Fact: The National Institute of Mental Health estimates that 50 percent of all lifetime problems with behavioral health begin by age 14; 37 percent of students 14 and older with behavioral health problems drop out of school; and 70 percent of incarcerated youth in state and local juvenile justice systems have behavioral health problems.

Fact: More than 90 percent of youth who die by suicide have a behavioral health condition, the Department of Health & Human Services’ Substance Abuse and Mental Health Services Administration reports.

Framing the Issue

  • Behavioral health problems affect a significant number of young people, and often youth do not receive treatment.
  • Schools are a key venue where these problems can be addressed.
  • Kaiser Permanente has awarded grants to support behavioral health programs in schools, recently in its Colorado region.
  • These behavioral health programs focus on training, access, treatment and environment and are based on collaboration with local school districts.

Fact: The American Psychological Association has found that nearly 1 in 4 middle school and high school students experiences poor behavioral health; yet, less than half of those affected receive treatment, services or support.

With these disturbing statistics in mind, Kaiser Permanente decided to tackle the problem in our schools, where young people spend the majority of their formative years. The Oakland, Calif.-based system has awarded multiple grants to support enhanced behavioral health services across its regions’ schools, and Kaiser Colorado is one of the latest recipients.

In August, five school districts across Colorado received nearly $1.5 million in behavioral health grant funding. The three-year grants will be used to improve student access to behavioral health and wellness programs while helping teachers and staff learn how to identify and address students’ behavioral health needs as well as their own.

“Research confirms the connection between social-emotional wellness, behavioral health and academic achievement,” says Carmen Martin, senior community benefit specialist for Kaiser Permanente Colorado. “Students who feel connected to their school are more likely to have better attendance and academic achievement, stay in school longer and avoid high-risk behaviors. And because students are much more likely to seek support when school-based services are available, schools need comprehensive behavioral health systems to create positive learning environments.”

Collaborative growth

The Colorado grants are the latest expansion of Kaiser’s systemwide Thriving Schools program, launched in 2013 with a focus on healthful eating, active living and school-employee wellness. Now, Thriving Schools is adding behavioral wellness to its goals, supporting behavioral health initiatives for students, teachers and administrative staff from pre-kindergarten through high school.

“As this innovative work launches in our Colorado region, our Northern California region is in its third round of funding school mental health and wellness,” explains Vincent Staupe, senior communications consultant with Kaiser’s national public relations and communications division. “In addition, our Southern California region has funded a student-focused effort on mental health wellness in one school district, and our Pacific Northwest region also plans to launch a similar initiative in the coming school year.”

Martin says the four overarching goals of the Thriving Schools behavioral health initiative are to:

  1. Implement and improve school policies and practices to create trauma-sensitive and culturally responsive classrooms.
  2. Increase participation in social and emotional wellness programs.
  3. Create a stronger sense of belonging and connectedness among students, their families, teachers and staff.
  4. Improve teacher and staff social-emotional wellness competencies through professional development.

“We have a national problem with mental health — kids are under a lot of stress, and there’s a heavy burden on our teachers as well,” affirms Doug Newton, M.D., a pediatric psychiatrist with Kaiser Colorado, who has provided consultation on the Thriving Schools grants. “The continuum of care shows the importance of taking a population-health approach to addressing behavioral health at an early age, because prevention is key.”

Kaiser also encourages grantees to make the program their own.

“These grants are unique to each school,” Martin explains. “We wanted to set certain parameters but also allow the schools to set their own goals and choose from a variety of strategies.” In addition to the grant funding, Kaiser will host professional learning communities three times a year for the five districts’ teachers, offering expert-led presentations on relevant topics, as well as the opportunity to network with fellow grantee schools. The system has partnered with the University of Colorado at Colorado Springs for ongoing data collection and evaluation to measure the program’s success and scalability.

“Collaboration is necessary for sustainability,” Newton says. “Based on the patients I see on a daily basis, I know there is no way we can fix these issues solely in the clinical setting.” Following is a closer look at how these five Colorado school districts are using their Thriving Schools behavioral health grants.

Boulder Valley School District

Boulder Valley has taken a comparative approach to its grant-funded schools. One recipient is Fairview High School in Boulder with a student population of 2,200, while the other two are the elementary and middle school in the isolated mountain town of Nederland.

