School-based Mental Health Counseling

Relationship building involves leveraging existing connections and relationships with mental health clinics and school administrators in the community and building new networks to develop the plans and processes for SBMH counseling. Due to the complexity of the strategy, articulating the need for constant communication and partner engagement early on is vital.

To start the process of implementing SBMH counseling, beginning with the development of standard practices and procedures is integral. These include Memorandums of Understanding (MOU) between mental health counseling agencies and school districts, standardizing agreements between mental health clinics to formalize their partnerships, and building an Onboarding manual/FAQ to assist in the on-boarding of new members. The manual outlines the program background, how the SBMH counseling process works, relevant data, and lessons learned. It is also helpful when introducing new partners to the work and sharing the model with other communities looking to adapt the process to their local conditions.

Marathon County MOA (PDF)
DPI MOU Template (PDF)
Clinic Agreement (PDF)

Utilize individual school or district YRBS data to showcase where mental health currently stands in your community as a basepoint to determine action steps that make sense for your region and drive the strategy forward. This is crucial to making the current condition of what life is like for teens visible and accessible to the public. Collecting data consistently over time will also provide benchmarks and trend analysis so the community can determine whether the strategy effectively improve outcomes among youth in your region.

Note: MCS-BCC uses an online data platform (Marathon County Pulse) to showcase youth mental health data through a polished impact report, making clear how SBMH counseling improves the lives of students in the community with over 1,200 printed reports distributed.

2017 Marathon County YRBS Middle School Report (PDF)
2017 Marathon County YRBS High School Report (PDF)
Marathon County Pulse YRBS Data Dashboard

Work with school administration to designate a space used for mental health therapy services on specific days the counselor is on-site. The space should abide by the standards listed in the School Space Requirements handout.

School Space Requirements (PDF)

Before SBMH counseling is implemented, consider how to collect data on student outcomes for those participating in SBMH counseling. The Client Satisfaction and Wellness Survey is a simple, anonymous online survey allowing you to collect data on demographic information, grade level, school district, mental health clinic, as well as a variety of qualitative responses to questions on the impact of counseling on the student’s mental health. In planning this survey, consider the fact that this information will be shared, and therefore, should be noted when students and parents sign off for a proper release of information.

The questions tracked by MCS-BCC may not be the same you want to track; however, their template provides a starting point.

Client Satisfaction & Wellness Survey K-5th (PDF)
Client Satisfaction & Wellness Survey 6th-12th (PDF)

During the summer months, organize meetings between local clinics who will be providing counseling integral to a county-based initiative to determine which counselors will go to which schools and when. This allows the clinics to present school districts with a coordination plan that works for them based on availability, capacity, and specializations that would provide the most benefit for individual schools.

At the start of the school year, organize a series of meetings between the clinics and the school district to discuss the plan for the year, including where space for therapy is located, what the clinic’s availability and capacity is, communication methods, and general best practices to make the process simpler for both parties. The meeting should include the clinic director, a school principal, school counselor, and any other staff official the school administration deems important to attend.

To aid in spreading awareness about SBMH counseling, consider developing a social media plan and producing marketing materials, like posters, brochures, and handouts on the benefits of counseling. Additionally, work with schools to update their websites to include template language on how to get a referral and listing therapist schedules.

Tip: Having mental health therapists present at open-houses, back to school nights, and parent-teacher conferences are also great ways to spread awareness about SBMH counseling to parents.

The Client Satisfaction and Wellness Survey should be administered yearly by the mental health therapist or an identified school administrator in order to collect data from students in counseling. This allows for identification of strengths and gaps in service, populations disproportionately impacted by mental health challenges, monitoring implementation progress, and evaluation of the strategy’s effectiveness. Links to the survey should be shared with both the therapist and school administrator to disseminate to their students.

Client Satisfaction & Wellness Survey K-5th (PDF)
Client Satisfaction & Wellness Survey 6th-12th (PDF)

When asked about SBMH counseling, one student responded:
“It just helped to have someone else to talk to. It made me feel like someone cares about me. No one talks to me at home, so I only get to talk to people at school.”

“It is nice that it is at school, so transportation was made easier for me. She really listened to everything I was feeling and talking about it is also a great resource when I’m feeling overwhelmed with anything.”

“I like counseling. It’ nice to be able to express reasons for my anxiety. It’s helped me to learn coping skills. My anxiety has gone way down since I started therapy.”

In order to showcase the progress mental health therapy has made, data from the client satisfaction and wellness surveys should be aggregated - both by school and by district - and formatted into a digestible report. These reports should be discussed and disseminated annually and be made available upon request to the identified school administrator.

Impact of School-Based Counseling in Marathon County 2017-2018 (PDF)
Improving Youth Mental Health in Marathon County 2017-2022 (PDF)

To further embed therapists into the schools and reduce stigma, clinics, school districts, and community organizations should work together to hold therapist-led educational opportunities, trainings, and networking events with school staff and parents. This allows clinics to diversify their opportunities to receive reimbursement and further increase their visibility within the district.

Note: MCS-BCC participated in and coordinated over 120 educational opportunities, trainings, and certifications on the subjects of trauma-sensitive schools, mindfulness, psychological first-aid, self-care for staff, and trauma coping.

Parental involvement and consent for SBMH counseling services is necessary to ensure appropriate and ethical delivery of mental health services. Mental health stigma, perceived risk of information being shared with school staff, and other personal beliefs may give parents hesitation when providing consent. Therefore, education about the benefits of these services within schools should be communicated to parents early and often. In some cases, parents are simply not present or responsive to signing consent forms. A Mental Health Navigator and/or School Social Worker within school districts can serve as the liaison between students, families, and the clinics, creating a system of communication for parents to make a truly informed decision and ensuring information stays confidential from those otherwise not involved.

