A Guide to K-12 Student Behavioral Health Supports with a Focus on Prevention, Early Intervention, and Intervention for Students’ Social, Emotional, and Behavioral Health Needs

(1) The general assembly finds that:

• (a) School mental health professionals, including school social workers, positively impact the school environment by working with young students and their families to identify safety-net insecurities, social and emotional skills deficits, instances of abuse and neglect, and mental health challenges;

• (b) Identifying these student issues as early as possible increases the likelihood that problems can be resolved successfully and in a manner that decreases long-term problems with learning and other barriers to student success in the future ... (2) Therefore, the general assembly declares that the creation and successful implementation of a Colorado K-5 social and emotional health pilot program could have a profound impact on the early educational and social experiences of kindergarten through fifth-grade students, resulting in those students graduating to middle and high school programs with fewer social, emotional, and behavioral issues; adverse childhood experiences; disciplinary referrals and delinquent conduct; school absences and truancy; and incidences of self-harm.

(1) There is created the K-5 social and emotional health pilot program in the department to determine the impact of dedicated school mental health professionals in kindergarten through fifth grade in elementary schools that have high-poverty, high-need students. The pilot program is implemented within the selected pilot schools and administered by the department. Operation of the pilot program begins in the 2020-21 school year and continues through the conclusion of the 2022-23 school year, unless the repeal of the pilot program is extended by the general assembly. Pursuant to section 22-102-106, the department shall employ or contract with a pilot program coordinator and contract for preliminary and final program evaluations of the pilot program. The department shall promulgate any rules necessary for the administration of the pilot program.

(2) (a) No later than January 15, 2020, the department shall select up to ten pilot schools to participate in the pilot program. If available appropriations and gifts, grants, or donations are insufficient to fully fund the pilot program, the department may select fewer than ten pilot schools to participate in the pilot program. The department shall select pilot schools that exhibit the characteristics set forth in subsection (2)(b) of this section and that are appropriate test schools to evaluate the impact and effectiveness of the pilot program. The pilot schools must demonstrate a willingness to participate in the pilot program and to collect the data and information necessary for the evaluation of the pilot program.

• (b) The department shall select pilot schools, including rural, small, and geographically diverse schools, which schools shall be located in a school district that has a high rate of youth suicide, attempted suicide, or suicidal ideation; have a high-poverty student population and a high percentage of students who experience or may experience food insecurity, as evidenced by the number or percentage of students in the school who are eligible for free and reduced-priced meals; and may include schools:

• (I) In large, metropolitan school districts;

• (II) That have significant ethnic, cultural, and language diversity within their student populations, which may include students from refugee populations;

• (III) That have a high number or density of youth who are students in out-of-home placement, as defined in section 22-32-138;

• (IV) That are in a school district that has a high percentage of students who are adjudicated delinquent; and

• (V) That are in a school district that has a plan in place to recruit, hire, and retain a diverse workforce that reflects the race, ethnicity, and other characteristics of the student body.

• (c) Prior to a selected school implementing the pilot program pursuant to this article 102, the school must notify all parents or legal guardians of students at the school of the school's selection as a pilot school.

(1) In the first and subsequent years of operation of the pilot program, each pilot school shall employ or contract with additional school mental health professionals so that each of grades one through five and the kindergarten program in each pilot school has a school mental health professional dedicated to each grade and the kindergarten program. If a single grade or the kindergarten program has more than two hundred fifty students, additional school mental health professionals must be added to the grade or kindergarten program to maintain a ratio of approximately one school mental health professional per two hundred fifty students, as determined by the pilot school. A small pilot school shall maintain a ratio of approximately one school mental health professional per two hundred fifty students, as determined by the pilot school. At least one of the school mental health professionals at each pilot school must be a school social worker.

(2) The goal of the pilot program is for a school mental health professional to develop an ongoing relationship with pilot school students and to follow those students, to the extent possible, as the students advance through the grades at the pilot school. This will allow the school mental health professional to understand the needs of the students and their families over time and to help address those needs over time, if necessary. To achieve this goal, school mental health professionals may be assigned to a cohort of students by grade or, in a smaller school, by multiple grades. School mental health professionals in each pilot school shall work as a team to address the academic and social-emotional needs of the pilot school's students and to create a safe and positive school learning environment through additional behavioral health supports.

