Feasibility of networked mental health care in school-based clinics

Background: School based clinics networked with community providers offer a potential solution to chronic disparities in access to mental health care for children. Psychiatric treatment for childhood mental health problems has expanded dramatically, but unevenly. Among poor and rural populations, access to quality mental health services for children is limited, while in other sectors of the population there is concern with excessive treatment. School based clinics can potentially expand access and at the same time improve quality through integrated collaborative practice models.

Objective: This project aims to specify the conditions necessary for successful implementation of such networked mental health care, identifying assets and barriers within a school to manage a telemental health project, the capacity among rural providers to serve the children, and specific technology needs.

Methods: We conducted a detailed asset mapping in a rural school district in California with documented lack of mental health providers, including interviews and focus groups with key stakeholders (school administrators, school health providers, teachers, counselors, parents, and youth).

Results: Mental health services are critically lacking, particularly in rural areas. Telemedicine technologies offer a practical option for bringing together services from multiple providers, teachers and other school representatives, students and families to improve child mental health. Potential barriers and challenges to be addressed in implementation include identifying a system for care coordination within schools, providing support to the school and clinic based staff who would arrange the telemedicine encounters, billing and reimbursement, as well as sustainability.