School Social Work and Mental Health Funding

Abstract

School social workers provide mental health services to millions of students each year. However, few studies focus on how social workers generate funding and other support for school mental health. The purpose of this study is to identify the continuum of school mental health supports and how social workers advocate for and generate these supports. This study examines variation in school social worker experiences across three school types: Chicago neighborhood schools, Chicago charter schools, and Chicago-area suburban schools. This study uses the ecological systems framework to structure the interview guide and inform coding. This study finds three major themes: (1) schools improve student access to mental health services, (2) social workers advocate for mental health supports differently depending on their school type, and (3) schools sideline social workers through inadequate support of their positions. Findings suggest greater support for school social work positions and greater collaboration between administrators and school social workers to fully leverage available resources and meet student mental health needs.

National data suggest that nearly one in five children have a mental, developmental, or behavioral condition (Agency for Healthcare Research and Quality, 2022; Office of the Surgeon General [OSG], 2021). However, only half of children with mental health conditions receive care (Whitney & Peterson, 2019). Mental health challenges are the leading cause of death and disability among young people and have long-term consequences if unaddressed, including lower academic achievement and worse health outcomes (De Luca et al., 2016; OSG, 2021).

Few studies focus on school mental health funding and how school social workers generate and support this funding (Bye et al., 2009; Maag & Katsiyannis, 2010; Mallett, 2013). School mental health funding is especially important in the context of heightened mental health needs among students and the positioning of school social workers as a primary provider of these services (Duong et al., 2021; U.S. Department of Education, 2023). In 2022, 69 percent of U.S. public schools reported an increase in students seeking mental health services, and 96 percent reported offering mental health services (National Center for Education Statistics, 2022; Panchal et al., 2022). This study identifies the continuum of school mental health supports and how social workers advocate for and generate these supports in Chicago-area schools.

BACKGROUND

Social Work Profession and Advocacy

School social workers focus most of their time on providing special education services to individuals or small groups of students (Bye et al., 2009; Kelly et al., 2015). Frey and Dupper (2005) suggest that the individual and small-group focus is due to several factors, including the profession’s commitment to addressing the immediate needs of students and the narrow understanding of social work among school administrators. Although most focus on individual and small groups, school social workers are also trained to lead school or district initiatives and engage in policy at the local, state, and national levels. Some examples include leading the implementation of a social–emotional curriculum and engaging in policy advocacy on school mental health funding.

Advocacy is a critical component of the school social work profession; however, most studies on advocacy focus on how social workers advocate for individual student needs. Strategies to more effectively advocate beyond individual student needs include the use of empirical data and research to support claims about the need for school social workers and additional mental health funding. Another strategy is to highlight how school social workers generate revenue for their school districts through Medicaid reimbursement for school-based social work services and improving enrollment and attendance, which determines school and district funding (Tan et al., 2020).

School Mental Health Funding

School social workers can generate funding for their district in many ways, including applying for grants, creating community partnerships, and documenting the mental health services they provide to receive Medicaid reimbursement. Almost half of schools report funding as a factor limiting their ability to effectively provide mental health services to students (Panchal et al., 2022). Despite their critical role in generating critical mental health funding, national data on income generated by social workers at the school and district level are often difficult to find or unavailable (Poirier & Osher, 2006).

Limited data on school mental health funding, and specifically on revenue generated by school social workers, may limit the ability of social workers to advocate for and schools to leverage available school mental health funding. One study on the sources of school social work funding found that school administrators and lead school social workers differed substantially in their reports on income generated by school social workers (Bye et al., 2009). Half of lead school social workers chose Medicaid as a key income generator, while only 17 percent of administrators chose it. Overall, 25 percent of administrators, most of whom were school principals, did not know what types of revenue school social workers generated.

Medicaid provides reimbursement to school districts for the mental health services they provide to Medicaid-eligible students. The Individuals with Disabilities Education Act (IDEA) requires public schools to provide services to students with disabilities, including social work services. These services are outlined in a student’s Individualized Education Plan (IEP). In 1988, IDEA included an amendment to allow Medicaid to provide reimbursement for IEP services, and now all states allow school districts to receive reimbursement for these services.

