[Senate Hearing 117-557]
[From the U.S. Government Publishing Office]


                                                        S. Hrg. 117-557

                    CARING FOR OUR KIDS: SUPPORTING
                    MENTAL HEALTH IN THE TRANSITION
                      FROM HIGH SCHOOL TO COLLEGE

=======================================================================

                                HEARING

                               BEFORE THE

                 SUBCOMMITTEE ON CHILDREN AND FAMILIES

                                 OF THE

                    COMMITTEE ON HEALTH, EDUCATION,
                          LABOR, AND PENSIONS

                          UNITED STATES SENATE

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             SECOND SESSION

                                   ON

EXAMINING CARING FOR OUR KIDS, FOCUSING ON SUPPORTING MENTAL HEALTH IN 
               THE TRANSITION FROM HIGH SCHOOL TO COLLEGE
                               __________

                           NOVEMBER 30, 2022
                               __________

 Printed for the use of the Committee on Health, Education, Labor, and 
                                Pensions
                                
                                
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        Available via the World Wide Web: http://www.govinfo.gov
        
                               __________

                    U.S. GOVERNMENT PUBLISHING OFFICE
                    
51-557 PDF                WASHINGTON : 2024           
        
        
          COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS

                    PATTY MURRAY, Washington, Chair
BERNIE SANDERS (I), Vermont          RICHARD BURR, North Carolina, 
ROBERT P. CASEY, JR., Pennsylvania       Ranking Member
TAMMY BALDWIN, Wisconsin             RAND PAUL, M.D., Kentucky
CHRISTOPHER S. MURPHY, Connecticut   SUSAN M. COLLINS, Maine
TIM KAINE, Virginia                  BILL CASSIDY, M.D., Louisiana
MAGGIE HASSAN, New Hampshire         LISA MURKOWSKI, Alaska
TINA SMITH, Minnesota                MIKE BRAUN, Indiana
JACKY ROSEN, Nevada                  ROGER MARSHALL, M.D., Kansas
BEN RAY LUJAN, New Mexico            TIM SCOTT, South Carolina
JOHN HICKENLOOPER, Colorado          MITT ROMNEY, Utah
                                     TOMMY TUBERVILLE, Alabama
                                     JERRY MORAN, Kansas

                     Evan T. Schatz, Staff Director
               David P. Cleary, Republican Staff Director
                  John Righter, Deputy Staff Director
                                 ------                                

                 SUBCOMMITTEE ON CHILDREN AND FAMILIES

              ROBERT P. CASEY, JR., Pennsylvania, Chairman
BERNIE SANDERS (I), Vermont          BILL CASSIDY, M.D., Louisiana
CHRISTOPHER S. MURPHY, Connecticut   MITT ROMNEY, Utah
TIM KAINE, Virginia                  SUSAN M. COLLINS, Maine
MAGGIE HASSAN, New Hampshire         LISA MURKOWSKI, Alaska
TINA SMITH, Minnesota                JERRY MORAN, Kansas
JOHN HICKENLOOPER, Colorado          ROGER MARSHALL, M.D., Kansas
PATTY MURRAY, Washington (ex         TOMMY TUBERVILLE, Alabama
    officio)                         RICHARD BURR, North Carolina (ex 
                                         officio)

                            C O N T E N T S

                              ----------                              

                               STATEMENTS

                      WEDNESDAY, NOVEMBER 30, 2022

                                                                   Page

                           Committee Members

Casey, Hon. Robert, Chairman, Subcommittee on Children and 
  Families, Opening statement....................................     1
Cassidy, Hon. Bill, Ranking Member, a U.S. Senator from the State 
  of Louisiana, Opening statement................................     3

                               Witnesses

Hoover, Sharon, Ph.D., Professor of Psychiatry and Co-Director of 
  the National Center for School Mental Health, Univ ersity of 
  Maryland School of Medicine, Baltimore, MD.....................     6
    Prepared statement...........................................     8
Wright, Curtis, Ed.D., Vice President of Student Affairs, Xavier 
  University of Louisiana, New Orleans, LA.......................    16
    Prepared statement...........................................    18
    Summary statement............................................    21
Weiss, Ashley, D.O., M.P.H., Director of Medical Student 
  Education in Psychiatry, Tulane University School of Medicine, 
  New Orleans, LA................................................    23
    Prepared statement...........................................    26
Williams, Brooklyn, high school senior and founder of the Chill 
  Club, Pittsburgh, PA...........................................    28
    Prepared statement...........................................    29

                          ADDITIONAL MATERIAL

Statements, articles, publications, letters, etc.
Casey, Hon. Robert:
    Excerpt From the 2020 National Survey on Drug Use and Health.    49
    Childrens Hospital Association Statement for the Record......    67
    AAFP Statement for the Record................................    70

 
                    CARING FOR OUR KIDS: SUPPORTING
                    MENTAL HEALTH IN THE TRANSITION
                      FROM HIGH SCHOOL TO COLLEGE

                              ----------                              


                      Wednesday, November 30, 2022

                                       U.S. Senate,
                     Subcommittee on Children and Families,
       Committee on Health, Education, Labor, and Pensions,
                                                    Washington, DC.
    The Subcommittee met, pursuant to notice, at 10:01 a.m., in 
room 430, Dirksen Senate Office Building, Hon. Robert Casey, 
Chairman of the Subcommittee, presiding.

    Present: Senators Casey [presiding], Murphy, Kaine, Hassan, 
Smith, Cassidy, Marshall, and Tuberville.

                   OPENING STATEMENT OF SENATOR CASEY

    The Chairman. This hearing will come to order. I want to 
thank everyone for being here, especially our witnesses, for 
their testimony today and the expertise they bring to bear, as 
well as traveling to be with us.

    I want to thank Ranking Member Cassidy for his leadership 
on these issues, as well as working with us and our two staffs 
to arrange this Subcommittee hearing. I don't think it comes as 
news to many Americans that our Nation faces a crisis in 
adolescent mental health.

    At any given time, 1 in 5--1 in 5 adolescents are 
experiencing a mental, developmental, or behavioral disorder. 
The COVID-19 pandemic placed a heavy burden on young people 
struggling with their mental health.

    One survey of high school students found that 44 percent 
persistently felt sad or hopeless. In addition to that survey, 
we know of other surveys that find similar results. We know, 
for example, that about half of all people who experience a 
mental health condition begin presenting symptoms by the age of 
14, making high school a critical intervention point.

    The Biden administration and the 117th Congress has 
recognized the importance of mental health support in our 
schools and have made critical investments in our communities 
to this end. It is critical that students, particularly those 
with disabilities, feel both academically and emotionally 
supported in their schools.

    Most schools have some mental health supports in place, 
like peer support, one on one counseling, and outside care 
referrals. But many students are falling through the cracks. To 
reach every student, we need all hands on deck.

    That means far more mental health professionals and making 
every student, every caregiver, teacher, and school staff 
member a part of the solution to teen mental health crisis. In 
2021, the average ratio of students to school counselors was 
415 to 1, despite a recommended ratio of 250 to 1.

    We cannot expect progress in addressing this crisis without 
lifting up professionals in such high impact settings. We must 
do more to identify and help secondary students in need of 
mental health support, especially as they prepare for college. 
The transition to college is, of course, both exciting but also 
very stressful and a very stressful time for our teens.

    Living away from home and an emotional support system for 
the first time, it is easy for students to be caught up in 
their new life and not get the mental health care that they 
need. When students arrive on campus, they may confront new 
challenges to adjusting to hectic schedules, making new 
friends, and keeping up with academic expectations, which can 
compound feelings of stress and despair.

    The social isolation of the pandemic left students 
unprepared for the social transition to college and less likely 
to establish connections with peers and mentors at school. 
These forces are compounded for students entering college with 
a mental health condition.

    Without supports in place, these students care can and 
often does lapse just when they need it the most. The task of 
navigating a switch to telehealth or finding a new provider in 
college largely falls on the students, and if available, their 
parents.

    Students are left to maneuver the complexities of the 
health care system, including insurance coverage. With a 
shortage of providers in most areas and many not covered by 
insurance, finding an affordable and timely care can be very 
onerous.

    Data shows that when college students don't get the mental 
health care that they need, it can lead to major disruptions in 
their education, as unaddressed mental health needs are 
associated with poorer academic performance and lower rates of 
degree completion.

    In a survey conducted in 2021, over 70 percent of 
bachelor's and associate degree students who had considered 
taking a break from school in the past 6 months said emotional 
stress was an important reason.

    In order to set students up for success in college, early 
identification of mental health needs and ready access to 
treatment are, of course, critical. When students move away 
from home and transition to college and adult life, continuity 
of care and reasonable accommodations help them manage new 
stressors and lead--new stressors and lead meaningful, 
productive lives.

    That kind of support shouldn't be a luxury for students 
experiencing mental health conditions, but today, 
unfortunately, it is. Families are getting priced out of timely 
mental health care and the evaluations needed for mental health 
accommodations can cost thousands of dollars out-of-pocket.

    Because of gaps in our pediatric mental health care system, 
many needs are not being addressed until far too late, if at 
all. Accessing timely mental health care that is covered by 
insurance shouldn't feel like winning the lottery. It should be 
the same as getting care for any other health condition.

    That is why Ranking Member Cassidy and I introduced the 
Health Care Capacity for Pediatric Mental Health Act, which 
would establish grant programs to expand mental health 
integration, workforce training, and care capacity among 
providers to treat young people.

    Senator Cassidy and I also introduced the RISE Act, which 
would provide information to students with mental health 
disabilities and their families to help them select the right 
college and streamline disability documentation requirements so 
that the cost of repetitive testing is not a barrier to 
reasonable accommodations.

    In addition, Senator Portman and I introduced the Investing 
in Kids Mental Health Now Act, which would provide guidance to 
states on expanding pediatric mental health care capacity, and 
a Medicaid payment increase for pediatric behavioral health 
services to strengthen the continuum of care for many children.

    While we have made strides this Congress to address the 
mental health crisis among our youngest Americans, it is clear 
that more work needs to be done. When pediatric emergency 
departments across the country are overwhelmed with children in 
need of mental health care, it is a cry for help.

    Young people experiencing mental health challenges need 
somewhere to go and get the care they really need in a 
supportive environment where they can thrive. So I look forward 
to hearing from today's witnesses about how we can expand 
mental health support in preparation for and in the transition 
to college.

    I will now turn to Ranking Member Cassidy for his opening 
statement.

                  OPENING STATEMENT OF SENATOR CASSIDY

    Senator Cassidy. Somewhere there is a teenager who will one 
day be sitting in that chair, in this chair, and be speaking of 
ranking members and chairs and be sitting on the dais, and she 
or he is our future leader.

    Our obligation to that person is how do we best equip she 
or he in order to be the person sitting there are sitting here? 
And of course, I hope they are all Republicans, but maybe you 
can only hope for so much. And so we have to take that within 
the context of what we are currently addressing.

    The context which we are currently addressing is that 3 
years of COVID have just had their toll upon the mental health 
of adolescents and college students. The isolation that 
formerly was kind of never there because you were always with 
others, under COVID it became so pronounced that those who had 
issues could not convey them to others, but rather kept them 
within themselves, and we see, if you will, despair.

    Now, the studies--the statistics bear out the intuition. 
Suicide, third leading cause of death among those 15 to 24 in 
2021. Mental health emergency room visits increased 25 percent 
in children, 30 percent in teens in 2020. And I go back, this 
is more than a statistic, it is our future. So the question is, 
how do we care for those teens who are our future?

    Now, several people on the dais here, we have worked 
together. We need to reauthorize the Mental Health Reform 
Reauthorization Act of 2022, which Senator Murphy and I worked 
back on in 2016, and we need to reauthorize it. It expired in 
September.

    There is an urgency here that we need to accomplish. I will 
point out, since this law passed, all 50 states now have 
wraparound, coordinated specialty care for teens with early 
psychosis.

    Previewing my question for Dr. Weiss will be, why has the 
reach been so limited? When we put this in, we wished to have 
those wraparound services so that when the young person has his 
first psychotic episode at 16, it is his last psychotic episode 
because everything he needs to return him to wholeness is 
wrapped around and it becomes a distant memory, but not a life 
defining event.

    We need to ensure that would occur. We also, as my co-
sponsor of the legislation, Senator Casey spoke out, need to 
help with that transition to college from high school. And 
again, the Mental Health Reform Reauthorization Act of 2022 can 
help achieve this.

    Now, we have had success on, aside from the bill I just 
talked about, recent success addressing mental health issues. 
In response to the Uvalde shooting, there are resources that 
are put in that response bill, which are for troubled youth at 
risk of suicide, at risk of addiction, of harming others, and 
other mental health issues that would be in high schools.

    We have increased access to mental health and crisis 
intervention services, telemental health and in-school mental 
health services. I would just echo what Senator Casey just 
said, two bills that we put forward, Health Care Capacity for 
Pediatric Mental Health Act, to increase mental health access 
outside of hospitals so children can stay at home and don't 
miss school.

    The RISE Act. A child will get an IEP in a high school, 
say, for example, for dyslexia. Then they got to get them 
redone when they go to college. The underlying problem leading 
to the IEP has not changed.

    Why are we putting this obstacle as they transition from 
high school to college? Oh, you got to go through it again. If 
the condition is not permanent, that can be indicated. But 
usually, for example, with dyslexia, the condition is 
permanent.

    Why do we put obstacles for people to receive the 
interventions they need as they are on their pathway to be 
filling these halls to be our future leaders. Now, it is so 
wonderful you see young people stepping forward.

    Ms. Williams, thank you for your example that we will hear 
of how you have used grief in your life in order to lead people 
your age to mental health wholeness. An example from my own 
state, Emma Benoit, who attempted suicide, but after coming out 
of that, has used her experience and the kind of the process of 
events that led her to that terrible state to help others, to 
help her peers avoid it.

    That is the way our democracy works, in which it is not 
just the folks on this dais helping those younger people who 
are our future leaders, but those younger people providing 
leadership in and of themselves, so they help prepare 
themselves to be our future leader.

    With that, I yield.

    The Chairman. Thank you, Ranking Member Cassidy. Now we 
will turn to our witness introductions. I will provide several 
and Ranking Member Cassidy will provide some as well. Our first 
witness is Dr. Sharon Hoover.

    Dr. Hoover is a licensed clinical psychologist and 
professor at the University of Maryland School of Medicine, 
Division of Child and Adult Psychiatry. Dr. Hoover is also the 
co-director of the National Center for School Mental Health and 
the Director of the National Child Traumatic Stress Network's 
Center for Safe, Supportive Schools.

    We want to thank Dr. Hoover for being here. Maybe hadn't 
had to travel as long as some of the others. We are grateful 
she could be with us to bring her expertise. For our second and 
third witnesses, I will turn to Ranking Member Cassidy.

    Senator Cassidy. I get to introduce two people today, two 
folks from Louisiana. I will begin with Dr. Curtis Wright. Dr. 
Wright is a Vice President for Student Affairs at Xavier 
University in New Orleans. He oversees numerous programs 
dedicated to improving student life, including education, 
wellness, campus safety, and athletics.

    Before joining Xavier, Dr. Wright served as the Dean of 
Campus Life at Wagner College in New York City, and oversaw 
multicultural affairs at New York University, and in residence 
education at the University of Arkansas at Little Rock.

    Dr. Wright earned his B.A. in Sociology, a Master's of 
Education in Adult Education from the University of Arkansas, 
and a Doctorate in Higher Education Management from the 
University of Pennsylvania. Dr. Wright's experience will allow 
him to speak with a wealth of knowledge and experience to us. 
Thank you.

    Dr. Ashley Weiss. Dr. Weiss is an Associate Professor of 
Psychiatry and the Director of Medical Student Education and 
Psychiatry at Tulane University School of Medicine. She 
received her Bachelor of Science at Loyola University in New 
Orleans, and a Master of Public Health at Tulane.

    Attended medical school at Lake Erie College of Osteopathic 
Medicine in Florida, returned to New Orleans to do a Residency 
in Psychiatry and Subspecialty Fellowship in Child and 
Adolescent Psychiatry at Tulane.

    After developing expertise and caring for the young 
person's mental health during her medical training, Dr. Weiss 
built the first comprehensive first episode psychosis care 
program in New Orleans called Epic NOLA.

    She also launched Calm, which is a community education 
campaign to increase people in Louisiana's awareness about 
emerging psychosis symptoms and available treatment. In my 
medical practice, I worked in the same setting as Dr. Weiss, 
taking care of the uninsured and the chronically mentally ill.

    They would have, I tell you, benefited from your expertise, 
Dr. Weiss, so I am grateful that you are here, and we look 
forward to hearing how your experience and your education can 
improve the support for our youth. Mr. Casey.

    The Chairman. Thank you, Ranking Member Cassidy. Our final 
witnesses, Ms. Brooklyn Williams. Brooklyn is a high school 
senior at Baldwin High School in Pittsburgh, Pennsylvania, 
where she has founded the Chill Club, an offshoot of the 
Allegheny Health Network's Chill Project.

