The Behavioral Health Approach to Closing Ohio’s Educational Achievement Gap

Having convened for its final two scheduled meetings earlier this month, the Speaker’s Task Force on Education and Poverty (STFEP) will soon present its findings and recommendations for closing Ohio’s educational achievement gap in a report to the General Assembly. Over the past five months, The Center for Community Solutions has followed the deliberations of the task force as it heard testimony from witnesses with expertise in education, social services, behavioral health, early childhood development, and more. Judging by the group’s efforts to learn from all systems that bear influence on the educational achievement of children in poverty, we can expect any recommendations the group issues to be multifaceted, leveraging the capacities of multiple systems to create a deeper support network for disadvantaged students.

In a recent report, Community Solutions drew attention to the need for greater state and local investments in substance use prevention efforts both in schools and throughout entire communities. In February of this year, the Joint Study Committee on Substance Use Prevention Education issued 15 recommendations for policymakers to strengthen the abilities of schools to effectively educate students on the dangers of drug and alcohol dependency. Although Ohio’s addiction epidemic is far from the only barrier faced by students living in poverty, the consequences of mental health and addiction disorders on academic performance cannot be understated. The recommendations to be issued by STFEP are another opportunity to bring meaningful policy solutions to the attention of the General Assembly, so that Ohio can take necessary steps toward ensuring all students have access to behavioral health services and effective prevention education, regardless of socioeconomic status.

This issue was brought to light during the task force’s meeting on November 9, when it heard testimony from Teresa Lampl of the Ohio Council of Behavioral Health and Family Services Providers. Ms. Lampl presented the group with multiple statistics that make the case for a strengthened relationship between the behavioral health and education systems. For example:

  • About 50 percent of behavioral health conditions develop before the age of 14, with 75 percent present by the age of 24;
  • Suicide is the second leading cause of death for 15-24 year-olds;
  • Youth that begin drinking alcohol before age 15 are six times more likely to develop dependence or abuse than those who begin drinking at age 21.

Ms. Lampl also pointed to the negative impacts of adverse childhood experiences (ACEs), which are stressful or traumatic events, such as abuse or neglect, that can result in a near constant state of extreme stress and severely impair a student’s ability to focus and store new information. There is extensive evidence that children with ACEs are at higher risk of mental and substance use disorders later in life.  Unsurprisingly, children living in or near poverty are much more likely than their peers to have ACEs, making it even more difficult to lift themselves out of poverty through academic success. Breaking the cycles of both poverty and addiction faced by so many young people throughout Ohio will require an enhanced capacity of schools to provide for the behavioral health needs of their students, both through universal prevention and targeted intervention efforts.

Of course, as the Ohio Council has found, there are challenges to seamlessly integrating behavioral health services and prevention curricula in school settings. Schools often lack both the time in the school day and the physical space necessary to provide quality services. Principals, teachers, and guidance counselors can be resistant to bringing in outside professionals to work with students. Likewise, parents of the children with the greatest needs can be difficult to engage. And perhaps the greatest challenge is a lack of stable funding, particularly for prevention and early intervention services which rely heavily on grant funding and other local sources due to limited options for reimbursement through commercial insurance.

Despite these challenges, the Ohio Council’s member providers maintain successful relationships with partner schools throughout the state. In a voluntary survey earlier this year, 36 private behavioral health providers indicated that they are delivering prevention, early intervention, and/or treatment services in 1,160 school buildings in over 200 school districts. According to the survey results, the school-provider relationship is most successful when:

  • A wide variety of evidence-based practices are in use and tailored to the individual school’s culture;
  • There is clarity in roles and responsibilities for school personnel and behavioral health professionals;
  • Educators feel supported by behavioral health professionals in achieving academic performance;
  • There is open communication and mutual respect between school personnel and behavioral health professionals;
  • Treatment services are funded as health care services by Medicaid and some commercial insurance.

Ms. Lampl emphasized that Ohio has knowledge and a strong infrastructure to expand school-based behavioral health services, and offered the following policy recommendations to achieve this goal:

  • Create a unified state policy on prevention across all state agencies;
  • Recognize and reimburse prevention of substance use and mental illness as a health care service;
  • Assist and encourage school district/building and community behavioral health provider partnerships;
  • Support school, family, and community engagement in implementation of positive behavioral support interventions and adoption of evidence-based practices to address school-community culture;
  • Support continuing education for teachers and principals  in social-emotional development, ACEs and toxic stress, and trauma informed classroom management;
  • Develop strategies to address the shortage of addiction and mental health treatment professionals.

Though it remains to be seen whether any of these recommendations or similar ones will be incorporated into the task force’s report to the General Assembly, the group is keenly aware that the needs of students in poverty cannot be met in the classroom alone. When Wellston School District Superintendent and Task Force Member Karen Boch was asked the first thing her district would do with increased funding, her immediate response was wraparound services.

Poverty’s toll on educational outcomes is inextricably tied with poverty’s impact on behavioral health. School-based behavioral health prevention and treatment services are a key element of the kind of wraparound services necessary to ensure all children can go to school ready to learn, allowing schools to finally begin closing the achievement gap between students in poverty and their more affluent peers.