Ecological Systems Framework

Ecological systems provide the framework for this study, including conceptualizing how school social workers interact with individual students and their greater environment (Friedman & Allen, 2011). This framework includes the microsystem, mesosystem, exosystem, and macrosystem (Cigrand et al., 2015). The microsystem consists of direct interactions between school social workers and individuals in their immediate environment, such as providing services to students. The mesosystem includes interactions that take place across and between microsystems and reflects how school social workers communicate, interact, and relate with others in these systems, such as community partnership work. The exosystem consists of organizations that are not in school social workers’ immediate settings but have the potential to affect their role, such as government agencies and accreditation organizations that create policies and regulations governing school social work and education practice (Tan et al., 2020). The macrosystem refers to the overarching cultural patterns and values in a society, such as cultural patterns and values that shape mental health stigma or support of mental health services.

Current Study

This study uses a qualitative approach to examine the continuum of school mental health supports and how social workers advocate for and generate these supports. Two overarching research questions guide this study: (1) What are the sources of mental health funding and supports? (2) How do school social workers generate and advocate for these sources of funding and supports? This study provides insight on how school social workers generate mental health funding for their schools, advocate for additional funding and supports, and interpret their role in the school system in promoting student mental health. Additionally, this study shares how these insights are shaped by school type (i.e., Chicago neighborhood, Chicago charter, and Chicago-area suburban schools).

METHOD

Study Design

The current study presents findings from a qualitative study of nine school social workers in the Chicago area. This study used semistructured interviews to explore how school social workers generate funding and other support for school mental health. The interview data were coded inductively for themes and informed by the ecological systems framework.

Setting

All schools in the study are in the Chicago metropolitan area (CMA; U.S. Census Bureau [UCB], 2020). The CMA is the third-largest metropolitan statistical area in the United States, with the fourth-largest school district (UCB, 2020). The CMA employs over 10,000 social workers and has 9.5 million residents, 11 percent of whom are below the poverty line and 50 percent of whom identify as White, 23 percent as Hispanic, 16 percent as Black, 7 percent as Asian, 3 percent as two or more races, and 1 percent as other.

Sampling and Participants

Stratified purposeful sampling was used to sample school social workers from across grade levels, geographic areas, and school types. All participants were recruited through online publicly available school directories and were contacted through email. The school types included Chicago neighborhood, Chicago charter, and Chicago-area suburban schools.

The study included nine school social workers: three from neighborhood schools, three from charter schools, and three from suburban schools. Participants varied in work experience, ranging from one to 27 years. All participants were professionally licensed school social workers in Illinois. Six participants worked in elementary schools, and three worked in high schools. Eight participants identified as female, and one identified as male. Seven participants identified as White, one identified as African American, and one identified as Jewish. Participants ranged in age from 28 to 66 years.

Data Collection

The interviews lasted 30 to 50 minutes, with an average time of 35 minutes. The interview questions focused on how school social workers generate funding and other supports for school mental health, including creating community partnerships and documenting Medicaid services for reimbursement. All interviews were conducted by me (the author of this article) over an encrypted Zoom video call in fall 2020, audio recorded by an external recorder and transcribed using transcription software. After transcription, all interviews were reviewed for accuracy by reading and listening to the interview recording. Any discrepancies between the audio and the transcription were corrected.

Data Analysis

This study used inductive analysis, which allows concepts and relationships among ideas to emerge from the data (Glesne, 2006). I read each transcript line by line and coded them in NVivo (Version 12) using an inductive, constant comparison process (Charmaz, 2006; Padgett, 1998). Ecological systems informed the coding process by providing a framework for examining social work practice at the school and district levels, interactions between these levels, and how federal and state policy impact practice at these levels. As new codes emerged in the coding process, I reread and recoded previously coded transcripts with these new codes. Once all the transcripts were coded, I sorted the transcripts by code to identify emerging themes across participants. To refine the themes, I used NVivo to visually display all codes simultaneously to explore possible relationships between codes. Last, I read all transcripts to confirm both examples and counterexamples to finalize the key themes (Padgett, 1998).

