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.

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.

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.

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?

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.

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.

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