The Commonwealth of Massachusetts
Executive Office of Health and Human Services
Department of Public Health
250 Washington Street, Boston, MA 02108-4619
KATHLEEN E. WALSH
MAURA T. HEALEY Secretary
Governor
ROBERT GOLDSTEIN, MD, PhD
KIMBERLEY DRISCOLL Commissioner
Lieutenant Governor
Tel: 617-624-6000
www.mass.gov/dph
October 29th, 2024
Steven T. James
House Clerk
State House Room 145
Boston, MA 02133
Michael D. Hurley
Senate Clerk
State House Room 335
Boston, MA 02133
Dear Mr. Clerk,
Pursuant to Chapter 24 of the Acts of 2021, please find enclosed a report from the Department of
Public Health entitled “School Telebehavioral Health Pilot Program.”
Sincerely,
Robert Goldstein, MD, PhD
Commissioner
Department of Public Health
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School Telebehavioral
Health Pilot Program
October 2024
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Legislative Mandate
The following report is hereby issued pursuant to Chapter 28 of the Acts of 2023 as follows:
The Department of Public Health “in consultation with the department of mental health and
the department of elementary and secondary education, shall expend not less than $3,532,000
for a pilot program to increase student access to telebehavioral health services in schools;
provided further, that not later than June 28, 2024, the department of public health shall report
to the joint committee on mental health, substance use, and recovery and the house and
senate committees on ways and means detailing the: (i) number of students participating in the
program; (ii) frequency with which students use the program; (iii) cost of the services provided,
including the use of support staff; and (iv) manner in which costs have been supported by third
party reimbursement”
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Executive Summary
The School Telebehavioral Health (TBH) Pilot Program is a state-funded initiative to increase
access to quality youth mental health and substance use services by leveraging technology in
the delivery of care and building the capacity of schools and providers. In fiscal year 2024, the
pilot expanded services to 20 schools/districts and generated interest among an additional 5
districts that hope to join in FY25 (see Tables 1 and 2 for additional details). Participating and
prospective districts have been primarily identified through the pilot’s 2022 needs assessment.
Across participating districts, the pilot has served 940 students over the last two fiscal years,
offering a total of 11,103 TBH sessions to those students. In FY24, the pilot served 658 students,
offering a total of 6,739 sessions. This number reflects data collected through March 31, 2024,
and is expected to increase before the close of FY24 as several newly onboarded districts ramp
up service delivery. In addition to providing direct access to clinical care, the pilot also
supported over 2,400 referrals for health-related social needs, peer support, and accessing
higher-levels of behavioral health care.
The program expanded the number of service providers in FY24, bringing on two Community
Behavioral Health Centers (CBHCs)– High Point Treatment Center and the Brien Center – to
further expand access to care. The Brookline Center for Community Mental Health (BCCMH),
the pilot’s implementation vendor, is working with these agencies to build their TBH capacity in
service of school districts in their catchment areas. Engaging CBHCs in the delivery of school-
based TBH has highlighted an opportunity to integrate these services into the full continuum of
behavioral health care, providing timelier referral and access to higher levels of care, such as
Youth Mobile Crisis Intervention and Youth Community Crisis Stabilization supported by the
EHS Behavioral Health Roadmap. Strengthening collaboration between the CBHCs and school
TBH sites would possibly create a stronger pathway to financial sustainability and statewide
expansion that will be further explored in FY25.
BCCMH provided ongoing training and technical assistance to both schools and providers in
FY24. This included supporting the development of sustainable partnerships and workflows,
training clinical and school staff on topics such as telehealth technologies, cultural
responsiveness, trauma-informed care, and process improvement. BCCMH also developed new
training and onboarding materials to support TBH providers in onboarding Community Health
Workers (CHWs) to support service delivery in schools and supported districts in increasing
access to services for newcomer students and their families.
In FY24, BCCMH and Brandeis University made significant strides in data collection and
evaluation, working with provider agencies and school districts to ensure access to quality data.
Although larger sample sizes are needed to assess trends over time, the evaluation has started
to capture important themes related to service initiation, implementation, and outcomes with a
focus on health equity. Data tables highlighting student and workforce demographics, service
engagement, and outcomes are available in the appendix.
