II 118th CONGRESS 2d Session S. 4041 IN THE SENATE OF THE UNITED STATES March 21, 2024 Mr. Cornyn (for himself, Ms. Sinema , Mr. Tillis , Mr. Tester , and Ms. Hassan ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To support local educational agencies in addressing the student mental health crisis.

1. Short title This Act may be cited as the Creating Access and Resources in Education for Student Mental Health Act or the CARE for Student Mental Health Act . 2. Purposes The purposes of this Act are to address the student mental health crisis by— (1) increasing the number of, and diversifying, school-based mental health services providers; and (2) supporting local educational agencies in recruiting, hiring, retaining, and diversifying school-based mental health services providers to meet the mental health needs of students. 3. Definitions In this Act: (1) ESEA Definitions The terms child with a disability , educational service agency , elementary school , English learner , evidence-based , institution of higher education , local educational agency , other staff , outlying area , paraprofessional , professional development , school leader , secondary school , specialized instructional support personnel , Secretary , State , and State educational agency have the meaning given those terms in section 8101 of the Elementary and Secondary Education Act of 1965 ( 20 U.S.C. 7801 ). (2) Eligible institution The term eligible institution means an institution of higher education that offers a program of study in— (A) school psychology that prepares students in such program for a State credential as a school psychologist; (B) school counseling that prepares students in such program for a State credential as a school counselor; (C) school social work that prepares students in such program for a State credential as a school social worker; (D) another school-based mental health field that prepares students in such program for a State license or credential as a school-based mental health services provider under State law or regulation, as determined by the Secretary; or (E) any combination of study described in subparagraphs (A) through (D) that prepares students in such program for a State credential as a school based mental health services provider. (3) High-need local educational agency (A) In General The term high-need local educational agency means a local educational agency that, as of the date on which an application is submitted for a grant under this Act— (i) (I) has a locale code of 32, 33, 41, 42, or 43, as determined by the Secretary; or (II) is in the highest quartile of local educational agencies, as determined by the State educational agency, in a ranking of all local educational agencies in the State, ranked in descending order by the number or percentage of children in each such agency counted under section 1124(c) of the Elementary and Secondary Education Act of 1965 ( 20 U.S.C. 6333(c) ); and (ii) does not meet 2 or more of the following ratios: (I) A ratio of 1 full-time equivalent school counselor for every 250 students. (II) A ratio of 1 full-time equivalent school psychologist for every 500 students. (III) A ratio of 1 full-time equivalent school social worker for every 250 students. (B) ESA The term high-need local educational agency includes an educational service agency acting on behalf of 1 or more local educational agencies described in subparagraph (A). (4) Indian Tribe The term Indian tribe means any Indian tribe identified as such by the Secretary of the Interior under section 104 of the Federally Recognized Indian Tribe List Act of 1994 ( 25 U.S.C. 5131 ). (5) Minority-serving institution The term minority-serving institution means an institution of higher education that is an eligible institution under section 371(a) of the Higher Education Act of 1965 ( 20 U.S.C. 1067q(a) ). (6) School-based mental health partnership The term school-based mental health partnership means a partnership that— (A) is between an eligible institution and 1 or more local educational agencies; (B) prepares students enrolled in the eligible institution to obtain a State credential as a school-based mental health services provider; and (C) is designed to increase the number or diversity of school-based mental health services providers in schools served by local educational agencies in order to meet recommended ratios of students to full-time equivalent school-based mental health services providers in those schools, such as by— (i) recruiting, preparing, or respecializing students enrolled in the eligible institution’s school-based mental health provider program of study to obtain a State credential as, and to be employed as, a school-based mental health services provider; (ii) expanding supervised opportunities for students enrolled in such program of study to complete required field work, credit hours, internships, or related training in order to meet State credentialing requirements as a school-based mental health services provider in schools served by a local educational agency; and (iii) recruiting and retaining graduates of eligible institutions who have obtained a State credential as a school-based mental health services provider, to provide school-based mental health services related to prevention, early identification, and individualized intervention in schools served by a local educational agency. (7) School-based mental health services provider The term school-based mental health services provider has the meaning given the term in section 4102 of the Elementary and Secondary Education Act of 1965 ( 20 U.S.C. 7112 ). 