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Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory 20 For example, districts could dedicate staff at the district level to implementing evidence-based programs across multiple schools). Districts could also implement mental health literacy training for school personnel (e.g., Mental Health Awareness Training, QPR training). Expand the school-based mental health workforce.152 This includes using federal, state, and local resources to hire and train additional staff, such as school counselors, nurses, social workers, and school psychologists, including dedicated staff to support students with disabilities. For example, a lack of school counselors makes it harder to support children experiencing mental health challenges. The American School Counselor Association (ASCA) recommends 1 counselor for every 250 students, compared to a national average of 1 counselor for every 424 students (with significant variation by state).153 The American Rescue Plan's Elementary and Secondary School Emergency Relief funds can be used for this purpose and for other strategies outlined in this document.154 Support the mental health of all school personnel. Opportunities include establishing realistic workloads and student-to-staff ratios, providing competitive wages and benefits (including health insurance with affordable mental health coverage), regularly assessing staff wellbeing, and integrating wellness into professional development.155 In addition to directly benefitting school staff, these measures will also help school personnel maintain their own empathy, compassion, and ability to create positive environments for students.156 Promote enrolling and retaining eligible children in Medicaid, CHIP, or a Marketplace plan, so that children have health coverage that includes behavioral health services. The Connecting Kids to Coverage National Campaign also has outreach resources for schools, providers, and community-based organizations to use to encourage parents and caregivers to enroll in Medicaid and CHIP to access important mental health benefits. Families can be directed to HealthCare.gov or InsureKidsNow.gov. Schools can use Medicaid funds to support enrollment activities and mental health services.157 Protect and prioritize students with higher needs and those at higher risk of mental health challenges, such as students with disabilities, personal or family mental health challenges, or other risk factors (e.g., adverse childhood experiences, trauma, poverty).158 Resources for Educators, School Staff, and School Districts Supporting Child and Student Social, Emotional, Behavioral, and Mental Health Needs (Dept. of Education): Guidance for schools, school districts, and education departments National Center for School Mental Health: Resources to promote a positive school climate StopBullying.gov: Learn about what bullying is, who is at risk, and how you can help Turnaround for Children Toolbox: Tools to drive change towards a more equitable, whole- child approach to school Design Principles for Schools: Framework for redesigning schools with a focus on supporting students’ learning and social and emotional development Safe Schools Fit Toolkit (National Center for Healthy Safe Children): Resources and guides to build safe and healthy schools Mental Health Technology Transfer Center Network: School mental health resources Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory 21 Our health care system today is not set up to optimally support the mental health and wellbeing of children and youth. In addition to changing government policy (see recommendations for Governments on page 33), we must reimagine how health care organizations and health professionals prevent, identify, and address mental health challenges. Below are some steps health care organizations and health professionals can take: Recognize that the best treatment is prevention of mental health challenges. Implement traumainformed care (TIC) principles and other prevention strategies to improve care for all youth, especially those with a history of adversity. In addition to working in the clinic, for example to educate families on their role in healthy child development, health care professionals should work with other sectors (e.g., schools, child care, justice, social services, public health) on prevention strategies. For instance, health care professionals can refer patients to resources such as economic supports, school enrichment programs, and legal supports.12 Routinely screen children for mental health challenges and risk factors, including adverse childhood experiences (ACEs).159 Screenings can be done in primary care, schools, emergency departments, and other settings. For example, primary care providers can conduct screenings during well-visit appointments, annual physicals, or routine vaccinations using principles of traumainformed care. Screenings should account for the diverse ways in which mental health challenges can manifest, such as changes in physical health, sleep patterns, and behaviors. It’s critical that screening services link to appropriate follow-up care. The American Academy of Pediatrics offers tools and resources for screening processes. California’s ACEs Aware initiative offers ACEs screening tools for children, adolescents, and young adults. Identify and address the mental health needs of
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