California authorities and educators are looking to the health system to establish a statewide behavioural health effort in order to bridge the financing gaps in erratic, sometimes unpredictably changing school budgets and establish a stable mental health fund for the education system.
“There is insufficient integration between the health and education systems to ensure that prevention and treatment are implemented,” stated David Gordon, a commissioner for the Mental Health Services Oversight and Accountability Commission. “That is especially true for the communities that receive the least attention.”
The general education budget is where most funding for mental health services in California public schools comes from, which is why funding has never been steady. Administrators and experts are increasingly turning to the health system to better serve requirements that existing education budgets frequently can’t meet as demand for school-based mental health programmes and specialists soars.
While certain gaps are filled by schools employing psychologists, social workers, school counsellors, and nurses on campus, funding is never sufficient to completely address the mental health needs of kids. Districts are left to fend for mental health in schools on their own in the absence of a statewide system that is integrated into the system.
“We’re so used to trying to provide external funding to fund us to some sort of equitable level for every student,” stated California Association of School Counsellors executive director Loretta Whitson. “It’s kind of built into the cake; it’s never been the general fund will cover us.”
Whitson claimed that since starting her career in education in the late 1980s, at the latest, things had been that way.
More funding for mental health and “a more holistic view and review of schools” were made possible by the Local Control Funding Formula, a piece of law that altered how Californian education was funded, according to Whitson. “However, in the event that funds are scarce, school district administrators will have to make extremely difficult choices.”
Districts funding teachers and education programmes face competition if they must use general fund money for mental health professionals, according to Whitson. Budgets would have more money for schooling if they included more money set aside especially for mental health.
California encourages school districts to hire social workers, psychologists, nurses, and counsellors, but it does not require them to. Mandates, according to some experts, might guarantee that every school has a mental health specialist on staff. Whitson countered that it contradicts the notion of local control, which gives districts the authority to decide what is best for their community in light of its needs and resources.
Grants for mental health have been beneficial, but Gordon noted that they are not long-term. Grants to school districts are typically awarded for a few years or fewer, and if the districts do not have the funds to continue the programmes or mental health specialists, then neither do they.
In a same vein, districts used pandemic relief money to increase the number of school counsellors, social workers, psychologists, and nurses on staff; however, the money ran out in September.
Combining two systems
Gordon gives credit for initiating the integration of the health and education systems to Gov. Gavin Newsom’s Children, Youth, and Behavioural Health Initiative. The goal of unifying the two main systems is attainable, according to Gordon, “but it will take a lot of coordination and collaboration.”
Encouraging collaborations between Medi-Cal managed care plans and schools to enhance access for children using Medi-Cal—nearly 5.7 million in 2022—is a crucial part of the behavioural health effort. Increasing access to preventative mental and behavioural health care as well as early interventions is another objective.
The governor’s Master Plan for Kids’ Mental Health and the Budget Act of 2021 both included the behavioural health project. Over a number of years, the California Department of Health Care programmes will devote $4.7 billion to youth behavioural programmes.
Over 240,000 youngsters deal with depression, and 66% don’t receive therapy, according to the master plan. The suicide rate among children aged 10 to 18 rose by 20% in 2019–2020.
The behavioural health strategy was put into action in January 2022. Numerous organisations have received money totaling hundreds of millions of dollars so far for provider retention and training, loan payback, and scholarships to expand the number of providers in underserved areas.
However, Whitson stated that a portion of the funds is given out as grants and is just temporary.
It’s crucial, in my opinion, to think about how we can continue this. Seed money is necessary as many programmes are only available temporarily, according to Whitson. “We frequently view sustainable money as Medi-Cal.”
Thanks to recent legislation, school districts now have a higher maximum amount that they can bill to Medi-Cal. Following the passage of AB-2058, the California Education Code was modified in January to permit districts to charge Medi-Cal for mental health services rendered by school counsellors.
According to Whitson, there were roughly 11,000 school counsellors in the state as of 2018. Currently, she thinks there are roughly 14,000.
“School counsellors constitute a significant revenue source for the state.” It ought to be earning a sizable sum of money, according to Whitson. “It could be applied to reduce caseloads for social workers, psychologists, and school counsellors at all levels.”
Nonetheless, school districts may have to go through a drawn-out and difficult procedure to bill Medi-Cal.
