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In January 2007, The Center for Health and Health Care in Schools at the George Washington University School of Public Health and Health Services was commissioned to assess operations of school mental health programs in Washington, D.C. and recommend future directions in practices, policies and systems development. While this guidance is directed primarily at the District of Columbia Department of Mental Health, the goal of this report is to offer guidance for all public and private organizations and individuals that share a commitment to effective mental health programs for children in the District of Columbia. This report is based on a 16-month examination of school-connected mental health programs here in the District of Columbia and in cities, counties and states around the nation. In the course of the study, the authors conducted an in-depth examination of school mental health programs in DC, reviewed relevant literature, and interviewed 100 local and national experts in children's mental health and school mental health. Policymakers, program directors, educators and mental health professionals increasingly view school-connected mental health as essential to effective schools and well-functioning mental health systems of care. Last year this perspective was evident in the District of Columbia when the Interagency Collaboration and Services Integration Commission (ICSIC) included school mental health as part of the District of Columbia Public Education Reform Amendment Act of 2007. The overarching goal of this report is to document the critical components of effective school mental health programs utilizing the best current thinking and practice so that programs developed with this guidance in mind can withstand the political, economic, and social pressures that frequently erode best-practice models. To this end, the report recommends a number of roles, functions, and activities for the DC Department of Mental Health within five areas: organizational management, program development and evidence-based practices, training and professional development, financing, and program evaluation and outcomes research. Thirteen appendices are included: (1) Interviewees for DMH school mental health report; (2) List of supplemental reports available upon request; (3) District of Columbia schools with school mental health professionals; (4) Comparison of Staff Requirements, Cost, and Productivity Between D.C. and Other Cities; (5) Examples of state mental health laws that address a continuum of children's mental health care and the role of schools; (6) List of school health programs and initiatives in DC; (7) A guide for mapping school-based mental health activities; (8) Table of Organization for the D.C. Department of Mental Health Office of Programs and Prevention & Early Intervention Programs; (9) Template for the development of standards for school mental health programs in D.C; (10) List of Evidenced-Based Programs or Data Driven Practices or Programs for use in the School Mental Health Program for SY 2007-2008; (11) Sources that have reviewed evidence-based or promising programs for use in schools; (12) Sources of Federal funding for school-based mental health care; and (13) Proposed plan to implement a citywide school mental health evaluation program. (Contains 10 tables and 1 figure.) [This report was funded through the Safe Schools/Healthy Students Program, a partnership of the U.S. Departments of Education, Health and Human Services, and Justice.]

Governor Arnold Schwarzenegger has declared his intention to open health centers in 500 elementary schools across the state, which would bring the total number of such school-based clinics to 646. This initiative builds on California's 30-year history of using the school setting to increase access to care for children, improve clinical outcomes, and save money for public and private payers of child health services. This report explores the options and issues associated with the potential launch of a new school health center initiative in light of previous experience in California and other states. It concludes with a discussion of state policy development and possible directions for future state action. Three appendices are included: (1) School-Based Health Centers, by State and School Year; (2) K-12 Students and School-Based Health Centers, 2004-05; and (3) State Definitions of School-Based Health Centers (SBHCs). (Contains 1 figure, 6 tables and 32 endnotes.) [This paper was prepared for California HealthCare Foundation.]

In June 1999, Making the Grade and the National Assembly on School-Based Health Care sponsored a workshop to examine the best political and financial strategies for fostering the growth and stability of school-based health centers (SBHCs). State and local elected officials offered detailed accounts of how public support for a growing network of centers has been built in their localities. Public officials as well as private representatives from several hospital and health care systems discussed their successes and failures in designing funding strategies to sustain centers for the long term. This paper, inspired by and based in large part on the workshop proceedings, examines the political and funding strategies that have laid a foundation for continued expansion of the centers. (Author/EV)

In 1993, nine states were awarded Making the Grade grants to develop financial and other strategies to foster replication of school-based health centers (SBHCs). This report details the financial strategies used by Vermont, Rhode Island, Oregon, North Carolina, New York, Maryland, Louisiana, Connecticut, and Colorado, as reported in a meeting of grant recipients in 1998. Following an executive summary, the report describes the strategies taken by each state. The report notes that with the exception of Louisiana, these states directed their attention to linking SBHCs to Medicaid managed care arrangements, reflecting the belief that SBHCs had to align themselves with mainstream health care. In addition, the report indicates that the key to a successful state strategy is in clarifying the public purpose of SBHCs, and that the basic models for SBHCs (medical home, public health, and an add-on model) reflect the centers' purposes. The report concludes by noting that the experiences of the nine states demonstrate a variety of efforts to secure access to existing public and private funding streams as well as generate state fiscal support for SBHCs. The onus is on the centers to prove their worth, a task requiring documentation of the number of children served, their insurance status, and services provided. This information is needed to lobby for inclusion in health plan networks, and for state or local revenues to cover the services often excluded from insurance coverage. (Three appendices contain the policy questions addressed by the states, list the meeting participants, and include the meeting agenda.) (KB)

Under the State Child Health Insurance Program, states receive funds to purchase health insurance for low-income, uninsured children. Noting that partnering with managed care will be essential if school-based health centers are to receive reimbursement for serving the publicly insured portion of their clientele, this paper examines the relationship between this public insurance program and school-based health centers (SBHCs). The paper first describes the establishment of SBHCs in the early 1970s and their expansion, focusing on the financing mechanisms used. The paper then describes the State Child Health Insurance Program, including the views of federal and state agencies, health plans, and local SBHCs on the challenges of developing contracts, the incentives and disincentives health plans have to contract with SBHCs, and what has accounted for success where relationships are moving forward. Finally, the paper presents case studies on the experiences of Colorado and Connecticut in addressing these evolving issues. (KB)