Breaking down the Blueprint: The challenges school districts face in meeting students’ behavioral health needs

Lori Morrow says for the Blueprint for Maryland’s Future education reform plan to work effectively, schools must ensure students receive the mental health services they need.

Morrow, the mother of two children and education advocate from Prince George’s County, said school-based health centers should be created and staffed with mental health professionals accessible for students and their families, especially in rural and underserved communities.

“We want kids to be in school. It’s a lot easier to be in school when you’re healthy,” said Morrow, who served her last day Friday as a member of the state Board of Education. “COVID has taken a toll on everybody. We need to have the right mental health…support so that our teachers can focus on education and teaching curriculum.”

As part of the Blueprint process, education officials in all of Maryland’s 24 school systems must outline how they will fulfill the plan’s fourth “pillar,” or priority: how they will provide resources for all students to be successful.

Some of the Blueprint requirements include additional per pupil funding for special education students and English language learners, awarding personnel grants for schools with at least 55% of students on free and reduced lunch, and requiring school systems to provide annual training for staff to recognize mental health and behavioral issues in students.

The legislature approved House Bill 770 this, year which includes allowing a school counselor to join the state’s Consortium on Coordinated Community Supports, a group established as part of the Blueprint law with one of its main goals to expand access to behavioral and wraparound services for students and their families.

Mental and behavioral health have been major topics not only in Maryland but nationwide.

U.S Surgeon General Vivek Murthy issued an advisory last month about how social media “can also have a profound risk of harm to the mental health and well-being of children and adolescents.”

Liz Zogby, co-lead with the Maryland Down Syndrome Advocacy Coalition, wants to make sure children with intellectual and developmental disabilities aren’t forgotten in the Blueprint plan.

“There’s a lot of attention and detail that’s been focused on racial diversity and socioeconomic diversity, and absolutely rightly so. We have to make sure that that focus on equity also includes kids with disabilities,” she said. “They’re a critical piece for our schools.”

In the meantime, the Blueprint’s Accountability and Implementation Board could start approving local school system’s plans to provide mental health services beginning on July 20.

Each document, first submitted in March, must include work school officials conducted, completed and will continue to implement through the 2023-24 school year. Besides resources for students, the other main priorities include providing early childhood education, hiring and retaining high-quality and diverse teachers and preparing students for college and technical careers.

In their initial reports, local officials responded to several questions and statements about student resources with a focus on health.

To provide insight into how school districts are planning to support student behavioral health, we have gathered responses to one of the section’s questions: “Discuss the challenges that exist in meeting students’ behavioral health needs and how the [local education agency] overcomes these challenges. Include strategies related to funding, specialized staff, community partnerships, etc.”

Below are all or part of the responses from the school districts.

Allegany – “ACPS has recognized the major challenge of providing immediate direct services to students who need mental health counseling. In our rural district, community providers are limited and overwhelmed with few providers offering pediatric services. To help overcome this, over the last three years, ACPS has strategically increased our in-house capacity to deliver services while strengthening our community partnerships.

Increased school-based staffing:

• Additional staffing in 2022-2023 through a combination of Concentration of Poverty,

CARES, and local funding: A licensed was addictions counselor added to the RESTART/alternative

Program; reduced ratio of mental health specialists one for every two schools; additional elementary behavior specialist.

• Multiple mental health Board approved supervisors able to increase oversight and clinical skill development.

• Two behavior specialists are working towards becoming Board Certified Behavior Analysts.

• Deeper collaboration/partnership with Health Department counselors post-COVID.
• Partnering with the Maryland School Mental Health Response Program for training, program enhancement, needs assessment, and professional development.”

Programs Purchased:

• Second Step: SEL K-8 including bullying prevention facilitated by school counselors.
• Ripple Effects: facilitated through the RESTART program and behavior specialists for Tier II/III students.”