“We thought if we could implement the program at these two opposite ends of the spectrum, that would teach us a lot,” says Andrew Tucker, the district’s director of student support. All three are using an approach called “Let’s Connect.” The program focuses on adult modeling of social competence, including demonstrating emotional self-awareness, connecting with students through appropriate emotional expression and listening skills and, finally, effectively providing support to help students manage their feelings.

Although the program has been in place for three years, the Kaiser funding “will give us the opportunity to plant more seeds and put more promising practices and programs in place,” Tucker says. “We have focused on adults first because if adults don’t have strong social and emotional wellness themselves, they can’t impart that to kids.” Strategies focus on active skill-building and guidance for creating a safe and supportive school climate. A full-time, grant-supported coach divides her time among the three schools, providing classroom observation and teacher training.

“Since Let’s Connect is about relationships, we make sure all our students have at least one trusted adult to turn to in school,” says Brigitte Mutter, the district’s assistant director for research and assessment. “This program teaches our staff how to recognize signs of student trauma such as being withdrawn or reacting in ways inconsistent with a particular situation, understanding that the student's behavior may not reflect his or her emotions. The beauty of this coaching model is that it works with whatever emerges in the classroom.”

Cherry Creek School District

Cherry Creek has dedicated its behavioral health grant funding to Prairie Middle School in Aurora, one of the largest and most diverse schools in the state, with 1,780 students with backgrounds from 70 countries and 140 languages. More than 70 percent of students receive free or reduced-price lunches, and many students’ families face homelessness, deportation or incarceration.

The school will use its Thriving Schools grant to implement the Healthy Environments and Response to Trauma in Schools program, working in partnership with the Aurora Mental Health Center. “We were seeing a big increase in suspensions and suicide-risk assessments,” explains Lisa Olson, Cherry Creek’s competitive grants coordinator. “We conducted a safety wellness survey, and many more students than in the previous year reported feeling anxious and tense due to their family circumstances — this was a much-needed program.”

With the help of an on-site staff member from the mental health center, the HEARTS program is working to create a more trauma-sensitive, safe and supportive school environment “integrated through a cultural and equity lens,” Olson says. The school leadership team, teachers and staff are receiving training in the effects of trauma on learning and behavior, with ongoing consulting support and booster training available as they gain skill in using trauma-informed and culturally sensitive strategies to help students stay in the classroom. In addition, students’ families will be invited to attend parenting groups — offered in different languages as needed — aimed at reducing the effects of complex trauma and building resilience. School-based therapists are also providing classroom support for students, teaching mindfulness, self-regulation and anger-management skills.

“These kids need extra support. If they are worried about their safety, if they’re hungry, if their parent is in jail, they can’t come to school and focus,” Olson says. “Really, socio-emotional support is needed in many schools. The demographics [can] matter when it comes to children’s’ mental and emotional health.”

Fountain-Fort Carson School District

Serving 8,100 students in the southern part of the state, including 4,600 students from active-duty military families, Fountain-Fort Carson is splitting its Kaiser grant resources among three schools with different grade levels: Jordahl Elementary School, Fountain Middle School and Welte Education Center, an alternative high school.

“We chose these three buildings because of their changing dynamics. These schools represent 20 percent of the district but more than 30 percent of suspensions,” says Lisa Zimprich, assistant director of student support services. “We’ve seen a big jump in the number of children who qualify for free or reduced-price school lunches, and 7 percent are experiencing homelessness.”

Zimprich adds that 40 percent of the district’s students move before the school year ends, and that rate is rising even among nonmilitary families because of divorce and inconsistent employment. “As student demographics have changed, our teachers have asked for support in helping students who are behind or not engaged in learning because their personal difficulties are coming out in the classroom,” she says.

The Kaiser grant has allowed the district to hire a full-time “trauma-informed care coach,” who provides teacher training at each school, with a first-year goal to build a common language and understanding about trauma-informed practices and cultural responsiveness. The second year of the grant will focus on consistent implementation of lessons learned this year, and teachers will teach their peers in the final year, Zimprich says.

