Economic Evaluation of School-Based Mental Health Systems (2023-2024)


There is a rising need for mental health care for youth amid a dire shortage of mental health providers. In 2021, the American Academy of Pediatrics and other relevant medical associations declared a national emergency in child and adolescent mental health.

While there are effective, evidence-based practices to address mental health concerns, the current system of connecting children with the supports they need is insufficient. One way to increase equitable access for all children is to embed these interventions into schools. To reach young people where they are, it is imperative to implement, evaluate and advocate for sustainable programs that deliver evidence-based mental health practices in schools.

North Carolina Project AWARE (Advancing Wellness and Resiliency in Education) is an intervention that employs mental health programs in a multitiered system of supports via promotion, prevention and intervention. It has been realized in six counties throughout the state. Currently, Project AWARE is fully funded by grants from the Substance Abuse and Mental Health Services Administration. Ultimately, state policymakers will decide whether to continue funding and scale the program. 

Project Description

This project aims to carry out a benefit-cost analysis of Project AWARE focusing on its first cohort, including schools in Beaufort, Cleveland and Rockingham counties that are entering their fifth year of implementation. Team members will collaborate with community partners throughout this process.

To understand the costs and benefits of the program, the team will perform a detailed review of the implementation of Project AWARE in each district. Comparison districts with similar attributes will be identified to analyze counterfactual data. Team members will work with participating districts to identify a theory of change for each intervention they have implemented, providing a framework to account for hypothesized benefits to students, families, teachers or administrators engaged in the intervention.

Ultimately, the project seeks to provide not only data on the benefits, costs and scaling potential of Project AWARE, but also a methodology that others can use to evaluate similar programs across the United States.

Anticipated Outputs

Outline of methodology for benefit-cost analysis; list of implementation components; methods paper; data to advocate for state funding for sustainability and expansion

Student Opportunities

Ideally, this project team will include 2-3 graduate students and 7 undergraduate students. Undergraduate students with a background or interest in economics, education, mental health, social work, statistics, policy or healthcare would all add value to the team. Graduate students in the areas of economics or statistics would be preferred. 

Students will have the opportunity to work closely with community partners and experience how their work can tangibly affect policymaking decisions. They will also gain understanding about school systems, rigorous research methodology, mental health programs and the economics of education. Students will foster skills in literature review, evaluating measures and contributing to a peer-reviewed publication, and will likely be offered opportunities to present their individual contributions at relevant conference poster sessions. Graduate students will gain leadership experience and see how their skills in economics and statistics can be applied to real-world issues.

In Fall 2023, this team will meet on Thursdays from 4:00-5:15 p.m.

Undergraduate students who choose to participate in the summer component should expect to work about seven hours per week for eight weeks. (Please note that this summer component is encouraged but not required.)

Zoe Waddell will serve as project manager.


Summer 2023 – Spring 2024

  • Summer 2023 (optional): Begin literature review; make inventory of district implementation activities; outline costs related to implementation; begin mapping theory of change
  • Fall 2023: Continue literature review; identify economic value of measures relating to costs and benefits; begin planning statistical analysis; begin drafting paper for peer-reviewed publication
  • Spring 2024: Finalize methodology; submit paper for publication


Academic credit available for fall and spring semesters; summer funding available

Project Activate.

Team Leaders

  • Jeylan Close, School of Medicine– Psychiatry
  • Nicole Lawrence, Sanford School of Public Policy-Center for Child and Family Policy

/graduate Team Members

  • Zoe Waddell, Population Health Sciences-MS
  • Jonathan Wang, Masters of Public Policy

/undergraduate Team Members

  • Anjali Kapadia, Public Policy Studies (AB)
  • Job Trahan, Psychology (BS)

/yfaculty/staff Team Members

  • Heather King, School of Medicine-Population Health Sciences

/zcommunity Team Members

  • Heidi Austin, NC Project AWARE
  • Brooks Bowden, Graduate School of Education at the University of Pennsylvania
  • Ryan Etheridge, NC Project AWARE
  • Jane Fruehwirth, Department of Economics, UNC-Chapel Hill
  • Lara Gastelumendi, Undergraduate Student-UNC Chapel Hill
  • Clayton Lawrence, Undergraduate Student, Bridgewater College
  • Laura Muse, NC Project AWARE
  • Catharine Warner-Griffin, AnLar