School-Based Mental Health: Pediatric Mental Health Minute Series

The National Center for School Mental Health* defines school-based mental health as interventions that students receive to enhance social/emotional or behavioral adjustment and well-being. These services range from school-wide prevention efforts to individualized, intensive interventions including comprehensive mental health services provided directly on site in a school-based health clinic (SBHC). Increased scholastic performance, improved attendance, expansion in academic activities and fewer disruptions to the learning environment are some of the positive outcomes that occur with this medical-home model.

Scope in Pediatrics

• The Centers for Disease Control and Prevention estimates that 1 in 5 children have a mental, emotional, or behavioral disorder. However, only about 20% of impacted children receive care from a specialized mental health care provider. Minority and uninsured children are even less likely to receive services. Of those who obtain services, over 75% received treatment in school.
• The consequences of untreated mental illness in children and adolescents are profound and are associated with school failure, teenage pregnancy, unstable employment, substance use, violence including suicide and homicide, and poor medical outcomes.
• Pediatricians are uniquely situated when it comes to mental health, as they may be on the frontline of recognizing mental health concerns in the children. Through enhanced collaboration and communication with school mental health service professionals, such as school social workers, psychologist, and nurses, pediatricians can strengthen the medical-home model and improve the mental health of their patients.
• Pediatricians should build relationships with mental health specialists, including school-based providers, to identify and provide emergency care to children and teens at risk of suicide and to co-manage children with mental health conditions.

Teaching Points

• Child mental health problems have long term negative consequences. One of the most devastating consequences of untreated mental health conditions is suicide. It is the second leading cause of death in people between 10 and 24 years old and the sixth leading cause of death for those between the ages of 5 and 15. Because of the high rates of concerns, Physicians should address school and mental health matters with families at each visit to assure a thorough check-up.
• How do we reach these youth? One way is providing school-based mental health services in the school environment. Studies have shown that students are much more likely to seek behavioral health support when school-based services are available.
• School-based mental health services range from school-wide prevention efforts to individualized, intensive interventions. Prevention activities, often called Universal Prevention, are programs that address the entire population of the school and are designed to benefit all members of a community not just specific individuals or groups.
• Selective prevention programs are targeted at students who are at higher risk for developing emotional, behavioral, or social problems than are the general population of students.
• Multi-Tiered System of Support (MTSS) is a framework developed to improve outcomes for all students. This framework emphasizes 3 tiers of prevention, and it is used by schools to align various supports, including mental, behavioral, and emotional supports to improve education for all students.
• The third tier of health services targets the smallest population of students and addresses needs of children with severe mental health diagnoses and symptoms. Three models of service delivery for students with high behavioral health needs are: 1) Co-located services, 2) A school-based therapist located in the school or SBHC 3) A referral to a community-based therapist.
• Pediatricians are frequently on the front lines recognizing mental health concerns in children and adolescents and have a unique opportunity to diagnose youth early to help prevent negative outcomes. Pediatricians should communicate with school mental health service professionals, thereby strengthening the medical-home model and improve the mental health of their patients.