(3) For purposes of implementing this pilot program, the general assembly shall appropriate to the department for distribution to the pilot schools, or to the governing body for the pilot school, the amount of money necessary for the pilot schools to employ or contract with the number of additional school mental health professionals necessary to implement the pilot program, as described in subsection (1) of this section. Throughout the duration of the pilot program, the pilot school must employ or contract with, at the pilot school's expense, the same number of school mental health professionals employed by or contracted with the pilot school during the 2019-20 school year, so that the appropriation to the pilot school for the pilot program supplements, but does not supplant, the pilot school's existing expenditures for school mental health professional positions prior to the operation of the pilot program.

(4) (a) In implementing the pilot program, the school mental health professionals shall work as a team, with each professional providing services to students and offering training and resources to school faculty and administrators that are authorized under the school mental health professional's special services license and endorsement.

• (b) In addition, school mental health professionals shall, consistent with the school mental health professional's job duties and licensure:

• (I) Provide the school with resources to develop and improve the social and emotional health of students, including resources translated into the primary languages of the student population to the extent possible, and create a safe and positive learning environment through additional behavioral health supports; and

• (II) Provide social and emotional skill building in the school and with students in the classroom.

• (c) School mental health professionals may, consistent with the school mental health professional's job duties and licensure:

• (I) Assist students and their families with applying for and obtaining necessary public benefits for which each student and the student's family is eligible;

• (II) Provide services and supports to students who have an individualized education program, as provided in section 22-20-108;

• (III) Consult and coordinate with other school professionals on behalf of students and support families accessing community-based resources as needed and appropriate; and

• (IV) Identify food insecurity, homelessness, and other issues affecting students and make referrals to services within the community, bringing those services into the school setting where possible.

• (d) As appropriate, and to the extent possible, the school mental health professional must provide services or arrange for services to be provided for students at the school and during school hours or when student busing is available.

• (e) Services provided by the school mental health professional to the student must include the student's family and household, where appropriate. The school mental health professional is specifically authorized to make home visits when appropriate under the circumstances and consistent with licensure.

(5) Each pilot school's team of school mental health professionals shall participate in the school's or school district's multi-tiered systems of support process to assist in developing appropriate plans for the mental health and behavioral needs of individual students.

(6) Each pilot school, or each pilot school's governing body, where appropriate, shall collect, transmit, and retain any data and information necessary for the evaluation of the pilot program pursuant to section 22-102-106. Each pilot school shall record the unique student identifier, as defined in section 22-16-103, for all students enrolled in the pilot school.

(7) A student who is home-schooled but who participates in extracurricular activities or athletic programs at a school that is selected as a pilot school is excluded from any data collection or reporting requirements pursuant to this article 102.

(1) The department shall employ or contract with a pilot program coordinator to oversee the implementation of the pilot program across the pilot schools. The pilot program coordinator must be a school social worker who shall work with each pilot school's team of school mental health professionals. The duties of the pilot program coordinator include, at a minimum:

• (a) Coordinating data collection and program evaluation requirements with the professional program evaluator retained pursuant to subsection (2) of this section;

• (b) Serving as a contact person and resource for teams of school mental health professionals in the pilot schools;

• (c) Helping pilot schools identify successful practices for recruiting and retaining mental health professionals;

• (d) Sharing best practices relating to the pilot program and its implementation at the pilot schools; and

• (e) Ensuring fidelity to the goals of the pilot program across the pilot schools.

(2) (a) The department shall select a professional program evaluator to complete a preliminary evaluation of the pilot program on or before September 1, 2022, and a final evaluation of the pilot program to be completed on or before September 1, 2023. The department shall contract with the evaluator prior to the implementation of the pilot program in the pilot schools during the 2020-21 school year to create a process for the collection and transmission of data and information to the evaluator to ensure that the evaluator has the data and information necessary to complete the preliminary and final reports concerning the impact and outcomes of the pilot program. The pilot program evaluator, in conjunction with the department, shall select a group of control schools that have school characteristics and student demographics similar to those of the pilot schools, to serve as a control group for purposes of evaluating the impacts and outcomes of the pilot program on participating students and pilot schools. Data collected for pilot schools and control group schools must include data from school climate and healthy schools surveys for any grade in which such surveys have been created.

