1. Expanding Mental Health Services at School: Lessons from the Caring for Kids Grant Initiative
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, Washington, DC
National Assembly on School-Based Health Care, Annual Conference,
June 15, 2006, Portland, Oregon

2. Outline RWJF Caring for Kids Grant Program Grantee experience
Goals/History/Program design
Data collection
Grantee experience
Staffing
Services
Patient care revenue
Lessons learned

3. RWJF Caring for Kids Grant Initiative
Goals
Expand mental/dental health services
Move towards sustainable models of care
History
2001 grant announcement
organizational eligibility
fundable strategies
Jan mental health grant awards
17 participating schools/sbhcs -- 9 h.s., 6 m.s., 2 combined m/h.s.
All funded sites chose to expand services rather than develop community-school partnerships or school-SBHC partnerships

4. RWJF Caring for Kids Grant Initiative, #2
Data collection
Components
Rationale for the “Snapshot Quarter
Challenges in data collection and analysis
Management without a net, ie. data
Lack of consensus on importance of certain data, eg. Mental health diagnoses

5. Overview of Grantee SBHCs
School enrollment: Total - 24,003; median enrollment h.s. = 1,610, m.s. = 860
SBHC enrollment: 15,394 (64.1%). Range was 86% - 12% of school population
Snapshot quarter: Clinic users = 5605, visits totaled 17,023. Mental health visits totaled 5,499 (32% of all visits)

6. Core Mental Health Staffing
LCSWs: 5 of 6 m.s., 9 of 9 h.s., >35 hrs/week
Prevalence of social work in SBHC mental health
Importance of licensure
# of hours per week
Psychiatry: 13 of the 17 sites had several hrs of a psychiatrist’s time monthly
Mix of other MH professionals: clinical nurse specialist, 4 psychologists, psychologist & social work interns

7. Mental Health Services by School Level (Jan-Mar 2004) Data from all sites, CPT Coding
Middle Sch
# of visits
High Sch
Individual psychotherapy
1685 (79%)
1725 (59%)
Group interventions
370 (17%)
1032 (35%)
Case management
53 (2%)
178 (6%)
Medication management
35 (2%)
4 (<1%)

8. Mental Health Diagnoses by School Level, Jan-Mar/2004 #1 ICD-9 categories
Diagnostic category
Middle School (2)
Pri Diag All Diag
High School (8)
Pri Diag All Diag
Academic & LD
Anxiety Disorder
Conflict Disorders
Depression/Mood Disorders

9. Mental Health Diagnoses by School Level 1-3/2004 # 2 ICD-9 categories
Diagnostic category
Middle School (2)
High School (8)
Eating Disorders
Mental Health other
Physical/Sexual Abuse
Substance Abuse
Social Service

10. Health Insurance Status of Students Enrolled in SBHCs, Jan-Mar/2004 N = 8,407
Payment source # of students %
Medicaid FFS %
Medicaid MC %
SCHIP %
Other gov’t programs %
Private insurance %
Uninsured/self-pay %
Unknown %

11. Patient Care Revenues for Mental Health Services, Jan-Mar 2004 4 of 8 projects billed
Payment source Billed Collected
Medicaid FFS , ,615
Medicaid MC , ,083
SCHIP
Other gov’t programs 1,
Private insurance ,
Uninsured/self-pay
Total $136, $90,642

12. Caring for Kids: Lessons Learned #1
Creating access to care is a multi-part process and locating services within a school with underserved students is only the first step toward reducing unmet need.
Gender is an access issue
Service delivery mechanisms are another access issue (individual therapy v. group work v. consultation)

13. Caring for Kids: Lessons Learned #2
Expanding case management & medication management
Assessing the meaning of MH diagnoses --
are SBHCs located in schools where few or no students have alcohol or other drug issues?
Are we comfortable with few or no education-related diagnoses (excepting ADHD)
Integrating physical health and mental health, even in an SBHC, is a challenge

14. The Center for Health and Health Care in Schools
2121 K Street, NW, Suite 250
Washington, DC 20037
(fax)
School of Public Health and Health Services, The George Washington University Medical Center