K–12 Education: DOD Needs to Assess Its Capacity to Provide Mental Health Services to Students
Fast Facts
Schools across the country are concerned about student mental health, especially since the pandemic. DOD schools employ school psychologists and counselors to help meet students' mental health needs.
But these staff said they rarely had time to work with students to prevent crises due to competing responsibilities and other challenges.
Several DOD programs embed additional mental health services in many DOD schools. But these programs often don't coordinate and aren't always available to students with the greatest needs. Evaluating its programs would help DOD better understand what's working and what isn't.
We recommended addressing such issues.
Highlights
What GAO Found
The Department of Defense Education Activity (DODEA) educated more than 65,000 military-connected pre-K-12 students in 160 schools worldwide in school year 2023–24. GAO found that, like U.S. public school students, DODEA students have experienced increasing mental health concerns in recent years. Per GAO analysis, DODEA schools assessed one in 50 students for suicide risk in each of school years 2022–23 and 2023–24 in response to an identified mental health concern. In all 27 DODEA schools GAO visited worldwide, school leaders described more frequent and acute concerns (see figure).
Student Mental Health Concerns Shared by Leaders in Select DOD Schools
School psychologists and school counselors told GAO they rarely had time to work with students to prevent crises due to competing responsibilities and heavy administrative workloads, such as testing coordination duties. Such staff are key to successfully implementing DODEA's Multi-Tiered System of Supports (MTSS) framework—an evidence-based approach to help schools identify and proactively address student needs and build resilience. However, DODEA has not assessed its workforce capacity to implement MTSS with fidelity. Federal workforce planning principles include identifying and addressing human capital needs. Without a workforce plan, DODEA may be unaware of resource gaps that could hinder its success—particularly in light of DOD's recent directives to optimize its civilian workforce.
DOD has not assured that the three mental health programs it operates in DODEA schools meet student needs. First, none of the programs have been evaluated, contrary to DOD policy. The largest—Military and Family Life Counseling (MFLC)—places nonclinical counselors in nearly every DODEA school. However, school leaders raised concerns about the program, including poor collaboration with school staff and high turnover among counselors. Second, DOD has not assured that these programs provide the right mix of services to meet student needs. School leaders, parents, and military treatment facility staff all told GAO that DODEA students need additional clinical mental health care. Two programs provide clinical services in some DODEA schools. However, these programs are small—embedding one clinician in DODEA schools for every four non-clinical MFLC counselors. Further, DOD has not facilitated collaboration among these programs to assure that they provide the right mix of services to meet DODEA student needs. GAO has reported that collaboration can help agency components address cross-cutting challenges—such as responding to student mental health needs. Collaboration could help DOD better assure that these programs provide the right mix of services to meet DODEA student needs, in line with leading practices and its own goals.
Why GAO Did This Study
DOD research has found that military families and children face severe barriers to accessing mental health care, harming family well-being and military readiness. Without proper treatment, children with mental health concerns are at risk of school failure, substance misuse, and suicide.
Senate Report 118-58 includes a provision for GAO to examine mental health services in DODEA schools. This review examines (1) mental health concerns of DODEA students, (2) DODEA's capacity to implement its new MTSS framework, and (3) the extent to which DOD has assessed how well mental health programs in DODEA schools meet student needs and their collaboration in doing so.
GAO analyzed suicide-related incident data collected by DODEA for school years 2022–23 and 2023–24, the most recent data available. GAO also conducted site visits to 27 schools and eight military treatment facilities on 11 military installations across DODEA's three regions. GAO interviewed DOD and DODEA officials, reviewed relevant federal laws, policies, and procedures, and assessed DOD actions against policy and relevant federal standards.
Recommendations
GAO is making seven recommendations to DOD, including to assess capacity to implement MTSS, to evaluate its programs that provide mental health services in DODEA schools, and assure that these programs collaborate to align their services with student needs. DOD agreed or partially agreed with six recommendations, and disagreed with one, which GAO maintains is valid.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Defense | The Deputy Under Secretary of Defense for Personnel and Readiness should direct the DODEA Director to develop and disseminate guidance to schools for assigning standardized testing coordination responsibilities to school leaders. This guidance should discourage schools from relying on school counselors as standardized testing coordinators. (Recommendation 1) |
DOD partially concurred with this recommendation. DOD stated that it will direct DODEA to develop and disseminate guidance on assigning testing coordination responsibilities in a way that is mindful of school counselors' primary responsibilities. Our report noted that encouraging school leaders not to assign standardized testing coordination duties to school counselors, in line with the position of the American School Counselor Association, could help address some of DODEA's workload capacity issues. We continue to maintain that guidance to explicitly discourage assigning testing responsibilities to school counselors is warranted.
