By Melinda Young
School mental health providers find care coordination to be important for students in public school districts.1
“Care coordination in schools is multifaceted in the sense that I view it as two different realms: care coordination with outside providers — pediatricians, outside mental health providers, and psychologists — and connecting with school-based personnel,” says Malena Anda Nygaard, PhD candidate in the school psychology program at Indiana University.
Nygaard’s study focuses on care coordination within school districts. Care coordination refers to care activities for delivering services through communication to all involved, with the central goal of meeting the student’s needs and preferences and addressing gaps in care.
It is important to reduce the fragmented services that could produce gaps and redundancies. “Connecting schools is one thing, and we know that having ongoing communication with providers and releasing information and being able to coordinate in that way is an important area of study,” Nygaard explains. “What I did was survey school mental health providers across the nation to look at what care coordination looked like in the schools.”
For example, schools have been expanding their services for students beyond academics. Free and reduced price school lunches are the most common example. But some schools also provide dental services, and now it is expanded to meeting students’ mental health needs.
“Now that schools have expanded to meet this need, the purpose of the research I’ve conducted is to get a baseline assessment of what schools are doing,” Nygaard explains. “It’s looking at what their practices are for coordinating mental healthcare in the school.”
Nygaard and colleagues surveyed more than 160 school mental health providers. They found school psychologists and social workers personally endorse care coordination, and their training in mental healthcare coordination practices varies.
No Standard Practices
There are no protocols or standard practices for how school mental health providers connect with community mental health providers. “School psychologists can provide mental healthcare within the school day in school, but those services they provide at school may not continue from year to year, as students go up in grade level or from elementary to middle school to high school,” Nygaard says. “There’s not a process to ensure that continues, and there is not [enough] communicating with the next school.” For instance, it would be important for suicide risk assessments and other pertinent information to be transferred from one school’s mental health official to the next.
Some schools offer programs of bringing schools and families together to support students who return to school after psychiatric hospitalization.
“They [may] have a family connector and school transition specialists, so they have ways to do that and promote that collaboration,” Nygaard says. “But I think that’s definitely not common.”
Communication Barriers
When Nygaard worked in schools, she found it was difficult for school providers to even get community providers to respond to phone calls and other communication. There also are communication barriers related to HIPAA and school mental health professionals’ perceptions of privacy rules.
“They would say, ‘I want to share this information, but I’m not allowed to do it,’” Nygaard says. “There seems to be confusion there.”
School professionals also said they would contact private practices and not receive return phone calls. They would say, “It’s hard to know if I’m duplicating services. They wouldn’t even talk to me,” Nygaard notes.
Mental health providers also have expressed discontent with barriers, such as lacking important information about students under their care. “One outside mental health provider wished she was part of the school because she had difficulty getting access to academic data and attendance,” Nygaard recalls. “It takes time and a process to get approval for that information.”
Care coordination between schools and community mental health providers often falls on the shoulders of families. “A school nurse can refer the student to the school mental health clinician, and that person becomes a point of contact and follow-up with the family,” Nygaard says. “The system is [clearer] in following up what happens inside the school, but when it’s an outside provider, it becomes more challenging.”
Partner with Community Providers
One possible solution to care coordination breakdowns is for schools to partner with community providers. “They can have that connection and follow-through and build a relationship that is useful, as well as having active participation in obtaining releases of information and sharing information with one another,” Nygaard explains. “They can collaborate. Schools are part of mental health support, and they can make sure they’re not duplicating [services] in school.”
The goal is for both school mental health providers and community mental health providers to be on the same page and work together. “Health systems can reach out to schools and provide referral documents, fliers, and other information,” Nygaard says. “School-based people can refer students in that way.”
Schools also could keep a list of students who have been referred to community providers so they can maintain relationships with those providers and make sure their students have the information they need.
“This is definitely an area to conduct more research in and define the roles between school, mental health providers, and outside agencies, and how we can work together for expanded mental health and encouraging outside providers to contract with schools,” Nygaard says.
Ensure All Receive Care
With the current shortage of mental health providers to meet the needs of children and adolescents, care coordination is one way to ensure everyone who needs mental healthcare will receive it.
“We need to continue to look at what research has been done and apply it to schools to make sure we’re [coordinating care] in the best way possible,” Nygaard says. “We need to meet student needs in the most comprehensive and effective way.”
REFERENCE
- Nygaard MA, Renshaw TL, Ormiston HE, et al. Importance, quality, and engagement: School mental health providers’ perceptions regarding within-district transition care coordination practices. Sch Psychol 2023; Sep 4. doi: 10.1037/spq0000569. [Online ahead of print].
School mental health providers find care coordination to be important for students in public school districts. Care coordination refers to care activities for delivering services through communication to all involved, with the central goal of meeting the student’s needs and preferences and addressing gaps in care.
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