Mental health problems in children are a major deterrent to learning. Yet the President’s New Freedom Commission on Mental Health in 2002 pointed out that mental health services for children are so fragmented as to be ineffective in major ways. The commission’s report emphasizes the importance of using the school system as the means of delivering such services. The school-based approach to mental health helps accomplish several goals: • Minimizing barriers to learning • Overcoming stigma and inadequate access to care • Providing comprehensive on-site counseling services • Creating a school climate that promotes students’ social and emotional functioning • Promoting healthy psychological and social development This chapter will describe the mental health services at the Children’s Aid Society (CAS) community schools, focusing on staffing, structure, and strategies and describing the clinic at one school in greater detail. Questions of space, accountability, and funding will be explored, and some conclusions based on our work will be discussed. CAS’s school-based clinics, located in elementary and middle schools, provide individual and family counseling, group therapy, in-depth assessments and referrals, and crisis intervention for students and their family members. Referrals to the clinic are made by students, teachers, and parents. Assessment and intervention plans include the active participation of the child, his or her family, school staff, and anyone else who can help in understanding the child’s needs. Based on the assessment, the child and/or family are engaged in shortor long-term individual, group, or family counseling aimed at ameliorating the problems that precipitated the referral. An in-depth psychosocial assessment is the first step in developing a comprehensive treatment plan that includes short- and long-term goals. Psychological and psychiatric evaluations are scheduled as appropriate. Clinicians (social workers with M.S.W. or C.S.W. degrees) generally have caseloads of 18–22 students, with enough room in their schedules to see walk-ins and emergencies. Problems that have been successfully treated include suicide ideation, physical and sexual abuse, drug and alcohol use, disruptive school behaviors, academic delays, hyperactivity, family and peer conflicts, and depression.
Integrating Behavioral and Mental Health Services into the Primary Care Setting
