Behavioral Health Student Assistance Programs: Leveraging Non-traditional Mental Health Providers to Address Mental Health Workforce Shortages

• In Event: Implementing School-Based Mental Health Services to Support Students

Abstract

This research examines Washington State's Behavioral Health Student Assistance Program (BH-SAP), an innovative workforce solution addressing the youth mental health crisis by training paraprofessionals to deliver school-based behavioral health services. As workforce shortages undermine efforts to address rising youth mental health concerns, this model offers a promising policy approach that expands service capacity while maintaining quality care.

Our evaluation of 60 Student Assistance Specialists (SASs) during the 2022-23 school year demonstrated significant impact across multiple tiers of support. These paraprofessionals delivered 3,218 prevention activities, provided group interventions to 1,158 students, and served 2,532 students with individual interventions. Students receiving services reported significant improvements in hope, social connection, mental health agency, and reductions in internalizing symptoms and behavioral incidents, with small to moderate effect sizes (d = 0.23-0.39).

The study found important connections between implementation fidelity and outcomes. Students served by providers demonstrating greater adherence to the BH-SAP fidelity rubric showed significantly greater improvements than those from lower-adherence providers, particularly in hopefulness, trusted adult relationships, mental health agency skills, and school engagement. This highlights the importance of structured implementation supports when employing paraprofessional models.

The BH-SAP model addresses several policy challenges simultaneously. First, it tackles workforce shortages by creating clearly defined roles for paraprofessionals within a supervised practice structure. Second, it promotes regional equity by distributing resources across both urban and rural areas of Washington State. Third, it offers a potential career ladder entry point for future practitioners, serving as a "grow your own" approach particularly valuable for addressing shortages in underserved communities.

BH-SAP operates within a comprehensive infrastructure that includes standardized training, regional coordination, robust evaluation systems, and clinical supervision by licensed professionals. This multi-level support system ensures paraprofessional providers implement evidence-based practices effectively and maintain appropriate boundaries of practice.

Our findings contribute to the growing literature on task-shifting and workforce expansion strategies in behavioral health. The results demonstrate that paraprofessionals, when properly trained and supervised, can effectively expand the capacity of school behavioral health systems to serve more students across the prevention-to-intervention continuum.

As policymakers seek transformative and resilient solutions to the ongoing behavioral health workforce crisis, the BH-SAP model offers a promising approach that complements rather than replaces specialized providers. This study provides critical evidence supporting the scale-up of paraprofessional roles in school-based mental health, with implications for sustainable funding mechanisms, supervision structures, and career advancement pathways necessary to solidify such positions within the behavioral health workforce.

Author

• Eric Bruns, UW SOM
  Presenting Author