Featured Speakers:
- Natalie Romer, PhD, Senior Associate, WestEd
- Nicole Tirado-Strayer, PhD, Senior Associate, WestEd
Natalie Romer:
Hello and welcome. I’m Natalie Romer, and here with me is Nicole Tirado‑Strayer. We’re senior associates at WestEd, and we co‑direct the evaluation of the California Behavioral Health Student Services Act, or BHSSA. This webinar will provide early insights from the statewide BHSSA evaluation, work that our team at WestEd is leading in collaboration with the California Commission for Behavioral Health. During this webinar, we will be introducing the BHSSA School Behavioral Health Systems Survey and sharing some emerging findings. The full BHSSA evaluation report is expected in summer of 2027. With this in mind, please note that the findings in this presentation may change as new data review and analysis for the evaluation continues.
Here’s a quick look at what we’ll cover. We’ll begin with some background information on the BHSSA and the evaluation, then we’ll walk through some early county‑level survey findings and insights from BHSSA grantee case studies, and we’ll close by explaining how survey data will be integrated into the broader statewide evaluation report. The BHSSA is part of California’s substantial
investment in making behavioral health services in schools more timely, equitable, and high quality. It was signed into law in 2019 to support partnerships between county behavioral health departments and local education agencies. The first three phases of BHSSA funding provided grants to 57 partnerships across the state.
The map on this slide shows how those phases of grantees are distributed across California. Phase 1 grantees are spread mainly along the coast and through parts of the Central Valley. Phase 2 grantees are concentrated in Southern California, including the Greater Los Angeles and San Diego regions, along with a cluster in the Bay Area. And Phase 3 grantees are concentrated in the Northeastern and Eastern parts of the state, along with a few in the far north. The BHSSA evaluation looks at how implementation has contributed to statewide school behavioral health systems change. You can learn more by scanning the QR code on this slide or by visiting wested.org/bhssaeval.
Nicole will now share some additional details about the BHSSA evaluation’s conceptual model and survey.
Nicole Tirado-Strayer:
The evaluation and survey were built around a conceptual model, which is a framework that maps out how the grantee partnerships implementing BHSSA‑funded activities and services are situated within the school behavioral health system. The BHSSA evaluation conceptual model shows a series of nested layers starting from the outside in. On the outermost layer, you see the state system followed by the county system. Within the county‑level system is the BHSSA grantee partnership, which brings together behavioral health departments and local education agencies or county offices of education. The next layer is the school system, which is comprised of districts and schools and is where students access BHSSA‑funded activities and services.
And at the center of all these layers are outcomes for California’s youth that the BHSSA is working toward: better behavioral health and wellbeing, better school climate, better social-emotional learning skills, less stigma and discrimination, less prolonged suffering, less suicide and attempted suicide, and less school failure or dropout. The whole model sits within a cycle of continuous improvement and takes into account community factors and other behavioral health initiatives that influence the implementation and impact of the BHSSA.
The BHSSA evaluation conceptualizes school behavioral health around eight key features. They are a leadership team with representatives from both behavioral health and education, data systems and practices to monitor progress and support decision‑making, a continuum of intervention that aligns with the strengths and needs of the school community, strategic communication to keep messaging clear and consistent, youth and family engagement so that all families and youth, including at‑promise youth, have a voice, implementation support, including professional development and training, documented policies and procedures to guide inclusive and ethical implementation, and funding and resources to sustain the school behavioral health system over time.
Our team developed the survey through a step‑by‑step process. Informed by the conceptual model, we began by reviewing existing research and validated measures of school behavioral health systems and partnerships. From there, we created a pool of items. We then refined those items through feedback cycles with BHSSA grantees, a panel of national experts, and commissioned staff. The full survey has three sections in total: BHSSA Grant Partnerships, the School-and-District‑Level School Behavioral Health System, and the County‑Level School Behavioral Health System. This webinar focuses on one section of the survey, specifically the section that looks at the County‑Level School Behavioral Health System.