4. Strengthening the pipeline of school-based mental health services providers (a) Purpose The purpose of this section is to increase the number or diversity of school counselors, school social workers, school psychologists, and other school-based mental health services providers to serve students enrolled in schools served by local educational agencies. (b) Authorization of grants (1) In general From amounts made available to carry out this section and not reserved under paragraph (2), the Secretary shall award grants, on a competitive basis, to eligible institutions to support school-based mental health partnerships, in accordance with subsection (d). (2) Reservations From the total amount made available to carry out this section for any fiscal year, the Secretary shall reserve not more than 2 percent to support program administration, technical assistance, data collection, and dissemination of best practices under this section. (3) Duration and renewals (A) Duration A grant awarded under this section shall be for a period of not more than 5 years. (B) Renewal The Secretary may renew a grant awarded under this section if the eligible institution demonstrates to the Secretary that the eligible institution is effectively using funds to significantly expand the pipeline of school counselors, school social workers, school psychologists, and other mental health professionals who meet State credentialing standards as a school-based mental health services provider. (4) Geographic diversity In awarding grants under paragraph (1), the Secretary shall ensure that, to the extent practicable and in accordance with paragraph (6), grants are distributed among eligible institutions that will serve geographically diverse areas, including urban, suburban, and rural areas. (5) Sufficient size and scope Each grant awarded under this section shall be of sufficient size and scope to allow the grantee to carry out the purpose of this section. (6) Priorities In awarding grants under paragraph (1), the Secretary shall give priority to— (A) minority-serving institutions, including historically Black colleges and universities (defined as part B institutions under section 322 of the Higher Education Act of 1965 ( 20 U.S.C. 1061 ) and Tribal Colleges or Universities (as defined in section 316 of such Act ( 20 U.S.C. 1059c )); and (B) eligible institutions that seek to form a school-based mental health partnership with a high need local educational agency. (7) Timeline In carrying out the competitive process described in paragraph (1), the Secretary shall— (A) to the greatest extent practicable, ensure that an eligible institution receives not less than 90 days to submit an application described in subsection (c); and (B) to the greatest extent practicable, provide technical assistance to eligible institutions and to local educational agencies that are or may be part of a school-based mental health partnership, in applying for grants under this section, including by— (i) disseminating the application under this section to all State educational agencies and providing guidance, to the extent practicable, to ensure accurate identification of local educational agencies that may participate in a school-based mental health partnership; (ii) supporting eligible institutions in identifying prospective local educational agencies with whom to partner in a school-based mental health partnership that may be supported by a grant under this section; (iii) provide timely notice about the competitive process under this section, on the same day that a notice inviting applications is published in the Federal Register; (iv) making publicly available templates for sample letters of intent described in subsection (c)(5) and model application materials on the same day that a notice inviting applications is published in the Federal Register; and (v) addressing questions or concerns from the field in a timely manner, as well as offering multiple opportunities, webinars, or other efforts to engage eligible institutions and local educational agencies that are or may be part of a school-based mental health partnership with an eligible institution. (c) Application An eligible institution applying for a grant under subsection (b)(1) shall submit an application to the Secretary at such time, in such manner, and accompanied by such information as the Secretary may require, which shall include— (1) a description of the prevalent mental health or substance use and misuse concerns facing students enrolled in schools served by local educational agencies that will be part of the school-based mental health partnership (referred to in this section as participating local educational agencies ), and, if applicable, challenges related to high rates of chronic absenteeism in those schools; (2) the extent to which the proposed school-based mental health partnership will address the challenges described in paragraph (1); (3) a description of how the eligible institution will increase the number or diversity of school-based mental health services providers in participating local educational agencies through the establishment and operation of a school-based mental health partnership, including a description of such partnership’s strategies to— (A) recruit, prepare, respecialize, retrain, or diversify the students enrolled in school-based mental health programs of study in order to help such students to obtain a State credential and be employed as school-based mental health services providers in schools served by local educational agencies; and (B) provide supervised opportunities to place students enrolled in the eligible institution in schools served by a participating local educational agency to complete required field work, credit hours, internships, or related training to meet State credentialing requirements as a school-based mental health services provider, including a description of the factors the partnership will consider when determining the schools in which to place those students; (4) a description of how the school-based mental health partnership will increase the capacity of participating local educational agencies to provide evidence-based comprehensive school-based mental health services, accessible to all students, to address the concerns described in paragraph (1), and, if applicable, how such services will best meet the diverse population of students to be served; (5) if applicable, a description of how the school-based mental health partnership will collaborate with State, regional, and local public health agencies (including mental health agencies), the State Medicaid agency, child welfare agencies, or other related public and private agencies that provide mental health services to support the activities of the school-based mental health partnership; and (6) a preliminary letter of intent, signed by each eligible institution and each participating local educational agency in the school-based mental