To ensure the confirmability and credibility of findings, I employed the analytic technique of constant comparison (Charmaz, 2006). This approach to analysis introduces rigor into the analytic process by requiring researchers to substantiate the emerging analyses with existing data. To address and guard against researcher bias with one coder and to solicit feedback during the coding and analysis process, regular debriefings occurred between the primary researcher and a senior qualitative researcher to discuss coding, interpretation, and communication of findings. Codes and conceptual findings were refined through senior qualitative researcher feedback (Samuels, 2009). Memos documented throughout the research process were used to enhance dependability (Padgett, 1998; Shek et al., 2005). This recordkeeping process supports the transparency of the researcher’s analytic decision-making processes. Finally, this analysis draws upon existing literature on school social work and mental health funding to provide a broader context to interpret the generalizability and transferability of findings beyond this sample and setting (Samuels, 2009).

RESULTS

Three major themes emerged from this study: (1) schools improve student access to mental health services, (2) social workers advocate for mental health supports differently depending on their school type, and (3) schools sideline social workers through inadequate support of their positions (see Table 1). The results used participant pseudonyms to protect participant confidentiality and are described in Table 2 along with their gender, race/ethnicity, number of years as a school social worker, school level, and school type.

Schools Improve Access

Participants reported that school-based mental health services such as school social work services and community organizations improved access to services among students. Participants described how they have been creating and sustaining partnerships with these community organizations. As Charlie, a neighborhood school social worker, shared:

Most of these kids wouldn’t receive any kind of services whatsoever if they did not receive them at school. When I say most, I can think of four students on my caseload that are receiving outside therapy, and I’ve got 86 kids.

Participants reported barriers to community mental health services, including parent work schedules, transportation, health insurance, and cost, which align with earlier studies (Love et al., 2019). Taylor, a charter school social worker, underscored that many families “just don’t go” because of parent work schedule conflicts. Additionally, Alex, a charter school social worker, highlighted that “school-based mental health services are critical” because they are the most effective way to “break down systemic barriers to mental health supports,” like health insurance.

Most social workers in this study worked in low-income schools, where most students are eligible for Medicaid insurance. It is especially difficult for students to find community providers that accept Medicaid insurance, given Medicaid’s low reimbursement rate. As Charlie shared, even when a provider accepts Medicaid, “it’s impossible to find a provider that has afternoon or evening or weekend hours,” times that are most feasible for parents to take their children to appointments. Furthermore, Charlie stated that Medicaid reimbursement provides about

a third or half [of the cost of providing the service], which is why providers don’t take it. It’s not worth it. . . . You’re better off just seeing the kid for free and writing it off [for taxes]. . . . Incentives are all misaligned.

These misaligned incentives and their impact on service accessibility among low-income students further underscore the role of schools as frontline mental health providers.

Another pathway that social workers can provide support for school mental health and improve access to services is through creating and sustaining community partners to provide school-based mental health services (Bye et al., 2009). These community partnerships include community-based organizations, such as local nonprofits and community health centers. Participants in the current study reported that many of the partnerships were developed and sustained through their personal outreach efforts and helped bridge the needs of students. Adrian, a suburban school social worker, shared how the community health center provided critical services and referrals: “Students can access health care, right at school . . . clinicians can refer them all throughout the county health system.” Cameron, a neighborhood school social worker, also shared that community partnerships improve service continuity between the school and community by providing “services [that] families may not necessarily seek out on their own without that [school–community] relationship.” School social workers emphasized that families are more likely to trust and engage in mental health services for their child when there is a connection made through their school.

School Type Shapes Advocacy

School type shapes the ability of social workers to effectively advocate for school mental health. In Chicago neighborhood and charter schools, principals exercise significant discretion over school mental health funding, while in suburban schools, the school board exercises significant discretion over school budgets. In Chicago charter schools, social workers reported greater success, compared with neighborhood schools, in advocating for and receiving mental health funding. School social workers in charter schools reported greater success in receiving additional mental health support due to greater principal autonomy in the district to make independent funding decisions, such as hiring an additional school social worker using private donations earmarked for mental health.

Although school social workers often attempt to align their efforts with the goals of education, school social work salaries and resources are often positioned in competition with other education needs. This positioning makes advocacy especially difficult when requesting scarce and discretionary funding (Kelly et al., 2015; Sherman, 2016). Adrian, a suburban school social worker, discussed how her ability to advocate for mental health discretionary funding was shaped by structural education funding limitations:

We don’t really have a significant property tax base in the district . . . it’s a very low-income community. As opposed to Chicago where you’re pulling form all over the city . . . a lot of resources. We’re just a suburb that only has so much.