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| Department of Defense | The Deputy Under Secretary of Defense for Personnel and Readiness should direct the DODEA Director to assess the capacity of its workforce to provide the continuum of behavioral supports indicated in its MTSS framework. This assessment should consider the capacity of school psychologists and school counselors. (Recommendation 2) |
DOD partially concurred with this recommendation. DOD said it has assessed school-level staffing to ensure responsibilities are appropriately positioned to support the strategic instructional needs of military-connected students, and noted that student support is not limited to school counselors and psychologists. Rather, it involves a comprehensive team of school nurses, school social workers, and other professionals committed to student success. We agree, and note that the recommendation does not preclude taking a broader approach as DOD outlines.
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| Department of Defense | The Deputy Under Secretary of Defense for Personnel and Readiness should direct the DODEA Director to develop a plan based on the results of its workforce assessment to address any identified gaps in workforce capacity that could hinder the success of its MTSS initiative. (Recommendation 3) |
DOD partially concurred with this recommendation. DOD stated that the MTSS framework is meant to be adaptable to enable DOD to meet the ever-evolving needs of its schools and students. DOD also noted that the next phase of the MTSS rollout will focus on refining roles and responsibilities to ensure optimized resource allocation, and that MTSS requires cycles of continuous assessment. We agree that optimizing resource allocation is critical to the success of MTSS. However, DODEA has not yet assessed its capacity to implement all aspects of the MTSS initiative. We continue to believe that identifying any gaps in workforce capacity and developing a plan to address them will help DODEA align its staffing resources to meet students' needs and improve the success of its MTSS implementation.
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| Department of Defense | The Deputy Under Secretary of Defense for Personnel and Readiness should direct the Director of Military Community Support Programs to evaluate the MFLC program's use in DODEA schools, seeking feedback from DODEA headquarters staff and school leaders, and develop a plan to address any areas of concern identified through its evaluation. (Recommendation 4) |
DOD agreed with this recommendation. DOD has an ongoing multi-step project to assess the MFLC program's use and effectiveness across all locations. The project includes locations where Child and Youth Behavioral (CYB)-MFLCs serve military children. DOD also noted a recent report commissioned by Military Community Support Programs that examined military-connected children in military child development centers, youth programs and schools with military populations served by CYB-MFLCs. We await further progress on this recommendation.
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| Department of Defense | The Secretary of the Army should direct the Director of the Directorate of Prevention, Resilience, and Readiness to evaluate the ASACS program's use in DODEA schools, seeking feedback from DODEA headquarters staff and school leaders, and develop a plan to address any areas of concern identified through its evaluation. (Recommendation 5) |
DOD did not agree with this recommendation. DOD stated that, in the context of ongoing work to implement ASACS program guidance, ASACS staff in DODEA schools will collaborate with local DODEA school leaders and counselors for effective collaborative planning. Because this work is ongoing, DOD believes this recommendation is superfluous. While it is encouraging that the Army recognizes the value of collaboration, the ASACS program has not been evaluated for effectiveness in DODEA schools, and Army officials agreed that a formal program evaluation was needed. We continue to maintain that an evaluation of the ASACS program is necessary.
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| Department of Defense | The Deputy Under Secretary of Defense for Personnel and Readiness should direct the Director of the Defense Health Agency to evaluate the School Behavioral Health program's use in DODEA schools, seeking feedback from DODEA headquarters staff and school leaders, and develop a plan to address any areas of concern identified through its evaluation. (Recommendation 6) |
DOD agreed with this recommendation. DOD stated that evaluating the program - including obtaining feedback from DODEA leaders and other stakeholders - is essential to program development, sustainment and efficiency. We await further progress on this recommendation.
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| Department of Defense | The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to assure that the ASACS, MFLC, and School Behavioral Health programs collaborate to align their services to meet DODEA student mental health needs. In doing so, and in line with leading practices on federal collaborative efforts, the programs should define common outcomes, identify and sustain leadership for the effort, and involve relevant stakeholders, including DODEA. (Recommendation 7) |
DOD agreed with this recommendation. They are committed to strengthening collaboration and establishing feasible, common program goals, while acknowledging the operational independence to address the unique aspects and population needs managed by each program's overseeing office. We await further progress to implement this recommendation.
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