Recruiting and Retaining School-Based Mental Health Professionals


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As Mental Health Awareness Month comes to a close, many are reflecting on the current state of student mental health and considering policy levers available to better support students in schools. Earlier this month, Education Commission of the States convened policymakers from four states for a State Policy Academy on student health and wellness. Concerns about student mental health rang true for many attendees at the academy, including interest in policy levers to improve the pipeline for school-based mental health professionals like counselors and psychologists.

Given the increased need for student mental health support and that more than 70% of children who receive mental health support do so in a school-based setting, equitable access to school-based mental health professionals is vital. The National Association of School Psychologists (NASP) recommends a ratio of one psychologist for every 500 students and the American School Counselor Association (ASCA) recommends a ratio of one counselor to every 250 students. Despite the recommendations, ratios in many states still fall short.

According to NASP, the current national ratio is one school psychologist for every 1,211 students, and according to ASCA, the current ratio for the profession is one counselor for every 415 students. Staffing ratios vary greatly by state — some have a ratio of one psychologist for every 5,000 or more students and some states are nearing one counselor per 600 students. Staffing ratios also vary within individual states, as some localities have more access to school health professionals than others. One 2019 report found that only one in five high school students in the U.S. are enrolled in a school with a sufficient number of school counselors.

School-based health professionals provide important services for students and research demonstrates that access to mental health services in K-12 settings can improve students’ health, academic and social outcomes. Policymakers may consider a variety of policy options to address school-based mental health workforce shortages and challenges in their states to move them closer to the recommended ratios and ensure all students get the support they need. Available policy levers include:

  • Providing financial incentives.
  • Codifying staff to student ratios.
  • Providing sustainable funding.
  • Allowing license reciprocity.
  • Improving workplace conditions.
  • Expanding the potential pipeline.
  • Increasing the training and higher education infrastructure.

States such as Colorado, Montana and Ohio offer some innovative recruitment and retention strategies for their school-based health workforce.

In 2008, Colorado’s School Counselor Corps Grant Program was created to increase the number of school counselors in an effort to boost the graduation rate and postsecondary opportunities for K-12 students. The average grant-funded school’s student-to-counselor ratio is well below the best practice recommendation of 250-to-1. The grants are to be used for school counselor salaries and benefits, professional development opportunities and program development. Schools participating in the grant program saw improvements in student engagement, graduation rates and career readiness.

The Montana Office of Public Instruction, Montana State University and the University of Montana partnered to offer the Rural Mental-Health Preparation/Practice Pathway. This federally funded grant program prepares graduate counseling candidates to gain experience as counselors in rural communities where the state has heightened shortages. Some objectives of the program are to increase the number of counselors in rural schools and communities from 3.7 to 10 per year and to foster quality rural mental health services in Montana.

Launched by the Ohio School Psychologists Association over 60 years ago, the Ohio School Psychology Internship program trains future school psychologists to serve in Ohio’s public school districts. Each year, the Ohio Legislature allocates $3 million to the grant. The funding goes to the school districts where they will pay the interns for their efforts. The goal of the internship program is to graduate at least 90 to 100 interns every year in hopes of promoting positive behavior and mental health for more students across the state.

As state leaders continue to turn their attention to student mental health, they may consider increasing the capacity and strengthening the pipeline of the school-based mental health workforce. In doing this, states can help ensure students have equitable access to the support they need in school.

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Policy Researcher at Education Commission of the States |
Cassidy Francies is a former policy researcher at Education Commission of the States.
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As a policy researcher, Gerardo provides education policy leaders with quality and research-driven information on nationwide policies. He completed his bachelor’s degree in international affairs and ethnic studies at the University of Colorado Boulder and plans to complete a master’s of public health in health systems, management and policy at the Colorado School of Public Health. Gerardo is passionate about education policy because policies have an opportunity to promote better health outcomes in students and educators.

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