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Expanding Mental Health Services at School: Lessons from the Caring for Kids Grant Initiative

Expanding Mental Health Services at School: Lessons from the Caring for Kids Grant Initiative. Julia Graham Lear, PhD

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Expanding Mental Health Services at School: Lessons from the Caring for Kids Grant Initiative

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  1. Expanding Mental Health Services at School: Lessons from the Caring for Kids Grant Initiative 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, Washington, DC National Assembly on School-Based Health Care, Annual Conference, June 15, 2006, Portland, Oregon

  2. Outline • RWJF Caring for Kids Grant Program • Goals/History/Program design • Data collection • Grantee experience • Staffing • Services • Patient care revenue • Lessons learned

  3. RWJF Caring for Kids Grant Initiative • Goals • Expand mental/dental health services • Move towards sustainable models of care • History • 2001 grant announcement • organizational eligibility • fundable strategies • Jan 2002 -- 8 mental health grant awards • 17 participating schools/sbhcs -- 9 h.s., 6 m.s., 2 combined m/h.s. • All funded sites chose to expand services rather than develop community-school partnerships or school-SBHC partnerships

  4. RWJF Caring for Kids Grant Initiative, #2 • Data collection • Components • Rationale for the “Snapshot Quarter • Challenges in data collection and analysis • Management without a net, ie. data • Lack of consensus on importance of certain data, eg. Mental health diagnoses

  5. Overview of Grantee SBHCs • School enrollment: Total - 24,003; median enrollment h.s. = 1,610, m.s. = 860 • SBHC enrollment: 15,394 (64.1%). Range was 86% - 12% of school population • Snapshot quarter: Clinic users = 5605, visits totaled 17,023. Mental health visits totaled 5,499 (32% of all visits)

  6. Core Mental Health Staffing • LCSWs: 5 of 6 m.s., 9 of 9 h.s., >35 hrs/week • Prevalence of social work in SBHC mental health • Importance of licensure • # of hours per week • Psychiatry: 13 of the 17 sites had several hrs of a psychiatrist’s time monthly • Mix of other MH professionals: clinical nurse specialist, 4 psychologists, psychologist & social work interns

  7. Mental Health Services by School Level (Jan-Mar 2004)Data from all sites,CPT Coding

  8. Mental Health Diagnoses by School Level, Jan-Mar/2004 #1ICD-9 categories

  9. Mental Health Diagnoses by School Level 1-3/2004 # 2ICD-9 categories

  10. Health Insurance Status of Students Enrolled in SBHCs, Jan-Mar/2004N = 8,407

  11. Patient Care Revenues for Mental Health Services, Jan-Mar 20044 of 8 projects billed

  12. Caring for Kids: Lessons Learned #1 • Creating access to care is a multi-part process and locating services within a school with underserved students is only the first step toward reducing unmet need. • Gender is an access issue • Service delivery mechanisms are another access issue (individual therapy v. group work v. consultation)

  13. Caring for Kids: Lessons Learned #2 • Expanding case management & medication management • Assessing the meaning of MH diagnoses -- • are SBHCs located in schools where few or no students have alcohol or other drug issues? • Are we comfortable with few or no education-related diagnoses (excepting ADHD) • Integrating physical health and mental health, even in an SBHC, is a challenge

  14. The Center for Health and Health Care in Schools  2121 K Street, NW, Suite 250 Washington, DC 20037 202-466-3396 202-466-3467 (fax) jgl@gwu.edu www.healthinschools.org School of Public Health and Health Services, The George Washington University Medical Center

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