School Mental Health Services
in the United States, 2002–2003

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U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
Center for Mental Health Services

Acknowledgments

The authors of this report are Susan Foster, M.S.S.W., M.P.H., Mary Rollefson, Ph.D., Teresa Doksum, Ph.D., M.P.H., Denise Noonan, Ph.D., and Gail Robinson, Ph.D., of Abt Associates Inc. , and Judith Teich, A.C.S.W., of the Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (DHHS). Judith Teich was also the Government Project Officer. Jeffrey A. Buck, Ph.D., Associate Director for Organization and Financing, CMHS, served as advisor.

Disclaimer

Material for this report was prepared by Abt Associates Inc., for SAMHSA, DHHS, under Contract Number 282-98-0006, Task Order No. 32. The content of this publication does not necessarily reflect the views, opinions, or policies of CMHS, SAMHSA, or DHHS.

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA or CMHS. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, DHHS.

Electronic Access and Copies of Publication

This publication can be accessed electronically through the following Internet World Wide Web address www.samhsa.hhs.gov/. For additional free copies of this document, please call SAMHSA's National Mental Health Information Center at 1-800-789-2647 or 1-800-228-0427 (TTD).

Recommended Citation

Foster S, Rollefson M, Doksum T, Noonan D, Robinson G. (2005). School Mental Health Services in the United States, 2002–2003. DHHS Pub. No. (SMA) 05-4068. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.

Originating Office

Office of the Associate Director for Organization and Financing, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, One Choke Cherry Road, 6-1065, Rockville, MD 20857.

DHHS Publication No. (SMA) 05-4068

Printed 2005

Table of Contents

List of Exhibits

Executive Summary

1.0 Background and Study Methods

1.1 Introduction

1.2 Review of the Research Literature

1.3 Goals of the Study and Research Questions

1.4 Overview of Survey Design and Methodology

2.0 Mental Health Problems and Services in the School Setting

2.1 Eligibility for Mental Health Services

2.2 Types of Mental Health Problems

2.3 Mental Health Problems by School Level and Gender

2.4 Resource Use for Various Mental Health Problems

2.5 Mental Health Services in U.S. Schools

2.6 Summary

3.0 Administrative Arrangements for the Delivery and Coordination of Mental Health Services in Schools

3.1 Contracting Arrangements

3.2 Mental Health Units and School-Based Health Centers

3.3 Administrative Functions in School Mental Health

3.4 Coordination and Referral Practices

3.5 Summary

4.0 Staff Providing Mental Health Services in Schools

4.1 Characteristics of Staff Providing Mental Health Services

4.2 Summary

5.0 Funding, Budgeting and Resource Allocation, and Data Use

5.1 Sources of Funding

5.2 Funding Restrictions and Other Barriers to Providing Services

5.3 Changes in Funding and Need for Mental Health Services

5.4 Budgeting and Resource Allocation

5.5 Access to and Use of Data

5.6 Summary

6.0 Mental Health Problems and Services at the Elementary, Middle, and High School Levels

6.1 Mental Health Problems and Services at the Elementary School Level

6.2 Mental Health Problems and Services at the Middle School Level

6.3 Mental Health Problems and Services at the High School Level

6.4 Summary

7.0 Discussion and Implications for Further Research

7.1 Mental Health Problems

7.2 Mental Health Services

7.3 Staffing

7.4 Service Delivery Arrangements .

7.5 Funding

7.6 Implications for Further Research

References

Appendix A: Expert Panel

Appendix B: Summary of Open-Ended Responses

Appendix D: Survey Design and Methodology

Appendix E: School Questionnaire

Appendix F: District Questionnaire

Exhibit 2.1: Psychosocial and Mental Health Problems Categories

Exhibit 2.2: Percentage of Schools That Ranked the Following Mental Health Problems as Among Their Top Three Problems for Male and Female Students, 2002–2003

Exhibit 2.3: Percentage of Schools That Cited the Following Mental Health Problems as Among Their Top Three Problems, by School Level, 2002–2003

Exhibit 2.4: Percentage of Schools Reporting That Various Mental Health Problems Use Most of Schools’ Mental Health Resources, by School Level, 2002-2003

Exhibit 2.5: Mental Health Services Categories

Exhibit 2.6: Percentage of Schools Providing Various Mental Health Services, 2002–2003

Exhibit 2.7: Percentage of Schools Reporting Extent to Which Various Factors Are Barriers to Providing Mental Health Services, 2002–2003

Exhibit 2.8: Percentage of Schools That Provide Various Prevention and Early Intervention Programs, 2002–2003

Exhibit 3.1: Percentage of Schools Using Staffing Sources for Various Mental Health Services in Schools, 2002–2003

Exhibit 3.2: Percentage of Schools With Agreements With Various Community-Based Organizations and Individual Providers To Provide Mental Health Services, 2002–2003

Exhibit 3.3: Percentage of Schools Using Strategies To Coordinate Mental Health Activities and Services Within Schools, 2002–2003

Exhibit 4.1: Number of Staff and Percentage of Time Spent Providing Mental Health Services in U.S. Schools, 2002–2003

Exhibit 4.2: Percentage of Schools With Various Types of Staff Who Provide Mental Health Services, 2002–2003

Exhibit 4.3: Percentage of Schools Reporting the Number of Staff Providing Mental Health Services, 2002–2003

Exhibit 4.4: Percentage of Schools Using Various Combinations of Staff To Provide Mental Health Services, 2002–2003

Exhibit 4.5: Percentage of Staff Providing Mental Health Services With Master’s Degrees or Higher and With Licensure in Their Field, 2002–2003

Exhibit 5.1: Percentage of Districts Using Each Funding Source for Intervention and/or Prevention Services, 2002–2003

Exhibit 5.2a: Percentage of Districts Reporting the Degree to Which Various Funding Restrictions Are Impediments to the Delivery and Coordination of Mental Health Services, 2002–2003

Exhibit 5.2b: Percentage of Districts Reporting the Degree to Which Other Funding Obstacles Are Impediments to the Delivery and Coordination of Mental Health Services, 2002–2003

Exhibit 5.3: Percentage of Districts Reporting Changes in Levels of Funding and Changes in Need for Mental Health Services Since the 2000–2001 School Year, 2002–2003

Exhibit 5.4: Percentage of Districts Reporting Changes in School Mental Health Service Utilization and Resources Since the 2000–2001 School Year, 2002–2003

Exhibit 5.5: Average Percentage of District Mental Health Expenditures Allocated to Various Categories, 2002–2003

Exhibit 5.6: Among Schools That Collect or Have Access to Data, Percentage of Schools With Various Types of and Uses for Data, 2002–2003

Exhibit 6.1: Enrollment and School Mental Health in the Typical Elementary, Middle, and High Schools, 2002–2003

Exhibit 6.2: Top Mental Health Problems by School Level, 2002–2003

Exhibit 6.3: Percentage of Schools Providing Various Mental Health Services by School Level, 2002–2003

Exhibit 6.4: Percentage of Schools With Agreements With Community-Based Organizations; Of Those, Percentage With Agreements With Various Types of Community-Based Organizations, by School Level, 2002–2003

Exhibit 6.5: Percentage of Schools Reporting the Number of Staff Providing Mental Health Services, by School Level, 2002–2003

Exhibit 6.6: Percentage of Schools With Various Combinations of Staff (Regardless of Number) Providing Mental Health Services in Schools, by School Level, 2002–2003

Exhibit 6.7: Percentage of Time Spent by Selected Staff Delivering Mental Health Services, by School Level, 2002–2003

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