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Tag Archive: youth mental health

  1. Bill and Budget Explainer: School-based Mental Health Services

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    Virginia is poised to make significant progress in children’s mental health during the 2023 legislative session. Virginia ranked as 48th in Youth Mental Health access according to Mental Health America and recommendations were identified by JLARC in their report Pandemic Impact on K-12 Public Education. School-based mental health services are an integral component to address the youth mental health crisis as schools are often where children and youth form positive and trusting relationships with adults and peers to address their needs. However, we have seen too many incidents where schools are not fully equipped to address mental health needs of students. We also must look to the future where federal ESSER funds that have boosted school-based mental health responses are scheduled to end.

    Actions taken by the General Assembly in recent years to improve the ratio of counselors to students, create school-based mental health integration programs, seek the reversal of the “free care rule” to bill Medicaid for school-based services, integrate mental health into Standards of Learning and regional Recovery High Schools have created the positive momentum for further action this year. In addition, we have seen the expansion of federal grants included in the Bipartisan Safer Communities Act and recent guidance from the Centers on Medicaid and Medicare Administration to leverage Medicaid to pay for school-based services. Read more about Medicaid funding for school-based services here.

    Legislation Considered by Education Committees

    SB1043 (McPike) | HB2124 (Wilt) | HB2187 (Rasoul) – School mental health and counseling, definitions, licensure requirements – SUPPORT

    The Senate version of this legislation incorporates the two policy changes in the House bills to refine the roles of school counselors and to provide flexibility in staffing for school psychologists. To help improve coordination of services, the Senate version also includes a directive to the Department of Education (DOE) to work with Department of Behavioral Health and Developmental Services (DBHDS) to develop a model Memorandum of Understanding for school-based partnerships with community-based mental health providers.

    SB1300 (Deeds) – Elementary & secondary school teachers, public: requirements, trauma-informed care training – SUPPORT

    This Senate bill outlines a training program for classroom teachers to receive training every three years developed by the DBHDS related to recognizing and addressing childhood trauma. This bill was conceived by a youth advocate, Elijah Lee. A budget amendment in the Senate budget provides funds to DBHDS to develop the training.

    SB1325 (McClellan) – Standards of Quality Specialized Support Positions – SUPPORT

    While there is shared interest in building on the Standards of Quality in the General Assembly, SB1325 that has passed the Senate and is being considered in the House specifically addresses the specialized student support positions (school social workers, school psychologists, school nurses, licensed behavior analysts, licensed assistant behavior analysts, and other licensed health and behavioral positions) intended to address student mental health and behavior supports. The budget conference committee negotiators should include $57 million in additional resources to improve the ratio of specialized student support personnel.

    SB818 (Spruill) – Programs of instruction on mental health education – SUPPORT

    This legislation adds additional specificity to the 2018 legislation that added mental health to the physical and health education Standards of Learning. This legislation outlines more specific curriculum guidelines to improve technical guidance to school divisions for age-appropriate sequential instruction and for local school boards to develop and implement policies related to mental health instruction.

    Budget Amendments Considered by House Appropriations and Senate Finance and Appropriations Committee

    Department of Behavioral Health and Developmental Services/Department of Education

    School Based Mental Health Integration Grants

    Last year, the General Assembly approved the first state-funded school-based mental health integration grants allowing DBHDS to offer grants to school divisions to expand school-based mental health services and community partnerships. Lawmakers should encourage DOE and DBHDS to collaborate on these efforts and should help define the roles for each agency. DOE should have oversight for school division implementation and DBHDS should provide expertise on  mental health services. In comparison, federal efforts for school-based mental health services are designed as a collaboration among Education and Health and Human Services. For example, both DBHDS and DOE have been awarded additional resources under the Bipartisan Safer Communities Act to implement school-based mental health services.

    • Recommendation: Establish grant funds at both DBHDS and DOE to leverage the expertise of DOE and DBHDS to expand school-based mental health partnerships. The General Assembly should create two grant funds this year of up to $15 million at both the DOE and DBHDS with specialized focus areas that utilize existing partnerships and centers of excellence. The focus of DBHDS should be on clinical expertise for developmental practice, screening and assessment tools, integration with community violence and substance abuse prevention services, and evidence-informed practices for mental-health treatment services in school-based settings. The focus of DOE should be on expanding the use of school-based mental health professionals, providing technical assistance for collaboration among school-based professionals (VPSMH), and integration with the Virginia Tiered Systems of Support (VTSS).

