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The future of expanded school mental health.

The 2003 report from President Bush's New Freedom Commission on Mental Health (NFCMH) (1) provided impetus for those of us invested in children's mental health to consider how best to improve the current system of care. The Commission recognized the importance of providing a full continuum of services to children and families directly in communities. The report also included a recommendation to "improve and expand school mental health programs." ((1) (p 62))

Goals identified by NFCMH match the mission and framework of expanded school mental health (ESMH), and the goals should energize leaders to plan boldly for the future. ESMH creates a framework that captures core elements of effective programs and services including 1) a partnership between schools and community agencies and programs; 2) to move toward a full continuum of evidence-based prevention, mental health promotion, early intervention, and treatment; 3) for youth in both general and special education. The Center for School Mental Health Assistance (CSMHA), one of two national technical assistance and training centers, provides leadership and support to the school mental health movement in the United States. Organized in 1995, the CSMHA has dedicated itself to refining and promoting the ESMH framework (, and identifying emerging needs in the field, including the following three critical issues.

1. Advancing Advocacy and Building Infrastructure. Given the reality of poor capacity in child and adolescent education, and in mental health systems, we must develop advocacy and build infrastructure to promote ESMH, including systematic strategies to:

* Raise awareness about the poor capacity of child-serving systems that contributes strongly to unmet education and mental health needs. Concurrently, raise awareness of the promise for successful school-based programs to better meet needs and achieve outcomes valued by families, schools, and communities.

* Involve youth, families, school staff, community leaders (including faith communities), university personnel, business leaders, advocates, and legislators in efforts to advance ESMH.

* Develop formal advocacy and build coalitions to improve policy and increase the diversity of funding sources.

2. Doing and Coordinating the Work at School. Given the marginalized status of child and school mental health efforts, we must ensure resources are systematically delivered and coordinated in school-based efforts. Key strategies include:

* Develop a full continuum of services (universal, selective, targeted) tailored to the unique school environment.

* Develop coordinating teams of education and mental health staff--guided by youth and families--to plan, monitor, and improve programs and services.

* Develop methods to enhance the knowledge of educators about mental health issues.

* Improve referral and feedback mechanisms.

* Address special needs such as substance use problems, severe psychiatric disorders, violence-related issues, and co-occurring physical and mental health conditions.

* Connect the work in school with the work occurring at other child-serving systems.

3. Enhancing Quality and Accountability. With education and mental health systems both emphasizing quality and accountability in service delivery, we must implement high-quality and effective approaches to care. Systematic strategies include:

* Strengthen formal approaches to quality assessment and improvement, such as evaluating the achievement of best practice principles in ESMH and associated quality indicators.

* Improve training in evidence-based practice for mental health clinicians and educators involved in addressing behavioral issues of students, and provide adequate infrastructure support for implementing evidence-based practice.

* Develop "user-friendly" approaches to evidence-based practice, such as risk reduction and protective factor enhancement, and training in key cognitive-behavioral skills.

* Provide training to help all educators succeed in the classroom, such as methods for managing classroom behavior; and to help all school-based mental health providers succeed in their school environment, such as integrating with school staff, and increasing familiarity with school culture and policies.

* Support a full continuum of outcome evaluation approaches.

Conclusion. This communication summarizes our current thinking on three critical issues professionals must address to promote ESMH. We welcome your ideas, comments, and questions on these issues, or on any aspect of ESMH.


(1.) New Freedom Commission on Mental Health. Achieving the Promise: Transforming Mental Health Care in America--Final Report. Rockville. Md: 2003. DHHS publication SMA- 03-3832.

Mark D. Weist, PhD, Professor, (; Nancy A. Lever, PhD, Assistant Professor, (nlever@psych,; and Sharon H. Stephan, PhD, Assistant Professor, (; Center for School Mental Health Assistance, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, 680 West Leaington St., 10th floor, Baltimore, MD 21201-1570. Supported by cooperative agreement U93 MC 00174 from the Office of Adolescent Health, Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, with co-funding by the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.
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Title Annotation:Communications
Author:Weist, Mark D.; Lever, Nancy A.; Stephan, Sharon H.
Publication:Journal of School Health
Geographic Code:1USA
Date:Aug 1, 2004
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