Beyond Tier 3: What the Fourth Tier Means for Student Mental Health

Hello, and welcome. I'm Gina Katzmark, strategic communication director for TimelyCare. Please go ahead and use the chat to let us know where you're joining us from. I'm in Charlotte, North Carolina, and it's pollen invasion season here, so apologies if I sneeze. Thank you for joining us today. We know school leaders, administrators, and student support teams are caring a lot right now, and we really appreciate you being part of this conversation. Today's discussion leading through the mental health surge is vitally important. Across k twelve, students are seeing growing student mental health needs, increasing acuity, and added pressure on already stretched teams, and that's exactly why this conversation matters. As many of you know, schools are being asked to respond to needs that are not only more widespread but often more complex. We're seeing higher rates of anxiety, depression, and behavioral challenges often showing up earlier and with greater intensity. Counselors, school social workers, and administrators are being asked to respond to needs that go beyond what most systems were originally designed to support, often while managing limited time, staffing, and access to outside care. Even in districts with strong support systems in place, leaders are seeing greater urgency and pressure on the teams working to support students. Now that's what makes the fourth tier such a valuable frame for our discussion. The book authored by Armond Piras and Ryan Sherman pushes us to think beyond the limitations of a traditional tiered approach and to consider what it looks like to build a more responsive, connected system of support for students. In many cases, students who need more specialized or ongoing support are getting stuck. Schools are doing everything they can within their walls, but there are real limitations in the broader pediatric mental health system, from provider shortages to long wait times that make it difficult for students to connect to timely care. Our conversation will delve deeper into that idea, exploring how schools can evolve their approach to student mental health in practical, sustainable, and student centered ways. At the end of the discussion, we'll open up for a brief q and a. If you have a question for our panelists, please feel free to drop them in the chat at any time during the webinar. Now it's my pleasure to introduce our moderator, my colleague, Vanessa Howe, our director of k twelve therapy at TimelyCare. Vanessa is a licensed clinical social worker with nearly two decades of experience supporting students and families. She began her career as a school social worker and now leads programs focused on expanding access to high quality behavioral health care for schools. Vanessa, I'll turn it over to you to introduce the panelists. Okay. Great. Thank you so much, Gina, and welcome, everyone. We're so glad that you're here with us today. So to help us unpack these ideas, we're joined today by two leaders who are deeply involved in this work. Please join me in welcoming doctor Armond Piras. Armond has served as a superintendent in Massachusetts since two thousand and fifteen. Armond brings more than two decades of experience in education. His background combines both education and public health. Armen holds a master's of public health and a PhD, and much of his work focuses on leadership development, student mental health, and supporting educators. Armen was named the twenty twenty five Massachusetts superintendent of the year. And joining Armen today is his coauthor and district counterpart, Ryan Sherman. Ryan has served as the director of wellness for Medway Public Schools since two thousand and sixteen. Ryan focuses on the connection between schools and the broader outpatient mental health system. He helps schools build practical partnerships so students can access the care they need beyond the classroom. Ryan has worked as a behavioral health provider at Massachusetts General Hospital. He is also a senior professor of social and emotional learning at Cambridge College. So welcome, Arment and Ryan. We're so glad to have you today, and let's go ahead and jump in. Thank you. Yes. Okay. Great. So to start us off, in your book, the fourth tier, you outlined challenges to the traditional three tier MTSS framework, highlighting where the framework is breaking down and the impact at both the student and district level. So first question for you, Armand. For school leaders who may be encountering this concept for the first time, could you share more about the gaps you observed in the traditional model, and what motivated you and Ryan to propose expanding MTSS and the addition of a fourth tier? Sure. Thanks so much. This is a topic that's, super important for me as a school leader. In two thousand fifteen, when I took over as superintendent and finally had the sort of the keys to the district, one of the first things that I started to do was add staff. Right? We had this staffing challenge around student mental health, what seemed to be a staffing challenge around student mental health, and really thought that adding staff was the logical solution. And soon after I started in the role, Ryan joined the district, and we started really seeing that we weren't having the impact. What we were seeing was, regardless of the staffing levels being increased, we weren't seeing substantive changes with regard to, outcomes for students, the number of students who are in crisis. In fact, we can we continue to see an acceleration of both intensity and the number of students that needed more, levels of higher levels of support. So we were dealing with a supply and demand imbalance, but when we added supply, it didn't really have the impact anticipated on demand. And as a result, what we saw in schools, and what we often see in schools is a lot of reaction to those students who have the highest level of needs, both an increasing number of students overall with higher needs, but