DHHS Publication No. (SMA) 05-4068

Printed 2005

Susan F

Mary Rolle

Teresa Do

Denise No

Gail Rob

Judith 

and Financing, CMHS, served as advisor.

Disclaimer

Material for this report was prepared by Abt Associates Inc., for SAMHSA, DHHS, und

Contract Number 282-98-0006, Task Order No. 32. The content of this publication d

not necessarily reflect the views, opinions, or policies of CMHS, SAMHSA, or DHHS.

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced o

copied without permission from SAMHSA or CMHS. Citation of the source is

appreciated. However, this publication may not be reproduced or distributed for a fee

without the specific, written authorization of the Office of Communications, SAMHSA

DHHS.

Electronic Access and Copies of Publication

This publication can be accessed electronically through the following Internet World

Wide Web address www.samhsa.hhs.gov/. For additional free copies of this document

please call SAMHSA’s National Mental Health Information Center at 1-800-789-2647 o

1-800-228-0427 (TTD).

Recommended Citation

Foster, S., Rollefson, M., Doksum, T., Noonan, D., Robinson, G., Teich, J. (2005). Scho

Mental Health Services in the United States, 2002–2003. DHHS Pub. No. (SMA) 05-4068

Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health

Services Administration.

Originating Office

Office of the Associate Director for Organization and Financing, Center for Mental

Health Services, Substance Abuse and Mental Health Services Administration, One

Choke Cherry Road, 6-1065, Rockville, MD 20857. 

DHHS Publication No. (SMA) 05-4068

Printed 2005 

School Mental Health Services in the United States, 2002–2003 
iv School Mental Health Services in the United States, 2002–2003 
1.2 Review of the Research Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

1.3 Goals of the Study and Research Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

1.4 Overview of Survey Design and Methodology . . . . . . . . . . . . . . . . . . . . . . . . . .1 0

2.0 Mental Health Problems and Services in the School Setting . . . . . . . . . . . . . . . . . . .1 5

2.1 Eligibility for Mental Health Serv i c e s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 5

2.2 Types of Mental Health Pro b l e m s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 5

2.3 Mental Health Problems by School Level and Gender . . . . . . . . . . . . . . . . . . . .1 7

2.4 Resource Use for Various Mental Health Pro b l e m s . . . . . . . . . . . . . . . . . . . . . . .1 8

2.5 Mental Health Services in U.S. Schools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 9

2.6 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 4

3.0 Administrative Arrangements for the Delivery and Coordination of 

Mental Health Services in Schools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 5

3.1 Contracting Arr a n g e m e n t s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 6

3.2 Mental Health Units and School-Based Health Centers . . . . . . . . . . . . . . . . . . .2 8

3.3 Administrative Functions in School Mental Health . . . . . . . . . . . . . . . . . . . . . . .2 8

3.4 Coordination and Referral Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 9

3.5 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 0

4.0 S t a ff Providing Mental Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

in Schools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 3

4.1 Characteristics of Staff Providing Mental Health Serv i c e s . . . . . . . . . . . . . . . . . .3 3

4.2 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 8

5.0 Funding, Budgeting and Resource Allocation, and Data Use . . . . . . . . . . . . . . . . . .3 9

5.1 Sources of Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 9

5.2 Funding Restrictions and Other Barriers to Providing Serv i c e s . . . . . . . . . . . . . .4 0

School Mental Health Services in the United States, 2002–2003 
6.2 Mental Health Problems and Services at the Middle School Level . . . . . . . . . . .4 8

6.3 Mental Health Problems and Services at the High School Level . . . . . . . . . . . . .4 9

6 . 4 S u m m a ry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 5

7.0 Discussion and Implications for Further Researc h . . . . . . . . . . . . . . . . . . . . . . . . . . .5 7

7.1 Mental Health Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 7

7.2 Mental Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 9

7.3 Staff i n g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 0

7.4 Service Delivery Arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 0

7.5 Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 1

7.6 Implications for Further Researc h . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 1

E n d n o t e s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 3

R e f e re n c e s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 7

Appendix A: School Mental Health Services in the United States, 2002–2003 . . . . . . . .7 1

E x p e rt Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 1

Appendix B: Summary of Open-Ended Responses . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 3

School Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 3

District Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 5

Appendix C: Supplemental Ta b l e s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79

School Tables 

District Ta b l e s

vi School Mental Health Services in the United States, 2002–2003 
Exhibit 2.3 P e rcentage of Schools That Cited the Following Mental Health 

P roblems as Among Their Top Three Problems, by School Level, 2002–2003 . . . .1 8

Exhibit 2.4 Percentage of Schools Reporting That Various Mental Health 

P roblems Use Most of Schools’ Mental Health Resources, by School 

Level, 2002–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 9

Exhibit 2.5 Mental Health Services Categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 0

Exhibit 2.6 Percentage of Schools Providing Various Mental Health 

S e rvices, 2002–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 1

Exhibit 2.7 Percentage of Schools Reporting Extent to Which Various 

Factors Are Barriers to Providing Mental Health Services, 2002–2003 . . . . . . . . . .2 2

Exhibit 2.8 Percentage of Schools Providing Prevention and Early

I n t e rvention Programs, 2002–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 3

Exhibit 3.1 Percentage of Schools Using Staffing Sources for Various 

Mental Health Services in Schools: 2002–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 6

Exhibit 3.2 Percentage of Schools With Various Community-Based Organizations

and Individual Providers To Provide Mental Health Services, 2002–2003 . . . . . . . .2 7

S o u rce: School Mental Health Services in the United States, 2002–2003, 

Substance Abuse and Mental Health Services Administration, U.S. 

