Schehera Coleman, PhD, and Christine Waanders, PhD
Social determinants of health are the environmental factors surrounding a child that impact health outcomes, risk factors, and quality of life. These include trauma, adverse childhood experiences (ACEs), and poor access to services and support in under-resourced communities. Too many young people in Philadelphia are exposed to environmental factors that threaten their sense of safety, stability, and bonding with loved ones. Philadelphia youth often experience violence, exploitation, abuse, and neglect, and they witness violence in their home or community, or have a family member attempt or die by suicide.
While many youth in Philadelphia show impressive resilience in the face of serious social and environmental risks, others struggle. They may develop aggressive behavior, PTSD, anxiety, depression, or substance use disorder. When these mental health problems remain unaddressed, it can increase children’s behavioral or emotional difficulties and shape both short- and long-term outcomes.
Goal: Promote Resilience and Mental Health Wellness
Addressing these factors was the impetus for the development of CHOP’s School Based
Mental Health (SBMH) Program, which started in 2021 with a grant from the Independence Blue Cross Foundation (IBX Foundation). The vision of the Department of Child and Adolescent Psychiatry and Behavioral Sciences (DCAPBS) is to eliminate barriers and increase access to high-quality mental healthcare. We aim to provide students with evidence-based, culturally appropriate mental health services and supports, to lessen the impact of trauma and ACEs on youth and to promote resilience and wellness.
We prioritize interventions that have documented effectiveness with racially and ethnically diverse youth. Because youth are 6 times more likely to complete treatment when it is offered in schools than in community settings, the SBMH program has the potential to alter the trajectory for many students and their families by identifying and slowly dismantling structural and systemic hurdles that prevent success and emotional well-being. Our presence at the school facilitates valuable teacher input into children’s behavioral healthcare and allows our team to build bridges between school staff and families.
CHOP’s SBMH initiative started with a pilot program at Girard College, a boarding school in Philadelphia for academically capable students in grades 1 to 12 from single-parent families with limited financial resources. Our team partnered with school leaders and support staff to learn about their students’ strengths and mental health needs and how these were being met by the school’s existing programs.
Collaboration with School for Each Step
First, we offered professional development workshops in trauma-informed practices for teachers, administrators, and residential staff. In collaboration with school staff, we developed a process for identifying students whose mental health needs were not being met through classroom interventions or school social work supports. School staff and parents referred children and teens showing signs of distress, ranging from disruptive behavior in the classroom, to frequent tearful meltdowns, to low motivation and social withdrawal. These students were offered therapy and psychiatric services with a CHOP therapist or psychiatrist.
Since the 2021 – 2022 school year, we have conducted more than 60 behavioral health and psychiatric evaluations and hundreds of therapy sessions with students. About 25% of our patients have been prescribed medication and receive medication management services from our psychiatrist. Our clinicians have also consulted with teachers and families in person and via video meetings to coordinate care and share clinical guidance. Training continues for staff.
A Path to Right Care, Right Place, Right Time
Our SBMH program is being developed at a crucial time for children’s mental health. Post-pandemic, Philadelphia children face more trauma and ACEs than ever before. In the United States, 1 of 5 children experience a significant mental health condition. In Pennsylvania and across the U.S., fewer than half of all youth with depression are receiving mental health treatment. CHOP’s SBMH initiative can help address this gap and bring us closer to the goal of DCAPBS Psychiatrist-in-Chief Tami Benton, MD, to create a pathway to a full continuum of behavioral/mental health services so children can receive the right care, in the right place, and at the right time. There is a need for evidence-based services where children and adolescents spend the most time—in school! CHOP’s SBMH program is on the path to doing just that.
Using the model developed at Girard College, the IBX Foundation has committed the funds to expand our SBMH programming into 2 additional schools this year—a charter school and a traditional public school in Philadelphia. We plan to engage more school partners each year to continue expanding access to strong mental health services for Philadelphia students.
Schehera is the Clinical Director of the School Based Mental Health Program, and Waanders is a Clinical Consultant with the SBMH Program.
References and Suggested Readings
Bellazaire, A. (2018). Preventing and mitigating the effects of adverse childhood experiences. National Conference of State Legislatures. https://teamwv.org/wp-content/uploads/2017/11/2018-conference-of-state-legislator-report-on-mitigating-effects-of-ACES-retreived-9-13-18.pdf. Accessed April 9, 2024.
Center for Health and Health Care in Schools, School-Based Health Alliance, National Center for School Mental Health (2020). Understanding social influences of health and education: a role for school-based health centers and comprehensive school mental health systems.
https://www.schoolmentalhealth.org/media/som/microsites/ncsmh/documents/fliers-resources-misc-docs/resources/Understanding-Social-Influencers-of-Health-and-Education.pdf. Accessed April 9, 2024.
Langley AK, Nadeem E, Kataoka SH, et al. Evidence-based mental health programs in schools: barriers and facilitators of successful implementation. School Mental Health. 2010:2(3);105-113.
Reinert M, Fritze D, Nguyen T. The state of mental health in America 2022. https://mhanational.org/sites/default/files/2022%20State%20of%20Mental%20Health%20in%20America.pdf. Accessed April 9, 2024.
