At the Legislature’s request, staff of the Joint Legislative Audit and Review Committee (JLARC) inventoried mental health services available to students through schools, school districts, and educational service districts (ESDs). JLARC staff completed the inventory primarily through a survey of school districts, supplemented by interviews and analysis of existing data. The survey asked about what services are provided, who provides them, where they are provided, and who pays.
Three-quarters of school districts (218 of 295) completed the survey. The data in the inventory represent 85% of enrolled students and 83% of public schools (1,985 of 2,392) in Washington.
This report includes both summary information as well as topic-specific tables. Readers can sort, filter, and review the data presented in the tabs above. Readers also can download the complete data file for schools, school districts, or ESDs.
In 2015, of the 1.1 million students in public schools, 55,000 (5%) received Medicaid-funded mental health services. Most of these students were served outside their schools through managed care plans and publicly-funded mental health and substance abuse treatment centers. Approximately 10,000 of the students (1%) received Medicaid-funded mental health services in their schools. School districts receive reimbursement from Medicaid for certain services through contracts with the Health Care Authority.
The information in the inventory can be found by clicking on the top tabs. Please allow a moment or two for the data to load.
The Office of Superintendent of Public Instruction (OSPI) has identified a multi-tiered system of support as a best practice for behavioral supports and mental health services. According to OSPI, the goal of the multi-tiered system is to integrate mental health services into a student’s academic instruction.
Universal supports are the first tier of a multi-tiered system. They are focused on prevention by promoting desired behavior. For example, a school may expect that all students “Respect Yourself, Others, and Property.” Universal supports are intended to create an environment conducive to learning and to promote positive behaviors. Staff members are to provide these supports to every student.
Tiers 2 and 3 involve referrals and more direct mental health services such as support groups or individual counseling.
For Tier 1, JLARC staff collected data about the use and types of universal supports provided in schools. For Tiers 2 and 3, JLARC staff collected information about screening, referrals, and services, and also identified where and by whom services are provided. Below are some highlights from the survey about multi-tiered systems and universal supports, as well as approaches to serving students in the community or directly in the schools.
Districts were asked about multi-tiered systems of support and universal supports.
Some districts screen for mental health concerns. They report that if a need is identified, a referral to a community mental health provider is often made. The schools do not have licensed mental health professionals on staff or available from the district, and community providers do not come to the schools. Districts report that:
In some schools, after screening, students with identified needs are provided mental health services in their schools. These schools use a variety of approaches, such as:
Districts with these schools report that:
The Legislature asked JLARC staff to identify models of mental health services that are integrated into schools. Interviews with mental health professionals, OSPI staff and academics identified four such examples:
There are 1.1 million public school students in Washington. In 2015, the Health Care Authority (HCA) estimates that about 55,000 students (5%) ages 5 through 17 received Medicaid-funded (Apple Health) mental health services. Most of these students were provided services outside of a school setting through managed care plans and publicly-funded mental health and substance abuse treatment centers known as Behavioral Health Organizations (BHOs). Approximately 10,000 students – 1 percent of all students – received Medicaid-funded mental health services in their schools.
HCA contracts with 211 school districts to receive fee-for-service Medicaid reimbursement to provide medically necessary services. Counseling and psychological assessments are included in the covered services if provided by a qualified professional to a student as part of their Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP).
HCA notes that many school districts report not having qualified staff to meet program requirements for billing Medicaid. In fact, according to HCA, only 4 of the 211 contracted school districts consistently bill Medicaid for mental health services.
A recent clarification by the Centers for Medicare and Medicaid Services (CMS) related to reimbursement may make it easier for districts and educational service districts (ESDs) to seek Medicaid reimbursement. The clarification allows districts and ESDs that contract with HCA to seek reimbursement for services provided to Medicaid-enrolled students even if other students are not charged for the same services.
ESD 113 Capital Region and 37 school districts use the Medicaid Administrative Claiming program. They receive Medicaid reimbursement for helping students and their families learn about Apple Health (Medicaid), enroll in the program, and access services.
The 2016 Legislature passed E2SHB 2439 with a stated intent to improve access to adequate, appropriate, and culturally responsive mental health services for children and youth. The legislation directed the Joint Legislative Audit and Review Committee (JLARC) to inventory mental health services available to students through schools, school districts, and educational service districts (ESDs).