    The Chill Club is an open door mindfulness club aimed at 
supporting students coping with the stresses and anxieties of 
high school. Brooklyn, we are very pleased to welcome you here 
today.

    We will turn to our witnesses for their opening statements. 
We will begin with Dr. Hoover.

STATEMENT OF SHARON HOOVER, PH.D., PROFESSOR OF PSYCHIATRY AND 
 CO-DIRECTOR OF THE NATIONAL CENTER FOR SCHOOL MENTAL HEALTH, 
    UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE, BALTIMORE, MD

    Dr. Hoover. Good morning, thank you. I want to express my 
thanks to you, Chairman Casey, Ranking Member Cassidy, and to 
all the Members of the Subcommittee for inviting me here to 
speak with you about these important issues, and for your 
commitment to the mental health and well-being of our young 
people.

    Again, my name is Sharon Hoover, and I will be speaking to 
you today from my perspective as a Professor of Child and 
Adolescent Psychiatry and also the co-Director of the National 
Center for School Mental Health and the National Center for 
Safe, Supportive Schools, both funded by the U.S. Department of 
Health and Human Services.

    I also speak to you through my lens as a parent of three 
young people, a 9th grader, an 11th grader, and a freshman in 
college, so these issues are near and dear to my own heart. We 
are all concerned about the growing mental health needs of our 
young people.

    The good news is that there are many strategies and 
effective programs to support and promote youth mental health 
and to also support their effective transition from high school 
to college. And I hope we can get into some of those programs 
today. I am going to share three important ideas with you this 
morning.

    No. 1, invest early in nurturing environments for families 
and schools. We have incontrovertible evidence that the vast 
majority of challenges impacting our adolescents and young 
adults could be prevented by diminishing, or diminished rather 
by creating nurturing environment, starting early, and 
continuing into middle school and high school and beyond.

    In Dr. Anthony Bacon's book, The Nurture Effect, he details 
decades of scientific research into actionable steps to reduce 
youth problems and to produce caring--to reduce youth problems 
rather, and to produce caring and productive young people.

    Just as we were able to reduce the prevalence of smoking 
decades ago with a national public health movement, at this 
point in time, we need a relentless public health movement to 
increase the prevalence of nurturing environments that minimize 
toxic conditions and promote pro-social behavior in our young 
people.

    In the earliest years of children's development, effective 
family interventions include things like the incredible years, 
nurse family partnerships, the triple-p parenting program, 
which exist in many of the states across our Nation but are not 
really at full scale as they should be. In elementary years and 
beyond, interventions like Family Checkup are helpful to 
support parents as they handle some of the common problems of 
their children, as they use reinforcement to promote pro-social 
behavior, as they monitor their children's behavior and help 
set limits, and as they improve family communication and 
problem solving.

    Students who receive the family checkup program in sixth 
grade are much less likely to be depressed, to use substances, 
and to actually graduate from high school, and to not be 
arrested by the time they are 18.

    Schoolwide systems to minimize punitive interactions and to 
teach and promote and ritually reinforce pro-social behaviors, 
and these include programs like the good behavior game, like 
positive behavior interventions and supports, where we have 
decades of research, have demonstrated long term positive 
impacts on adolescent risk behavior and engagement in college 
and career.

    First, to optimize the success of our high school and 
college students, we must invest in nurturing environments at 
every level of their development. No. 2, establish 
comprehensive school mental health systems in all schools.

    This includes supporting the mental health of all students 
in their classrooms through teaching social and emotional 
skills and mental health literacy schoolwide, and providing 
mental health interventions where they are, in partnership with 
families in schools.

    Comprehensive school mental health systems not only improve 
mental health outcomes for our young people, but they also 
have, again, demonstrated success in improving really important 
academic indicators like attendance and grades.

    In my written testimony, I provide specific examples of 
policies to advance mental health in schools, such as 
establishing mental health as a state required component of K 
through 12 education, like those we see in New York and 
Virginia, and requiring health plans to reimburse for mental 
health screenings that are conducted on campus.

    The Hopeful Futures campaign this year released school 
mental health report cards across all 50 states and an 
accompanying legislative guide, and this is a great starting 
point for policymakers who wish to strengthen school mental 
health in their own communities, and it is detailed in my 
written testimony.

    No. 3, we must equip high school to college transition 
skills for all of our students, like self-determination, time 
management, emotion regulation, help seeking and navigating 
adversity. And again, we have evidence based strategies to do 
all of these.

    This should begin by middle school and extend into college 
and include efforts like self-guided modules to support 
emotional health, free well-being screenings at high school and 
college campuses, peer to peer mental health education and 
support, and texting warm lines where students can report 
concerns about themselves or others.

    For youth with mental health challenges, we need to provide 
tailored transition supports for in-person centered planning. 
And two such exemplary programs include the Renew Program which 
was developed and studied out of the University of New 
Hampshire, and a program called Got Transitioned, developed by 
the National Alliance to Advance Adolescent Health.

    I want to thank you again for the time to speak. I look 
forward to hearing from my fellow panelists and to our further 
discussion.

    [The prepared statement of Dr. Hoover follows:]

                  prepared statement of sharon hoover
    I want to express my thanks to you, Chairman Casey, and Ranking 
Member Cassidy, and to all Members of the Subcommittee, for the 
invitation to speak with you today and for your commitment to 
supporting the mental health and well-being of our Nation's youth. It 
is a privilege to be here with you today to discuss these important 
issues.

    My name is Sharon Hoover, and I am speaking to you from my 
perspective as a Professor of Child and Adolescent Psychiatry at the 
University of Maryland School of Medicine. I am the Co-Director of the 
National Center for School Mental Health and Director of the National 
Center for Safe Supportive Schools, both funded by the US Department of 
Health and Human Services. I also speak to you through my lens as a 
parent to three teenagers, 9th and 11th graders in high school, and a 
freshman in college. So, my remarks are informed by my 25 years of 
working with children, adolescents, and their families and schools, and 
are also personally meaningful to me as someone who is navigating the 
high school and college years of our own children.
            Youth Mental Health Needs are Urgent and Rising
    We are all concerned about the growing mental health challenges 
among our children and adolescents.

    This year, U.S. Surgeon General Vivek Murthy as well as some of our 
most valued child-serving national institutions including the American 
Academy of Pediatrics, the American Academy of Child and Adolescent 
Psychiatry, and the Children's Hospital Association have highlighted 
the urgency of youth mental health needs. \1\, \2\
---------------------------------------------------------------------------
    \1\  Office of the Surgeon General. (2021). Protecting Youth Mental 
Health: The U.S. Surgeon General's Advisory. U.S. Department of Health 
and Human Services. Washington, DC.
    \2\  American Academy of Pediatrics. (2021, October 19). AAP-AACAP-
CHA Declaration of a National Emergency in Child and Adolescent Mental 
Health. https://www.aap.org/en/advocacy/child-and-adolescent-healthy-
mental-development/aap-aacap-cha-declaration-of-a-national-emergency-
in-child-and-adolescent-mental-health/.

    Youth mental health has worsened over the past decade, and this has 
only been exacerbated during the pandemic, \3\ with increased rates of 
anxiety and depression symptoms and positive suicide risk screens among 
youth. \4\, \5\
---------------------------------------------------------------------------
    \3\  Centers for Disease Control and Prevention. (2020). Youth Risk 
Behavior Surveillance Data Summary & Trends Report: 2009-2019. https://
www.cdc.gov/nchhstp/dear-colleague/2020/dcl-102320-YRBS2009-2019-
report.html.
    \4\  Mayne, S. L., Hannan, C., Davis, M., Young, J. F., Kelly, M. 
K., Powell, M., Dalembert, G., McPeak, K.E., Jenssen, B.P., & Fiks, 
A.G., (2021). COVID-19 and adolescent depression and suicide risk 
screening outcomes. Pediatrics, 148(3), e2021051507. https://
publications.aap.org/pediatrics/article/148/3/e2021051507/179708/COVID-
19-andAdolescent-Depression-and-Suicide.
    \5\  Lantos, J. D., Yeh, H-W., Raza, F., Connelly, M., Goggin, K., 
& Sullivant, S. A. (2022). Suicide risk in adolescents during the 
COVID-19 pandemic. Pediatrics, 149(2), e2021053486. https://
publications.aap.org/pediatrics/article/149/2/e2021053486/184349/
Suicide-Risk-inAdolescents-During-the-COVID-19.

    Many youth lack the fundamental skills and supports necessary to 
---------------------------------------------------------------------------
transition from high school to college and career.

    The good news is that there are many best practices and strategies 
to promote student mental health and successful transition.

    As you consider opportunities to promote the well-being of our 
youth and set them on a path to successful college and career, I will 
share three important ideas for you to consider:

  (1) Invest Early in Nurturing Environments in Families and Schools.

    Especially in the wake of the pandemic, young people have not had 
adequate exposure to well-being promotion. Ask kindergarten and first 
grade teachers right now and they will tell you that their students are 
not adequately learning and demonstrating the critical social, 
emotional, and behavioral skills that will help them to succeed at home 
and in school and eventually in career and college. These need to be 
taught both at home and in school.

    I recognize that we are here today talking about high school and 
college students. However, I would argue that the environment of our 
youngest learners is what will foster or hinder their ultimate success 
at this critical transition. The data would back me up.

    We have incontrovertible evidence at our fingertips that the vast 
majority of challenges impacting our adolescents and young adults, 
those transitioning from high school to college, could be prevented or 
diminished by creating nurturing environments starting early and 
continuing into middle and high school and beyond.

    If I can urge you to add one book to your bookshelf today, it would 
be ``The Nurture Effect: How the Science of Human Behavior Can Improve 
Our Lives and Our World'' by Dr. Anthony Biglan. \6\ Dr. Biglan is a 
Senior Scientist at the Oregon Research Institute and has been 
conducting research on the development and prevention of child and 
adolescent problem behavior for the past 30 years.
---------------------------------------------------------------------------
    \6\  Biglan, A. (2015). The nurture effect: How the science of 
human behavior can improve our lives and our world. New Harbinger 
Publications.

    This book distills down decades of scientific research from our 
fields of psychology and prevention science into tangible, actionable 
steps that policymakers, families, and institutions like schools can 
take to reduce youth problems and to produce caring and productive 
---------------------------------------------------------------------------
young people.

    In a nutshell, the research from years of rigorous randomized 
trials tells us that all successful interventions make environments 
more nurturing in at least three of four ways:

          Promoting and reinforcing prosocial behavior

          Minimizing socially and biologically toxic 
        conditions, like poor nutrition and housing insecurity

          Monitoring and setting limits on influences and 
        opportunities to engage in problem behavior

          Promoting the mindful, flexible, and pragmatic 
        pursuit of prosocial values

    These interventions can and should be implemented with both 
families and schools.

    In the earliest years of children's development, effective 
interventions include things like Incredible Years, Nurse-Family 
Partnerships, and the Triple P Parenting Program. In elementary years 
and beyond, interventions like Family Check Up are helpful to support 
parents in handling common problems, using reinforcement to promote 
positive behavior, monitoring their child's behavior and setting 
limits, and improving family communication and problem solving. In a 
randomized trial of this program in middle schools in Oregon, the 
program significantly increased parents' monitoring and reduced family 
conflict. Even more striking is that although this program was 
implemented in 6th grade, those young people who received the program 
were less likely to use alcohol, tobacco, or marijuana and less likely 
to be arrested when they were 18 years old.

    Schoolwide systems to minimize coercive and punitive interactions 
and to teach, promote, and richly reinforce prosocial behaviors have 
demonstrated long-term positive impacts on adolescent risk behavior and 
engagement in college and career. When implemented with fidelity, the 
promise of programs like Good Behavior Game, Positive Action, and 
Positive Behavioral Interventions and Supports to promote prosocial 
outcomes in our adolescents and young adults is tremendous.

    An ounce of prevention is worth a pound of cure. Every time you 
move to invest in downstream interventions, first consider the root 
causes and reallocate investment upstream.

(2) Establish Comprehensive School Mental Health Systems in all Schools

    Increasingly, schools have comprehensive school mental health 
systems, reflecting partnerships between the education and behavioral 
health sectors to support a full continuum of mental health supports 
and services, from promotion to treatment. \7\ These school-based 
mental health supports improve vital academic indicators, including 
attendance, grades, and test scores. \8\ Every child deserves to have 
this type of mental health support in their school.
---------------------------------------------------------------------------
    \7\  Hoover, S. A., Lever, N. A., Sachdev, N., Bravo, N., Schlitt, 
J. J., Price, O. A., . . . & Cashman, J. (2019). Advancing 
Comprehensive School Mental Health Systems: Guidance from the Field. 
National Center for School Mental Health, University of Maryland School 
of Medicine.
    \8\  Kase C, Hoover S, Boyd G, et al: Educational outcomes 
associated with school behavioral health interventions: a review of the 
literature. J Sch Health 2017; 87:554-562.

    Below, I provide specific examples of policies to promote universal 
mental health promotion for all students and to expand early 
---------------------------------------------------------------------------
identification and intervention services in schools.

 Policies to Support Universal Mental Health Promotion and Prevention 
                                Policies

          Require the selection of indicators of student mental 
        health and well-being as a core metric of school performance 
        under federal education funding, with provisions to assist 
        schools as they strive to perform well on these indicators. 
        Indicators may include school climate, student-reported 
        subjective well-being and distress, and reports of school 
        connectedness.

          Incentivize teaching education programs to include 
        mental health literacy to improve the capacity of the educator 
        workforce to: promote mental health of all students in the 
        classroom, including teaching of social-emotional learning 
        competencies; identify mental health concerns and link students 
        to needed supports and services; reduce stigma related to 
        mental illness; and promote student and family help-seeking.

          Establish mental health as a state-required component 
        of K-12 curricula, with efforts in New York and Virginia as 
        examples. The federal government could support this state-level 
        effort by passing a resolution encouraging states to follow 
        existing state efforts to integrate mental health into 
        curricula and by providing direct funding for educator training 
        and ongoing professional development.

          Leverage Federal Title I and Title IV funding to 
        provide universal mental health programming for students, 
        including social-emotional learning programming. Joint guidance 
        by the U.S. Department of Education and the U.S. Department of 
        Health and Human Services could support states as they navigate 
        these funding mechanisms to support universal mental health in 
        schools.

          Expand federal grants to state and local education 
        and behavioral health authorities to increase mental health 
        awareness and promotion in schools. This could include the 
        expansion of grant programming initiated in recent years by 
        SAMHSA (e.g., Project AWARE) and the U.S. Department of 
        Education (School Climate Transformation) that require funded 
        states to partner with three local jurisdictions to promote 
        student well-being and mental health training and awareness for 
        school staff, and then to scale successful efforts statewide.
 Policies to Support Early Identification, Intervention, and Treatment 
                               in Schools
          Expand existing federal workforce development 
        programs (e.g., Behavioral Health Workforce Education and 
        Training Program, National Health Service Corps, Minority 
        Fellowship Program) to increase the school mental health 
        workforce. This strategy can also be applied to federal loan 
        repayment programs by increasing incentives for providers who 
        choose schools as a service setting.

          Expand federal, state, and local funding to ensure 
        adequate staffing and professional development for student 
        instructional support personnel, including school 
        psychologists, school social workers, school counselors and 
        school nurses. Funding expansion could include increased 
        investments in Title I of the Every Student Succeeds Act (ESSA) 
        to provide additional mental health staffing for students 
        living in poverty and in Title I, Title II, and Title IV of 
        ESSA and IDEA to increase opportunities for professional 
        development. State and local investments could include 
        competitive salary and benefits packages to recruit and retain 
        school mental health providers and supplementing federal 
        funding for staffing and professional development.

          Strengthen and support funding for mental health 
        services by investing in school Medicaid programs. Ensure 
        states and school districts are fully participating in school 
        Medicaid by modernizing existing guidance for schools to 
        provide clarity and best practices in school Medicaid, 
        including those that address mental health prevention and early 
        intervention.

          Require health plans to reimburse for mental health 
        screenings conducted in schools. Follow guidance from the 
        American Academy of Pediatrics and the American Academy of 
        Child and Adolescent Psychiatry to cover universal mental 
        health screening as a mechanism for improving mental health and 
        reducing mental illness. Coverage should include screening 
        conducted during well-child exams in pediatric primary care, 
        and also extended screening conducted in schools.

          Maximize Medicaid, Children's Health Insurance 
        Program (CHIP) and private reimbursement for school mental 
        health services, including early identification, intervention, 
        and treatment. This may include better understanding and 
        leveraging existing state Medicaid allowances for school mental 
        health or the initiation of state plan amendments to improve 
        school mental health coverage. As outlined in the 2019 Joint 
        Informational Bulletin from The Centers for Medicaid and 
        Medicare Services (CMS) and SAMHSA, several states already 
        access Medicaid and other payers, including private insurers, 
        to cover school and community professionals' delivery of mental 
        health services in schools. The Centers for Medicaid and 
        Medicare Services (CMS), the U.S. Department of Education and 
        the U.S. Department of Health and Human Services could offer 
        technical assistance to states seeking to improve Medicaid and 
        other payer coverage of school mental health.

