Opportunities in a School Setting

1. Evidence-Based Practice in a School-Based Setting: Opportunities, issues, and possible directions Julia Graham Lear, PhD, Director, Center for Health & Health Care in Schools, The George Washington University, Washington, DC. The MacArthur Foundation Mental Health Network. Chicago, IL. July 17, 2002. www.healthinschools.org

2. Opportunities in a School Setting • A school “base” enables providers to overcome access barriers for most children. 50 million American children and youth between ages 5 and 17 attend school; 90% attend public schools. • Perversely, economic and racial segregation in schools enables targeting on those populations with greatest need. • Many school districts, especially the largest, have established mental health-service arrangements -- including school system-organized care, school-based extensions of community-based mental health programs, & school-based health centers. www.healthinschools.org

3. Challenges, difficulties and just plain problems • Strengthening mental health interventions is low on school principals’ priority list and principals rule. • Participating in a mental health study may not be a priority for mental health professionals because they may have less time for student interventions than is indicated on paper. • Shortage of mental health providers may lead to IEPs under-identifying the mental health needs of students & thus students may not be eligible for service. • The strength and quality of the school system’s supervisory structure for mental health professionals in school are highly variable. www.healthinschools.org

4. Recurring issues in school-based mental health • Who to serve? Population-targeted practice v. individual targeted practice? Disadvantaged populations? • What services to offer? Prevention? Screening? Diagnosis? Short-term or long-term interventions? • How to serve? Are tools & interventions validated with target populations? • Whose goals? Does mental health care in schools support education objectives or health objectives? www.healthinschools.org

5. Who to serve, what problems to address? • The issues that mental health professionals in school-based health centers identify as needing greater attention and more effective interventions: Depression and ADD/ADHD Anxiety disorders. • Depression and ADD/ADHD have been identified as sentinel conditions on the CQI tool for school-based health centers. www.healthinschools.org

6. Increasing Likelihood of Study Success in a School Setting • Hold a competition for study participation • Precede the study with researcher-observations of the school setting. Identify disparities between the paper description and actual workday of the mental health staff. • Beware of school systems that may be transferring funding for school-based mental health providers from the superintendent to the discretion of principals. • Consider involving school-based health centers. There are more than 1500 around the country; they offer mental health care in a multi-disciplinary environment. www.healthinschools.org

7. Increasing Study Impact • Invite larger group to review study design; solicit input from parents, teachers, school policymakers, and school-based professionals • Lay the groundwork for a demand-driven strategy for strengthening mental health services in schools www.healthinschools.org