Studies explore mental health in schools

Key takeaways:

• Researchers recommended ways to improve access to services in schools.
• Study finds strengths and weaknesses in school nurses’ ability to respond to mental health emergencies.

WASHINGTON — Amid a national emergency in child mental health, two studies at the Pediatric Academic Societies Meeting explored ways that mental health is and can be treated at schools.

In the first, authors from University of North Carolina at Chapel Hill School of Medicine and Duke University School of Medicine examined policies affecting reimbursement and access to behavioral health supports in schools.

“Schools are an underutilized equity-promoting setting for services with minimized transportation barriers,” the authors wrote. “Youth are six times more likely to complete school-based vs. community-based therapy, though reimbursement is often a barrier.”

The authors interviewed 11 pediatricians and “reviewed Medicaid policies for school-based mental health services.”

Based on their findings, the authors identified four ways to improve access to mental health services in school: a “no wrong door approach,” which could provide opportunities for Medicaid enrollment and referral for care management through schools; standardized coverage, or develop standardized school mental health benefits that are required in Medicaid contracts, recommended for private insurers and inclusive of preventive services, such as teaching mindfulness; reducing administrative burden, or offering a centralized school health documentation system; and increasing reimbursement or school-based mental health services, including through novel funding sources.

“Strengthening behavioral health services in schools is an approach that pediatric providers could leverage for follow-up for children who screen positive for mental health issues,” they wrote. “Policy changes that facilitate reimbursement of school-based mental health services can improve management and advance equity.”

The second study explored ways in which school nurses deal with mental and behavioral health outcomes, and identified strengths and areas for improvement in the preparedness of school nurses to deal with mental health emergencies.

According to Marcus O. Erdman, MD, a second-year pediatrics resident at Wright State University Boonshoft School of Medicine in Dayton, Ohio, they focused on school nurses “because they serve as frontline providers for managing emergencies in schools.”

“They have a lot on their plate, and they've got hundreds of patients every day, but they do a great job of taking care of a wide variety of tasks,” Erdman told Healio.

In a questionnaire completed by 994 members of the National Association of School Nurses, 41% of respondents reported that “psychiatric/behavioral health” was one of the top five emergencies encountered during the last year, in what Erdman calls a “striking” statistic.

“Things like seizures, anaphylaxis, respiratory issues — the things that you would typically think of as emergencies,” Erdman said.

Further, although 76% of respondents felt “responsible for identifying students with mental health concerns,” only 5% had completed training through the American Psychiatric Nurses Association. Erdman said 95% of school nurses have access to guidelines for managing students who are prone to suicidal ideation.

“I’d love to see that number even closer to 100%,” Erdman said. “School is a big, stressful place, and school nurses need to be able to identify these kids rather quickly."

Erdman said primary care physicians and pediatricians should consider engaging with school nurses at the schools in their area.

“A primary care physician being well integrated with the school district can be a really important partnership for the school nurses to have,” Erdman said. “A lot of great things can come out of that relationship.”

References:

• Gupta N, et al. Preparedness of school nurses to manage mental health emergencies: A national survey. Presented at: Pediatric Academic Societies Meeting; April 28-May 1, 2023; Washington, D.C. (hybrid meeting).
• Tadikonda A, et al. Mental health supports in school: Pediatrician perspectives and policy prescriptions for improving equitable access and service reimbursement. Presented at: Pediatric Academic Societies Meeting; April 28-May 1, 2023; Washington, D.C. (hybrid meeting).