JLARC staff was directed to use only data that is already collected by schools, school districts, and ESDs. Staff could not and did not collect or review student-level data.
Interviews and Surveys: JLARC staff interviewed staff from the Office of Superintendent of Public Instruction (OSPI), ESDs, and school districts. JLARC staff learned that the inventory could not be completed with existing data due to a lack of information about current services. JLARC staff designed surveys in order to collect information requested by the Legislature.
School District Survey: JLARC staff worked with mental and behavioral health experts and staff from OSPI, ESDs, and school districts to develop and test school district survey questions. The Social and Economic Sciences Research Center (SESRC) at Washington State University conducted the survey between July and September 2016. Up to nine contacts (including letters, emails, postcards, and phone calls) were made to districts to encourage survey completion.
Overall, 218 school districts (74%) completed or partially completed the survey. The districts that responded include 85% of enrolled students and 83% of public schools (1,985 of 2,392).
Survey responses were compiled into an inventory of student mental health services. Readers can sort, filter, and review the data presented in the tabs above. Readers also can download the complete data files for schools, school districts and ESDs. In this report, the inventory is divided into five separate data sets based on different topics covered in the surveys. JLARC staff included additional information on districts and schools from the OSPI website to allow for more detailed sorting and analysis (Exhibit 2).
|Topic/Tab||District or School-Level Information?||Additional Detail Included|
Educational Service District Survey: JLARC staff surveyed ESD prevention directors and student support administrators. Questions focused on trainings offered to district staff and mental health services provided to students by ESDs. Seven of the nine ESDs responded to the survey. The non-responding ESDs were ESD 121 Pasco and ESD 171 North Central. Readers can review the data presented in the tab above and download the complete data file for ESDs.
John Bowden, Research Analyst, 360-786-5298
Eric Thomas, Research Analyst, 360-786-5182
Project Supervisor: John Woolley, 360-786-5184
Keenan Konopaski, Legislative Auditor
Eastside Plaza Building #4, 2nd Floor
1300 Quince Street SE
PO Box 40910
Olympia, WA 98504-0910
This table presents results from survey questions about universal supports and multi-tiered systems of support. Three-quarters of school districts (218 of 295) completed the survey. The data represent 85% of enrolled students and 83% of public schools (1,985 of 2,392) in Washington.
Districts report that screening for mental health concerns occurs in 1,844 schools. Many different staff members may screen students at each school.
This table presents results from survey questions about students’ access to services, screening, and where services are provided. Three-quarters of school districts (218 of 295) completed the survey. The data represent 85% of enrolled students and 83% of public schools (1,985 of 2,392) in Washington.
Districts report that:
Schools may have both community-based providers and providers in schools. Districts report that:
Districts reported that 823 schools receive information from providers, within limits of federal law, about students who access services to ensure coordination of care with their education.
This table presents results from survey questions about sources of mental health care funding. Three-quarters of school districts (218 of 295) completed the survey. The data represent 85% of enrolled students and 83% of public schools (1,985 of 2,392) in Washington.
Districts reported how the mental health services for students are funded, regardless of where the services are provided. Districts did not report total amounts spent. Districts report that:
Other sources include levy dollars (240 schools) and dedicated county sales taxes (221 schools). The county sales tax is 1/10th of 1 percent as authorized by RCW 82.14.460.
This table presents results from survey questions about barriers to accessing mental health services. Three-quarters of school districts (218 of 295) completed the survey. The data represent 85% of enrolled students and 83% of public schools (1,985 of 2,392) in Washington.
203 districts report that students experience barriers to accessing direct mental health services (e.g., therapy, interventions).
The survey asked districts to identify specific barriers and allowed respondents to choose more than one.
Seven of the state’s nine ESDs responded to the JLARC staff survey. This table presents results from the ESD survey.
All seven of the responding ESDs:
The number of mental health professionals employed by each ESD ranged from 0 to 9 staff members.
Only ESD 113 Capital Region reports that the ESD itself is a licensed mental health provider. It reports that this status allows it to implement comprehensive school-based behavioral health programs in pilot locations. ESD 112 Vancouver is exploring this option, and ESD 114 Olympic reports recently closing its program due to numerous barriers.
Three ESDs reported that mental health pilot projects are currently underway.
Updated on 11/8/16. Previous version incorrectly stated ESD 114 Olympic recently closed its licensed mental health program: this now reads ESD 189 Northwest recently closed its program.