1. Children’s Mental Health: Current Challenges and a Future Direction Sarah Olbrich MPH Candidate, George Washington University The Center for Health and Health Care in Schools June 7, 2002

2. Objectives Background on Children’s Mental Health – Statistics – Disorders – Traditional service provision A New Approach to Children’s Mental Health Services: School-Based Health Centers (SBHC) – Types of services provided – Types of mental health services and providers – Why SBHC-sponsored mental health services are a gold standard Opportunities and Challenges

3. Statistics 20% of children ages 9-17 have a diagnosable mental, emotional, or behavioral disorder (1) 70% of children with a diagnosable disorder do not receive mental health services (2) Minority populations are less likely to have access to mental health services (1,2) Greater than 50% of low-income children are at risk for a mental health problem (3) 1) US DHHS. Executive Summary. Mental Health: A Report of the Surgeon General. 1999 2) RAND. Health Research Highlights: Mental Health Care for Youth. 2001 3) Adelman H., Taylor L. Guidebook: Mental Health and School-Based Health Centers. The School Mental Health Project. The Center for Mental Health in Schools

4. The Prevalence of Common Mental Health Disorders Affecting Children and Youth DisorderNumber of Children/Youth Affected Anxiety8 to 10 out of 100 Conduct7 out of 100 Depression6 out of 100 Learning5 out of 100 Attention5 out of 100 Eating1 out of 150 Substance AbuseNot known 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

5. Current Mental Health Services There are four sectors in which children in need of mental health services can receive care: – the specialty mental health sector – the general medical/primary care sector – the human services sector – the voluntary support network sector

6. Limits of Current Mental Health Service Arrangements Do not meet the need – Mental health system capacity – Provider Shortage – Insurance Coverage Schools have become the de facto source of mental health services for children

7. Schools as Mental Health Service Providers Service Provider Arrangement School RelationshipProvider TypeServicesBarriers Special EducationHired by school or school district School PsychologistsSpecial Education Testing, IDEA implementation Time spent on testing, not accessible to all students Stand Alone School 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 LinkedSchool 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 Not always linked to school services, may not reach all needy children School Based Health Centers Located at or near schools Varied Funding and space

8. School-Based Health Centers 1500 SBHC nationally Provides primary care, intervention, and mental health services Can provide comprehensive mental health services Decreased stigma associated with mental health services 60% of SBHCs have mental health professionals on staff 80% of SBHCs provide crisis intervention services

9. Mental Health Services and Providers in SBHCs Services – Assessment – Counseling (group & individual) – Intervention Providers – Clinical Social Worker (36%) – Mental Health Unspecified (18%) – Psychologist (12%) – Substance Abuse Counselor (8%) – Psychiatrist (4%) Source: Census of the National Assembly on School-Based Health Care, NASBHC, Washington, DC 2000

10. Strengths and Weaknesses to Mental Health Care Via SBHC Strengths – Accessibility – Decreased Stigma Weaknesses – Provider Shortage Remains – Funding Problems Remain – Dependent on School Collaboration

11. Funding Issues SBHC – Grants (Federal, State, Local, Private) – 3 rd Party Reimbursement – In-Kind Contributions from Community SBHC Mental Health – Grant – 3 rd Party – Parity Issues

12. State Policy Support for Reimbursing SBHC SBHC are eligible for Medicaid reimbursement in 36 states SBHC are eligible for SCHIP reimbursement in 30 states SBHC contract with Medicaid managed care in 17 states

13. SBHC Mental Health Services Reasons for Optimism – Strong State Support – Increased Public Awareness of Children’s Mental Health Columbine Shootings Effects of WTC Attack on NY City School Children Reasons for Concern – Complexity of Funding – On-going Provider Shortage

14. The Future of Mental Health and SBHC SBHC are increasing the number of mental health providers and services in schools Decreased numbers of children with unmet mental health needs Reaching goals of Healthy People 2010

15. For More Information The Center for Health and Health Care in Schools www.healthinschools.org Center for Mental Health Services http://www.mentalhealth.org/cmhs/ Mental Health: The Surgeon General's Report http://www.surgeongeneral.gov/library/mentalhealth/toc.html#chapter3 National Institute of Mental Health http://www.nimh.nih.gov University of Maryland Center for School Mental Health Assistance http://csmha.umaryland.edu/ School Mental Health Project http://smhp.psych.ucla.edu