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Current funding levels present a significant challenge heading into FY25 as the pilot does not
have sufficient funds to support the expansion of services to additional districts, including those
that have already expressed interest (several of which are larger, high-need districts according
to the pilot needs assessment). A key focus of FY25 will be identifying additional funding to
support ongoing expansion of pilot services, including grant funding and improved MassHealth
reimbursement. Other FY25 activities will include expanding participation among CBHCs,
leveraging funding to support smaller group practices that provide more culturally responsive
and linguistically appropriate care, ongoing training and technical assistance, data collection
and evaluation, and initial development of a replication guide.
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Introduction
The Brookline Center for Community Mental Health (BCCMH) was awarded the contract to
implement the school telebehavioral health (TBH) pilot on October 1, 2021. This third legislative
report captures the second year of service delivery, covering the period of July 1, 2023 through
March 31, 2024.
The goals of the pilot are to:
• Expand access to mental health and substance use services for school-age youth,
• Evaluate the impact of services and capture any needed adaptations, and
• Demonstrate feasibility for statewide replication, including pathways to financially
sustain school TBH service delivery and other elements necessary for success in schools.
As the lead implementation vendor, BCCMH has been charged with:
• Designing a pilot program after conducting a thorough needs assessment and
investigation of past successful projects,
• Implementing the pilot program including site selection, funding, and support to sites to
achieve sustainability in the provision of services,
• Providing a rigorous evaluation of the program, and
• Producing a replication guide to support further expansion of school TBH across the
Commonwealth.
To date, BCCMH has completed the needs assessment to identify priority districts for school
TBH service delivery and is in the second year of program implementation and evaluation. In
compliance with the legislative mandate, the Massachusetts Department of Public Health, in
collaboration with BCCMH, is reporting on the progress of the fiscal year 2024. In addition to
the metrics required by legislative mandate, the report includes information on the project
infrastructure, capacity-building activities, evaluation, and ongoing and proposed activities for
fiscal year 2025.
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 Report
During this reporting period (July 1, 2023 – March 31, 2024), activities focused on expanding of
school TBH service delivery, engaging additional behavioral health providers, continuing
capacity building, and identifying pathways toward financially sustaining ongoing expansion of
school TBH.
Number of students participating in the program during the reporting period: 658
The program is currently being implemented in collaboration with 20 schools/districts. For
grade levels and demographic characteristics of students engaged in the pilot program, see the
data tables available in the appendix.
Table 1. School Districts Active in School TBH Pilot and Clinical Provider Organizations
Needs
Implementation Total
Current Districts Clinical Provider Assessment
Start Date¹ Enrollment
Score
Athol-Royalston Regional Heywood Hospital / July 2022 / 1,596 2
School District Cartwheel Care September 2023
Ayer Shirley Regional School Cartwheel Care January 2024 1,687 2
District
Berkshire Hills Regional Cartwheel Care January 2023 1,179 N/A*
Boston Arts Academy Cartwheel Care October 2023 473 5
Fall River Public Schools Cartwheel Care Pending 10,656 5
Fitchburg Public Schools Cartwheel Care June 2023 5,124 3
Gardner Public Schools Heywood Hospital July 2022 2,472 2
Lowell Public Schools Cartwheel Care April 2023 14,274 4
Methuen Public Schools Cartwheel Care September 2023 6,532 N/A*
Narraganset Public Schools Heywood Hospital January 2023 1,453 N/A*
North Adams Public Schools Cartwheel Care + The March 2023 1,207 4
Brien Center²
Pittsfield Public Schools Cartwheel Care September 2023 4,876 3
RC Mahar Regional School Heywood Hospital January 2023 504 N/A*
Salem Public Schools Cartwheel Care January 2023 3,811 2
Marlborough Public Schools Cartwheel Care Feb 2024 4,729 2
Haverhill Public Schools Cartwheel Care March 2024 7,882 2
Greater Lawrence Regional Cartwheel Care June 2023 1,774 2
Vocational Technical
Greater New Bedford Regional Cartwheel Care Pending 2,147 2
Vocational Technical
Lawrence Family Development Cartwheel Care Pending 879 2
Charter
Wareham Public Schools High Point Treatment Pending 1,950 2
Center³
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¹ Defined as when the first referrals were processed.
² Brien Center is partnering with Cartwheel Care as they build their clinical capacity for TBH service delivery and is also not yet included in the
evaluation as a unique TBH provider agency.