Suburban school social workers reported having the greatest difficulty in effectively advocating for additional resources, even requesting small amounts for conference funding. Peyton, a suburban school social worker, shared that “in terms of funding in general, I think our services are not super valued. [The Board of Education] pretty much gives us like, you can do whatever you want, as long as it’s free.” Conversely, charter school social workers shared that their principals could exercise considerable autonomy over the management of school funds without having to consult others in the district and could provide social workers with additional funding. Alex, a charter school social worker, stated that he could “advocate with my principal for more funds” while also receiving a separate social work budget. Additionally, Taylor, another charter school social worker, reported that “a portion of what we get from donors . . . is earmarked for students in social–emotional well-being.” These differences illustrate the disparities that exist between schools based on structural funding inequities at the district level.

Schools Sideline Social Workers

Social workers emphasized the disconnect between administrators’ stated valuation of their roles and their experiences of being sidelined in the education setting. This finding confirms previous work circumscribing the role of social work practice as being in the “host” education environment. In this host setting, educators are in positions of power and social workers may experience role ambiguity and value discrepancies (Sherman, 2016). Peyton, a suburban school social worker, detailed these challenges:

[Administrators] play hot potato with us because . . . we’re not technically part of the special education department. But we’re also not fully in the general education department . . . . It just really depends on who’s in charge. . . . [Administrators] have been telling me that we’re valuable and that [mental health] is important, but if no money is sort of put towards our positions, what does that say?

This finding aligns with prior work describing how school social workers experience challenges in the education setting, such as the devaluation of their role, role ambiguity, and misperceptions of their work (Teasley, 2018). Although IDEA establishes the role of school social work in providing mandated services to students with disabilities and Congress provides partial funding for these services, most of the funding responsibility devolves to the local level where there is significant discretion over funding social work positions (Allen-Meares et al., 2000). School social workers in this study report insufficient school and district funding to meet student mental health needs. Given that school social workers are the primary provider of school mental health services, they interpret this insufficient funding for their positions as a devaluing of their work.

Pat, a suburban school social worker, described the devaluation of social work and the misalignment of education and social–emotional goals:

Some districts I worked in had a director of social work that was really effective in advocating. . . . But what happens is nobody looks at it and social work is the stepchild. . . . Social workers are in a tertiary setting where social work and social–emotional health is not the primary. So they’re educators, and . . . administrators are thinking . . . on an educational level instead of a child level. So more social–emotional integration at the administrative level would be huge.

Pat described how administrators do not value social work. Without representation of social workers in leadership positions, such as director roles, this contributes to the continued segmentation of education and social–emotional development. Integration requires valuing the social work role by providing positions of leadership for social workers to integrate social–emotional development into the education setting.

Cameron, a neighborhood school social worker, expressed that although she is aware of the ability of Medicaid to generate funding, she does not know where the money goes:

We’re trained how to document [student school-based mental health] services, not necessarily about where that money goes. . . . My understanding is only [the services are] being billed for students who are on Medicaid. . . . That’s as much as they tell us, and [schools] get so much money per service. We’re not told how much money schools get. . . . And we’re told it’s supposed to be reinvested in the [hiring of] clinicians.

School social workers can generate mental health funding by providing services that are reimbursed to their district by Medicaid (Bye et al., 2009). School and district compliance measures, such as documenting Medicaid-eligible services, shape school social workers’ awareness of the role of Medicaid in schools. Although social workers are told that this funding is supposed to be reinvested in clinicians, they do not report being included in funding decisions at the school or district level. Alex, a charter school social worker, stated, “I know that there is a level at which they’re not going to give the details about . . . unrestricted, all those different ways that funding can be used.” Limiting information about the mechanisms that social workers use to generate funding and the ways in which schools use that funding may further sideline the social work profession by preventing meaningful discussions on how to utilize funding to most effectively promote mental health services.