also an increasing level of intensity. And, you know, we recognized pretty early on that we just were not designed for that. Most of our staff at the time hadn't dealt with students who were traditionally not seen in public schools. We then pretty quickly get into pandemic times when we see a further acceleration of this, and you realize that the system is really broken. And because our staff was spending so much of their time dealing with the, very intensive need students and trying to manage and coordinate care for them, they were in fact not able to get to what we traditionally think of as the other tiers of MTSS, tier one and tier two. So there weren't lunch bunches going on, and and counseling staff weren't sort of dropping into classrooms to do explicit teaching about certain concepts within within SEL. So that was kind of, part of what we saw. That's from my lens as as the district leader. I know Ryan has some, other perspectives on this as well. Yeah. Thanks, Armen, and thanks, Vanessa, for for having us. We're excited to be here. And I adding on to what Armen mentioned, we did add resources to tier three, but there was just never going to be enough addition that worked with the prevalence and intensity that student mental health needs were increasing at. The rate was just going too fast for anyone to keep up, let alone in today's budget. What we're seeing in that three tier model, which worked well when it was designed for about one to five percent of students with that intensity of mental health needs, that those could be met through an IEP in some in school counseling and perhaps a referral to the pediatrician who had a a relatively average size prevalence of need and could work with outside clinicians to get them the care they need. But when this and this isn't a new thing. It certainly accelerated in the pandemic, but even prior, just with the rates of increases in in need, what we're seeing at the tier three level was ten to twenty percent of students. And what that looked like in school was, as Armen mentioned, our counselors spending all their time reaction in reactionary mode trying to help students with behavior and manage the school day and having them in their office on the phone with adults, whether that was parents trying to get in home supports or navigate insurance or on the phones with providers trying to find openings for their students. So we quickly realized that if we continue with this model, one, it's not what's best for kids, and two, our our counselors are gonna burn out very quickly without without additional supports. Yeah. Absolutely. And you really highlight some of the system challenges. And and looking at that, there's a lot of time and effort being spent in that tier three. Therefore, right, kind of those universal supports or earlier interventions, it sounds like it was more and more challenging for the school staff to really support students in those tiers. Okay. For sure. And I would say, importantly, what then happens, as we all know, is that students that are in lower tiers, if not supported in appropriate and effective ways, are gonna migrate to higher some portion of those students are gonna migrate to higher levels of need. And so you have this real bottlenecking going on. You're not able to deal effectively with the students who are in front of you right now. And without effective supports at tier one and two, you're gonna continue to add to that number of students over time. Yep. Yep. So part of what I'm hearing is is that, you know, we've seen rising levels of anxiety, depression, and behavioral needs among students while also navigating provider shortages, really stretched school based teams. I will also say I have a lot of conversations with families and just, you know, overall navigating the behavioral health system with things like insurance or, you know, that you had mentioned can be really challenging. So this next question is for you, Ryan. So from your vantage point working within schools and in public health, When students have unmet mental health needs, how does that present in schools? Can you share a bit more about the long term consequences of that? Yeah. Absolutely. And I'll kinda start with, that we talked about kind of prevalence and intensity and and time to care. I think, you know, in the United States as a whole, if we look at, say, a hundred students need mental or or have mental health concerns, school age students, we know that about twenty of those will have their concerns identified and referred. And of that twenty, four of those on average will get to a clinical level of care, meaning that they'll get referred to care, they'll go to enough sessions for a clinical, a significant change in in their clinical disposition. Often, that's the gold standard is about six sessions. So that leaves in schools, right, on average, over nine out of ten students who have a mental health concern aren't having those needs met by the outpatient, you know, traditional referral system. So that overflows to schools. Right? So how are we meeting those needs in schools, and how are those unmet needs showing up? And, unfortunately, that often shows up in in behaviors. Right? So that could be they're coming to school, but really struggling with behaviors and and, of course, learning if if they have unmet mental health needs. And, unfortunately, I think what we're seeing now is that it's really turning into there many are not even coming to school. Right? So rates of chronic absenteeism are going up. Certainly, that correlates with, the prevalence of depression and anxiety. It's almost an exact correlation, in some cases in our high school students. So I I think that's how schools are really feeling it, whether they're just not coming to school or they are and they're really disruptive, not because they wanna be, it's because they don't have the skills they need from these unmet needs. Yeah. And, Armen, perhaps you could share a bit about what what you're seeing in schools, how it's showing up