mckinsey -依托校园服务改善青少年心理健康状况 Addressing youth mental health through school-based services

Mcsey

&company

June2025

EducationPractice

Addressingyouth

mentalhealththroughschool-basedservices

OneinfiveUSchildrenhasamentalhealthcondition.Schools

mayplayacriticalroleinprovidingevidence-basedinterventions.Wesuggestsixactionsforstatestoconsider.

byJimmySarakatsannisandLeahPollackwithEmmaDornandNikhilSeshan

ThenumberofUSchildrenstrugglingwith

mentalhealthchallengeshashithistorichighs.In2023,fourintenhighschoolstudentsreportedexperiencingpersistentfeelingsofsadnessor

hopelessness,andtwointenstudentsseriouslyconsideredattemptingsuicide.Foryouth,nearlyallindicatorsofpoormentalhealthandsuicidalthoughtsandbehaviorsworsenedfrom2013to

2023.

1

Despitethis,about50percentofyouths

withamentalhealthconditiondonotreceive

neededtreatmentorcounselingfromamental

healthprofessional.

2

Obstaclestogettingan

appointment,costissues,andalackofservicesweretheprimaryreasonschildrendidnotreceivecareformentalhealth.

3

Schoolshaveanopportunitytomakeadifference.Districtleadersconsiderstudentmentalhealth

tobeatoppriority(seesidebar“K–12district

fundingandspendingdynamics”).Yetresearch

hasshownthatschoolscurrentlylackthestaff

coverage,accesstolicensedmentalhealth

professionals,andfundingtoeffectivelyprovide

mentalhealthservices.

4

Tobettersupportstudents’mentalhealth,bothstatesandschooldistricts

couldconsiderhowtoprioritizeevidence-basedinterventionsanddeterminehowtosustainablyfundthem.

Ourresearchandexperiencesuggestthat

leadersofstateandlocalagencies—suchasstateeducationalagencies,localeducationalagencies,

stateMedicaidagencies,anddepartmentsof

health—couldtakesixactionstomakealasting

differenceinschool-basedservicesandthe

mentalhealthofstudents.Theseincludeofferingcomprehensiveservices,cultivatingcommunitypartnerships,buildingupthementalhealth

workforce,establishingacleargovernance

structure,implementingintegrateddatasystems,andsecuringsustainablefunding.

Oferingcomprehensiveschool-basedservices

Schoolshavealreadyprovedtobeanimportant

partofthecontinuumofcare:Halfofchildrenaged12to17whoreceivementalhealthservicesreceiveatleastsomeofthatcareineducationalsettings.

5

Thereisanopportunitytosustainandexpand

comprehensiveschool-basedservicestosupportchildrenandyouthswheretheyare.Theseincludethefollowing:

—upstreamservicesandsupportssuchas

promotionofwellness,includingsocialandemotionallearning

6

—prevention(forexample,briefscreeningfordepression)andeducationrelatedtomentalhealth

7

—safeandhealthyuseofsocialmedia

8

1YouthRiskBehaviorSurveydatasummary&trendsreport:2013–2023,USCentersforDiseaseControlandPrevention,August6,2024.

2DanielG.WhitneyandMarkD.Peterson,“USnationalandstate-levelprevalenceofmentalhealthdisordersanddisparitiesofmentalhealthcareuseinchildren,”JAMAPediatrics,February2019,Volume173,Number4.

3JulieFangMengandEileenWiznitzer,“Factorsassociatedwithnotreceivingmentalhealthservicesamongchildrenwithamental

disorderinearlychildhoodintheUnitedStates,2021–2022,”PreventingChronicDisease:PublicHealthResearch,Practice,andPolicy,October10,2024,Volume21.

4NirmitaPanchal,CynthiaCox,andRobinRudowitz,“Thelandscapeofschool-basedmentalhealthservices,”KFF,September9,2022.

5KeysubstanceuseandmentalhealthindicatorsintheUnitedStates:Resultsfromthe2019NationalSurveyonDrugUseandHealth,SubstanceAbuseandMentalHealthServicesAdministration,September2020.