    Department of Education

    Virginia Tiered Systems of Support (VTSS)

    The House and Senate budgets both include additional funding to expand the Virginia Tiered Systems of Support in conjunction with recommendations from the Behavioral Health Commission. Currently, 58 school divisions participate in VTSS and have reported declines in school discipline referrals and school suspension. The Senate budget includes $1.5 million and the House includes $500,000 to expand VTSS.

    School Safety and Security Funding

    The House and Senate budgets both include additional resources to improve school safety and security. However, in light of several incidents of violence on school campus, or within a school community, such as the incidents at Richneck Elementary, we recommend that the purpose of these funds be expanded to not only to make school environments secure, but to also help respond to schools and communities when violence occurs.

  2. Prioritizing Youth Mental Health Requires Intention and Investment

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    Whether you are a young person, a parent, a mental health professional, or an educator, you have likely heard about the youth mental health crisis in the United States—it is being discussed everywhere, from kitchen tables to news stations to the Governor’s office. And while there is finally urgency around addressing the mental health needs of Virginians, we continue to see a catch-all response for adult and children’s mental health needs in our current policies. It is undoubtedly easier to design mental and behavioral health systems and services for adults and retrofit young people into them, but this results in supports that inadequately meet the needs of children and youth. To truly invest in the mental health of young people, policymakers must do so with intention. It requires centering the needs and experiences of young people—especially those who are Black, Latino, and LGBTQ+—and developing mental health services that prioritize healing and well-being.

    The past few years have been particularly difficult for young people. The Joint Legislative Audit & Review Commission’s (JLARC) November 2022 report shared several alarming statistics that articulate the dire need to intervene and support young people right now: 

    • Self-harm-related emergency department visits among Virginia youth, ages 9 to 18, more than doubled from 2016 to 2021, with the largest increase in self-harm visits occurring in 2021, according to the Virginia Department of Health, and   
    • Youth deaths by suicide, ages 9 to 18, averaged 4.9 deaths per 100,000 youth from 2015–2019, and were 6.2 per 100,000 youth in 2020 and 5.6 per 100,000 in 2021.

    Graph showing youth emergency room visits for self-harm have risen over time; increasing substantially in 2021

    This constitutes a youth mental health crisis. In order to meet this moment for youth mental health, there must be major shifts in how children and youth are prioritized in our system. Historically, new initiatives and service expansions have delayed the implementation of child- and youth-focused plans until phase two—a step that often takes too long to achieve. Mental health resources that are not intentionally designed to reach children and youth will not reach them.

    Capacity to build up the infrastructure at local Community Services Boards, particularly for children and youth, is needed. The ideal system offers young people mental health support when and where they need it, but the reality is children and youth do not have access to a comprehensive array of crisis response services depending on where they live, who pays for their care, and who helps them identify resources.

    Currently, there are only three Residential Crisis Stabilization Units (RCSUs) specifically for young people across the Commonwealth. One goal of Governor Youngkin’s “Right Help. Right Now.” behavioral health transformation initiativeis to add more youth RCSUs and to develop 23-hour Crisis Receiving Centers (CRCs) to serve as a “behavioral health urgent care”, both of which are critical components of the crisis services continuum. However, if the locations and services are not developed with young people’s needs in mind, they will not be as effective of a resource. Having a cross-lifespan model for RCSUs and CRCs that only incorporate child-sized recliners does not make a space child- and youth-friendly. The design of RCSUs and CRCs must be fundamentally different from the design of a traditional hospital, which are often sterile and unwelcoming environments. Young people need culturally and developmentally appropriate resources in these locations, such as places for their family members to rest, blankets, sensory toys and comfort items, and a warm and inviting environment to encourage healing and create emotional and physical safety.

    Virginia lawmakers have a chance to reimagine what it means to put young people’s needs at the forefront of their decision-making during the 2023 General Assembly session. Between Governor Youngkin’s proposed budget and several budget amendments before the legislature, there are opportunities to ensure behavioral health services are available in every region and designed with the needs of children and youth in mind. This includes expanding crisis response services with components specific to children and youth and providing adequate resources to build the capacity of the system.

    TAKE ACTION: We urge lawmakers to prioritize young people’s healing and well-being. This can be done by making a targeted investment in youth mental health through the state budget.

    Build out crisis response and stabilization services that offer young people support when and where they need it.

