Public policy and school-based mental health services in Pennsylvania.

摘要

Objective. Recognition of unmet mental health needs of school age children, and adolescents has raised voices calling for change in public policy, and mental health care practice. A growing number of reports recommend policy support for locating programs, and services in public schools. This study is an exploration of the contextual factors surrounding, and influencing public policy development regarding public school-based mental health in Pennsylvania. The results should inform policy makers, administrators, and practitioners of significant context for their efforts to develop public policy, and appropriate mental health student services. Method. This policy case study used naturalistic, and qualitative methods. Research reports, policy documents, conversations with policy makers, and participant-observation field notes provided the primary data for analysis. The author, an experienced public mental health administrator, looked for patterns in the data. The patterns established a taxonomy of contextual factors influencing school-based mental health public policy nationally, and in Pennsylvania. The author describes policy influences of each contextual factor. Results. There is evidence of a national trend toward policy support for school-based approaches to mental health care. Pennsylvania is in line with, and perhaps helps to lead, this policy trend. There is evidence that multiple, complex contextual factors influence public policy in Pennsylvania. Factors include: national trends in health care financing reform and managed care, the family movement, and special education; growing recognition that services currently are fragmented; recommendations for collaboration; litigation; tradition; existing Student Assistance Programs, and Instructional Support Teams; the Child and Adolescent Service System Program (CASSP); Pennsylvania's administration of federal Title XIX or Medicaid; the philosophy of local control; professional training initiatives; and ideal system design papers. Conclusions. Public policy dictates critical issues for school-based mental health. Policy determines answers to the questions: Who pays for it?; Who gets it?; Who does it?; and What is done? Funding issues will continue to play a key role in choices Pennsylvania policy makers face. Current policy trends, influenced by complex, interacting contextual factors, leave the education system situated to provide a broad range of mental health services to a large number of children, and adolescents. Policy supporting public school-based mental health has developed even while important questions remain unresolved.