Amid a school mental health crisis, a new training approach shows promise

For several years, Julia Taylor had one of the nation's most underappreciated jobs: middle school counselor.

"I was in the trenches for a decade before higher ed," said Taylor, now an associate professor of counselor education in the University of Virginia's School of Education and Human Development. "I would have loved something like this."

"This" is a pilot project that pairs people like Taylor, who are steeped in the research on student mental health, with school counselors, psychologists, nurses and social workers who face a growing number of students in crisis.

In fact, Taylor is a co-author of a recent study published in Child & Youth Care Forum, which showed this new approach works. She and colleague Michael Lyons have found that something relatively simple—regular Zoom calls with a handful of school divisions—leaves the school mental health professionals feeling better equipped to help students with mental health challenges.

Simply put: "We're trying to improve the quality of mental health services provided to youth in schools," Taylor said.

Getting to that point meant bridging what Taylor and Lyons call the "research-to-practice gap." That's the divide that separates people who immerse themselves in the study of child and adolescent mental health from front-line school workers who "have a problem with a kid right now," said Lyons, an associate professor of clinical and school psychology at UVA. "And they need solutions to that problem."

The problem is growing.

"Student mental health has plummeted and the pandemic has disrupted almost every aspect of their lives," Taylor said. "It is not plausible to simply bounce back from this."

According to a Centers for Disease Control and Prevention report, emergency-room visits related to mental health increased 31% among adolescents from 2019 to 2020. A recent UVA Health study showed suspected suicide attempts by poisoning among children ages 6 to 19 increased nearly 27% between 2015 and 2020.

"Researchers at UVA and all over the country have developed new interventions, new assessment tools to be more efficient and effective at identifying kids who need mental health supports, and then to effectively intervene," Lyons said. "The problem is that often doesn't get into the hands of frontline providers."

One potential solution, they believe, is an idea centered on a tele-mentoring model called Project ECHO, or Extension for Community Healthcare Outcomes. It's a system medical doctors created to consult on complex cases in rural areas. This study tested the idea in a new context: schools.

As part of a statewide initiative called the Virginia Partnership for School Mental Health, mental health staff from four Virginia school divisions participated in a professional development program. To see what was more effective, some participants had access to online training modules while others had both the online training and the monthly Zoom sessions.

During each virtual session, one participant presents a specific case, then the full team discusses and shares recommendations. Topics cover a range of mental health concerns, including trauma in schools and the mental health needs of high-achieving students. Conversations would reference resources in the modules, helping participants apply it to a real-life scenario.

The group that participated in ECHO sessions showed higher engagement with the training modules, and higher satisfaction with the program, compared to the participants who only interacted with the modules.

A key finding, Taylor said, is that the regularity of the meetings provided a more engaging and cost-effective way for school mental health professionals to learn, compared to more traditional avenues like annual training or seminars.

"Consistency is the key," Taylor said. And, Lyons added, this approach is tailor-made for rural school districts where counselors and nurses may not have access to robust training and support.

While these findings are preliminary, the research team has several follow-up studies in the works. Researchers said upcoming studies currently under review suggest that ECHO could also affect participants' knowledge and confidence.

"What we want folks to do is sustain the learning and distribute it over time," Lyons said. "We're starting to see this in later studies, but the hope is that it actually changes the way that they understand their role, and school mental health evidence-based practices, and then change the team's behavior to promote better student mental health outcomes—which is the ultimate goal."

The study, and the ongoing ECHO sessions, are one part of a much larger initiative to improve school mental health in the commonwealth. The Virginia Partnership for School Mental Health began in 2019, bringing together school divisions and universities to increase the number of school mental health professionals who provide evidence-based services in Virginia.

Another focus of the partnership is training graduate students in mental health leadership.

At UVA, with grant funding from the partnership, six school counseling students graduated in May having engaged in more than 700 hours of fieldwork in a high-need school division, supervised by practitioners trained by the partnership. They also participated in a semester of ECHO sessions and took extra course credits focused on school mental health.

"They worked tremendously hard in their two years at UVA and I could not be prouder of their flexibility, curiosity and determination," Taylor said. "Their counseling skills are polished, their case conceptualization skills are seasoned, and they exemplify the term 'leader.' I have no doubt they will make an incredible impact on the youth they serve in Virginia's public schools."

In the past two years, the partnership has continued to expand—recently adding Old Dominion University, William & Mary, Radford University, James Madison University and Virginia Tech, as well as the Hampton and Roanoke city schools. The team also hopes to explore how to widen the community involved in the partnership.

"School mental health really is a whole-school and community problem to tackle," Lyons said. "So there's interest in thinking about how to engage other allied professionals, families and community partners to create an even more robust, integrated network to support student well-being."

Lyons said participants in the ECHO sessions shared that the experience worked because it helped them feel like part of a team. For Lyons himself, participating in the ECHO sessions brought the partnership's vision—of a strong local community of school mental health professionals working together to support students—to life.

"In real time, you see how a network of people working together can come up with solutions that no one person would have come up with alone," he said. "And that's an amazing thing to be a part of."