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Behavioral health Integrated Resources for Children Project100 Morrissey Blvd.Boston, MA 02125Birch.Project@umb.eduBehavioral Health Capacity of Massachusetts PublicSchool Districts: Technical ReportThis report was developed by the Behavioral health Integrated Resources for ChildrenProject (BIRCh), representing a collaboration between the University of MassachusettsBoston and the University of Massachusetts Amherst and funded by Boston Children’sHospital.The mission of the BIRCh Project is to provide professional development and resourcesfor schools and strengthen the coordination of behavioral health supports provided byschool and community agencies. More information is available atwww.umb.edu/birch, or contact us at Birch.project@umb.edu.Recommended Citation:Pearrow, M., Berkman, T., Walker, W., Gordon, K., Whitcomb, S., Scottron, B., Kurtz,K., Priest, A., & Hall, A. (2020). Behavioral health capacity of Massachusetts publicschool districts: Technical report. https://www.umb.edu/birch/research evaluation

Behavioral Health Integrated Resources for Children Project100 Morrissey Blvd.Boston, MA 02125Birch.Project@umb.eduExecutive SummaryAccess to critical school-based behavioral health services varies significantly acrossthe state of Massachusetts. A central goal of the BIRCh Project is to increase thecapacity of schools to promote and integrate behavioral health services.Understanding current behavioral health supports available to school districts acrossthe Commonwealth is crucial to this mission. This technical report summarizesfindings from the first phase of an ongoing resource mapping project focused onworkforce capacity, state-funded grants, and Educational Collaborative membership.Students in Massachusetts lack adequate access to school-based behavioral healthstaff according to national recommended ratios. Moreover, school districts servingstudents with high economic needs have less access to school-based behavioral healthprofessionals, particularly Social Workers and School Psychologists. Priorities of the 25Educational Collaboratives across the Commonwealth include sharing resources toprovide direct services to students, professional development, technical assistance,and programs and services to improve district operations. Resource mapping suggeststhat 26.9% of identified high needs districts do not belong to a Collaborative, andthere are no Collaboratives servicing the most western part of the state. Additionally,34.6% of the school districts with high economic need and disproportionately lowstaffing of school-based behavioral health professionals did not access anyDepartment of Elementary and Secondary Education (DESE) behavioral healthgrants.Stakeholders representing state agencies, district administrators, EducationalCollaboratives, school-based and community-based providers, and university trainersnoted fragmented access across geographic regions and limited coordination ofresources. The fragmented allocation of behavioral health resources reflects the lackof a state-driven coordinated plan for school-based prevention efforts. Withoutdesignated district leadership to focus on these efforts and with competing districtlevel priorities, schools and districts have limited access to quality and sustainableschool-based behavioral health programming.Our hope is that the current findings serve as a foundation to strengthen thecoordination of behavioral health services available through school, community, andstate agencies. The report offers strategies to address gaps in access to mental healthservices so that all students can benefit from high-quality services that emphasizeprevention and promote positive education and life outcomes. It offers policyrecommendations organized around the following five areas: Consistent andCoordinated Professional Development; Workforce Development Opportunities;Supportive and Collaborative Partnerships; Incentivizing Collaboratives; and,Regional Technical Assistance Centers.Background2

Behavioral Health Integrated Resources for Children Project100 Morrissey Blvd.Boston, MA 02125Birch.Project@umb.eduThe behavioral and mental health needs of children have been called a ‘silentepidemic’ with grave implications for families and communities (Anderson & Cardoza,2016). Despite the estimate that 20% of U.S. children meet criteria for behavioralhealth disorders, our nation’s response continues to fall short with the vastmajority (80%) of children identified as in need of services receiving nointervention (Caldarella et al. 2008; Kataoka, Zhang, & Wells, 2002; Perou et al.,2013). Among children who do access services, schools played an integral role(Farmer, Burns, Philip, Angold, & Costello,2003; Merikangas, He, Burstein, Swendsen,Avenevoli, Case, Georgiades, Heaton,Swanson, & Olfson, 2011). The school settingis a convenient location that reduces a varietyof access barriers (Blake, Ledsky, Goodenow,& O’Donnell, 2001; Durlak, Weissberg,Dymnicki, Taylor, & Schellinger, 2011). Yet,even within the context of school settings,access to needed behavioral health servicesvaries tremendously across geographicregions, states, and local communities.The minimum standard for school-basedservices is established and enforced by thefederal government (e.g., IDEIA), though the bulk of responsibility for ensuring qualityeducation services is carried out at the state and local levels. State agencies maintainoversight of qualifications and licensing of professional staff; still, states delegatemuch of the authority for the management of public schools to local educationagencies (LEA; Jacob, Decker, & Hartshorne, 2010). As such, the responsibility of staffappointments, employment expectations, and professional role configurations fall onlocal districts and leadership. Within these complex layers of governmental oversight,there remain tremendous gaps in access to school-based mental health services acrossstates, as well as within states across local communities.Throughout the Commonwealth, schools often struggle to effectively implement acontinuum of student support initiatives that promote healthy development andaddress mental health needs of students. Numerous overlapping agencies support thedevelopment of the whole child, yet some of our most vulnerable children experiencelimited access to services due to fragmented organizational systems. Even thoughMassachusetts is the leader in academic achievement, the lack of integratedbehavioral health services results in vast disparities and a failure to address thedemonstrated needs of children.3