Anne Arundel – “The stigma around mental health remains a challenge in Anne Arundel County. Many families feel ashamed to admit their child may need behavioral health support. This can lead to students being afraid to talk about their mental health struggles at home and leading them into further despair. For that reason, AACPS has collaborated with community partners on initiatives designed to overcome the stigma around mental health. These programs include:

• The Sound of Silence is a school assembly and community program by the Northern Lights Against Substance Use. The program discusses mental health and substance abuse and how they are tied together. There are members of child and family serving agencies throughout Anne Arundel County on the panel answering questions for students and families.
• AACPS also has a club called Student Alliance for Flourishing, a partnership between AACPS and Notre Dame University of Maryland. This club thrives at five high schools and three middle schools and focuses on teaching students to flourish mentally and physically. It reduces stigma by teaching students how to succeed in school, community and globally.”

Baltimore City – “City Schools has continued to strengthen its behavioral health supports for students, including the allocation of at least one social worker in each traditional school and the development of coordinated Student Wellness Support Teams (SWST) at the school level. The greatest challenge City Schools currently faces in meeting students’ behavioral health needs is the shortage of providers – social workers, school psychologists, school nurses, school counselors, and other related services providers. City Schools is currently addressing this challenge through external partnerships with local and state organizations, and we are intentionally creating internal partnerships through our Student Wellness support Teams to maximize the collaboration and impact of the related services staff in each school. Related services staff, specifically social workers and school psychologists, are integral members of the SWST which works to proactively meet schools’ overall climate and culture needs. The formation of the SWST has increased the collaboration among its members; specifically, those staff who support behavioral health. As a part of SWST, social workers lead the completion of the school wellness needs assessments in the beginning of the year. This data assists in providing support that is targeted and reflective of the individual schools’ needs.”

Baltimore County – “Supporting Students’ Behavioral Health by identifying challenges and appropriate strategies to address challenges has continued to be prioritized in BCPS. The growth of access to resources, including school counselors, psychologists and social workers has continued to expand with increased staffing as well as increased community partnerships with community mental health providers, mental health organizations and the local department of behavioral health. The focus on student behavioral health has forged community collaboration resulting in the Mental Health Advisory Council.

The BCPS Mental Health Advisory Council (MHAC) that is representative of all stakeholders, identified various challenges with specificity around awareness and access to the tiered system of supports that includes access points to mental health supports for students across schools, the measurement of success of the interventions in each tier, understanding the gaps in services, equitable and accessible supports and services, and what determinants inform professional learning.”

Calvert – “CCPS is experiencing a shortage of mental health professionals due to the national shortage.There are not enough school psychologists and school social workers in our schools. In addition, our county health department school-based therapists are not fully staffed in our schools. The Calvert County Health department continues to attempt to recruit more staff to better support our schools. Strategies to overcome these challenges are to provide increased salaries, reimbursement for license renewal, and funding for attendance at professional development. Currently we require social workers to have their Licensed Clinical Social Worker (LCSW-C) but we are considering changing this requirement to a Licensed Master Social Worker (LMSW) in order to be able to pull from a bigger pool of applicants. We will have some discussions of whether an Licensed Clinical Professional Counselor (LCPC) should be considered as an applicant. School Psychologists with Nationally Certified School Psychologist certification receive an annual salary adjustment of $2,500 [and] social workers with LCSW-C certification receive an annual salary adjustment of $2,500, provided certification [for both are] in good standing.”

Caroline – “The challenges we experience in meeting students’ behavioral health needs include:

• School-based behavioral health (SBBH) needs/referrals outweigh the capacity of CCPS
• Difficulties in recruiting and hiring qualified behavioral health therapists for school and
• Difficulties connecting students to behavioral health services due to lack of parent involvement and follow-through, parent/child refusal, transportation and other barriers.
• Caroline County is a resource-poor area for standard and specialized behavioral health services.
• The need for contracted SBBH providers to increase their presence and become more infused into school buildings/routines/meetings and culture.”

and contracted providers to respond and ensure a timely connection to services. There are currently waitlists at 5 of the 9 CCPS Schools. CCPS has seen an increase in total SBBH referrals from 286 for the 20/21 school year, to 434 for the 21/22 school year, and referrals are currently on track to exceed those numbers this year as well. There have also been waitlists in many community-based provider offices in the area as well, some reaching up to 6 months.

community-based providers result in waitlists for some SBBH, and difficulty connecting waitlisted students with alternative community-based services.

