Generally, school-based programs are staffed with licensed and associate-level clinicians, on-site from one to five days per week. Many practitioners serve multiple schools and are funded via a blend of insurance (primarily Medicaid/PeachCare for Kids®) and private and government grants, the latter of which can be used to support nonbillable, comprehensive interventions to serve an entire school population. Leveraging insurance billing and flexible grant funding for program implementation and sustainability are key for success, as are school buy-in and provider flexibility.
Once a child is referred to a provider (most often by teachers and school counselors), clinicians obtain verbal consent from the student’s parent or guardian prior to assessment or treatment. Parents and students are required to meet with the clinician in person for the initial assessment, where written consent is then obtained. All providers in this sample deliver three-tiered system supports, in addition to services after school and over the summer. Without exception, Tier 3 interventions (e.g., individual therapy) make up the majority of their workload, followed by Tier 2 interventions (e.g., group therapy), and then by Tier 1 (e.g., teacher trainings or schoolwide activities). Of interest is the effectiveness of such comprehensive school-based mental health, which results from increased opportunities to identify students’ needs and intervening early, preventing or offsetting further decline or complications. Comprehensive programs also increase the chances that misdiagnoses are avoided, particularly for students who may initially appear to have a mental health disorder but are actually experiencing another challenge — such as family instability, lack of access to food, or vision or hearing trouble. Additionally, these providers conduct home visits, provide crisis support, and manage medication as part of their treatment. Telemedicine for treatment and medication management, as well as home delivery of medication, are employed by some as necessary to help the families they serve.
Despite far-reaching service provision and heavy caseloads, however, clinicians report that their greatest burden is paperwork — either requesting treatment authorization from insurers or completing documentation required for billing. Committed parental involvement can also be elusive, by virtue of competing family or work priorities, or simply a lack of transportation.
Barriers to success include some of the same challenges as non-school-based pediatric mental health care, namely:
- Workforce shortage, salary constraints, and clinician burnout
- Blurred roles in schools and extra demands on clinicians’ time outside of service provision
- Lack of student transportation for afterschool and summer services
- Mental health stigma and generational barriers
- Limited parental involvement