          Expand reimbursement and technical assistance for 
        telemental health services in schools. Given the current 
        national shortage of mental health specialists, particularly in 
        rural settings, schools will benefit from access to telemental 
        health consultation and direct service, facilitated by public 
        and private insurance coverage and federal- and state-supported 
        technical assistance.

          Implement accountability mechanisms that require the 
        implementation of high-quality, evidence-based practices that 
        align with national performance standards for school mental 
        health. Federal, state, and local investments should shift 
        their metrics away from counting frequency and duration of 
        services to measuring the implementation of national best 
        practices for school mental health care and impacts of school 
        mental health services provision on psychosocial and academic 
        outcomes (see www.theSHAPEsystem.com).

    The Hopeful Futures Campaign, a coalition of national organizations 
committed to ensuring that every student has access to effective and 
supportive school mental health care, released this year the first ever 
``America's School Mental Health Report Card and Action Center,'' with 
individual report cards for all 50 states and the District of Columbia. 
These school mental health report cards highlight accomplishments and 
provide important action steps to help address the children's mental 
health crisis in every state. They serve as a great starting point for 
policymakers who want to strengthen school mental health supports and 
policies in their communities. I also urge you to review The Hopeful 
Futures Campaign School Mental Health Legislative Guide released just a 
few weeks ago. \9\ This guide offers exemplar legislation across eight 
key dimensions of school mental health (detailed below) and can serve 
as a roadmap for states and Federal policymakers to advance school 
mental health.
---------------------------------------------------------------------------
    \9\  Hopeful Futures Campaign. State legislative guide for school 
mental health. August 2022. https://hopefulfutures.us/wp-content/
uploads/2022/09/State-Legislative-Guide-for-School-Mental-Health-1.pdf.
---------------------------------------------------------------------------
  School Mental Health Legislative Guide Recommendations and Examples
    1. School Mental Health Professionals--We urge states to meet 
nationally recommended ratios for school psychologists, counselors, and 
social workers, and to ensure that these providers reflect the 
diversity of the students they serve. We also urge you to consider how 
to broaden your workforce beyond these specialists to include peer 
supports, community health workers, and bachelors level professionals 
that can receive a certificate in youth mental health.

    Delaware and Arizona both passed bills to implement a process of 
reaching national ratios for school counselors and psychologists or 
licensed mental health professionals.

    Alabama requires each local board of education to establish a 
school mental health service coordinator.

    2. Teacher and Staff Training--Regular training in mental health, 
substance use, and suicide prevention can help educators and staff feel 
better equipped to identify warning signs of mental health or substance 
use problems, to respond appropriately, and to have knowledge of 
available resources and effective interventions. While many states have 
training in one or more of these topics, few states specifically 
require all three topics.

    North Dakota is notable for requiring a minimum of eight hours of 
youth behavioral health training every two years for teachers and 
staff, and specifying a range of topics, including trauma, resiliency, 
suicide prevention, bullying, understanding of the prevalence and 
impact of youth behavioral health wellness, behavioral health symptoms 
and risks, referral sources and evidenced-based interventions, 
strategies to reduce risk factors, and evidence-based behavior 
prevention or mitigation techniques.

    3. Funding Supports--Sustainable funding for school mental health 
services is critical and Medicaid can play an important role, bringing 
federal matching funds that help state dollars go further. Multiple 
state Medicaid programs cover school mental health services, including 
via telehealth, for all Medicaid-enrolled students, but many others 
limit coverage to students on an Individualized Education Programs 
(IEP). Some states have taken the additional step of ensuring that all 
school mental health professionals are eligible to bill under their 
state's Medicaid program.

    Michigan has taken a further step by also including certified 
school psychologists and licensed school social workers as Medicaid-
billable providers.

    4. Well-Being Checks--Regular checks of mental wellness can help 
identify students and staff who may need support. With high rates of 
trauma, anxiety, depression, and other mental health and substance use 
challenges, it's important to be able to intervene early and provide 
the services and supports.

    New Jersey stands out for taking a step in the right direction on 
well-being checks. In 2021, New Jersey created a $1 million Mental 
Health Screening in Schools Grant Program that provides funds for 
schools to administer annual depression screenings for students in 
grades 7-12.

    Illinois followed suit by recently Establishing the Wellness Checks 
in Schools Collaborative for school districts that wish to implement 
wellness checks to identify students in grades 7 through 12 who are at 
risk of mental health conditions.

    5. Healthy School Climate--This involves policies that foster safe, 
supportive schools help create a positive learning environment and 
foster mental wellness for all students, but especially for LGBTQ 
students, students of color, and other highly impacted populations.

    As of last year, Arkansas Requires every school district to conduct 
a school safety audit every three years, including an audit of the 
school climate and culture.

    In 2019, Utah passed legislation that Requires creating a model 
school climate survey that may be used by a local education agency to 
assess stakeholder perception of a school environment.

    6. Skills for Life Success--Life skills competencies, such as 
developing healthy relationships, responsible decision-making, and 
self-management, can help students at every age succeed in school and 
life. Washington State has gone the extra mile to support students in 
gaining age-appropriate K-12 life skills through multiple statutes.

    Many states have taken promising steps by adopting life skills 
competencies in K-12 but have yet to establish them in statute. One 
example is Arkansas, which offers the G.U.I.D.E. for Life program, 
which is designed to help K-12 students develop skills in growth 
(manage yourself), understanding (know yourself), interaction (build 
relationships), decisions (make responsible choices), and empathy (be 
aware of others).

    7. Mental Health Education--Mental health education, when well-
implemented and fully integrated into K-12 health education, can 
increase awareness and understanding and promote help-seeking behavior. 
While many states mention mental health concepts in their health 
education, states are increasingly passing legislation to ensure 
comprehensive, age-appropriate mental health education in every grade.

    New York deserves continued praise for its widely lauded mental 
health education law, which requires that all schools' health education 
programs include mental health.

    Utah just passed legislation that Requires the Huntsman Mental 
Health Institute and the State Board of Education to coordinate to 
develop a youth mental health curriculum in schools.

    I love that Utah was intentional about not only sharing this 
curriculum with schools, but also with parents and families and other 
youth-serving organizations so that we can all be in this together.

    8. School-Family-Community Partnerships--Partnering with and 
effectively engaging families, youth, and community stakeholders, 
including community-based mental health providers, is vital to 
successfully implementing and sustaining a comprehensive school mental 
health system.

California established the Children and Youth Behavioral Health 
Initiative with multiple requirements, including competitive grants to 
support school-linked behavioral health services for children and youth 
25 years of age and younger. The bill also requires health insurance 
plans to cover mental health and substance use disorder treatment 

delivered at schools.Last year, Maryland installed The Consortium on 
Coordinated Community Support Partnerships to fund community 
partnerships to meet students' behavioral health needs, to ensure 
partnerships provide services in a holistic and non-stigmatized manner 
and coordinate with youth-serving government agencies, and to develop a 
model for expanding school behavioral health services and maximize 

  Medicaid and private insurance participation.3. Equip Students With 
     High School-to-College Transition Skills Using Evidence-Based 
                               Strategies

    In addition to providing early nurturing environments at home and 
in school and installing comprehensive school mental health systems in 
every school in the Nation, we can invest in evidence-based programming 
to equip our students with transition skills like self-determination, 
time management, emotion regulation, and coping with adversity.

    This programming can begin in high school and extend into college, 
and can be fostered at home and in school, including through self-
guided modules.

  Examples of Programs to Support High Schooler Mental Health as They 
                     Prepare for College and Career

          Postsecondary Resilience Education Program (PREP) is 
        designed to help ease the transition to college. In this 
        course, students master the skills needed to reach their 
        academic goals. The structure of PREP lets students access the 
        content in any order and to any depth, so they can focus on the 
        skills that they would most benefit from mastering.

          Student Curriculum on Resilience Education (SCoRE)--
        Self-Paced helps students cope with the personal, social, and 
        academic challenges of college life and prepare for future 
        success. This online course can be purchased by individual 
        students or offered by colleges and universities as part of a 
        counseling program, first-year experience curriculum, wellness 
        program, or student retention initiative.

          The JED Foundation (nonprofit that protects emotional 
        health and prevents suicide for our nation's teens and young 
        adults):

                Y  "Set to Go"--information and resources specific to 
                the transition from high school to college

                Y  The Transition of Care Guide, provides a detailed 
                steps for students and families to take during each 
                year in high school and in college in order to 
                transition their care. Major steps outlined: learn the 
                details of your condition and treatment; discuss, 
                discover, and define your personal needs to find the 
                best college for you; manage the transition of care

          NAMI Mental Health College Guide (developed in 
        collaboration with the JED Foundation). Provides guidance about 
        transition from high school to college focused on relationships 
        and self-care; self-advocacy, HIPAA & FERPA; mental health, 
        identity, race; taking care of your mental health; staying 
        safe.

          Guidance from American Academy of Child and 
        Adolescent Psychiatry Provides guidance for students with 
        mental health challenges and their families on considerations 
        for colleges (e.g., mental health supports on the campus, 
        developing expectations about academic workload etc.)

 Examples of Programs to Support College Student Well-Being and Mental 
                                 Health

          Free mental health screenings. Drexel University's 
        Recreation Center has a mental health screening kiosk. Students 
        can complete a private, short mental health screening. At the 
        end of the screening, students receive information for mental 
        health resources and supports, if needed. The work is a product 
        of collaboration between Drexel, the Thomas Scattergood 
        Foundation, a local grant-making organization; Screening for 
        Mental Health, Inc., a nonprofit geared toward large-scale 
        mental health screenings; and the Philadelphia Department of 
        Behavioral Health and Intellectual disAbility Services.

          Developing and fostering resilience. Florida State 
        University launched an online trauma resilience training tool 
        developed through the Institute of Family Violence Studies and 
        their College of Social Work. The Student Resilience Project 
        developers recognized that many students coming to their 
        university have experienced ``significant family and community 
        stress'' and that stress can affect their learning. Florida 
        State University now requires all incoming freshmen and 
        transfer students to participate in the training, which 
        features videos, animations, and TED-talk-style informational 
        sessions to foster student strengths and coping strategies. 
        Student Resilience Project: https://strong.fsu.edu/.

          Encouraging talking about mental health (personal 
        challenges and talking with peers).

                Y  Kognito Program. At least 350 colleges use Kognito's 
                ``HigherEd Mental Health Suite'' that ``prepares 
                learners to lead real-life conversations around mental 
                health and suicide prevention that build resilience, a 
                strong campus culture and strengthens relationships.'' 
                Kognito Mental Health Suite: https://kognito.com/
                mental-health-suite/

          Texting programs. University of Sioux Falls--one of 
        the first universities to offer free texting hotline for 
        students called Text4Hope. Aims to guide students who are 
        concerned about a peer or about themselves. https://
        mentalhealthfoundation.ca/text4hope/

          Peer-to-peer approaches.

                Y  Active Minds is a national organization supporting 
                mental health awareness and education for young adults. 
                Hundreds of college campus chapters across the country. 
                Active Minds changes the conversation about mental 
                health among adolescents and young adults, reduces 
                stigma associated with mental health conditions, and 
                establishes a culture of caring on college and 
                university campuses. Programs and resources are built 
                for students, faculty, staff, administrators, and the 
                broad campus community to ensure long-term change at 
                the individual, campus community, and policy levels. 
                Active Minds prioritizes the student voice to ensure a 
                student-driven and student-focused approach in mental 
                health promotion. We inspire mental health advocates to 
                have conversations that have the potential to save 
                lives. Link to information for specific higher ed 
                programming here: https://www.activeminds.org/programs/
                colleges-universities/

                Y  UVA Project RISE is a peer counseling service that 
                was established in 2006 by a small group of Black 
                students. It is a university-sponsored program that 
                provides free, one-on-one, confidential services to 
                enrolled University of Virginia students. Program 
                directly connected through both the Office of African 
                American Affairs and to the department of Counseling 
                and Psychological Services in Elson Student Health More 
                information here: https://oaaa.virginia.edu/project-
                rise

          Training/resources for university faculty and staff.

                Y  University of North Carolina recently trained 900 
                faculty and staff in Mental Health First Aid--aimed to 
                provide basic skills to support students with mental 
                health and substance use challenges

                Y  Penn State "Red Folder Campaign"--guides faculty, 
                staff, student leaders, and others who are interacting 
                with students to recognize, respond effectively to, and 
                refer Penn State Students in various states of distress 
                (high, moderate, low)

          Rapid access to support.

                  Let's Talk Programs. Many universities across 
                the country use "Let's Talk" programs to facilitate 
                rapid access to support. Let's Talk encourages informal 
                one-on-one sessions with a university counselor. Many 
                universities offer tele options.

          College orientation. More colleges beginning to share 
        mental health information with students during orientation 
        sessions. Approaches to these sessions include traditional 
        presentations and panel discussions, role plays, short videos, 
        and student testimonials. Goal of these sessions is for 
        students to understand how to recognize signs of mental health 
        challenges, know where to access resources and supports, and 
        learn how to talk with friends who might be struggling with 
        their mental health. Example from Northwestern University: 
        Originally, mental health orientation sessions included 
        information provided by expert speakers. Based on feedback from 
        students, orientation organizers shifted to student 
        testimonials that included narratives of alumni sharing their 
        mental health challenges and how they received help.

    In addition to programming for all students to navigate the high 
school-to-college transition, it is important to invest in tailored 
supports for students at risk for or with mental health needs. There is 
good evidence that providing person-centered planning and transition 
support for students with specific health care needs, including mental 
health, can significantly improve the probability of a successful 
transition to college and career.

    As one example, colleagues at the University of New Hampshire 
demonstrated the success of the RENEW program to promote college and 
career readiness for students with significant emotional and behavioral 
disorders.

    Similarly, the National Alliance to Advance Adolescent Health 
developed the Got Transition program to facilitate the health care 
transition of youth with special health care needs from pediatric to 
adult health care.

    Colleagues at the University of Washington have demonstrated the 
success of weaving mental health education and support into a 
comprehensive college preparation program that supports vulnerable 
youth from middle school through successful college graduation.

    I want to express my gratitude to you all for opening up this 
important discussion and I look forward to hearing from my fellow 
panelists and engaging in discussion with you all.
                                 ______
                                 
    The Chairman. Thank you, Dr. Hoover.

    Now we will turn to Dr. Wright.

 STATEMENT OF CURTIS WRIGHT, ED.D., VICE PRESIDENT OF STUDENT 
    AFFAIRS, XAVIER UNIVERSITY OF LOUISIANA, NEW ORLEANS, LA

    Dr. Wright. Subcommittee Chair Casey, Subcommittee Ranking 
Member Cassidy, and the Members of the Committee on Health, 
Education, Labor, and Pensions Subcommittee on Children and 
Families, thank you for the opportunity to testify today.

    It is an honor and privilege to sit before you this morning 
as the Vice President for Student Affairs and Interim Vice 
President for Enrollment Management at Xavier University of 
Louisiana, the Nation's only Black and Catholic institution of 
higher education.

    I was asked to testify this morning to address the 
importance of strengthening the continuum of mental health 
support for all adolescents, particularly in the years leading 
up to and during the transition to college. I will do that, and 
of course, I will also offer a particular lens which allows me 
to address the issues confronted by those students who choose 
to matriculate at HBCUs.

    Chairman Casey, most students who entered Xavier University 
in August have never known a world without Facebook or war. 
While I learned how to exit the building in a single file line 
in preparation for a potential fire, my students have learned 
how to run, hide, or fight their ways out of an active shooter 
situation.

    They are all too familiar with social, political, and 
racial unrest in this country, and they have probably 
participated in more marches or rallies than most of us in this 
room. They have lived through global economic recessions that 
resulted in family members losing their jobs, homes, and 
overall financial instability.

    They are also still in the midst of a global pandemic that 
caused the entire world to stand still and reimagine what 
normal looks like. Some of these young people lost multiple 
family members due to COVID related illness, in part because 
they lacked access to affordable health care, and also had 
family members whose primary source of income meant their 
status as a front line worker was non-negotiable.

    Our students were well acquainted with loss long before the 
pandemic as they routinely attended candlelight vigils, 
memorials, and funerals for friends who died due to gun 
violence, drug addiction, and suicide. What our student at 
Xavier experience mirrors what their peers across the country 
are experiencing.

    The prevalence of anxiety and depression is rising across 
the Nation, particularly among young people. College students 
of all ages are more distressed than ever before, and 
increasing shares are enrolling with mental health histories in 
terms of diagnosis, treatment, and medication.

    Institutions like Xavier are challenged to recreate systems 
of care and support to meet the growing needs of a very 
different student body. While students and their lived 
experiences they bring to campus have changed, the funds who 
take care of them have not.

    The number of students seeking help at campus counseling 
centers have increased almost 40 percent between 2009 and 2015 
and continued to rise until the pandemic began. This is 
according to data from Penn State University's Center for 
Collegiate Mental Health.

    We, like so many of our peers, know that we can't do it 
alone and are developing strategic relationships with our K 
through 12 partners and our parent community. Access to health 
care, specifically mental health care, is not always readily 
available to students who come from rural areas, inner cities, 
or economically depressed communities.

