title: Bringing Wellness to Schools: Opportunities for and Challenges to Mental Health Integration in School-Based Health Centers.
abstract: School-based health centers (SBHCs) reduce access barriers to mental health care and improve educational outcomes for youths. This qualitative study evaluated the innovations and challenges of a unique network of SBHCs in a large, urban school district as the centers attempted to integrate health, mental health, and educational services.
  
  
  
  The 43 participants sampled included mental health providers, primary care providers, and care coordinators at 14 SBHCs. Semistructured interviews with each participant were audio recorded and transcribed. Themes were identified and coded by using Atlas.ti 5.1 and collapsed into three domains: operations, partnership, and engagement.
  
  
  
  Interviews revealed provider models ranging from single agencies offering both primary care and mental health services to colocated services. Sites where the health agency provided at least some mental health services reported more mental health screenings. Many sites used SBHC wellness coordinators and coordination team meetings to facilitate relationships between schools and health agency and community mental health clinic providers. Partnership challenges included confidentiality policies and staff turnover. Participants also highlighted student and parent engagement through culturally sensitive services, peer health advocates, and "drop-in" lunches.
  
  
  
  Staffing and operational models are critical in the success of integrating primary care, mental health care, and education. Among the provider models observed, the combined primary care and mental health provider model offered the most integrated services. Despite barriers, providers and schools have begun to implement novel solutions to operational problems and family engagement in mental health services.
authors.affiliation: Dr. Lai, Dr. Ijadi-Maghsoodi, and Dr. Kataoka are with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute, and Ms. Guo is with the School of Psychology, all at the University of California, Los Angeles (UCLA). Dr. Ijadi-Maghsoodi is also with the Health Services Research and Development Center, Department of Veterans Affairs (VA), Los Angeles. Ms. Puffer is with L.A. Trust for Children's Health, Los Angeles. Send correspondence to Dr. Kataoka (e-mail: skataoka@mednet.ucla.edu ).
authors.forename: Karen
authors.initials: K
authors.lastname: Lai
authors.affiliation: Dr. Lai, Dr. Ijadi-Maghsoodi, and Dr. Kataoka are with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute, and Ms. Guo is with the School of Psychology, all at the University of California, Los Angeles (UCLA). Dr. Ijadi-Maghsoodi is also with the Health Services Research and Development Center, Department of Veterans Affairs (VA), Los Angeles. Ms. Puffer is with L.A. Trust for Children's Health, Los Angeles. Send correspondence to Dr. Kataoka (e-mail: skataoka@mednet.ucla.edu ).
authors.forename: Sisi
authors.initials: S
authors.lastname: Guo
authors.affiliation: Dr. Lai, Dr. Ijadi-Maghsoodi, and Dr. Kataoka are with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute, and Ms. Guo is with the School of Psychology, all at the University of California, Los Angeles (UCLA). Dr. Ijadi-Maghsoodi is also with the Health Services Research and Development Center, Department of Veterans Affairs (VA), Los Angeles. Ms. Puffer is with L.A. Trust for Children's Health, Los Angeles. Send correspondence to Dr. Kataoka (e-mail: skataoka@mednet.ucla.edu ).
authors.forename: Roya
authors.initials: R
authors.lastname: Ijadi-Maghsoodi
authors.affiliation: Dr. Lai, Dr. Ijadi-Maghsoodi, and Dr. Kataoka are with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute, and Ms. Guo is with the School of Psychology, all at the University of California, Los Angeles (UCLA). Dr. Ijadi-Maghsoodi is also with the Health Services Research and Development Center, Department of Veterans Affairs (VA), Los Angeles. Ms. Puffer is with L.A. Trust for Children's Health, Los Angeles. Send correspondence to Dr. Kataoka (e-mail: skataoka@mednet.ucla.edu ).
authors.forename: Maryjane
authors.initials: M
authors.lastname: Puffer
authors.affiliation: Dr. Lai, Dr. Ijadi-Maghsoodi, and Dr. Kataoka are with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute, and Ms. Guo is with the School of Psychology, all at the University of California, Los Angeles (UCLA). Dr. Ijadi-Maghsoodi is also with the Health Services Research and Development Center, Department of Veterans Affairs (VA), Los Angeles. Ms. Puffer is with L.A. Trust for Children's Health, Los Angeles. Send correspondence to Dr. Kataoka (e-mail: skataoka@mednet.ucla.edu ).
authors.forename: Sheryl H
authors.initials: SH
authors.lastname: Kataoka
mesh_terms: D019033:Delivery of Health Care, Integrated; D006282:Health Personnel; D006801:Humans; D008605:Mental Health Services; D010290:Parents; D036301:Qualitative Research; D012572:School Health Services; D012574:Schools; D014481:United States