Behavioral Health Integrated Resources for Children Project100 Morrissey Blvd.Boston, MA 02125Birch.Project@umb.eduOur hope is that the findings presented in this report serve as a foundation tostrengthen the coordination of behavioral health services available through school,community, and state agencies. It merges findings from multiple data sources tobetter understand the disparities across the Commonwealth, and offers strategies andpolicy recommendations for more equitable access to school behavioral healthservices.Purpose of Current ReportWith the overarching goal of understanding the capacity of school districts inMassachusetts to address the behavioral health needs of students, the goals of thecurrent project were threefold. First, the research team examined students’ access tolicensed Professional Support Personnel (e.g., school psychologists, school socialworkers, school counselors, school nurses), as reported by the Department ofElementary and Secondary Education (DESE). Student-to-staff ratios were calculatedand then compared to the recommendations of each national, professional andcredentialing organization. These findings on the current capacity were thencompared across school districts, with a focus on equitable access based on studenteconomic need.In addition to sufficient staffing levels, schools anddistricts need access to high quality professionaldevelopment and support to provide comprehensiveschool-based services. The second aspect of the studywas to examine the dissemination of state educationresources - specifically competitive funding to supportsocial, emotional, and behavioral health. As such, grantsprovided by DESE to schools and districts that targetedstudents' social, emotional, mental, and behavioralhealth were explored.Finally, this report highlights findings from state and community leaders and otherexperts, in the field of behavioral health, on the variability of districts’ capacity through staffing, professional development, and grants - to meet the behavioralhealth needs of students. In these interviews, factors that contribute to communities’access to services, and the impact of overlapping and competing priorities at thebuilding, district, and state level were explored.Procedures for the three studies, more specifically methodology, analysis procedures,and findings, are described in depth in the sections below. The consolidation offindings, strategies to ameliorate inequities, and policy recommendations for moreequitable access to school behavioral health services are outlined in the final sectionof the report.4

Behavioral Health Integrated Resources for Children Project100 Morrissey Blvd.Boston, MA 02125Birch.Project@umb.eduStaffing Ratios & Student Economic NeedSchool-based behavioral health workforce was evaluated using publicly available datafrom DESE for the 2018-19 school year. The four fields credentialed through DESE asProfessional Support Personnel licenses are as follows: SchoolSchoolSchoolSchoolCounselor (Levels: PreK-8; 5-12)Social Worker/School Adjustment Counselor (All Levels)Psychologist (All Levels)Nurse (All Levels)Requirements for these professional licenses include graduate courseworkaccompanied by supervised field experiences and demonstrated competencies in theimplementation of social, emotional, and behavioral health and/or health services.Only those employed by the local education agencies (LEAs) were included in theanalysis.The number of students in each LEA was also examined, including the percentage ofstudents identified as economically disadvantaged. “Economically disadvantagedstudents” are defined by DESE as those who participate in one or more of thefollowing state-administered programs: the Supplemental Nutrition AssistanceProgram (SNAP); the Transitional Assistance for Families with Dependent Children(TAFDC); the Department of Children and Families (DCF) foster care program; andeligible MassHealth program (Medicaid).These data were calculated to determine staff-to-student ratios for each of theprofessional licenses. Staffing ratios of districts were organized into quartiles.Similarly, districts with the highest concentrations of economically disadvantagedstudents were organized into quartiles. Data were combined to identify districts withthe highest economic need and poorest staffing ratios. These districts were thenmapped using ArcGIS software and geospatial data available through MassGIS1.FindingsDuring the 2018-2019 school year, the 406 public school districts employed 7,475Professional Support Personnel in schools to meet the needs of 951,631 students.2,048 school nurses provide a range of health services, and the remaining 5,4271MassGIS, Bureau of Geographic Information, Commonwealth of Massachusetts EOTSS; school-district data waslast updated in June 20195