    Most colleges and universities were the direct beneficiary 
of the CARES Act, the HERF II of the Consolidated 
Appropriations Act of 2021, and HERF III authorized by the 
American Rescue Plan. These critical legislative lifelines 
allow us to maintain university life for our students 
throughout the pandemic.

    The HBCU bond thrust of 2022 have altered the higher 
educational landscape for every single student studying at 
historically Black college to better their lives. For this 
specific set of institutions, not only to be singled out and 
threatened repeatedly, have caused our students untold mental 
anguish and stress.

    Although the prosecution of those who maliciously caused 
the situation is a law enforcement issue, the impact on our 
students is not. Specific mental health focus should be 
directed to us as the sole recipients of these threats.

    Senator Casey, over 20 years ago, a mentor asked me if I 
knew the difference between a high school senior and a college 
freshman. After often what I considered to be these profound 
responses, she replied without emotion, 3 months.

    For incoming students, 3 months is the only thing for 
separate high school from college. Yet we believe that these 
students should arrive on campus fully prepared to not only 
make adult decisions, but more importantly, to live within 
those adult consequences. It is our responsibility to help them 
navigate the contested intersections of university life.

    While the landscape as it relates to mental health with 
young people can appear bleak, I like my fellow Arkansan 
President William Jefferson Clinton still believe in a place 
called hope. I am hopeful because of the resilience of our 
students and the generation from which they have come.

    However, for them to achieve success, we must dismantle our 
outdated systems that were not designed for their success. So, 
Mr. Chairman, I want to leave you with some recommendations.

    First, similar to the guidance offered by the Office of 
Civil Rights related to Title IX, the Department of Education 
should consider offering guidance on mental health first aid to 
support educators and administrators for all K through 16 
institutions which receive Federal funding.

    No. 2, the Department of Education should extend the 
funding period for HERF I, II, and III, as well as the HBCU, 
TCU, and MSI set aside funding until August 31st, 2026. HELP 
must push the Senate to red line House Resolution 6893, IGNITE 
HBCU and MSI Act to improve HBCU facilities in response to the 
HBCU bomb threats and increase the sense of security on our 
campuses.

    No. 4, financial stress is one of the most prevalent causes 
of anxiety for students entering college across the country. 
Congress should continue to advance common sense legislation to 
reduce the costs of higher education and support President 
Biden's plan to address college debt through limited student 
loan forgiveness.

    Last, Congress should follow the lead of Senator Casey and 
the distinguished gentleman from the great State of Louisiana 
to Senator Cassidy and pass the Health Care Capacity Act for 
Pediatric Mental Health and the RISE Act. It has been an honor 
to present this testimony, and I thank the Committee for 
addressing this important issue.

    As a leader in higher education, I know the benefits of 
early screening, the impact of developing coping strategies, 
and the importance of empowering families to train their 
children to become problem solvers.

    We must address this mental health concern of our youth as 
the stakes have never been higher and our collective work 
should be a priority for every American. I am grateful to the 
Committee for leaning into this very difficult conversation, 
and Xavier University of Louisiana stands ready to serve as a 
resource and Committee partner.

    For more information and details regarding my remarks, I 
ask that you read my written testimony for support for your 
review.

    [The prepared statement of Dr. Wright follows:]

                  prepared statement of curtis wright
                              Introduction
    Subcommittee Chairman Casey, Subcommittee Ranking Member Cassidy, 
Committee Chair Murray, Ranking Member Burr, and Members of the U.S. 
Senate Committee on Health, Education, Labor, and Pension's 
Subcommittee on Children and Families, thank you for the opportunity to 
testify today.

    It is an honor and privilege to sit before you this morning as the 
Vice President for Student Affairs and Interim Vice President for 
Enrollment Management at Xavier University of Louisiana. Xavier was 
founded by Saint Katharine Drexel of the sisters of the Blessed 
Sacrament and is the only institution of higher education in the 
country that is both Catholic and a historically Black college or 
university (HBCU).

    Xavier's mission since 1925, in part, has been to contribute to the 
promotion of a more just and humane society by preparing our students 
to assume roles of leadership and service in a global society. We do 
this by cultivating a diverse learning and teaching environment that 
incorporates all relevant educational means--including research and 
community service. Our students can engage in a world class practical 
liberal arts curriculum while living out the mission of our university.

    Before the Committee today, I will address the importance of 
strengthening the continuum of mental health support for all 
adolescents, particularly in the years leading up to and during the 
transition from high school to college. I will also address unique 
challenges of students who are first generation college students, 
students who come from lower socio-economic backgrounds, and those who 
are attending HBCUs.

    Chairman Casey, most students who entered Xavier University of 
Louisiana in August, have never known a world without Facebook or war. 
While I learned how to exit the building in a single file line in 
preparation for a potential fire, my students have learned how to 
``run, hide or fight'' their way out of an active shooter situation. 
They are all too familiar with social, political and racial unrest in 
this country, and they have probably participated in more marches or 
rallies than most of us in this room. They have lived through global 
economic recessions that resulted in some family members losing their 
jobs, homes and overall financial instability. They are also emerging 
from a global pandemic that caused the entire world to stand still and 
reimagine what normal looks like. These young people have lost multiple 
family members due to COVID related illnesses, in part, because they 
lacked access to affordable healthcare. Additionally, for the student 
population we serve, the vast majority of their parents were front line 
workers, and because of that the members of their households have been 
more exposed to the coronavirus pandemic . Whether they are from Staten 
Island, Chicago or New Orleans, these students were well acquainted 
with loss, long before the pandemic as they routinely attended 
candlelight vigils, memorials, and funerals for friends who died due to 
gun violence, drug addiction, or suicide.

    We, like so many of our peers, know that we cannot confront our 
students mental health challenges alone, and we are developing 
strategic relationships with our K-12 partners and our parent 
community. We have learned that the habits of self-care that our 
students bring with them are informed, in part, by their environment. 
Access to healthcare, specifically mental healthcare, is not always 
readily available to students who come from rural areas, inner cities 
or economically depressed communities. Most colleges and universities 
are the direct beneficiaries of the Coronavirus Aid, Recovery, and 
Economic Security (CARES) Act, Public Law 116-136; the Consolidated 
Appropriations Act of 2021 and its Higher Education Emergency Relief 
Fund II (HEERF II), Public Law 116-260; and the HEERF III which was 
authorized by the American Rescue Plan (ARP), Public Law 117-2. These 
critical legislative lifelines allowed colleges and universities, like 
ours, to maintain university life for our students throughout the 
pandemic. In fact, at Xavier, we were able to expand the reach of our 
Counseling and Wellness office by adding additional therapists, 
offering enhanced services and training our community on mental health 
first aid. In addition to the HEERF funding received by almost every 
college and university, the specific funding allotted only to HBCUs, 
Tribal Colleges and Universities (TCUs), and Minority Serving 
Institutions (MSIs) has been instrumental in the accomplishments above. 
We are acutely aware that the provisions of three pieces of legislation 
have an expiration date and are working alongside community partners to 
identify other resources that may fill the gaps that will be left as 
the funding sunsets. However, we would like the Senate HELP Committee 
to consider passing an extension of the funding through August 31, 
2026.
                   Mental Health on College Campuses
    What our students at Xavier experience mirrors, what their peers 
are experiencing across the country, even though there are some real, 
unique, and necessary to mention experiences recently at HBCUs. In a 
2022 Chronicle of Higher Education article entitled, ``Overwhelmed: The 
real campus mental-health crisis and new models for well-being'', 
Researchers suggests the following:

        The prevalence of anxiety and depression is rising across the 
        country, particularly among young people. College students of 
        all ages are more distressed than ever before, and increasing 
        shares are enrolling with mental-health histories, in terms of 
        diagnoses, treatment, and medication.'' Institutions like 
        Xavier University are challenged to recreate systems of care 
        and support to meet the growing needs of a very different 
        student body.

    According to data cited in a 2022 article in the Journal of 
Affective Disorders, ``By nearly every metric, student mental health is 
worsening.'' During the 2020-2021 school year, more than 60 percent of 
college students met the criteria for at least one mental health 
problem, according to the Healthy Minds Study, which collects data from 
373 campuses nationwide (Lipson, S. K., et al., Journal of Affective 
Disorders, Vol. 306, 2022). In another national survey, almost three 
quarters of students reported moderate or severe psychological distress 
(National College Health Assessment, American College Health 
Association, 2021). While students and the lived experiences they bring 
to campus have evolved and changed, the funding to take good care of 
those students has not although the demands for that funding have 
increased dramatically.

    Penn State's Center for Collegiate Mental Health shared, ``That 
rising demand (for mental health care) hasn't been matched by a 
corresponding rise in funding, which has led to higher caseloads.'' 
nationwide, the average annual caseload for a typical full-time college 
counselor is about 120 students, with some centers averaging more than 
300 students per counselor (CCMH Annual Report, 2021). The number of 
students seeking help at campus counseling centers increased almost 40 
percent between 2009 and 2015 and continued to rise until the pandemic 
began, this is according to data from Penn State University's Center 
for Collegiate Mental Health (CCMH), a research-practice network of 
more than 700 college and university counseling centers (CCMH Annual 
Report, 2015).
                The Xavier University Community Response
    At Xavier University of Louisiana, and institutions like us, we are 
working across the campus to address the growing mental health 
challenges of our students. At Xavier specifically, we have expanded 
the reach of our Counseling and Wellness office by using HEERF funding 
to add additional therapists and mental health counselors. Relatedly we 
expanded offerings around campus to empower students with the tools to 
address commonly known stressors, which include:

          Mindfulness and Meditation

          Time Management/Study Skills/Financial Literacy 
        Workshops

          Creating Virtual Parent Communities

          Enhanced Fitness and Wellness Options

    Recognizing the need to deepen the pool of individuals prepared to 
respond in emergency situations, we engage in Mental Health First Aid 
training. These workshops provide student leaders, faculty, and staff 
with basic skills in identifying mental health concerns and connected 
them with resources to support students before a crisis arises.

    One of the major projects introduced at Xavier University is the 
``Take A Minute RU Ok'' campaign. Guided by the notions of connection, 
commitment and community, students, faculty and staff are encouraged to 
engage in intentional self-care. Through workshops, social media and 
random acts of kindness, the community is routinely exposed to 
information about how to connect to something outside of themselves, 
challenged to follow-through on commitments, and invited to be involved 
in a community that cares.

    Our unfinished work requires us to build alliances with faith 
communities, K-12 partners, and community groups, to share resources. 
We know that our students come to us from communities that have not 
always placed value on asking for help. Central to our efforts will be 
exposing our students and families to resources in their communities 
along with the need to reduce the stigma attached to accessing mental 
healthcare. We are heartened by the work that lies ahead.
                           HBCU Bomb Threats
    The HBCU bomb threats of 2022 have altered the higher education 
landscape for every student studying at an historically Black college 
to better their life. For this specific set of institutions, only, to 
be singled out and threatened repeatedly has caused our students--Black 
students already who have likely overcome significant societal 
pressures to find themselves on the verge of a life changing degree--
untold mental anguish and stress. Although the prosecution of those who 
maliciously caused this situation is a law enforcement issue, the 
impact on our students is not. Specific mental health focus should be 
directed to us as the sole recipients of these threats. The Commerce, 
Justice, and Science (CJS) Appropriations bill for fiscal year 2023 
should have language that guides the funding for National Joint 
Terrorism Task Force's ability to harden campuses specifically to HBCUs 
instead of generally extending the funds to states who do not report 
back to Congress which institutions receive it and likely award the 
funding to their ``flagship institutions.'' Additionally, the Senate 
HELP Committee must pass the IGNITE HBCU and MSI Excellence Act (H.R. 
6893) to improve HBCU facilities, harden the campuses to reduce the 
likelihood of these kinds of threats, and allow the cyber-related 
infrastructure to be strengthened enough to track these threats when 
they occur.

                         Commonsense Solutions
    As it relates to mental health and our young people, the national 
landscape can appear bleak. However, I have much in common with my 
fellow Arkansan, President William Jefferson Clinton: I still believe 
in a place called Hope. I'm hopeful because of the resilience of our 
students and their generation. For them to achieve success, we must 
dismantle outdated systems that were not designed for their success. 
So, Chairman Casey and Ranking Member Cassidy, I want to leave you with 
some recommendations:

          Similar to guidance offered by the Office of Civil 
        Rights related to Title IX, the Department of Education should 
        consider offering guidance on mental health first aid to 
        support educators and administrators for all K-16 institutions 
        which receive Federal funding.

          The Department of Education should consider extending 
        the funding period for the HEERF I, II, and III as well as the 
        HBCU, TCU, and MSI set aside funding until August 31, 2026, 
        which will allow colleges and universities to continue to 
        provide uninterrupted coordinated care to our students as they 
        transition to campus.

          HELP must push the Senate to ``redline'' H.R. 6893, 
        the IGNITE HBCU and MSI Act to improve HBCU facilities in 
        response the HBCU bomb threats and increase a sense of security 
        on the campuses. The fiscal year 2023 CJS Appropriations bill 
        must also include guiding language to direct funding to HBCUs 
        to harden their campuses in response to the HBCU bomb threats.

          Financial stress is one the of most prevalent causes 
        of anxiety for students entering college across the country. 
        Congress should continue to advance common-sense legislation to 
        reduce the costs of higher education and support President 
        Biden's plan to address college debt through limited student 
        loan forgiveness.

          As previously mentioned, students arrive on campus 
        with few coping skills as well as co-morbidities that impact 
        their academic success. Earlier intervention would provide 
        those students with the strategies and resources that they 
        could equip them with tools for success. With that being said, 
        Congress should follow the lead of Senators Casey and Cassidy 
        and pass S. 4472 the Health Care Capacity for Pediatric Mental 
        Health Act and S. 2550, the RISE Act.

                               Conclusion
    It has been an honor to present this testimony. I thank the 
Committee for addressing this important issue. As a leader in higher 
education, I know the benefits of early screening, the impact of 
developing coping strategies, and the importance of empowering families 
to train their children to become problem solvers. We must address the 
mental health concerns of our youth as the stakes have never been 
higher and our collective work should be a priority of every American. 
I'm grateful to the Committee for leaning into this very difficult 
conversation and Xavier University of Louisiana stands ready to serve 
as a resource and community partner.
                                 ______
                                 
                  [summary statement of curtis wright]
    Subcommittee Chairman Casey, Subcommittee Ranking Member Cassidy, 
Chair Murray, Ranking Member Burr, and Members of the U.S. Senate 
Committee on Health, Education, Labor, and Pension's (HELP) 
Subcommittee on Children and Families, thank you for the opportunity to 
testify today.

    It is an honor and privilege to sit before you this morning as the 
Vice President for Student Affairs and Interim Vice President for 
Enrollment Management at Xavier University of Louisiana. Xavier was 
founded by Saint Katharine Drexel of the sisters of the Blessed 
Sacrament and is the only institution of higher education in the 
country that is both Catholic and a historically Black college or 
university (HBCU).

    Xavier's mission since 1925, in part, has been to contribute to the 
promotion of a more just and humane society by preparing our students 
to assume roles of leadership and service in a global society. We do 
this by cultivating a diverse learning and teaching environment that 
incorporates all relevant educational means--including research and 
community service. Our students can engage in a world class practical 
liberal arts curriculum while living out the mission of our university.

    I was asked to testify before the Committee today to address the 
importance of strengthening the continuum of mental health support for 
all adolescents, particularly in the years leading up to and during the 
transition from high school to college. I will do that, and of course I 
will also offer a particular lens which allows me to address the issues 
confronted by African Americans and those choosing to matriculate at 
HBCUs.

    Chairman Casey, most students who entered Xavier University of 
Louisiana in August, have never known a world without Facebook or war. 
While I learned how to exit the building in a single file line in 
preparation for a potential fire, my students have learned how to 
``run, hide or fight'' their way out of an active shooter situation. 
They are all too familiar with social, political and racial unrest in 
this country, and they have probably participated in more marches or 
rallies than most of us in this room. They have lived through global 
economic recessions that resulted in some family members losing their 
jobs, homes and overall financial instability. They are also still in 
the midst of a global pandemic that caused the entire world to stand 
still and reimagine what normal looks like. Some of these young people 
lost multiple family members due to COVID related illnesses, in part, 
because they lacked access to affordable healthcare and, also, had 
family members whose primary source of income meant their status as 
front line workers was non-negotiable. Whether they are from Staten 
Island, Chicago or New Orleans, they were well acquainted with loss, 
long before the pandemic as they routinely attended candlelight vigils, 
memorials and funerals for friends who died due to gun violence, drug 
addiction, or suicide.

    What our students at Xavier experience mirrors what their peers are 
experiencing across the country. In a 2022 Chronicle of Higher 
Education article entitled, ``Overwhelmed: The real campus mental-
health crisis and new models for well-being'', researchers suggest:

        The prevalence of anxiety and depression is rising across the 
        country, particularly among young people. College students of 
        all ages are more distressed than ever before, and increasing 
        shares are enrolling with mental-health histories, in terms of 
        diagnoses, treatment, and medication.'' Institutions like 
        Xavier University are challenged to recreate systems of care 
        and support to meet the growing needs of a very different 
        student body.

