Utah takes a collaborative approach to school mental health
Usually, Dr. Jenna McGinnis’ workday involves supervising master’s level and doctoral students training to be school mental health professionals as part of the Utah School Mental Health Collaborative’s well-being team.
Most days, McGinnis observes and gives feedback to well-being team members. They work with elementary and middle school students and staff to deliver counseling tailored to each school’s needs and culture.
But today is different. Along with supervision, she also pitches in to lead a few therapy sessions because the caseload at this school is growing. And just as she’s about to leave for the day, a staff member flags her down. A student is distraught and needs help right away.
“It was basically drop-in therapy,” McGinnis says. “To just be able to be like, ‘Yep, I’m here, I'm listening,’ and things like that.”
McGinnis, a post-doctoral fellow and psychology resident in the University of Utah’s department of educational psychology, treats the impromptu session like it’s no big deal. But this kind of support and flexibility is what sets the collaborative apart: Meeting young people with mental health care where and when they need it.
The Utah School Mental Health Collaborative is a statewide initiative formed with funding from Regence’s parent company and the Huntsman Mental Health Institute. It provides technical assistance and training to Utah schools on how to apply evidence-based, comprehensive school mental health practices.
The collaborative has a big goal: Transforming how youth mental health services are delivered and sustained in the state. “We go in unassuming to a school and ask them what they need,” McGinnis says. Then the collaborative finds a way to provide those services.
Dr. Aaron Fischer, a professor of school psychology and psychiatry at the university, is the collaborative’s co-founder and director of the University of Utah’s Technology in Training Education and Consultation Lab (U-TTEC). He says the program is making inroads because it works on multiple fronts, offering layers of support to reach schools and communities in new ways. This includes:
- Placing well-being teams in schools to give direct support based on what each school needs most.
- Training a new generation of youth mental health providers.
- Gathering data on students’ well-being (with parents’ consent) so schools can plan their services accordingly.
- Consulting with educators and health care providers statewide to solve problems together.
- Using technology to connect with partners in rural areas with limited services.
Fischer’s team started with a few schools nearby in Salt Lake City but soon recognized the potential for much more. “Seeing the success that we had locally, we started to reach out to schools across the state to gauge that interest,” he says.
“We wanted to see what would happen if we extended this to 10 schools. What would happen if we invited everyone across the state interested in mental health in schools? And what would happen if we could get all those folks together and actually transform the system?”
Flexible, effective use of resources
The collaborative’s school programs use a framework known in education as multi-tiered systems of support. It’s traditionally used to find and help students with mental health, academic and behavioral support early on.
Fischer says this type of intervention can also have a big impact when used for mental health. “The reason for that is because it creates more efficiency with the resources that are available. We’re still working in a system that's under understaffed and that's under-resourced.”
Here’s how the collaborative applies the framework in schools:
- Tier One addresses student well-being widely, through gatherings like assemblies or open lunch groups where young people can connect with a caring adult.
- Tier Two focuses on students identified as at risk for mental health concerns. They get small-group support for whatever they’re going through — grief, anxiety, depression, emotional regulation or other issues.
- Tier Three is individual therapy for students with higher needs who would benefit from one-on-one support from school or community providers.
Along with school-based services, the collaborative brings together mental health leaders virtually for monthly conversations to help improve access to resources statewide.
“Utah already has great mental health leaders,” says Dr. Chathuri Illapperuma-Wood, the collaborative’s implementation coordinator and coordinator of research and programs at U-TTEC Lab. “They have unique skills and plenty of resources; some lead their own efforts. But there needed to be a way to link everyone's initiatives and agendas. That way, we aren’t replicating the work or working in silos. Through the collaborative, we connect everyone in the state working toward bettering the mental health for our children. It takes a village to do this work.”
Several years in, they’re seeing results. The monthly meetings that had 15 to 20 participants at the start have more than doubled, with attendees from all over the state. The USMHC started by serving three or four schools. It’s now working with more than 10 in urban and rural Utah, with more to come.
Creative solutions to urgent needs
The USMHC’s work is unfolding at a time when concern about young people’s emotional state has been growing for years. The statistics are making headlines, both nationally and in Utah:
- A 2021 U.S. Surgeon General's report found that even before COVID-19 disrupted their lives, “mental health challenges were the leading cause of disability and poor life outcomes in young people.”
- A 2022 CDC study found that almost 4 in 10 high schoolers self-identified as having poor mental health during the pandemic. A similar number said they persistently felt hopeless or sad over the past year.
- Research by the American Psychological Association found that about half of Gen Z teens felt that COVID-19 severely disrupted their plans for the future. About half also reported that it made planning for their future feel impossible. Summarizing its findings, the APA notes: “We are facing a national mental health crisis that could yield serious health and social consequences for years to come.”
