July 1st, 2024
How Methuen Public Schools Selected Relevant Resources to Create a Comprehensive School Mental Health System
This case study is provided directly from the named school district and may not be applicable to every community’s needs. Examples are provided for educational and informational purposes only and do not necessarily reflect the position of SecondMuse or its partners, The Jed Foundation (JED) and the Meadows Mental Health Policy Institute.”
Challenge
From 2013 to 2015, Methuen Public Schools saw a rise in student behavioral issues and mental health challenges. They began a decade-long effort to develop new methods for screening and supporting students, and connecting them to essential services.
Approach
Methuen developed a Comprehensive School Mental Health System (CSMHS) as a participant in the University of Maryland’s Center for School Mental Health's National Quality Initiative program, creating a detailed plan, focused on consistently improving quality.
Results
Methuen's mental health system is a national model. Screening high school students for anxiety and depression increased identified cases by 66%. They now offer enhanced in-school mental health services, including care coordination and targeted screening for all.
About Methuen Public Schools
Methuen Public Schools is located 30 miles north of Boston, an area that has been heavily affected by the opioid crisis. Like other schools facing similar challenges, Methuen deals with a range of mental health challenges. The district comprises one PreK center, four K–8 schools and one high school, serving 6,532 students. Half of those students live in poverty, and more than 30% of them speak a native language other than English. (Methuen has partnered with TalkingPoints, a technology solution focused on family engagement to provide a communication tool for preferred language translation.) During the 2023-24 school year, Methuen had just over 500 teachers and about 50 staff clinicians. That resulted in a 12-to-1 student-to-teacher ratio, which is higher than the state average.1
Methuen’s Challenge: Need for a Comprehensive School Mental Health System
Without a Comprehensive School Mental Health System (CSMHS), Methuen Public Schools could not ensure all students who needed mental health support received it. In the 2014-15 school year, John Crocker, M.Ed., the Director of School Mental Health and Behavioral Services, and his team started to develop and implement CSMHS in Methuen Public Schools. At that time, setting up a CSMHS was a bold and rare goal. Crocker, however, recognized the need to upend the system as it existed and make advancements toward changing the field.
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Student Challenges: Anxiety and Depression
Using data from the Youth Risk Behavior Surveillance System, counseling logs, and student staff reports, anxiety and depression were found to be the top areas of concern and most prevalent among their high school students.
Existing Programming
Methuen previously used a school counselor model in which different types of counselors offered different services. For instance, guidance counselors helped all students develop social-emotional skills. They also focused more on helping students with schoolwork and planning for college or careers. Some counselors specialized in handling crises and helping students access care, often by connecting them with community services. As they built their plan for a CSMHS, they recognized this model wasn’t working. They needed a more comprehensive staffing model, one that, among other things, allowed them to rework caseload assignments.
Barriers to Change
- Community stakeholders, parents, and students were not used to talking about school mental health
- Funding
- Role definition and staffing models
- Limited clinical supervision available for counselors and clinical staff
- Limited professional development for staff
- Staff readiness to support additional referrals for mental health services
- School mental health infrastructure, including teaming, data systems, and ability to conduct needs assessment resource mapping
Opportunities for Change
Methuen Public Schools applied and was accepted to join the first cohort of districts collaborating with the University of Maryland’s Center for School Mental Health’s National Quality Initiative program. Methuen was engaged in a learning collaborative and had the ability to access the expertise of the National Center for School Mental Health and gain support in developing a framework for planning prevention and intervention services.
Strategic Priority: Creating a formal system for collecting, analyzing, and using data.
Methuen did not have a system for collecting, analyzing, and using psychosocial data, which they uncovered while working with the Center. Their main goal had been identifying students who needed help and providing them with access to care using the clinical staff they already had working in the district.
By using the School Health Assessment and Performance Evaluation (SHAPE) system, however, they were able to create a plan focused on continuously improving quality.
