Health Services is comprised of supports for the physical health of students and are typically delivered by a school nurse and/or other credentialed staff such as a nurse practitioner or physician. School nurses report spending approximately one-third of their time on behavioral health issues. There are over 2,000 school based health centers (SBHCs) operating across the US that serve as acute and primary care providers in a school setting, with an increasing number providing mental health services co-located within or in partnership with the SBHC. School health services typically include emergency/acute care, support for students with chronic conditions, care coordination, prevention efforts and education.
Include school health service providers (i.e. school nurse, SBHC provider) on school climate teams and other climate related efforts. Ensure these professionals are also involved in the development of policies and protocols to support a student in crisis or at risk of suicide and postvention efforts in the event of a suicide.
Establish information sharing agreements and Memoranda of Understanding (MOU) to ensure necessary student information can be shared while maintaining confidentiality.
Provide behavioral health training to health service professionals, and clear referral pathways if a mental/behavioral health need is identified as a part of services. For example, school nurses and school-based health providers may identify a mental health need in the context of a routine well visit or care coordination efforts.
National School Based Health Alliance Hallways to Health: Creating a school wide culture of health. This toolkit provides best practices, tools and stories organized around the steps to create a culture of health in schools.
Deepening Community Ties to Support Students with Mental/Behavioral Health Needs
Advanced Health, a Coordinated Care Organization that manages care for people on the Oregon Health Plan (Medicaid) funded a pilot project to better connect and coordinate care for students in Coos Bay School District, in partnership with Bay Clinic Pediatrics.
The funding supports a part time nurse liaison role that is filled by Barb Yost. Barb started the role in April of 2018 and has seen the caseload grow over time- she is now serving 32 students.
Barb works with families, students, school administrators, teachers and community providers to coordinate care for identified students. Students are typically referred to her by a building administrator or teacher, as they begin to build a team to identify necessary supports for the individual student. The majority of her caseload are students with behavioral and mental health needs, though she also helps coordinate care for students with other health needs (like asthma).
The unique partnership between Bay Clinic and the school district allows Barb to have immediate access to a student’s medical record. The partners worked together to create a Memorandum of Understanding (MOU) between the school district and Bay Clinic and developed a release of information that included access to mental and behavioral health records. “With the MOU in place, I can have immediate access to a student’s history. I can see that they have missed their last three appointments with their provider or that they have stopped taking their medication.” Additionally, access to a student’s electronic health record allows Barb to bill for some applicable services.
In her role, Barb goes out into the community to meet face to face with family, providers and other people who can help provide a fuller picture of what is going on in a student’s life. She may catch a teacher at recess and then head to the pediatrician’s office to discuss a student. “I just recently spoke with a student’s behavioral health provider and pediatrician. The pediatrician told me that he had never heard from someone in the schools prior to an appointment, and it helped give him important information to follow up on, as well as me gaining his perspective on what might be happening with the student.” Barb’s role is critical in not just coordinating across education and health systems, but providing important follow up and support to students and families. Barb ensures that students are plugged into the right supports and provides ongoing communication and coordination, such as help filling out paperwork, to ensure care continues beyond an acute crisis.
An early focus of the pilot project was on students that were chronically absent from school. Barb started by looking to the attendance roster, and following up with families of students that had 10 or more excused absences. “This was a failed model. Having someone follow up on absences from months ago immediately put parents on the defensive. They kept their kid home, went to the doctor and called the school. They were wondering why someone was calling about it now.” As the school year progressed, Barb noted that it became less and less about attendance because it seemed like she was getting pulled into the conversation before a student was chronically absent.
While grant funding has ended, the school district sees the value in Barb’s role. There are discussions about potentially funding the half time position using shared resources between Coos Bay School District and Bay Clinic Pediatrics. The unique position leverages important partnerships and deepens connections among important community providers that work together to support students and families.
For more information, contact Barb Yost, Nurse Liaison, at BarbYo@coos-bay.k12.or.us
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 Bobo, N., & Shubert, A. (2013). From tragedy to opportunity: Investing in students’ mental health and well being. The American Nurse, 45(2), 8. Retrieved from http://www.TheAmericanNurse.org