Caring for Kids:

1. Caring for Kids: Expanding Mental Health Services for Children through School-Based Health Centers Julia Graham Lear, PhD The Center for Health & Health Care in Schools GWU School of Public Health and Health Services November 12, 2002 The Center for Health and Health Care in Schools

2. Children’s Mental Health Needs As described in the Surgeon General’s Report on Mental Health, unmet mental health needs among children are substantial. On average, only 25% of those needing care, get the help they need. Minorities have less access to mental health services and are less likely to receive needed care. The Center for Health and Health Care in Schools

3. Mental Health Disorders and the Number of Children and Youth CMHS. Mental, emotional, and behavior disorders in children and adolescents. The Center for Mental Health Services. Accessed at www.mentalhealth.org/publications/allpubs/CA-0006/default.asp The Center for Health and Health Care in Schools

4. The Role of Schools Research suggests that schools may function as the de facto mental health system for children & adolescents Of those children receiving mental health care, 70-80% receive that care in a school setting. A large percentage of schools report providing case management and mental health services. The Center for Health and Health Care in Schools

5. Service Provider Arrangement School Relationship Provider Type Services Barriers Special Education Hired by school or school district School Psychologists Special Education Testing, IDEA implementation Time spent on testing, not accessible to all students Stand Alone Sch Program School or school district hires providers or program Social Workers, child psychologists, teachers Counseling, Interventions for specific mental health issues Stigma, Time, Program cost Community Linked School or school district contracts with organization for the provision of services Social Workers, child psychologists, psychiatrist, crisis counselors Varied – crisis/ as needed to comprehensive mental health services Not linked to other school services, providing as needed does not address issue of lack of services Other Service Provider Options May occur on school premises but not during school hours Varied Varied Not always linked to school services, may not reach all needy children School Based Health Centers Located at or near schools Varied Varied Funding and space Mental Health Service Providers in Schools The Center for Health and Health Care in Schools

6. School-Based Health Centers Characteristics: Sponsored by mainstream health care organizations; offer a comprehensive range of services provided by qualified health professionals;generally require parental consent; work with school health personnel, and supported by community advisory committees Mental health: About 80% provide crisis intervention services, more than 60% have mental health professionals on staff, 55% offer violence prevention programs The Center for Health and Health Care in Schools

7. Preliminary Data from CHHCS State Survey of SBHCs Nearly 1500 SBHCs across the country 36% in high schools, 18% in middle schools, 37% elementary schools, 3% k-12, 4% other. 61% are located in urban communities, 27% in rural communities, 12% in suburbs 54% full-time, 46% part-time Leading states: N Y (170 ), CA (135) , AZ (97), FL (89), CT (68), MA (67), TX (63), MD (57), LA (53), MI (53) The Center for Health and Health Care in Schools

8. The Robert Wood Johnson Foundation and Caring for Kids A 25-yr history of support by RWJF for school-based health centers Opportunity to reduce disparities by focusing on schools that enroll historically-underserved populations Purpose of grant program: to increase access to mental & dental health services for underserved children and to reduce disparities in access to care. The Center for Health and Health Care in Schools

9. Caring for Kids: Expanding Mental Health Services through SBHCs $3.4 million grant initiative funded by RWJF Grants awarded February 2002; 3-year grants 15 funded sites: 8 mental health; 7 dental health Goals for mental health projects: to support development of sustainable models; increase available mental health services, and connect services to relevant public and private programs & policies The Center for Health and Health Care in Schools

10. Caring for Kids: Program Experience Applications invited for three models of service: prevention programs, expanded mental health services, integrated community/school-based mental health programs. 56 grant applications received. The Center for Health and Health Care in Schools

11. Types of Expanded Mental Health Programs Psychiatry consultation programs. Focus: increase availability of “deep-end” services & medication management skills. Seattle/King County, U of New Mexico, Lynn CHC. Expanded clinical social work modelsFocus: formalize procedures for patient identification & sharpen treatment plans. Dorchester County HD, Buncombe County HD, Children’s Aid Society. Expanded services using psychologists, psych externs. Focus: improved reimbursement. Schneider Children’s Hospital-LIJ, CHLA. The Center for Health and Health Care in Schools

12. Benefits of Building on Existing SBHCs Use of existing administrative & management structure may reduce start-up cost & increase odds of success Co-locating mental health with primary care may reduce stigma Locating in school enables mental health staff to observe & work with children in classroom School location facilitates mental health staff taking a population-focused approach, work with whole school -- faculty, admin, parents & students The Center for Health and Health Care in Schools

13. Early Lessons Adopting new structures & processes is hard Developing a cross-disciplinary mental health practice is hard Defining the roles of medical staff in providing mental health services is hard Learning to partner with school personnel to develop a population-focused practice is the hardest challenge of all. The Center for Health and Health Care in Schools

14. Contact Information The Center for Health and Health Care in Schools 1350 Connecticut Avenue, NW Suite 505 Washington, DC 20036 202-466-3396 202-466-3467 fax www.healthinschools.org The Center for Health and Health Care in Schools