behaviorally. Yeah. I think, you know, while this conversation is focused on the needs of this population of students that is larger than it used to be and with likely more intense needs, I think anyone that works in schools has felt the ripple effects of trying to meet those needs. I think first about sort of, the the the climate of buildings. Right? And even if you don't have a lot of out facing behaviors that are creating, challenges within classrooms that you have to manage as a building leader, you are likely dealing with staff who feel, as Ryan mentioned earlier, completely burnt out. I think about our counselors who are sort of swimming against the against the tide, so to speak, and are not feeling like they're making good progress in that old system, that tier three system, where traditionally the model has been. And what I heard throughout a lot of my career, even with the background in public health, that our responsibility on the school side was to sort of patch them up and get them back to class as quickly as possible because that lost instructional time was so critical to, their potential trajectory. What has shifted has been important and I think has supported some changes in the space. But before we made that change, before we saw that change in action, what we were dealing with was significant amount of impact of staff and how they were generally feeling about their job. It was a really tough space to be a a counselor or a mental health support provider because you didn't feel like you were making progress. And in many cases, you're dealing with more intensive students than you were ever trained to deal with and not doing the prevention work that, had been a real hallmark of what happens in schools, traditionally. Yeah. Thank you for sharing that. You know, I know for school staff, burnout is really top of mind in making sure that we have, kind of school climate initiatives going. And I you know, to your point, Armen, I know there's been a lot of great work done at the schools to kinda shift some of the lens here. So one of the things I'd love to dive deeper into, can you tell us more about how adding a tier four may allow for a more proactive approach, specifically school supporting students around tier one and tier two interventions? Yeah. I I guess I'll I'll start with, sort of what it is, or the way that we've thought about and kind of framed it, and then Ryan will talk a little bit more about the components. Because I think that there's a an important, sort of mental model shift here that needs to take place. You know, I talk to colleagues in other districts pretty regularly, and there's frustration about the fact that these students are not being supported within the traditional models that have existed. Ryan mentioned, you know, in the in the old days, which was probably not very long ago, you know, a counselor would work with a family. They'd call the pediatrician. The pediatrician would help navigate the incredibly complex mental health care system. And what what wasn't happening effectively was because of the increases generally, pediatricians and and community based mental health providers didn't have the space or the bandwidth to do that. So we saw these increasing waiting times, etcetera. So as Ryan and I really thought through this, we thought about it. We thought about tier four and our conception of tier four is is it's a both both a conceptual shift and a programmatic approach. For all my building and and district leader colleagues who are out there, we have to get past the old model and understand that it it has become our responsibility as building and district leaders to make sure that we're providing the coordination of or direct care for students. No one else is going to do it. There's not a system. This system isn't going to fix itself. We're in a space where if we're not doing it for our students, then it's simply not happening. And the the lengthy wait times and the lack of persistence in care that we've seen in the traditional model results in more intense needs, staff being burned out, and you're kind of in this cycle of ineffectiveness largely. So conceptually, the shift really for tier four is like, it's our responsibility. Very clearly, it's our responsibility. Should it be as an argument we can have at some point? Whether or not this funding is an argument we can have, but it very clearly is. And if we don't do something to act now, then we're gonna continue to impact the potential trajectories of the students for whom we are responsible. Second to that, it's really about a suite of services that we're either coordinating or directly providing for students that become tools for our school counselors to help ensure that there's quick access and ready access to mental health care directly connected to what our students need. And that's really, really important. And since this is Ryan's space and he's way better at it than I am, certainly, I'll invite him to talk through the components of what, tier four looks like. Great. Yeah. I think that oh, sorry, Vanessa. You go ahead. No. You go ahead. I was just saying thanks for sharing that. Go ahead, Ryan. Yeah. Yeah. I think that Armin's point is is really important because without that, you you can't get to the components of it. But the components are, first and foremost, universal screening. So we talked about those students or lack of students traditionally identified. Waiting for student behaviors to trigger a a screening or waiting for a parent to call is not the approach to take. That's reactive. It's usually at that point, the behaviors or, the needs have grown so much they've turned into behaviors. The way to do it is to universally screen, identify those that might have intrinsic needs that they aren't showing in in those that might have moderate needs that if you can support right away won't turn into disruptive behavior. So universal screening is number one. The second is care coordination. I mentioned how our school counselors spend so much time trying to