Help cannot come soon enough amid a crisis in youths’ wellbeing, local school and health officials said.

“The need increased during the pandemic,” said Verna Ruffin, superintendent of Waterbury Public Schools, the community identified by the task force as having the greatest need. “People are living it right now.”

In recent months, hospital leaders in Connecticut have sounded alarm bells as their emergency departments have been overwhelmed with children in crisis during the pandemic.

An “incredible mental health burden” has been placed on children, the state Department of Public Health’s commissioner, Dr. Manisha Juthani, said in late February.

But, relying on hospitals to treat children’s mental health is known to be less effective, and more costly, than getting them help before they reach a crisis stage.

Lawmakers and children’s health advocates have sought and proposed a variety of other? measures to address the roots of the problem.

One area that has gained attention is to expand and bolster the state’s network of school-based health centers — onsite clinics at K-12 schools around Connecticut that provide mental and medical care for kids during school hours.

The centers are considered by many to be one of the most efficient ways to address youth health needs.

A legislative task force, led by the Department of Public Health with members spanning the health and education fields, began meeting late last year to study where to add more school-based mental health services.

The group, in a report released this week, said it found out of 999 schools statewide, roughly two-thirds lack such a health center. 

However, among the 694 schools without a school-based health center, some need help in this area significantly more so than others, the group said, and they identified 157 schools that need help the most.

Of any town, Waterbury is home to the highest number of schools in need, but the 157 schools span the state between Danbury and Killingly. 

The findings confirm what the state’s child advocate, Sarah Eagan, told lawmakers in November when she said “the majority of school districts in Connecticut don’t have school-based mental health.” 

Lawmakers this session are making earnest efforts to change that. Gov. Ned Lamont last month proposed spending $82.6 million in new funding to address the youth behavioral health crisis.

And amid dozens of proposals with competing priorities, at least one bill in the Senate has set aside $21.8 million for the Department of Public Health to expand the school-based health sites. 

‘Increases in violent behavior’

Ruffin, Waterbury’s superintendent, said after kids came back to in-person learning full-time in the 2021-2022 school year, educators noticed serious differences in students’ behavior. 

“We saw increases in violent behavior,” she said. “The interactions were more reactions than they were conversations. We saw evidence of mediation not working.” 

Ruffin said the district added more counselors in some schools, and the district noticed “tremendous” benefit for the kids as a result. Ruffin said it’s clear which Waterbury schools still need more support. 

But the superintendent also said hiring people has been a huge challenge, and she said even if they are given additional funding from the state, she hasn’t seen a solution for staffing new clinics. 

The majority of Connecticut is in need of more mental health professionals, according to government estimates. One recent CDC-led survey found a third of Connecticut residents have symptoms of anxiety or depression. 

Rep. Bill Petit, R-Plainville, agreed the availability of health care providers is the biggest challenge. 

Petit, who is a physician and had his own private practice for many years, said legislators are looking at options to remove regulatory barriers that would allow professionals to practice across state lines more easily. 

A mental health bill that House legislators are considering takes a few steps to ease the steps of becoming a professional in the field; for example, the legislation would make it easier to practice across state lines and makes obtaining a license smoother. 

But Petit also said making sure people have access to mental health services close to home is key to preventing crises. School-based health centers are just one example, he said. 

“They’re local, and they’re convenient, and people are more likely to utilize them,” Petit said. 

The argument for school-based health

Connecticut’s health commissioner last month said there is a shortage of inpatient beds in hospitals to treat kids in crisis. Lamont’s proposed budget calls for $15 million to open a new 12-bed psychiatric unit at the Connecticut Children’s Medical Center to alleviate backlogs in emergency departments.

But, Melanie Bonjour, manager of the school-based health program at Connecticut Institute for Communities based in Danbury, said emergency departments are a poor substitute for mental health care for the state’s youths, both in terms of the outcome and the cost.

“It’s like a band-aid,” she said. “It’s an extremely expensive band-aid, and it doesn’t provide long-term care.”

School-based health centers, though they are housed on-campus, aren’t typically operated by schools. Instead, outside organizations — usually a community health network — staffs and runs the program. Every child can use its services for free.

Bonjour, who is also a past president of the state’s Association of School Based Health Centers, said the model has been shown over decades of work to make kids healthier and safer. 

Even if families seek out mental health care in their communities, it’s easy to fall out of sync and miss appointments, Bonjour said, and some can’t afford to pay for the services. But in the school setting, counselors’ closeness to their patients helps keep students in the loop. 

School-based health centers like the five run by Connecticut Institute for Communities accept Medicaid and are legally obligated to offer their services to every student, regardless of ability to pay. 