health partnership described in paragraph (3), that details the financial, programmatic, and long-term commitment of the institution or agency, with respect to the strategies described in the application. (d) Use of funds An eligible institution that receives a grant under subsection (b)(1) shall use such funds to establish and operate the school-based mental health partnership described in subsection (c)(3) to increase the number or diversity of school-based mental health services providers and support the recruitment, preparation, respecialization, retraining, or diversification of students enrolled in school-based mental health programs of study, in order to help such students to obtain a State credential and be employed as school-based mental health services providers in schools served by local educational agencies, by engaging in 1 or more of the following: (1) Establishing a new, or expanding an existing, program of study in school psychology, school counseling, school social work, or another school-based mental health field that prepares students to obtain a State credential and be employed as a school-based mental health services provider. Funds may be used to— (A) support recruitment and retention of new or additional faculty; (B) purchase training materials; (C) develop and disseminate materials to recruit potential students; (D) offer financial support to enrolled students; or (E) carry out any other activity necessary to establish or expand such a program of study. (2) Expanding supervised opportunities for students enrolled in school-based mental health programs of study to be placed in schools served by a participating local educational agency in order to complete required field work, credit hours, internships, or related training required to obtain a State credential as a school-based mental health service provider. (3) Developing pathways for staff, particularly diverse and multilingual staff, of local educational agencies to receive necessary education and training to obtain a credential as a school-based mental health services provider. (4) Supporting activities to diversify the school-based mental health services provider workforce, including multilingual school-based mental health services providers. (5) Providing stipends or other financial assistance for students enrolled in school-based mental health programs of study, and supporting required field work, credit hours, internships, or related training in local educational agencies. (6) Supporting collaborations with State, regional, and local public health agencies (such as State substance abuse agencies and State mental health agencies), State Medicaid agencies, community health centers, child welfare agencies, and other related public and private agencies that provide mental health services to support activities under this subsection. (e) Reporting requirements (1) Annual report Each eligible institution that receives a grant under subsection (b)(1) shall submit a public report to the Secretary on an annual basis and publish such report in a clear and easily accessible format on the website of the eligible institution. Such report shall contain, at a minimum, the following information: (A) The number of postsecondary students enrolled in relevant programs of study operated by the eligible institution and any increases in student enrollment or faculty in such programs of study from the prior year. (B) The number of such postsecondary students supported under the grant. (C) If applicable, the number of such eligible institutions that met their goal of increasing the diversity of school-based mental health services providers. (D) The number of such postsecondary students supported under the grant who were placed in a school served by a participating local educational agency— (i) for training; or (ii) for employment. (E) The ratios of students to full-time equivalent school-based mental health services providers, disaggregated by profession to the extent practicable, at schools served by a participating local educational agency in the school year immediately preceding the first year of the grant and in the most recent year of the grant. (F) The number of school-based mental health services providers employed by participating local educational agencies, disaggregated by the number of such employees who graduated from an eligible institution and obtained a credential as and were placed into employment as a school-based mental health services provider. (2) Secretary’s report Not later than 3 years after receiving the reports described in paragraph (1), and every 2 years thereafter, the Secretary shall submit a report to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Education and the Workforce of the House of Representatives and make the report publicly available in a clear and easily accessible format on the website of the Department of Education. Such report shall include a summary of the reports submitted by eligible institutions and identify best practices related to— (A) improving, expanding, and diversifying preparation programs for school counselors, school psychologists, school social workers, and other school-based mental health services providers; and (B) supporting the recruitment and preparation of school-based mental health services providers, including effective respecialization and retraining programs. (f) Disaggregation of data Disaggregation of data shall not be required under this section when the number is insufficient to yield statistically reliable information or the results would reveal personally identifiable information about an individual. (g) Supplement not supplant Funds made available to an eligible institution through a grant under this section shall be used only to supplement and not supplant, any State, local, or non-Federal funds that would otherwise be used to carry out the activities described under this section. (h) Multiple grants to single institution In awarding grants under subsection (b)(1), the Secretary may award multiple grants to a single eligible institution if the Secretary determines that— (1) the eligible institution submitted a high-quality application for each distinct program of study, such as a program related to school psychology or school social work; and (2) each award would support students enrolled in distinct programs of study in related school-based mental health services fields. (i) Prohibition A local educational agency that enters a school-based mental health partnership with an eligible institution that receives funds under this section shall not be eligible to participate in another school-based mental health partnership with another eligible institution that receives funds under this section until the original grant period has ended. (j) Authorization of appropriations There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2025 through 2029. 