navigate the complex behavioral health system. There are services out there that will support schools and do it at low cost and take that burden off of parents and our school staff. So that's, to me, is a no brainer. Third is in school outpatient, therapy. So in many areas of our country, there are outpatient providers for pediatrics that have empty offices all day, and they just wait for kids to get out of school to give them the care they need. That's not a great setup for them. Also not ideal for schools. So having them come into your schools, they can still act as an outpatient therapist and bill insurance. Schools are really just providing them with the space, but helps remove many barriers to care. The third is teletherapy. This is certainly, I think, maybe one of the few nice silver linings of the pandemic because we moved into this space as reimbursable and accessible. We'll talk a bit more about this later, but this is a key component to removing barriers to care. And then lastly is the wraparound service, component. So much of students' mental health needs occur outside of school and don't fit neatly into the six and a half hour school day and expecting school counseling to happen and supports to happen only at the school building and during the school day is an outdated model that doesn't work for families. Right? So getting out to the community, making sure those social service needs and mental health needs are met, and meeting literally where the parents where they are and the families, is is a component of fourth tier, and I think, certainly a a more complex one, but a a crucial one. Wonderful. Thanks, Ryan. One of the things that you already touched on is, you know, although we've seen some positive shifts, mental health stigma still exists, and we may have families who are hesitant to seek care for a variety of reasons. From your vantage point, what what steps can schools take to better support families in accessing and getting connected to mental health services? Yeah. I can start, then Armin might have some additional thoughts. I think you're right. I think we have certainly, generationally, this is getting better, but there are certainly, you know, stigma that still exists and certainly that's dependent on culture and experience. I think schools provide a unique kind of safe place for that. Schools have become an access point for so many things, for access to food, to social services. And now, you know, certainly, our approach is mental health care. And so schools can be a place to normalize this, not only with our students, but our families, and know that it's just a normal part of just like public education, it's a normal part of our culture or should be, and can be accessed at places other than hospitals and, and places that are not community hubs like schools. So I think just normalizing within your community, sharing the resources that are available, and, having public events or, parts of your school curriculum and regular calendar that are, involve mental health and the normalizing of that, I think, can go a long way in a community. Yeah. I'd probably add to that. I just to highlight something something Ryan said is that I think because of the place that schools hold for families generally, that burden to access, the mental burden that some families might have and the stigma that might exist in families is lessened when the the construct is sort of through the school. And I I think if you go back to the the the tier four elements, you know, in school outpatient services or virtual services, you've created a couple of, pathways for students that can really meet families where they are. The old model, as we all know, was like, okay. After school, a someone had to drive a child to a an in office, appointment, and they had to do that with a level of consistency and a frequency that was really gonna have that impact. We're really excited about the persistence we've seen in care, especially as our counselors are able to our school counselors are able to sort of match a student's need with with an approach that's going to be a best fit, not just from a, a clinical perspective, which is outside of my wheelhouse, but really from a family dynamic perspective of how do you create those opportunities and sort of get over those get over those barriers for families. And for some reason, it's just more acceptable when it's coming from coming through the school or if it's happening during the school day than, it would be for them to try to navigate an incredibly complicated system on their own, and then try to manage that themselves. Absolutely. And I think you highlight schools can be such a trusted source for families and also kind of thinking about, being able to do sessions in the school environment or a comfortable environment versus kind of traveling. You know, transportation can be a barrier to an outpatient office can make such a huge difference for families. Sure. Alright. So next question, Ryan, in the book, you talk a bit about the growing role of external behavioral health partnerships in supporting students whose needs extend beyond what schools can deliver internally. How do you see virtual therapy and other virtual behavioral health supports fitting into the fourth tier model for schools? Yeah. I think teletherapy has really been a game changer for us and I'm sure many other communities as well. When we talk about barriers to care, you know, I talked about earlier about four percent of those students make it through the care they need. Our our virtual care model, we see those numbers high as high as in the seventies, seventy percent of students. And and that's because it's reducing barriers. Right? If you think about these students, they're for the most part, they're dependent on their caregivers to help them access care, whether that's through matching the right insurance, through getting to appointments after school. And in some cases, it means having to give up something else, right, because that takes time and travel