6Forexamplesofevidence-basedsocialandemotionallearninginterventions,seeCASEL’swebsite.

7Forexample,thesecouldincludeschool-basedpreventioninterventionsforopioidusedisorderandcannabisusedisorderaswellas

interventionsforalcoholuseharmreduction.Formore,seeJoeMarkiewicz,KimSwanberg,andMartinWeis,“Awareness,education,and

collaboration:Promisingschool-basedopioidpreventionapproaches,”SubstanceAbuseandMentalHealthServicesAdministration,2018;Preventingmarijuanauseamongyouth,SubstanceAbuseandMentalHealthServicesAdministration,2021;and“SchoolhealthandAlcoholHarmReductionProject,”NationalDrugResearchInstitute,updatedonDecember19,2023.

8In2023,theOfficeoftheSurgeonGeneralissuedanadvisorycallingattentiontogrowingconcernsabouttheeffectsofsocialmediaonyouthmentalhealth.Formore,see“Socialmediaandyouthmentalhealth,”USSurgeonGeneral,2023.TheMcKinseyHealthInstitutealsorecentlycompletedresearchonthemixedimpactsofsocialmediauseonGenZ.Formore,seeEricaCoe,AndrewDoy,KanaEnomoto,andCheryl

Healy,“GenZmentalhealth:Theimpactoftechandsocialmedia,”McKinseyHealthInstitute,April28,2023.Thenot-for-profitCommon

Senseprovidesdigitalcitizenshiplessonplansforuseinschoolsthataddressanarrayofdigitalliteracytopics,includingmediabalanceandwell-being.

Addressingyouthmentalhealththroughschool-basedservices2

Addressingyouthmentalhealththroughschool-basedservices3

—earlyidentificationandintervention,suchasbriefinterventionsforanxietyandbullying

—treatmentthatreflectsthefullcontinuumofcareformentalhealthneeds,includinghigheracuity,whichmaybeprovidedbycommunitypartners9

—provisionoffamilysupportsandservicestocaregiversforthebenefitofthechild

9“WhatisPBIS?,”PositiveBehavioralInterventions&Supports,accessedFebruary18,2025.

K–12districtfundingandspendingdynamics

McKinsey’s2024surveyofapproximate-ly500schooldistrictsuperintendents

indicatesthatschoolswanttoprioritizestudents’mentalhealth.Butitremainschallengingtofundandstaffenviron-mentsthatcanadequatelysupport

students’needs,especiallygiventhatElementaryandSecondarySchool

EmergencyRelief(ESSER)fundinghasended.

Schooldistrictsanticipate

mentalhealthwillbeakeypriorityoverthenextthreeyears

Thementalhealthcrisisisreflectedin

threeofthetopfivespendingprioritiesforschooldistrictsinthecomingyears:

combatingchallengesinstudentbehav-ior,alleviatingstudentabsenteeism,andaddressingchallengesinstudentmentalhealth.Studentbehaviorandstudent

absenteeismsawthelargestincreasesinprioritizationcomparedwiththe

previousthreeyears,withrisesof18and14percentagepoints,respectively.1

Whenaskedhowtheyexpecttoaddressthesechallenges,nearlyhalfofall

surveyrespondentsnotedthatprovidingmentalhealthandwellnesseducation

andprogrammingwasatoppriorityinthecomingyears,withapproximately40percentplanningtoprioritizeandinvestinprovidingadditionalmentalhealthservices.2

Schooldistrictsexpectadecline

inbudgetsandareconcernedabout

theirabilitytofundprograms

However,contractingbudgetsandstaffingshortagesmaymakeitdifficultforschoolstorealizetheseplans.Pandemic-era

ESSERfundingprovidedapproximately

$190billiontoschooldistrictsfrom2021

to2024.3WiththeexpirationofESSER,

approximatelyhalfofdistrictsuperinten-

dentsareconcernedabouttheirabilityto

fundstudentprogramsmovingforward.4Inaddition,thereisuncertaintyaboutfutureactionsregardingtheUSDepartmentof

Education,TitleI,andtheIndividualswith

DisabilitiesEducationAct,significant

sourcesofcurrentfundingfordistrictmen-talhealthinitiatives.

