Michigan schools once lagged in behavioral health care. Here's how they made it a priority.

This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

Thanks to new findings, new funding, and a new focus on mental health, Michigan’s schools are expanding behavioral health services. While a huge demand for behavioral health services in Michigan’s schools remains — and some schools are giving up on it in the face of COVID-19 – others recognize the need to keep the push going more than ever.

Here's a look at how Michigan has bounced back from having some of the lowest-ranked school behavioral health services in the nation – and how advocates are working to keep the momentum going through the turmoil of the pandemic.

Helping kids, helping teachers

An independent consultant who has worked with the Michigan Department of Education (MDE) and the Michigan Department of Health and Human Services, Lauren Kazee wrote MDE's Early Childhood to Grade 12 Social and Emotional Learning (SEL) Competencies and Indicators.

SEL helps students learn five key competencies: how to recognize their emotions, manage those emotions, have empathy for others, establish and maintain positive relationships, and make positive decisions. Michigan was the first state to provide benchmarks, strategies, and indicators for educators to build SEL competencies in their classrooms, from Pre-K through 12th grade.

"There have been over 200 research studies done in the last couple decades that look at when schools introduce SEL," Kazee says. "On average, academics improve by 11 percentile points."

For the last 12 years, Kazee has been working with school districts to train staff to recognize signs and symptoms of mental health concerns and increase students’ access to mental health resources. By providing school staff with tools that support their own mental health, those adults are better empowered to identify and support children with depression, anxiety, or trauma-related behavior problems.

"If you focus on the adults first, it’s like that whole airplane oxygen mask thing. You cannot pour from an empty cup. If our educators are so stressed that they don’t have it together, we are not setting up a school to win," Kazee says. "When the teachers are whole, healthy, happy, have good morale, and feel valued, they can, in turn, instill that into kids."

A University of Michigan (U-M) Medicine program, TRAILS — Transforming Research into Action to Improve the Lives of Students — has been making this approach work since 2014, improving mental health care for students in schools across Michigan, including all of Detroit Public Schools’ 110 buildings. To support Michigan’s SEL Competencies, TRAILS implements a three-pronged approach that trains school professionals in evidence-based mental health care approaches, specifically cognitive behavioral therapy and mindfulness; connects the school with community mental health providers for follow-up coaching; and provides an extensive library of free downloadable resources including handouts, worksheets, activities, multimedia, and manuals.

In early demonstration trials, TRAILS' approach not only significantly improved school professionals' understanding and application of cognitive behavioral therapy but also successfully helped students deal with depression and anxiety.

Elizabeth Koschmann.

"The mission is to improve access to mental health care for school-aged youth," says Elizabeth Koschmann, TRAILS director and research investigator at the U-M Department of Psychiatry. "We believe the best way to do that is to leverage the availability, accessibility, and expertise of school mental health professionals. That includes school social workers, counselors, school psychologists, nurses, [and] health teachers."

New funding

While the state’s SEL Competencies and programs like TRAILS are leading the nation, historically, Michigan had done poorly in providing medical and mental health resources to its kids when compared to other states. In 2014, Michigan ranked last among states in the ratio of school nurses to students and third lowest in the ratio of school counselors to students. School districts have not had the financial resources to hire these essential staff members. And, according to Kazee, even when mental health resources were available in their communities, the organizations offering services had difficulty connecting with the schools.

However, in 2019, the Michigan legislature approved $31 million for expanding mental health services in schools.

Deb Brinson.

"That is significant. That came a lot from school safety, violence, and suicide issues. The money has remained intact and will continue," says Deb Brinson, interim executive director of the School-Community Health Alliance of Michigan (SCHA-MI). "Also, the state has worked with Medicaid to look at unique financing mechanisms that would allow Medicaid students to receive mental health services through the schools. That sets a tone and creates a pathway for reaching the next level of having conversations with commercial carriers about covering mental health services in schools."

One of the inspirations for the 2019 appropriation was SCHA-MI's 2018 white paper, "Financing Options for Supporting School Health Teams," which was created as a resource to support schools in their efforts to secure and maintain long-term funding to either expand or provide health care services. At a minimum, those include access to mental health care, school nursing, general and preventative care, and a range of other supports for students and their families.

SCHA-MI stated that Michigan’s lack of school-based mental health providers and school nurses had resulted in a serious health crisis for children without access to care outside of school. It recommended targeted investments in school-based mental health services for the significant number of children with behavioral health disorders (20% nationally, according to the white paper), noting that as many as 80% of them do not get the care they need.

Renee Edmondson, SCHA-MI deputy director, is excited about a line item within the $31 million budget that allocates $6.5 million for school-based mental health-specific centers that offer students both primary and mental health care.

"Sixty-two sites have been up and running for two years. Then, for this current fiscal year, an additional $1.5 million will open up 10 new sites in schools where there were no services," Edmondson says. "They are all over Michigan, everywhere from Detroit to Grand Rapids to Cheboygan and the Upper Peninsula. They are really trying to reach those kids that otherwise would not have access."

Now more than ever

According to Kazee, the losses caused by COVID-19 have had a huge impact on children’s mental health. Kids have lost their normal routines and simple freedoms, like playing team sports. Many live in families that have lost jobs, homes, or loved ones. The Wayne State University School of Social work reports that the pandemic has compounded risks for child abuse and neglect due to domestic violence, financial stress, and social isolation.

Lauren Kazee.

"When you focus on the emotions, which tie into mental health, COVID-19 has caused a huge increase in anxiety, a huge increase in kids experiencing trauma, and a lot of loss," Kazee says. "For kids especially, the imaginary COVID-19 monster can be so scary for them."

In Detroit Public Schools, where Koschmann did an assessment of the district's behavioral health needs for the TRAILS program, she and her team have provided pandemic-specific resources on behavioral health and shared them at food distribution sites in the city. The resources are also available online.

"COVID-19 presents massive mental health concerns among school-aged kids," Koschmann says. "In response to that, we have developed a number of new resources … to help them manage stress, anxiety, sadness, and isolation."

She says response to those resources so far has been "overwhelming." Since March, the materials have been downloaded over 85,000 times and TRAILS' website has seen 30,000 unique visitors. For Michigan’s children, new focus and funding for mental health have come just in time.

"I am very happy to see all the talk about mental health. Over the past couple of years it has really been brought to the forefront," Edmondson says. "... I feel hopeful that services will continue to grow, expand, and become more sustainable and that more Michigan kids will have access to high-quality mental health services."

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media, communications manager for Our Kitchen Table, and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at [email protected] or www.constellations.biz.

Lauren Kazee photos by Steve Koss. All other photos courtesy of subjects.