considerations. So for many of our students, they're able to access virtual care and continue with sports or continue with an extracurricular that they might otherwise, not get to to have. So I think that's been, in talk terms of reducing barriers, that's been a huge, game changer for us. And we're not even a rural community. I think if you think of communities that aren't close you know, we're a suburb of Boston, so we have relatively good access to providers, and we still need it. I think if you look elsewhere in the country, there's certainly even a greater need. And I think a but a growing need for us has been around language. We don't have access to, providers that speak, you know, multiple languages or all the languages of our students certainly. So virtual care has opened the door for that as well. I think the other big component is one that we were really struggling to figure out even within school outpatient therapy was our lower elementary students. So talk about, relying on their their adult. They are in such a place where if they want to improve their mental health and their well-being, they really need the support of their, caring adult. In virtual therapy, you know, we've started with in school outpatient therapy for that that, age group, and it just doesn't work. Right? They're not ready for talk therapy. Doing play therapy well in school is really hard, and then there needs to be communication with the parent at that age in such a strong way. And that would that's really hard when the the child's not there with the parent. So virtual care is allowed for this parent guidance piece that's, of course, covered by insurance, but it's so critical. And we've seen that, for our virtual care students. About forty percent of our referrals go to to, this parent guidance piece because it is such a crucial component. And, really, I think if you talk to our early elementary school counselors, they'd say this has been the biggest game changer for them because there are so many changes that can support students at home, and they don't really feel comfortable suggesting those changes. They're they're, like, working with little kids, not so much adults. That's not their comfort zone. So teletherapy has really been a game changer for all those reasons for us. Yeah. That that parent caregiver element, especially when working with younger students, is is so important. And I love to hear about, the value that virtual therapy or teletherapy brings to be able to improve access for parents and caregivers who have very busy schedules. And I know myself as a provider utilizing play based engagement strategies even in a virtual setting is possible similar to how you would work with a younger student in an office. So that's that's great to hear that that's been working really well, and you're hearing really positive feedback, especially at the elementary level. Absolutely. Anything to add, Arment? Yeah. Thank you. I I guess I would probably pull back a little bit. So Ryan talked about some of the components, which I think are so important. But if we pull back and sort of look at for a second what the result is, what the impact is within the school. So if you think about some of those students' needs being met outside the framework of traditional school counselors, you've freed up staff time and and opportunity to reengage strong tier one, tier two levels of support depending on how sort of you think about those kinds of things. You have created more bandwidth so that they can do work and potentially have actually created some resource opportunities. What I mean by that is, like, the the big question that we we got often and continue to get is really about how are you gonna pay for this? And there's a part of this where we are currently having school counseling staff do and paying them in the way that we pay them for pretty routine tasks that really could be handled some other way. So when we think about care coordination as as one of the elements of tier four, you think about if you've contracted to have have an organization that's expert in doing that, do that, now your counselors have more space and time. When we were able to enlist and engage the opportunities around virtual or teletherapies, one of the things we saw was that we were able to free up resources to add the wraparound services component that we talked about, which is another level of care that would not have existed without sort of, what was really dealing with the the total system and the available resources within the total system of student care, importantly. The only other things I'd add is that for my, building and district colleagues out there, make sure that your school committee is on board before you go down this road. I think as as Vanessa mentioned, some of the stigma that exists with mental health, it certainly exists in the adult community and sometimes those folks are decision makers. So be thoughtful about how you engage this conversation and what the values of that are going to be. And then we spend some time especially, to understand when we engage, these kinds of opportunities, what are our legal obligations, where does liability fall, those kinds of pieces. That's not very a very exciting part of it, but it is important to make sure you know what what you're getting yourself into on on the front end so that you're not dealing with it if something doesn't go well. We haven't had that experience, by the way, and it's important to sort of to, you know, to be well planned is an important, sort of aspect of all of this. Absolutely. To to dive a little bit deeper on that piece, Armond, you note, you know, important considerations around, compliance and and legal vetting when you're working with partners or virtual therapy providers. What what should district leaders be thinking about in those areas? Yeah. I think when we're thinking about out, sort of in school outpatient services, you have to think of all of the sort of your local district policies and then, have conversations with