1ESSERSurvey,McKinsey,2024,n=approximately500.

2ESSERSurvey,McKinsey,2024,n=approximately500.

3SchooldistrictsreportedspendinginitialCOVIDrelieffundsonmeetingstudents’needsandcontinuingschooloperations,USGovernmentAccountabilityOffice,September2024.

4ESSERSurvey,McKinsey,2024,n=approximately500.

Addressingyouthmentalhealththroughschool-basedservices4

Datahasshownthatyouthswithseriousemotionaldisturbancearetwotimesmorelikelytodrop

outofschoolthanthosewithotherdisabilities.

10

Proactivelyidentifyingstudentswithmental

healthneedspriortointerventionmayimprove

outcomes,

11

saveoncosts,andincreaseschool

attendance.

12

Forexample,someschoolshave

successfullyimplementedanevidence-based

schoolinterventioncalledtheGoodBehavior

Game,ateam-andclassroom-basedbehavior

managementstrategy.

13

Teachersandotherschoolstaffwhohaveusedthisinterventionhavecreatedclassroomenvironmentsthataremoresupportiveforstudentswithmentalhealthneeds,leadingtofewerclassroomdisruptions.

Toaddresstheneedsofallstudents,

comprehensivecareincludesanarrayof

research-andevidence-basedpracticesalong

thecontinuumofcare,suchasuniversalmental

healthscreenings,

14

social-emotionallearning,

15

andinterventionsthattargetstudentmentalhealthchallengesandpositivelyaffectacademicoutcomes(suchastheBriefInterventionStrategyforSchool

CliniciansandCognitiveBehavioralIntervention

forTraumainSchools16).Stateagenciescouldalsoconsiderprovidingincentivesandresourcestohelpdistrictssupportthementalhealthneedsofschoolstaff;doingsohasbeenshowntopositivelyaffectthementalhealthofstudents.

17

Theseinterventionscouldaddressstress,burnout,anxiety,and

secondarytraumaamongschoolstaff.

18

Multiplestateagencies(includingstateeducation,health,andMedicaidagencies)havereleased

guidanceandprovidedfundingandtechnical

supporttohelpdistrictsadoptcomprehensive

mentalhealthservicesinschools.Forexample,the

stateeducationalagenciesofWisconsin

andColoradoreleasedframeworksforschool-

basedmentalhealthservices,andMichigan

launchedatechnical-assistancecentertosupportstateagenciesinimplementingcomprehensive

caremodels.

19

Cultivatingstrongcommunitypartnerships

Comprehensiveservices,frompreventionto

targetedsupports,aremosteffectivewhen

schoolspartnerwithlocalcommunitiesto

understandcommunityneedsandbuildupon

existingcommunityassets.Youngpeoplethrive

whentheyliveinhealthy,inclusivecommunities

thataugmentprotectivefactorsthatarevitalto

increasingresilienceandwell-being.

20

Conversely,mentalhealthconditionsmaybeexacerbated

bychallenginglivingconditions,suchashousing

insecurity.Communitypartnershipscouldbea

conduittoamoreholistic,wraparoundsupport

systembyconnectingschoolswithabroaderset

ofsocialservicesandcommunity-basedresources(suchashousing,transportation,andfamily

supports),thusreducingtheburdenonschoolsandindividualstudenthouseholds.

Communitypartnershipsmayincludecollaboratingwithfamily-andyouth-basedorganizationssuch

asSesameWorkshop(forpreschool-agedchildrenwhohaveexperiencedtrauma),Federationfor

Families,CommunityAnti-DrugCoalitionsof

America,andYouthMOVE.Partnershipscouldalsoinvolvefaith-basedorrecreationalorganizations

thatoffermentorshipandsocialsupports,ortheycouldincludephysical-healthproviderssuch

asoutpatientclinics,federallyqualifiedhealth

10“OSEPfastfacts:Childrenidentifiedwithemotionaldisturbance,”IndividualswithDisabilitiesEducationAct,May6,2020.