“If we can learn to help students through a trauma-informed lens, we will create a better learning environment for all students,” she says. “By doing as much as we can [to help students] while they are young, we will affect their ability to be productive members of society. Being able to partner with a medical system in this way will have a permanent positive impact on how our teachers and staff work with students.”

Summit School District

Spanning several diverse mountain communities, the Summit district serves more than 3,500 students across nine schools. Its Thriving Schools grant will support the district’s SAFE KIDS Summit County project at the grade-school level, focusing on three elementary schools with the highest number of at-risk students: Dillon Valley, Silverthorne and Upper Blue. Like many Kaiser grantee schools, from 30 to 70 percent of Summit’s students qualify for free or reduced-price lunches, and a significant proportion come from non-English-speaking homes. The grant work will begin with teacher wellness training so teachers can support their young students.

“Between 2011 and 2015, the need for behavioral health services doubled in our middle schools and high schools, and we decided we needed to give our kids the chance to build resiliency skills earlier,” explains Julie McCluskie, the district’s director of communications and community engagement.

SAFE KIDS offers a 22-week curriculum of half-hour lessons followed by activities. For example, first-graders learn empathy, emotional self-control and fair ways to play. Each grade adds on to these principles as developmentally appropriate. “We think of this Kaiser grant as a prevention tool,” McCluskie says. “SAFE KIDS will be successful if we can provide ongoing time to reinforce these social and behavioral skills consistently in each classroom.”]

The grant also will fund parent education, “so that what we teach will be reinforced outside the school,” she explains. She adds that partnering with Kaiser has been a “delightful surprise” with robust support, including an integrated arts program that offers free plays to students at all grade levels, covering mental health topics ranging from understanding autism to dealing with bullying.

“We hope this program helps students come to middle school that much stronger and well-prepared to deal with adolescence,” McCluskie says. “Ultimately, if you have even one child with [behavioral health] issues, it affects everyone’s ability to learn. When we can get ahead [of problems], it makes a difference in what learning can be.”

Thompson School District

Three elementary schools in this northern Colorado district are using their Kaiser grant to continue their work with a teaching resource named “In Focus.” Lessons are presented at the free school breakfast all children receive and cover such topics as community building, conflict resolution and handling stress.

“A few years ago, we saw a need for better mental health support in our schools,” explains Michelle Malvey, principal at the district’s Lincoln Elementary School. “We’ve been using In Focus here for four years, and now, thanks to the Kaiser grant, Monroe and Truscott elementary schools are fully implementing the program.”

Using 15-minute lessons that build on one another, the program helps grade school students to develop their social and emotional intelligence by first understanding the different parts of their brain: the brain stem or “lizard brain,” responsible for creating a sense of safety, security and connection; the limbic system or “dog brain,” used for identifying, controlling and expressing emotions; and the cortex, or “owl brain,” designed to support thinking and learning. Significantly, until the brain stem is convinced that an individual is safe, none of the higher parts of the brain can be engaged. “We ask students: ‘Which part of your brain is working now? What do you need to do to get to owl brain?’” Malvey says.

“Our ultimate goal is to build a model that any school can use,” she says. “School is the only place where everybody comes, because it’s required by federal law. That’s why Kaiser wants to partner with us, because we do proactive work before lifetime habits are developed. We have the opportunity and the platform for reaching everyone — and we have to do something different to help kids in this stressful world.”

Hospital homework

For hospitals and health systems interested in pursuing a similar behavioral health partnership with their local school districts, Martin believes Kaiser’s process could be easily replicated. “First, we convened a focus group of public health organizations to understand the unique role schools play in behavioral health,” she says. “We needed to understand what schools could take on and what was appropriate, as well as where there was community momentum so we didn’t attempt to operate in a vacuum. And we needed to align and leverage community resources so that our schools could sustain the efforts started with our funding.”

Kaiser leadership also attended a statewide conference of wellness coordinators and asked what type of funding support, length of funding and wraparound services would advance local behavioral health initiatives. Martin adds that hospitals also could offer behavioral health professional development training to school district administrative staff and teachers.

“In the end, the biggest reason this program matters to me is my own experience,” she says. “I remember feeling invisible and disconnected during my middle and high school years. I know what a critical time that is for young people, and I wanted something better for the youth in my community and for my own kids. We can do better, and we should.”

Laurie Larson is a freelance writer in Chicago.