As school districts across the country struggle to find enough professionals to help students through a widescale mental health crisis, the Boston school district remains one of the few that meets the nationally recommended ratio of mental health staff to students.
That’s in part because of the vision, persistence, and decadeslong work of Andria Amador, Boston’s senior director of behavioral-health services, who forged a nationally recognized partnership with a local hospital and university to ensure the district has a stable pipeline of mental health-care professionals. Amador has also revamped hiring processes to attract staff from diverse backgrounds to address the unique concerns of students in a district that’s majority nonwhite and where 32 percent are English learners.
The groundbreaking partnership, called the Comprehensive Behavioral Health Model, allows the University of Massachusetts-Boston and Boston Children’s Hospital to bring more social workers and school psychologists, including graduate students, into the district to treat students dealing with issues such as anxiety, depression, and trauma. The district has also created a health collaborative with more than 20 community organizations and state and city officials. They’ve committed to working together to improve student well-being and academic outcomes by expanding therapy services for young people, advocating for mental health programs, delivering training on best practices, and creating opportunities for family engagement. The goal: to address students’ mental health and well-being issues before they balloon into problems that require hospitalization.
“Our vision is that each school would have a full-time school psychologist, a full-time social worker, and a full-time mental health partner to ensure we are able to focus on prevention and promotion of mental health,” Amador said.
Amador, 51, was incredibly prescient in setting up those programs, which took flight long before other districts started prioritizing students’ mental health that suffered during the coronavirus pandemic. Nearly 44 percent of youth said in a 2021 survey by the Centers for Disease Control and Prevention that they felt persistently sad the year before—a year marked by massive disruption in schooling, socialization, and a sense of normalcy. As schools regain some measure of stability, students’—and staff—mental health challenges have jumped to the top of districts’ priority lists.
Amador’s foresight has put Boston in a unique position of having the staffing capacity to respond to the crisis. While the National Association of School Psychologists recommends a student-to-psychologist ratio of 500-to-1, Boston’s is 453-to-1. (The national average was 1,127 students to every school psychologist, according to 2021-22 federal school data. )
In the 10 years since the partnership started, the district has nearly doubled the number of psychologists, to 106 from 54, while the number of social workers jumped to 187 from just six. Nearly all the schools—90 of 121—have a mental health partner, which can include a social worker, licensed mental health counselor, or a clinical psychologist from the community.
A ‘mental health saleslady’
Amador realized early in her career, while working as a school psychologist in Lawrence, Mass., that her role was very circumscribed, limited to conducting special education evaluations and leaving the vast majority of students who could benefit from the expertise without it.
“We were working with about 20 percent of the students in the district rather than 100 percent of students,” said Amador, who moved to Boston in 1998. “We were engaging with students when a problem already existed rather than working to build safe and supportive schools and prevent problems from happening or becoming worse.”
After becoming the assistant director of behavioral-health services, Amador vowed to do things differently. That’s when she came up with the idea for the partnership, which is rooted in prevention.
Our vision is that each school would have a full-time school psychologist, a full-time social worker, and a full-time mental health partner to ensure we are able to focus on prevention and promotion of mental health.
Amador knew that the shortage of school psychologists would make it hard to put a psychologist in every school building, and even if she could find the psychologists, the district wouldn’t have the money to hire them all. So, she became what she calls a “mental health saleslady,” traveling around the community to persuade hospital officials, university program directors, nonprofit organizations, and parents that student mental health was a worthy investment.
She was ready to accept anyone who was willing to help.
Shella Dennery, a licensed social worker and the director of Boston Children’s Hospital’s Neighborhood Partnership Program, was the first to commit. It was a no-brainer for Dennery, who had seen the hospital treat countless young patients suffering from extreme mental health conditions that could have been averted with earlier intervention.
The hospital partnership provided on-site school psychologists and social workers, who work directly with students in schools, as well as a data and evaluation coordinator, who tracks student outcomes. Dennery also helped Amador overhaul mental health trainings so that teachers, school psychologists, and other school staff would be able to follow best practices.
The district trained school psychologists in the National Association of School Psychologists’ Practice Model, which outlines 10 areas every school psychologist should focus on, such as family, school, and community collaboration; equitable practices for diverse student populations; and data-based decisionmaking.
“At the time, I don’t think we realized having a hospital, a university, and a school district partnering together, is incredibly powerful,” Dennery said.
