School-based Health Centers: A Model of Care to Meet the Behavioral and Mental Health Needs of Children and Adolescents.

摘要

Exposure to chronic childhood trauma increases the risk for the development of behavioral and mental health disorders and poor academic achievement. Nearly 70% of children have experienced some form of trauma, in the form of either a victimizing or non-victimizing event. Estimates suggest that 20% of children and adolescents have a mental health disorder, yet 70% do not receive mental health services. Children and adolescents of minority racial/ethnic groups and those living in poverty are at greater risk of exposure to trauma and less likely to have access to and utilization of mental health services. This increases the risk for poor academic achievement and school dropout. School success is a major determinant of a person's opportunities for employment and social mobility advancement. Structural interventions are needed to provide resources to help prevent or mitigate the harm from exposure to chronic childhood trauma. One strategy to increase access and utilization of mental health services is the school-based health center (SBHC) model of care. This dissertation begins with a literature review to explore the association between trauma, mental health, academic success, mental health care disparities, and SBHC mental health services. This paper then employs a cross-sectional design to examine the School-based Health Alliance 2010-11 Census to describe and assess the characteristics of SBHCs with mental health providers. This study also examines the 2010 California Healthy Kids Core Module Survey to assess the need for mental health services in school-aged children in California. The findings demonstrate that exposure to chronic childhood trauma negatively impacts school achievement when mediated by mental health disorders. There are multiple characteristics associated with SBHCs having a mental health provider on-site at the school. There is a need for mental health services for 6th-12th graders. These students are being exposed to victimizing events on school campuses and are thus at higher risk for use of substances, symptoms of depression and eating disorders, and poor academic achievement. These findings have implications for policy makers and school health stakeholders in addressing the need for mental health services in children and adolescents exposed to chronic childhood trauma.