Increasing mental health access through school and community partnerships

In 2014, I shifted from working as a professional counselor in a mental health agency to working as a school counselor in the metro Atlanta area. I had experience working with adults and children who had emotional, behavioral and substance abuse disorders, so I thought that transitioning to the school system would provide a much-needed break and keep me from burning out.

I told myself, “This is going to be so much better because I’m going to have a regular schedule and lots of breaks. No more managing crises, being on call, treatment planning or dealing with severe problems.” But I was wrong. Although my role and job title changed, I was still seeing a lot of the same issues, especially self-harm, anxiety and depression.

In addition, working with middle school students requires a lot of energy, flexibility, patience and compassion. You are helping young people at a pivotal time in their personal, social and academic development. They are beginning to learn what is most important to them and create their identity. Combine that with peer pressure, hormones and more rigorous classes and your job as a school counselor seems never-ending.

The current challenges in schools

School counselors, much like teachers, were already suffering from high levels of burnout, fatigue and stress before the COVID-19 pandemic. And the last three years have only made the situation worse. At my school, more students are struggling with depression and anxiety and have less resiliency or grit. Many of our students’ families are also dealing with unemployment, homelessness and financial issues.

All these factors have the potential to affect students’ behavior, mental health and interactions with others. I have noticed an increase in the number of students who engage in self-harm as well as students presenting with suicidal ideations. My school district has a specific protocol for school counselors to follow if a student presents with suicidal ideation. This includes using the Columbia-Suicide Severity Rating Scale, communicating with parents and guardians, referring to crisis services and creating safety plans when students return to school. But this protocol only addresses part of the problem: the suicidal ideation and the need for a safety plan. It doesn’t address the presenting problems of depression or anxiety, nor does it help students develop coping skills to prevent future crises.

My school also administers a survey to students in the fall and spring each year to assess school climate, student resiliency, social-emotional learning and other topics. The survey results from the previous school year help guide social-emotional learning curriculum the following year. The survey data from 2020-2021 revealed that many students at my school lacked coping skills and grit, so the school system has taken several steps to help students with these issues, including weekly social-emotional learning lessons, wellness campaigns and an anonymous reporting system that allows parents and students to report students who are at risk (e.g., engaging in self-harm, experiencing child abuse, being bullied). 

The Georgia Apex program

My school district was chosen to participate in the Georgia Apex Program during the 2021-2022 school year. This state-wide program, which is funded by the Georgia Department of Behavioral Health and Developmental Disabilities, promotes collaboration between community mental health providers and schools to make mental health services accessible to students and their families.

The program’s goals include early detection of adolescent behavioral health needs, increased access to mental health services for children and youth, and coordination between mental health providers and local school districts. This is a wraparound (comprehensive) program that includes behavioral health assessments, psychiatric/nursing services, individual and family therapy (school-based and community), and community support services (e.g., case management).

My school district partnered with two local mental health agencies so that three schools, including mine, could have a school-based professional counselor onsite to help students who present with a variety of issues, including anxiety, depression, self-harm and suicidal ideation. Kasey Ross, a licensed professional counselor (LPC) who is employed by a mental health agency in north Georgia, is one of the two school-based therapists my school district hired. She works two days at the middle school, two days at the high school and one day at her mental health agency (with the option to come to the school that day if needed).

“When we can detect behavioral health needs early, we can help reduce admission to higher levels of care, reduce unexcused absences and reduce disciplinary actions as well,” Ross says. “Additionally, the program is available at schools, homes and other community places, which makes it flexible and convenient for many families.”

The Apex referral process

School counselors often have large caseloads and limited time to work with each student. This can make it difficult to help students with more severe issues. In addition, school counselors are seeing an increase in students who need mental health services.

This is where the Apex program comes in. The school counselor can gather more information about the student’s personal needs and can give the student and their parents/guardians information about the Apex program. With the parent’s/guardian’s permission, the school counselor can then refer a student to the Apex therapist who has partnered with the school. The referral includes student demographics, presenting problem(s), insurance information (if they have any) and contact information for the parent/guardian.

The program is primarily for students who have PeachCare (Georgia’s version of Medicaid); however, students who do not have insurance are also able to receive services for up to 60 days, and the Apex therapist helps to connect them with local resources to obtain insurance. The school counselor can also refer students who have private insurance, and the Apex therapist can also help connect them with providers who accept their insurance.

Having a school-based therapist in our building, who is accessible four days out of the week, has been a game changer. This program allows school counselors such as myself to help students who might not otherwise receive the care they need because of our high caseloads. Even if we were allowed to provide therapy to students, we simply don’t have the time because our work is solution-focused and brief. Now, after meeting with a student who is in crisis, I can refer them to the school-based therapist, which is often a huge relief for the student’s parents.

And the process is quick and easy. I can give the student the information packet for Apex and do the online referral while they are in my office. The school-based therapist typically reaches out within 24 hours to set up an intake appointment, where they will do a behavioral health assessment and then develop a treatment plan. The therapist discusses with the student and parent/guardian when they will provide therapy and how often, and because the therapist is connected to the school, they can access the student’s school schedule and arrange counseling sessions so they do not affect students’ academic performance. For example, I have several students who meet with our Apex therapist during their electives. In addition, the Apex therapist can also meet with students and families in the community, including at the library, at the therapist’s clinic or in the students’ homes.

The benefits of the program

The Apex program appealed to several parents of my middle school students because it made counseling accessible, convenient and affordable. The community-based mental health provider, Ross, was able to help these students in some way.

One student, for example, reported feelings of depression and anxiety because her parents were going through a divorce and her mother had been diagnosed with breast cancer. As her school counselor, I was able to meet with her and gather more information about how this had been affecting her at school and home. After meeting with the student, I called her parents to tell them about the Apex program and how it could benefit their daughter. They agreed and asked me to send the information home with her and to also go ahead and do the online referral.

The next day, Ross contacted the parents and scheduled a first session with the parents and the student for later in the week. I continued to check in with this student throughout the year, and she said that the counseling sessions had helped her to feel less depressed and anxious.

There are many advantages to the Apex program. According to Ross, “the benefits of school-based mental health services include increased access to mental health services, improved attendance and academic performance, increased engagement at school and a reduction in mental health stigma. In addition, there are typically fewer classroom disruptions, less disciplinary referrals, less course failures and a decrease in inpatient hospitalizations.”

Three schools in our district currently have an Apex therapist. Ross, the therapist working with my middle school and the connected high school, has a caseload of 32 students. Our district also plans to expand this to two elementary schools next year. Ross notes that her agency also provides Apex services to six other counties and has helped 294 students so far. “We are growing and will be able to help even more students and their families next year,” Ross says.

I hope that the funding for this program (and others like it) will continue because it has made a positive impact on the climate at my school and the lives of my students.

 

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Related reading: See Counseling Today‘s August cover story (in which Holt is quoted), “Responding to the youth mental health crisis in schools.”

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Jessica Holt is a licensed professional counselor and has been working as a counselor since 2010. She is starting her ninth year as a school counselor. She primarily works with middle and high school students to help them meet their academic, social and emotional needs.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.