Fort Worth, TX,
11:06 AM

Report Spotlights Progress and Challenges for Mental Health in Texas Schools

Texas schools received a top score for efforts in some areas and low scores in others.

A new national “report card” gives Texas mixed grades statewide for school policies that support the mental health of students and teachers.

Texas schools received a top score for efforts to promote engagement with families and community partners. The report card also gave high marks to the Lone Star State for taking steps to help school employees recognize students at risk for mental health problems, substance use and suicide.

But the grades for Texas in several other categories – including the extent of Medicaid coverage, well-being checks and the ratio of school psychologists/counselors – came in lower. Findings were issued in February 2022 by the Hopeful Futures Campaign, made up of 17 organizations including the National Alliance on Mental Illness and UNICEF USA. 

“We urge readers to use the report cards as a starting point to spark a dialogue about what is working in their state and what policies and practices are needed to improve school mental health,” according to the introduction.

The Hopeful Futures Campaign describes its analysis as a snapshot of each state’s school mental health structures. Texas earned scores on both the high and low ends, depending on the category.

Just breathe. Open up. You matter. That’s the truth behind the Cook Children’s Joy Campaign, an ongoing rollout of information designed to raise awareness about young people struggling with their mental health. Cook Children’s kicked off the Joy Campaign one year ago in response to an alarming rise in suicide attempts locally and nationally. The Raising Joy podcast and other resources aim to equip families with key messages of resiliency. 

Opportunities for Improvement

According to the report card, staffing for mental health professionals falls short in schools across Texas:

·       1 school psychologist for every 4,962 students (recommended ratio is 1:500)

·       1 school social worker for every 13,604 students (recommended ratio is 1:250)

·       1 school counselor for every 423 students (recommended ratio is 1:250)

The report card’s point about personnel resonated with some of the experts who work every day to help North Texas children and teens.

Michelle Broadwater, assistant director of counseling services at Birdville Independent School District in Haltom City, said 10 crisis intervention counselors share duties at 33 elementary schools in her district. Those counselors are stretched thin with children dealing with trauma, anger, unregulated emotions and lack of social-emotional skills in the 2021-2022 school term, Broadwater said.  

“How to walk down the hall or how to behave in the cafeteria … our behaviors are really a challenge this year,” she said. “The counselors do a lot of putting out fires, constant fires. They’re literally running from one classroom to another.”

Students in the upper grades, Broadwater said, have increased anxiety and stress about falling behind academically due to online learning during the COVID-19 pandemic. The counselors at some BISD middle schools and high schools do as many as 10 suicide risk assessments each day.  

“They feel a little bit inadequate because they see that their students are hurting,” she said. “We talk about students, but our staff are in crisis too, and they’re struggling.”

The Birdville district recently joined the Texas Child Health Access Through Telemedicine service, which provides students with limited mental health care beyond what the school counselors can provide, at no charge. Broadwater credited the BISD Board of Trustees with recognizing the increased need.

Greg Gibbons, a licensed clinical social worker for Wise Health System in Decatur, pointed out that additional counselors on campus would allow more time to build rapport with the students.

“The relationship makes a huge difference. It’s that safe space within the school environment,” to hopefully prevent mental problems from escalating, Gibbons said. “That early intervention would be critical.”

Most of the clients he sees in his practice are elementary and middle school students from Decatur and the outlying rural areas. Gibbons cited ADHD, oppositional defiance, anxiety and depression as the most common complaints that his clients report. To get an appointment, there’s about a six-week waitlist.

Gibbons listed various efforts that could ease the crunch: peer support groups in the schools, social media campaigns to destigmatize mental illness, and more educational conversations like the Parent Cafés organized in Wise County by the Cook Children’s Center for Children’s Health, led by Cook Children’s.

He also emphasized the importance of training teachers to recognize the signs of mental illness, particularly in students who don’t stand out. “Sometimes it’s the shy kid that you don’t know is being bullied on the bus and is just trying to keep to themselves, or it’s the girl who’s hiding her cutting under her hoodie,” he said.

The report card further recommended that Texas adopt annual checks of students and staff members’ mental wellness, excused absences for mental health concerns, and expanded Medicaid coverage.

Progress and Strengths

Meanwhile, the report card gave high scores for these bright spots in Texas schools:

  • Inclusion of mental health as part of the K-12 health instruction
  • Anti-bullying measures
  • Training the teachers to recognize and intervene when a student needs help
  • The Texas Education Agency task force was established by the Legislature in 2019 to study the mental and behavioral health climate in the schools
  • Policies that foster engagement with families and the community

Blair Williams, a community health analyst at the Cook Children’s Center for Children’s Health, said she heard creative problem-solving ideas from community leaders and partners who participated in our 2021 Community Health Needs Assessment (CHNA). Williams includes coalitions, healthcare systems, clinics, churches, public health experts and nonprofit organizations among the many groups that have stepped up to support schools.   

“The common thread with all of our community partners is that they genuinely want what’s best for children and families, and they’re willing to collaborate and explore partnerships in order to do that,” she said.

Williams highlighted the UNICEF Kid Power® platform as an example of a community collaboration that benefits the physical and mental health of schoolchildren. Through a partnership with Cook Children’s, the Kid Power videos are available free of charge for schools in Collin, Denton, Grayson, Hood, Johnson, Parker, Tarrant, and Wise counties. The videos promote exercise and life skills such as showing respect, making new friends and resolving conflict.

The 2021 CHNA parent survey conducted last year by the Center for Children’s Health yielded data on various health questions. One finding indicated in the survey? That 1 in 3 school-aged children ages 6-17 have at least one of the most commonly diagnosed mental health conditions (ADHD, anxiety, depression or behavioral/conduct problems). Also, more than 63,000 children are going without needed mental health care in the eight-county service area around Cook Children’s.

Williams said the Center shares the CHNA data with local organizations for strategic planning and grant-writing purposes – another example of community teamwork in Fort Worth and the surrounding area. 

Schools are working diligently to address the many variables that impact a child’s mental health and mental well-being, Williams said. The incorporation of social-emotional lessons helps too, she said, built into the school culture or curriculum so that students learn ways to cope and manage their emotions. 

 “We’re all going in the right direction,” she said. “There is a heightened awareness of the mental health needs of children, and many community partners are helping to connect families with available resources in their community.”

Participants in CHNA focus groups reported the challenge of finding providers who take their insurance, or sometimes difficulty with transportation to the appointments. Williams says those barriers make the schools a key location for delivery of mental health services. “Having those resources in the school is a protective factor for child mental health.”

About Cook Children's

Cook Children’s Health Care System embraces an inspiring Promise – to improve the health of every child through the prevention and treatment of illness, disease and injury. Based in Fort Worth, Texas, we’re proud of our long and rich tradition of serving our community. Our not-for-profit organization is comprised of nine companies, including our Medical Center, Physician Network, Home Health company, Northeast Hospital, Pediatric Surgery Center, Health Plan, Health Services Inc., Child Study Center and Health Foundation. With more than 60 primary, specialty and urgent care locations throughout Texas, families can access our top-ranked specialty programs and network of services to meet the unique needs of their child. For 100 years, we’ve worked to improve the health of children from across our primary service area of Denton, Hood, Johnson, Parker, Tarrant and Wise counties. We combine the art of caring with leading technology and extraordinary collaboration to provide exceptional care for every child. This has earned Cook Children’s a strong, far-reaching reputation with patients traveling from around the country and the globe to receive life-saving pediatric care. For more information, visit