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TOPIC. The research, planning, implementation, and evaluation of school-based mental health clinics located throughout a large metropolitan city, which were established in a joint project by four local mental health centers.

PURPOSE. To explain the evolution of the idea of providing school-based mental health to a large, inner-city population, including the delineation of team roles and responsibilities.

SOURCES. Nursing, medical, social work, and educational literature. Notes detailing the formation of InteCare, the school-based mental health clinic system.

CONCLUSIONS. Providing mental health services in inner-city schools improves access and removes barriers to treatment for this population. Working collegially with school personnel and families significantly improves the academic function of the children, the functioning of the families, and the relationships between parents and schools.

Search terms: Collaborative project, inner-city psychiatric population, school-based mental health centers

Studies show that the majority of inner-city children could benefit from mental health services, yet fewer than one third of those children needing mental health services receives adequate treatment (U.S. Department of Health and Human Services, 1999). School-based programs "not only minimize the stigma of seeking care, but also avoid financial, transportation, and other barriers, as well as long waiting lists and long intake procedures" (Lamberg, 1998, p. 5).

Violence in the schools is both a traumatic event for students and staff and a reflection of the poverty, violence, and unmet mental health needs of the community. Children who frequently experience violence and crime in their communities and schools accurately feel that adults do not protect them. They often become depressed and anxious, and may suffer from post-traumatic stress disorder. They may begin carrying weapons to school to protect themselves from perceived threats.

The U.S. Department of Education (USDE, 2001) reports that for 1999,2.5 million 12- to 18-year-olds were victims of crimes at school. Of these crimes, 186,000 were serious violent crimes such as rape, sexual assault, robbery, and aggravated assault. During this period, 1.7 million teachers were victims of nonfatal crimes in schools, of which 635,000 were violent crimes such as rape, sexual assault, robbery, or aggravated or simple assault (Kostinsky, Bixler, & Kettle, 2001). Unfortunately, statistics for elementary school violence is not available. Seven percent of high school students admitted to carrying a weapon at school (USDE).

School systems are becoming more aware of the link between violence and unmet mental health needs of their students and families. The Indianapolis Public School System identified increased mental health services as one of the top five goals in its system's 5-year long-range plan. In response to this, the four local mental health centers collaborated in a joint project to establish school-based mental health centers in many of the public schools. An effort was made to eliminate as many barriers to service as possible. After 4 years of operation, there are now school-based mental health centers in 54 of the district's 76 schools. This article addresses details in the research, planning, implementation, and evaluation of this program. Practical matters such as funding, billing, establishing relationships, team roles, and challenges encountered are discussed, and a strength-based model is presented. And, finally, we share what we have learned throughout this process, as well as the difficulties encountered in obtaining outcome data.

How We Got Started

Building a Coalition

InteCare was created as a nonprofit corporation formed through an affiliation among the four Indianapolis mental health centers: Adult and Child, Behavior Corp, Gallahue, and Midtown. Program development focused on a collaborative effort among the four InteCare providers and the Indianapolis Public School System (IPS). InteCare's mission is to manage a comprehensive, integrated, nonprofit behavioral healthcare system that is customer driven, demonstrates high quality, is community based, and assures the provision of services to individuals and their families regardless of their source of payment or resources for payment. Many of the specifics of the collaboration are contained in agreements, signed annually, between the mental health centers and the school system. The schools agree to provide space, furniture, and a telephone. The providers agree to provide staff and all supplies needed to deliver mental health services. Medical records are maintained and remain the property of the InteCare provider. Confidentiality is maintained, and communication to school personnel is with appropriate consent from the parent(s) or guardian.

Establishing Funding

The school-based clinics arose out of a shared vision by the clinical leaders of the child/adolescent teams of the four local mental health centers. Each of the respective managers felt strongly that providing mental health services to our inner-city children was the right thing to do, and committed to providing services. No grant money was available, thus program development became, in many ways, a leap of faith for all parties involved. Fortunately, the IPS system, through research and work in the Bridges to Success Program, had established the need for mental health services and was eager to contract for services.

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