Carroll – “The behavioral health needs of our students are rising with the need for social, emotional, and

behavioral supports increasing in frequency, duration, and intensity across all grade levels. Due to limited resources within CCPS, MOUs have been established with Advanced Behavioral Health (ABH) and Life Renewal Services (LRS) to provide therapy to students at school with Medical Assistance (MA). Although the MOUs enable these agencies to serve all schools in the county, those agencies do not have enough therapists to fully cover the needs in all schools. As of 11/28/22, there were five schools that did not have one or both agencies supporting students with MA at school during the school day. There is a significant need for families who are insured or under-insured to receive behavioral health services, but there are long wait lists and CCPS currently does not permit our partner agencies to serve students without MA at school. To address this significant need, CCPS has developed several contracts to provide services outside of school.”

Cecil – “Challenges include:

• Lack of trained mental health providers.
• Volume of student behavioral health needs.

1. Family substance use/abuse that impacts student behavioral health, physical health.
2. Caregiver ability to understand their child’s behavior health needs and how to find resources.
3. Poverty
4. Neglect
5. Pandemic related issues [such as] Families navigating their work lives at home, while children are also home; lack of socialization with peers and adults; loss of loved ones; loss of income.

• Funding to hire staff to meet the needs of students.
• Discipline first” in schools to get things settled and instruction-ready; schools dealing with immediate crisis can make it difficult to meet behavioral health needs.
• Lack of school staff understanding/awareness of student behavior/mental health.

Strategies to overcome these challenges:

• Professional development to increase school staff understanding of behavioral health needs and how to address them within the school setting.
• Additional staff (School Mental Health Professionals) who are licensed social workers who support the social and emotional needs of students in schools with high concentrations of poverty; they also provide professional development and support when specific needs arise in any school.”

Charles – “Post pandemic, CCPS, like many of our other Maryland systems, is struggling to meet the myriad social-emotional needs of our returning to in-person learning students. CCPS has seen an increase in severe behavioral incidents, threat assessments, and referrals for mental health services. We are currently using multiple funding sources to increase mental health staffing and put programs in place to address these needs.

Staff strategies include the following:

• SY22-23 Grant from Charles County Department of Health to fund two Mental Health Clinician
• SY22-23 Three Behavioral Support Teacher positions created to assist with rising behavioral concerns with K-2 students.
• SY 22-23 regionalized sites staffed with a teacher and IA to work with referred K-2 students presenting significant behavioral challenges.
• SY21-22 Four and a half school counselor positions added to general budget.
• On-going agreement with community mental health agency to provide mental health services in all schools. Between 12-16 contractor mental clinicians receive referrals from schools to provide intensive mental health services to students in K-12 grade.”

Dorchester – “Challenge: Schools following different procedures relative to tiered behavioral supports. Solution: District Social Emotional Learning (SEL) Leadership Team will develop a framework for the consistent implementation of the following supports: PBIS, Conscious Discipline and Zones of Regulation across Tiers 1, 2 and 3. This framework will accompany the existing DCPS Behavior MTSS Flip Book (linked artifact). DCPS is committed to a districtwide approach to address common social emotional and behavioral mental health through preventative instruction, support, reinforcement of self-management and replacement behaviors, and restorative practices to address the trauma and root causes of behavior.”

Frederick – “The behavioral health needs of our students currently exceed staff capacity in both volume and intensity across school levels. We continue to prioritize behavioral health positions in the FCPS operating budget to address these increasing needs. Additionally, we have enhanced community partnerships to provide in-school therapeutic support for students, doubling the number of providers authorized to access students in school during the school day. One focus continues to be the utilization of FCPS trauma therapists to provide support for students with significant exposure to Adverse Childhood Experiences (ACES). Alternative educational opportunities have been expanded or enhanced for students at all school levels. At the elementary level, the Delta program has been expanded to five regional sites serving a total of 16 schools. Delta supports students in K-2 who are not responding to building level behavior interventions and are struggling to demonstrate age-expected social regulation. Other enhancements at the elementary level include music and animal-assisted therapy. Examples of secondary enhancements include leadership development, therapeutic supports, professional learning, trauma informed care, service-learning opportunities, and positive behavioral support initiatives.”

