According to the School-Based Health Alliance, “Staggering numbers of children with mental health needs do not receive appropriate services. By conservative estimation, approximately 20% of youth need mental health intervention; some estimates range as high as 38%. When children do receive mental health services, it is most likely to occur not in the specialty mental health sector but in public schools (Rones & Hoagwood, 2000; U.S. Department of Health and Human Services, 1999, 2001).”
Collaborative school-based initiatives may provide integrated behavioral care to underserved populations in ways traditional models cannot and can achieve positive outcomes not only in emotional well-being, but in increased attendance, decreased suspensions, etc. For example, when Milwaukee-based Aurora Family Service and Aurora School-Based Health teamed up to develop an integrated model for the school system, assigning counseling interns and nurse parishioners to public and parochial elementary schools, 38% of referred children demonstrated a reduction in school absences in the three months following counseling intervention according to their reports.
For a comprehensive examination of collaborative efforts for the treatment of young children and their families, see “Partnership Between Primary Care, Mental Health and Substance Abuse for Young Children and Their Families” by Elisa Rosman et al. from Georgetown University.
California Initiatives
The Integrated Behavioral Health Project (IBHP, this website’s host) and LA Health Action collaborated to foster the development of an integrated behavioral and physical health model for schools. Their resultant report, Creating an Integrated School Health Center Model: The Los Angeles Experience, Accomplishments, Lessons Learned and Recommendations, was published in January, 2011.
The Los Angeles County Board of Supervisors established board policy to pursue integrated school health centers as a strategy for improving the health status of children and communities. The 2009 Model Standards for Integrated School Centers in Los Angeles County can serve as a self-assessment tool as well as a quality improvement measure for gauging integrative programs.
Alameda County is building a school health center network supported by county funding and the co-location of mental health services on school campuses. It currently is expanding its model to create ten middle school health centers. The effort is a partnership among county government, Kaiser Permanente, the City of Oakland, Oakland Unified School District and philanthropy. The middle school health centers will address the health, emotional and social development of students. More information is available at acschoolhealth.org
The California School Health Centers Association provides start-up information as well as tool kits and technical assistance, some of it free to the public and some free to members only.
In Los Angeles, the LA Trust is collaborating with the LAUSD student Health and Human Services Division to increase student access to health and mental health services.
Initiatives in Other States/Regions
Many states support the development and funding of school-based health centers as a strategy for improving access to care, student educational outcomes and life trajectories. This section highlights a few that have been vanguards in the field through leadership, state administrative support, dedicated school health center funding and integrating mental health into their school health center models.
Colorado established the Colorado Association of School Based Health Centers in1996 to support the development and implementation of SBHCs. The Association has posted two publications, “Colorado Medical Home Initiative and Its Impact on SBHCs” and the “Financing of Behavioral Health Services at Colorado SBHCs“.
Maine supports integrated school health centers through funding and mandating mental health services through its state standards. The Maine Primary Care Association hosts the Maine Association on School Based Health Centers and the Department of Education’s Maine Coordinated School Health Programs provides guidelines on how to start a school based health center as well as state standards and guidelines for integrated behavioral health.
New Mexico‘s SBHC Initiative is a collaborative partnership of multiple state agencies – Departments of Health, Public Education, Human Services Division and Children Youth and Families – which operate as a State funded network with many statewide coordinated efforts. A SAMHSA grant provides funding for a comprehensive suicide prevention model in four communities.
The Community Schools movement brings integrated health, mental health and social services to school campuses. Its wellness focus creates school operated networks that address multiple emotional, social and health needs of students and their families. The National Center for Community Schools web site hosts guides, case studies, reports and a consultation practice to assist school communities fully integrate health and social services into the school.
The Canadian School Based Mental Health and Substance Abuse Consortium website contains archives of past Powerpoint presentations and video webinars.
Confidentiality Issues
Integration of health, mental health, social services at schools means addressing federal and state regulations that guard confidentiality for both students (the Family Educational Rights and Privacy Act–FERPA) and patients (Health Insurance Portability and Accountability Act–HIPAA). Depending on the particular SBHC staffing and parental consent obtained, operating interdisciplinary teams, keeping integrated records, and conducting cross-agency conferencing while meeting education and health care confidentiality regulations can be challenging. The National Youth Law Program provides a guide to minor consent and confidentiality. The California Association of School Health Centers provides summary of laws and links to federal guidance and its own confidentiality Tool Kit. For more about confidentiality, see the CONFIDENTIALITY SECTION of this website.