Marlon Morgan, the founder and CEO of Wellness Together, a charity that provides mental health services to school campuses in California and New York, stated that occasionally districts won’t receive a complete reimbursement and that it can take several years before the money is reimbursed.
Schools are reluctant to employ that billing option, according to Morgan, because they can wind up spending $1 million and only receiving $500,000 back. As a school board member, you have a significant advantage that, to be honest, isn’t utilised very often: knowing what to expect and how to stabilise your budget.
According to Gordon, the superintendent of the Sacramento County Office of Education, schools in Sacramento County are collaborating with the Sacramento County Health Department to assign a mental health professional to each school. The reason the relationship works so well is that the county health departments already oversee Medicaid and Medi-Cal plans, which cover over 60% of the county’s insured population, he continued.
According to Gordon, the goal is to have a health system representative stationed at schools, where they can regularly engage with staff, students, and families in addition to offering direct services. As opposed to a place where people go to seek treatment for issues that should have been identified years ago, the intention is to establish “centres of wellness and prevention,” he stated.
Certain organisations bring providers to schools by combining grant financing and insurance billing. According to Thomas Shaffer, the founder and president of Campus Clinic, which seeks to lower barriers to health care access by stationing medical professionals in schools, the organisation has sent physicians and mental health specialists to over 600 schools across 14 districts in California.
The majority of districts have not had to pay for it. Shaffer stated that Campus Clinic began covering all expenses and was able to continue its services by charging insurance, such as Medi-Cal, and submitting grant applications. Managing the billing and documentation is one task that Campus Clinic and other groups of a similar nature take on from the districts.
Shaffer stated, “We aim to complete, not compete, with existing resources.”
Nevertheless, the demand for mental health doctors and services is too high to meet supply. According to Shaffer, Campus Clinic has contracts with 28 additional districts that are merely in the planning stages.
Additionally, Shaffer added that Campus Clinic provides universal health exams that let schools swiftly determine which students are at danger of self-harm, exhibiting symptoms of anxiety, or despair. Through a dashboard that features real-time notifications for children who are at risk of self-harm, schools can view the replies. Teams from Campus Clinic begin contacting families to offer help.
It is not without difficulties, though. It can be difficult to establish trustworthy relationships with families in order to make them feel comfortable accepting services.
“The trust and culture piece”
Chula Vista’s Feaster Charter School administrators observed benefits right away when Campus Clinic screened all sixth- through eighth-graders for mental health issues in May.
According to school counsellor Karena Haro-Esparza, out of the 350 children, almost 40% were found to have some form of anxiety or depression.
According to her, Campus Clinic teams immediately began reaching out to families. She continued, “The cultural and trust piece” has presented issues even though it has been a big assistance.
“They have a lot of questions because they are not a regular part of our staff when Campus Clinic communicates with families,” Haro-Esparza said. “How do we further educate families to destigmatize and normalise the partnerships?” has been our struggle.
One of the reasons families or guardians don’t look for or use resources for kids is the stigma associated with mental health, particularly among persons of colour and those from diverse cultural backgrounds. The majority of mental health professionals who work in education concur that it’s critical to preserve trust between families, educators, and clinicians.
“It involves more than just spending money on services. In spite of the fact that the medical systems are located outside of communities, efforts are being made to connect them so that families will become familiar with and trusting of them, according to Gordon.
One tactic used by Campus Clinic clinicians is to move among classrooms and spend fifteen minutes talking with kids about health and wellbeing in order to build rapport and get to know them better.
According to Morgan, CEO of Wellness Together, the organisation invests in interns in order to diversify the workforce and foster dependable partnerships between mental health practitioners and communities.
Beginning his professional life as a school counsellor, Morgan said he has witnessed numerous individuals never obtain their licences due to their inability to accept free labour. It adds to the lack of diversity in the workforce in behavioural health, he claimed. The nonprofit now works with more than 30 Californian institutions to guarantee that interns receive benefits and a living salary. In the meanwhile, interns pursuing licences as licenced social workers, clinical and mental health counsellors, and licenced marital and family therapists are paid by Campus Clinic.
Morgan stated, “Finding staff and making sure the staff reflects the communities they’re serving is the biggest challenge.” “By compensating associates and interns, we now have the choice and chance to truly employ the best candidate.
