When teachers see students struggling in their classrooms, it can show up in many ways. Withdrawal from participation. Disruptive behavior. Missed assignments. Even violence. While they might once have seen all these things as problems of discipline, teachers and school administrators now understand something more complex and serious is often at the root of such problems—attention deficit/hyperactivity disorder, anxiety or depression, trauma related to experiences at home.
That doesn’t mean it’s always easy to connect students with the help they may need. Many parents struggle to find care, balance work and children’s schedules, and even get transportation to and from appointments.
Last year, a $1 million grant from UnitedHealthCare helped Cone Health expand telehealth in five public schools—Alderman Elementary School, Hunter Elementary School, and Jones Elementary School in Guilford County; and Moss Street Elementary School in Rockingham County. The pilot program helped provide students 76 mental health sessions, with a community health worker staying with each child during sessions to assist the provider.
The trial was so successful that the initiative is expanding into an additional 24 schools, officials from Cone Health, UnitedHealthCare, and Guilford County Schools announced this month.
“Since we’ve been able to provide more mental behavior health services to students during the school day, we’ve seen significant reduction in disciplinary actions, reduction in our suicide risk assessments, behavioral threat assessments, self-injury assessments, improvements in attendance,” said Dr. Alex Tabori, executive director of mental and behavior Health Services with Guilford County Schools.
“So we know that we can get better outcomes for kids when we make these services more accessible during the school day and make them more accessible to parents,” Tabori said. “We can break down some of the barriers that parents and families deal with when it comes to maybe transportation availability, accessibility of these services.”
Over the last several years, the schools secured millions of dollars in grants toward this work, Tabori said. But over the last year, they lost some of that funding due to federal Department of Education cuts.
“Our opportunity to build partners and have great partners with Cone, and allowing them to come on into the schools and provide, in addition to their telehealth services, the expansion of the behavioral health services has been kind of a godsend for us,” Tabori said.
Trent Walton, principal at Hunter Elementary School in Greensboro, said the results are obvious.
“It results quickly in behavior improvements and attendance improvement,” Walton said. “Students start experiencing academic progress because now behavior difficulties or attendance is not standing in the way of being more focused in the classroom and getting the education they need.”
Early childhood education should be a time of discovery and joy, Walton said. But in reality, students are facing serious life challenges from an early age.
“Our students are happy, and our students at Hunter are extremely resilient,” Walton said. “But they are coming into school from some homes that have a lot of trauma going on, a lot of big things happening. I had a student just two weeks ago who got off the school bus, went into her house, and found her mother deceased. She’s one of the students that we hope to get started enrolling in this for this period.”
Recognizing the importance of mental and behavioral health as part of overall health is important, said Dr. John Jenkins, medical director for school-based care at Cone Health.
“Where we uncovered part of our vision for behavioral health was that we started with physical health, and we spread to 35 sites across Guilford County,” Jenkins said. “We have four in Rockingham and four in Alamance right now, and what we saw in the four years we’ve been active in physical health is that many of the physical symptoms that a child has that they present and that gets them discharged from school and affects their learning ability originates from a behavioral issue.”
Things like instability at home or food insecurity can contribute to anxiety and depression, Jenkins said, leading to attendance problems and students falling behind in learning. Being able to provide care at school, without classroom disruption, is key.
“What we’ve learned in our partnership with principals like Trent is that our main focus is keeping the student healthy in a learning environment,” Jenkins said. “And behavioral health therapy, behavioral health treatment, behavioral health encounters are a part of our ability to help students be healthier learners, and do better in school.”
“ We’ve seen evidence in physical medicine,” Jenkins said. “We’ve seen reading scores and math scores go up, and we’ve seen attendance improve. We’ve seen then those other things that kind of partner with behavioral health decrease risk to the students and decreased behavioral incidents in the schools.”
Breaking down barriers of stigma around mental health care has also been important.
“I think particularly over the last four years or so with COVID, I think there’s a greater recognition of the importance of mental, emotional, behavioral health,” said Anita Bachmann, CEO of United Healthcare Community Plan of NC.
“I think that opened the aperture lens to really pay attention not only to the physical health, but again the mental, emotional health, as well as the social determinants of health,” Bachmann said. “So I think people are looking at it in a much broader perspective—what health really means— than, I think, ever before.”
There is still some stigma to overcome, said Walton. But as a school principal, he’s seen the results of this regular care help.
“There are cultures and communities who don’t value it at the same level, or aren’t willing to risk their child telling things that they don’t necessarily want known,” Walton said. “Our perspective is, if our families trust us, and if we show them that we value it enough to have it in the building, we’re hoping that that shows them that it is a safe thing and it is valuable to them.”
According to the latest America’s Health Rankings report, North Carolina is ranked 32nd out of 50 states for children’s mental health conditions. An estimated 23.3% of children ages 3-17 are told by a health care provider that they have ADHD, depression, or anxiety problems, or told by a doctor or educator that they have behavior or conduct problems.
“That’s pretty staggering, given the sophistication of our healthcare system to have systems in North Carolina being ranked 32nd,” Bachmann said.
“I think the other interesting statistic that we continue to look at is two-thirds of our children and adolescents that are diagnosed with depression haven’t gotten the treatment that they’ve needed,” Bachmann said.
“It’s been [an issue of] access, probably a lot of it, across the state,” Bachmann said. “Access to behavioral health professionals, as well as people not being able to have the transportation or even have the time to get to seek those services. What we’ve been excited about here at United is to be able to partner with the school system and Cone Health to be able to expand this program.”
United Healthcare found it important to invest in Greensboro, where it was founded 40 years ago, Bachmann said. But ideally, they’d like to see this work expand statewide and beyond. That will take buy-in from leaders at the local, county, state and federal levels, she said—and there are signs they understand the urgency.
Last week Governor Stein and the North Carolina Department of Health and Human Services announced $1.25 million in federal funding through the North Carolina Rural Health Transformation Program to expand preventive and acute health care, provide nutrition support, and address behavioral health needs.
“As we work to build a coordinated system that increases access to care for everyone in North Carolina, it is critical we reach people where they are, and for children, that is in their schools,” said NC Health and Human Services Secretary Dev Sangvai. “This investment will remove barriers to care in rural communities, ensuring more children get resources and services they need.”
