Mental Health Support that Drives Academic Outcomes: Medway Public Schools' Integrated Support System

When Dr. Armand Pires became Superintendent of Medway Public Schools — a 2,200-student district outside Boston — he did what many superintendents in his position had done: he hired more staff. New school counselors. Social workers. Adjustment counselors. Talented people committed to students.

A year later, the numbers hadn't moved. Students with mental health needs were still being seen by five, six, seven different staff members with no coordinating framework between them. Outside providers had waitlists running eight to twelve weeks. Families were agreeing to referrals, and then losing momentum before a first appointment ever happened.

"The real point of recognition for me," Dr. Pires noted, "was that a year into that, there was almost no discernible change in what we were seeing for outcomes."

That moment of recognition set Medway on a ten-year build — one that now includes a formal academic outcomes evaluation and a documented return on investment.

Dr. Pires joined Jillian Kelton, M.Ed., Director of District Engagement at Cartwheel, for a conversation that is the practitioner follow-up to The Double Standard webinar. Where that conversation made the case that mental health support deserves the same systematic rigor as academic intervention, this one showed what it looks like when a district actually builds it.

Note: Medway Public Schools is a current Cartwheel partner. That partnership is referenced openly throughout this recap.

The Framework Behind the Build

Dr. Pires and the Director of Wellness at Medway Public Schools, Ryan Sherman, whose background is in public health rather than traditional school administration, organized Medway's approach around a concept they co-authored in The Fourth Tier: A Practitioner's Guide to MTSS and Mental Health. It argues that the standard three-tier MTSS model is structurally incomplete. The fourth tier isn't more intensive than Tier 3; it's categorically different. It's clinical infrastructure: licensed clinicians, evidence-based therapeutic modalities, and integration with care coordination and insurance systems that schools don't typically have.

"A district leader or school leader has to recognize that it has become — whether we like it or not — our responsibility to either coordinate or provide direct services to students that are going to need ongoing mental health services," Dr. Pires observed.

That shift in thinking, from patching students up to genuinely treating them, is what the Fourth Tier is designed to make possible.

The Four Components of Integrated Mental Health Support

Medway's Fourth Tier has four components. Dr. Pires was transparent that they didn't arrive at this sequence all at once; the build happened over a decade, shaped by what was working and what wasn't.

1. Teletherapy. Medway's partnership with Cartwheel launched in October 2023. The immediate effect was that the 8–12 week community waitlist disappeared. Students who had been edging toward higher levels of need could access licensed clinical support the same week a concern was identified. As of May 2025, Medway students had averaged 15 therapy sessions through the partnership, well past the 6-session threshold the research identifies as where meaningful clinical progress begins. Roughly half of students served had an IEP or 504 plan.

The secondary effect was less obvious but equally important: school counselors had hours back in their week. "We've reduced the amount of time our counselors are spending on the phone trying to coordinate care by two or two and a half hours a week," Dr. Pires noted. "Depending on the size of your district, you're basically adding FTEs, at nowhere near the cost of FTEs."

2. Care coordination. Even when teletherapy solves access, coordination doesn't automatically follow. Medway built a care coordination layer to make sure students don't fall through the gap between identification and ongoing support.

3. In-school outpatient therapy. Not every family was initially comfortable with virtual care. In-school outpatient provides a second entry point: local clinicians with office space in the building, seeing students during the school day, with communication back to school staff where families have given permission. "It removes the barriers and the burden of when kids would typically go to counselors, which is after school, on the weekends, when they're booked solid."

4. Wraparound services. For students whose needs extend beyond clinical therapy, Medway built its own wraparound program. It includes a full-time clinical social worker (deliberately hired outside the teacher's contract, so she can make home visits and calls on evenings and weekends), a bachelor's-level community mentor who accompanies students into the community, and a parent liaison — a community member who has navigated mental health challenges with her own child and can meet other families in that experience.

Dr. Pires has noted that the district's most effective entry point for many families is another parent who has "walked a mile" — someone who understands the confusion and specific barriers families face when their child is struggling. Jillian observed: "Often how we get parents more engaged in schools is when they hear it from their peers."

For districts thinking about how to sequence this work, Dr. Pires's advice was direct: start with access. "Find that quick, frictionless access to a provider. That takes the load off of school counselors to try to figure out how we're going to make this happen." Everything else can be built from there.

The Case to Leadership: ROI Before the Numbers Move

The outcomes data from Medway's 2025 academic evaluation is documented in the Medway Public Schools case study:

• 81% of students receiving teletherapy maintained or improved their GPA, compared to 76% of students not receiving services — a 5-percentage-point lift on the metric boards are watching
• 100% of students showed a significant reduction in depression and anxiety 
• 93% of students reported finding virtual therapy helpful

Dr. Pires was candid about what those numbers do and don't accomplish in a board meeting. Clinical outcomes are meaningful. Academic outcomes move conversations. What moves budget decisions is ROI.

"For every dollar we spend on this work — on these four components — we're seeing $1.72 in return, or preventative costs." Behind that figure is a less visible but equally important one: Medway is interrupting the pathway that would otherwise lead some students out of the district, at costs that dwarf the investment in the integrated support system.