the municipality's insurer to understand where the liability falls. Right? This service of people in your building who are typical outside providers happens outside. They carry liability insurance, etcetera, because of their, because of their practice. When they come inside, you need to make sure that you understand what their classification is as far as being a school employee or not because that's gonna have an implication. And, again, we've been able to sort of deal with that. Many districts have been able to deal with that. But if you're not thinking about that and don't sort of front load it, the conversation after something has taken place, especially if you're in a community like ours where the town owns the buildings, not the schools. It's it gets it can get pretty complicated. So you wanna do, good work around that that legal vetting. And similarly, with regard to teletherapy services to understand and ensure that the agreement you have with with TimelyCare or others is one that, you know, your attorneys have looked at. And one of the things that I'll I would just add, you know, I've been in school school building administration for a long time now. You know, what I find myself regularly asking our attorneys when we talk to them is like, okay. Is this a strict legal opinion or you're giving your advice and counsel? Because the letter of the law is the letter of the law, and everyone has to interpret that. So you really need to understand where there may be, where your counsel may be advising you based and why they're advising you in a particular way and how that connects to the law. This is not my space, certainly. I'm not a lawyer by training, and so it's just super important to make sure you have all of that clarified. Last thing I'd mention is that, it's also important to make sure that you have a conversation with your local union. If you are a unionized, teaching force, student supports during the school day is a function of folks that, for us, exist within a within a union structure. And that conversation needs to happen because, of course, there are provisions that prevent, district administrators from taking, work away from that union structure. And what what you're able to do is really talk through why this isn't that same work and and in in our in our view, why this isn't that same work and how this works, otherwise. So those are some, higher level considerations with regard to sort of how to manage what would be an implementation. And my view is that if you don't do that on the front end, like, trying to clean that up just becomes impossible. And if you're gonna move forward, you need to, make sure that you as you all do, I'm sure, cross your t's and dot your i's so that you have a successful rollout of whatever elements of tier four you're thinking about. Absolutely. Do your do your homework ahead of time, it sounds like. I see. Yeah. Absolutely. Well, kind of piggybacking off of that question, what would you recommend in order to get, you know, really kind of district buy in? What has been helpful from you know, and this question is either for you, Arment, or for Ryan. What has been helpful to get buy in around ensuring that students have access to services and student support services in place? Correct. Do you wanna start, Ryan, and and I'll Sure. I I can let Armen talk about if he wants to, about the financial component because I think that's been a a big and important one. It's not, you know, where our space likes often where we like to start as educators and mental health providers, but it's important. But I can talk about the other the components. I think part of our our original mission when creating this approach was to increase access to care. And we measure that and realized we did that pretty quickly and effectively, and we're proud of that. The next step for us was to say, okay. Well, how is this impacting in addition to access to care, how is this impacting students in ways that other stakeholders in our community who may not believe or their first inclination is mental health should be in schools. So we looked at our rates of absenteeism and our our academic, measures for those that were engaged in these services. And what we found is that seventy percent over seventy percent of our chronically absent students, came to school more often post intervention, regardless whether it was teletherapy, care coordination, in school outpatient therapy, wraparound, whatever it might be. And then academics, actually, GPA increased at even higher rate, around seventy seven percent for those engaged in those services. So although not our starting point and initial motivation, very important to to us, of course, but, those who are, in education kind of from traditional paths, would also I I think it's hard to argue that if you invest in student mental health, they're gonna come to school more often, and they're gonna do better academically. That's kind of an easy way, to get buy in in the community. And I would just broaden that a little bit by saying the voices of our staff, the voices of your staff is going to ring a more true and more compelling than any any potential promises of improved outcomes for students in a lot of ways. So when when staff talks about feeling overwhelmed, feeling like they're not making progress, when they talk honestly about their current, sort of experience in the broader context of how difficult it is to work in schools right now, how difficult it is to be an educator, I think that that's incredibly compelling. And that voice carries a level of weight, that I think regardless of how good, we are able to articulate that, that people sort of react and respond to. Importantly and Ryan and I have talked a lot about this. You know, as someone with a public health background, I and an educator, I love the fact that we're seeing improved academic outcomes. I love the fact that we're seeing students come to school more frequently than they would expected would be expected to if we didn't engage these