• (b) The department shall select a professional program evaluator that has the knowledge and skills necessary to evaluate the effectiveness of services provided by the pilot program and the resulting impacts and outcomes of the pilot program on the student cohorts participating in the pilot program. The department is encouraged, but is not required, to contract with a state institution of higher education to complete the evaluation of the pilot program.

• (c) The department and the pilot schools shall cooperate fully with the pilot program evaluator's collection and analysis of data and information relating to the pilot program's impact and outcomes. The department, pilot schools, the pilot program coordinator, and the contracted evaluator shall comply with all state and federal laws relating to the confidentiality of academic and medical records of students and shall provide aggregated data where appropriate.

• (d) The pilot program evaluator shall determine the impact of the pilot program on students' academic, mental, social-emotional, and physical health and well-being. The evaluator shall collect and analyze data relating to student and school outcomes, which outcomes may include:

• (I) The increase or decrease in students' disciplinary referrals, either within the pilot school, or pilot school's district, if relevant, or with law enforcement, and the increase or decrease in students adjudicated delinquent within the pilot school's district;

• (II) The increase or decrease in students' lost instruction time due to disciplinary action or visits to the school nurse or school counselor;

• (III) The increase or decrease in excused and unexcused absences and truancy;

• (IV) The increase or decrease in overall student performance on statewide assessments, by grade;

• (V) The increase or decrease in the student cohorts' grade point average, by grade;

• (VI) The increase in access to supportive services for students and their families, as evidenced by:

• (A) An increase in the number or percentage of students identified as eligible for free or reduced-price meals, by grade;

• (B) An increase in employment outcomes for students' families;

• (C) An increase or decrease in students' food security as demonstrated by an increase or decrease in the number or percentage of students participating in the federal supplemental nutrition assistance program;

• (D) An increase or decrease in the number or percentage of eligible students accessing public benefits;

• (E) An increase or decrease in the pilot schools' awareness of or involvement with domestic violence or child abuse issues affecting students;

• (F) Impact on the school's learning environment and changes to the school climate during the operation of the pilot program and evaluation of school climate;

• (G) The reduction in adverse childhood experiences or the positive resolution of adverse childhood experiences, if available;

• (H) The reduction in youth suicide and attempted suicide; and

• (VII) Any other relevant data and information relating to pilot program outcomes and impacts as determined by the pilot program evaluator.

(1) The department, with assistance from the office of suicide prevention created pursuant to section 25-1.5-101 (1)(w)(I), the Colorado youth advisory council created pursuant to section 2-2-1302, and the suicide prevention commission created pursuant to section 25-1.5-111, shall create and maintain a resource bank of evidence-based, research-based, and promising program materials and curricula pertaining to mental health, which materials and curricula may be used in elementary and secondary schools in the state. The resource bank and curricula must be youth-friendly, culturally sensitive, and available in both English and Spanish. In creating the resource bank and curricula, the department may provide internet links to resources and materials pertaining to mental health available from other entities that the department finds reliable. Additionally, the department shall solicit input from persons, including youth, within and outside of the mental health profession, including both community and school mental health professionals. Subject to available appropriations, the department shall solicit requests for information and may contract for:

• (a) The organization and enhancement of the resource bank, including materials on the prevention of suicide and education on mental health;

• (b) The development of mental health curricula for schools and providing such curricula to schools; and

• (c) Training for educators and school staff concerning mental health.

(2) On and after July 1, 2020, the department shall make material in the resource bank available without charge to school districts, charter schools, institute charter schools, boards of cooperative services, professional educators, parents or guardians of youth, students, and community providers. At the request of a school district, charter school, institute charter school, or board of cooperative services, the department shall provide technical assistance to the school district, charter school, institute charter school, or board of cooperative services in designing age-appropriate curricula pertaining to mental health.

(3) The materials and resources available to students must be developed and updated with input from youth.

(4) School districts, charter schools, institute charter schools, and boards of cooperative services are encouraged to report to the department on the effectiveness of the resource bank and curricula and to recommend changes to improve the resource bank or curricula. The department is encouraged to update the resource bank and curricula based on recommendations from school districts, charter schools, institute charter schools, boards of cooperative services, professional educators, parents or guardians of youth, students, and community providers.

