The HOPE (Honor Opportunity Purpose Excellence) Alternative Learning Program: A Replication Success Story
March 2024

Enhancing Mental Health Support in Schools

Lauren’s Journey: A Teacher’s Transformation

Lauren was a teacher in her mid-forties working in an alternative school in North Carolina. Her commitment to her students—especially those with complex mental health needs—was unwavering. However, the lack of specialized resources and support for these students left Lauren feeling overwhelmed and burned out. The turning point came when an innovative project was introduced to the school district, which enabled a social worker trained in handling complex trauma to be hired. Lauren’s work environment significantly transformed when she could pair her students with appropriate support. Not only did her students experience improved academic outcomes and fewer behavioral challenges, Lauren’s feeling of burnout diminished significantly, and she found renewed energy in teaching.

Rob’s Transformation: A Student’s New Beginning

Rob, a student at Lauren’s alternative school, had attended nine different schools in four years. His behavioral issues, stemming from unaddressed complex trauma, often led to his removal or expulsion from schools. This replication project brought a pivotal change in Rob’s life. The school district employed a dedicated mental health service provider who provided Rob with daily support tailored to his specific needs. The school was able to pay for the provider using Medicaid money already allocated by the state. Rob began to show profound improvement in both his behavior and academic performance. The benefits for Rob were borne out in school-wide data: during the time that the mental health provider was available, there was a 28% reduction in suspensions and a 38% decrease in disciplinary actions.

This Innovation Hub Practice Offers a Beacon of Hope

Like much of the United States, North Carolina is grappling with a mental health crisis exacerbated by both the COVID-19 pandemic and a historical underinvestment in community support systems. Adolescents, in particular, are struggling significantly.

This replication of Project NC AWARE/ACTIVATE through AMCHP’s Replication Projects offers evidence that employing mental health experts in schools is effective for classroom teachers and students. The project aims to encourage more districts to access Medicaid funding for these types of initiatives. Rural Opportunity Institute, a nonprofit in Eastern North Carolina that worked with the school district to secure Medicaid funding for mental health providers, is working with the NC Department of Public Instruction to create a toolkit using the lessons learned in this project. The toolkit documents how the pilot school district successfully implemented the program as a “blueprint” for others to follow while incorporating best practices from experts on Medicaid mental health implementation in other cases. Toolkits are essential for replicating projects like this because school staff are often overwhelmed trying to simply keep up with their existing workload. Without toolkits like this one, it is unlikely that many districts would have the capacity to access Medicaid funding for mental health care in schools, even though NC has allocated that funding.

The two paths to scale up the project’s impact are: (1) sharing information through the Toolkit and to schools that have the capacity to implement it and (2) seeking additional grants for direct technical assistance to provide direct support in implementing the Toolkit for districts with less capacity.

Operational Challenges and How Cultural Competence “Changes the Game”

Implementing this project involves complex, tedious operational work, particularly as it relates to learning Medicaid billing procedures. In many cases, school districts will need dedicated technical support at first to bill Medicaid for mental health care. However, the outcomes were well worth the effort. Hiring culturally responsive, competent therapists has been a game-changer. These professionals connect with students on a deeper level, making them feel safe, seen, heard, and validated. The interventions they deliver are not just trauma-informed—they can be leveraged broadly due to their significant and positive impact on students’ well-being. The Toolkit has the potential to change hundreds of thousands of students’ lives for the better and use already-existing state Medicaid resources to do it.

The Bigger Picture: Learning, Failing, and Succeeding

Participating in the replication project has added value beyond the immediate benefits. For one thing, the project created a network and community where best practices are shared, and support is readily available. Navigating the complexities of Medicaid billing involves a learning curve, where staff are continuously learning, failing, and succeeding. The Toolkit and associated implementation support will spread the lessons learned in this project throughout the state.


The replication project stands as a testament to the power of innovative thinking and dedicated effort in addressing the mental health crisis in educational settings. It shows how targeted support and specialized resources make a significant difference in the lives of students and teachers alike. This initiative shows the potential that a comparatively technical assistance effort has to leverage existing funding to transform the educational landscape across North Carolina and beyond. Within a few years, districts could use the Toolkit to provide desperately needed mental health care for millions more students.