DISCUSSION

This study examines how school social workers generate funding and other supports for school mental health. This study uses the ecological systems framework to examine these processes. This study identified three major themes: (1) schools improve student access to mental health services, (2) social workers advocate for mental health supports differently depending on their school type, and (3) schools sideline social workers through inadequate support of their positions. School social workers emphasize the critical role of schools in increasing access to mental health services, both through the services they provide and through community partnerships. Social workers report that community mental health organizations not only promote greater access to services in the school, but also promote continuity of care in the community. Additionally, school social workers describe how school type shapes their advocacy efforts, with suburban schools reporting the greatest barriers to securing additional mental health support. Finally, school social workers describe their experiences with being sidelined by the education setting and report the devaluation of their work in the school setting by administrators.

Findings from this study have implications for both practice and policy. First, this study identifies significant variation across school type (neighborhood, charter, and suburban) in the discretion of school administrators over school mental health funding decisions. This motivates the need to consider not only the level at which social workers practice (i.e., school or district), but also how school type shapes how they practice in a school or district. Additionally, this study finds that schools sideline social workers through many processes, including a devaluation of their work, low representation in leadership roles, and low information about how funding is being generated and used. Although school social workers underscore the critical role of schools in promoting student access to services and their role in providing these services, they overall do not experience adequate support from administrators.

This study supports earlier research findings that schools’ greatest needs include personnel and finances and that having school-based mental health personnel strengthens school mental health (Frabutt & Speach, 2012; Garbacz et al., 2023). These findings align with participants’ emphasis on the importance of school social workers’ role in promoting student mental health and the high need for additional mental health funding, especially in suburban schools. Furthermore, the results of this study are consistent with earlier research by Blackman et al. (2016), who found that school mental health programs were successful because of strong relationships built between schools and community providers, mirroring this study’s finding, which reveals the critical role that community partnerships play in improving accessibility and continuity of services for children.

This study also affirms previous findings that highlight local administrators’ power in determining personnel and budget decisions (Higy et al., 2012). Principals often have the power to promote or discourage school initiatives, which can emphasize the power imbalance between school social workers and administrators, especially given their underrepresentation in leadership (Blackman et al., 2016). This challenge is representative of the broader challenge that school social workers face in effectively advocating for their positions, including funding to support their positions.

Lee (1983) proposed that to achieve greater support for the profession, school social workers should seek access to information that can be marshaled to effectively communicate their value to educating students and to increase their representation in leadership. In the school context, this could mean recognizing who the key decision makers are, presenting data on how they support student mental health and academic outcomes, and knowing when to ask for support or resources. School social workers are their own best advocates and their successful participation in meeting the education system’s needs at critical times provides a point of leverage to advocate for and support their position. This is a critical time to advocate for the school social work profession and mental health funding, given recent national attention to the role of school social workers in meeting students’ mental health needs and newly available Medicaid funding to support student services (U.S. Department of Education, 2021; Williams, 2022).

There are several limitations that should be considered when interpreting this study’s findings. One limitation is that the sample size was limited to nine participants. Additional interviews would likely provide new information, and new findings would likely emerge. A second limitation is that this study used one coder. Although this is addressed in part by following best practices in qualitative research, including debriefing with a senior qualitative researcher, the findings may be limited by the single researcher’s perspective. A third limitation relates to the characteristics of the current sample. All but one of the participants identified as female, and all but one identified as White. Future studies could expand our understanding by recruiting a larger, more diverse sample, with specific efforts to recruit male school social workers and participants of various racial and ethnic backgrounds. Additionally, it is important to recognize that the sample represents the experiences of only one metropolitan area. Given the local nature of school financing, more research is needed to understand how widespread these findings are nationwide.

CONCLUSION

Mental health funding continues to be a challenge for schools to meet the mental health needs of students (Panchal et al., 2022). School social workers are experts at recognizing and addressing student mental health needs and are well positioned to advocate for mental health funding. This study finds that school type, including the discretion exercised by principals and administrators, shapes the ability of school social workers to effectively advocate for school mental health. The present findings highlight the increasing need for greater investment in school mental health, including school social work positions, to increase and sustain funding of school mental health. Future research should aim to understand how to improve interprofessional collaboration among school social workers and administrators to ensure adequate funding and resources for student mental health, including how to better leverage existing and sustainable funding sources, such as Medicaid. Research on school social work and school mental health funding is critical as school social workers provide services for millions of children every year.

REFERENCES