One analysis of emergency department costs nationwide pegged the price of one visit at above $400 for adolescents and teenagers. The costs could increase if the patient is admitted. Running a school-based health center, meanwhile, can cost anywhere between $90,000 and $210,000, depending on what they offer, according to one estimate in the journal Public Health Reports.

“It’s an effective use of state dollars,” Bonjour said.

The state Department of Public Health chips in roughly $125,000 to 90 school-based health centers in 27 communities, meaning the majority of centers must find ways to fund themselves. 

Tricia Orozco, who directs East Hartford-based InterCommunity Health Care’s school-based health program, said there are waitlists for the mental health providers at most of its seven school sites. 

Of those seven clinics, Orozco said five receive partial state funding. The centers offer a full range of primary care for kids, she said, and the organization works to fill in other gaps – by providing a food pantry, for example. 

Virtual visits have created flexibility, she said, but some students don’t have access to technology. Even in recent weeks, the demand for help with kids’ behavioral health has continued to increase. 

More funding from the state would enable InterCommunity, a nonprofit, to hire more staff and even expand its services to other schools in East Hartford, Orozco said. 

“We’ve established that there’s a great demand for services, however in the absence of funding, how do school-based health centers hire more staff?” she said. “School-based health centers are frequently the only health care these students are receiving.” 

Proposals on the table

Connecticut is home to among the most school-based health centers per capita of any state already, according to the national School-Based Health Alliance, but advocates agree it’s still inadequate. 

In the state Senate, the bill appropriating $21.8 million to school-based health centers directs funds to 36 schools that have no mental health services in any format, located in 11 towns. Seven of those schools are in New Britain, the most of any town. 

Sen. Doug McCrory, D-Hartford, said the total amount would be split into roughly $590,000 for each of the 36 schools. He said the $21.8 million is a large portion of the budget and a “healthy start.” 

“Every community has a school,” McCrory said. “Why not use that facility that everybody is comfortable going to, whether it’s for health care or education, to get the services that they need.”

McCrory said he would be open to adding more funding to more of the sites the legislative report identified in future sessions. 

The Senate bill has the endorsement of the Connecticut Association of School Based Health Centers.

It is not the only proposal on the table that addresses the need for more mental health support in schools. 

State representatives put forward a bill in the House of Representatives that calls for a detailed plan to be drafted to expand school-based health across Connecticut.  Rep. Jonathan Steinberg, D-Westport, said funding school health centers will help to close the care loop that legislators are trying to address. 

“We continue the struggle in terms of getting to young people at the most appropriate time to get them help,” he said. 

House lawmakers still need to decide how much money to appropriate to the various proposals in the 103-page children’s mental health bill, Steinberg said. Later in the legislative session, House and Senate legislators will have to reconcile their proposals, leaving the question of how much school-based health centers will receive open-ended.  Steinberg also noted there “will be further efforts next year.” 

Need for state funding

The largest provider of school-based health in the state says it is already growing, even absent of additional state funding.

Community Health Center Inc., a nonprofit, operates more than half of the school-based health clinics in Connecticut, approaching 190 in total, according to an analysis by Hearst Connecticut Media. But only 17 clinics receive state dollars directly from the Department of Public Health. 

Not all of the organization’s clinics offer all three of the core services the centers could offer: Medical, mental health and dental. But Yvette Highsmith-Francis, vice president of the health network’s eastern region, said the organization offers what the school believes it needs, and that almost always includes mental health services. 

The organization told legislators recently it saw a 22% increase in the number of children it has treated in the last two years, both inside and outside of schools.

Highsmith-Francis said Community Health Center Inc. has developed a way to sustainably fund the centers without outside support by billing insurance plans and keeping services lightweight and focused on what kids need. In fact, it opens between 10 and 12 of the clinics every year.

“We’re not asking the school for additional resources, we’re not dependent on a grant from the state. We’re able to respond to the needs of the community,” she said. “We’ve never said ‘no’ to a community that has approached us.” 

Still, Highsmith-Francis said state aid is needed. She noted funding could help schools that lack the physical space to house a clinic. Others need to be updated to accommodate a medical suite, another common barrier to adding the service, so the organization is suggesting adding sites focused solely on students’ mental health. 

The committee of experts also assigned each of the 157 schools a score based on how much a school-based health center could be needed. Charter schools in Hartford and Bridgeport, each run by the organization Achievement First, topped the list. 

Tiffany Bostic, director of social work for the charter, said in a statement the organization supports efforts to increase funding for students in the highest-need communities, noting it “would be game-changing in many ways.”

“Our students would greatly benefit from increased mental health support and programming,” she said. “They would also benefit academically because learning can’t happen until a student’s basic needs are met.”