O3254: Integrated Mental Health Program in School Based Health Centers

Background: The COVID-19 pandemic brought attention to children's emotional and behavioral health with increasing rates of depression, anxiety, suicidality, trauma, and loneliness. To ensure equitable access to mental healthcare, continued focus is critical to employ integrated mental health care programs in schools. Students presenting to school-based health centers (SBHCs) with behavior health concerns face several barriers in accessing care and connecting with services in the community. Care Connections is a school-based health services program in central Ohio providing primary care and behavioral healthcare delivered via 13 SBHCs. This program partnered with psychiatry to provide access to comprehensive integrated mental health care within the school setting through a peer consultation and telehealth program. The development of the model, implementation, and initial results are described below.

Methods: This project combined resources from school health clinics, department of Psychiatry and behavior health services, school and district level supports involved in social-emotional learning to match the needs and provide best outcomes for our students and families. Initial steps included identifying the need and engaging the stake holders including school staff, healthcare providers, families, and behavior health clinicians. The integration of psychiatry services in school health clinics was an important part of multi-tiered service delivery for youth with mental health conditions. Key interventions included weekly provider to provider consultations with a psychiatrist focusing on both specific and broader mental health issues with goals of inter disciplinary education, knowledge transfer, and case discussion. Other interventions included diagnostic consult by psychiatrist together with the primary care providers and direct delivery of services via school-based telepsychiatry visits.

Results: Beginning in September 2020, weekly consultation rounds began with the school-based psychiatrist and primary care providers in the school health clinics providing tele-mentoring, guidance on diagnosis and medical management of behavior health concerns, clinical case discussions and psychosocial rounds. In December 2020, the addition of direct patient tele-psychiatry services in school health clinics was launched. Initial outcomes showed an increase in provider confidence in managing mental health diagnoses and clinical care, leading to increased numbers of students served with an identified behavioral health diagnosis. (Table 1) Additionally, a total of 64 new patients received psychiatric evaluations in the school health clinics via tele health.

Conclusion: The model of integration of psychiatry care in school-based health services through peer consultation, education and direct patient care can provide a roadmap for other SBHCs in the country. This can be utilized to expand the reach and provide equitable access to psychiatry and behavioral health services. The specific outcome measures including the impact of this program on reduction of wait times, extent of service utilization, treatment adherence, academic and behavioral health outcomes are yet to be obtained.