The Carolina Network for School Mental Health (CNSMH), established in 2010, is a multidisciplinary school mental health network among professionals in North Carolina and South Carolina, including K-12 educators, academics, and mental health professionals. From its inception, the network has aimed to facilitate productive collaborations within and between states, including clinical activities, empirical endeavors, grant writing, policy development, and dissemination of evidence-based practice. The goal of each of these activities has been to promote a full continuum of effective mental health promotion, prevention, and early intervention for youth in both states to promote behavioral and physical health, wellness, academic achievement, and postsecondary vocational success. 

Through partnerships with schools, community agencies, families, and youth-serving systems and organizations, the CNSMH hopes to improve all children's educational outcomes, especially those with unmet mental health needs. The CNSMH seeks to accomplish this mission by 1. Understanding and facilitating communications between local and state initiatives to promote supportive policies to expand and improve SMH in North Carolina and South Carolina, 2. Building a full continuum of effective strategies focused on mental health promotion, prevention of social, emotional, and behavioral problems, early intervention and intervention for students in general and special education, 3. Evaluating the quality of SMH in North Carolina and South Carolina to ensure that students remain in school, positively engaged in their home life, and out of trouble, 4. Building and sustaining action to promote a shared agenda for mental health-education-family collaborations with essential stakeholder representation through family-driven and youth-guided programs and services, and 5. Promoting awareness and reducing stigma surrounding mental health needs and the critical links between positive mental health and school success for North Carolina and South Carolina youth. 

The University of South Carolina (UofSC) School Behavioral Health Team (SBHT) recently received funding from BlueCross® BlueShield® of South Carolina Foundation (June 2021-June 2024) to create an infrastructure to recruit, train, and retain school mental health supports and professionals by working with both undergraduate and graduate students across the state. The Enhancing Capacity in School Mental Health (ECSMH) program recruits undergraduate students to participate in an internship designed to support the tiered mental health needs of South Carolina public school students and families by helping to close any gaps in service provided by school mental health professionals (e.g., mental health clinicians, social workers, counselors, psychologists).  ECSMH targets undergraduate students interested in pursuing a future career in school mental health. Additionally, this program recruits graduate students enrolled in mental health related programs (i.e., counseling, school psychology) to increase their training in school mental health and connect them to “school-based” positions. 

Through ECSMH, the School Behavioral Health Team provides the hands-on and timely experience of assisting our state in building and training a well-qualified school mental health workforce. This program also builds our connection to schools and districts across the state that need to better support the mental health challenges facing their students and families. 

The SBHT has received funding from the Institute of Education Sciences (IES). This grant project, Improving Social, Emotional, Behavioral, and Academic Functioning of Elementary School Students through the Interconnected Systems Framework, is funded from 2020-2025. This project aims to improve the Social, Emotional, Behavioral, and Academic functioning of elementary school students. It will evaluate the best way to support students using the Interconnected Systems Framework , an evidence-based approach to supporting students' mental health. This project will take place in 16 North Carolina and South Carolina schools, following one cohort of students during their third to sixth-grade years. This project will inform many aspects of SBH programming through its enhanced universal screening of students for SEBA functioning, improved education-community mental health connections, expanded District-Community Leadership Team support, more intentional involvement of students in both general and special education, and better use of disaggregated data to address disciplinary inequities for students of color. Additionally, SBH programming will be further informed through the project's aims to understand the contribution of the ISF on overall team functioning and student needs, as well as the cost-effectiveness of implementing the ISF in comparison to current SBH programming efforts. 

This project, funded by Blue Cross Blue Shield (BCBS) of South Carolina, is a program evaluation of the Ending the Silence (ETS) suicide awareness program for students, staff, and families by the National Alliance on Mental Illness (NAMI) SC. The evaluation team utilizes surveying methods to evaluate changes in knowledge and perception of mental health conditions, stigma, suicide awareness, and prevention, the benefits of early intervention, and if the presentation resulted in youth seeking treatment following the ETS presentation. Additionally, evaluation team members conduct qualitative interviews with individuals who indicate their willingness to participate and provide in-depth information about their changes in knowledge of suicide and mental health in general, their ability to respond if they or others experience suicidal ideations, and their general thoughts and satisfaction with the ETS training. 