D e p a rtment of Health and Human Serv i c e s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 7

Exhibit 3.3 Percentage of Schools Using Strategies To Coordinate Mental 

Health Activities and Services Within Schools, 2002–2003 . . . . . . . . . . . . . . . . . . . .3 0

Exhibit 4.1 Number of Staff and Percentage of Time Spent Providing

Mental Health Services in U.S. Schools, 2002–2003 . . . . . . . . . . . . . . . . . . . . . . . . .3 4

Exhibit 4.2 Percentage of Schools With Various Types of Staff Who Provide 

Mental Health Services, 2002–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 5

School Mental Health Services in the United States, 2002–2003 v
P revention Services, 2002–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 0

Exhibit 5.2a Percentage of Districts Reporting the Degree to Which Various Funding

Restrictions Are Impediments to the Delivery and Coordination of Services, 

2 0 0 2 – 2 0 0 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 1

Exhibit 5.2b Percentage of Districts Reporting the Degree to Which Other

Funding Obstacles Are Impediments to the Delivery and Coordination 

of Mental Health Services, 2002–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 2

Exhibit 5.3 Percentage of Districts Reporting Changes in Levels of Funding

and Changes in Need for Mental Health Services Since the 2000–2001 

School Ye a r, 2002–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 3

Exhibit 5.4 Percentage of Districts Reporting Changes in School Mental Health

S e rviceUtilization and Resources Since the 2000-2001 School Ye a r, 2002–2003 . . .4 4

Exhibit 5.5 Average Percentage of District Mental Health Expenditures 

Allocated to Various Categories, 2002–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 5

Exhibit 5.6 Among Schools that Collect or Have Access to Data, Percentage 

of Schools with Various Types of and Uses for Data, 2002–2003 . . . . . . . . . . . . .4 6

Exhibit 6.1 Enrollment and Provision of Mental Health Services in Typical 

E l e m e n t a ry, Middle, and High Schools, 2002–2003 . . . . . . . . . . . . . . . . . . . . . . . . .5 1

Exhibit 6.3 Percentage of Schools Providing Various Mental Health Services 

by School Level, 2002–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 2

Exhibit 6.2 Top Mental Health Problems by School Level, 2002–2003 . . . . . . . . . . . . .5 2

Exhibit 6.5 Percentage of Schools Reporting the Number of Staff Providing 

Mental Health Services by School Level, 2002–2003 . . . . . . . . . . . . . . . . . . . . . . . .5 3

viii School Mental Health Services in the United States, 2002–2003 
School Mental Health Services in the United States, 2002–2003 

g, )

Recent research points to public schools as the major providers of mental health

services for school-aged children. The current study, School Mental Health Services in

the United States, 2002–2003, provides the first national survey of mental health

services in a representative sample of the approximately 83,000 public elementary,

middle, and high schools and their associated school districts in the United States.

The purpose of the study was to identify—

• The mental health problems most frequently encountered in the U.S. public

school setting and the mental health services delivered

• The administrative arrangements for the delivery and coordination of mental

health services in schools

• The types and qualifications of staff providing mental health services in schools

• Issues related to funding, budgeting and resource allocation, and use of data

regarding mental health services

The findings of the study provide new information about the role of schools in

providing mental health services, and how these services are organized, staffed,

funded, and coordinated. 

The survey methodology included two mail questionnaires. The school questionnaire

collected data on the types of mental health problems encountered in schools, the

mental health services provided, the types and qualifications of staff providing

services, the type and degree of care coordination, and the arrangements for

delivering mental health services. The district questionnaire collected data on

funding sources for mental health services and issues related to funding. The report

also includes impressions from school administrators and mental health personnel

concerning issues affecting school mental health services. Questions concerned

services and supports delivered to students who have been referred and identified as

having psychosocial or mental health problems. 

Key Findings

• Nearly three quarters (73 percent) of the schools reported that “social,

interpersonal, or family problems” were the most frequent mental health

School Mental Health Services in the United States, 2002–2003 
• Virtually all schools reported having at least one staff member whose responsibilities

included providing mental health services to students.

• The most common types of school mental health providers were school counselors,

followed by nurses, school psychologists, and social workers. School nurses spent

approximately a third of their time providing mental health services.

• More than 80 percent of schools provided assessment for mental health problems,

behavior management consultation, and crisis intervention, as well as referrals to

specialized programs. A majority also provided individual and group counseling and

case management.

• Financial constraints of families and inadequate school mental health resources were

the most frequently cited barriers to providing mental health services.

• Almost half of school districts (49 percent) used contracts or other formal

agreements with community-based individuals and/or organizations to provide

mental health services to students. The most frequently reported community-based

provider type was county mental health agencies.

• Districts reported that the most common funding sources for mental health services

or interventions were the Individuals with Disabilities Education Act (IDEA), State

special education funds, and local funds. In 28 percent of districts, Medicaid was

among the top five funding sources for mental health services.

• One third of districts reported that funding for mental health services had decreased

since the beginning of the 2000–2001 school year, while over two thirds of districts

reported that the need for mental health services increased.

• Sixty percent of districts reported that since the previous year, referrals to

community-based providers had increased. One third reported that the availability of

outside providers to deliver services to students had decreased.

While survey findings indicate that schools are responding to the mental health needs of

their students, they also suggest increasing needs for mental health services and the

multiple challenges faced by schools in addressing these needs. Further, more research is

needed to explore issues identified by this study, including training of school staff

delivering mental health services, adequacy of funding, and effectiveness of specific

services delivered in the school setting.

2 School Mental Health Services in the United States, 2002–2003 
School Mental Health Services Services in the United States, States, 2002–2003 2002–2003 

M

and youth points to public schools as the major providers of

mental health services for school-aged children. The Surgeon

General’s 1999 Report on Mental Health (U.S. Department of Health and

Human Services [US DHHS], 1999) cited prevalence studies that found that

approximately one fifth of the children and adolescents in this country

experience the signs and symptoms of a mental health problem1 in the course

of a year. That report further suggests that schools are primary settings for the

identification of mental disorders in children and youth. 

More recently, the President’s New Freedom Commission on Mental Health

recognized the critical role that schools can play in the continuum of mental health

services. The Commission’s final report, Achieving the Promise: Transforming Mental

Health Care in America (2004), emphasized the building of a system that is evidencebased, recovery-focused, and consumer- and family-driven. Continuing that effort,

SAMHSA, in partnership with key Federal agencies, recently developed and issued

the Federal Mental Health Action Agenda (2005). One of the Agenda’s goals is the

initiation of a national effort focused on the mental health needs of children, which

would promote early intervention for children identified to be at risk for mental

disorders and identify strategies to appropriately serve children with mental health

problems in relevant service systems.

One review of small area research studies (Weist, 1997) found that there has been

some movement nationally in favor of enhancing and improving school mental

health services. The focus on mental health problems of youth in the early 1980s,

accompanied by consistent findings that some youth were not receiving the services

they needed, led to national reforms for improving approaches to service delivery.

Schools came to be seen as a natural entry point for addressing student mental

health needs. This, along with recognition of the importance of sound mental health

as an essential support for academic success, led to a growth in school mental health

programs as part of broader school reform efforts. Advocates for a system of care for

children’s mental health (Stroul & Friedman, 1986) and for school-based health

centers (Advocates for Youth, 1998) have further underscored the critical role that

integration of mental health services into the school setting has had in the

recognition, assessment, and treatment of mental health problems. 