11Scalingcoordinatedspecialtycareforfirst-episodepsychosis:Insightsfromanationalimpactmodel,NationalAllianceonMentalIllness,November2024.

12LisaB.Dixonetal.,“TransformingthetreatmentofschizophreniaintheUnitedStates:TheRAISEInitiative,”AnnualReviewofClinicalPsychology,January12,2018,Volume14.

13Formore,seeGoodBehaviorGameatAmericanInstitutesforResearch.

14See,forexample,“Schoolmentalhealthqualityguide:Screening,”SchoolHealthAssessmentandPerformanceEvaluationSystem,2023.

15SeeSecondStepforexamplesofprogramming.

16Formore,seethewebsiteofTheCenterforSafeandResilientSchools.

17Advancingcomprehensiveschoolmentalhealthsystems:Guidancefromthefield,NationalCenterforSchoolMentalHealth,

September2019;Everyyoungheartandmind:Schoolsascentersofwellness,MentalHealthServicesOversight&AccountabilityCommission,October7,2020.

18LindseyPhillips,“Acloserlookatthementalhealthprovidershortage,”CounselingToday,May2023.

19Advancingcomprehensiveschoolmentalhealthsystems:Guidancefromthefield,NationalCenterforSchoolMentalHealth,September2019.

20“Protectivefactors,”NationalCenteronSafeSupportiveLearningEnvironments,accessedonFebruary18,2025.

Addressingyouthmentalhealththroughschool-basedservices5

centers,primarycareandpediatricpractices,

andhospitals.Thesepartnershipscanincreasethevolumeandtypesofmentalhealthservicesavailableforstudentsbothwithinandoutside

theschoolbuilding.

21

Schooldistrictscould

considertelehealth-basedpartnershipstobringaccessibleandremoteservicestoregionswheretransportationtoaphysicallocationisabarriertocare.

22

Stateagenciescouldconsiderestablishingor

enhancingexistingstateandlocalchildren’s

cabinets.

23

Thesecollaborativenetworksaremade

upofchildren’shealthadvocates,peers,and

youngadultswithlivedexperiences;government

officials;andprivatesectorornot-for-profit

leaders.Theyofferabroadplatformforsharing

knowledge,capabilities,andresourcesandfoster

adeepsenseofaccountabilityfromagovernance

andpolicystandpoint.Asof2019,27stateshave

stoodupchildren’scabinets(orsimilarstructures),

with30percentofthosecabinetsembeddedin

thegovernor’soffice.

24

Forexample,Maryland’s

Children’sCabinetprioritizesinterventions

andsupportstoaddressadversechildhood

experiences,preventout-of-stateplacements

throughstrongerinteragencycollaboration,addressyouthhomelessness,andmore.

25

Buildingarobust,diverse,andwell-trainedmentalhealthworkforce

Schoolsystemscannotwaitforbroadermental

healthworkforceshortagestoberesolved.Actionscanbetakennowtomitigateshortages—includingexpandingcoachingandpeersupport,upskilling

existingstaff,andexpandingtelehealthservices.Itmaybepossibletoattractadditionaltalenttothe

fieldbyreformingcomplexlicensureandeducation

requirements,increasingcompensation,and

recognizingandfundingthefullarrayofmental

healthprofessionals.Peersupportspecialists,

communityhealthworkers,mentalhealthcoaches,andschool-basedmentalhealthcoordinatorscan

expandthediversityandavailabilityofservices

andinterventionsformildtomoderateconditions

whilefreeingupcapacityforlicensedclinicians

toaddressmoresevereorcomplexconditions.In

addition,researchsuggeststhatstudentsareopento,andwant,peersupport.Forexample,ina2020MentalHealthAmericasurvey,44percentofyouthsaged14to18respondedthatsupportfromother

youngpeoplewouldbemosthelpfulfortheirmentalhealth,

26

highlightinganopportunitytoincrease

peersupportspecialists.

