• Barriers to the provision and coordination of mental health services in school settings.

  • The numbers, availability, and qualifications of mental health staff in public schools.

The final report is to be released during fall 2005.6

Experts on school-based mental health services note that (1) schools should not be viewed as responsible for meeting all the mental health needs of their students (in some cases they are already overburdened with demands that should be addressed elsewhere); and (2) connections between school-based mental health services and substance-use treatment services are nonexistent or tenuous (Weist et al., 2005). These two factors, plus the need to coordinate M/SU services with general health care, impose responsibilities on school-based M/SU providers to collaborate with other specialty and general health care providers serving the student, and for the other specialty and general health care providers to do the same.

Child Welfare Services

Almost half (47.9 percent) of a nationally representative, random sample of children aged 2–14 who were investigated by child welfare services in 1999–2000 had a clinically significant need for mental health care (Burns et al., 2004). Even higher rates have been observed in children placed in foster care arrangements (Landsverk, 2005). This is not surprising given that the circumstances of children who are the subject of reports of maltreatment and investigated by child welfare services are characterized by the presence of known risk factors for the development of emotional and behavioral problems, including abuse, neglect, poverty, domestic violence, and parental substance abuse (Burns et al., 2004). Moreover, substantial rates of substance use among adolescents in child welfare have been detected (Aarons et al., 2001).

Ensuring the well-being of children is typically considered part of the mandate of child welfare services, and the children served by these agencies also have very high rates of use of mental health services. However, the first nationally representative study examining the well-being of children and families that came to the attention of child welfare services (the National Survey of Child and Adolescent Well-Being [NSCAW]) found that three of four youths in child welfare who met a stringent criterion of need did not receive mental health care within 12 months of a child abuse and neglect investigation (Landsverk, 2005). States have traditionally used Medicaid to provide medical, developmental, and mental health services to children in


Personal communication, Judith L. Teich, ACSW, Health Policy Analyst. Center for Mental Health Services/SAMHSA on July 15 and October 10, 2005.

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