Supporting Children Through Mental Health Care at School Julia Graham Lear, PhD Research Professor, Department of Prevention and Community Health, and Director, Center for Health and Health Care in Schools, SPHHS, The George Washington University Medical Center Grantmakers for Children, Youth and Families, Annual Conference, September 27, 2005, Denver, Colorado

Mental health care in schools: an overview Context: The school setting Opportunities at school and key issues to consider Current approaches to service delivery Lessons from a Foundation school-based mental health initiative - 2 -

School Health Services & Prevention Programs Policy Program Planning & management School Board Community Parents Voters based providers Superintendent Associate Superintendent Facilities Associate Superintendent Pupil Support Associate Superintendent Special Education Associate Superintendent Academic Affairs Principals Services & prevention School mental Health program - Individ. & group counseling - Family - Teacher consultations School-Based Health Center - Physical health - Mental - Nutrition School Nurses Health Aides Guidance Counselors Mental health professionals Testing for Special Ed. placement School psychologists Related Services - Mental health - OT/PT - Health Services - Health education - Physical -Recess Policy Program Planning and Management Community-based sponsor: - Health system - Community health center - Health department - Hospitals Community-based sponsor: - Community mh center - City/county mh dept. - Other human services organizations The Center for Health and Health Care in Schools 2121 K Street, NW, Suite 250, Washington, DC 20037 www.healthinschools.org copyright©2005 Send permissions for reprint to chhcs@gwu.edu or call 202-466-3396. - 3 -

Context: the School Setting School system -- locally & state driven and funded. Federal government pays about 10% cost. States & local governments, and private sources provide 48%, and 9% respectively. Unlike health care, local communities may take active role in deciding what programs and services are allowed in schools. - 4 -

Opportunities in a School Setting A school “base” enables providers to overcome access barriers for most children. 52 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. - 5 -

Basic decisions in building school mental health services Population-targeted practice v. individual- targeted practice? What services to be offered? Prevention? Screening? Diagnosis? Short-term interventions? Long-term services? Whose goals? Is mental health care in schools supporting an education agenda or a health a agenda? - 6 -

Current school-based health and mental health programs School-system organized care School-based health centers: primary care & mental health School-based mental health services - 7 -

Lessons from a Foundation School-Based Mental Health Initiative Caring for Kids: An RWJF grant initiative RWJF-funded program: Caring for Kids: Expanding Mental and Dental Health Services through School- Based Health Centers. 2001-2005 History: data from 3-yr program, 8 mental health grantees, 17 schools Objectives: Expand mental health services organized by SBHCs, reduce barriers to care and strengthen quality Build on existing resources in school and in the community - 8 -

Outcomes from Caring for Kids CFK outcomes: With grant support, SBHCs hired more mental health staff--LCSWs, psychologists, and CNS to provide services. During the Jan-Mar 2004 quarter, the 17 participating schools served 5,605 students and provided a total of 16,853 visits. Mental health visits = 5,321 in that quarter. Male students accounted for 56% of counseling visits in middle schools and 24% in high schools. Individual counseling represented 79% of total visits in middle schools and 59% of visits in high schools. - 9 -

Caring for Kids: Lessons Learned Questions to consider in program development: How is need measured and how are project services linked to student needs? If there is much unmet need, how can new resources be used to greatest effect? When hiring new mental health staff, how will the project assure that staff are trained to do what the project proposes? Are adequate resources allocated to program management? - 10 -

The Center for Health and Health Care in Schools  2121 K Street, NW, Suite 250 Washington, DC 20037 202-466-3396 202-466-3467 (fax) jgl@gwu.edu www.healthinschools.org School of Public Health and Health Services, The George Washington University Medical Center