Improving Student Mental Health in Texas Through the Handle with Care Program

Introduction: Texas Faces a Student Mental Health Crisis

The need for new student-focused mental health care strategies is rising following the COVID-19 pandemic. Numbers provided by Texas Care for Children suggest a 73% increase in major depression among children ages 11 to 17 between 2015 and 2022,[1] and many Texas school educators and administrators do not have the tools to help these students. Mental health services have been historically underfunded, with 98% of school districts failing to meet the Texas Education Agency’s recommendation of one counselor for every 250 students.[2]

Recognizing the severity of the situation, Texas legislators took several steps to improve student access to mental health services in the 87th legislative session, including expanding telehealth opportunities through the Texas Child Health Access Through Telemedicine program. However, the challenges surrounding student mental health have not diminished, and the topic is once again a central part of the Texas Legislature’s 2023 policy agenda on the heels of a $33 billion budget surplus.[3] Indeed, addressing student mental health access in Texas will take a comprehensive and proactive approach that identifies and meets the complex needs of each child.

This policy brief examines one particular legislative proposal that could have a dramatic impact on student well-being if implemented: HB1537, the Handle with Care program.

What is the Handle with Care Program?

Several legislative proposals have been filed in recognition that a multifaceted approach is required to improve student mental health access in schools. Among these proposals is HB 1537, which would implement a statewide Handle with Care program.[4] The Handle with Care program is a simple intervention that creates partnerships between schools and local police departments. Once officers respond to non-routine calls where a minor is present and might have experienced trauma, they send a confidential, automated message to the school district.[5] These experiences may include house fires, evictions, abuse, or neglect, among others. The notice provides no information about the traumatic experience, only the words “handle with care” and the student’s name, date of birth, and school. Once a student’s name is communicated to the school, teachers can then watch for signs of trauma, utilize trauma-informed practices, and connect the student with mental health services as needed.

Handle with Care can be implemented without cost for both the school district and the police department, which can typically adapt already existing communications infrastructure for the program. Considering the program’s relative simplicity, Handle with Care is a feasible policy option for schools to help improve academic performance and long-term student health.

The Prevalence and Impact of Adverse Childhood Experiences

A study conducted by the National Survey of Children’s Health in 2016 revealed 46% of the nation’s youth aged 17 and younger reported experiencing at least one traumatic event.[6] Nevertheless, every child has a different support system and environment that can help — or inhibit — a child’s ability to heal.[7]

Childhood mental health is a critical issue for educators and administrators to address. Most visibly, stress caused by trauma can cause children to have difficulty focusing in the classroom and performing well academically. The difficulties grow for children continuously and repeatedly exposed to trauma — as with domestic violence and abuse. Children then become at risk for an over-reactive stress system in which their bodies and nervous systems function in a constant state of emergency. They may struggle to process new information and become prone to mistrust, aggression, and longer-term mental and physical health problems.[8]

The risks associated with trauma have been extensively studied and enumerated in a list of adverse childhood experiences, or ACEs, which typically include abuse, neglect, and household dysfunction.[9] Reflective of studies concerning childhood trauma, research evidence shows that the effects of ACEs can compound across a student’s life. A higher number of ACEs is associated with poor grades, relatively low attendance, and behavioral issues for elementary school children.[10] Thus, addressing ACEs should be a part of a comprehensive strategy for educators seeking to improve the academic performance of their students through mental health support.

The effect of ACEs on student well-being reaches far beyond the school environment. Such traumas can impact a person’s mental and physical health for decades. In fact, the toxic effects of ACEs can alter the very brain chemistry of a child,[11] leading to altered physical health development trajectories. Experiencing ACEs can increase an individual’s chances of diabetes, cancer, and heart attacks — and cause other functional limitations.[12] Exposure to ACEs is also associated with risky adolescent behavior, such as smoking and substance abuse.[13] Similar to trends with academic performance, the more ACEs a child faces, the greater risk they have of developing health or behavioral problems in adulthood.

While ACEs can have long-lasting and damaging consequences, they are quite common among children in the United States, underscoring the need for educators and administrators to develop programs that reduce their impacts. Per the National Survey of Children's Health, nearly half of all children have experienced at least one ACE by age 18. Almost 9% of children report exposure to five or more ACEs, and ACEs disproportionately impact economically vulnerable children.[14] Previous research suggests that ACEs impact children across all income levels. However, children who belong to families that are below the federal poverty level are five times more likely to encounter four or more ACEs than children in families with an income four times higher than the federal poverty level.[15] Further, more than 50% of Black and Hispanic children have experienced at least one ACE compared to 40% of white children.[16]

How the Handle with Care Program Helps

The Handle with Care program is uniquely suited to assist children who have been exposed to trauma and ACEs by taking proactive steps to counter their trauma exposure. Utilizing trauma-informed practices to prevent re-traumatization and providing interventions can help students cope and limit the consequences and impacts of trauma.

Identifying children who encounter trauma can be quite challenging for educators and administrators,[17] especially since the signs of trauma are often subtle and frequently mirror misbehavior.[18] Children respond to traumatic experiences differently, with some potentially hesitant to seek out mental health resources. Students may act out in response to their experiences, sometimes leading educators to pursue disciplinary action instead of providing mental health support.[19] Handle with Care can help ensure that teachers and administrators have additional information that can put a student’s emotional and behavioral health into context, thus connecting the child with appropriate services.

Handle with Care has been adopted into statewide programs in Maryland, Kentucky, and Oklahoma, and the groundwork for such a program already exists in Texas. The Handle with Care program has been successfully implemented across several Texas school districts, many of which differ significantly in size and demographics. In 2019, San Antonio-area schools were the first in Texas to pilot the program.[20] Since then, Handle with Care has continued to expand. In 2022, multiple school districts across the Rio Grande Valley implemented a Handle with Care program, including Brownsville and Harlingen.[21] Similarly, Galena Park Independent School District was the first in the Houston area to start a Handle with Care program in 2022 in partnership with the Hackett Center, which provided training for educators, counselors, and staff on how to assist students experiencing trauma.[22]

Handle with Care is also expanding in Harris County to include HISD, Texas’ largest school district. On January 13, 2023, the Houston Independent School District (HISD) approved the implementation of a Handle with Care program in partnership with the Houston Police Department and the Minaret Foundation. The program will first be utilized across several HISD schools before expanding throughout the district. Since HISD is among the most diverse school districts in the United States, expanding Handle with Care into HISD represents a significant step forward in tackling the trauma associated with ACEs.

Conclusion: Handle with Care Should be Implemented Statewide

As Handle with Care expands at the local level in Texas, legislators should consider implementing the program statewide during the 88th legislative session. Improving student health will involve a multifaceted approach, including boosting the student-to-counselor ratio. A statewide Handle with Care program is one important facet of the strategy to improve mental health access for students.

Handle with Care provides a significant opportunity to help students facing trauma, especially considering the program’s low cost and practicality. It will help strengthen the relationship between school districts and police departments. Further, and most importantly, the Handle with Care program can provide positive support for a child’s physical and mental health development for decades to come.