"In schools, we have a tendency to feel good about the work and not measure the work," he observed. The dashboard Medway maintains tracks academic and attendance outcomes by component, updated annually. Most recently, it has surfaced a notable finding: teletherapy is showing stronger academic outcomes than in-school, in-person outpatient therapy. Dr. Pires's working hypothesis is that the flexibility to match a student's specific clinical needs with the right clinician — which teletherapy enables and local provider availability doesn't always allow — is driving the difference. [Source: Dr. Pires's direct statement in the June 11, 2026 webinar, approximately 29:45–30:50 in the recording.]

How to Fund Student Mental Health Support When School Operational Budgets Are Tight

Dr. Pires's honest answer to the funding question is that Medway didn't fund everything at once. They piloted, measured, and made the case incrementally. Ryan Sherman's Director of Wellness position was funded for two years out of School Choice revenue — a source nobody considers sustainable — specifically to demonstrate impact before asking the school committee to make it permanent.

"I don't walk into the school committee meeting and say, we need a million and a half dollars for all of this stuff. We're very deliberate in saying, we're able to identify a grant, or we want to use these available resources to try this thing out."

The other financial reality: having a clear, fully developed framework changes how you see grant opportunities. "The grant that comes across your desk from the State Department of Ed suddenly provides you with an opportunity to fund something that you've been thinking about ahead of time," rather than requiring you to twist the work to fit the grant.

Below is a curated set of funding sources Medway has used, along with nationally available resources for districts in any state. Note that the federal funding landscape has shifted considerably in 2025–2026; federal grants listed here were available at the time of this writing but districts should verify current program status before applying.

Massachusetts-Specific Funding Sources

• MetroWest Health Foundation — Serves 25 communities in the MetroWest region of Massachusetts, including Medway. Biannual grant cycles with priority areas including adolescent mental health. Accepts unsolicited applications; a concept paper is required before a full proposal.
• Massachusetts Department of Public Health — Community Health and Healthy Aging Funds and other state-administered grants that school districts in Massachusetts can access directly or through community health partnerships.
• Massachusetts Department of Elementary and Secondary Education (DESE) — State-level competitive grants for Massachusetts districts focused on MTSS, SEL, and school mental health. Check the DESE grants page for current opportunities.
• Massachusetts Legislative Earmarks — Dr. Pires noted that Medway has accessed earmarked state budget funds. District leaders in Massachusetts with strong legislative relationships may be able to request earmarks for mental health infrastructure.
• Norfolk County District Attorney's Office — Community-facing grants and partnerships relevant to Massachusetts districts in Norfolk County.
• Community Health Network (CHNA-6) — Regional health network in Massachusetts offering grant funding for community health programs in the MetroWest and Greater Milford area.
• Mass General Hospital / Diversion Programs — Hospital-based community benefit programs and diversion grants; districts with hospital partnerships may be able to access clinical support funding.
• Project HERE — A Massachusetts initiative supporting high-need students. 

Nationwide Funding Sources

• Parent-Teacher Organization (PTO/PTA) — PTOs and PTAs can designate funds for mental health programming. Many districts have successfully partnered with their PTO to seed pilot programs before seeking larger grants.
• School District Education Foundation — Many districts have affiliated education foundations or community foundations that fund innovation in student support. If your district has one, it can be a nimble early source of funding for piloting new components before moving them into the operational budget.
• The JED Foundation — JED has partnered with AASA (The School Superintendents Association) to offer a two-year District Mental Health Initiative for pre-K–12 school districts nationwide. The program includes assessments, strategic planning, and implementation support, with funding opportunities available for eligible districts.
• AASA: The School Superintendents Association — In addition to the JED partnership, AASA regularly provides grant resources and program funding for member districts.
• CDC Drug-Free Communities Grant — Federal grant program administered through the CDC supporting community coalitions that reduce youth substance use, which often intersects with mental health infrastructure.
• SAMHSA STOP Act Grant — A federal grant program through the Substance Abuse and Mental Health Services Administration (SAMHSA) designed to support community-based substance use and mental health programs, including school-based initiatives. Federal SAMHSA funding has experienced significant volatility in 2025–2026; districts should verify current program availability and status before planning around this source.

What Integrated Mental Health Support Looks Like Over Time

The question that surfaces in nearly every district considering this work is whether they can afford it. Dr. Pires reframes it: the question is what it costs to keep doing things the way they are.

"We often separate these two worlds. The academic world is obviously our primary focus — but we have an obligation to make sure we're educating kids holistically. We might be able to patch them up and get them through high school. But what are those outcomes? We need to think about these things in connection to each other: what's the academic goal, how are we going to make that happen, and how are we going to make sure that we provide support for students' social-emotional development — including meeting their mental health needs?"

Jillian closed the conversation with a challenge that every district leader in the room could take back to their team: "When a student is struggling, do we have a system that catches them before a crisis?" Medway's answer is yes. And the students inside that system are showing up to class, maintaining their grades, and feeling better.

Medway built this without waiting for perfect conditions. They started with teletherapy — one component, one access point — demonstrated the impact, and expanded from there. The model doesn't require a perfect MTSS, a large district, or a fully formed plan. It requires a decision to start measuring what's already happening and building from that foundation.

The academic outcomes Medway documented aren't a byproduct of the mental health work. They're the result of treating mental health support as academic infrastructure — not a parallel system, but part of the same investment. That's the replication opportunity for districts ready to make it.