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Issues and Opportunities in the Organization and Financing of Mental Health Services in School. Julia Graham Lear, Center for Health and Health Care in Schools, The George Washington University MacArthur Foundation Mental Health Network Meeting, Miami Beach, FL December 6, 2001.
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Issues and Opportunities in the Organization and Financing of Mental Health Services in School Julia Graham Lear, Center for Health and Health Care in Schools, The George Washington University MacArthur Foundation Mental Health Network Meeting, Miami Beach, FL December 6, 2001
Mental health services in schools: an overview • Lurking issues in school-based mental health services • Current approaches to service delivery • Organization-of-care issues • Financing challenges • Related activities • Possible directions for MacArthur Network
Lurking issues in school-based mental health services • Population-targeted practice v. individual-targeted practice? • What are the 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 agenda?
Current approaches to service delivery • School -system organized care • School-based health centers • School-based mental health services
Organization-of-care issues • Who’s in charge? • Clinical practices: methods, quality measurement, confidentiality, parent consent • Staffing: credential and training requirements, continuing education, union issues
Financing challenges • Multiple sources of funding: state grant funds; Medicaid; managed care -- carve outs, carve-ins, falling in-between; local health and education budgets • Meeting requirements of funding agencies • Ability of provider organization to bill and collect from 3rd party payers • Reluctance of primary care providers to diagnose children with billable disorders
Thinking ahead:Related activities • The Survey of the Characteristics & Financing of School Mental Health. Abt Associates, SAMHSA funded. • Depression in Primary Care: Linking Clinical & System Strategies. RWJF multi-site grant program. • Caring for Kids: Expanding Mental & Dental Health Services through School-Based Health Centers. RWJF multi-site grant program
Possible directions • Synthesis of post SGR work: at national, state & local level • Research opportunities: content of school-based mental health care, patient care outcomes • An invitational workshop for Mental Health Commissioners, researchers & educators: to discuss demonstrations & test political and financial feasibility of expanding mental health services in schools