Garrett – “GCPS faces the following challenges in implementing Behavioral Health Services:

• GCPS has twelve schools spread out over the largest county in Maryland along with one of the smallest student populations which is declining. These factors play a huge factor in providing the behavioral supports and specialized staff to meet the students and families growing needs.
• Limited behavioral support staff: Not every school has a School Social Worker, School Psychologist, Behavior Coach or Board Certified Behavior Analyst (BCBA). We have four Social Workers, two School Psychologists, four Behavior Coaches and two BCBAs to serve the twelve schools.
• Lack of types of services: Garrett County does not have a child psychologist in-county; an in-patient health provider in county; a non-public school in school in-county (limited continuum of educational services); [and] lack of in-patient beds and facilities for students in crisis.
• Inconsistencies in school-based capacity to support students with behavioral health needs.
• Inconsistencies in implementation of Social-Emotional Learning (SEL) within the school day.
• Building space for behavioral health providers to have confidential and comfortable areas to work with students in some schools.”

Harford – “The challenges HCPS experience in meeting students’ behavioral health needs are: the overall availability of mental health services in the community, long wait times from referral to the commencement of services, ongoing stigma associated with accessing mental health services, and families who experience barriers to accessing services in the community, especially those families who are uninsured. HCPS works closely with the local Office on Mental Health to provide school-based mental health services in school buildings. HCPS has developed working relationships with 10 outpatient mental health clinics to provide services to students during the school day in our buildings. This practice removes barriers for those families that struggle to access behavioral health services in the larger community. In some instances, school-based services are accessed with greater ease than families navigating the behavioral system on their own. In most cases, this availability of these services limits wait-times from referral to service delivery. To address service availability, HCPS is considering a partnership with a third-party care coordination organization that will work with families to locate behavioral health resources to support the mental health of students. This would be a no-cost resource offered to families.”

Howard – “HCPSS has needed to expand staffing and other supports to address the growing needs of students that have resulted from trauma related to the pandemic. HCPSS has leveraged grant funds and operating dollars to increase the number of programmatic school social workers (18 social workers serving that role) and other school mental health professionals to reduce high caseloads for school system staff and approach the staff-to-student ratios recommended by national social work, school psychologist, and school counseling professional organizations. HCPSS’ primary intervention to address the aforementioned challenges has been advocacy for the expansion of the HCPSS School-Based Mental Health Program, delivered with the assistance of our school social workers. HCPSS has used grant funds from community partners to accelerate expansion of the program to address pressing student needs. Delivery of therapeutic services in schools during the school day helps to remove barriers to access for students and families in HCPSS schools. HCPSS partners with local behavioral health agencies who provide therapists who come into the school buildings to work with students. These partnerships help to address the needs of students with complex behavioral and mental health needs…”

Kent – “Challenges that exist with meeting student’s behavioral health needs are financial barriers, lack of mental health care professionals/services, limited availability of mental health education/awareness, time, and transportation. To assist with these challenges KCPS has applied for grants and partnered with our stakeholders such as local mental health agencies, the Kent County Health Department, and the Kent County Local Care Team, which includes wrap-around services, and the Kent County Department of Social Services. We have employed school social workers to work with students exhibiting behavioral needs in four out of five of our schools. They conduct small group and individual counseling services.”

Montgomery – “There are three significant challenges facing MCPS with regard to meeting students’ behavioral health needs: the increases in student social-emotional and mental health needs since the pandemic; the availability of mental health professionals to meet those needs; and the challenge of destigmatizing and raising awareness of mental health and its impact on students across all stakeholder groups and communities. It is noteworthy that these needs are not unique to MCPS. More than 61,000 of our 150,000+ MCPS students were surveyed regarding socio-emotional and mental health needs. They reported that stress and anxiety, family conflict, and communication were among their top concerns. MCPS has taken a multipronged approach to addressing these challenges. By prioritizing funding to support student well-being needs, MCPS has increased specialized staffing to support student behavior health needs. This includes the addition of 14 parent community coordinators, 44 part-time elementary counselors, 16 part-time middle school counselors, 16 high school counselors, and 7 emergent multilingual therapeutic counselors. Between December 2021 and December 2022, MCPS has created and hired 40 well-being social workers and one social work supervisor to provide direct counseling support, case management, and resource provisioning to students within their local school communities.”

