'Our students can't wait': how a new law will help kids access consistent therapy at school

Gov. Tony Evers has signed a bill into law that allows marriage and family therapists to work directly in schools. 

It’s an effort many have been pushing for since Wisconsin recognized the profession more than 50 years ago, said Amanda Anderson, chair of the Wisconsin Association of Marriage and Family Therapy.

“Under our previous presidents, WAMFT attempted to draft and pass legislation to get (marriage and family therapists) in schools, but the reforms all stalled,” said Anderson, who owns and serves as a therapist at Oshkosh Marriage and Family Therapy Center LLC.

Under the new law, schools can hire marriage and family therapists to work on a regular basis with students on campus, which not only removes the middle man, but the economic barriers associated with counseling. The onus will no longer fall on parents to pay for these counseling services, since the therapists would be on the school’s payroll and services would be provided through the schools.

But the new law is likely to face challenges at a time when daunting financial deficits face districts statewide. Schools have had to make difficult budget decisions specifically around school closures, staff numbers and benefits, and, increasingly, are turning to taxpayers to vote on referendums.

Still, marriage and family therapists, as well as lawmakers, remain optimistic about the law giving schools the option to hire such therapists. For Rep. David Steffen, R-Howard, who introduced and advocated for the bill, making this a local decision is key to its success.

"Every school and school district will be able to determine if this is a solution that works for them, either short term or long term," Steffen said. "And it provides a tremendous amount of flexibility."

Anderson explained the law doesn’t replace a school district’s ability to work with third-party counseling services; rather, it allows schools to choose how and in what capacity they hire school-based counselors.

“Our hope is that they will want to create this position because youths will be more inclined to open up to trusted adults, especially ones they see daily," Anderson said.

Why did advocates think this bill was necessary?

Before the bill’s introduction, state law prohibited marriage and family therapists from providing services directly within a school. Social workers and professional counselors, however, could be awarded Tier 1 licensing through the Wisconsin Department of Public Instruction, which enables those mental health professionals to work within a school for a single year.

Expanding the pool of eligible mental health professionals who can work in schools is just one proactive way to respond to the growing mental health crisis, advocates of the bill said.

As is the case nationwide, Wisconsin struggles with student-to-counselor ratios. The ideal ratio, 250-to-1, as determined by American School Counselor Association, is still far from reach in the Badger State, where the current ratio is 366 students for every one counselor.

While the state has made some strides toward improving its numbers, it has a long way to go. And the stakes couldn't be higher.

Increasingly, young people between the ages of 12 and 17 are experiencing major depressive episodes; high schoolers are feeling sad and hopeless; and students, especially LGBTQ+ students, are attempting suicide and contemplating suicide, according to the 2021 Youth Risk Behavior Survey conducted by DPI.

At the same time, half of all youth diagnosed with a mental health condition receive no treatment, according to the Wisconsin Office of Children's Mental Health.

The need for professionals will only skyrocket, said state Sen. Jesse James, R-Altoona, a co-sponsor of the bill, during the public hearing on the bill in November 2023. The state will need about 1,500 more mental health professionals working in schools to “handle the increased demand of mental health services by students,” he said.

“If we have a shortage, as is, we need to be proactive about trying to address the need for this workforce,” James said.

For Steffen, the bill had obvious importance and, even better, didn’t require additional money at the state level to make happen. 

“Obviously, the long-term ideal situation would be that we'd have more than enough school therapists that would be available in every school,” Steffen said. “But the reality is, our students can't wait.”

How did these bills get off the ground?

The timing worked out well, given that Evers declared 2023 “The Year of Mental Health,” Anderson said. 

Anderson and her team at WAMFT worked with the Wisconsin Council on Mental Health Legislative and Policy Committee, an advisory council under the Department of Health Services. The goal was to expand the marriage and family therapy section under the Marriage and Family Therapy, Professional Counseling, and Social Work Examining Board (MPSW) Board, so that all mental health professionals on the board could work in schools.

Steffen and James “worked tirelessly to get unanimous support out of each committee chamber,” Anderson said.

What can parents and caregivers expect?

One of the ways schools have increased access to counselors is by contracting with third-party agencies. Embedding additional counseling services on school campuses removes transportation barriers and allows students to receive counseling during the school day, a boon for busy parents.

But costs can be a serious undertaking, for both parents/caretakers and school-based counselors. Before the new law was approved, families either had to pay out of pocket, through their private insurance or via BadgerCare or Medicaid.

The high cost and high needs also mean third-party counselors may take a pay cut when they work in schools. As the former executive director of Connections for Mental Wellness Rebecca Rockhill told USA TODAY NETWORK-Wisconsin last January, mental health providers going into schools is “a tremendous income drain” when working with students on Medicaid or without insurance.

Part of that is because additional reimbursements aren’t possible on top of the government-contracted service of Medicaid or BadgerCare, which covers only a percentage of the services provided each quarter, Rockhill said.

But if those same counselors are salaried through the district, reimbursements are a moot point, Anderson said, and so are the counseling fees.

Who opposed these new bills and why?

Both the Wisconsin School Psychologists Association and the Wisconsin School Social Work Association opposed the bill during the November public hearing.

Part of their opposition, which they delivered in a joint statement, is that authorized pupil services professionals were denied adequate staffing and support in the 2023-25 biennial budget, even as the state was contending with an unprecedented opportunity for new state spending.

This new administrative ruling, they argued, isn't the best strategy for responding to the needs of schools.

How will it work?

DPI’s Tier 1 licenses allow professionals to contract with schools for one year, Anderson said, although DPI hasn’t made it clear yet what the licensing process will look like.

If it’s anything like the Department of Safety and Professional Services, Anderson suspects it’ll take a month or two to get credentialed. 

Schools will be responsible for creating the job position. So far, Anderson has heard positive feedback from schools in rural districts that don't have the option of contracting with third-party services.

The idea is to create continuity for students, which will increase the likelihood of them discussing their problems. Anderson noted that younger people tend to downplay their plights, assuming “no one will care.”

"It is our job as adults to ensure every student feels heard and recognized and should they ever not feel that way, that they have a place to go," Anderson said.

Natalie Eilbert covers mental health issues for USA TODAY NETWORK-Wisconsin. She welcomes story tips and feedback. You can reach her at neilbert@gannett.com or view her Twitter profile at @natalie_eilbert. If you or someone you know is dealing with suicidal thoughts, call the National Suicide Prevention Lifeline at 988 or text "Hopeline" to the National Crisis Text Line at 741-741.