Advancing School-Based Mental Health in Dane County

At a Glance

This project, led by Madison Metropolitan School District (MMSD), aimed to ensure students with mental health concerns achieve wellbeing, maximize their potential to engage in their education and grow academically to attain educational success. Low-income students are twice as likely to experience mental health concerns, and students of color are overrepresented among MMSD students living in poverty. These students also face disparities in access to mental health services, with only 20 percent receiving community support compared to 50 percent of their economically-advantaged peers. Multiple studies substantiate links between participation in mental health services and improved mental health and school participation and performance.

The Behavioral Health in Schools (BHS) program, initially piloted in three schools, successfully expanded to 13 schools over five years. The population of students grew 63 percent annually, and clients were consistently seen for an average of 17 sessions per year. The program primarily served traditionally underserved students. Notable improvements were reported among elementary school students, while middle school outcomes varied. Caregivers emphasized positive changes in their child’s mental health and functioning and expressed additional desire to work on family communication. Finally, the COVID-19 pandemic brought unexpected benefits and challenges, including highlighting the vital role of virtual sessions and concerns about equity in service access.

The Challenge

People living in poverty often face a greater number and severity of life challenges, including mental health concerns. Currently, 48 percent of Madison Metropolitan School District (MMSD) students live in poverty, indicated by qualifying for free or reduced-price school meals. MMSD’s low-income students are twice as likely to be identified with a mental health concern than their economically-advantaged peers. Students of color are overrepresented among MMSD students living in poverty. According to the Race to Equity Report, 75 percent of Dane County’s African American children live in poverty compared to 5 percent of white children. Additionally, disparities in access to mental health services are evident as only 20 percent of low-income elementary students receive community services compared to 50 percent of their economically advantaged peers. Multiple studies substantiate links between participation in mental health services and improved mental health and school participation and performance. Early detection of childhood mental health problems, timely referral, and access to appropriate services leads to improvements in both mental disorder symptoms and school performance.

Project Goals

The overarching goal of this project, led by MMSD, was that Dane County students with mental health concerns will achieve wellbeing, maximize their potential to engage in their education and grow academically to attain educational success. This goal was addressed four specific aims:

1. Improve the mental health and school related functioning of students receiving Behavioral Health in Schools (BHS) Services.
2. Establish continuity of care for referred students that is inclusive of family and health system providers.
3. Enhance the school climate for all students at schools implementing the BHS program.
4. Build stability and support expansion of BHS programs in MMDS and Dane County.

Results

The Behavioral Health in Schools (BHS) program was successfully piloted at Schenk and Henderson Elementary Schools and Sennett Middle School, integrating licensed mental health therapists into schools to provide therapy to students and collaborative teaming support to school staff. Over its initial five years, the BHS program expanded from 3 to 13 schools and grew the annual population by about 63 percent. The COVID-19 pandemic impacted student utilization, but despite the pandemic, BHS clients were consistently seen for an average of 17 sessions per year. The program primarily served traditional underserved students, with 63 percent being male, 80 percent students of color, 75 percent first-time mental health services users and 84 percent having Badger Care insurance.

Quantitative findings revealed consistent wellness improvements for elementary school BHS students, while middle school outcomes varied. Year four showed improvement in middle school students’ emotional behavior, but data from Social, Academic, and Emotional Behavior Risk Screener (SAEBRS) performed in Year 5 did not exhibit significant progress. The SAEBRS did demonstrate significant improvement in social behavior and total difficulties. Qualitative findings from caregiver interviews uniformly indicated improvements in their child’s mental health and functioning through BHS program participation, emphasizing self-regulation, interpersonal skills, relationship quality and classroom engagement. Some caregivers expressed desire for continued improvement in specific areas and a need to work on family communication and problem-solving.

The COVID-19 pandemic highlighted challenges and unexpected benefits of the BHS program. Virtual sessions proved vital for maintaining connections with students and families, aiding in crisis navigation and online school engagement. However, challenges included technical and scheduling difficulties, higher cancellation rates and concerns about the quality of virtual sessions. Caregivers and clinicians noted amplified equity issues, as some individuals who needed services may have been systematically excluded during the pandemic.