Statescouldalsoconsideropportunitiestotrainandupskillneworexistingschool-basedstaffwhoplaymeaningfulrolesinfosteringstudentwell-being.

Forexample,educatingandtrainingteachers,

coaches,andadministrativestaffaboutmental

healthandsubstanceusedisordersmayincreasereferralstoscreening,supports,andservices.

Last,somestatesmayconsiderexpanding

telehealthsupportsandservicesinschoolsby

embracingrelevanttechnologiesandremoving

barrierstotelehealthreimbursementsinschool-

basedsettings.Doingsocouldpotentiallyaddressshortagesinschoolpsychologistandotherclinicianroles,reducewaittimestoseeaprofessional,and

allowschoolstoreachabroadergroupofstudents.

27

Severalstateshavealreadybeguntakingthese

typesofactions.Forexample,in2021,California

launchedtheChildrenandYouthBehavioralHealthInitiative(CYBHI),amorethan$4billioneffortto

enhance,expand,andredesignthesystemsthat

21Advancingcomprehensiveschoolmentalhealthsystems:Guidancefromthefield,NationalCenterforSchoolMentalHealth,September2019.

22Preliminaryevidencesuggeststelehealthservicesmaybeasfeasible,acceptable,sustainable,andeffectiveasin-personservices.For

example,onestudyfoundasignificantconcordancebetweenvideoandin-personevaluationsandnomeaningfuldifferenceinsatisfactionintheuseoftelehealthwithchildrenandadolescents.NicoleE.Gloffetal.,“Telementalhealthforchildrenandadolescents,”InternationalReviewofPsychiatry,2015,Volume27,Number6.

23Formore,see“Children’sCabinetNetworks,”ForumforYouthInvestment,accessedonFebruary18,2025.

24“Buildingandempoweringimpactfulchildren’scabinets,”NationalGovernorsAssociation,March8,2024.

25“MarylandChildren’sCabinetthree-yearplan(2021–2023),”MarylandGovernor’sOfficeofCrimePreventionandPolicy,2021.

26Youngpeople’smentalhealthin2020:Hope,advocacy,andactionforthefuture,MentalHealthAmerica,2020.

27Preliminaryevidencesuggeststelehealthservicesmaybeasfeasible,acceptable,sustainable,andeffectiveasin-personservices.For

example,onestudyfoundasignificantconcordancebetweenvideoandin-personevaluationsandnomeaningfuldifferenceinsatisfactionintheuseoftelehealthwithchildrenandadolescents.NicoleE.Gloffetal.,“Telementalhealthforchildrenandadolescents,”InternationalReviewofPsychiatry,2015,Volume27,Number6.

Addressingyouthmentalhealththroughschool-basedservices6

supportmentalhealthforchildrenandyouths.In

addition,CYBHIexpandsthenumberofmental

healthtrainingopportunitiesacrossthestate,

buildsoutanew“wellnesscoach”role,andprovidestrauma-informedtrainingforalleducators.28

Establishingacleargovernanceandaccountabilitystructure

Achievingeffectiveandcontinuousdeliveryof

comprehensiveserviceswithinschoolsrequires

collaborativeeffortsamongessentialsystems

concernedwithchildwelfare,suchascommunity-basedorganizations,serviceproviders,andotherstateagenciesresponsibleformentalhealth,

education,justice,childwelfare,housing,and

socialservices.Toooften,thesesystemsoperateinsilos,limitingthepotentialforimpactbecauseofuncoordinatedeffortsinfunding,datasharing,

stakeholderengagement,accountability,anddecision-making.

Statesmaybenefitfromcreatingamore

coordinatedcentralgoverningstructurethat

prioritizesthehealthofchildrenandyouthsandhasregulartouchpoints.Thegovernancestructures

couldbeformalizedandfullyfunded.Inaddition,

rolesandresponsibilitiescanbedelineatedacrossrelevantcommunityandsystemstakeholders—

includingeducators,pediatricians,psychiatrists,schoolpsychologists,counselors,socialworkers,andagencyleaders—inthementalhealthjourney.