Prince George’s – “Challenges:

• Staffing mental health positions (school counselors, school psychologists, and mental health clinicians).
• Increased student need for mental health supports post-pandemic – Readjusting to in-person learning has taken longer than expected.
• PGCPS has seen the impact of the increased percentage of chronically absent students. Currently, PGCPS is exploring the reasons for increased absenteeism and engaging in parent outreach to provide information and strategies related to increasing student attendance.
• Increased number of challenging behaviors with students in grades PreK-2.
• Access to mental health resources outside the school system.
• Increase in students overdosing, particularly on fentanyl.

PGCPS has a comprehensive plan for supporting students’ behavioral health needs through a layered approach that includes: expanding mental health professionals; creating mental health support office; providing staff training; launching telehealth services; screening and data monitoring; providing student training; expanding counseling partnerships; listing community resources; and communicating services and programs to parents/guardians and students. PGCPS’ Behavioral Health Report 2021 and Enhanced and Expanded Behavioral Health Services Mandatory Report November 2022, provide further details on how each component will lend to the exposure of and access to behavioral health programming and services for all students, staff and families in PGCPS.”

Queen Anne’s – “The main challenge is the lack of Behavioral Health providers in our area. The demand for Behavioral Health services is significantly higher than the supply of providers. Other barriers include:

• Ability to cross state lines (Queen Anne’s County borders the state of Delaware).
• The amount of responsibilities School Counselors have can limit their ability to provide behavioral health services to all students who need them.

QACPS does however partner with eight community based providers in order to deliver School Based Mental Health (SBMH) services via tele-health and in-person. QACPS provides in-kind space and supports these providers in grant applications to provide additional funding. Additional strategies include:

• Adding 2 School Counselors for FY23 and 2 more for FY24.
• Adding two internal Mental Health Professionals for FY23.
• Adding two internal Social Workers for FY23.
• Partnership with Community Mediation Upper Shore (CMUS).
• Tier 1 Social & Emotional Learning.
• Tier 1-3 Multi Tiered System of Supports (MTSS).
• Partnership with the Local Management Board (LMB).
• Referral process for community programs such as Healthy Transitions.
• Mobile Response Stabilization Service (MRSS).
• Anti Bullying presentations – Rachel’s Challenge.
• Social Media Safety Programs – Organization for Social Media Safety.”

St. Mary’s – “Challenges that impact meeting students’ behavioral health needs include a significant increase in the number and severity of student mental health concerns and limited availability of funding to hire adequate staff to support all schools within the district. Currently, eight secondary schools have a full-time social worker providing mental health counseling support to students and four School Social Workers serving 8 elementary schools. There are 10 elementary schools and two program locations uncovered/unsupported due to lack of funding. School counselors and school psychologists address needs as appropriate in these schools and share community resources with families. Ongoing efforts are made to seek out funding opportunities to expand services to all school sites and programs. We have utilized grant funding to secure all current School Social Work staff that focus on Tier 3 1:1 (ongoing, individual mental health counseling) student supports. The School Social Work positions are dedicated to mental health supports for students. In addition, SMCPS partners with a community agency to provide clinical counseling services for four schools (two elementary and two middle) serving students with state insurance 1-2 days per week.”

Somerset – “There are systemic and school-wide challenges that impact students receiving services for their behavioral health needs. Systemic barriers include: lack of transportation, language barriers, teacher shortage, lack of diversity in available therapists, and lack of programs or services for students needing a higher level of care. Additional barriers system-wide are stigma about mental health, lack of strategies to support a child with mental health challenges, and an inability to access mental health services due to financial hardship / no insurance. We have addressed some of the systemic concerns internally by providing transportation for needed appointments, providing interpreter services for families where language is a barrier, as well as community based small group interventions. Mental health courses are made available to decrease the stigma and provide strategies to staff, families, and community members. To overcome the challenge of teacher shortage and encourage retention we have provided competitive salaries and retention bonuses. School-wide barriers include limited space for mental health providers to meet with students, and limited Professional Development related to student behavioral health. Additionally, staff buy-in, and student-staff relationships impact students receiving behavioral health support.”