- In Utah, the numbers are striking. Its suicide rate is nearly twice the national rate — and especially high for young people. Self-harm is the leading cause of death for ages 10 to 17, while kids as young as 9 have expressed thoughts of depression and suicide.
“It’s a humanitarian crisis at this point,” says Dr. Michael Franz, senior behavioral health director for Regence, whose parent company supports the USMHC’s work. “We don’t have anywhere near the adequate behavioral health resources for our youth. Especially in the right places or with the right cultural competencies to meet the demand.”
Franz says that one way to address the crisis is by integrating behavioral health into new settings. That’s one reason Regence’s parent company recently donated $1 million to the University of Utah’s mental health outreach programs, including the USMHC.
Understanding needs to tailor care
In a state as sprawling and rural as Utah, it can be hard to find children’s therapists outside of the big cities — and tough to get in with a counselor even in urban communities.
“Why would we consider looking at schools to help address this behavioral health crisis? It’s where the kids are,” Franz says.
He adds that what makes the USMHC remarkable is not just that it offers school-based support: “It really hits the mark because they’re taking this a step further and integrating with the rest of the community — primary care, specialty behavioral health, hospitals, all various types of behavioral professionals — to really get kids and families connected to care when it needs to go beyond what can be offered at school. It’s an amazing program. I hope we can replicate it in other settings and in other states.”
The collaborative is able to understand different schools’ mental health needs by conducting regular mental health screenings. With parents’ permission, three times a year the school’s well-being team coordinates the administration of a brief screener called the Student Subjective Wellbeing Questionnaire. It gives the team a snapshot of students’ sense of joy, connectedness, belonging and academic performance.
The USMHC hopes to make the screening tool universal to all its sites. For now, they’re taking it one step at a time to work around the silence or stigma that sometimes comes with talking about emotional health.
The message they want families to hear is that “mental health or well-being screening is similar to those done for vision, hearing and reading ,” Illapperuma-Wood says. “Typically, screenings are advantageous — they help identify risks and detect early warning signs. Mental health screenings are no different in their use, but there is so much stigma tied to the idea of them. This prevents us from reaching children in need of support.”
If a school isn’t ready to screen all students— perhaps because of challenges obtaining caregiver consent or lack of resources or personnel to implement screening procedures — schools can always start small by screening a single class or grade at a time.
Any data they can gather will help them better serve the school population, McGinnis and Illapperuma-Wood say. It allows them to identify students who may be experiencing mental health and well-being challenges and triage them for services in a timely way.
In order to support schools’ mental health needs effectively, it’s critical to understand that their needs aren’t one-size-fits-all, says Trevor Olsen. He’s director of student services for San Juan County Schools, a USMHC partner district that includes a dozen schools in Southeast Utah and serves members of the Navajo and Ute Mountain tribes.
San Juan County students’ needs vary. The district sprawls across nearly 8,000 miles, encompassing Canyonlands National Park, the La Sal and Blue Mountain ranges and the Four Corners area bordering Colorado, New Mexico and Arizona. San Juan is Utah’s largest county by area, but fewer than 5,000 families live there. Some have little or no electricity and running water, while others are in villages or small towns with access to municipal services.
“The partnership has been really valuable because each school is different for us,” Olsen says. “We’ve tried to meet each of the school’s needs by being able to screen students and get the right level of care for each one.”
The pandemic hit San Juan County’s indigenous communities hard, too. Students returned from isolation carrying more grief and loss than the schools could address on their own, Olsen says. Working with the collaborative and community partners, some schools were able to go from almost no mental health counseling to 40 to 80 hours a week.
“Those additional counseling hours have lifted a lot of the burden from our staff, who in these remote areas have been isolated or alone prior to having the collaborative support,” he says.
The district also works with the USMHC to bring individual counseling to remote areas using telehealth. These video visits can serve young people in Navajo and Ute Mountain communities that wouldn’t have access to counseling services otherwise.
As it builds partnerships in these communities, the collaborative’s members aim to respect each location’s cultural norms and work within its traditions. “One of the trickiest things we find when working with communities, is the language around mental health,” says Grecia Corona, USMHC’s marketing and communications coordinator. “Language may be used or interpreted differently depending on culture, so communicating about mental health is going to look different in every community.”
For instance, urban and suburban Salt Lake City school communities may be open to talking about suicide directly, she says. Schools in San Juan County handle the topic differently. School counselors and social workers avoid the word “suicide” because it’s seen as inviting negative energy into their community. Instead, they offer help and address the concept in a way that is consistent with traditional Navajo culture.
The collaborative has also bridged some gaps by introducing families to the program via the school district’s community liaisons, who already visit homes. The liaisons are familiar messengers who can explain the school’s mental health services in culturally appropriate ways.