Uninsured or underinsured students and their families may face financial barriers to receiving mental health therapy. Additionally, high deductible insurance plans and co-pays provide similar barriers that force families to choose whether to pay for their child to receive mental health therapy. Additional grant funding may be needed to cover direct therapy services for students who are uninsured or families with high deductible insurance plans.

Every school district operates with different levels of funding, different levels of administrative capacity, and with different student needs overall. Moreover, the clinics serving each district may differ from one another, making some partnerships “hyper local,” and requiring individual details and procedures to be discussed, agreed upon, and implemented by the school-clinic team. To address the additional nuances in each district’s needs, communication with each must be conducted individually, meaning separate agreements should be made with each district and standard procedures should be understood and practiced with each. You should also rely on the school district itself to be adaptable and to take responsibility of the referral pathways in their schools.

A primary challenge in the facilitation of SBMH counseling is that counselors are typically only paid for the time spent conducting counseling sessions; not for transportation (which is especially difficult for counselors going from metros to rural areas), meetings, or even when patients don’t show up. To address this issue, the inclusion of a School Social Worker who actively communicates and coordinates between the school and clinics is instrumental in ensuring that time is not being wasted and counselors are being paid fairly. Obtaining additional funding through local foundations, DPI or United Way grants is often needed to cover non-billable services, such as transportation, consultation, and presentation time.

Often, schools are utilizing all of the space they have in the building for classrooms. Consider what options you have to ensure there are safe, private and confidential spaces (no windows) for therapists to conduct counseling. One option includes converting school social worker offices into counseling spaces or even building out additional space on the school building specific for mental health spaces/therapy rooms.

School Space Requirements (PDF)

Communication gaps between overburdened clinic directors and school pupil service teams are leading to empty schedules and lower salaries for therapists, which is threatening the viability of school-based mental health therapy services for schools moving forward. It is getting increasingly difficult for clinics to commit to SBMH counseling.

Across the nation, there is a shortage of mental health providers. Paired with the lack of consistent billable time, providers are unmotivated to pursue an in-school practice, especially if their financing is not always guaranteed. To remedy this issue, districts work to embed the School Social Worker and/or Mental Health Navigator into the school system, allowing them to coordinate better between therapists and the schools, letting them know when field trips are scheduled or when students are sick, so they avoid wasting billable time.

In the event of a situation where in-person counseling is not available, schools and mental health clinics may need to quickly adapt from an in-person to virtual setting. Telemental health, however, is complicated. It requires coordination on behalf of the school district to ensure confidentiality. Moreover, the appropriateness of offering pediatric telemental health services is up to the licensed therapist, as these sessions do pose some risk to students who don’t feel supported or safe during or after their session. Having a school staff support person available before, during, and after a telemental health session is critical to ensuring student safety.

In order the refine the process and procedures of implementing school-based counseling into a school or district, consider starting small and monitoring the impact before scaling up.

Through YRBS and Client Satisfaction and Wellness surveys, key data about students and their experiences with onsite mental health counseling services can be reported, allowing the consortium to disseminate their findings locally, state-wide and nationally, thus increasing awareness for youth mental health.

Developing and maintaining trusting relationships between for-profit, non-profit, and not-for-profit mental health clinics, as well as school districts, community organizations, and local leaders around a common agenda of improving behavioral health for youth in the area fosters further embedding of mental health therapists in the schools and communities they serve.

Having a Mental Health Navigator is an evidence-based best practice strategy to improve student and student mental health outcomes. A Mental Health Navigator is a school staff position that coordinates the integration of student and staff mental health and wellness into existing school systems and structures. The Mental Health Navigator facilitates various school mental health meetings; coordinates mental health development trainings for staff; and oversees the operations of the overall comprehensive school mental health system.

A School Social Worker is a position with a direct service role, whose responsibilities are to coordinate with mental health therapists to communicate schedules; make connections between students, families, and clinics; coordinate SBMH services; connect families to resources; and conduct community outreach. Mental health clinics working directly with the School Social Worker to determine referral and intake processes will lead to better coordination for SBMH counseling.

School-Clinic teams foster direct collaboration between clinics and the schools they serve. School representatives may include pupil/student services, school psychologist, School Social Worker, Mental Health Navigator, superintendent, principal, and school counselors. The Clinic representatives may include the clinic director, behavioral health services director, coordinator of school counseling, manager, therapist/licensed professional counselor, and licensed clinical social worker.

Working with school districts to support student-led advocacy and awareness mental health clubs fosters the building of strong universal supports, enabling students to succeed, develop leadership skills, become mental health advocates, expand awareness, and reduce stigma.

Note: Wausau East and West High Schools partner with a local mental health organization to support the student-led advocacy and awareness club, Raise Your Voice. The club is dedicated to increasing mental illness awareness, inspiring advocacy, and promoting acceptance.

Aligning with the Comprehensive School Mental Health Framework will bring the best outcomes for schools in their efforts to embed therapists into their institutions as they seek to improve mental and behavioral health.

SMH Framework with MC Examples (PDF)
Wisconsin School Mental Health Framework (PDF)

• Computer software
• Professional training for staff, parents, and community partners
• Room reservations for community events

• School/Clinic Collaboration Coordination: 40-70 hours/week total