Acoreaspectofthisstructureisincludingthe

voicesofyouthsandfamilieswithlivedexperiencesaspartofthedecision-makingprocess(see

sidebar“Guidingprinciplestosupportthesixactions”).

28“CYBHIforSchools,”CYBHI,May3,2024.

Guidingprinciplestosupportthesixactions

Statescouldadoptasetofguiding

principlestohelpshapetheapproachto

thesixactions.Examplesofthesetypesofguidingprinciplesincludethefollowing:

Youth-guidedandfamily-driven

Statesmaywishtoadoptayouth-and

family-centeredapproachthatensures

youthsandtheirfamilies,asthe

beneficiariesofschool-basedservices,

haveacentralroleinguidinganddriving

coreelementsofassessment,design,anddecision-making.Children’scabinets,

schooldistricts,andyouthandfamily

advocacygroupsatthenationalandstatelevels(suchasFederationforFamilies,

YouthMOVE,ActiveMinds,andCommunityAnti-DrugCoalitionsofAmerica)maybe

naturalpartnersinthiswork.

Equitableandinclusive

Toachievelarge-scalechange,stateswillneedtounderstandhowthestartingpointandprojectedimpactofdifferentactions

mayvarybydemographicgroup(suchas

byraceandethnicity,disabilitystatus,andincomelevel).Statesmaywishtoadopt

anapproachthatemphasizesequityand

inclusionateachstepintheprocess,

includingcontinuousmeasurementto

supportidentificationofdisparitiesand

inclusionofadiverseandrepresentative

setofvoicesineveryelementofthedesignanddecision-makingprocess.

Collaborative

Addressingtheneedsofyouthandfamiliesrequiresawhole-stateandwhole-communityapproach,withall

stakeholdersworkingcollaborativelyto

providestreamlinedservices.Without

strongstateleadership,organizationalandfundingsilosmaystallorslowcriticalwork.Strongleadershipandconveningfrom

governors’offices,regularcross-agency

leadershipmeetings(forexample,from

agenciesfocusingonchildwelfare,mentalhealthandsubstanceuse,education,andjuvenilejustice),andongoingstate-and

community-levelcommunicationwith

stakeholdersmaybehelpfulstructuresforstatestoestablishorstrengthen.

Addressingyouthmentalhealththroughschool-basedservices7

Implementingintegrateddatasystems

Datacanbeapowerfultoolfordrivingequitable,

systemicchangebyprovidingacomprehensive

viewofthelandscapeofschool-basedmental

healthneeds,resources,providers,andoutcomes.Itcanbeusedtoidentifyareasoffocusbased

ondisparatestudentneeds,suchassuicidality

amongfemaleorLGBTQ+studentsoranxietyratesamongBlackboys.Datacanthenbeusedtomap

thoseneedstoavailableresources,suchasthe

numberofchildren’smentalhealthprofessionals

orthenumberofclinicianstrainedinculturally

relevantcaretoserveTribalyouths.Followingthismapping,thedatacanbeusedtoidentifygapsin

treatment—forinstance,ifaparticulardistricthasinsufficientstafftrainedintrauma-informedcare.

Data’spotentialimpactonmentalhealthoutcomesisevidentincrisis-counselinghotlinesthatuse

machinelearningtoidentifyindividualsmostatriskforsuicidalideationorself-harmandmovethemtothefrontofthequeue.

29

Strategicuseofdatacanhelpdrivecontinuous

qualityimprovementacrossservicesbyallowing

statestotrackoutcomesandassessimpactacrossavarietyofhealthindicators,suchaschanges

instudents’academicperformance,ratesof

depression,andsubstanceuse.Itcanalsobe

usedtohelpstreamlinecareandsustainfundingacrosssystemsandproviders,asseeninthedatacollectioneffortsbySystemofCaregrantees

oftheSubstanceAbuseandMentalHealth

ServicesAdministration,nowtheAdministrationforaHealthyAmerica.

