Aurora Public Schools

Aurora Public Schools (APS) is a mid-sized school district in the Denver, CO metro area. Home to many refugee and immigrant families, as well as military families stationed at the local space force base, APS prides itself on its diversity–students come from over 130 countries and speak more than 160 languages.

• 63 schools
• 38,000 students
• 87% students of color
• 74% students qualify for free or reduced price lunch

Hazel Programs

• Mental Health
• Hazel at School
• Hazel at Home

Funding Source(s)

• ESSER funds

Challenge

• Colorado is one of many states in the US facing a youth mental health crisis
• Even with strong community mental health partnerships and a low student to counselor ratio, counselor caseloads reached capacity
• Only 20% of counselors and social workers in APS identify as a Person of Color, compared with 87% of students

Goal

Support more student’s mental health needs by expanding mental health care capacity and increasing student access to racially and linguistically diverse therapists.

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APS is a district with a robust mental health infrastructure. Understanding the American School Counselor Association’s recommended ratio of one school counselor for every 250 students, APS used local funding in 2019 to hire a significant number of school-based mental health professionals. The district employs 277 mental health professionals, including school counselors and psychologists. School-based therapists from two local community health organizations also provide therapy to students during the school day.

Despite the district’s strong prioritization of mental health support, the need that arose during the pandemic put a strain on resources. In addition to the impacts of the pandemic itself, Aurora students grappled with a series of shootings that took place in the community in 2021, which left several students injured. In schools, providers' caseloads became very heavy, and many reached capacity. As a result, students were added to waitlists. In many cases, students were facing immediate challenges, where a delay in care could cause long-term harm.

Colorado is one of many states seeing significant increases in youth struggling with mental health challenges— in October 2021, mental health-related emergency visits at Children’s Hospital Colorado were up 73%. Suicide is the leading cause of death for 10 to 24 year olds in Colorado.

APS sought to partner with an additional mental health organization that could address some of the district’s challenges by providing students with timely care. In addition, since APS students are racially and linguistically diverse, the district hoped to find a partner who could support students with unique backgrounds and experiences by providing culturally competent mental health care.

• Assembled a culturally competent provider team, including therapists who provide direct services in Spanish and many who identify as Persons of Color
• Launched telehealth services in school and at home, giving students the flexibility to access care where they are most comfortable
• Established a self-referral program for students 12 and older*
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When Hazel launched in APS in January 2022, several key program features were implemented to ensure that the partnership augmented APS’s existing mental health care infrastructure.

Before Hazel, all of APS’s mental health offerings were on-site at school–there was no telehealth option. Hazel’s teletherapy services opened the door for both in-school and at-home access, creating more appointment times and scheduling flexibility. Teletherapy maximizes the number of available mental health care providers, since providers can be licensed anywhere in the state, and do not commute or travel between school locations. Telehealth also ensured that students who were more comfortable engaging in therapy from home were still able to access care.

Hazel assembled a bilingual team of therapists with a variety of backgrounds to represent the diverse student population of APS. The better a student is represented and understood by providers, the better they can be treated, and the more likely they are to experience positive outcomes.

APS worked closely with Hazel to ensure that the referral process would not be a barrier to care. In Colorado, students who are of legal age of consent for mental health services (12 years or older) can self-consent for mental health services. While Hazel supports having a parent or guardian involved in their child’s mental health care, students who self-consent can choose whether to notify their guardians, which is sometimes in the best interest of the student. APS established a request form that students could access by scanning a simple QR code on posters throughout its school buildings. Once students fill out the form, APS counseling staff support students by connecting them with the best mental health partner for further care, which in many cases includes filling out a direct referral on behalf of the student for care with Hazel. Empowering students to give consent for themselves brings the school in compliance with Colorado state law while also expanding access.

As a district that had already heavily invested in school counselors, APS’s partnership with Hazel offered the added benefit of affordability. Hazel’s offering is significantly less expensive than hiring full-time, school-based counseling staff, and Hazel handles the recruitment, onboarding, training and retention of its mental health providers, removing these expenditures for the district.

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*Colorado state law allows minors 12 years and older to provide consent for therapy services. Therapists must use clinical judgment to confirm the minor’s capacity and medical necessity of services. State law in reference: Colo. Rev. Stat. § 12-245-203.5.

• 1,807 total therapy sessions during the Spring 2022 semester
• 324 unique students served, including 9 crisis cases
• 53% of all intakes were for middle school students
• 12-year-old average age at intake
• 94 referring staff members
• 48% therapy sessions at home
• Generalized Anxiety Disorder and Adjustment Disorder were the top diagnoses

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In just one semester, Hazel was able to serve over 300 APS students who would have otherwise been on a waitlist, providing direct mental health care through over 1,800 therapy sessions. This significantly helped to reduce district wait lists, and make sure that students on a waitlist who needed faster care were able to receive it. Throughout the spring, Hazel supported 9 crisis cases, where Hazel was able to make an immediate intervention, create a safety plan, and find local support for a student in need. For hundreds of other students, Hazel’s short-term mental health care served as a bridge until availability with one of the on-site school counselors became available, or until they were able to meet with a local provider.

During the partnership, APS staff shared concerns about the mental health of the district's middle school population, many of whom were struggling with the transition from elementary to middle school. Hazel’s partnership complemented APS’s substantial in-school support to help this age group, with over 50% of therapy sessions taking place with middle school students. In addition, five out of six of the district’s schools with the highest percentage of referrals to Hazel were middle schools. In many cases, those referrals and sessions were to address adjustment disorder, which was the second most common diagnosis among APS students. The self-referral program for students 12 and over also likely led to an increase of care for this age group. In APS, the average student age at intake for mental health services was 12 years old, two and a half years younger than the global peak age for onset of a mental health condition (14.5).

Hazel’s ability to offer therapy appointments from home was advantageous for students and families. Nearly half (48%) of all Hazel mental health sessions took place at home during the spring semester. The flexibility of the structure allowed even more students to access care.

Nationally, APS serves as a model district for ESSER fund usage. In May 2022, U.S. Deputy Secretary of Education Cindy Marten visited APS to learn about the challenges the community faced during the pandemic and see the programs implemented with ESSER funds, including Hazel, in action.

APS is excited to continue to serve as a role model for ESSER fund usage in the 2022-2023 school year as the district maintains its partnership with Hazel Health. With so much success seen in just the first five months of the program, both Hazel and the district anticipate an even bigger impact in the year ahead.