1. Issues and Opportunities in the Organization and Financing of Mental Health Services in School
Julia Graham Lear, Center for Health and Health Care in Schools, The George Washington University
MacArthur Foundation Mental Health Network Meeting, Miami Beach, FL
December 6, 2001

2. Mental health services in schools: an overview
Lurking issues in school-based mental health services
Current approaches to service delivery
Organization-of-care issues
Financing challenges
Related activities
Possible directions for MacArthur Network

3. Lurking issues in school-based mental health services
Population-targeted practice v. individual-targeted practice?
What are the 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 agenda?

4. Current approaches to service delivery
School -system organized care
School-based health centers
School-based mental health services

5. Organization-of-care issues
Who’s in charge?
Clinical practices: methods, quality measurement, confidentiality, parent consent
Staffing: credential and training requirements, continuing education, union issues

6. Financing challenges
Multiple sources of funding: state grant funds; Medicaid; managed care -- carve outs, carve-ins, falling in-between; local health and education budgets
Meeting requirements of funding agencies
Ability of provider organization to bill and collect from 3rd party payers
Reluctance of primary care providers to diagnose children with billable disorders

7. Thinking ahead: Related activities
The Survey of the Characteristics & Financing of School Mental Health. Abt Associates, SAMHSA funded.
Depression in Primary Care: Linking Clinical & System Strategies. RWJF multi-site grant program.
Caring for Kids: Expanding Mental & Dental Health Services through School-Based Health Centers. RWJF multi-site grant program

8. Possible directions
Synthesis of post SGR work: at national, state & local level
Research opportunities: content of school-based mental health care, patient care outcomes
An invitational workshop for Mental Health Commissioners, researchers & educators: to discuss demonstrations & test political and financial feasibility of expanding mental health services in schools