    • Continue the expansion and modernization of the statewide crisis services system by investing in crisis receiving centers and crisis stabilization units. Hire a staff member to oversee Children’s Crisis Response Services.
      • Support the Governor’s proposed budget to increase funding for a comprehensive crisis services system | $58,345,204
    • Fund contracts with private providers to establish mobile crisis units in underserved areas.
      • Support the Governor’s proposed budget to provide one-time funds for mobile crisis units | $20 million

    Prioritize young people in the design and implementation of mental health services.

    • Build upon the base of $8.4 million the legislature has provided since SFY2017 to expand or enhance children’s behavioral health services in all five Department of Behavioral Health and Developmental Services (DBHDS) health planning regions and keep a dedicated focus on infrastructure specific to children and youth services within DBHDS’s Office of Child and Family Services.
      • Support budget amendments for Children’s Behavioral Health Services: Item 313 #1h (Price)/Item 313 #6h (Seibold); Item 313 #5h (Rasoul); Item 313 #3s (Favola)
  3. Impact of Burnout on Transitional Aged Youth

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    This post was written by former Voices intern Abby Aquije.

    Between a rigorous academic schedule, part-time job, and extracurriculars, my high-school self often had 12+ hour days. Just thinking about it makes me overwhelmed and exhausted. This, unfortunately, is the norm for young people, especially those that are looking to go to college or who have families they help to support. It is a lot of pressure to put onto young people and having graduated the year before COVID-19 started its impact, I can only imagine how much worse it has gotten.

     

    Youth Experience Burnout Too

    Burnout, which is on the World Health Organization’s (WHO) International Classifications of Diseases list, is when chronic stress is not successfully managed. It is characterized by feelings of exhaustion, depersonalization or cynicism, and reduced efficacy. Workplace burnout has been a hot topic for years and is especially talked about as we continue to face widespread labor shortages that are impacting healthcare workers, behavioral health providers, and educators. Though the WHO cautions not to apply burnout to other areas of life, as it is an occupational phenomenon, they fail to realize that youth can experience unofficial occupational roles.

    These roles have aspects of, at minimum, part-time occupation. The average American student spends about seven hours in school, which is just shy of a full-time workday. Only an extra hour spent traveling, doing homework, or studying makes being a student a full-time job, and it is often more than that. Extracurriculars alone can add eight hours to a student’s week, and socializing and family demands add even more. Students have long days, lots of stress, loads of pressure, and few breaks. It’s no wonder that these students are affected by burnout. Those that learn and think differently are even more susceptible to burnout and burnout in young athletes is also a risk factor.

     

    Current Events and Societal Stressors are Worsening the Impact

    With all the uncertainty throughout the first years of the COVID-19 pandemic, motivation was low. I remember in the fall of 2022 I barely got ready for my second year of college. I did not want to fully commit myself to something that could be taken away from me as it was the semester before. Beyond the fear of having to go back into a full lockdown, I also knew the year was not going to be anything like the college experience everyone talks about. Online schooling, frequent testing, and following the ever-changing safety guidelines all contributed to my burnout. Yet, I know I did not have it bad.

    A survey of online learning experiences found that nearly 3 in 4 college students felt their learning was impacted due to low engagement. I would agree that engaging in virtual classes was a challenge, however, for many, it was not just the style of learning that caused academic disengagement. Changes in life circumstances were said to be one of the greatest reasons for students not engaging in distance learning. Students were dealing with grief, illness, or economic hardships, including having to work during the virtual school day, among other stressors.

     

    When Burnout Persists, Other Concerns Arise

    Many students faced serious signs of burnout. As a result, we saw students wanting to stop school and get a GED and showing concerning signs of depression. In the following semester (Fall 2020) nationwide rates of college enrollment dropped. Although Virginia’s overall higher education enrollment was stable, new student enrollment decreased. Unsurprisingly, the impact was worse for community colleges and Virginia’s historically black colleges and universities (HBCUs) considering lockdowns disproportionally affected low-income students and Black children were more likely to have lost a caregiver to the pandemic.

     

    Tackling Burnout Can Help Prevent Other Mental Health Crises

    Burnout is certainly not at the top of the list for reasons young people struggle with depression or stop pursuing higher education, however, tackling it can help prevent those outcomes. Catching signs of youth burnout early can allow adults to help these individuals engage in routines and other preventative measures.  In addition, there are many stressors that adults can work on limiting or managing better. This is especially so for students that have additional hardships and stressors. Students with learning disabilities, students from low-income families, and students of color are all at higher risk for burnout. Policies aimed at alleviating these stressors can tackle symptoms of burnout early on. If burnout is inevitable, it is necessary to integrate peer support and other forms of behavioral health resources to assist youth through the symptoms.

     

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