School personnel are often the first to recognize a student’s mental health needs. (Stock photo)
As the mental health crisis continues across the country, children and teens are in greater need of mental health services than ever before. In many cases, the first person to recognize the child’s need is a teacher. But the teacher may not always know how to help. That’s why Children’s of Alabama recently expanded one of its mental health programs to offer training for school personnel.
The program, Pediatric Access to Telemental Health Services (PATHS), has been around since 2019. Children’s established it—with support and funding from the Alabama Department of Mental Health (ADMH)—in response to the need for more mental health services, especially in rural areas. The initial goal was to help primary care providers understand how to help patients who present with mental health concerns. Through the program, Children’s mental health professionals offer consults or education for providers or even telehealth appointments for their patients.
PATHS has since expanded into urban areas, and now, thanks to the extension of a Health Resources and Services Administration (HRSA) grant, Children’s is offering support to school systems across the state.
“This is an important step for our program,” PATHS director Margo Harwell, LICSW, PIP, said. “Because they see students daily, school personnel play a critical role in identifying early signs of mental health concerns in students.”
How it Works
When the PATHS team decided to expand their services to schools, they immediately realized their assistance would differ from what they offer medical centers. Providing on-the-spot consulting for teachers and administrators wouldn’t work, nor would telemedicine appointments. What they could provide, however, was education.
They began their efforts in the summer of 2024, meeting with mental health coordinators in school systems across Alabama to discuss what topics might need to be covered in their respective districts. Once those needs were identified, PATHS leaders set up in-person, virtual or hybrid training sessions.
“We have found that every school system is unique and has different training needs,” Harwell said. “For example, if schools mention that they have had an increased number of students experiencing anxiety, we can partner with that school to provide a targeted training that is focused on strategies to help students manage their anxiety within the school environment.”
PATHS leaders have offered training on that topic and others, including behavior management, depression, trauma and bullying. They’ve also taught educators how to identify the red flags of mental health concerns among students.
The focus is, of course, on how to help students. But educators’ mental health needs are crucial, too. To help with that, the PATHS team offers sessions on self-care. “If a teacher or counselor isn’t caring for themselves, it becomes much harder to have the patience and emotional capacity needed to identify and support a child facing mental health challenges or coming from a background of trauma—especially when those students might be exhibiting challenging behaviors,” Harwell said. By practicing better self-care, school personnel may be more likely to recognize that the child who’s acting out may actually be in need of support, she added.
The sessions, whatever the topic, are opportunities for discussion among school staff and Children’s mental health experts. “Training sessions include conversations about intervention strategies and guidance on how to help and support students within the school setting who may be experiencing mental health challenges,” Harwell said. Ultimately, they hope to help educators understand how to handle these issues as they arise.
Right now, the team is offering training sessions to teachers and counselors. Eventually, they may offer them to support staff or administrators, who often develop close relationships with students, Harwell says. “Think about bus drivers, for example. In many cases, they’re the first person to see a student each morning,” she pointed out. “Some students have the same bus driver for years, so they get to know them and may share their feelings or thoughts. This gives them insight into the child’s concerns or emotional state.”
More on the HRSA grant
The PATHS program exists because of a HRSA grant awarded to ADMH. The grant is a Pediatric Mental Health Care Access Program (PMHCA) grant, which Children’s helped write. The hospital receives the majority of the money awarded through the grant, which was originally approved in 2018, then extended in 2023. “These grants have been monumental to the building of this program and really sustaining it thus far,” Harwell said.
With the initial grant, Children’s started PATHS and began enrolling primary care practices. Today, 128 practices are enrolled. “The funding has been instrumental in being able to do that,” Harwell added.
The partnership with ADMH also has been vital. The organization offers guidance and facilitates collaboration with the other states and organizations through the HRSA network of PMHCA awardees. “This continually challenges us to look at how we’re doing, what we do and how we can continue to improve our program and our processes.”
The next step
The program’s next improvement may involve expansion into rural emergency departments (EDs). PATHS leaders already have initiated conversations with a few around Alabama. Harwell says the PATHS team hopes to offer access to their consultation lines to extend support if the ED has a child who arrives with mental health concerns. The goal, Harwell says, is not to intervene in situations of acute crisis—that is outside the role of PATHS. “But if a child is in a rural ED and needs to stay for a few days due to, say, lack of available beds, and there are concerns about mild to moderate mental health issues, we want to offer consultation services to support that child’s care,” Harwell said.
The impact
As the PATHS team keeps an eye toward the future, they’re also aware of how far they’ve come. Mental health care is difficult in Alabama—the non-profit Mental Health America (MHA) in 2019, the year PATHS was founded, ranked the state 7th in prevalence of mental illness among youth and 45th in youth access to care. By 2024, when MHA released its most recent rankings, Alabama had dropped to 14th in youth prevalence of mental illness and risen to 36th in youth access to care. Multiple factors have played a role in the improvements, and Harwell says PATHS is one. “Our state has really taken steps forward,” she said. “I happen to believe the PATHS program has helped with that.”
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