    According to data cited in a 2022 article in the Journal of 
Affective Disorders, ``By nearly every metric, student mental health is 
worsening.'' During the 2020--2021 academic year, more than 60 percent 
of college students met the criteria for at least one mental health 
problem, according to the Healthy Minds Study, which collects data from 
373 campuses nationwide (Lipson, S. K., et al., Journal of Affective 
Disorders, Vol. 306, 2022). In another national survey, almost three 
quarters of students reported moderate or severe psychological distress 
(National College Health Assessment, American College Health 
Association, 2021). While students and the lived experiences they bring 
to campus have evolved and changed, the funding to take good care of 
those students has not although the demands for that funding have 
increased dramatically.

    Penn State's Center for Collegiate Mental Health shared, ``That 
rising demand (for mental health care) hasn't been matched by a 
corresponding rise in funding, which has led to higher caseloads.'' 
nationwide, the average annual caseload for a typical full-time college 
counselor is about 120 students, with some centers averaging more than 
300 students per counselor (CCMH Annual Report, 2021). The number of 
students seeking help at campus counseling centers increased almost 40 
percent between 2009 and 2015 and continued to rise until the pandemic 
began, this is according to data from Penn State University's Center 
for Collegiate Mental Health (CCMH), a research-practice network of 
more than 700 college and university counseling centers (CCMH Annual 
Report, 2015).

    We, like so many of our peers, know that we can't do it alone and 
are developing strategic relationships with our K-12 partners and our 
parent community. We've learned that the habits of self-care that our 
students bring with them are informed, in part, by their environment. 
Access to healthcare, specifically mental healthcare, is not always 
readily available to students who come from rural areas, inner cities 
or economically depressed communities. Most colleges and universities 
are the direct beneficiaries of the Coronavirus Aid, Recovery, and 
Economic Security (CARES) Act, Public Law 116-136; the Higher Education 
Emergency Relief Fund (HERF II) of the Consolidated Appropriations Act 
of 2021, Public Law 116-260; and the HEERF III authorized by the 
American Rescue Plan (ARP), Public Law 117-2. These critical 
legislative lifelines allowed colleges and universities to maintain 
university life for our students throughout the pandemic. In fact, at 
Xavier, we were able to expand the reach of our Counseling and Wellness 
office by adding additional therapists, offering enhanced services and 
training our community on mental health first aid. The traditional 
HEERF funding along with the funding allotted specifically to HBCUS, 
Tribal Colleges and Universities, and Minority Serving Institutions 
(MSI) were used to increase these services. We are acutely aware that 
these funding sources have an expiration date, and while we are working 
alongside community partners to identify other resources that may fill 
the gaps that will be left as the funding sunsets, one of our asks 
today is that sunset deadline be extended through at least August 31, 
2026.

    The HBCU bomb threats of 2022 have altered the higher education 
landscape for every student studying at an historically Black college 
to better their life. For this specific set of institutions, only, to 
be singled out and threatened repeatedly has caused our students--Black 
students already who have likely overcome significant societal 
pressures to find themselves on the verge of a life changing degree--
untold mental anguish and stress. Although the prosecution of those who 
maliciously caused this situation is a law enforcement issue, the 
impact on our students is not. Specific mental health focus should be 
directed to us as the sole recipients of these threats. The Commerce, 
Justice, and Science (CJS) Appropriations bill for fiscal year 2023 
should have language that guides the funding for National Joint 
Terrorism Task Force's ability to harden campuses specifically to HBCUs 
instead of generally extending the funds to states who do not report 
back to Congress which institutions receive it and likely award the 
funding to their ``flagship institutions.'' Additionally, the Senate 
HELP Committee must pass the IGNITE HBCU and MSI Excellence Act (H.R. 
6893) to improve HBCU facilities, harden the campuses to reduce the 
likelihood of these kinds of threats, and allow the cyber-related 
infrastructure to be strengthened enough to track these threats when 
they occur.

    While the national landscape as it relates to mental health with 
young people can appear bleak, I like my fellow Arkansan, President 
William Jefferson Clinton, still believe in a place called Hope. I'm 
hopeful because of the resilience of our students and the generation 
from which they come. However, for them to achieve success, we must 
dismantle outdated systems that were not designed for their success. 
So, Madam Chair, I want to leave you with some recommendations:

          Similar to guidance offered by the Office of Civil 
        Rights related to Title IX, the Department of Education should 
        consider offering guidance on mental health first aid to 
        support educators and administrators for all K-16 institutions 
        which receive Federal funding.

          The Department of Education should consider extending 
        the funding period for the HEERF I, II, and III as well as the 
        HBCU, TCU, and MSI set aside funding until August 31, 2026, 
        which will allow colleges and universities to continue to 
        provide uninterrupted coordinated care to our students as they 
        transition to campus.

          HELP must push the Senate to ``redline'' H.R. 6893, 
        the IGNITE HBCU and MSI Act to improve HBCU facilities in 
        response the HBCU bomb threats and increase a sense of security 
        on the campuses. The fiscal year 2023 CJS Appropriations bill 
        must also include guiding language to direct funding to HBCUs 
        to harden their campuses in response to the HBCU bomb threats.

          Financial stress is one the of most prevalent causes 
        of anxiety for students entering college across the country. 
        Congress should continue to advance common-sense legislation to 
        reduce the costs of higher education and support President 
        Biden's plan to address college debt through limited student 
        loan forgiveness.

          As previously mentioned, students arrive on campus 
        with few coping skills as well as co-morbidities that impact 
        their academic success. Earlier intervention would provide 
        those students with the strategies and resources that they 
        could equip them with tools for success. With that being said, 
        Congress should follow the lead of Senators Casey and Cassidy 
        and pass S. 4472 the Health Care Capacity for Pediatric Mental 
        Health Act and S. 2550, the RISE Act.

    For more information and details regarding my remarks, I ask that 
you read my written testimony submitted for your review.
                                 ______
                                 
    The Chairman. Dr. Wright, thanks very much for your 
testimony.

    Dr. Weiss.

STATEMENT OF ASHLEY WEISS, DO, MPH, DIRECTOR OF MEDICAL STUDENT 
EDUCATION IN PSYCHIATRY, TULANE UNIVERSITY SCHOOL OF MEDICINE, 
                        NEW ORLEANS, LA

    Dr. Weiss. Thank you for having me here, Chairman Casey, 
and Ranking Member, Dr. Cassidy, and the rest of the Committee.

    Again, my name is Ashley Weiss. I am a Child and Adolescent 
Psychiatrist at Tulane School of Medicine in New Orleans, 
Louisiana. I specialize in first episode psychosis. Psychosis 
is a symptom typically associated with the onset of 
schizophrenia and bipolar disorder.

    These illnesses can have devastating consequences, from the 
increased risk of cardiovascular disease and premature death, 
to the ramifications of being chronically marginalized by 
society. Why am I bringing up illnesses like schizophrenia in a 
hearing about mental health and high school and college 
students? It is because this is where they start, in our young 
people and not by any fault of their own.

    Adolescence is a time of incredible brain maturation, and 
for some, this maturing process goes awry, leading to the 
emergence of severe psychiatric disorders. These illnesses 
don't discriminate. They were present pre-COVID, and they are 
still present now with a little bit of a different context.

    Globally, these illnesses lead to the greatest costs, both 
directly and indirectly. So what is psychosis? Psychosis can be 
described as a loss of touch with reality. Examples of 
psychosis symptoms are hallucinations, confusion, and 
delusions.

    These experiences start small, like mishearing sounds as 
voices or beginning to feel as if people are watching you. This 
paranoid feeling could turn into a belief, a delusion, where 
one is convinced the world is literally out to get them. And it 
is difficult but very necessary to imagine what this might feel 
like for a young person.

    Some facts about psychosis. 3 out of 100 people will 
experience psychosis in their lifetimes, mostly occurring for 
the first time between ages 16 and 25. For every one person 
experiencing psychosis, six other friends or family are 
directly impacted.

    In the U.S., the average time one experiences psychosis 
prior to treatment is 72 weeks, not days, weeks. 1 in 10 will 
attempt or complete suicide with the highest risk being after 
the first episode.

    To give these statistics a local context, George Washington 
University enrollment is about 26,000 students, which means 
almost 800 will experience psychosis annually and will not 
receive appropriate care for over a year.

    Over 4,500 friends and family are impacted. Nearly 80 will 
attempt or complete suicide. So there is a sense of urgency 
because time is not on our side. The impact of the brain can be 
deteriorating.

    The last three decades of research show that specialized 
intervention as early as possible after psychosis onset 
improves outcomes across the board. There is no time to wait. 
The same philosophy is already accepted in stroke intervention 
and should be accepted in psychosis intervention as well.

    In 2015, I started the Early Psychosis Intervention Clinic 
in New Orleans. We have treated nearly 100--nearly 1,000 people 
since we opened our doors. Our multidisciplinary team provides 
coordinated specialty care, including medication management 
from psychiatrists, individual family, and group therapy, and 
wellness coaching.

    All treatment is deeply individualized, with the goal of 
getting young people back on track, and that often means back 
to school or graduating or to their first job. But what we do 
in the clinic is not enough. Because of the need for early 
treatment in psychosis, we are forced to think about early 
detection.

    We have a robust early detection campaign called Calm, 
which was mentioned, and this aims to educate the community 
about psychosis, debunk myths, reduce stigma so hopefully 
people will feel comfortable and safe coming forward for 
treatment.

    Our goal is that an individual comes forth on their own and 
they don't have to wait for someone else to bring them in, and 
they certainly don't have to wait for the police to pick them 
up having an acute psychosis and take them to the emergency 
room.

    There are significant challenges and barriers that must be 
considered. For most people, recovery can take many, many 
months, but time continues to pass for everyone else in their 
lives. Their friends have often moved on, graduated, moved away 
to college, or started their first job. They often feel 
misunderstood, ashamed, quickly leading to the loss of 
confidence and increased isolation.

    There is a conspicuous gap in school based recognition of 
these needs for these individuals and keeping them engaged or 
even welcoming them back after their recovery. I have multiple 
college students in my program.

    Students in every college in Louisiana, actually, which 
makes me very proud, who didn't even know that they were 
eligible for retroactive medical leave that would erase 
incompletes from their transcripts, who have crushing student 
loan debt from the semesters that they became ill. We are often 
the first place to provide guidance in how to approach these 
issues. There are financial threats to programs like ours.

    Although our program is committed to long term care, most 
programs like ours don't go beyond two to 3 years. We are now 
realizing that people lose their gains when they lose 
specialized care. But how do we pay for continued care?

    We have subsidized our growth through the Congressional 
legislation mandating a portion of the SAMHSA block grant be 
set aside for early, severe mental illness. We appreciate this 
opportunity because it covers the necessary care that is not 
covered by insurances.

    In our State of Louisiana, Medicaid and commercial insurers 
do not reimburse any of the coordination of care that is 
required to provide this model. No case management, no record 
review, no coordination with community partners like schools or 
hospitals, no treatment team meetings.

    Without the coordination, the risk of relapse increases 
exponentially. And commercially insured patients might have two 
co-pays a week, that will quickly add up after a month, and 
that becomes unattainable.

    People in this age group fall off their parents' insurances 
and they might not even qualify for Medicaid. And then barriers 
exist beyond our clinic. There is a pervasive lack of education 
coupled with ample misinformation about psychosis and what it 
even is.

    This gap in education exists in the general public but 
extends even to mental health professionals. Psychosis is not a 
topic in health education curriculums for high school or 
college students, even though their age group is most at risk.

    Psychosis education is not a prominent part of the 
curriculum for those interfacing with high risk groups. 
Psychosis intervention is far from being considered an 
essential part----

    The Chairman. Doctor, we have to wrap up.

    Dr. Weiss. Okay. Can I have a 10 second wrap up?

    The Chairman. Sure.

    Dr. Weiss. Okay. I am here today to say out loud for the 
record that our youth and young adults are the vulnerable ones 
to these illnesses, and we cannot ignore this fact as a society 
any longer.

    These illnesses are not curable, but they should not be 
associated with an inevitable lack of productivity and 
institutionalization. They are not preventable, but there are 
strategies to mitigate risks, such as early detection. They are 
manageable, and management does not mean doing the bare 
minimum.

    That approach has not served us well historically, and we 
need to do better for our people. It is a necessity for them. 
We must be ambitious in our commitment to these youth and young 
adults so that their recovery is supported while they explore 
their opportunities that they deserve and expand their futures.

    [The prepared statement of Dr. Weiss follows:]

                   prepared statement of ashley weiss
    My name is Ashley Weiss. I am a child and adolescent psychiatrist 
at Tulane School of Medicine in New Orleans, Louisiana. I specialize in 
first-episode psychosis. Psychosis is a symptom typically associated 
with onset of schizophrenia or bipolar disorder. These illnesses can 
have devastating consequences, from the increased risk of 
cardiovascular disease and premature death, to the ramifications of 
being marginalized by society. Why am I bringing up illnesses like 
schizophrenia in a hearing about mental health in high school and 
college students? Because this is where they start, in our young 
people, and not by any fault of their own. Adolescence is time of 
incredible brain maturation, and for some, this maturing process goes 
awry, leading to the emergence of severe psychiatric disorders.

    What is psychosis? Psychosis can be described as the loss of touch 
with reality. Examples of psychosis symptoms are hallucinations, 
confusion, and delusions. These experiences start small, like mis-
hearing sounds as voices, or beginning to feel as if people are 
watching you. This paranoid feeling could then turn into a belief, a 
delusion, where one is convinced the world is literally out to hurt 
them. It is difficult, but necessary, to imagine what this may feel 
like.

    Some facts about psychosis:

          3 out of 100 people will experience psychosis in 
        their lifetimes

                Y  Mostly occurring for the first time between 16 and 
                25 years old.

          For every 1 person experiencing psychosis, 6 more 
        friends and family are directly impacted.

          In the US, the average time one experiences psychosis 
        prior to treatment is 72 weeks

          1 in 10 will attempt or complete suicide with the 
        highest risk after the first episode

    To give these statistics a local context:

          George Washington University enrollment is about 
        26,000 students

          Which means, almost 800 will experience psychosis 
        annually and will not receive appropriate care for over a year

          Over 4500 friends and family are impacted

          Nearly 80 will attempt or complete suicide.

    There is a sense of urgency because time is not on our side when it 
comes to psychosis and its impact on the brain. But the last 3 decades 
of research shows that specialized intervention as early as possible 
after psychosis onset improves outcomes across the board. There is no 
time to wait. The same philosophy is already accepted in stroke 
intervention and should be in psychosis intervention as well.

    In 2015, I started the Early Psychosis Intervention Clinic in New 
Orleans. We have treated nearly 1000 people since we opened our doors. 
Our multi-disciplinary team provides coordinated specialty care, 
including medication management from psychiatrists, individual and 
family therapy, groups, and wellness coaching. All treatment is deeply 
individualized, with the goal of getting young people back on track, 
and often this means back in school.

    But what we do in the clinic is not enough. Because of need for 
early treatment of psychosis, we are forced to think about early 
detection. We have a robust early detection campaign called CALM-Clear 
Answers to Louisiana Mental Health that aims to educate the community 
about psychosis, debunk myths and reduce stigma, so hopefully people 
will seek help for themselves or their loved ones sooner than later.

    There are significant challenges and barriers that must be 
considered. For most people, recovery can take many months, but time 
continues to pass for everyone else in their lives. Their friends have 
often moved on, graduated, moved away to college, or started their 
first job. They often feel very misunderstood and ashamed, quickly 
leading to loss of confidence and increased isolation. And there is a 
conspicuous gap in school-based recognition of the needs of these 
individuals, in keeping them engaged, or welcoming them back during 
recovery. I have multiple college students in my program who didn't 
know they were eligible for retroactive medical leave that may erase 
incompletes from transcripts, who have crushing student loan debt from 
the semesters they became ill. We are often the first place to provide 
guidance in approaching these issues.

    There are financial threats to programs like ours. Although our 
program has committed to long-term care, most programs like ours do not 
go beyond 2 or 3 years, and we are realizing now that people lose their 
gains when they lose specialized care. But how do we pay for continued 
care? We have subsidized our growth through the congressional 
legislation mandating a portion of a SAMSHA block grant be `set-aside' 
for early severe mental illness. We are appreciative of this 
opportunity because it covers the necessary care that is NOT covered by 
insurances. In our state, Medicaid and commercial insurers do not 
reimburse ANY of the coordination of care services-no case management, 
no record review, no coordination with community partners like 
hospitals and schools, no treatment team meetings-and without the 
coordination, the risk of relapse increases exponentially. If 
commercially insured, patients may have 2 co-pays a week for treatment 
which quickly adds up and becomes a burden. People in this age group 
also fall off their parents' insurance but may not qualify for 
Medicaid.