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Schehera Coleman, PhD, and Christine Waanders, PhD
Social determinants of health are the environmental factors surrounding a child that impact health outcomes, risk factors, and quality of life. These include trauma, adverse childhood experiences (ACEs), and poor access to services and support in under-resourced communities. Too many young people in Philadelphia are exposed to environmental factors that threaten their sense of safety, stability, and bonding with loved ones. Philadelphia youth often experience violence, exploitation, abuse, and neglect, and they witness violence in their home or community, or have a family member attempt or die by suicide.
While many youth in Philadelphia show impressive resilience in the face of serious social and environmental risks, others struggle. They may develop aggressive behavior, PTSD, anxiety, depression, or substance use disorder. When these mental health problems remain unaddressed, it can increase children’s behavioral or emotional difficulties and shape both short- and long-term outcomes.
Goal: Promote Resilience and Mental Health Wellness
Addressing these factors was the impetus for the development of CHOP’s School Based
Mental Health (SBMH) Program, which started in 2021 with a grant from the Independence Blue Cross Foundation (IBX Foundation). The vision of the Department of Child and Adolescent Psychiatry and Behavioral Sciences (DCAPBS) is to eliminate barriers and increase access to high-quality mental healthcare. We aim to provide students with evidence-based, culturally appropriate mental health services and supports, to lessen the impact of trauma and ACEs on youth and to promote resilience and wellness.
We prioritize interventions that have documented effectiveness with racially and ethnically diverse youth. Because youth are 6 times more likely to complete treatment when it is offered in schools than in community settings, the SBMH program has the potential to alter the trajectory for many students and their families by identifying and slowly dismantling structural and systemic hurdles that prevent success and emotional well-being. Our presence at the school facilitates valuable teacher input into children’s behavioral healthcare and allows our team to build bridges between school staff and families.
CHOP’s SBMH initiative started with a pilot program at Girard College, a boarding school in Philadelphia for academically capable students in grades 1 to 12 from single-parent families with limited financial resources. Our team partnered with school leaders and support staff to learn about their students’ strengths and mental health needs and how these were being met by the school’s existing programs.
Collaboration with School for Each Step
First, we offered professional development workshops in trauma-informed practices for teachers, administrators, and residential staff. In collaboration with school staff, we developed a process for identifying students whose mental health needs were not being met through classroom interventions or school social work supports. School staff and parents referred children and teens showing signs of distress, ranging from disruptive behavior in the classroom, to frequent tearful meltdowns, to low motivation and social withdrawal. These students were offered therapy and psychiatric services with a CHOP therapist or psychiatrist.
Since the 2021 – 2022 school year, we have conducted more than 60 behavioral health and psychiatric evaluations and hundreds of therapy sessions with students. About 25% of our patients have been prescribed medication and receive medication management services from our psychiatrist. Our clinicians have also consulted with teachers and families in person and via video meetings to coordinate care and share clinical guidance. Training continues for staff.
A Path to Right Care, Right Place, Right Time
Our SBMH program is being developed at a crucial time for children’s mental health. Post-pandemic, Philadelphia children face more trauma and ACEs than ever before. In the United States, 1 of 5 children experience a significant mental health condition. In Pennsylvania and across the U.S., fewer than half of all youth with depression are receiving mental health treatment. CHOP’s SBMH initiative can help address this gap and bring us closer to the goal of DCAPBS Psychiatrist-in-Chief Tami Benton, MD, to create a pathway to a full continuum of behavioral/mental health services so children can receive the right care, in the right place, and at the right time. There is a need for evidence-based services where children and adolescents spend the most time—in school! CHOP’s SBMH program is on the path to doing just that.
Using the model developed at Girard College, the IBX Foundation has committed the funds to expand our SBMH programming into 2 additional schools this year—a charter school and a traditional public school in Philadelphia. We plan to engage more school partners each year to continue expanding access to strong mental health services for Philadelphia students.
Schehera is the Clinical Director of the School Based Mental Health Program, and Waanders is a Clinical Consultant with the SBMH Program.
References and Suggested Readings
Bellazaire, A. (2018). Preventing and mitigating the effects of adverse childhood experiences. National Conference of State Legislatures. https://teamwv.org/wp-content/uploads/2017/11/2018-conference-of-state-legislator-report-on-mitigating-effects-of-ACES-retreived-9-13-18.pdf. Accessed April 9, 2024.
Center for Health and Health Care in Schools, School-Based Health Alliance, National Center for School Mental Health (2020). Understanding social influences of health and education: a role for school-based health centers and comprehensive school mental health systems.
https://www.schoolmentalhealth.org/media/som/microsites/ncsmh/documents/fliers-resources-misc-docs/resources/Understanding-Social-Influencers-of-Health-and-Education.pdf. Accessed April 9, 2024.
Langley AK, Nadeem E, Kataoka SH, et al. Evidence-based mental health programs in schools: barriers and facilitators of successful implementation. School Mental Health. 2010:2(3);105-113.
Reinert M, Fritze D, Nguyen T. The state of mental health in America 2022. https://mhanational.org/sites/default/files/2022%20State%20of%20Mental%20Health%20in%20America.pdf. Accessed April 9, 2024.
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