5. School-based mental health services grant program (a) Purpose The purpose of this section is to support high-need local educational agencies in recruiting, hiring, retaining, and diversifying school-based mental health services providers to expand access to school-based mental health services for students enrolled in schools served by such agencies. (b) Authorization of grants (1) In general From amounts made available to carry out this section and not reserved under paragraph (2), the Secretary shall award grants, on a competitive basis, to high-need local educational agencies, in accordance with this section. (2) Reservations From the total amount made available to carry out this section for a fiscal year, the Secretary shall— (A) reserve not more than 2 percent of such amount for program administration, technical assistance, and data collection; (B) reserve 1 percent for the Secretary of the Interior for schools operated or funded by the Bureau of Indian Education, in accordance with the purpose of this section; and (C) reserve 1 percent for allotments for payments to the outlying areas, to be distributed among those outlying areas on the basis of their relative need, as determined by the Secretary, in accordance with the purpose of this section. (3) Duration and renewals (A) Duration A grant awarded under this section shall be for a period of not more than 5 years. (B) Renewal The Secretary may renew a grant awarded under this section for a period of not more than 2 years. (4) Diversity of projects (A) In general Subject to subparagraph (B), in awarding grants under paragraph (1), the Secretary shall ensure that, to the extent practicable, grants are distributed among high-need local educational agencies that will serve geographically diverse areas, including urban, suburban, and rural areas. (B) Rural local educational agencies In awarding grants under paragraph (1), the Secretary shall ensure that, to the greatest extent practicable, not less than 30 percent of the amounts made available to carry out this section that remain after making reservations under paragraph (2) are awarded to high-quality applications submitted by high-need local educational agencies to support rural high-need local educational agencies described in section 3(3)(A)(i)(I). (5) Sufficient size and scope Each grant awarded under paragraph (1) shall be of sufficient size and scope to allow the high-need local educational agency receiving the grant to carry out the purpose of this section. (6) Timeline In carrying out the competitive process under this subsection, the Secretary shall— (A) to the greatest extent practicable, ensure that high-need local educational agencies have not less 90 days to submit an application; (B) to the greatest extent practicable, send a communication to every high-need local educational agency containing notice of the application and the award deadline; and (C) to the greatest extent practicable, provide technical assistance to high-need local educational agencies, including by— (i) addressing questions or concerns from the field in a timely manner, as well as offering multiple opportunities, webinars, or other efforts to engage local educational agencies about the application process; and (ii) publishing not less than 3 examples of grant applications from geographically diverse locales, including not less than 1 such example from a rural high-need local educational agency described in section 3(3)(A)(i)(I). (c) Application A high-need local educational agency applying for a grant under subsection (b)(1) shall submit an application to the Secretary at such time, in such manner, and accompanied by such information as the Secretary may require, which may include— (1) a description of the prevalent mental health or substance use and misuse concerns facing students enrolled in schools served by the high-need local educational agency, and, if applicable, challenges related to high rates of chronic absenteeism in those schools; (2) a description of the current shortage of school-based mental health services providers in schools served by the high-need local educational agency that will be served under the grant; (3) a description of the applicant’s plan to support recruiting, hiring, retaining, or diversifying school-based mental health services providers in schools served by the high-need local educational agency to be served under the grant; (4) if applicable, a description of the high-need local educational agency's plan to increase the capacity of educators, school leaders, school-based mental health services providers, and other relevant staff to address the needs described in paragraph (1); and (5) an assurance that any school-based mental health services provider, including any provider offering telehealth services, provides services in a manner consistent with section 444 of the General Education Provisions Act ( 20 U.S.C. 1232g ; commonly known as the Family Educational Rights and Privacy Act of 1974 ) and the Individuals with Disabilities Education Act ( 20 U.S.C. 1400 et seq. ), as well as all applicable Federal, State, and local laws. (d) Use of funds (1) Recruiting, hiring, and retaining school-based mental health services providers A high-need local educational agency that receives a grant under subsection (b)(1) shall use such funds to carry out 1 or more of the following: (A) Implementing strategies to recruit school-based mental health services providers in schools served by high-need local educational agencies to help mitigate shortages of such providers, such as— (i) salary stipends or other financial incentives; (ii) relocation benefits; and (iii) opportunities for