As San Juan County schools and collaborative members have learned from each other, they’ve gone a step further, too. “We developed a system where students have multiple options, including traditional Navajo consultation,” Olsen says. “It’s considered therapy, but it’s a traditional Navajo way of doing counseling where there’s storytelling and concepts that help students learn from ancestors in order to make improvements to their life.”
If students don’t want traditional consultation, they can get counseling that uses techniques drawn from Western European culture — whichever option feels right for them. “We’ve tried to value it all and bring all of it together,” he says. “That’s where our success has really come from.”
Another way the collaborative is making inroads is by giving young people the opportunity to share their own perspectives on mental health. This spring, Corona and her colleagues started a student well-being ambassador program. Every month, student ambassadors come together as a team to learn about mental health topics. They then develop content to share through school-approved social media accounts in their own communities. They get a stipend for being part of the program, and work with a local USMHC mentor to create an end-of-year video about their experience.
“We have junior high and high school kids really showing their voices,” Corona says. “They can talk about mental health online to their own communities, using a platform that is available for most students their age.”
Training to support transformation
When Utah mental health advocates talk about a lack of resources, they don’t just mean funding for counseling services. They also mean there’s a lack of mental health professionals to serve the state. Plus, it takes a particular skill set to work with young people.
In a recent report on the state of mental health in America, the nonprofit Mental Health America identified Utah as a state with a higher frequency of youth mental illness and less access to care.
The collaborative is helping close care gaps by integrating its graduate clinicians into school well-being teams. More than four dozen grad students support the U-TTEC lab, Fischer says. Some provide telehealth counseling, while others go into schools to offer multi-tiered systems of support.
Providing mental health care in high-need areas can be tough, Fischer adds, and many caregivers experience burnout or fatigue. That’s why the collaborative makes sure that as its students work toward their master’s and doctoral degrees, they also get lessons in how to be resilient.
“We are super intentional about it,” he says. “We can train all the people we want, but if they burn out, it doesn’t matter. We have to figure out ways that they can find value and sustainability in themselves, too.”
Grad students on the school well-being teams get practical experience within their first year, and supervisors like McGinnis help them work through challenges or re-set expectations.
“It’s hard to do the work that we strive to do alone,” she says. “It’s heavy, it’s difficult, and you’re never going to have all the answers. Being willing to connect with your team, whether that’s at school, in the collaborative, or with your other peers is important.”
When she goes on supervision visits, McGinnis also reminds grad students that providing mental health care in schools requires flexibility in their approach. An individual or group therapy session may not unfold as anticipated — and that’s OK.
“When you’re learning about therapy, you have all these ideas of how it should go,” she says. “But having the openness to be involved and meet people where they’re at is important. If you meet with them and end up playing tic tac toe for 30 minutes and asking them four questions, that might be good enough, because you haven’t done that with them before. It’s a work in progress.”
Building for the future
As the collaborative gains momentum, its leaders are planning for the future. That means finding ways to make this kind of school-based support last — and to expand its reach.
“More and more schools are saying, ‘We want to participate. How can we get going with the system-level support, how can we get the individual services?’ ” Fischer says. “There are so many people who are asking for it, and so much potential.”
With interest growing, the USMHC has taken a wide-ranging approach to make sure its work has the resources needed to get the job done.
As she looks over the group’s five-year strategic plan, Illapperuma-Wood ticks off the avenues available to reach their goals:
- Working with the state Legislature to ask for funding.
- Supporting more schools with mental health technical assistance and training.
- Increasing collaboration between schools and community mental health organizations.
- Addressing the school mental health workforce shortage in Utah.
“One of the main goals is to make sure that the collaborative is accessible to all schools in Utah,” Illapperuma-Wood says. “That’s where we want to go.” Down the line, she and Fischer imagine the collaborative growing into a one-stop shop: A hub for Utah schools and community partners to access any type of mental health supports they need, a place to hold annual conferences and to host its education and training programs.
For places like San Juan County, finding the money to sustain its school mental health programs is essential, Olsen says. Federal funding for school-based mental health is winding down as the United States comes out of the COVID-19 pandemic. With that in mind, the district and the collaborative are looking for ways to find or re-allocate funding to maintain mental health care for students.
And that goes back to the data the USMHC has collected with San Juan County schools, Olsen says. “It’s valuable for sustainability, because if we're doing it right, we know exactly what we need. Then we have to utilize resources from wherever possible, because it’s expensive to provide those services.”
Whether the money will come from the state, county, foundations or grants, finding it is a priority for educators like Olsen, who now see the USMHC as transformational for their communities.
There was a time when the district’s staff was so overworked and overwhelmed that he couldn’t see them surviving. Today it’s getting better, he says. “All of our mental health agencies are growing and developing with the help of this collaborative.”
Asked what it would be like to return to a time without USMHC’s partnership, Olsen pauses to reflect.
“I don't think I can see us without it, really.”
Jillian Cohan Martin is a journalist and content strategist based in Portland, Oregon