We identified and recruited survey respondents to ensure the sample reflected the range of settings where the BHSSA is being implemented. Here’s a quick snapshot of who responded. A total of 139 individuals completed this section of the survey, representing 86% of BHSSA‑funded partnerships across California. Respondents came from all three BHSSA cohorts. The sample includes both new and existing partnerships, along with some that were not specified. The sample spans all regions of the state, including Central, Northern, and Southern California, and covers rural, suburban, and urban communities. While representation spans every category, the sample skews somewhat towards Cohort 3 partnerships, Northern California, and urban communities, each making up roughly 35 to 52% of respondents.
Most respondents were BHSSA grant leads, program managers or coordinators, and administrators or leads of a partnering entity. More than half have been supporting BHSSA implementation for at least two years and 41% for more than three years. Roughly 75% of respondents identified as White and female, which is consistent with the field more broadly, but also points to an ongoing lack of diversity among school behavioral health providers, including those in leadership roles.
Natalie Romer:
Now let’s look at some early findings that give us a snapshot of how respondents describe their county‑level school behavioral health systems. Findings are organized around seven themes shown here in a numbered wheel. One, leadership. Two, data systems and practices. Three, implementation support. Four, culturally responsive intervention. Five, funding for a continuum of intervention. Six, funding sustainability. And seven, workforce. For each theme, we’ll look at the level of agreement with each survey item and the consistency of responses. Consistency refers to the extent to which respondents had very different responses from one another. For example, in some cases, the level of agreement was high, but there was a wide variation in responses.
For each theme, we’ll also connect the survey data to what we heard from school behavioral health leaders that participated in the evaluation’s grantee case study. Let’s start with School Behavioral Health Systems Leadership. A note on how to read the data. The survey used a four‑point scale ranging from one, strongly disagree, to four, strongly agree. The results shown reflect the percentage of respondents who chose agree or strongly agree. Respondents generally agreed that foundational elements of school behavioral health leadership are in place. 87.8% agreed to having a cross‑agency leadership team, 79.3% a shared vision, and 86.7% a plan for implementation.
Responses were also fairly consistent across counties. This suggests that many counties have created a solid foundation for shared leadership. The case studies provide insight into what it actually takes to create shared leadership structures. Partners described some real challenges. Education and behavioral health systems often have different priorities and ways of operating. Decision‑making authority is spread across organizations, and staff turnover can disrupt momentum. To work through these challenges, counties formed cross‑system leadership teams, developed shared goals and implementation plans, and created regular opportunities for joint problem‑solving and decision‑making. Many also built on inter‑agency partnerships that were already in place.
Together, findings show that cross‑agency leadership is more than just coordination. It’s about building a cohesive system that helps partners align priorities, address barriers, and guide implementation over time. We’ll see how leadership connects to other parts of the school behavioral health system as we move through the next slides.
Nicole Tirado-Strayer:
Turning to data systems and practices, 85.2% of respondents agreed that data are used to guide decisions, 84.6% agreed that information is shared with partners and key interest holders, and 78.9% agreed that resource mapping and needs assessments help guide priorities for school behavioral health. However, ratings for the item about monitoring systems change was notably lower and varied quite a bit across counties. 70.6% agreed that there is a process for monitoring school behavioral health systems change. This suggests that while some counties have built more formal processes for tracking change over time, others are still in the early stages of developing them.
Case study partners agreed that using data to guide decisions is important, but they also described some challenges. Data are often spread across multiple organizations, and partners don’t always have access to the same information. It can also be hard to know how to act on data even when access is available. And in many counties, formal systems for monitoring change are missing or still a work in progress. To address this, counties conducted needs assessments and resource mapping. They also created shared systems for reviewing data to incorporate services, identify service gaps, and refine referral pathways. Some also started developing structured approaches to tracking implementation over time.
Together, findings show that while counties are using data and sharing information to support planning and decision‑making, more formal approaches to monitoring systems change are still emerging. Beyond data, building a strong school behavioral health system also requires robust implementation support, such as professional development, coaching, and training. Let’s turn to that next.