School Mental Health Services in the United States, 2002–2003 
Adding to the rationale for the current study is an analysis of data from the 1994–1995

National Longitudinal Study of Adolescent Health (Slade, 2003). That study concluded

that although half of middle and high schools nationally offer some level of mental

health counseling, there are serious disparities in availability by region, locale, and

school size. Schools that are larger, either suburban or urban, situated in the Northeast,

and have high Medicaid enrollment are more likely to provide counseling on site, while

only 28 percent of Midwestern schools provide counseling (Slade, 2003). The author

acknowledged, however, that the study findings were limited by the small sample size,

and that further research is needed on a national sample of schools.

The current study, School Mental Health Services in the United States, 2002–2003, provides

the first broad and comprehensive description of the prevalence and distribution of

mental health services in a nationally representative sample of the approximately 83,000

public elementary, middle, and high schools in the United States. Sixty percent of these

schools are elementary schools, 19 percent are middle schools, and 18 percent are high

schools. The remaining three percent are combined schools, with grades spanning two

or more levels (U.S. Department of Education, 2002–2003).2

This study describes differences in resources, organization, delivery and funding of

school mental health services across the country. Rather than focusing on children in

special education, this study includes mental health services provided to all children in

the school setting. It focuses on mental health services supported by the school or

district, regardless of whether the services are provided by the school’s own staff or by

community-based providers with whom the district has a formal or contractual

arrangement. In order to capture how schools define providers of mental health services,

nurses and other school staff such as outreach workers and behavioral aides were

included, although their training may not be specific to mental health. 

The primary focus of this study was on mental health interventions, but since

schoolwide prevention programs are increasingly common, data were collected and

reported on prevention programs as well. For the purposes of this study, mental health

interventions were defined as “those services and supports delivered to individual

students who have been identified as having psychosocial or mental health problems.”

The study is intended to provide baseline information on the characteristics of mental

4 School Mental Health Services in the United States, 2002–2003 
• Administrative arrangements for the delivery and coordination of mental health

services

• Funding for school mental health services

Several criteria were used for inclusion of research in the literature review: The researc

had been completed within the previous 10 years; was considered seminal in the field 

school mental health; focused on school mental health interventions as opposed to

broad-based prevention services; and pertained both to children in general education

and in special education. To better understand the types of staff providing mental heal

services in schools, documents were obtained from various professional associations th

described school mental health provider functions, guidelines for staff-to-student ratio

and standards for licensure and credentialing. The major results from the literature

review are presented below.

Mental Health Problems and Services in the School Setting

National data on childhood mental illness, as well as smaller studies, describe the

prevalence of various mental health problems in children and youth. The Surgeon

General’s Report on Mental Health (US DHHS, 1999) cites the following prevalence

estimates for various disorders of childhood and adolescence: 3–5 percent of school-ag

children are diagnosed with attention-deficit/hyperactivity disorder in a 6-month perio

5 percent of children aged 9–17 are diagnosed with major depression; and the combin

prevalence of various anxiety disorders for children ages 9–17 is 13 percent.

The Youth Risk Behavior Survey (Centers for Disease Control and Prevention, 1999), a

nationally representative survey of youth, found problems covering a range of severity

from daily sadness and hopelessness (experienced by over one quarter of students) to

thoughts of suicide (nearly 20 percent) to attempted suicide (8 percent). Many of the

children with these conditions had not been identified and many had not received

services. 

A “small area” study of serious emotional disturbance among Appalachian children an

youth in North Carolina found that three out of five children with diagnosed mental

health problems had received no recent mental health services (Costello et al., 1996). 

those students who had received services, between 70 and 80 percent were seen by

school-based providers. 

School Mental Health Services in the United States, 2002–2003 
disturbance (e.g., anxiety, depression, suicidal tendencies), and situational problems such

as bereavement (Walter et al., 1995).

In another study related to an inner-city school-based clinic, 65 percent of all mental

health visits fell into three diagnostic clusters: pregnancy and sexuality; dysphoria; and

conflict and violence (Jepson, Juszczak, & Fisher, 1998). 

Another study (Advocates for Youth, 1998) found that 65 percent of users of schoolbased health centers were females. The authors found that the use of these services was

facilitated by extensive outreach to the adolescents themselves, and to teachers, other

school officials, and community members, including parents. 

The literature review revealed few studies of school problems or services by school level.

One survey of 62 school administrators (Weist et al., 2000) found that behavioral

problems were rated as more serious as students progressed through school levels. Urban

youth were reported as experiencing greater stress and internalizing problems more than

suburban or rural youth. 

Increasingly, school systems are recognizing the need to address barriers to learning,

such as substance abuse, violence, teen pregnancy, family problems, and behavioral

issues, and they are restructuring their mental health services accordingly. Brener et al.

(2001) reported that most schools offer some combination of mental health and social

services and have developed some structure to support them. Some districts are

enhancing service capacity by collaborating with health centers and other communitybased agencies.

Staff Providing Mental Health Services in Schools

The research literature suggests that there are diverse staffing structures, types of

professionals, roles and levels of service in school systems. Staffing structures may

include individuals and groups of professionals working in programs operated by single

schools, individual districts, and/or in collaboration with the community, city, and/or

county agencies. Mental health providers typically provide direct and indirect services

not only to students, but also to families, education staff, and school administrators. 

The School Health Policies and Programs Study (SHPPS) provided national data on the

staffing of school mental health services (Centers for Disease Control and Prevention,

6 School Mental Health Services in the United States, 2002–2003 
comprehensive array or continuum of mental health and social services, including

prevention, referral, diagnostic evaluation, treatment, and case management. 

Administrative Arrangements for the Delivery of Mental Health Services

Research on models of delivery of school mental health services suggests that there are

many ways to describe and categorize service delivery arrangements. The Policy

Leadership Cadre for Mental Health in Schools, a policy-oriented coalition facilitated b

the Center for Mental Health in Schools at UCLA, describes five “delivery mechanisms

and formats” for the provision of school mental health services: 

• School-financed student support services, in which school districts hire professional st

to provide traditional mental health services

• Formal connections with community mental health services, in which formal agreemen

are made between schools and school districts and one or more community agenc

to provide mental health services and to enhance service coordination; the service

can be co-located within the school or provided at the community agency

• School-district mental health units or clinics, in which districts operate and finance th

own mental health units and mental health clinics that provide services, training,

and/or consultation to schools, or districts organize multidisciplinary teams to

provide a range of psychosocial and mental health services

• Classroom-based curricula, which are activity-driven approaches aimed at optimizin

learning by enhancing social and emotional growth. Interventions tend to be teach

led and prevention-oriented

• Comprehensive, multifaceted, and integrated approaches, in which districts bring

multiple partners (e.g. community-based organizations) together to provide a full

spectrum of services for children and youth with mental health needs. This approa

would include such models as Systems of Care in which an array of mental health

and wraparound services are provided to children with mental health problems an

their families via partnerships among various child-serving systems (Policy

Leadership Cadre for Mental Health in Schools, 2001; Weist, 1997).

