MHAT: The Mental Health Assistance Team

The Mental Health Assistance Team (MHAT) is a district-wide implementation framework to increase the delivery of Evidence-Based Practices (EBPs) in Mental Health. The overall goal of the MHAT is to identify students with mental health needs and provide greater access to a full spectrum of evidence-based mental health services, delivered by highly trained and skilled BSD staff, for the purpose of enriching student well-being. In short, the mission of MHAT is to:

1. Provide better Identification of students in need
2. Increase student Access to mental health services
3. Achieve better Outcomes for students

In addition to these guiding principles, the MHAT Framework also strives to:

1. Identify students with suicide ideation and intervene quickly
2. Employ and retain more school-based mental health professionals
3. Improve the ease of access to services by providing those services in schools
4. Increase sustainability by looking at mental health services from a systems level analysis and employing consistent training, consultation, coaching, and supervision
5. Increasing support for marginalized students and students of color
6. Increasing the use of pre-referral interventions in a Response to Intervention (RtI) framework to potentially reduce special education referrals
7. Increase mental health advocacy in the community at-large

MHAT, as envisioned in the Bellevue School District, is a team of 23 mental health service providers comprised of individuals trained as School Psychologists, School Social Workers, and School Counselors. MHAT Counselors serve all grades, yet differently across levels. At the middle and high school level the MHAT Counselors serve six primary functions:

1. Support our suicide prevention lessons (Signs of Suicide) given by our Science Teachers
2. Conduct suicide risk screens
3. Provide a student well-being screening called the Behavior Intervention Monitoring and Assessment System 2 (BIMAS-2)
4. Deliver short-term mental health counseling
5. Provide consultation and coaching to support students, staff, and families
6. Provide a warm hand-off to other professionals when more intensive services are needed

MHAT services reside within the Multi-Tiered System of Supports (MTSS) at the upper Tier 2 and lower Tier 3 level. Secondary MHAT Counselors can offer a variety of counseling services ranging from individual check-ins to individual and/or group counseling. MHAT Counselors employ a variety of Evidence-Based Practices in Mental health such as Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT) skills, solution-focused counseling, and Motivational Interviewing. MHAT Counselors typically work with students for 12-15 weeks but may work with them a little longer depending upon needs; however, students needing further services are supported in finding longer-term supports through the school or community resources.

Due to limited staffing and different needs, the MHAT Counselors at the elementary serve five primary functions:

1. Assisting school teams with students in crisis
2. Supporting well-functioning MTSS Teams at each school
3. Supporting the implementation of the BIMAS-2 screening and Tier 2 interventions
4. Provide general coaching/consultation and professional development for school teams
5. Providing parent support through presentations

MHAT Origins & History

The MHAT and its framework are built upon research conducted using Implementation Science as a lens to understand how initiatives and interventions become ensconced within an organization and sustain over time. The framework and team are highly data-driven and based on the Response to Intervention (RtI) process that uses initial assessment and progress monitoring to determine the effectiveness of the services.

MHAT started in the Bellevue School District in the Fall of 2017 as a proof of concept to work out the details and procedures of the implementation. The team started with 4 full and part-time mental health professionals. The team screened approximately 125 students at Sammamish High School and provided counseling for 16 students. Over the next two school years, the team expanded services to students in grades 7 and 10. By the end of the 2020-2021 school year, MHAT Counselors had provided the BIMAS2 screen to 1300 students and supported at least 110 students through direct counseling.

Prior to the 2021-2022 school year the team expanded significantly to a total of about 18 full-time and part-time staff. This expansion occurred due to funding from the Elementary and Secondary School Emergency Relief (ESSER) funds from the federal government. The team expanded services to students in grades 7 through 11 at all secondary schools. They screened over 6,700 students and provided services to nearly 400 students. Progress monitoring of students from the brief measures showed that 86% of students that received CBT counseling showed a decrease in symptoms. Additional data on the increase of coping skills revealed that 93% reported gains in these skills.

For the 2022-2023 school year, MHAT expanded to the elementary level to provide crisis response services to all elementary schools as well as supporting limited screening of students for small group counseling.

Student Access to MHAT Services

Students in all grades may access MHAT services through three primary ways depending upon their grade:

1. Annual Screening
2. Self-Referral
3. Staff/Parent Referral

The annual screening process uses the BIMAS-2 to identify students that might benefit from services. Currently the team screens students in grades 7-11, as well as selected grades in the elementary. Due to limited staffing at the elementary level, students identified in need of support can currently receive services through small group instruction. In addition to screening, students at all grades may also choose to self-refer to MHAT counseling services. Since schools operate under FERPA rules, parent permission is sought to provide mental health services for all students. For student concerned about parent permission, the MHAT Counselors work with the student to access community mental health services where parent permission is not required for students aged 13 and older in Washington State.

The last approach toward students accessing mental health services can be through staff or parent/guardian referral. Students do not need to go through the screening process and instead a school employee or parent/guardian can ask for services on behalf of the student. One very important consideration though, is that all MHAT services are voluntary, and students must agree to services without coercion. Students that are interested in MHAT Counseling may enter services through different phases of the MHAT process.