Talbot – “In Talbot County, the current local demand for behavioral health services greatly exceeds the availability of current practitioners to manage. In response to the lack of available organizational partnerships, TCPS hired ten school-based social workers to supplement the void in contractual positions. These social workers provide essential support to students on-site at each school, which is supported through grant-funding. We are currently exploring how to incorporate additional behavioral health positions into our local budget to provide students with increased necessary resources to ensure their wellbeing. While there are not many Behavioral Health Clinics in the area, TCPS partners with seven private/community-based health agencies that have contracted an additional ten licensed Mental Health Clinicians that provide services to students all year internal and external to TCPS facilities. When schools are not in session (evenings, weekends, summer), however, the lack of TCPS transportation further challenges the ability to provide these necessary services to students living in geographically rural areas of Talbot County. TCPS acknowledges this concern and is currently discussing ways in which this issue can be mitigated.”

Washington – “The challenges WCPS experiences in meeting student’s behavioral health needs include: lack of transportation for families to access services, uninsured or under-insured students, limited resources in the community, access to services in school and the community, difficulty recruiting independently licensed/experienced school system clinical staff; stigma; increase in K-5 behavioral health needs; limited level of care options for high risk/ aggressive students; parental involvement; and meeting the continuing training needs of staff. During the summer months, outside providers continue services. If students are referred to Student Services by WCPS staff during the summer due to behavioral health concerns, Student Services staff work with home school staff and family to coordinate outside community resources. An additional challenge is that due to summer schedules, parents/guardians are not always able to consistently follow through with continuity of services.

Difficulty recruiting independently licensed clinical staff: WCPS created and hired a social work specialist to provide clinical supervision so staff can achieve a higher level of licensure and increase clinical skills. This position also covers open positions, provides troubleshooting, and delivers professional development.”

Wicomico – “The difficulties we face in meeting students’ behavioral health needs are as follows: WCPS adolescent families and caregivers must overcome numerous barriers to gain access to outpatient and inpatient rural behavioral health treatments. Obstacles can be of the familial, clinical, or socioeconomic variety. Even though demand for services has steadily increased over the last ten years, the current treatment options have significant limitations. Long wait times are frequently cited as the most significant barrier to receiving assistance. Reduced food, housing, and financial security as a result of the pandemic, as well as increased trauma and stress, have either triggered or exacerbated pre-existing mental health issues in vulnerable individuals.

The strategies utilized include:

• Training(s) on the use of the universally available Behavioral Toolkit, developed by school psychologists, occurs for all teachers, giving them access to the resource listing for all disabilities and proactive strategies for classroom management and instruction of students with these unique needs.
• Elementary school counselors are continuing to teach the Second Step social-emotional curriculum for PreK to 5th Grade (topics include recognizing emotions, how to establish friendships, bullying prevention, child protection, self-control, etc.).”

Worcester – “The challenges that exist in meeting students’ behavioral health needs are:

• Workforce recruitment and retention for school social workers and community treatment providers.
• Community Treatment providers’ fee-for-service funding structure limits time to provide case management and collaboration with multidisciplinary school team.
• Absence of specialized therapy services (i.e., Spanish and other language therapists, therapy services for non-verbal students, ABA therapy, Functional Family Therapy).
• Finite number of designated confidential space for school-based therapy services from outside providers.
• Decreased parental involvement in school-based therapy models that limit progress and generalization of skills.
• Ongoing stigma from caregivers about their child participating in behavioral health treatment.

[WCPS] seeks to overcome these challenges by working with Salisbury University School of Social Work to support workforce development. Beginning in 2023, WCPS’s Career Fair will include specific outreach for social workers and behavioral health professionals. WCPS hosts quarterly meetings of the School Behavioral Health Council to collaborate with community stakeholders on community behavioral health trends, needs, and effective practices. WCPS is in communication with community partners to discuss and seek grant opportunities to offset costs to allow providers to be more flexible within their fee-for-service structure, and partnership with our local health department on awareness and prevention efforts.”

Click through to read earlier roundups of Blueprint reform efforts on college and career readiness, expanding early childhood education, and efforts to hire high-quality and diverse educators.

Editor’s Note: This story is part of a Maryland Matters series to break down tens of thousands of pages of education reform plans into digestible insights. Click through to read roundups of Blueprint efforts on college and career readiness, expanding early childhood education, bolstering mental health supports, and efforts to hire high-quality and diverse educators.

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