Effects of Advancing Wellness and Resiliency in Education Grants on Low-Income Children's Mental Health-Care Utilization and Outcomes.

PURPOSE: Federal Advancing Wellness and Resiliency in Education (AWARE) grants have been awarded to states and local educational agencies (LEAs) to aid them in developing sustainable infrastructure for delivering school-based mental health services, but there is little rigorous evidence on their use and effectiveness. We help to close this gap by examining how the introduction of AWARE grants changes mental health-care utilization, diagnoses, and disciplinary outcomes among Medicaid-enrolled, low-income school-aged children, and how AWARE grants are being used to increase school capacities for serving children's mental health needs.

METHODS: Effects of AWARE grants awarded in Tennessee in 2014 and 2019 were estimated using linked health and education data for all Medicaid-enrolled, school-aged children from 2012-2023 on children's mental health-care utilization, mental health diagnoses, and disciplinary outcomes. Difference-in-differences methods were employed to compare grantee school districts to those without grants and school-based health centers. Qualitative data were collected in interviews with grantees and analyzed to illuminate implementation and mechanisms of grant effects.

RESULTS: AWARE grants increased diagnoses of low-income student mental health conditions and decreased outpatient school-based health claims and exclusionary discipline actions.

DISCUSSION: Qualitative insights showing that AWARE grantees hired in-school mental health staff to identify and meet student mental health needs (regardless of health insurance status or families' ability to pay) are consistent with the quantitatively estimated decline in outpatient school-based claims. Diagnoses of low-income student mental health conditions increased, while rates of exclusionary discipline declined, achieving an important grantee goal.