SHAPE is a web-based platform open to the public that supports the improvement of school mental health services. It provides users with the ability to assess, track, and enhance goals for improved quality. With an interactive dashboard, users can create custom reports to plan activities, monitor performance, and track progress.
By using the School Health Assessment and Performance Evaluation (SHAPE) system, however, they were able to create a plan focused on continuously improving quality.
SHAPE is a web-based platform open to the public that supports the improvement of school mental health services. It provides users with the ability to assess, track, and enhance goals for improved quality. With an interactive dashboard, users can create custom reports to plan activities, monitor performance, and track progress.
Objective 1:
Select specific screening tools to support identification and intervention
Why:
Methuen’s goal was to identify students who needed help and ensure they could access care through the mental health staff already at the school. Crocker, the director, explained that the focus was on making sure the clinical staff could use their field training to effectively support students.
What it Took:
- Formed a mental health committee with clinical and administrative staff from each school to ensure collaboration
- Engaged parents and caregivers through presentations and newsletters to raise awareness and support
- Chose evidence-based, cost-effective screening tools
- Piloted specific tools for ease of use, and validated data to inform evidence-based, therapeutic intervention plans and assess student progress and needs
Objective 2:
Start a pilot program at the high school to screen all students for anxiety and depression using Plan-Do-Study-Act (PDSA) cycles
Why:
Methuen began screening during one of its first PDSA cycles because the mental health staff could not easily tell which students needed help or identify internalizing concerns. It often took a crisis, staff, parent, or self-referral to identify those students. They chose to start with high school students because the assessment of needs showed it was necessary, and they had the staff and technology available at that level to screen.3
What it Took:
- Provided training for staff on screening, data collection, and review
- Created guidance for clinical interviews, understanding results, and referring students for school- or community-based support
- Planned follow-up for after screening, including having crisis teams ready and informing community partners to prepare for potential referral surges
Objective 3:
Make targeted mental health screening a sustainable practice
Why:
Screening students of every age helped Methuen identify the mental health services needed across the district for different age groups, enabling them to plan both immediate and future actions. Early identification of students in need of support helped make the case to key stakeholders that additional staff could significantly reduce their caseloads, which are currently down to about 150 students for each staff member. It also meant students could be referred sooner to preventive care that could reduce crises.
What it Took:
- Changed policy and protocols for obtaining guardian permission to screen
- Conducted screenings during advisory periods using secure Google Workspace forms to adhere to privacy and security policies
- Managed more referrals by creating group therapy programs and collaborating with community partners
- Used free, accurate screening tools to identify externalizing and internalizing disorders in students4
District and Student Outcomes
From 2020-21 to 2022-23, Methuen increased identification of students with mental health needs and saw decreased anxiety and depression in grades 5-12.
From 2020-21 to 2022-23, Methuen saw rates of moderate and severe PTSD in students decrease by 52.6% in grades 5-8 and 68.7% in grades 9-12.
In 2017-18, 236 intervention plans were created for students newly identified for individual services, 68.7% of whom showed improved behavioral outcomes.
Key Takeaways and Learnings
In the past decade, Methuen Public Schools has learned numerous lessons. Committed to sharing those insights, they offer further details on their experiences here: The Methuen Comprehensive School Mental Health System (CSMHS): 2013-2019 and in their strategic plan.
Some specific lessons include:
Some specific lessons include:
Insight #1
Technology enhancements sped up services
Ten years after starting CSMHS, Methuen Public Schools has budgeted for and greatly increased the number of staff clinicians and their ability to serve students in need. Initially, Methuen used paper and pencil screenings. Early on, however, they learned from their PDSA cycles that using computers allowed mental health staff to access data faster. That helped them quickly identify students who needed urgent care, especially those showing signs of self-harm or suicidal thoughts.
By providing iPads to all high school students and using online consent forms, screenings became more efficient and data collection improved. The data not only tracks progress and the effectiveness of interventions, but also helps relate local experiences to national trends.