School Mental Health Services in the United States, 2002–2003 
Information related to funding for mental health services in schools is difficult to collect

because of the number and diversity of funding streams and the fact that costs for

mental health services tend to be bundled with allocations for education. The Policy

Leadership Cadre for Mental Health in Schools (2001) noted:

To date there has been no comprehensive mapping and no overall analysis of the

amount of resources used for efforts relevant to mental health in schools or of

how they are expended. Without such a “big picture” analysis, policymakers and

practitioners are deprived of information that is essential to determining equity

and enhancing system effectiveness.

What is known from reviews of policy and legislative documents suggests that funding

comes from multiple categorical funding streams, often with different missions and

funding limitations. Multiple funding streams can lead to fragmentation of services. The

Policy Leadership Cadre noted that the legislative support for mental health funding is

generally for children with diagnosed emotional/behavioral disabilities and mental

illness, or is intended to address violence and substance abuse. The Cadre also suggested

that the cost-cutting measures of managed care are reshaping the nature of services,

making comprehensive service provision difficult. The Cadre concludes that schools may

be in a unique position to reverse the fragmentation and marginalization of student

mental health services.

8 School Mental Health Services in the United States, 2002–2003 
The literature specific to school-based health centers also provided valuable informatio

on the types of mental health problems addressed in school settings, staffing

configurations, services provided, and funding sources. However, school-based health

centers operate in only a small proportion of schools (in 1,700 schools nationwide,

according to the National Assembly on School-Based Healthcare), so these results cann

be generalized to the majority of schools in the nation. Other studies provide in-depth

insights into issues such as mental health problems of youth, but they are either limite

in scope and not related to school settings, or they have not been replicated at the

national level.

Based on the information gaps identified in the review of the research literature, the

purpose of this survey was to describe the following:

1. Types of mental health problems encountered in the school setting and the

mental health services available in schools to address those problems

2. Administrative arrangements for the delivery and coordination of mental health

services in schools

3. Types and characteristics of providers of mental health services in schools

4. Ways that school mental health services are funded, and how funding

mechanisms may affect delivery of services

Although the survey focused on interventions delivered to individual students who ha

been referred and identified as having psychosocial or mental health problems, school

were also asked to report on the types of prevention and early intervention programs

they offered.

With regard to administrative arrangements, the survey aimed to determine whether o

not community-based professionals and organizations were contracting with schools t

provide mental health interventions. The study also sought to elicit the mechanisms b

which mental health services were organized administratively (e.g., under the auspices 

special education or in a separate department), how staffing was organized (e.g., hired

by district or acquired via contract), and where authority rested for various

administrative functions such as hiring and supervision. Also of interest were the

School Mental Health Services in the United States, 2002–2003 
The study also sought to elicit information about Federal, State, and local-level funding

sources for school mental health services. This included questions about the extent to

which school districts generated revenue via third-party reimbursement, or solicited

grant funding. Information was also sought on funding allocation, restrictions on

funding based on categorical funding streams, and other funding obstacles. 

The survey was designed to address each of the above research questions at the national

level for public schools and districts, and to provide comparisons by subgroups of

schools and districts, as follows:

• School comparisons by level (elementary, middle, and high school), region of the

country (Northeast, Midwest, South, and West), school size as measured by student

enrollment (small, medium, and large), race/ethnic minority enrollment of student

body (low, medium, and high), and poverty status as measured by the proportion

of students eligible for free and reduced price lunch (low, medium, high)

• District comparisons by region and district size, as measured by the number of

schools in the district. These comprise the major categories or groupings that

distinguish schools and school districts across the nation and are standard variables

used for comparisons in education research. Several of these subgroups are

described in more detail in the following section. A full description of the

definitions of each of these variables may be found in Appendix D, available at

http://www.mentalhealth.samhsa.gov/cmhs/ManagedCare/.

1.4 Overview of Survey Design and Methodology

School Mental Health Services in the United States, 2002–2003 involves a nationally

representative sample of regular public K–12 schools and their associated school

districts. The study was conducted as a self-administered mail survey during the

2002–2003 school year. The survey consisted of two questionnaires. The school

questionnaire collected data on the types of mental health problems encountered in

schools, the mental health services provided, the types and qualifications of staff

providing services, the type and degree of care coordination, and the arrangements for

delivering mental health services, including agreements with community-based

10 School Mental Health Services in the United States, 2002–2003 
reflected the most up-to-date thinking on the characteristics and funding of school

mental health services. (Members of the expert panel are listed in Appendix A.) The

questionnaires were reviewed and endorsed by professional mental health associations

and representatives of State education associations.5 The surveys were also pilot tested 

a small number of school and district staff who represented the intended respondent

types, and were revised prior to data collection. The instruments included a final open

ended question to elicit respondent comments. 

The diversity of school systems and State guidelines for school mental health services

made the construction of response categories difficult in some respects. Recognizing th

there can be many staff titles for persons with similar training who perform similar

functions in schools, the authors consulted with the expert panel to arrive at a set of

staffing categories that were most likely to be recognizable to respondents across the

country. Mental health problem categories were derived from the literature and adapte

for the survey by a licensed child psychologist. These categories represented a range o

severity, from interpersonal/family problems to major psychiatric disorders.

The questionnaires did not provide definitions of staffing categories, mental health

problems, or services. Regarding staffing categories, the research team determined that

without standardized definitions in the literature, and given the variability in function

among various staff types from district to district, it would be overly limiting to the

respondent if a definition were imposed. The problems and services categories were

developed to reflect commonly understood terminology. All terminology was vetted w

respondents in several school districts in different geographic regions and with the

expert panel prior to finalizing the survey instrument. 