Natalie Romer:
When we look at implementation support, respondents generally agreed at 96.1% that county offices of education are supporting school behavioral health systems work in districts and schools. To a slightly lesser degree, at 81.3%, they also agreed that county behavioral health departments are supporting this work. That said, respondents rated the alignment and coordination between behavioral health and education somewhat lower at 78.9%. On a positive note, respondents reported having access to ongoing professional development at 89.7%, and those responses were fairly consistent across counties. Overall, these findings suggest that counties are actively supporting school behavioral health systems change, but aligning that support across behavioral health and education systems is more of a challenge.
Case study partners spoke candidly about the opportunities and challenges across system alignment. They described systems that often operate independently, have different roles and responsibilities, and bring different expectations to the work. Some also pointed to staff turnover and vacant positions that result in lost knowledge and delays in coordinating implementation. To tackle these challenges, counties created opportunities for cross‑agency learning, worked to clarify roles among partners, and established more formal coordination structures such as reoccurring leadership meetings, multiple points of contact, and clear documentation to maintain continuity as staff and leadership changed. Together, findings show that while implementation support is being provided in many counties, aligning support across education and behavioral health systems takes sustained effort, relationship‑building, and coordinated workforce development.
Nicole Tirado-Strayer:
On the topic of aligning behavioral health interventions with recipients’ cultural backgrounds, 95.3% of respondents agreed that culture is considered in how services are delivered. 92.7% agreed that services are available in the most commonly spoken languages, and 97% agreed that supports are designed with at‑promise youth and their caregivers and families in mind. Responses were fairly consistent across counties, suggesting that cultural and linguistic responsiveness is broadly seen as part of the school behavioral health system. That said, these findings should be interpreted with some caution, as these survey items alone are insufficient to measure culturally responsive practice. Partners that participated in the case study described cultural responsiveness as an ongoing area of focus.
They frequently discussed challenges related to building trust with students and families, addressing behavioral health stigma, meeting the needs of culturally and linguistically diverse communities, and recruiting and retaining bilingual and bicultural staff. To address these challenges, counties adapted services and communication strategies to better reflect the communities they serve. They partnered with trusted community organizations, expanded language access, and culturally responsive outreach efforts, and engaged families and community members in planning and implementation activities. Together, findings show that counties continue to invest significant effort in strengthening culturally responsive practices and aligning them with changing community needs. Culturally responsive practice also relies on adequate funding, which brings us to the next survey section.
Natalie Romer:
On Funding for a Continuum of Intervention, 83.2% of respondents agreed that available school behavioral health funding is being directed to the districts and schools with the greatest need. However, when asked whether funding is sufficient to sustain Tier I, II, and III interventions and services, ratings drop significantly and consistently across all three tiers. 36% agreed that funding is sufficient for sustaining Tier I, 27.3% for Tier II, and 27% for Tier III. This suggests that counties may be making thoughtful decisions about how to allocate resources, but are still facing real challenges in securing enough funding to sustain a full continuum of behavioral health services.
The case studies offer additional insight into how counties are navigating these funding challenges. Partners frequently noted a lack of available resources, a demand for services that exceed capacity, highly variable needs across schools and communities, and struggles investing resources across prevention, early intervention, and intensive services. To navigate this, counties used local data to guide resource allocation, prioritized high‑needs schools and student populations, expanded partnerships to increase service availability, and adapted service delivery based on what their community could realistically support. Many partners emphasized that these decisions often involve balancing investments across a continuum of services and supports. Together, findings show that resource allocation was often described not as a one‑time funding decision, but as an ongoing process of responding to evolving needs.
Funding pressures also affected how counties thought about long‑term fiscal sustainability.
Nicole Tirado-Strayer:
Respondents expressed limited confidence that existing funding strategies will be enough to sustain school behavioral health services. Only 44% agreed that core dollars would be sufficient. However, 72.2% agreed that blended and braided funding will be how services are sustained over time. When asked if Medi‑Cal billing is being leveraged to its fullest potential, only 49.5% of respondents agreed, but they were more optimistic when asked about the multi‑payer fee schedule. This was a newer funding approach at the time the survey was administered, and 85.1% agreed that it will help sustain school behavioral health services. Responses varied notably when it came to core dollars, suggesting that counties are operating under quite different fiscal conditions.
