Mental health care in a high school based health service

Adolescence, Spring, 1998 by Lisa Jepson, Linda Juszczak, Martin Fisher

At the time of data collection, the center was staffed by (1) a social worker; (2) a doctoral student in clinical psychology, who worked two days a week and was supervised by an off-site licensed psychologist; (3) two pediatric nurse practitioners, one of whom served as the center's director; (4) attending physicians and fellows from North Shore University Hospital, who rotated to cover the center 3-5 hours three times a week; and (5) two health aides provided by the school, who were responsible for record keeping, emergency services for both enrolled and nonenrolled students, reception, triage, and basic, on-site screening tests.

Since the inception of the program, the goal has been to integrate mental health and medical services, which has been accomplished on two levels. First, clinic staff interact on an ongoing basis and discuss both policy issues and individual cases. Second, the initial evaluation communicates to each student that staff are interested in both medical and psychosocial issues, and provides for a screening of every registered student in these areas. The center has been successful in treating a large number of students for a wide range of medical and psychosocial problems. The services provided by the center are listed in Table 1.

Data Collection

Students are seen in the center either for scheduled appointments or as walk-ins. Each new student receives a comprehensive health evaluation, which includes a patient and family medical history; a psychosocial history; a complete physical examination, including a gynecologic examination for sexually active females or those with gynecologic complaints; and laboratory screening tests.

Information obtained from all health evaluations is maintained in patient charts and compiled on a regular basis. Additional information is gathered for each visit (including reason for visit, services provided, diagnosis, referrals, and length of contact), and these data are also compiled regularly.

During the initial evaluation, students who respond affirmatively to questions relating to depression, past or present suicidal ideation, moderate or severe family or interpersonal problems, or any form of self-destructive behavior are referred to the center's mental health providers for a more in-depth interview. Students are also referred if they request "to talk with somebody" or if during the medical examination it appears that mental health services are warranted - such as in the case of physical findings that indicate child abuse.

For the purpose of this study, the charts of all students who used the mental health between January and December 1992 were reviewed for a primary diagnosis. Because the clinic serves adolescents from multiproblem families, only the most urgent treatment issue was recorded. Treatment issues were therefore ranked in order of salience. In cases where crisis intervention was needed, only the reason for the intervention was recorded regardless of whether that student had been using the mental health services for other reasons.