continuing professional development. (B) Hiring school-based mental health services providers to— (i) provide school-based mental health services to students enrolled in schools served by high-need local educational agencies; and (ii) implement evidence-based practices to improve school climate to support positive student mental health. (C) Implementing strategies to retain school-based mental health services providers in schools served by high-need local educational agencies, which may include providing— (i) incentives described in subparagraph (A); and (ii) ongoing professional development, induction, mentorship, or peer support for school-based mental health services providers. (2) Additional uses In addition to the activities described in paragraph (1), a high-need local educational agency that receives a grant under subsection (b)(1) may also use such funds to increase the capacity of the high-need local educational agency to address student needs described in subsection (c)(1), through activities that may include— (A) providing professional development to school-based mental health services providers, teachers, principals, other school leaders, specialized instructional support personnel, paraprofessionals, other staff employed by each high-need local educational agency, and to the extent practicable, families, related to— (i) meeting the needs of students at elevated risk of suicide, mental health concerns, or substance use and misuse; (ii) implementation of evidence-based school-based mental health services with high fidelity, including such services related to— (I) prevention, early identification, and individualized intervention; (II) addressing substance use and misuse; and (III) preventing and eliminating any existing stigma in accessing such services; (iii) mitigating indirect or secondary trauma experienced by staff employed by the high-need local educational agency and implementing evidence-based programs to promote mental health among such staff; (iv) supporting school-based mental health services providers qualified to support students in languages other than English and children with disabilities; (v) understanding when and how to refer a student to a school-based mental health services provider; (vi) supporting the use of evidence-based practices to address student mental health needs; and (vii) addressing chronic absenteeism; (B) supporting high-need local educational agencies in billing and accessing reimbursements under the Medicaid program under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ) and the Children’s Health Insurance Program under title XXI of the Social Security Act ( 42 U.S.C. 1397aa et seq. ); or (C) other activities that support the development and implementation of innovative strategies to increase access to school-based mental health services in schools served by high-need local educational agencies, which may include increasing access to school-based mental health services provided through telehealth, including ensuring any services provided through telehealth are accessible for children with disabilities. (e) Disaggregation of data Disaggregation of data shall not be required under this section when the number is insufficient to yield statistically reliable information or the results would reveal personally identifiable information about an individual. (f) Reporting requirements (1) Reporting Each high-need local educational agency that receives a grant under subsection (b)(1) shall submit a report to the Secretary on an annual basis and publish such report in a clear and easily accessible format on the website of the high-need local educational agency. Such report shall contain any information required by the Secretary and, at a minimum, the following: (A) The number of school-based mental health services providers employed by high-need local educational agencies served under the grant and any increases from the prior year, disaggregated by— (i) the number of each type of such providers who was recruited, hired, or retained, with support under this grant; and (ii) the demographics of such providers. (B) The ratio of students to school-based mental health services providers in schools served by high-need local educational agencies served under the grant and the extent to which such ratio has decreased since the start of the grant period. (C) The reduction in the annual attrition rate of school-based mental health services providers employed by high-need local educational agencies served under the grant and the extent to which such attrition rate has decreased since the start of the grant period. (D) A description of the strategies used by high-need local educational agencies served under the grant to implement innovative evidenced-based strategies to increase access to school-based mental health services and to improve school climate for students enrolled in schools served by such agencies. (2) Secretary’s reports (A) In general Not later than 3 years after receiving the reports described in paragraph (1), and every 2 years thereafter, the Secretary shall submit a report to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Education and the Workforce of the House of Representatives that— (i) includes a summary of the reports submitted by grant recipients under paragraph (1); (ii) identifies effective practices related to the activities supported by the grant program under this section; and (iii) includes an analysis of whether the recipient carried out its plan described in subsection (c)(3). (B) Publicly available Not later than 1 month after submitting a report described in subparagraph (A), the Secretary shall publish such report in a clear and easily accessible format on the website of the Department of Education. (g) Authorization of appropriations There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2025 through 2029. 6. Rule The requirements of section 4001 of the Elementary and Secondary Education Act of 1965 ( 20 U.S.C. 7101 ) shall apply to an eligible institution, local educational agency, or educational service agency receiving a grant under this Act, or participating in a program that receives funds under this Act, in the same manner as those requirements apply to an entity receiving an award under title IV of such Act.