    Barriers exist beyond the clinic. There is a pervasive lack of 
education (coupled with ample misinformation) about what psychosis even 
is. This gap in education exists in the general public but extends even 
to mental health professionals. Psychosis is not a topic in health 
education curriculums for high school or college students, even though 
their age-group is the most at-risk. Psychosis education is not a 
prominent part of the curriculum for those interfacing with the high-
risk groups, for instance teachers and school-based mental health 
professionals. Psychosis intervention is far from being considered an 
essential part of school-based healthcare. At this point, we should not 
be surprised when a college freshman experiences psychosis, we should 
be anticipating this, working to disseminate knowledge about early 
warning signs, and strategically planning with community partners to 
ensure students get back on track once well.

    I'm here today, to say out loud and for the record, that our youth 
and young adults that are the topic of this hearing are the vulnerable 
ones, where the severe mental illnesses strike. We cannot ignore this 
fact as a society any longer. These illnesses are not curable but they 
should not be associated with inevitable lack of productivity and 
institutionalization. They are not preventable but there are strategies 
to mitigate risks associated with earlier onset such as substance use. 
They are manageable but management doesn't mean doing the bare minimum. 
That approach has not served us well historically. A specialized 
approach may require a weekly meeting with their team for years, 
however, if that means individuals have more opportunities, more 
graduations, more jobs, more meaningful relationships, improved quality 
of life, then we are in a better place. If our communities have fewer 
suicides, fewer inpatient psychiatric hospitalizations, fewer ER 
visits, fewer people living in poverty, then we are in a better place. 
We collectively benefit from a progressive and more accurate narrative 
about psychosis, but for our young people, it is necessity. We must be 
ambitious in our commitment to these youth and young adults, so that 
their recovery is supported while they explore opportunities and expand 
their futures.
                                 ______
                                 
    The Chairman. Doctor, thanks very much.

    We will conclude now with Brooklyn Williams.

STATEMENT OF BROOKLYN WILLIAMS, HIGH SCHOOL SENIOR AND FOUNDER 
               OF THE CHILL CLUB, PITTSBURGH, PA

    Ms. Williams. Senator Casey, Senator Cassidy, thank you for 
listening to my story. And everyone else here, thank you for 
listening to my testimony. Looking at me, you might not suspect 
that I am dealing with a lot of internal struggles.

    I am speaking in public so you might not suspect that I 
have severe social anxiety. I cover my eye bags, and no one 
tells that I struggle with insomnia. I ate my entire breakfast 
this morning, but I still have bulimia.

    I got out of bed and did my hair, so to not look depressed. 
Just because I did not fit the description of someone with 
mental health problems that does not mean that I am fine, and I 
feel like we as a society overlook people with these health 
issues because they do not fit into the concrete mold in the 
textbooks of mental health symptoms.

    There is a fluidity in the way each of us experience mental 
health, and I feel like schools and communities only intervene 
when it becomes intensely severe, or in unfortunate cases too 
late. In my experience, mental health highs and lows happen in 
waves, always sporadic, and most recently due to being a high 
school senior, in my last year of childhood.

    As a child, I do not remember feeling there was any 
disordered thinking in my life. Yet looking back on it, I feel 
that mental health was not ever a topic of conversation at 
school or home until I was 18.

    When I was 13, my mom passed away from stage four 
metastatic breast cancer after a 10 yearlong battle with the 
disease. Losing her devastated my family and I, and I felt like 
a portion of myself died with her. As much as I love my dad and 
my siblings, my mom was my lifeline and my best friend.

    Although we tried to prepare as much as possible for her 
passing, it was the worst feeling that I have ever experienced. 
The following year was a blur of numbness and therapy sessions, 
but the pandemic caused everything to shut down and I felt 
alone.

    To combat those feelings of grief, depression, and 
isolation, I started to paint and do crafts to cope. It helped 
me express and lose myself in an activity rather than sulk in 
my emotions. Once school started up again, I thought, if this 
is making me feel better, then maybe it will make others feel 
better too.

    I started the Chill Club where we do activities like 
meditation, yoga, crafts and painting every month as a group to 
come together and talk about our shared emotions and not worry 
about the problems in our lives.

    From starting my club 2 years ago, I have been graced with 
many opportunities that helped me to share my story and cope 
with the loss of my mom and the struggles resulting from that, 
but I feel there is a long way to go. Incorporating mental 
health topics from an early age would be the first 
steppingstone I would take to support people's needs.

    Talking about these issues with teens before they are 
reaching for help. Providing more accessible outreach 
professionals in schools, having all students speak to these 
professionals and not only the ones that come for help.

    Allowing for mental health absent days to be excused, just 
like having physical illnesses, because mental health and 
physical health are equally as important. Allowing for 
anonymous assistance would also be effective because it is 
evident that most teens do not want to ask for help publicly.

    Last, professionals working with teenagers should be more 
open and equipped to talk about mental health struggles by 
being provided with the correct necessities to help teens work 
through their problems. As a high school senior, I have grown 
to see that the process of moving from adolescence to adulthood 
is tricky enough with college essays, picking a major, and 
knowing that I will leave my childhood behind.

    Providing teens with assessable professionals to speak with 
will only benefit our communities. Everyone needs to be aware 
of their mental health because it is not selective or to be 
stigmatized or to be put aside because it is too hard to 
understand.

    Working through these issues will not only give 
opportunities for teens to grow and flourish into adults, but 
also to allow our communities to be stronger as we improve the 
way of life one kid at a time. Thank you.

    [The prepared statement of Ms. Williams follows:]
                prepared statement of brooklyn williams
    Thank you to all who listen to my story. Looking at me you might 
not suspect I am dealing with a ton of internal struggles. I am 
speaking in public so you would not suspect that I have severe social 
anxiety. I cover my eye bags so no one can tell I struggle with 
insomnia. I ate my entire breakfast this morning but I still have 
bulimia. And I got out of bed and did my hair, but I do not ``look 
depressed''. Just because I do not fit the description of someone with 
mental health problems does not mean that I am fine and I feel we as a 
society overlook people with these health issues because not all of us 
fit into the concrete mold in the textbooks of mental health symptoms. 
There is a fluidity in the way each of us experience mental health, and 
I feel schools and communities only intervene when it becomes intensely 
severe or in unfortunate cases, too late.

    In my experience, my mental health highs and lows happen in waves. 
Always sporadic and most recently due to me being a high school senior 
in my last year of childhood. As a child I do not remember feeling like 
there was any disordered thinking in my life, yet looking back on it, I 
feel that mental health was never a topic of conversation at school or 
home until I was a teen. When I was 13, my mother passed away from 
stage 4 metastatic breast cancer after a 10-year long battle with the 
disease. Losing her devastated my family and I felt like a portion of 
myself died with her. As much as I love my dad and my siblings, my 
mother was my lifeline and best friend and although we tried to prepare 
as much as possible for her passing it was still the worst feeling I 
have ever experienced. The following year was a blur of numbness and 
therapy sessions, but the pandemic caused everything to shut down and I 
felt alone.

    To combat those feelings of grief, depression, and isolation, I 
started to paint and do crafts to cope. It helped me to express myself 
and lose myself in an activity rather than sulk in my emotions. Once 
school started again I thought ``if this is making me feel better maybe 
others will feel better too''. So I started the Chill Club where we do 
activities like meditation, yoga, crafts, and painting every month as a 
group to come together to talk about our shared emotions and not worry 
about the other problems in our lives.

    From starting my club 2 years ago to now I have been graced with 
many opportunities that have helped me to share my story and cope with 
the loss of my mom and the struggles resulting from that, but I feel 
there is still a long way to go.

    Incorporating mental health topics from an early age would be the 
first stepping stone I would take to support people's needs. Talking 
about these issues with teens before they are calling out for help. 
Providing more accessible outreach professionals in schools and having 
all students speak to these people, not just the ones that come for 
help. Allowing for mental health absent days to be excused just like 
having a physical illness because mental health and physical health are 
equally as important. Allowing for anonymous assistance would also be 
effective because it is evident that most teens do not want to ask for 
help publicly. Last, professionals working with teenagers should be 
more open and equipped to talk about mental health struggles by being 
provided the correct necessities to help teens work through their 
problems.

    I have grown to see that the process of moving from adolescence to 
adulthood is tricky enough with college essays, picking a major, 
knowing I will have to leave my childhood behind. So providing teens 
with accessible professionals to speak with will only benefit our 
communities. Everyone needs to be aware of their mental health because 
it is not selective or to be stigmatized or put to the side because it 
is ``too hard'' to understand. Working through these issues will not 
only give opportunities for teens to grow and flourish into adults, but 
to also allow our communities to become stronger as we improve the way 
of life one child at a time.
                                 ______
                                 
    The Chairman. Well, Ms. Williams, thanks very much for your 
testimony. And I want to thank the testimony of all our 
witnesses, and especially to you for demonstrating uncommon 
courage at any age, but we have rarely heard testimony like the 
testimony you presented today, so we are thankful that you are 
here with us.

    I will start a round of questions. I will just do one 
question to expedite our schedule a little bit. I will start 
with Dr. Wright. In your testimony, you described how a large 
number of students at your university are struggling with 
mental health.

    Given that around half of mental health conditions begin by 
age 14, it is likely that many of the challenges that you are 
seeing, of course, started long before college. In addition to 
school staff, parents can be a child's strongest advocate to 
help with getting the needed support that they require. But 
these families, these parents need to know what to watch out 
for in their children.

    How should we begin engaging families so that they are 
aware of the signs that their child may have a mental health, 
developmental, or learning disability?

    Dr. Wright. Thank you, Senator. That is an amazingly 
profound question. And when you think about the intersections 
of our students and their families, where they are coming from.

    Many of our students come with these undiagnosed 
challenges. So when they first have their first moment, we 
don't know what to do, and neither do they.

    I really believe that the work that you all are advancing 
in your bill, the Pediatric Access Act, will help with that 
because providing more touch points, training folks from the 
very beginning, having mental health first aid in our high 
schools and our elementary schools, but also in our community 
centers and in our churches.

    Faith communities. I think so many of our families have 
been told that mental health is a secret, and they won't allow 
their students or kids to get help. So we have got to create 
some level of understanding that mental health is tantamount to 
having diabetes.

    If someone has a heart attack, we don't keep them hidden 
away but we rush them to the hospital. And when someone is 
having these symptoms, we need to do it. So removing the stigma 
of mental health is one of the first things, but then educating 
their parents on how to connect them with folks in the 
community.

    In rural spaces that might be harder. So working with them 
in their schools, with their counselors, working with them in 
their--in some spaces in their housing authority places or 
their therapist or their counselors there, but I do think being 
able to expand the reach of qualified mental health 
professionals in these spaces will allow those parents to see 
those warning signs, because many of our students' parents may 
not have been trained to know what to look for.

    But providing schools, community organizations, resources 
to help them, I think will be essential in that.

    The Chairman. Great. Doctor, thank you very much. I will 
turn to Ranking Member Cassidy. I will reclaim some of my time 
later.

    Senator Cassidy. I will defer to Senator Tuberville and 
allow a colleague to go.

    Senator Tuberville. Thank you very much. Thank you for 
being here today. This is important. I don't think people 
really know how important it is. I coached for 40 years. I 
coached in eight states.

    I went to high schools all over this country, and in the 
80's and 90's we had a mental health problem. But after 2000, 
after the internet and this thing right here came out, it has 
devastated our kids, and I saw it every day. So this is a huge 
problem. It is going to get worse before it gets better.

    Dr. Wright, I am like you, faith based family--I mean, that 
is how we are going to overcome a lot of this. It is going to 
have to come through that, but we have got to be prepared. We 
have got to be able to recognize a problem.

    Dr. Hoover, for years I saw kids come play for me and a lot 
of them came in, and early in my career, with very little 
problems. Last 20 years, they came in and they had ADHD. They 
said they did, and we were giving them drugs right and the 
left. We weren't--the doctor were prescribing them.

    Do we have a medication problem in this country when it 
comes to mental health?

    Dr. Hoover. It is a good question. And first of all, 
Senator Tuberville, I want to thank you for your coaching 
years, because we know that all of the adults, as was said 
earlier, by Chairman Casey, all of the adults have a 
responsibility to take care of the mental health of our young 
people, including our coaches.

    I was on a plane yesterday next to a school bus driver, and 
I was telling her that she has one of the most important jobs 
when it comes to actually supporting the everyday experience of 
our young people and their mental health.

    In terms of medication and the diagnoses that seem to be 
increasing, part of it, I would argue, is really that we are 
just becoming more aware of the mental health needs of our 
young people. I would say that our medications are far from 
perfect.

    In fact, many would argue that they are imperfect solutions 
to the mental health challenges of our young people.

    But there is also strong evidence that some of the 
medications for our children and adolescents, including for 
ADHD, as you mentioned, and other mental health challenges, 
have been effective, but they are most effective when combined 
with other interventions, and that includes mental health 
interventions provided by licensed counselors, social workers 
and psychologists, but also the everyday supports, whether it 
is from the faith community, from families, or from schools.

    It is not a one size fits all approach and it is not a one 
intervention approach. In fact, most of the data would agree 
that medication, combined with other interventions, is probably 
the most effective for some of our most debilitating disorders.

    Senator Tuberville. Thank you. Dr. Weiss, we locked these 
kids down for several years. Fortunately, in Alabama, we didn't 
do as much. And we had a study come out not too long ago.

    We went from 49 to 39 in some areas of our scores 
improving. We went from 40th in the country to first in the 
country in graduation rate because we stayed in school. My 
question is, we have already spent so much money on a lot of 
these problems.

    In your opinion, how do we best direct these funds in the 
future to help with mental health?

    Dr. Weiss. I have to--full disclosure, I am from Alabama 
and grew up with Auburn football, so----

    [Laughter.]

    Senator Tuberville. Well you did good. I should have asked 
you in the first place----

    [Laughter.]

    Dr. Weiss. The work that I do is addressing severe mental 
illnesses that have long been underfunded. This--we don't have 
a good track record historically of taking care of those with 
the most severe mental illnesses and they really weren't given 
opportunities to complete school, to go to higher education.

    Now we have them actually getting well after their first 
episode with a severe illness, just like you could get well 
with diabetes diagnosis early, just like you could get well 
with other major medical problems.

    The cost needs to be reflective and encompass what it takes 
to scaffold them into these opportunities that they really 
haven't had before. And that might be more costly than to 
support a kid with ADHD from high school to college.

    However, we are just really learning now in the last 10 
years what that is going to look like for this country. So 
because early intervention and severe mental illnesses is such 
a new concept, and literally we are talking about the last 10 
years of clinics, the last 20 years of research.

    Senator Tuberville. Dr. Hoover, I know we are talking about 
going to high school to college. Half the kids in this country 
don't go to college. They get a job. They get in the military. 
How do we help them? How do we evaluate them? Because most kids 
that go to college get some kind of valuation through the 
process of higher education. How do we help those kids don't go 
to college?

    Dr. Hoover. It is a great question. And when I saw the 
subject of today's hearing, I was hoping that it was--it would 
go beyond just college, because we know so many young people 
don't go on to college.

    I would wish that we had better supports in place for them. 
I mean, I do think it really speaks to the first issue that was 
brought up that we need to start earlier. The supports that we 
are talking about from high school to college are critical.

    But what is more critical is that we put systems in place 
from pre-K to K-12 to actually identify and provide scaffolding 
and structured support for their mental health. And that 
doesn't just mean--I think our young panelist, as usual, said 
it best, which was we can't wait until there is a crisis.

    We can't wait until things get really bad to provide 
services. We need to be doing mental health literacy in the 
classroom. We need to be putting systems of identification into 
their hands, whether it is in schools, on college campuses, or 
in their communities. I think the efforts to support 
integration into primary care are critical.

    For those who do go on to career, maybe not college, they 
can get some of those same supports in their primary care 
setting. Or in other natural settings, whether that is their 
faith community, whether that is their family.

    There are many interventions that can support families to 
better equip them to support their young people, including as 
they transition to adulthood. So we need to not just put these 
services in schools or primary care, but we need to put them in 
the hands of families.

    Senator Tuberville. Dr. Wright, you got to comment on any 
of that, about kids that don't go to college? You see probably 
a lot of those.

    Dr. Wright. We do in just--in communities in general. And I 
think as she was describing, being able to put those--have them 
access those resources in other spaces. There is dignity and 
honor in our work but sometimes we privilege, this transition. 
The way that--my profession.

    But being able to make sure that they have access to an 
affordable health care so that they can afford to take 
advantage of that, whether it is through state sponsored 
Medicaid or private insurance. But I do think that being able 
to recognize that we all live within the context of our lives 
and learn within the context of our lives, that there is 
support in their spaces of work and worship.

    Then they have the ability to talk with their family 
because, again, secrets are the things that kill us. And so 
but, yes, I absolutely agree with what she said.

    Senator Tuberville. Thank you.

    Thank you, Mr. Chairman.

    The Chairman. Thank you, Senator Tuberville.

    We turn next to Senator Smith.

    Senator Smith. Well, thank you, Senator Casey and to 
Senator Cassidy, who I believe had to leave, for pulling 
together. I really appreciate. It is a great panel.

    I think the people here in this room today believe that 
mental health care is health care and that every young person 
deserves access to the mental health care that they need. And 
yet, I think we also know that we failed in that mission, but 
we are working hard on it.