… (3)(b) A professional licensee shall complete such ongoing professional development within the period of time for which such professional license is valid. Such professional development may include, but need not be limited to, in-service education programs, including programs concerning juvenile mental health issues and the awareness and prevention of youth suicide and training in preventing, identifying, and responding to child sexual abuse and assault; college or university credit from an accepted institution of higher education or a community, technical, or local district college; educational travel that meets the requirements specified in subsection (3)(d) of this section; involvement in school reform; service as a mentor teacher for teacher candidates participating in clinical practice, as defined in section 23-78-103; internships; and ongoing professional development training and experiences. The state board of education, by rule, may establish minimum criteria for professional development; except that such criteria shall not:

• (I) Specify any particular type of professional development activity as a requirement or partial requirement for license renewal;

• (II) Require completion of more than six credit hours or more than ninety total clock hours of activities during the term of any professional license;

• (III) Prescribe a schedule for completion of professional development activity during the term of any professional license; or

• (IV) Require prior approval or supervision of professional development activities. …

(1) The general assembly hereby finds and declares that:

• (a) Colorado ranks fortieth in the nation in the school nurse-to-student ratio;

• (b) The federal center for disease control's healthy people 2020 recommended one school nurse for every seven hundred fifty general education students, but many school nurses in Colorado are responsible for as many as six thousand students, making it difficult to provide the social-emotional support necessary to students and staff;

• (c) In 2011, prior to the legalization of retail marijuana, almost forty percent of students surveyed reported having tried marijuana one or more times, with nine percent reporting that they had tried marijuana before age thirteen;

• (d) In addition, twenty-two percent of students reported using marijuana one or more times in the last thirty days, with six percent reporting that they had used marijuana on school property one or more times;

• (e) The legalization of retail marijuana is anticipated to increase the availability of marijuana to underage youth;

• (f) Marijuana use by minors can have immediate and lasting health implications, and many youth who engage in substance abuse develop or have underlying behavioral health needs;

• (g) School health professionals have already started to experience the results of marijuana as a newly legalized substance in increased visits to the health office and referrals from school staff; and

• (h) School health professionals are in a unique position to educate, assess, and treat youth who have substance abuse or behavioral health issues.

(2) The general assembly further finds and declares that a program to provide matching grants to education providers to enhance the presence of school health professionals in schools throughout the state will facilitate better screening, education, and referral care coordination for students with substance abuse and other behavioral health needs.

(1) (a) There is created in the department the behavioral health care professional matching grant program, referred to in this article 96 as the "program", to provide funding to education providers for the following purposes:

• (I) To increase the presence of school health professionals in schools to provide behavioral health care to students who have mental health, substance use or misuse, or other behavioral health needs;

• (II) To provide training and resources for school staff on the implementation of evidence-based programming on behavioral health education for all students;

• (III) To allow school health professionals to connect students with services that are provided by community-based organizations for treatment and counseling for students who need behavioral health care; and

• (IV) To provide behavioral health care services at recipient schools, including but not limited to screenings, counseling, therapy, referrals to community organizations, and training for students and staff on behavioral health issues.

• (b) An education provider that receives a grant under the program shall use the money to increase the level of funding the education provider allocates to school health professionals to provide behavioral health care to students prior to receiving the grant and not to replace other funding sources allocated to provide school health professionals for students. The education provider may use the money to contract with a community partner for behavioral health care services, including hiring private health care professionals, training, screening, and preventive supports. Additionally, the education provider may use the money to provide direct services or consultation by a school health professional through telehealth technology. The department shall administer the program as provided in this article 96 and pursuant to rules adopted by the state board.

(2) The state board shall adopt rules pursuant to the "State Administrative Procedure Act", article 4 of title 24, C.R.S., for implementation of the program, including but not limited to rules regarding:

• (a) The timeline for submitting applications to the department;

• (b) The form of the grant application and any information in addition to that specified in section 22-96-104 (2) to be included in the application;

• (c) Any criteria for awarding grants in addition to those specified in section 22-96-104 (3); and

• (d) Any information to be included in the department's program report in addition to that required in section 22-96-105.

(1) As used in this section, unless the context otherwise requires:

• (a) "Department" means the department of public health and environment created and existing pursuant to section 25-1-102.

• (b) "Fund" means the crisis and suicide prevention training grant program fund established in subsection (5) of this section.

• (c) "Grant program" means the crisis and suicide prevention training grant program created in subsection (2) of this section.

