How Paraprofessionals Can Boost Youth Mental Health in Schools
Bruns, E. J., Ehde, C., Gaias, L. M., Kebede, B., McWherter, C., & Wick, E. (2025). Behavioral Health Student Assistance Programs: Leveraging Non-Traditional Mental Health Providers to Address Workforce Shortages and Mitigate the Youth Mental Health Crisis. Administration and Policy in Mental Health and Mental Health Services Research. Advance online publication. https://doi.org/10.1007/s10488-025-01465-8
Introduction
Rising rates of depression, anxiety, and suicidality among young people have reached unprecedented levels, particularly following the COVID-19 pandemic. Despite increasing need, fewer than half of youth with behavioral health concerns receive treatment, largely due to a shortage of credentialed professionals and structural barriers in schools. Washington State developed the Behavioral Health Student Assistance Program (BH-SAP) to address this gap by embedding paraprofessional Student Assistance Specialists (SASs) within schools. This model draws on evidence supporting task shifting, whereby trained non-credentialed staff deliver prevention and early intervention services, thereby extending the behavioral health workforce and broadening access for youth.
Methods
The study evaluated statewide implementation of Washington’s BH-SAP during the 2022–23 school year. Sixty SASs, supervised by regional coordinators, were placed in 88 schools across 52 districts. SASs conducted Tier 1 prevention activities, Tier 2 group and individual interventions, and referred students requiring intensive support to Tier 3 services. Fidelity to the BH-SAP practice rubric was tracked using an activity log, with adherence categorized as “high” or “low.” Student outcomes were assessed using a 30-item pre/post survey measuring hope, social connection, mental health agency, internalizing symptoms, behavioral incidents, and substance use. In total, 3,218 prevention sessions were delivered, 1,158 students received group interventions, and 2,532 students received individual support.
Results
Students demonstrated significant improvements in hope, self-efficacy, social connectedness, and coping strategies, alongside reductions in depression, anxiety, and behavioral incidents. Effect sizes ranged from small to moderate (d = 0.23–0.39). High-fidelity implementation was linked to greater improvements compared to low-fidelity delivery. While positive changes were observed in emotional health and behavior, shifts in substance use were minimal. Importantly, 96% of students surveyed reported the program was helpful, and over 80% of students with low attendance reported increased school engagement.
Discussion
Findings indicate that paraprofessionals, when trained and supervised within a structured fidelity framework, can deliver meaningful prevention and early intervention services in schools. This workforce expansion strategy helped fill critical service gaps, with outcomes comparable to those achieved by licensed providers in previous studies. Regional differences in fidelity suggest that local context influenced delivery, with some districts emphasizing individual interventions over group or universal supports. While the study lacked a control group, results underscore the potential for paraprofessionals to complement professional staff in addressing youth behavioral health needs.
Implications for Mentoring Programs
Mentors trained in evidence-based strategies could reinforce hope, coping skills, and social connection—the very domains improved in this study. Fidelity monitoring is essential, as higher-quality implementation yielded stronger outcomes. Mentoring programs can adapt lessons from BH-SAP by providing structured training, ongoing supervision, and multi-tiered supports that align with students’ varying levels of need. Such integration can expand the reach of mentoring, positioning programs as vital partners in addressing the youth mental health crisis.
Read the full paper here
