1. 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

2. 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
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3. 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
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4. 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.
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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.
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6. 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?
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7. 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
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8. 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
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
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9. 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.
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10. 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?
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11. 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