School-based mental health services on the line in some districts (2024)

Over two dozen mental health professionals who provide school-based care to kids and teenagers across multiple counties in western Montana will be without a job this summer.

Western Montana Mental Health Center (WMMHC), which offers community-based mental health services at locations in seven counties in the region, will be suspending the roles of 16 staff members who provide care through the Comprehensive School and Community Treatment (CSCT) program for at least the next couple months. The state-run initiative reimbursable through Medicaid brings licensed practitioners straight to the classroom to support students experiencing mental health crises.

Programming always declines in the summer for WMMHC as fewer students rely on the school for their support services, but its mental health care teams are typically put on “variable status,” meaning they work a reduced load of 10 to 20 hours per week.

This year, the health center couldn’t afford to keep everyone on the payroll. Instead, it placed teams with heavier summer workloads on the reduced schedule, putting the remaining providers on “reduction in force status,” interim Executive Administrator Colleen Rudio told the Montana State News Bureau.

According to Rudio, there are five full teams across multiple school districts that will remain in place during the summer months, serving about 60 students with another 10 who said they might participate. Those teams account for about 13 staff members.

Another 16 WMHCC employees will be placed on the reduction in force status. Employees whose roles have been suspended do not have work and will not receive pay. Should WMMHC restart the school-based program or some version of it within 13 weeks, the clinic is required to give these former staffers the right of first refusal to have their jobs back.

Rudio said she could not say how many students would be affected by the service lapse since the number of students for summer programming wasn’t confirmed. She did say that the teams suspended for the coming months were those with smaller caseloads.

Additionally, Rudio did not provide a list of all the impacted school districts. The Montana State News Bureau confirmed that Missoula County Public Schools has lost services at one school at least. NBC Montana reported that Lolo School District was having services cut.

WMHCC plans to re-evaluate the CSCT program and determine how it can provide essential services for young Montanans while remaining sustainable, something it has struggled to achieve in recent years.

“We are simply using this time to make the most efficient and best decisions we can,” Rudio said.

According to correspondence obtained by the Montana State News Bureau, families were given 10 days' notice of the forthcoming change. Students who have been receiving services through the program will be referred to other community providers effective June 21 if their school’s care team is suspended.

“I don’t think there’s ever an ideal time for parents to receive notice,” Rudio said. “We recognize that.”

CSCT pairs licensed or supervised in-training practitioners from a mental health center and behavioral health aides with children who can get services at school, in their homes or in the community. Teams provide intensive and hands-on service to the kids who need it most, reducing the barriers to accessing care by making it available directly in the school.

It’s been the subject of repeated disagreements at the Legislature for multiple years. Sparring and bureaucratic mishaps have contributed to fewer school districts participating and fewer students receiving mental health care.

In 2015, there were over 100 districts participating, serving around 5,000 students. As of 2021, there were only 50 school districts participating, reaching just 3,827 students.

Jon Ebelt, spokesperson for DPHHS, told the Bureau that 48 school districts have submitted the necessary memorandum of understanding to the agency agreeing to the payment process. As of May, only 36 of the districts who had agreed to the program parameters were actually billing for the service.

All this comes against a backdrop of a worsening health crisis among Montana youth.

More high schoolers either considered, planned or attempted suicide last school year than in the three decades before, according to the Youth Risk Behavior Survey. A DPHHS report concluded that the state’s suicide rate among young people between 11 and 17 years old is double the national average.

Oversight of the CSCT program has changed hands twice since 2021. First, the state Legislature opted to move the program from the purview of the Department of Public Health and Human Services to the state’s education agency, citing frustrations with the handling of financial challenges.

Under the Office of Public Instruction, districts said they experienced undue administrative burden and struggled to get clarity on how to implement the program. There was also an ongoing back-and-forth between lawmakers, government agencies, third-party mental health care providers and school districts over who should foot how much of the bill.

The 2023 Legislature decided to transition the CSCT program yet again back over to the health department, basically turning the clock back on how things were before the previous changes, effective July of last year.

“No roadblocks were identified" during the transition, according to Ebelt. The same program rules and requirements have been in effect since 2021 with DPHHS taking over from OPI to address education, communication and information.

“There were no changes to the role of (DPHHS) overseeing the programmatic, enrollment and claims aspects of the program," Ebelt said, responding to questions about any changes the department had made since taking back over.

DPHHS Director Charlie Brereton told lawmakers in 2023 ahead of the program's move over to his agency that they would like to explore ideas for what an alternative school-based model might look like, but that nothing would happen to CSCT for at least another year.

“We also want to think in the future and do a deep dive on what’s working, what’s not, and ask is CSCT really serving Montana students well in 2023?” he said at the time.

Rudio from WMMHC says the facility’s summer pause on the program is directly tied to this very question. She said the clinic will be working with the health department and school districts to determine how to most effectively serve families and students come the fall.

“It may very well be CSCT,” Rudio said. “This is an assessment period.”

Ebelt did not share any plans for how CSCT might evolve in the future.

Districts have been stalled by paperwork backlogs and a web of requirements that make responsiveness all but impossible. Third-party providers in certain parts of the state have run into staffing issues, dwindling the availability of aides and practitioners in classrooms.

Funding has been a continued roadblock in recent years, too.

Changes to the Medicaid reimbursem*nt rate in 2021 made it harder for districts to pay their share of program fees. Lawmakers in that year’s Legislature decided not to allocate $20 million that would have helped offset the remaining balance borne by school districts after Medicaid reimbursem*nts, also contributing to fewer schools electing to fund the program for their students.

Providers like WMHCC were also hit hard by Medicaid redetermination, a process that’s led to more than 130,000 in Montana losing health insurance coverage under the joint federal-state program.Rudio said redetermination meant the facility could not bill the state for the same number of children as it had previously, so it went into this summer with less Medicaid money than it had planned.

One of the things WMHCC will be exploring is whether it should offer home support or outpatient services for youth, as opposed to the clinic’s current model of school-based care.

“We are committed to working with school districts and the state to make sure we make the decision as quickly as we can,” Rudio said.