Although the arrangements for service delivery identified by the Policy Leadership Cad

for Mental Health in Schools described earlier served as the basic framework for the

design of questions related to administration of mental health services in schools, cert

aspects of the delivery mechanisms were determined to be not mutually exclusive. It w

further recognized that schools and districts might not fit into any particular model (o

might combine different aspects of these models). Therefore, the models were broken

down into dimensions, such as whether mental health services are district-, school-, o

community-based; the types and combinations of staff providing mental health service

the types and range of services provided; the settings in which services are delivered; t

School Mental Health Services in the United States, 2002–2003 
2000–2001. The size of the sample was designed to provide reliable estimates of the

universe of regular public schools by level (elementary, middle, and high school) and by

size, as measured by student enrollment: small (from 1 to 250 students); medium

(251–500 students); large (501–1,000 students); and very large (1,001 and more

students). The sampling strategy was also designed to yield estimates by each region

(Northeast, Midwest, South, West) and locale (urban/central city, suburban/large town,

small town/rural) and to populate the standard table shell used in this report. The

composition of the four regions is provided in the supplementary tables in Appendix C.

Data Collection and Response Rate

Data collection began in November of 2002, with advance letters sent to superintendents

in each of the school districts in the sample, notifying them of the survey and requesting

contact information for the respondent designated by the superintendent as the most

knowledgeable about mental health services. District respondents ranged from

superintendents to assistant superintendents and directors of Pupil Services or Special

Education. School surveys were sent to the principal, who in turn, passed them on to

the ultimate respondents. Survey responses reflect the best estimates of the respondent

as to mental health staffing and services.

A total of 58 districts, 3.5 percent of the sampled districts, required that a research

application be submitted prior to conducting the study in their districts. The great

majority of these applications were ultimately approved. The survey forms were mailed

in late January of 2003, and data collection continued throughout the school year and

into the early summer, with the remailing of survey forms and telephone follow-up calls

for nonresponding schools and districts. 

Trained interviewers conducted follow-up phone calls and “refusal conversion”

interviews with respondents. During these calls, interviewers often learned that

questionnaires had been forwarded to another person in the school, or that the

questionnaire had been lost. This resulted in numerous calls to track down the ultimate

respondent. Over 30 percent of districts and 39 percent of schools requested remailings.

The target response rate for the school survey was 80 percent (about 1,600 schools,

excluding the 100 schools that were closed or ineligible to participate). As the school

year was nearing its end, only 69 percent of districts and 54 percent of schools had

12 School Mental Health Services in the United States, 2002–2003 
the bias analysis can be found in Appendix D, available from

http://www.mentalhealth.samhsa.gov/cmhs/ManagedCare/.) 

The survey did not include a screener question asking schools to report whether or no

the school provided mental health services, out of concern that respondents might op

out of responding to the survey prior to reading the questions. Once questionnaires w

received, the research team reviewed incomplete questionnaires to determine whether 

not they contained enough information to be included in the final sample. About 2

percent of the returned questionnaires had to be removed from the sample because it

was determined by reviewing their responses and comments that they did not provide

mental health services and therefore could not answer the survey questions. The

estimates in this report reflect the remaining 98 percent of returned survey

questionnaires, or 1,147 questionnaires.

It is important to note that the estimates presented here represent any mental health

services provided, including identification, assessment, and/or referral to outside ment

health service providers. Further, the estimates do not indicate the quantity of services

available in schools, nor do they indicate whether services were provided by trained

mental health professionals or by other school personnel. Differences in the estimates 

the availability of mental health services in public schools may be due to differences in

sample design, definitions of mental health services, location of services, and year of d

collection.6

Ultimately,1,147 schools in 1,064 districts across the country responded to the survey

“Critical items” information was collected from an additional 150 schools. The

quantifiable data were weighted to create national estimates for numbers of schools an

districts by region and by size. This was done so that the total numbers and the

distributions would match those of all schools and districts in the nation in the

2002–2003 school year. The final weighted response rates were 60.5 percent for schoo

and 59.85 percent for school districts.

Analysis

The exhibits in the report are intended to highlight the findings. More detail can be

found in the analytic tables in Appendix C. These analytic tables are organized accord

to the order in which the questions appeared in the survey. The school tables display

School Mental Health Services in the United States, 2002–2003 
health services. A notable 800 school respondents (70 percent) and 330 district

respondents (28 percent) provided written comments in the space provided at the end of

each questionnaire. This level of response and the length of the responses reflected a

surprising degree of interest in further describing school mental health services and the

challenges inherent in meeting student mental health needs in the school setting. These

responses were coded into themes and synthesized; the themes are described in

Appendix B. 

14 School Mental Health Services in the United States, 2002–2003 
School Mental Health Services Services in the United States, States, 2002–2003 2002–2003 

T

mental health problems among students in public schools, student

eligibility for mental health services, and the services available to meet

student mental health needs. On average, 20 percent of students had received

mental health services during the previous school year (2001–2002). Since

the survey did not ask for amount or units of service provided, these services

could have ranged from a single encounter to long-term counseling. Because

the survey included a broad range of potential providers of mental health

services, such services could have been provided by staff with variable mental

health training.

2.1 Eligibility for Mental Health Services

The survey asked which categories of students were eligible to receive mental health

services (e.g., all students versus students in special education). Eligibility for mental

health services varied across schools, although all students were eligible to receive

mental health services in the vast majority of schools (87 percent). A small

proportion of schools (10 percent) required students to have an Individualized

Education Plan (IEP), indicating special education status, to qualify for mental health

services. There were differences in eligibility, however, by region and by some school

characteristics. The proportion of schools in which all students were eligible was

higher in the Northeast (96 percent) than in other regions. While the overall

percentage of schools with eligibility for all students was high, it was lower in

schools with high enrollment of minority students.7 Eighty-three percent of schools

with high enrollment of minority students reported that all students were eligible for

services, compared to 91 percent of schools with low minority enrollments

(Appendix C, School Tables, Table 3).

2.2 Types of Mental Health Problems

The survey asked respondents to report on the problems most frequently presented

by students in their school. From a list of 14 psychosocial or mental health

problems, respondents were asked to rank the three most frequently seen problems

for male and for female students. The list covered a broad spectrum of concerns,

from relatively mild, commonly seen problems such as difficulty adjusting to a new

school, to more significant behavior problems such as bullying, to serious psychiatric
16 School Mental Health Services in the United States, 2002–2003 

Aggression or Disruptive Behavior

• Behavior Problems Associated with Neurological Disorders

• Delinquency or Gang-Related Behavior

• Suicidal or Homicidal Thoughts or Behavior

• Substance Use/Abuse

• Eating Disorders

• Concerns about Gender or Sexuality

• Physical or Sexual Abuse

• Sexual Aggression

• Major Psychiatric or Developmental Disorders

Source: School Mental Health Services in the United States, 2002–2003. Substance Abuse and Mental Health Services Administration,

U.S. Department of Health and Human Services.