This five-year longitudinal study, funded by the Patient-Centered Outcomes Research Institute (PCORI) includes partners at the Medical University of South Carolina, University of Maryland – Baltimore, National Center for School Mental Health, Baltimore City Public Schools, Greenville (SC) County Schools, and the Greater Greenville Mental Health Center (SC DMH). Through this project, the SBHT seeks to understand the incremental impacts of evidence-based enhancements to a framework for evidence-based practice in school behavioral health. Partnering with 22 middle schools in the target districts, the project is evaluating the impact of an intervention in increasing the number of students and families receiving services and expressing satisfaction with them; the impact of the intervention on students’ social, emotional/behavioral, and academic outcomes; and the follow-up effects of the intervention on social, emotional/behavioral, and academic outcomes for students in high school. Elements of the project that are anticipated to provide generalizable knowledge across South Carolina include the impact of a mental health literacy curriculum, cultural responsiveness and equity training with school mental health clinicians, and use of a modular, evidence-based practice system. In addition, the project seeks to increase family engagement in school mental health systems and is utilizing the Extension for Community Healthcare Outcomes (ECHO) model to disseminate and democratize knowledge across sites, which may prove useful in sharing best practices in school behavioral health across the state. 

In 2011, in recognition of significant emotional and behavioral needs of children in SC, particularly students contending with ED, the South Carolina (SC) School Behavioral Health (SCSBH) Community was formed to foster a unified agenda for effective prevention, early intervention and treatment of student emotional and behavioral problems, capitalizing on the universal natural environment of schools and focused on achieving outcomes valued by families, and health and educational systems.  A major goal of the SCBHC was to help the SBH agenda in SC to be more coherent, and to involve all disciplines and systems (e.g., education, mental health, child welfare, juvenile justice, disabilities, primary health care) in working together to improve the depth, quality, and impact of SBH services in the state.  

The Southeastern School Behavioral Health Community (SSBHC) builds on the work of the SCBHC and now enables multiscale learning and collaboration with 12 other states in the southeast region, enabling showcasing SC’s leadership in this area, and bringing in lessons learned, insights and resources from these other states. The SSBHC includes diverse stakeholders from southeastern states, representing families and youth, leaders and staff from youth serving systems (e.g., education, mental health, juvenile justice, child welfare, primary care), government officials, researchers, advocates and others, and has close relationships with national centers for school mental health and PBIS, a range of other regional organizations, and widespread and deep relationships with leaders and staff from diverse student-focused systems in SC.  Further, the SSBHC has decided the annual conference will always be in SC, and regional work will build from and support our work in the state. To date, the SSBHC has convened eight successful conferences (in Columbia, 2014; Charleston, 2015; Myrtle Beach, 2016, 2017, 2018, 2019, 2021) offering professional development opportunities for educators and practitioners to build capacity for effective SBH. In addition to the annual conference, scheduled in 2022 for April 28 and 29 (again in Myrtle Beach), the SSBHC features a website (www.schoolbehavioralhealth.org), and listserv that reaches more than 2000 diverse educators and stakeholders in SC (and an additional 14,000 stakeholders in southeastern states).   

Through the support of the PCORI award, leaders for the SSBHC conducted forums throughout SC on critical issues to advance SBH.  The outcomes of the annual forums (2015-2017) were the identification of key conference themes and special populations: 1) building school-wide approaches, 2) promoting family-school-mental health and other youth serving system partnerships, 3) assuring that programs and services are of high quality and are evidence-based, 4) enhancing implementation support for effective practices, 5) promoting cultural competence/humility in all efforts and 5) child welfare, juvenile justice, and military connected youth.  Each theme has an emphasis on identifying barriers and ways to overcome them, and identifying recommendations for improving practices for all students in schools, with a particular emphasis on effective services for students with ED.  The SSBHC 2022, titled “Advancing School Behavioral Health in a Critical Time of Need, Recovery, and Opportunity”, highlights key objectives 1.) Effective Approaches and Interventions across the Multi-Tiered System of Support (MTSS; Tiers 1, 2, and 3) 2.) Building Foundational MTSS Practices (e.g., Teams, Data-Based Decision Making, Evidence-Based Practices, Coaching, Alignment of Programming) 3.) Enhancing Collaboration with Diverse Stakeholders and 4.) Empowering Students and Families as Leaders within the MTSS and 5.) Enhancing Awareness, Promoting Inclusive Environments, and Improving Opportunities for All Students (e.g., students from military families, in child welfare juvenile justice systems; and/or other students with unique personal needs) with cross cutting themes of 1.) Improving Programming for Students with Disabilities and 2.) Assisting Schools/Districts in the Challenging 2021-2022 Context.  This work is led by professor Weist, Ms. Headley-Greenlaw and Ms. Davis from the University of South Carolina SBHT, along with Dr. Bob Stevens and other colleagues from the SC Association for Positive Support, with all of this work guided by systems leaders (especially from SC departments of education and mental health) as well as other stakeholders, including youth and families (as emphasized by PCORI). 

