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Recently, a national priority has been set to improve mental health services for children and families. It has been identified in epidemiological literature that in the United States, an approximate 15% of youth meet diagnostic criteria for emotional or behavioral problems. Furthermore, less than one in every five children that present with such needs receive mental health services. Individual, family, and system barriers such as transportation, competing demands, and long waiting lists have negatively impacted access to mental health services. Therefore, the school system has become the “de facto” mental health system for children and adolescents, in part because of the significant time students spend at school. However, meeting the needs of students with behavioral or emotional problems within the school system poses its own challenges. Schools have reported being limited in their ability to deliver basic mental wellness to students due to the lack of available resources. Specifically, there is a shortage of school-employed mental health personnel and the ratio of student to mental health professional is two to three times larger than recommended. Expanded school mental health programs are partnered systems that utilize existing services and collaborate with community mental health (CMH) professionals at each level of the three-tiered system. This partnership enables CMH staff gain access to youth with emotional and behavioral problems, resulting in increased prevention and intervention services for students. Additionally, a coordinated effort such as student-transition services has an integral role of facilitating the process from the school system to postsecondary employment, training, and or additional education.

Public schools possess a unique constellation of opportunities and challenges for mental health service provision. Schools, as settings within a larger ecological context, can be a community institution that supports a child as s/he develops assets for resilient development while providing opportunities for a range of life choices. School is the setting where children can learn and practice peer relations and social norms, and it can be a refuge where children who have many environmental risks can find structure and effective methods of success (Doll, 1999). When Willie Horton, the infamous bank robber, was asked why he robbed banks, he responded, “Because that's where the money is.” At a most basic level, schools are where the children are. Every day more than 52 million students attend over 1,14,000 schools in the United States, and including the 6 million adult staff, this amounts to almost one-fifth of the population passing through the Nation's schools on any given weekday (New Freedom Commission on Mental Health, 2003).

Models of Child Health Appraised (MOCHA) defines school health services (SHSs) as those that exist due to a formal arrangement between educational institutions and primary health care. SHSs are unique in that they are designed exclusively to address the needs of children and adolescents in this age group and setting.

We investigated SHSs have been provided to schools and how they contribute to primary healthcare services for school children. We did this by mapping the national school health systems against the standards of the World Health Organization, and against a framework measuring the strength of primary care, adapting this from an existing, adult-focused framework.

We found that all but two countries in the European Union and European Economic Area have SHSs. There, however, remains a need for much greater investment in the professional workforce to run the services, including training to ensure appropriateness and acceptability to young people. Greater collaboration between SHSs and primary care services would lead to better coordination and the potential for better health (and educational) outcomes. Involving young people and families in the design of SHSs and as participants in its outputs would also improve school health.

Students with emotional and behavioral challenges are significantly impacted by mental health issues. Teachers and other school staff need mental health knowledge to work more effectively with these students. Collaboration with mental health professionals and sharing of information is essential.

Purpose – This chapter discusses the promise of and challenges to providing effective and culturally responsive trauma-focused mental health services to immigrant and refugee youth and their families within school settings.

Design/methodology/approach – This chapter utilizes “practice-based evidence” to outline successes and address the barriers associated with the implementation of school-based, trauma-focused, evidence-based interventions in four immigrant or refugee-dense cities: Los Angeles, Chicago, Minneapolis, and Boston.

Findings – Making cultural adaptations to identified trauma interventions that were consistent with community priorities, cultural norms, and values resulted in more accessible programs and greater engagement in treatment services.

Practical implications – The strategies tested in these real-world settings contribute to the development of culturally competent trauma-informed services for immigrant and refugee youth and their families. Mental health providers and program developers will better understand the need for multilevel engagement strategies and for culturally driven modifications when employing evidence-based programs with immigrant and refugee youth.

Originality/value – This chapter adds to the scarce evidence about useful methods to engage immigrant and refugee youth and families in treatment and to increase the likelihood of positive outcomes.