Melissa Pearrow, the director of UMass’s school psychology doctorate program and a former president of the Massachusetts School Psychologists Association, also signed onto the compact. Before the alliance, Pearrow had avoided sending her graduate students to intern in the district because their duties were limited to special education evaluations.
Through the partnership, graduate students’ roles expanded. Each year, 52 students work in the same capacity as school psychologists, spending two to five days a week in schools, managing caseloads, conducting behavioral consultations and assessments, developing support plans, and directing interventions, such as group or individual counseling, for students.
“The invitation into the [Comprehensive Behavioral Health Model] executive work group really galvanized our training program,” Pearrow said. “It enhanced our ability to train graduate students to be in urban schools and learn some of the grit that’s needed to navigate some complex systems that are underresourced.”
The partnership, Pearrow said, was “a synergy of growth,” with UMass’ students sharing their working experiences with their professors, who in turn give their feedback to the district.
Prevention, not reaction
Amador hasn’t lost sight of the fact that early intervention is the key to helping students.
To spot the early-warning signs and get students into treatment sooner, the district had to make a lot of internal changes.
“Particularly in urban districts, students who seek mental health support in the community often attend three sessions [at] the most and then stop going to get help,” Amador said. “That happens, in part, because of all the barriers: if your parents work, if you don’t have a car, if you can’t pay the co-pay. So one of the things we knew we needed [was] to develop high-quality internal services to level the playing field.”
Those services weren’t going to be effective if every student sought help when they were experiencing an intense mental health crisis, Amador said. But, she thought, the system would be less strained if the district could identify at-risk students and support them early on.
The district started mental health screenings for all students, using a diagnostic method known as the Behavior Intervention Monitoring Assessment System, or BIMAS-2, which identifies students showing signs of mental health upsets, such as anxiety or depression. It flags when a student might be struggling with a behavioral-health or social-emotional-learning issue.
For example, the screening may identify that a student is prone to losing their temper. This alerts the behavioral-health department to work with the student on self-soothing or coping skills.
“Teachers are great at finding externalizing kids—the kids that are throwing something, disrupting class, fighting; that’s easy for educators to see,” Amador said. “The kids that are being lost when you’re not doing screening are the internalizing kids, the kids with anxiety, depression, school phobia, lack of social skills, or lack of friendships.”
The district has also invested in robust and universal social-emotional learning. Students participate in Second Step, a program that helps them learn how to regulate their emotions, problem-solve, and build kindness and empathy.
Amador has also been more intentional about hiring staff, focusing on building a corps of school psychologists from diverse backgrounds.
The department starts by recruiting candidates who are bilingual and racially diverse. As a result, 41 percent of the staff are people of color, and 47 percent are bilingual, with the entire school psychology staff speaking 14 languages among them.
“If we have a family in crisis and they only speak Haitian Creole, I can’t help them in the same way that a school psychologist who’s from Haiti, knows the culture, but also knows the language, can help,” Amador said.
Fighting for what’s right
Amador’s partnership with the hospital and university has been cited as an effective practice for school-based mental health services in research papers published in the American Journal of Psychiatry and a 2019 report by the Newark Trust for Education.
The papers applauded Boston for developing a tiered system of support, strong community partnerships, and early-screening system, all of which “are worthy of emulation in like initiatives in other cities,” the Newark Trust paper said.
“One of the things that Boston public schools has done so successfully is create a strong school mental health program, but also they have successfully engaged community partners,” said Shawna Rader Kelly, a member of the NASP board of directors and a school psychologist in Bozeman, Mont. “That, to me, is what really makes a program stand out as exemplar.”
Amador, Pearrow, and Dennery also regularly consult with other districts on how to develop similar models and speak on panels with NASP about mental health best practices. Pearrow has shared the UMass program’s experience with other universities to help them train mental health staff to work with students of color and those in urban settings.
The progress in Boston would have been impossible without Amador’s commitment, Dennery said.
The district, like many large school systems, has been plagued with leadership turnover at the top and in key positions, and Amador has had to persist with the behavioral-health model through the churn.
“She has had to fight for a lot of this work,” Dennery said. “Now, we’re at a time where people get it a little bit more. But we were doing this a long time ago, and starting this, people weren’t really on board. … So, she’s a fighter.”
Amador still believes there’s a lot to be done.
“We didn’t start here,” Amador said. “We started with nothing, and each year we build on it.”