• (d) "Office of suicide prevention" means the office of suicide prevention in the department, established pursuant to section 25-1.5-101 (1)(w).

• (e) "Public school" means a school of a school district, a district charter school, or an institute charter school.

• (f) "School district" means any public school district existing pursuant to law.

• (g) "School safety resource center" means the school safety resource center in the department of public safety, established pursuant to section 24-33.5-1803.

(2) (a) There is created in the department the crisis and suicide prevention training grant program. The purpose of the grant program is to provide financial assistance for the provision of comprehensive crisis and suicide prevention training annually, if grant funding is available, for all teachers and staff at public schools and school districts in Colorado who work directly or indirectly with students. Priority for grant awards is for public schools and school districts with educators and staff who have not yet received such training. The grant program may authorize up to four hundred thousand dollars in grants per year in varying amounts based on the size and need of the public school or school district.

• (b) On and after January 1, 2019, a public school or a school district may apply to the department for a grant pursuant to the guidelines adopted in subsection (3) of this section to provide crisis and suicide prevention training in the public school or school district.

• (c) The department shall administer the grant program in consultation with the office of suicide prevention and the school safety resource center.

• (d) Notwithstanding any other provision of this section, the department is not required to implement the provisions of this section until sufficient money has been transferred or appropriated to the fund.

(3) (a) On or before November 1, 2018, the office of suicide prevention and the school safety resource center shall make recommendations to the department for the administration of the grant program, and the department shall adopt formal training guidelines for the grant program. The guidelines must include:

• (I) Application procedures by which public schools and school districts may apply for a grant pursuant to this section;

• (II) Criteria to utilize in selecting public schools and school districts to receive grants and in determining the amount of grant money to be awarded to each grant recipient. The criteria, at a minimum, must include:

• (A) That first priority for grant awards is to provide crisis and suicide prevention training to public schools and school districts that have not previously received such training;

• (B) An emphasis on providing such training to all staff at the public school or school district, not just educators; and

• (C) A requirement that each application, at a minimum, must describe how the applicant public school or school district will use a grant award to provide comprehensive crisis and suicide prevention training to all educators and staff who have not yet received such training.

• (b) If there is money remaining in the fund after grants are made to all public schools or school districts that applied for a grant and that had not previously received crisis and suicide prevention training, the department may award grants to a public school or school district that had previously received such training.

• (c) The office of suicide prevention and school safety resource center shall assist the department with reviewing grant applications, making recommendations to the department on which public schools and school districts that applied must receive a grant from the grant program and the amount of each grant, and acting as a resource for grantees.

(4) (a) Each grant recipient shall submit a written report to the department not later than six months after the expiration of the term of its grant. The report must include a summary of activities made possible by the grant money.

• (b) The department shall include in the report required pursuant to section 25-1.5-101 (1)(w)(III)(A) the following information regarding the administration of the grant program during the preceding year:

• (I) The number of public schools and school districts that received a grant from the grant program;

• (II) The amount of each grant award by recipient;

• (III) The number of pupils who are enrolled at each public school or school district of each grant recipient;

• (IV) The number of school staff and educators who were provided training as a result of a grant; and

• (V) A copy of the grant recipients' crisis and suicide prevention plans.

(5) (a) There is established in the state treasury the crisis and suicide prevention training grant program fund. The fund consists of money transferred or appropriated to it and any other money that may be made available by the general assembly. The money in the fund is continuously appropriated to the department for the direct and indirect costs associated with implementing the grant program. Any money not provided as grants may be invested by the state treasurer as provided in section 24-36-113. All interest and income derived from the investment and deposit of money in the fund must be credited to the fund. Any amount remaining in the fund at the end of any fiscal year must remain in the fund and not be credited or transferred to the general fund or to any other fund.

• (b) No more than three percent of the money annually expended from the fund may be used for the expenses incurred by the department in administering the grant program.

• (c) The department may seek, accept, and expend gifts, grants, and donations from public and private sources to implement this section; except that the department shall not accept a gift, grant, or donation that is subject to conditions that are inconsistent with the provisions of this section or any other law of the state. The department shall transfer all private and public money received through gifts, grants, and donations to the state treasurer, who shall credit the same to the fund.

• (d) Nothing in this section requires the department to solicit money for the purposes of implementing the grant program.

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