Exhibit 2.2

Percentage of Schools That Ranked the Following Mental Health Problems as Among Their Top Three

Problems for Male and Female Students, 2002–2003

Source: School Mental Health Services in the United States, 2002–2003. Substance Abuse and Mental Health Services Administration,

U.S. Department of Health and Human Services. School Questionnaire, Item 27, Appendix C, School Tables 15, 15A
School Mental Health Services in the United States, 2002–2003 

2.3 Mental Health Problems by School Level and Gender

There were differences in the frequency of some mental health problems according to

school level and gender, as shown in Exhibit 2.3. Substance use or abuse and

delinquency and gang-related problems were included here, although they were noted

only for middle and high schools.

Among male students, behavior problems associated with neurological disorders were

more frequently reported by elementary than by middle or high schools (51 percent

versus 35 percent versus 20 percent, respectively). Aggressive or disruptive behavior w

more frequently reported by elementary and middle schools (64 percent and 69 perce

respectively) than by high schools, although 54 percent of high schools reported it as

among their top three problems. For boys, social, interpersonal, or family problems w

cited most often by middle schools and least often by high schools. High schools were

more likely than elementary or middle schools to report depression as one of the top

three problems (Exhibit 2.3 and Appendix C, School Tables 15 and 15A).

Among female students, adjustment issues, aggression or disruptive behavior, and

behavior problems associated with neurological disorders were reported more frequen

in elementary and middle schools than in high schools. Social, interpersonal, or family

problems were more frequently cited for girls in middle schools and reported less

frequently in high schools. For both boys and girls, depression and substance use/abu

were reported more frequently as school level increased (Exhibit 2.3). For example, on

third of middle schools reported depression as a top mental health problem for female

while almost half of high schools did so. Although depression was less frequently cited

as a top mental health problem in boys, reporting frequency rose substantially from

middle school to high school. The frequency of citing substance abuse as a major

problem also jumped sharply from middle school to high school (for males, from 4

percent of middle schools to 34 percent of high schools; for females, from 3 percent o

middle schools to 19 percent of high schools).
18 School Mental Health Services in the United States, 2002–2003 

2.4 Resource Use for Various Mental Health Problems

Schools were asked which mental health problem consumed most of their mental health

resources. The top-ranked mental health problem reported by schools for both males

and females (i.e., social, interpersonal, or family problems) was also the most frequently

reported as consuming the most mental health resources. However, about one fifth of

schools named aggression/disruptive behavior as the most resource-intensive, and over

10 percent named behavior problems associated with neurological disorders, such as

attention deficit disorder. The other 11 problems on the list rated much lower on

resource usage (Exhibit 2.4).

Resource use for social, interpersonal, or family problems was high across all school

levels, with 42 percent of elementary schools to 50 percent of middle schools reporting

it as the mental health issue that used the most resources. However, aggression or

disruptive behavior consumed the most resources at the elementary level, and

successively fewer resources at the middle and high school levels. Similarly, resources

Source: School Mental Health Services in the United States, 2002–2003. Substance Abuse and Mental Health Services Administration, U.S.

Department of Health and Human Services.

School Questionnaire, Item 27, Appendix C, School Tables 15, 15A

** Value <1%

disruptive behavior 64 30 69 30 54 18

Behavior problems

associated with

neurological disorders

51 26 35 15 20 6

Adjustment issues 24 37 27 37 23 27

Depression, grief

reaction 8 21 12 31 23 47

Anxiety 17 42 22 12 17 36

Substance use or

abuse   4 3 34 19

Delinquency and gangrelated problems 2 **  11 4 10 5
School Mental Health Services in the United States, 2002–2003 

expended on behavior problems associated with neurological disorders decreased as

school level increased. These are similar to the patterns for the top three mental health

problems encountered among male and female students: social, interpersonal, and fam

problems were consistently reported by elementary, middle, and high schools as amon

the top three problems; aggression and disruptive behavior and behavior problems

associated with neurological disorders both tended to be more frequently cited by

elementary and middle schools than by high schools. As the problems decrease, so too

does the consumption of resources. 

Urban, suburban, and rural schools reported some differences in their use of mental

health resources. Urban schools reported that they expend more of their resources

dealing with aggression or disruptive behavior. Schools located in suburban and rural

areas, on the other hand, were using more of their resources to assist students with

social, interpersonal, or family problems. For social, interpersonal, and family problem

the consumption of resources followed the same pattern as for the occurrence of the

problem; that is, in suburban and rural schools the reported occurrence of the problem

was higher than it was in urban schools (Appendix C, School Tables 15, 15a, 16).

2.5 Mental Health Services in U.S. Schools

Mental health services were defined in this study as “those services and supports

delivered to individual students who have been referred and identified as having

psychosocial or mental health problems.” The survey focused on treatment services

provided to individual students with identified mental health concerns, rather than on

preventive services provided to all students. However, a question on the range of

Source: School Mental Health Services in the United States, 2002–2003. Substance Abuse and Mental Health Services

Administration, U.S. Department of Health and Human Services. Questionnaire, Item 28, Appendix C, School Table 16 
20 School Mental Health Services in the United States, 2002–2003 

Types of Services Most Frequently Provided

Overall, the majority of schools in the nation provided almost all of the mental health

services listed. A high percentage (87 percent) of schools provided assessment for mental

health problems, behavior management consultation, and crisis intervention, as well as

referrals to specialized programs (84 percent). Individual counseling, case management,

and group counseling were also frequently provided (by 76 percent, 71 percent, and 68

percent of schools, respectively).8 In general, short-term interventions, such as

assessment for mental health problems, behavior management consultation, crisis

intervention, and referral services were more commonly provided than were services that

tend to be longer term, such as counseling of all types, case management, and family

support services. Less than half of all schools reported that they provided substance

abuse counseling, and medication/medication management was the least likely of all

services to be provided (Exhibit 2.6).

