Behavior Surveillance System (YRBSS) monitors six types of health-risk behaviors that contribute to the leading causes of death and disability among youth and adults, including behaviors that contribute to unintentional injuries and violence; sexual behaviors that contribute to unintended pregnancy and sexually transmitted disease, including HIV infection; alcohol and other drug use; tobacco; unhealthy dietary behaviors; inadequate physical activity.

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Resource: The Children’s Health and Education Mapping Tool

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Resource: The Children’s Health and Education Mapping Tool

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The Children's Health and Education Mapping Tool
Read our blog published in Health Affairs about the Children's Health and Education Mapping Tool: https://www.healthaffairs.org/do/10.1377/hblog20190808.517170/full/
This tool leverages our latest National School-Based Health Care Census data and Geographic Information System (GIS) technology to give you an interactive look at the intersection of school-based health centers (SBHCs) and high-need areas. This tool is especially helpful for SBHC sponsors, practitioners, and advocates, as well as child and adolescent health researchers, policymakers, and supporters. You'll be able to identify and target geographic areas for new or expanded health services, learn about SBHC characteristics, and help address the inequities that lead to poor health, wellbeing, and student achievement outcomes for children and adolescents.

Get Started

Ready to get started?

Click here to go directly to the mapping tool

Use the right-hand navigation pane to learn more about the tool and its functions

What can the tool do?

Support the expansion of the school-based health care model by identifying geographic areas where adverse child and adolescent health outcomes intersect with key social determinants of health

Provide information about nearby SBHCs to aid in collaboration and improve quality of care

Acknowledgements

School-Based Health Alliance staff developed this tool in partnership with colleagues from HealthLandscape and with support from several funders.
Read More

The Children's Health and Education Mapping Tool is supported by grants from the Aetna Foundation, Bechtel Foundation, the Atlantic Philanthropies, and the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services (HHS) (Cooperative Agreement No. U30CS09738-08-00). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.

# data[].attributes.attachment_link.description
Read our blog published in Health Affairs about the Children's Health and Education Mapping Tool: https://www.healthaffairs.org/do/10.1377/hblog20190808.517170/full/ This tool leverages our latest National School-Based Health Care Census data and Geographic Information System (GIS) technology to give you an interactive look at the intersection of school-based health centers (SBHCs) and high-need areas.