    Everybody in this room, I think, in one way or another on 
this side has been working to expand access to mental health 
care in schools. I certainly have with legislation that I have 
introduced.

    Let me ask you, Ms. Williams, if I could, so I first 
realized that I was suffering from depression when I was in 
college. I am quite sure now that I was having that experience 
when I was in high school, but I didn't quite understand what 
was going on. I didn't really see how it was incapacitating me.

    I am quite sure now that my experience wasn't unique. It 
seems like with physical health care we do a lot of thinking 
around preventative care and early intervention, but yet what 
happens with mental health care is you get to a crisis point 
where you are really incapacitated and then you are sort of 
starting from behind.

    I am wondering if you could just say from your perspective, 
like what that might look like in a high school setting where 
you are getting at it, getting at people's challenges earlier 
rather than later?

    Ms. Williams. Yes, so I feel like in my experience, I 
really--I was behind like how you said. I started becoming 
really low in my depressive state before I thought to seek 
help. But I feel like now, nowadays there is a lot more--it is 
a lot more noticeable because of social media or being online 
and talking.

    Like people just say anything nowadays and they talk about 
all the things in their lives. So like really just getting out 
there and saying that they are not feeling like the way they 
should or something. It really brings out the topic more. But I 
feel like starting at a young age, I feel like that would be a 
lot more beneficial for kids to learn about what is going on 
and start seeing the signs.

    If they don't feel like they want to go outside or go to 
school or not feel the way they should feel, or they feel like 
they might be a little bit different, they should always have 
someone to talk to. And I feel like the first step to do that 
is to get everyone, get everyone like the care they need 
beforehand so nothing will escalate and get too great that no 
one can control it.

    Unfortunately, there is so many cases of suicides and 
people going to psychiatric wards and stuff like that because 
they haven't got the help that they needed. And I have 
definitely seen that in my personal life. There is a lot of 
kids in my surrounding schools and even in my school that have 
lost their battle to depression or anxiety and stuff.

    I feel like that should be a lot more preventable if we 
take the steps to reach out to their therapists and get them 
into schools more. Because I definitely see that also we have a 
school therapist on my school, but there is not that many 
people that are aware that there is a school therapist or have 
access or know the way to get to the therapy that they need or 
talk to the counselors, because there are thousands of kids 
inside one school at one time and there are four or five 
counselors for those thousands of kids.

    Senator Smith. Right, right. The part of it is not having 
enough--not having enough providers of therapy in schools. And 
part of it is making sure that people see the pathway from the 
way that they are feeling to the help that is there that they 
might not even realize is there, right?

    Ms. Williams. Yes.

    Senator Smith. Let me just ask really any of the other 
panelists, I am very interested in how we can integrate 
physical health care and mental health care in a doctor's 
office setting too. And at the pediatric level, what kind of 
integration can we do there?

    I am just wondering if you have any insight for us as we 
think about that, because it seems to me that a lot of folks, 
assuming they have access to health care, and God knows not 
everybody in this Country does have access to health care, 
physical health care. Kind of what we have seen.

    Maybe, Dr. Hoover, you would like to address that.

    Dr. Hoover. I would be happy to. Thank you for the 
question, and I appreciate your asking, again, our youngest 
member of the panel first, because I think when we speak to our 
youth about kind of their ideas of how we can get services and 
supports to them, they usually have the best answers.

    With respect to better integration into primary care, first 
of all, it can happen out in our pediatric, mental health 
clinics, and our young adult clinics. We often have this 
bifurcation. It is a really artificial bifurcation between 
pediatric medical care and adult medical care.

    I would argue that we shouldn't just drop young people off 
at the age of 18 and say that they have to switch to an adult 
provider, that is No. 1. But in terms of integration into 
primary care, it can happen both in those health care settings, 
but also in health care settings in schools.

    School based health centers, I appreciate the investment in 
school based health care. More young people are able to access 
primary care when it is offered in the context of school based 
health.

    Whether it is out in the community, in primary care, or in 
the context of a school based health center, we have wonderful 
examples of mental health, behavioral health providers situated 
in those settings, but we also have many examples, especially 
in a more rural or smaller campuses, where they don't have the 
provider network to be situated physically in the building.

    We actually have wonderful examples of effectively using 
telemental health to integrate right there into the mental 
health--or excuse me, into the primary care setting. And the 
last thing I will note is just the increased investment in the 
child psychiatry access programs are now called the primary 
care, the mental health and primary care access, where you have 
primary care providers that can pick up a phone or get on tele 
and actually reach out to a specialty mental health provider, 
have been instrumental.

    I really appreciate the expanded coverage of that. We have 
seen it not only in primary care can be critical, but also in 
the context of schools.

    Senator Smith. Thank you. Chairman Casey, I know I am out 
of time. I am going to submit for the record a question that I 
have also around the sort of--the plethora proliferation of 
mental health care apps. And I am trying to understand the 
efficacy of those and what kinds of consumer protections we 
need to think about for those. Thank you very much.

    The Chairman. Thank you, Senator Smith.

    I will turn next to Ranking Member Cassidy.

    Senator Cassidy. I will defer to Dr. Marshall.

    Senator Marshall. Thank you, Senator Casey. Thank you, 
Senator Cassidy. Again, thanks to all of our panel for being 
here. And especially Ms. Williams, thank you for coming. You 
are absolutely the most courageous person I will meet today, to 
come and share your story. You may be the most courageous 
person I will meet all week and all month, and I got a question 
for you in a second.

    My first question is going to be for Dr. Weiss and Dr. 
Hoover. Prior authorization, access to care has been a bigger 
issue--is the No. 1 physician administrative concern in 
America. As an obstetrician, I saw the issue delay care for 
infertility patients, for high risk patients.

    My friends in orthopedic surgery tell me that it is getting 
harder and harder to get the joint replaced and maybe that the 
process delays it three or 4 months' time. And meanwhile, we 
get the patient addicted to two narcotics.

    I am just curious, in your clinical experience, when it 
comes to mental health issues, are you seeing any challenges in 
the prior authorization realm? Dr. Weiss, why don't you go 
first.

    Dr. Weiss. It is mind numbing.

    Senator Marshall. Mind numbing.

    Dr. Weiss. Yes our clinic bills for services and we also 
have some money that subsidizes what is not covered.

    But even the services that are covered, and I deal with a 
lot of antipsychotic medication and long acting antipsychotic 
injectables that are not preferred on formulary, but that are 
the best medications of certain classes of medications that are 
more appropriate for young patients versus the older ones for 
many, many more reasons, like less side effects.

    It will take weeks sometimes. Getting prior authorization 
for community based mental health services can sometimes take 
weeks, and then every 3 months they want you to repeat the 
authorization.

    In Louisiana, Medicaid has been privatized, so there are 
five companies that provide Medicaid services, each requiring a 
different type of pre-authorization or prior authorization for 
services. So this is a job of two or three people.

    We have a census of about 170, so it is hard to finance 
that because I am, aware that businesses need to be financed in 
a fiscally responsible manner. But the amount of administrative 
support you need to get these things done is astronomical.

    Senator Marshall. Yes. Dr. Hoover, do you have anything to 
add?

    Dr. Hoover. The only thing I would add is I certainly agree 
with everything you said. And yet, of course, we need some 
authorization in place, especially for our most vulnerable 
youth, who may, for example, experience polypharmacy.

    Young people in the foster care system, for example, we 
know may be on multiple medications. There needs to be some 
authorization and process for understanding the medications 
that they have been prescribed so that it is done responsibly.

    But the wait times for getting into mental health care, as 
you said, it is mind numbing, astronomical, and for families 
can be really impossible to navigate.

    Senator Marshall. In my experiences, what was most 
frustrating is after my nurses had spent days and days in the 
back and forth with faxes, not emails or on online, but faxes, 
eventually I get to talk to a person and maybe it was a 
neurologist trying to explain to me why we shouldn't be using 
progesterone for pre-term--have you ever had that same 
frustration? I wouldn't begin to want to tell you the drugs you 
should be using.

    Dr. Hoover. Yes. I left inpatient work specifically because 
of this. I would be told that someone did not qualify for 
inpatient psychiatric hospitalization because they weren't 
actively trying to kill themselves or someone else.

    I would say, so what about like hearing the demon and 
coming to get you, and you can't even get out of your bed or go 
to your house or eat food--you don't qualify for inpatient 
services. And I just----

    Senator Marshall. I just want to reassure you that we do 
have legislation that we could get across the finish line that 
would impact Medicare, this prior authorization issue. And then 
we will go after CHIP and Medicaid and some of those others.

    I am running out of time. I want to go to Dr. Wright and 
Ms. Williams for a second as well. One of the tragedies in this 
country is fentanyl poisoning. And this is an editorial written 
by a mom from Kansas who lost her son, Cooper Davis, a little 
bit over a year ago.

    A 16 year old who ordered a half of a Percocet tablet via 
Snapchat, unknowingly laced with fentanyl and the child died. 
Dr. Wright are you seeing any problems with--the high risk 
group we are talking about, I am afraid oftentimes they are 
trying to find Xanax or Adderall or uppers, downers, and they 
are being laced with fentanyl.

    Are you seeing any of this in your world, Dr. Wright?

    Dr. Wright. Specifically at my institution, no. We don't 
see--that is not the drug of choice for our student population. 
However, prior to Xavier, I lived in Staten Island, and I 
worked in a private liberal arts college on Staten Island where 
we saw a huge problem with the drugs that were laced with 
fentanyl.

    Students who were--whose prescriptions had lapsed, and so 
now they are going out and finding other ways. And so, yes, 
that is a huge problem that our young people are dealing with.

    It is partly because as Senator Tuberville said, they came 
medicated, and now they don't have access to those medicines 
now, and they are trying to find it any way they can. But it is 
a growing problem, particularly for students who are trying to 
take care of themselves.

    Senator Marshall. Sure. Thank you. Ms. Williams, and I 
certainly don't want to get too personal. I always tell my 
patients, you can pass on any of my questions, but are do you 
see any problems, any--are students able to find those types of 
things online? Do you see it in your school or any concerns 
about it?

    Ms. Williams. You mean drugs?

    Senator Marshall. The specifically fake pills laced with 
fentanyl. Like people are trying to find Xanax or Adderall and 
my goodness, it has been laced with fentanyl.

    Ms. Williams. Never in my experience have I heard of anyone 
doing that, no.

    Senator Marshall. All right. All right. Well, thank you so 
much. Dr. Weiss, you want--do you have anything to add?

    Dr. Weiss. I just--I think one thing that you bring up is 
important, that every community is different in terms of what 
very emergent substance use problem is going on. In New 
Orleans, we have a major problem with synthetics and people 
smoking mojo and becoming psychotic----

    Senator Marshall. I don't know what that is.

    Dr. Weiss. The point that you can't get them--well, it is 
just a fake marijuana. I can buy it in a grocery store. I mean, 
just and it can ruin your kidneys. So you have to be attentive 
to what is happening in different areas for sure.

    The Chairman. Senator Marshall, thank you.

    We will next turn to Senator Kaine.

    Senator Kaine. Well, thanks to Senator Casey and Cassidy 
for pulling this together. And what a great panel. I want to 
talk a little bit about before college and then want to talk 
about the transition of college.

    I spent Thanksgiving with family and friends, and one of 
the friends I spent time with is an administrator in the St. 
John County Florida school system, which includes Saint 
Augustine, and her responsibility includes all the guidance 
counselors.

    She was telling me, we don't have enough, and they are 
doing college guidance and helping people with financial aid 
forms and trying to be counselors. And there are some Florida 
laws now that are making it even harder because they can't talk 
about everything with the student without letting parents know.

    But setting that aside, the point she was making is there 
is just not enough people here. So, Ms. Williams, let me just 
ask you. You go to Baldwin High School in Pittsburgh. How big 
is Baldwin High School? How many kids?

    Ms. Williams. It is like 1,400, but it is also with the 
middle school and high school.

    Senator Kaine. It is all--that is all together.

    Ms. Williams. Yes.

    Senator Kaine. When you decided, hey, I need to seek help 
from somebody because of the many issues I am dealing with. And 
as you described, death of your mom and COVID and there are so 
many, was it--where did you go? And was it easy to get help or 
was it hard to get help?

    Ms. Williams. I think I did it the wrong way. But I went to 
my principal first because I was having trouble with like just 
trying to get to school and get to do things I wanted to do 
with my friends and everything. So I went to the principal 
first because I was closer to him because I didn't have the 
same guidance counselor of years in my high school.

    Senator Kaine. You were getting assigned a different one?

    Ms. Williams. Yes. There was--I think I have had five in 
the past 4 years, so it was just a little----

    Senator Kaine. Is that because you get assigned a different 
one each year, but also just there is some turnover and people 
coming in and out.

    Ms. Williams. Yes. It is because--we were supposed to have 
the same one all 4 years, but because of, COVID and everything, 
and some people taking maternity leave and different things 
like that, it was just not consistent, so we just didn't have 
the same----

    Senator Kaine. Well, let me ask Dr. Hoover a question. I am 
going to come back to you in a minute about college, Ms. 
Williams. Dr. Hoover, do you think families utilize the IEP 
process sufficiently to help children deal with emotional and 
mental health issues?

    I have been a Mayor and worked with my school system and am 
really familiar with IEPs. One of my three kids had an IEP. But 
commonly for something like a speech therapy or a very narrowly 
defined learning disability, families can use the IEP process 
for getting accommodations for students to deal with emotional 
mental health issues.

    Do you think we use that enough in the K-12 space?

    Dr. Hoover. Thank you, Senator Kaine, for the question and 
for your support of mental health in schools. So the simple 
answer is, yes, families can use IEP process, and no, they 
don't use it probably as often or as well as they should have, 
in part because they are not often aware of how to do it. They 
don't have the family peer support to help them navigate the 
process. Of course the stigma----

    Senator Kaine. To the extent that there is still any stigma 
about mental health issues too, that would probably be an 
additional variable----

    Dr. Hoover. Hugely detrimental. But the other point I want 
to make, so we need to increase awareness, decrease stigma 
about using special education accommodations to support mental, 
emotional, behavioral issues.

    But we also need to provide supports that go outside of or 
beyond the special education system. There are a lot of young 
people who could get mental health supports in schools that 
would not require an IEP, but they can still get mental health 
support in schools.

    Senator Kaine. I want to go over to the college side. So 
Ms. Williams, you are a senior. So when--are you thinking about 
going to college next year?

    Ms. Williams. Yes.

    Senator Kaine. When you go to college, with the experience 
you have had and you have now found some support systems that 
have helped you, and you have created support systems that have 
helped others, but you are going to show up on a campus where 
like you will be one of maybe hundreds or thousands and you 
will be kind of a free agent day one.

    What are you going to do when you go to college to try to 
make sure you have the services that you need? And I ask you 
this because there might be a lot of people just like you 
listening to this hearing that would want to hear the way you 
are going to do it, since you have been appropriately sort of 
assertive in trying to find the help that you need.

    Ms. Williams. I am thinking about joining different clubs 
and different social settings that will help me with mental 
health and other people that deal with the same things that I 
deal with, and different groups that deal with kids with a 
parent that passes or a person that deals with depression or 
anxiety or something like that.

    I wanted to join different groups. But I also talked with 
my therapist a little bit about how to transition from her 
being my child therapist to becoming--having an adult 
therapist.

    What they were planning on doing is like overlapping sort 
of the time between her leaving my life and having a new 
therapist so we can--so she can talk me through the way I 
should interact with the new therapist and try to overlap them 
and try to, I don't know, get a way through the----

    Senator Kaine. I get you--the transition, yes----

    Ms. Williams [continuing]. Process easier--the transition 
easier.

    Senator Kaine. That is good advice for others. And Mr. 
Chairman, could I ask one more question of Dr. Wight. We have 
had two really tough situations in Virginia in recent years. 
One, when I was Governor, a tragic shooting at Virginia Tech, 
and then recently a tragic shooting on the University of 
Virginia campus.

    In both instances, there is some differences, and I don't 
want to make them sound exactly similar when they are not. But 
in both instances, the individuals who carried out these 
grievous crimes had tough high school years but had found 
supports in high school where they were able to be successful, 
successful students, successful athletes.

    But then when they went to college, it was like none of 
that information that helped them succeed in the high school 
setting, it is like none of it went to the university setting.

    In each instance, and we are still learning more about the 
University of Virginia situation, it seems like there was sort 
of a downward spiral, and maybe partly because they didn't have 
the support services surrounding them that knew their situation 
and knew how to help them succeed when they were in high 
school.

    The RISE Act, which you all have introduced, would take, if 
somebody has an IEP, it would take that information from high 
school and not just make it easier for them to continue it in a 
university setting, but it would also transfer the knowledge 
about how to help this young person succeed to the college 
setting.

    But how do you deal with that in your institution? This 
coming into a place where you are brand new and it is all you 
were expecting after 3 months to be an independent adult, make 
good choices, and maybe you have a past history that doesn't 
really--it is not--it is not made known to anybody on campus.

    How do you help students in that transition at Xavier?