Schools indicated that some services were more difficult to deliver than others. The

service most frequently ranked as “difficult” or “very difficult” to deliver was family

support services, followed by medication or medication management, substance abuse

Exhibit 2.5

Mental Health Services Categories

• Assessment for emotional or behavioral problems or disorders (including behavioral

observation, psychosocial assessment, and psychological testing)

• Behavior management consultation (with teachers, students, family)

• Case management (monitoring and coordination of services)

• Referral to specialized programs or services for emotional or behavioral problems or 

disorders

• Crisis intervention

• Individual counseling/therapy

• Group counseling/therapy

• Substance abuse counseling

• Medication for emotional or behavioral problems

• Referral for medication management

• Family support services (e.g., child/family advocacy, counseling)

Source: School Mental Health Services in the United States, 2002–2003. Substance Abuse and Mental Health Services Administration,

U.S. Department of Health and Human Services.
School Mental Health Services in the United States, 2002–2003 2

counseling, and referral to specialized programs or services (Appendix C, School Table

18). The services most frequently ranked as “not difficult” or only “somewhat difficult

to deliver were individual and group counseling, followed by behavior management an

crisis intervention. For the most part, services provided most frequently by schools we

not as difficult to deliver as those less frequently provided. Referral to specialized

programs or services was an exception. Although 71 percent of schools provided

referrals, 37 percent said that such referrals were difficult or very difficult to make.

Barriers to Delivery of Services

Schools were asked to rank the extent to which various factors were barriers to the

delivery of mental health services, using a scale of 1 to 4, where 1 was “not a barrier”

and 4 was a “serious barrier.” Exhibit 2.7 shows the percentage of schools that

responded 1 or 2 versus 3 or 4. Although schools reported providing a wide array of

services, they also described barriers to ensuring that children and youth receive the

services they need. Financial constraints of families (defined in the survey instrument 

“can’t afford services or lack of insurance”) and insufficient school and community-bas

resources were the factors most often reported as barriers or serious barriers. This

finding suggests that even if some mental health services are provided free of charge b

school staff, families must pay for other services. This survey did not ask which servic

require payment, but this issue bears further investigation.

Competing priorities for use of funds and difficulties with transportation were also

considered barriers. Least often reported as serious barriers were protection of student

confidentiality and language and cultural barriers. However, in open-ended comments

Source: School Mental Health Services in the United States, 2002–2003. Substance Abuse and Mental Health Services Administration

U.S. Department of Health and Human Services. 

School Questionnaire, Item 29, Appendix C, School Table 17

Assessment 

For Emotional 

or Behavioral 

Problems/ 

Disorders

Behavior 

Management 

Consultation

Crisis 

Intervention

Referral to 

Specialized 

Programs/ 

Services

Individual 

Counseling/ 

Therap y

Case 

Managemen t

Group 

Counseling/ 

Therap y

Family 

Support 

Services

Substance 

Abuse 

Counselin g

Medication/ 

Medication 

Managemen t

34%

0%

20%
22 School Mental Health Services in the United States, 2002–2003 

Prevention and Early Intervention Programs and Services 

Increasingly, education and mental health experts recognize a definition of mental health

in schools that includes not only treatment, but promotion of social and emotional

development and efforts to address psychosocial and mental health problems as barriers

to learning (Policy Leadership Cadre for Mental Health in Schools, 2001). Schools have

begun to direct resources to schoolwide and/or curriculum-based programs intended to

reach the broader student population, not just those individual students identified with

mental health problems. Early intervention by mental health staff or multidisciplinary

teams is gaining ground as a means to address mild psychosocial problems quickly and

thereby prevent unnecessary entry into special education. Although the focus of the

current survey was on traditional mental health treatment, schools were also asked to

report on the types of prevention and early intervention programs that they offer.

Exhibit 2.7 Percentage of Schools Reporting Extent to Which Various Factors Are Barriers to

Providing Mental Health Services, 2002–2003

Source: School Mental Health Services in the United States, 2002–2003

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services

School Questionnaire, Item 32, Appendix C, School Table 19
percent and 72 percent, respectively). Less frequently reported approaches to preventi

and early intervention were peer counseling and mediation and peer support groups (

percent) and outreach to parents regarding mental health issues (34 percent).

In an open-ended question, schools were asked to describe approaches or strategies th

have proven most successful in improving student mental health. Some respondents

described curriculum-based programs and classroom guidance to enhance social and

emotional functioning as their most successful approaches. Topics for such programs

included anger management, prevention of violence and bullying, conflict resolution,

resisting peer pressure, communication skills, substance abuse, and character educatio

(e.g., developing citizenship skills, responsibility, honesty, fairness, patience). Several

specific programs were named repeatedly, including Responsive Classroom

(www.responsiveclassroom.org), the Second Step program (www.cfchildren.org), and

Drug Abuse Resistance Education (DARE) (www.dare.com).

The availability of interdisciplinary “student assistance” or “student service” teams was

also mentioned by some schools. These teams were described as including mental hea

School Mental Health Services in the United States, 2002–2003 2

Source: School Mental Health Services in the United States, 2002–2003, Substance Abuse and Mental Health Services

Administration, U.S. Department of Health and Human Services

School Questionnaire, Item 36, Appendix C, School Table 21
p, y ggp

and behavioral problems associated with neurological disorders. Depression was more

frequently reported as a top mental health problem in high school (for both boys and

girls) than in middle school, as was substance abuse. Most schools reported that they

provide a range of mental health services, but these results are tempered by the fact that

half of schools also reported that inadequate mental health supports in schools are a

serious barrier. Financial constraints of families were reported by over half of schools as

barriers to service. The majority of schools also reported that they provide schoolwide or

curriculum-based prevention and early intervention programs.

24 School Mental Health Services in the United States, 2002–2003 
School Mental Health Services Services Services Services in the United States, States, States, States, 2002–2003 2002–2003 2002–2003 2002–2003 2

This chapter presents survey findings on the prevalence of various

administrative arrangements for the delivery of mental health services

in U.S. public schools. Survey questions were based on a number of

“delivery mechanisms and formats” described by the Policy Leadership Cadre

for Mental Health in Schools (2001) and summarized in Chapter 1. These

formats include:

• School-financed student support services

• Formal agreements with community mental health services

• School or district-supported mental health units or clinics

• Classroom-based curricula

• Comprehensive, multifaceted, and integrated approaches 

Since these models are not mutually exclusive, survey questions were designed to

measure the features or dimensions of each model, rather than explicitly measuring

the existence of each model as a separate entity. The dimensions include the types

and combinations of staff providing mental health services to students (addressed in

the previous chapter); administrative arrangements for delivery of services, including

the use of school- or district-based staff, and of community providers; locus of

responsibility for various administrative functions at the district or the school level;

and ways in which services are coordinated internally and across delivery systems.