³ Data does not yet include districts served by High Point Treatment Center as service initiation has recently begun.
*There are four participating districts that were not identified in the pilot’s 2022 needs assessment. BCCMH has been prioritizing outreach to
schools identified in the needs assessment but experienced early challenges related to engaging and onboarding those districts, as many
schools cited concerns around limited capacity. The pilot made the strategic decision to support these sites that demonstrated significant needs
within their student population and were at risk of losing existing services. BCCMH continues outreach to needs assessment sites and is
supporting all districts in financially sustaining services as we seek ongoing expansion.
During FY24, between July 1 and March 31, the pilot provided TBH services to 658 students in
selected schools across the Commonwealth. We expect this number to increase by the end of
the fiscal year. The pilot has the opportunity for ongoing expansion in FY25 given expressed
interest of schools identified in Table 2. However, with current funding, the pilot will not be
able to expand to these sites immediately. The Massachusetts Department of Public Health
(MADPH) will continue outreach to CBHCs to increase their awareness of the SBTH pilot,
identify priority schools within their catchment area, and leverage the CBHC bundled
reimbursement rate for sustainability. Further, MDPH will explore grant funding to support
ongoing expansion of pilot sites, and will continue to work with BCCMH, other state agencies,
participating schools, and providers to maximize third party reimbursement and explore
pathways toward financially sustaining school TBH services.
Table 2. School Districts Interested in FY25 School TBH Pilot Engagement (as of March 31, 2024)
Current Districts Clinical Provider Projected Total Needs
Referrals Enrollment Assessment Score
Boston Public Schools Cartwheel Care 750 45,742 5
Brockton Public High Point Treatment 200 14,954 5
Schools Center
Lawrence Public Cartwheel Care 200 13,008 4
Schools
Framingham Public Cartwheel Care 100 9,134 2
Schools
Randolph Public Codman Square Health 75 2,685 2
Schools Center
Frequency with which students use the program: 6,739 sessions completed during the
reporting period.
The frequency with which students use the program varies based on individual clinical need and
the provider agency. Some students receive weekly individual therapy sessions while others
receive sessions once or twice a month. The number of sessions per student ranges from one to
thirty-five (1-35) sessions. Preliminary data suggests that the average number of TBH sessions
for students receiving care from Cartwheel Care is just over six sessions, with a range of one
session to twenty-two (1-22) sessions. For students engaged in Heywood Healthcare’s services,
the average number of TBH sessions is just over fourteen (14) sessions, with a range of one
session to thirty-five (1-35) sessions. Because these samples include students who are still
actively in care, it is expected that the average number of sessions per student is higher than
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reported here. MDPH does not yet have this data from the Brien Center or High Point
Treatment Center as those agencies are in earlier stages of service initiation and delivery.
Cost of the services provided, including the use of support staff:
The total cost of the services provided varies by site based on student enrollment, the needs of
each district, and the partnering TBH provider. Costs include:
• Clinical service delivery and care coordination, including direct care provided by
behavioral health clinicians, intake processes, care coordination, student and family
engagement, and other services provided by Community Health Workers and clinician
extenders. For schools working with Cartwheel Care, this also includes clinical care with
“rapid access” which applies an additional cost to reserve clinical capacity as a strategy
to reduce waitlists and expedite a connection to care for students.
• Administrative and general operating costs, including clinical supervision, project
management, licensing, credentialing, billing, supplies, technology, training and local
travel for on-site support staff.
• Capacity building activities, including partnership development between schools and
TBH providers as well as training, technical assistance, and professional development
offered to schools and provider agencies that support TBH service implementation and
quality of care with a focus on health equity.
Tables 3 and 4 break-down costs per student for both Heywood Healthcare and Cartwheel Care.
These cost estimates were calculated separately for each provider organization based on
available data and do not include costs reimbursed by health insurance. The cost estimates only
reflect the contributions made by the pilot and local education agencies. Please note that the
cost estimates provided below are not comparable between the provider agencies because of
the different service models. Students receiving services from Cartwheel Care are typically seen
for two to six (2-6) months whereas Heywood Healthcare often provides longer-term services
for students who need them as well as referrals for mental health-related social needs through
the Community Health Worker (a role that is n