There is a need for rigorous research documenting the important role of school nurses in facilitating positive health outcomes among students. Poorly managed care can affect student absenteeism rates, which are associated with academic performance and school funding, and students in underresourced schools are at particularly higher risk of suffering chronic conditions (e.g., asthma, diabetes) that necessitate proper care and management. The San Jose Unified School District (SJUSD) Nurse Demonstration Project was developed as a five-year endeavor to expand school nursing and formally link school nurses to a school-based health clinic. The initiative provides for full-time school nurses at four elementary and middle schools in SJUSD, and a nurse practitioner at School Health Clinics of Santa Clara County. The objectives are to: (1) improve access to primary care and prevention services, specifically asthma and chronic condition management and (2) facilitate the establishment of a medical home for students. Evaluation of the project employs a mixed methods research design, including a logic model, an intervention and control study design (comparing outcome measures in the four demonstration schools with five “control” schools), parent, teacher, and school administrator feedback, systematic nurse reports, and quantitative analysis of school health and administrative data, including health conditions and absenteeism information. Key findings in Phase I of the project are discussed, including improvement in screening and referrals, follow-up care among students with asthma, and mean days absent due to illness. With increasing budget cuts to public schools, documenting the impact of full-time school nurses will remain crucial in leveraging support and resources for school health services. Findings of this project indicate that school nurses provide valuable services and could be a major player in providing and coordinating effective management and prevention of chronic disease among children.

The Models of Child Health Appraised (MOCHA) project identified the different models of primary care that exist for children, examined the particular attributes that might be different from those directed at adults and considered how these models might be appraised. The project took the multiple and interrelated dimensions of primary care and simplified them into a conceptual framework for appraisal. A general description of the models in existence in all 30 countries of the EU and EEA countries, focusing on lead practitioner, financial and regulatory and service provision classifications, was created. We then used the WHO ‘building blocks’ for high-performing health systems as a starting point for identifying a good system for children. The building blocks encompass safe and good quality services from an educated and empowered workforce, providing good data systems, access to all necessary medical products, prevention and treatments, and a service that is adequately financed and well led. An extensive search of the literature failed to identify a suitable appraisal framework for MOCHA, because none of the frameworks focused on child primary care in its own right. This led the research team to devise an alternative conceptualisation, at the heart of which is the core theme of child centricity and ecology, and the need to focus on delivery to the child through the life course. The MOCHA model also focuses on the primary care team and the societal and environmental context of the primary care system.

The role of the school nurse has evolved. It has expanded from administering first aid and promoting hand washing to key participation in program planning for health and educational outcomes for the school-aged child. Nurses provide leadership in promoting a healthy and safe school environment, case management of chronically ill children, collaboration between family and school, and referral to essential community resources. Additionally, the school nurse is a valuable resource on the multidisciplinary special education team. The school nurse is the health care expert in the school and is in a unique position to meet the actual and potential needs of all students – including those with special needs.

Students with physical and health impairments represent a small but growing group of individuals with diverse educational needs. They are those students whose physical limitations or health problems interfere with school attendance or learning to such an extent that special services, training, equipment, materials, or facilities are required. Therefore, the purpose of this chapter is to discuss some of these impairments and acquaint both general and special educators with interventions for helping students with physical and health impairments succeed.

There is more to primary care than solely medical and nursing services. Models of Child Health Appraised (MOCHA) explored the role of the professions of pharmacy, dental health and social care as examples of affiliate contributors to primary care in providing health advice and treatment to children and young people. Pharmacies are much used, but their value as a resource for children seems to be insufficiently recognised in most European Union (EU) and European Economic Area (EEA) countries. Advice from a pharmacist is invaluable, particularly because many medicines for children are only available off-label, or not available in the correct dose, access to a pharmacist for simple queries around certain health issues is often easier and quicker than access to a primary care physician or nursing service. Preventive dentistry is available throughout the EU and EEA, but there are few targeted incentives to ensure all children receive the service, and accessibility to dental treatment is variable, particularly for disabled children or those with specific health needs. Social care services are an essential part of health care for many extremely vulnerable children, for example those with complex care needs. Mapping social care services and the interaction with health services is challenging due to their fragmented provision and the variability of access across the EU and EEA. A lack of coherent structure of the health and social care interface requires parents or other family members to navigate complex systems with little assistance. The needs of pharmacy, dentistry and social care are varied and interwoven with needs from each other and from the healthcare system. Yet, because this inter-connectivity is not sufficiently recognised in the EU and EEA countries, there is a need for improvement of coordination and with the need for these services to focus more fully on children and young people.