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, SPHHS, The George Washington University Medical Center
Board on Children, Youth,and Families, National Academy of Sciences, May 20, 2004

2. Mental health services in schools: an overview
The school setting
Basic questions in school-based mental health services
Current approaches to service delivery
Organization-of-care issues
Financing challenges

4. The School Setting
School system structure -- locally & state driven & funded, with federal government paying about10% of total cost of elementary/secondary schooling. States & localities, and private sources provide 48%, 42%, and 9% respectively.
Unlike health care, local communities may take active role in deciding what programs and services are allowed in schools (Community elects school board, votes on special funding referenda)

5. 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 -- including school system-organized care, school-based extensions of community-based mental health programs, & school-based health centers.

6. Basic questions in school-based 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 agenda?

7. Current approaches to school-based service delivery
School -system organized care
School-based health centers: primary care & mental health
School-based mental health services

8. 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

9. 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