New ASTHO Report Outlines 10 Strategies to Improve Behavioral Health in Schools

May 02, 2022

ARLINGTON, VA—In light of the rising rates of teen depression and anxiety in the United States, today, the Association of State and Territorial Health Officials (ASTHO) is releasing a new report outlining 10 high-level strategies to improve behavioral health in schools. Per recent data from the CDC, among adolescents aged 12-17 years, 15% had a major depressive episode, 37% had persistent feelings of sadness or hopelessness, 19% seriously considered attempting suicide, and 16% made a suicide plan.

“Youth rates of anxiety and depression have been climbing at an alarming rate,” said ASTHO CEO Michael Fraser. “The COVID-19 pandemic amplified these trends as many students were isolated from their friends, teachers, and mentors for months at a time. America’s youth needs to be supported, and there is no better place to do this than within our schools.” 

ASTHO, in partnership with CDC Healthy Schools Branch, convened a School Behavioral Health Advisory Committee to identify policy gaps and strategies for delivering behavioral health services in schools. This advisory committee identified 10 strategies school leaders can implement to improve mental health among their students.

The 10 strategies include:

  1. Collaborate with the Department of Education on a comprehensive mental health framework to guide student well-being, such as the Multi-Tiered System of Supports Framework
  2. Utilize shared and inclusive language when communicating work around school behavioral health.
  3. Use a strength-based approach when collecting, analyzing, and disseminating data highlighting the role of student connectedness and resiliency.
  4. Harmonize data sources between cross-sector agencies to understand a complete picture of youth behavioral health.
  5. Assemble a cross-sector team with representation across all relevant sectors and levels of implementation.
  6. Improve the capacity of the traditional and non-traditional school workforce to address behavioral health.
  7. Expand Medicaid reimbursement in school settings, by removing state restrictions on school health services, to align with national Free Care Reversal Guidance.
  8. Expand school telehealth service provision.
  9. Leverage recent federal school health funding to support school behavioral health services.
  10. Braid/layer funding to support a shared risk and protective factors approach to youth behavioral health.

"Youth are suffering now more than ever as we continue to see the impact of the pandemic on their development and well-being," said Sharon Hoover, PhD, professor with the Division of Child and Adolescent Psychiatry of the University of Maryland School of Medicine and co-director with the National Center for School Mental Health. "To promote the mental health of all children and adolescents, and to recognize and address mental health challenges early and effectively, state behavioral health officials must support young people where they are. Schools are an essential place to promote the well-being of all youth and to conduct early identification and treatment for those experiencing mental health challenges."

The COVID-19 pandemic deepened existing inequities and increased exposure to variety of risk factors that may negatively impact the health and education of youth. However, changes in state and federal policies both before and during the pandemic have created opportunities for improving health equity and increasing behavioral health service access for youth. States can leverage cross-sector collaboration between education, Medicaid, health agencies, and community partners to address the behavioral health needs of youth.

View the full report here: Improving Youth Behavioral Health Through School-Based Strategies.


ASTHO is the national nonprofit organization representing the public health agencies of the United States, the U.S. territories and freely associated states, and Washington, D.C., as well as the more than 100,000 public health professionals these agencies employ. ASTHO members, the chief health officials of these jurisdictions, are dedicated to formulating and influencing sound public health policy and to ensuring excellence in public health practice.