30

Datarelatedtochild

andyouthmentalhealthoutcomesarecollectedatregularintervalstohelpgrantmakers,

communitymembers,providers,andsystem

leadersunderstandtheimpactofthosegrantsonimprovingchildandyouthhealth.Similarly,stateagenciescouldcollectdatatohelpclarifystudentneedsandguidepolicytowardbetteroutcomes

oruseavailabledatafromschooldistricts,public

healthagencies,orpartnershipswithuniversityresearchdepartments.

Stateswillneedtoensurealignmentwithdata

privacylawssuchasHIPAAandFERPA,

31

includingconsentfromyouthsandfamiliestosharetheirdata.Throughappropriateandtransparentdata-sharingagreements,statescouldconsiderintegrating

dataaboutmentalhealth,substanceuse,orschoolclimateintostatereportingandaccountability

systems(forexample,schoolreportcardsas

requiredbytheEveryStudentSucceedsActand

reportsbystateorlocalgrantprograms).Andtheycouldpotentiallyworkwithotheragenciesfocusedonchildrenandyouths,suchasthoseinvolvedin

childwelfareandjuvenilejustice,tosetbenchmarksandcommongoalstotrackprogresstowardbetterK–12outcomes.

32

Securingflexibleanddiversifiedfundingmechanisms

Alltheaboverecommendationsfallflatwithout

thefundingtomakethempossible.WithESSER

fundingnowexpiredandfuturefederalfunding

uncertain,statesareataninflectionpoint.

Alternativefundingmechanisms,suchasinsurancereimbursement,maybeneededtosustainand

enhanceschool-basedmentalhealthservices.

Insurancereimbursement

In2023,theCentersforMedicare&Medicaid

Services(CMS)releasedupdatedguidanceto

statestofacilitatereimbursementforhealthcare

servicesprovidedinschool-basedsettings.

33

Thisguidancebuildsonprioreffortstofacilitate

reimbursement,suchasthe2014CMSguidance

allowingstatestopayformedicallynecessary

servicesforanystudenteligibleforMedicaid,

34

regardlessofwhetherthoseservicesareidentifiedinanindividualizededucationprogramor

individualizedfamilyserviceplan.

29BrianResnick,“HowdatascientistsareusingAIforsuicideprevention,”Vox,June9,2018.

30“SystemofCare,”NTTACMentalHealth,accessedJune3,2025;

31TheHealthInsurancePortabilityandAccountabilityActandtheFamilyEducationalRightsandPrivacyAct.

32Advancingcomprehensiveschoolmentalhealthsystems:Guidancefromthefield,NationalCenterforSchoolMentalHealth,September2019.

33“Deliveringserviceinschool-basedsettings:AcomprehensiveguidetoMedicaidservicesandadministrativeclaiming,”CMS,May18,2023.

34“SMD#14-006,Re:Medicaidpaymentforservicesprovidedwithoutcharge(freecare),”CMS,December15,2014.

Addressingyouthmentalhealththroughschool-basedservices8

Findmorecontentlikethisonthe

McKinseyInsightsApp

Scan•Download•Personalize

StatescouldalsoconsideropportunitiestoexpandprivateinsuranceandMedicaidparticipationin

thereimbursementofschool-basedservicesand

looktootherstatesforinspiration.InCalifornia,

forexample,CYBHIestablishedafirst-of-its-kindmultipayerfeescheduleprogram

35

tomakeit

easierforchildrenandfamiliestoreceiveoutpatientservicesandsupportformentalhealthand

substanceusedisorderwhen,where,andhowtheyneedthem.Thisprogramallowslocaleducational

agenciesandpublicinstitutionsofhighereducationtoreceivereimbursementforservicescarriedout

inschools.Sinceitsinception,morethan3.6millionstudentsandmorethan500localeducational

agencieshaveenrolledinthep