When it came to braided funding and newer financing approaches, responses were more consistent. The case studies illustrate how counties are working through the complexities of financing school behavioral health services. Partners across counties expressed concern about planning in the midst of funding uncertainty. They described the difficulty of relying on time‑limited funding sources and the administrative complexity of billing and reimbursement across multiple funding streams. To address this, counties creatively braided funding across multiple sources, expanded the use of reimbursement mechanisms where possible, and leveraged partnerships to share resources and increase capacity. Some also made fiscal sustainability a priority early in their planning process.
Findings show that overall, counties are making progress toward securing more sustainable funding, but uncertainty remains about whether available funding will be enough to meet future needs. Beyond funding, one of the most critical school behavioral health resources is the workforce itself, which is the final theme we’re going to look at.
Natalie Romer:
Respondents generally agreed at 79.5% that coordinated efforts are underway at the county level to sustain and expand the behavioral health workforce. However, they expressed considerably less agreement, 41.7%, that current staffing levels are adequate to support a comprehensive school behavioral health system, and those views were fairly consistent across counties. This suggests that counties are actively working to address California’s behavioral health workforce shortages, but that those efforts haven’t yet caught up with current needs. Case study partners frequently describe difficulty recruiting and retaining qualified school behavioral health staff. They pointed to competition from licensed professionals and workforce shortages that limit the services and supports that counties can offer.
Some counties, particularly those serving geographically dispersed communities, also struggle to attract providers to their region. To respond, counties partnered with colleges and universities, expanded internship and training experiences to create new career pathways into behavioral health, and coordinated workforce recruitment and retention efforts across partner organizations. Some also used telehealth and other alternative service delivery models to expand services. Together, findings show that while counties are making coordinated efforts to grow their workforce, shortages continue to affect service delivery. Stepping back and looking at the findings as a whole, many California counties are making meaningful progress in building school behavioral health systems.
Four themes stand out: leadership, alignment and coordination, monitoring implementation, and sustainability. Respondents report having leadership structures in place that support culturally responsive capacity‑building. At the same time, consistency in implementation is still developing, particularly when it comes to cross‑agency alignment and formal processes for monitoring systems change. A final theme relates to resources. Despite efforts to coordinate financing and address workforce shortages, funding and staffing are not yet considered sufficient to sustain school behavioral health systems at the scale needed. Before we close, a few things to keep in mind when interpreting these findings. This is self‑reported data, which means that responses can be influenced by social desirability, which is the tendency to rate practices more positively based on what seems expected or valued.
Self‑reported responses are also shaped by each persons understanding of what effective implementation looks like. And in complex systems work, that understanding tends to evolve over time. So it’s best to read these findings as a snapshot of how respondents perceive their systems at one point in time and not as a direct measure of implementation. This is also why the survey is just one piece of the larger BHSSA evaluation, which draws on multiple data sources.
Nicole Tirado-Strayer:
Our team has several next steps as we move forward with analyzing and sharing evaluation data. Over the coming months, we’ll complete cleaning and analysis of all the School Behavioral Health Systems Survey data. We’ll then hold sensemaking sessions with grantees and other interest holders to interpret survey findings alongside data from all the other evaluation components. The final BHSSA evaluation report will be submitted to the California Commission for Behavioral Health in the summer of 2027. We’ll also keep developing interim resources to share what we’re learning along the way. You can see some of the resources we’ve developed here.
Our next resource will focus on understanding BHSSA partnerships. You can learn more about the BHSSA evaluation by scanning the QR code on this slide, visiting wested.org/bhssaeval, or emailing us at [email protected]. Thanks for watching. We hope this has given you a helpful introduction to the BHSSA School Behavioral Health Systems Survey and some of our early findings. Again, if you have questions, please don’t hesitate to reach out.