Carolina CARES will focus on building resilience among children contending with poverty in Florence, Darlington, and Marion counties in South Carolina. Funding will build sustainable Safety & Support Teams (SSTs) in schools, including SBMH clinicians, who will work closely with school nurses and counselors. The goal is to move beyond isolated and ineffective approaches for disadvantaged students contending with emotional/behavioral (EB) problems toward a coordinated approach emphasizing the most effective integrated practices to prevent and reduce problems, while promoting resilience and healthy psychosocial and school functioning.  BCBS Foundation grant funding supports the installation of SBMH clinicians in Florence, Darlington, and Marion county elementary schools. In addition to the clinician’s daily responsibilities providing mental health intervention, SBMH clinicians will be active participants in Safety & Support Teams (SSTs) in the schools. Focused on building a multi-tiered system of support (MTSS), these teams will also include school-employed mental health staff (e.g., psychologists, counselors), educators, school nurses, school administrators, and family members/parents (as indicated). SSTs will coordinate prevention (Tier 1 in the MTSS), early intervention (Tier 2 MTSS), and treatment (Tier 3), will implement evidence-based practices at each tier of support, and will monitor and refine these practices using data-based decision making. 

Funding from PCORI will provide the opportunity to host two high quality conferences on effective school behavioral health (SBH) for patients, families, leaders and staff from youth-serving systems and other stakeholders in 2016 and 2017 in Myrtle Beach, SC. PCORI funding will address a three-pronged agenda of engaging patients and stakeholders in training, research, and dissemination which we anticipate will result in increased engagement and collaboration between the research community and patients and stakeholders. Funding from this grant will specifically do the following: 

1) Provide state-of-the art training on evidence-based prevention, early intervention and treatment in SBH. 

2) Support a research pre-conference including patients, clinicians, researchers and other stakeholder groups, with training focused on principles of PCORI, Comparative Effectiveness Research, and research strategies for improving the quality of SBH and assessing its impacts compared to other service delivery approaches. We will also hold research forums including these groups to enable patients and other stakeholders to be actively involved in and guide SBH research in SC.  

3) Broadly disseminate information through a growing listserv, website, newsletters, and other methods on effective and evidence-based practices, and on progress of research to improve the quality of SBH in SC.

The purpose of this National Institute of Justice-funded study is to evaluate the efficacy of the interconnected systems framework (ISF) in improving school safety and positive school climate, behavioral and discipline problems, emotional and behavioral health, and student academic outcomes. This study is the first experimental evaluation of the ISF’s contributions to school and student safety and functioning above the effects of PBIS alone or PBIS and SMH clinicians operating in a normative (i.e., disconnected) fashion. Participating schools will be 24 elementary schools across sites in South Carolina and Florida currently implementing PBIS with high levels of implementation while also maintaining an absence or minimal presence of school mental health. Schools will be randomly assigned to one of three conditions---PBIS only, PBIS+SMH, or ISF. Students and teachers in all three conditions will be asked to complete climate surveys and additional surveys assessing students’ exposure to violence, emotional and behavioral health, and student satisfaction with school mental health services. We hypothesize that students in schools assigned to the ISF condition will receive less discipline referrals and report fewer emotional/behavioral health concerns by follow up compared to their peers. By evaluating the effectiveness of multiple interventions and their impact on school climate and school safety, results from this study will expand knowledge in the field of school behavioral health and has the potential to impact related judicial and educational policies nationally and in the communities participating in the study.