interventions. But that doesn't carry the day when we're talking about, you know, the the funding sources for schools. What carries the day is to really be able to articulate that the old adage of an ounce of prevention is worth a pound of cure actually shows up here too. Right? If you're able to more effectively meet the needs of students, what we've seen is we've avoided we've had some significant cost avoidance relative to higher levels of need, ultimately, special education placements for students, importantly. And I think as as institutions and organizations, it's really hard we talk about prevention or early intervention all the time as part of the MTSS model. What's been harder for us to do is to to measure the impact in ways that are really understandable and translatable to people outside of the education space that have to make the decision. So in communities like mine, there is a select board or a town council or a city council or a mayor that's ultimately making decisions about what school funding looks like. The compelling argument is really, like, if we invest this amount of money, we can anticipate over this this amount of time of avoiding these costs. And then, of course, it's better for kids, and kids will have improved, outcomes, which which is is the argument. But it's interesting because at the end of the day, this is a bottom line kind of issue and a decision that we have to make about where our fiscal priorities are. And we found that, to to Ryan's point, that spending some energy and resources in this space has really paid dividends. And not just the idealistic dividends that educators hope for of improved outcomes, but really dividends with regard to financial impact. It's great to hear. And it sounds like you really kind of took a holistic approach, you know, kind of looking at the the the broader school climate and, student outcomes and how to really set the the district up for success, even financially. Yeah. For sure. And I as a result, there's been no continued sort of hesitation around what our funding sort of approach looks like, and we've been able to add very atypical positions for a district of our size into our employee structure into the into the budget. The wraparound service coordinator is an example of that. Because of the real felt impact, again, not only from student outcome perspectives, but also from, financial sort of cost avoidance perspectives. Yep. Absolutely. Well, wonderful. Well, it has been such a pleasure talking with you both. And and, really, it's been a great conversation and appreciate all of the information that you were able to share with me and our audience today. I have seen quite a few questions come in through the chat, and we certainly wanna take a couple minutes here before we close out to be able to answer those. So I will go ahead and turn it over to Gina. Thanks, Vanessa. Something Ryan mentioned early in the conversation about universal screeners, really grabbed the attention of some of our listeners today. And, we have questions related to whether there's recommendations on universal screeners and also how your district does universal screening. Ryan, do you wanna take that? Sure. Yeah. I think rec so I think my top recommendation is to you know, you'll know your community better than me and what their kind of level of comfort is, whether it's a school community or a greater community. I think in broad terms, when we're thinking about screening, we think about, social emotional screening, right, for competencies for social emotional learning, which are important and have a place. And that's usually an easier entry point for districts. And then we think about mental health screening. So using validated tools to, screen students for anxiety or depression or, you know, at the younger younger ages, maybe a broader spectrum screener where you can, find, you know, intrinsic or intrinsic behaviors. So I think if depending where your district's at, I think if, you know, they're you're in a good place to go either route. I think mental health screeners would be my choice or a combination of both, which is what we do. You know, in in the book, we kind of outlined a variety of those tools and kind of the thought process to where you might get there. I think well, just one last thing, and then I'll stop on this. I think when I'll just share my experience. When I introduced universal screening, one of the first things I heard was, well, we can't do this because we we don't know we don't have the right supports in place on the back end, so we don't wanna know. Right? And so I I think that's the approach you wanna avoid. Right? Because, one, it's not gonna be as many students as you think. And just because you don't ask doesn't mean those needs don't exist. So I think if you can get past that, then then any screening is is good. Another attendee asked about family education, saying it's very critical and would like to learn more about your approach. Yeah. So I I I can start, and, Armin, you might have additional thoughts on this. I think family education is one of the trickiest things. Right? Because and I'm a parent too of young kids. Right? You want your time is limited, and you want to be educated on what exactly you need when you need it. Right? And so that's, like, a tricky thing for schools to figure out. I think, you know, you the traditional approaches around speakers or webinars are good and important, and I wouldn't stop doing those. We certainly have it. But I think if you can personalize, the approach to parent education, especially if we're talking mental health around psychoeducation, if you have tools that can do that. We've, recently leaned into a partnership around, single session interventions, and those are short modules that, a parent can get, hopefully, all they need in one single dose around fifteen minutes, whether it's around supporting your student with anxiety or school avoidance or depression. I think that's the the most recent approach we're taking, but, certainly, I wish I