Schools are dealing with an increase in student behavioral, social-emotional, and mental health concerns, as well as a decrease in student academic achievement.
These are challenges that shouldn’t be addressed separately, said a group of school-based health professionals who recommended this during a congressional briefing in the U.S. House of Representatives on May 19 as Congress works on the budget for the next fiscal year.
There’s a need for a more multidisciplinary approach to addressing student health and well-being so kids can succeed in school and beyond, the panelists said.
The briefing emphasized the distinct roles of school-based health providers in supporting student success and the policies that could help alleviate the challenges schools are facing. It featured representatives from the School-Based Health Alliance, the National Association of School Psychologists, the American School Counselor Association, the National Association of School Nurses, and the School Social Work Association of America.
“Student health is fundamental to the way students learn,” said Betsy Looney, a school nurse coordinator for the Catholic Diocese of Richmond, Va. Research shows that students’ academic achievement is linked to their physical and mental well-being.
“You could put the world’s best teacher with the most evidence-based curriculum in a classroom, [but] that child is not going to learn, they’re not going to achieve [to the best of their abilities] if they have unmet health needs,” said Kelly Vaillancourt Strobach, the director of policy and advocacy for the National Association of School Psychologists.
Kids don’t leave their problems at the door when they walk into the school, Strobach said. That’s why schools can’t separate students’ mental, behavioral, and physical health needs from other challenges affecting learning, she added.
Most schools do not meet the recommended student-to-health worker ratios
As of the 2020-21 school year, 73% of schools have at least one full- or part-time counselor, 52% have at least one full- or part-time psychologist, and 40% have at least one full- or part-time social worker, according to the most recent data from the National Center for Education Statistics. A 2021 National Association of School Nurses survey found that 66% of schools have access to a full-time nurse.
Most schools also do not meet the recommended student-to-health worker ratios. The national student-to-school-psychologist ratio during the 2024-25 school year was 1071 to 1, double the recommended 500 to 1. The national student-to-school-counselor ratio during the 2024-25 school year was 372 to 1, higher than the recommended 250 to 1.
“These [professionals] are not luxuries in schools,” said Strobach. “They need to be integral,” the same way reading and math teachers are.
They’re also not interchangeable, the panelists said.
“Each one of us brings a different lens, [while] working toward the same goal,” said Gloria Ho, a school social worker for Milton Elementary in Milton, Del. A nurse might notice chronic health concerns that hinder learning; a counselor might support academic planning and social-emotional skills; a social worker might look at family needs and community resources; and a psychologist might assess mental and behavioral challenges.
“A student might be missing school because of anxiety, housing instability, medical issues, or family stress,” Ho said. “No one role can fully address that alone, but together we can understand the whole picture and respond more effectively.”
Having a full staff of school-based health workers can also reduce the burden on other educators in the building, the panelists said.
Teachers and administrators don’t want to be the nurse or counselor or psychologist or social worker, Looney said. Teachers and administrators should be able to focus on their actual responsibilities, she said.
A school counselor also shouldn’t have to do the work of a school psychologist or school social worker, said Amanda Fitzgerald, the assistant deputy executive director for the American School Counselors Association.
“All those ratios and workforce needs impact not only what school counselors do, but also what your reading and math and science teachers do, because they’re dealing with those issues that are unmet, if they don’t have these professionals,” Fitzgerald said.
Coalition of school health professionals wants new legislation and funds restored
The coalition of organizations representing school-based health professionals urged Congress to address the shortage of school-based health workers and ensure schools have the resources they need to hire these professionals.
Last year, the Trump administration cut roughly $1 billion in grants that were meant to increase the ranks and training of mental health professionals who work in schools. The Trump administration argued the mental health grants—along with hundreds of others it canceled in 2025—conflicted with the president’s policy priorities, including a crackdown on efforts to promote diversity, equity, and inclusion.
Below are the legislation and grants that the organizations want Congress to support:
- A bill that would reauthorize the school-based health centers grant program;
- A bill that would provide grants for schools to hire school nurses;
- A bill that would provide grants to hire school social workers;
- Restore the Mental Health Service Professional Demonstration and the School-Based Mental Health Services grant programs. The Trump administration has twice proposed eliminating $216 million in combined annual funding for these two Biden-era programs, and last year sparked an extended legal battle after discontinuing dozens of previously awarded grants.
What happens outside the school matters, too, said Ho. Policymakers also need to address food and housing insecurity, Medicaid access, and other community resources, she said.
“These aren’t separate from education; they directly impact whether students can attend consistently, focus on school, and feel safe enough to learn,” Ho said.