By providing iPads to all high school students and using online consent forms, screenings became more efficient and data collection improved. The data not only tracks progress and the effectiveness of interventions, but also helps relate local experiences to national trends.
Insight #2
Shifting to a passive consent model increased participation
For Methuen, switching to a passive, opt-out consent model that aligns with state policies for other types of screenings, such as vision or hearing, has made it easier for Methuen to screen students. There is only a 1% opt-out rate across the district. Several times a year, via the district’s all-call system and email, parents and caregivers are provided with information about opting out. Students are also provided with a verbal opt-out message just before each screening, letting them know they can choose not to participate.
The district keeps parents and caregivers up to date about all the elements of the CSMHS through its website, email, and an automated calling system. Methuen’s dedicated website for mental health screening includes a “Why It Works” section, details on crisis protocols and the referral process, FAQs, links to the screening tools, and an opt-out form.
The district keeps parents and caregivers up to date about all the elements of the CSMHS through its website, email, and an automated calling system. Methuen’s dedicated website for mental health screening includes a “Why It Works” section, details on crisis protocols and the referral process, FAQs, links to the screening tools, and an opt-out form.
Insight #3
Ongoing monitoring and improvements ensure success
Over the past decade, Methuen Public Schools has continuously refined its mental health program, from updating staff roles to adding new screening tools and providing more training. The district is dedicated to enhancing its CSMHS. For example, by partnering with Care Solace, a care-matching service that partners with a national database of providers, Methuen has saved hundreds of clinical hours previously spent on coordinating community-based care. Those hours are now redirected to student support. Methuen also has received a grant to consider expanding services through a telebehavioral health partner, aiming to further improve student support.
Plans for Sustaining and Expanding the Program
Methuen has committed to continuous improvement of their CMSHS. Continuously contextualizing nationwide data by using Methuen-specific numbers, such as the fact that 20% to 22% of Methuen’s high-schoolers fall into the moderate to severe range for anxiety and depression, remains crucial for shifting mindsets and reallocating funds to hire additional school mental health staff.
Challenges and Opportunities
Challenges:
- Ensuring the district is providing culturally and linguistically matched services
- Continuing to improve the quality and enhance the scope of evidence-based, therapeutic programming
Opportunity:
- The district has started using Collaborative Problem Solving and plans to offer more training for staff as a way to support and intervene early.
Ongoing Professional Development Plans
- Methuen arranged for professional development courses from the Beck Institute. The courses will help with setting up group and individual therapy, including a special course on trauma made just for Methuen and the specific challenges its students face.
- Methuen is focusing on helping newcomers and will start the Supporting Transition Resilience of Newcomer Groups (STRONG) for schools program in the 2024-25 school year.
- Methuen is implementing iDECIDE to improve substance misuse programming in the 2024-25 school year.
1 Massachusetts School and District Profiles.” 2024. Teacher Data (2021-22) - Methuen High (01810505). Accessed April 24.
2 Crocker, John. Personal interview with the author. 25 April 2023
3 Crocker, J.& Bozek, G. (2018, NPEN). District-wide Mental Health Screening: Using Data to Promote Early Identification and Quality Services [PowerPoint slides]. National Center for School Mental Health. https://www.schoolmentalhealth.org/media/som/microsites/ncsmh/documents/archives/CS-3.1-District-wide-Mental-Health-Screening---Using-Data-to-Promote-Early-Identification-and-Quality-Services.pdf
4 Lane KL, Oakes WP, Crocker J, Weist MD. Building Strong Partnerships: Education and Mental Health Systems Working Together to Advance Behavioral Health Screening in Schools. Rep Emot Behav Disord Youth. 2017 Fall;17(4):93-101. PMID: 30079000; PMCID: PMC6075829.
Conclusion
Implementing data-informed mental health screening has improved Methuen’s ability to use data to guide services and provide access to mental health care for all students. Using technology and online services along with strong in-person support shows the importance of a comprehensive approach to mental health that meets the needs of every student.
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