had the answer to what works for all parents, but, haven't quite landed on that yet. Yeah. And I I would just add that it's probably a little bit different than the intention of the question, but I think it's important, is really about what is the district's communication plan relative to issues of social emotional learning and mental health. And I think that, you know, communication is hard for all the reasons that Ryan mentioned, and, you know, what's important gets communicated. What gets important in many school districts is, you know, how the how students did overall in the state assessment, the annual state assessment, or it might be changes to the schedule. It's it's all of those things. And I think we need to create space to have this be part of what continues to be elevated as a really important component of the holistic education we're providing students. And I think that that ultimately ends up doing a number of things, including opening up opportunities for families to recognize the school as a resource and and and staff within the school as a resource who might be a a place to go besides just the pediatrician if they're if they're having some of the challenges that we mentioned, as well as elevating sort of the profile of this so that you can deal with the stigma piece, but also demonstrate real proactivity around trying to support the holistic child, not just the educational kind of piece. And I know no school is only paying attention to the education components only, but sometimes our communications, are, you know, super challenging, I I totally recognize and and feel all of that. In fact, I'm late. Today was supposed to be a a email release that I haven't written yet, so I'll do that maybe a little bit later tonight or tomorrow. But it's important to keep that elevated and front of mind for the community so that they recognize not only the work that's going on, but where there are opportunities for them to engage should they need the assistance, at some time as as Ronnie mentions. We have time for one final question, and it's this. In districts where there isn't currently dedicated mental health leadership role or structure, How have you seen teams effectively build buy in with school and district leadership to invest in this important work? Yeah. It's I so I will have often said we are fortunate. Ryan was hired in our district. Ryan has a public health background and, a different lens than a traditional education, sort of based individual. I think it starts with really trying to have these conversations. There's kind of two elements here. One is really about, elevating the importance of this conversation with the people who can make the decisions. Right? So it might be a school or district based leader. And once they recognize why this is important, then to to give them the steps to understand how they start making progress in this really import in this under this really important sort of framework. And we've talked a lot about this. I think, you know, success begets success. So if you can take some small steps and see some real impacts with regard to that, then there's going to be more of a willingness to, try things out and sort of assess where they are. So if you're a building based individual and you're thinking about your building leader, part of it could be conversations about, like, what does care coordination look like and how can we get support for care coordination? That tends to be relatively low cost, relatively low cost, and really have a huge impact on the time experience of staff. I think when we did a measure of this, we saw that staff were spending I I don't wanna mess this up, Ryan, but they went from two and a half hours a week to a half hour a week maybe of care coordination time. Is are those numbers correct? Yeah. You're there. So think about every one of your sort of mental health staff that are trying to coordinate care for families gaining two hours back and then multiply that across your district. So I think what happens in schools is that we are passionate about the changes we wanna make because it's in the best interest of students and even for building and district leaders. That's not the only calculus they can use. I would love to do much more than we're doing, but I'm not able to because we have to make decisions about how we're gonna prioritize things. So you really need do need to lead them down the path, try things on a small scale, really hear the voices of staff to understand how it's working, and then, and then potentially expand. I think what's great about organizations like TimelyCare is that once it it it's, you know, it's a set it and forget it, so to speak, where you're not managing all the complexity on the back end. You're really making sure that you have a a pathway and a pipeline for families and students who need it. And that unburdening of the stress that we've seen from so many of our school counselors, is totally worth it. And a building principal or a district leader will understand that differently than perhaps the nuances and the complexities of mental health care as a framework. Great advice. Thank you, Armond and Ryan, again for being here today. And before we close, could you share with the attendees where they can find the fourth tier? Sure. Super excited. Fourth tier was published by Bloomsbury, so it's certainly available on their website, also available on readily available on Amazon. And for anyone who might be interested in bulk purchasing, we invite you to reach out to Ryan or I. We're both on LinkedIn and fairly active on LinkedIn or to head over on to website that's listed in the comments where you can make a connection with us there as well. Thank you. We hope this leaves you and one useful idea or one next step for our attendees. TimelyCare is here to help, so please reach out to us anytime. And thank you, and have a great day. Thank you very much. We appreciate the opportunity. Thank you, everyone. It was great to connect with both arm Armand, you, and Ryan as well.