How is this different from school counseling?

Cartwheel provides clinical mental health treatment from licensed therapists specializing in school avoidance, which differs from school counselors who focus on academic and social guidance. Our clinicians are specifically trained in evidence-based approaches for school refusal and anxiety disorders.

What is the difference between school avoidance and truancy?

School avoidance is driven by emotional distress such as anxiety, depression, or trauma, where students want to attend but struggle due to mental health barriers. Truancy typically involves willful absence without emotional distress as the primary cause.

How quickly can students access services?

Students can typically access services within 7-10 days of referral.

Does Cartwheel provide full-spectrum treatment?

Yes, Cartwheel provides comprehensive mental health care including individual therapy, parent guidance, psychiatric evaluations, and medication management when needed.

Is teletherapy effective for school avoidance?

Yes, teletherapy has proven effective for treating school avoidance. It provides accessible, convenient care that removes barriers to treatment and allows for flexible scheduling.

How are outcomes measured?

Outcomes are measured through validated clinical assessments, attendance data tracking, and the School Refusal Assessment Scale (SRAS) to monitor progress throughout treatment.

Is medication management available?

Yes, psychiatric evaluations and medication management are integrated into the program when clinically appropriate.

What is expected of families?

Families are expected to be committed to regular participation, seek guidance actively, and serve as active treatment partners in their child's care.

What is required of school staff?

School staff coordination involves collaboration with Cartwheel clinicians to support student progress and implement recommended accommodations.

Is the program compatible with IEP/504 plans?

Yes, the program is fully compatible with IEP and 504 plans and can support documentation and recommendations for educational accommodations.

Case Study: Achievement First

Case Study: Achievement First

Achievement First Students Receiving Cartwheel Services See 38% Drop in Chronic Absenteeism

81% of students maintained or improved their behavior after Cartwheel

73% of students with prior suspensions had zero suspensions afterwards

Measurable results for students and schools

Achievement First is one of the largest urban charter networks in the country—41 schools across Connecticut, New York, and Rhode Island, serving 15,000 students. The majority of students are Black, Latinx, and from low-income families.
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Achievement First was navigating a challenge shared by many large networks: growing student mental health needs and not enough resources to meet them. Long waitlists, language and cultural barriers, and limited access to culturally responsive clinicians were leaving students without the tier 2 and tier 3 support they needed to stay in school and succeed.
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Achievement First was looking for a partner who could fit into their existing MTSS model, deliver linguistically and culturally matched care across three states, reduce burden on school staff, and provide data to demonstrate impact.

Download Case Study

Achievement First Public Charter Schools network across NY, CT, RI

15,000 students across 41 schools

76% free/reduced lunch

Sample size of 28 students who attended 6-15 therapy sessions with Cartwheel during the 2023-24 and 2024-25 school years (about the avg. and median # of Cartwheel sessions in the district). First bar shows % of students attending 6-15 Cartwheel sessions who were chronically absent in the year they were referred for services. The second bar shows chronic absenteeism rate in the school year after they started therapy for kids who attended 6-15 sessions. Chronic absenteeism defined as missing at least 10% of school days within an academic year.

Absences per Student
Before vs. After Cartwheel

↓ 38%

Reduction in chronic absenteeism

↑ 81%

Students maintained or improved behavior

↓ 55%

Reduction in absences

↓ 73%

Reduction in students with prior out-of-school suspensions

“This partnership allows us to keep our students in the building. It helped them with their wellness. It helped them build their confidence, and it helps remove barriers to academic and social achievement. And that's what you want to be investing in.”

Tiffany Bostic, LCSW

Chief of Support Services, Achievement First

What This Meant for Salem Public Schools

More Instructional
Time

More students in the building means more learning time and stronger accountability metrics across the network

Improved School
Climate

Fewer suspensions and behavioral incidents means less disruption for all students and staff

Better Resource
Allocation

School counselors and social workers have more capacity for tier 1 and tier 2 supports

Stronger Family
Engagement

Culturally matched, native-language therapists help families engage with care and reduce mental health stigma.

Why Achievement First Needed a Different Approach

Like charter networks nationwide, Achievement First recognized growing student mental health needs—and the barriers families faced accessing care.

Before Cartwheel, students needing tier 2 and tier 3 support faced:

Months-long waitlists for outside providers

Limited access to culturally responsive clinicians who could build trust and reduce stigma

Language and cultural barriers limiting access for non-English speaking families

Overwhelmed school staff managing increasing crises with limited clinical resources

The consequences showed up in the data: elevated suspension rates, rising chronic absenteeism, and students falling behind academically. Without timely intervention, unmet mental health needs were contributing to disruptions in learning—not just for individual students, but across the network.

“Cartwheel stepped in to fill that gap—closing what would be a very long waitlist for our families regardless of insurance by providing native language therapists, therapists who look like them, who knew their culture, who speak their language, who know their norms, and can help provide and break down stigma when it comes to mental health support.”

Tiffany Bostic, LCSW

Chief of Support Services, Achievement First

School Avoidance Program

Students with Mental Health Needs Miss Twice as Many Days of School

Cartwheel's specialized School Avoidance Program helps students address the challenges at the root of chronic absenteeism—so they can confidently return to school.

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What Makes Cartwheel Different

Achievement First partnered with Cartwheel to remove barriers, integrate with school teams, and address the root causes of attendance and behavior challenges.

Specialized for school outcomes

Therapy, psychiatry, and family support focused on school avoidance, anxiety, depression, and behavioral challenges.

Rapid access to care

Students are matched with clinicians in 7–10 days instead of waiting months.

Integrated with school teams

Ongoing collaboration with counselors and social workers, shared strategies, and real-time progress updates.

Sustainable through insurance

No costs for families on Medicaid; in-network with military and commercial insurers.

Multilingual care

Students are matched with a clinician who speaks their native language.

“Cartwheel is the best kind of partner. They are well informed in how school districts work, what our funding looks like, what we're able to do, what we are not able to do. They understand the way that schools function, especially from the financial end—and they are open to adapting to the needs of their clients.”

Tiffany Bostic, LCSW

Chief of Support Services, Achievement First

Achievement First Students Receiving Cartwheel Services See 38% Drop in Chronic Absenteeism

Absences per Student
Before vs. After Cartwheel

“This partnership allows us to keep our students in the building. It helped them with their wellness. It helped them build their confidence, and it helps remove barriers to academic and social achievement. And that's what you want to be investing in.”