Introduction

There is tremendous variability in how schools identify and manage mental health problems in children. Many schools don’t have adequate training or resources to recognize and appropriately help children adjust to emotional and behavioral problems. There are an alarming number of incidents in which children with behavioral issues are reprimanded, suspended or expelled from school. Disciplinary infractions in school often land children in trouble with the law because of zero-tolerance policies — the so-called school to prison pipeline that pulls troubled or needy students inexorably towards jail. At the same time, youth with anxiety disorders and depression go unrecognized. Dropout rates are as high as 40% among those enrolled in special education programs because of learning, attention or emotional problems.

Schools are by no means ignoring these issues. The results of the only nationally representative sample of adolescents in the United States revealed that schools can and do provide services for youth with attention and behavior problems that are more obvious to teachers and are more common in youth with learning problems. Federal mandates for evaluation and treatment of children with specific learning difficulties have also facilitated care for these children. In fact, young people with access to mental health services in school-based health centers are 10 times more likely to seek care for mental health or substance abuse than those who do not.⁴ But we do not yet have true parity between mental and physical health care, nor do robust mental health services in schools currently exist.

Today, optimal models of care pair school-wide behavior and discipline systems with services using community partners for targeted help. In this report, we provide examples of interventions and approaches that are working to help children with specific mental health and learning disorders and to improve the mental health of all children in the school environment. These programs can work for children today and spur innovation that will help more children tomorrow through the sensible integration of universal approaches with individualized, focused attention from professionals partnering with educators in the school environment.

N.B. Because this report does not generally cover clinical approaches to mental health care, interventions and outcomes are described using the common school-based language of symptoms and behaviors, not diagnoses

N.B. Because this report does not generally cover clinical approaches to mental health care, interventions and outcomes are described using the common school-based language of symptoms and behaviors, not diagnoses.

⁴ Kaplan, D.W., Calonge, B.N., Guernsey, B.P., Hanrahan, M.B. (1998). Managed care and school-based health centers: Use of health services. Archives of Pediatrics and Adolescent Medicine. 152: 25–33.