    Dr. Wright. Sure. So there is peer to peer training that we 
conduct so that the freshmen are paired with what we call peer 
deans, who are upper class students who help connect them to 
not only the social side of university life, but also those 
resources that will help them navigate the university.

    We also think about those spaces where students are going 
and try to marry. So we know that students are going to see our 
campus ministry office, right. So training those folks to be 
able to help identify when they hear things, get them the 
counseling.

    Similarly doing that same work in the classroom because 
sometimes faculty will interact with students, and they will 
see something in a report that they have written.

    Or they will come to them, and they will say, I missed 
class today because of x. Or they will also let us know when 
they start to see things that are different. But I do think 
that the other--one of the most important things that we have 
been doing is really engaging our students' parents.

    We want to respect them as full adults, but we also 
recognize that we can't do it without a full support system for 
them. And so working with those parents will oftentimes get us 
information that we didn't know that will then help us connect 
with their previous therapist.

    Senator Kaine. Thank you. Thank you for that. I appreciate 
your letting me go over.

    The Chairman. Thank you, Senator Kaine.

    Senator Cassidy.

    Senator Cassidy. Dr. Wright, just to follow-up the kind of 
same thread as did Senator Kaine, and I think this is more for 
the audience watching so I just want you to kind of document by 
your testimony, if somebody does have an IEP as in a high 
school and they are trying to transfer to Xavier or another 
university, are you able to access that information at all? Can 
you access it even though there is difficulty in terms of 
utilizing or using that information. Can you comment on that, 
please?

    Dr. Wright. We can't access it unless they give it to us. 
So they have to bring it to us. And then when they bring it to 
us, even if it is outdated, what we will do is provisionally 
provide those accommodations and set them up with a coordinated 
care plan to get them the evaluations that they need.

    But unless they bring it to us, we don't have access to 
that, because in our admissions process, we are not allowed to 
ask them information about their mental health. Doctor----

    Dr. Weiss. I was just going to add, and what you I think 
demonstrated so beautifully, is that when there is a mental 
health team involved with a high school student that is going 
to be transitioning to college or to a job, whatever they want 
we are very aware of what is going on in the senior year of 
high school.

    We are sort of anticipating and preparing ahead of time of 
where they are planning on going, the application process. I 
have had to read a lot of personal statements for college 
applications.

    We have already identified the key players in their new 
community. Whether it is a--they need a first episode program 
in their community. We have already reached out to them. We 
don't have----

    Senator Cassidy. Sorry, excuse me. What you are telling me 
is a best practice is that the high school counselor would then 
be seeking a HIPPA form release that she or he could send the 
information to the college, and the college could just again 
continue that sort of enveloping we are going to support you?

    Dr. Weiss. Yes.

    Dr. Wright. Correct.

    Senator Cassidy. Do you have a sense of----

    Dr. Weiss. You can be clear about what----

    Senator Cassidy. Do you have a sense of how often this best 
practice is actually implemented?

    Dr. Wright. Very little.

    Dr. Weiss. Very little. I mean, it is----

    Senator Cassidy. Is it not implemented well or implemented 
so little, is that the problem with the university or is that 
the problem of the high school? Or what is going on here?

    Dr. Wright. I think that there is many, many things going 
on depending on what the situation is that you are dealing 
with. Via if it is an academic disability, then it would be----

    Senator Cassidy. But we are speaking specifically of mental 
health.

    Dr. Weiss. Mental health.

    Senator Cassidy. Now, by the way, our RISE Act, if you have 
dyslexia, that doesn't change with lifetime. Forever you are 
dyslexic.

    Dr. Weiss. Right.

    Senator Cassidy. That is easily taken over.

    Dr. Weiss. Right.

    Senator Cassidy. Mental health is obviously a different 
issue.

    Dr. Weiss. Right.

    Senator Cassidy. Again, if you had to tell us what is the 
problem between the person who is helping someone like Ms. 
Williams, sending that information to the college which she 
chooses to attend, and then that seamlessly moving into the 
counseling that she needs. Because if not, it ends up with the 
tragic consequences that Senator Kaine just referred to. What 
is the problem there? What can we do?

    Dr. Weiss. Coordinating care from both sides.

    Senator Cassidy. Yes, ma'am, I get that. But what is the--
--

    Dr. Weiss. People are answering the phones----

    Senator Cassidy [continuing]. Mechanism where we forced 
that marriage, if you will. It sounds like it is just not 
happening, and it sounds like it is just not happening because, 
it is a too strong to say, a lack of effort? Dr. Hoover.

    Dr. Hoover. Well, I would just say that we have to have 
some protections in place for health care privacy and----

    Senator Cassidy. But signing a HIPPA form would be----

    Dr. Hoover. That is exactly right. So we need to educate 
our young people as they transition to adulthood about their 
privacy rights and how to sign a HIPPA form.

    Senator Cassidy [continuing]. Because that really should 
be. I am a health care doctor----

    Dr. Hoover. Yes.

    Senator Cassidy. If somebody comes to me and I know they 
are moving to another state, I say, listen, I need to send your 
records to Mississippi and I need you to sign this form. I 
don't think it is incumbent upon the patient to understand that 
there is a form which she needs to sign.

    Dr. Hoover. But it is incumbent upon them to understand 
whether they would wish to. A lot of college students, one of 
the biggest hindrances of college students to actually having 
the--to actually getting services is because they don't 
necessarily know or want those services when they get to 
college.

    Senator Cassidy. But we are talking about something 
different. What we are talking about, because you and Dr. 
Wright, I think, spoke of, and Dr. Weiss spoke of proactively 
reaching out.

    But that suggests that they have been informed that there 
is an issue. Now, I will say that the nice thing about somebody 
being 17 or 18, mama is still there.

    Dr. Wright. Correct.

    Senator Cassidy. I find that mamas are--like we couldn't 
live without them.

    [Laughter.]

    Senator Cassidy. But she can come in and make sure, dear, I 
know that you need to sign this form, and I am going to sign it 
with you if you are a minor, and we are going to send those 
records. I am not sure I will accept the excuse that the 
student is unaware. Yes, that is true----

    Dr. Hoover. Not an excuse. I just think they need to be 
educated and I wholeheartedly agree.

    Senator Cassidy. But the initial sending of that record 
should be incumbent upon the guidance counselor or the social 
worker or whomever.

    Dr. Hoover. With the permission of the family, absolutely.

    Senator Cassidy. Exactly. I think what is not--what I am 
pushing, but what I am not quite sure I am receiving a yes that 
is true from, is there a problem, is there a lack of follow 
through on the behalf of the typical high school guidance 
counselor or social worker to trigger that?

    Dr. Hoover. Yes.

    Dr. Weiss. Yes.

    Senator Cassidy. Okay. Now, is there likewise a 
sufficient--insufficient pull through, the university gets it 
and what do we do with it? Oh, that is great, put it in the 
file.

    Dr. Hoover. Yes.

    Dr. Weiss. Yes.

    Senator Cassidy. As opposed to we are going to jump on this 
and make sure it doesn't happen?

    Dr. Weiss. Yes.

    Dr. Hoover. There is often a requirement for reassessment, 
which as you alluded to earlier, is often completely 
unnecessary.

    Dr. Weiss. Right.

    Senator Cassidy. Right. Our RISE Act addresses some of 
this.

    Dr. Hoover. Correct.

    Senator Cassidy. By this, I hope all my colleagues now will 
claim co-sponsors. But there is also, beyond Federal law, there 
is the lack of awareness in the high school and the university 
as to their respective roles.

    Dr. Wright. Correct. Senator, it is skill versus will, can 
we or will we. And I--can we? Absolutely, we can. But I do 
think that we sometimes hide behind policies, that will limit 
what we will do.

    Senator Cassidy. No, I totally get you, Dr. Wright. Oh, my 
gosh, people retreat because they are just so scared of their 
shadow, and they use that as an excuse.

    Dr. Wright. Right.

    Senator Cassidy. It is an incredible frustration of mine.

    Dr. Wright. Right. But I do think the RISE Act would help 
provide some Federal guidance on what we should be doing. And 
so----

    Senator Cassidy. But it is more than that, and I don't 
quite know what it is--it is probably----

    Dr. Wright. I think clinically if you are a clinically 
astute therapist with a high schooler, then you should be 
talking about these things. And it shouldn't be the day before 
you go, oh, let's send your mental health information.

    It should be this whole transition and what is going to 
happen to make them feel safe and comfortable with like 
continuing their mental health care in the next phase of their 
life.

    Senator Cassidy. I will say, on the Federal level, there 
are some times that we can do best practices and we judge 
different organizations by best practices. And can you do an 
audit of your charts and see how many X, Y and Z?

    I just say that for my colleagues, for us to start thinking 
about. I am out of time. I actually had other questions for you 
all, but I will submit those for the records, particularly for 
you, Dr. Weiss, as regards to how you are using the wraparound 
services and the need to augment Medicaid, which seems--just 
seems crazy. But we will get back to you. We will send you the 
letter for the record. Thank you.

    The Chairman. Thank you, Senator Cassidy. And I will, I 
know we have to wrap up soon, but I will exercise a Chairman's 
prerogative by just adding maybe one more question for Brooklyn 
Williams.

    But to our three doctors, if you can each, if you want to, 
provide anything else for the record that you hope you would--
we have on the record, in 30 to 1--30 seconds to 1 minute each, 
if you can do that. This is kind of a quick lightning round 
before I will wrap up with Brooklyn, and then we will do our 
closings.

    Dr. Hoover. Glad to. So the one thing that I want to 
emphasize is that while we do need to invest in child mental 
health specialists and increase the numbers of counselors in 
schools, psychologists, etcetera, we really do need to make it 
that every adult and peer has education and training to support 
mental health.

    That can be through things like mental health first aid and 
youth mental health first aid. There is also a free, federally 
funded mental health training for all educators called 
Classroom Well-Being Information and Strategies for educators 
or classroom wise.

    We have many tools at our fingertips to train everybody in 
the system, and that would include in mental health literacy in 
the K through 12 curriculum. It can't rely--we can't rely 
solely on mental health specialists to cure our way out of this 
mental health crisis.

    The Chairman. Thanks, Dr. Hoover.

    Dr. Wright.

    Dr. Wright. I also want to echo Dr. Hoover in the need for 
mental health first aid. As someone who has sat and attended 
far too many funerals of students over the course of my career 
who had bright, brilliant futures but they weren't able to see 
that, this is an important conversation, and I am so grateful 
to the Committee for engaging in it.

    But we also need to recognize that teacher preparation 
should involve a certain level of understanding how to navigate 
these spaces because they are the front line. So, thank you.

    The Chairman. Thank you. Thank you, Dr. Wright.

    Dr. Weiss.

    Dr. Weiss. I echo as well and think that this mental health 
first stage should also include specific and more severe 
illnesses and not just be a generic approach, because dealing 
with some of these more misunderstood mental health conditions 
can be very challenging for someone that doesn't have the 
background.

    I just want to stress that while we talk about early 
intervention, we have to think about early detection and beyond 
schools, like to the communities.

    The Chairman. Doctor, thanks very much. I am told Senator 
Kaine, you had something you wanted to say.

    Senator Kaine. If I could just quick, and this is back to 
Senator Cassidy, this point on best practices. A university 
probably wouldn't want to try to get a student's medical record 
before the student was admitted because the student and family 
might wonder, well, maybe they will turn me down if they see 
something in my metal record they don't like.

    But once a university admits a student the first letter 
that goes out is, hey, you have been admitted and here is the 
deposit you have to put down, and it has a whole lot of other 
information in it.

    That letter from a college could say, we can help provide 
services on day one that will help your students succeed if we 
know as much as we can about what services help the students 
succeed in high school, if you will fill out this HIPPA form 
and send it back to us, we can get the schools full record, not 
just the transcript, but the full record so we can do that.

    There are--the RISE Act is a really good one. But I also 
think there is best practices at that moment. Everybody is 
going to eagerly devour that letter, you are in and here is the 
deposit, but here is information, and that is a good moment to 
have that discussion.

    I just kind of wanted to put that on the record for anybody 
from colleges that might be listening to this hearing.

    The Chairman. Good point. Well, Brooklyn, you are going to 
be the last answer of the hearing. But I want to particularly 
thank you for not only being here. That is difficult enough. I 
could never do what you are doing when I was your age. Not even 
close.

    But also, as much as it is inspiring to have you here and 
to hear your testimony, and to listen to the answers to 
questions, your story, what you have had to overcome personally 
is not just inspiring to people here but will inspire countless 
young people across the country. So we want to commend you for 
that.

    I guess sometimes we don't often--often we don't listen 
enough here in Washington. We don't take enough time to hear 
the perspectives of young people. So I guess just by way of 
conclusion, what was your hope that we would hear? What point 
do you want to make before we conclude?

    Ms. Williams. I would say just like try to take advantage 
of the young people that want to come and work with you guys, 
and just try to get them to reach out to the people around 
their age more because talking to people that are around your 
age is a lot I would say easier than trying to talk to people 
that have not like grown up the same way you have.

    There is a lot of different experiences from when I would 
say when everyone here is like younger than whenever, like me 
now, like being a 17 year old in 2022. I would say just having 
more like ears and having the constant communication is very 
beneficial.

    Without that, I feel like there is a lot--there would be a 
lot less good in what we are trying to accomplish. And I just 
wanted to say thank you for letting me talk among these doctors 
and all of you very insightful, like professional people.

    It is just a really nice experience, and I am eternally 
grateful.

    The Chairman. Brooklyn, thanks so much. We are honored by 
your presence as we are by all of our witnesses. I will have a 
closing statement and then I will turn to Ranking Member 
Cassidy for his. We know that in today's hearing we heard very, 
very powerful testimony about how to address the crisis in 
adolescent mental health and set our Nation's young people up 
for success in college and in life.

    We also discussed creating systems of comprehensive mental 
health support in schools and communities to identify and 
respond to unprecedented mental health needs among our young 
people.

    We also talked about gaps in the continuum of mental health 
care that must be filled through care integration in health 
care, and health workforce development, and a greater variety 
of timely care options. Long before the pandemic, there was a 
significant rise in mental health conditions among our Nation's 
young people.

    Their mental health challenges have only been exacerbated 
by isolation and stress in recent years. Too many of our young 
people are not even able to show up as their full selves to 
fully enjoy the many experiences that make high school and 
college special.

    Too often they don't have that opportunity to perform at 
their best and to achieve meaningful goals. Young people across 
our Country have unbounded potential and their whole lives 
ahead of them, and yet suicide is the second leading cause of 
death among people ages 10 to 14, and the third leading cause 
of death among young people ages 15 to 24.

    We can't accept this. We must do more. We must do more here 
in Washington and across the country to help get young people 
the support they need. Congress must continue to support 
successful programs and legislation like those we have talked 
about today.

    I look forward to working with my colleagues to achieve 
that, and to make sure that young people have the future that 
they deserve. So I will turn to Ranking Member Cassidy for his 
closing remarks.

    Senator Cassidy. Very briefly. Thank you all. What a great 
conference. In one sense, oh my gosh, there is so much to do. 
But there are tangible things that can be done that came out of 
this.

    This room, as your example, of youth groups, peer to peer, 
if you will, helping others. The whole conversation regarding 
pre-authorization and how that can be better. And the whole 
idea that maybe we get to have Medicaid provide those sorts of 
services, those kind of coordination services, that therefore 
the SAMHSA grant would not be used for a lower calling, if you 
will, but could be a higher level of service.

    Dr. Wright, thank you so much for Xavier doing best 
practices. Dr. Weiss too as regards how to take a child who is 
leaving high school in those 3 months later enrolling. Dr. 
Hoover, you have kind of seen the whole spectrum.

    Thank you all. I think what we learned from this is a set 
of--a set of measures that, if taken, can make the situation 
better. And there is nothing more we could have asked for from 
this hearing. Thank you once more.

    The Chairman. Thank you, Ranking Member Cassidy, and thanks 
for your work in helping us arrange this hearing.

    I wanted to first, before we conclude also, in addition to 
thanking each of our witnesses for their testimony and their 
presence here today, I also want to ask unanimous consent to 
add two statements to the record. And I will describe them.

    The first is a statement from the Children's Hospital 
Association on the need to ensure children and adolescents 
receive the mental and behavioral health services they need to 
prepare them for healthy, young adulthood.

    The second is an excerpt from the 2020 National Survey on 
Drug Use and Health that includes current statistics on 
substance use, mental health, and treatment among adolescents.

    So ordered that they are made part of the record.

    [The information referred to can be found on page 49:]

    The Chairman. If any Senators have additional questions for 
the witnesses or statements to be added, the hearing record 
will be kept open for 7 days until next Wednesday, December the 
7th.

    Thank you all for participating. This concludes today's 
hearing.

                          ADDITIONAL MATERIAL

      EXCERPT FROM THE 2020 NATIONAL SURVEY ON DRUG USE AND HEALTH

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        CHILDRENS HOSPITAL ASSOCIATION STATEMENT FOR THE RECORD

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                     AAFP STATEMENT FOR THE RECORD 

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    [Whereupon, at 11:34 a.m., the hearing was adjourned.]

                                  [all]