The survey attempted to capture the extent to which schools and school districts

utilize their own mental health staff as opposed to contracting for these services with

community-based providers. The survey also queried respondents on a variety of

administrative functions (e.g., funding and staff allocation, hiring, supervision, staff

training, contract monitoring); whether the school, district, or another unit had

responsibility for mental health; and whether or not there were any differences

between general education and special education. Finally, several questions elicited

Health Services in

Schools
26 School Mental Health Services in the United States, 2002–2003 

, g

combination with outside providers. Almost half of school districts overall (49 percent)

used contracts or other formal agreements with community-based organizations and/or

individuals to provide mental health services to students (Appendix C, District Tables 3,

3A). These contractual arrangements augment the service delivery capacity of districts by

making other child-serving systems available to schools to provide services. Contractual

arrangements are most common in large districts.9 Because the survey focused on formal

or contractual arrangements, the results may underreport the professionals to whom

students may have access in the community.

Exhibit 3.1 Percentage of Schools Using Staffing Sources for Various Mental Health Services in

Schools: 2002–2003

Source: School Mental Health Services in the United States, 2002–2003, Substance Abuse and Mental Health Services

Administration, U.S. Department of Health and Human Services

School Questionnaire, Item 29, Appendix C, School Table 17

Note: Numbers do not total 100 percent because of missing data
School Mental Health Services in the United States, 2002–2003 2

or more community-based organizations or individual providers for student mental

health services. The most frequent arrangement was with county mental health agenci

followed by community health centers, individual providers, and juvenile justice syste

(Exhibit 3.2). Arrangements with local hospitals and faith-based organizations were no

as common. 

Middle schools were more likely than elementary or high schools to have contractual

arrangements with community providers and were significantly more likely to have su

agreements with community health centers and juvenile justice agencies (Appendix C

School Table 11). Many of the community agencies (62–86 percent) provided their

services on site, in the school (Appendix C, School Table 12). The exceptions were loc

Exhibit 3.2 Percentage of Schools With Various Community-Based Organizations and Individual

Providers To Provide Mental Health Services, 2002–2003

Source: School Mental Health Services in the United States, 2002–2003, Substance Abuse and Mental Health Services

Administration, U.S. Department of Health and Human Services

School Questionnaire, Item 15–25, Appendix C, School Table 11
28 School Mental Health Services in the United States, 2002–2003 

The literature and survey pilot testing revealed variability in the terminology used to

describe various service delivery mechanisms. The survey attempted to use terms that

would be universally understood by respondents. Key features of a schooldistrict–operated mental health unit are that they are operated and financed by the

district, or the district organizes a multidisciplinary team into a “unit” to provide mental

health services (Policy Leadership Cadre, 2001). School-based health centers can be

sponsored by organizations such as hospitals, community health centers, and nonprofit

organizations.

The literature showed that some districts operate their own mental health units or clinics

that serve one or more schools; others have their own school-based health centers

(Policy Leadership Cadre for Mental Health in Schools, 2001). In this study, district

respondents were asked if they operated a mental health unit or clinic serving multiple

schools. Only 2 percent of school districts reported that they had such district-operated

mental health units or clinics (Appendix C, District Table 3). 

School respondents were asked if they had an agreement with a “school-based health

center operated by a community-based organization” to provide mental health services to

their students. These health centers may be different from school-based health centers

that are members of the National Assembly on School-Based Health, so the estimates of

the number of such health centers in the nation may differ.

Seventeen percent of schools nationwide had such an arrangement. School-based health

centers were more often reported in middle schools (23 percent) than in elementary

schools (16 percent) or high schools (14 percent). They were also more prevalent in

urban schools (22 percent) than in suburban or rural schools (15 percent each)

(Appendix C, School Table 11).

3.3 Administrative Functions in School Mental Health

The literature review revealed a model for school mental health in which schools were

given the autonomy to determine the types of mental health staff they hired and the

overall allocation of mental health resources. The survey sought to determine the locus

of control for various administrative functions pertaining to school mental health.
School Mental Health Services in the United States, 2002–2003 2

health services for general and special education students together (67 percent). In oth

words, mental health services tended to be housed in the same administrative unit

regardless of the special education status of the student requiring mental health servic

There were some differences noted by district characteristics, however. For example, t

largest districts (those with 16 or more schools) were slightly more likely than smaller

districts to administer mental health services for general and special education student

separately (39 percent versus 24 percent; Appendix C, District Table 1B). High school

(12 percent) were more likely than middle schools (5 percent) and elementary schools 

percent) to manage mental health services for special education students separately fro

general education students (Appendix C, School Table 5).

3.4 Coordination and Referral Practices

The survey queried respondents on practices regarding coordination of services within

the school or district, as well as with community-based organizations and providers. 

Internal Coordination

Within the school setting, the survey sought information on the frequency of various

strategies used by mental health staff, special education staff, and classroom teachers t

coordinate activities and services for students in the school. Coordination strategies an

their frequency of use are depicted in Exhibit 3.3. Schools varied in the frequency wit

which they used these strategies. Approximately one third of schools rarely or never h

interdisciplinary meetings among mental health staff, conducted joint planning session

between mental health and other staff, or shared mental health resources with each

other. The exception to this was informal communication, which occurred weekly in o

third of schools. At the other end of the continuum, however, 40 percent of schools h

monthly or weekly interdisciplinary meetings and planning sessions, and one third of

schools held weekly or monthly joint planning sessions between mental health and ot

school staff as well as weekly informal communication. 
30 School Mental Health Services in the United States, 2002–2003 

Coordination With and Referral to Community-Based Providers

Many schools, even if they do not have formal agreements with community

organizations to provide mental health services, will refer students to community

agencies for such services. All school respondents were asked to report their routine

referral and coordination practices with community providers. Use of passive referrals

(e.g., distributing brochures, lists, phone numbers of providers) was the most common

practice, used by three quarters of schools (Appendix C, School Tables 14, 14A).

Nineteen percent of schools used passive referrals as their only routine practice. Active

referrals (e.g., staff completing forms with families, making calls or appointments,

assisting with transportation) were reported by over half (53 percent) of schools, and

followup with families and providers was also practiced by over 40 percent of schools. 

Forty percent of schools reported that their staff attended team meetings with the staff of

community providers. Schools that had agreements with community-based organizations

were more likely than schools without such arrangements to coordinate service planning

across agencies: 50 percent of schools with agreements had staff attend team meetings

with community providers as opposed to 29 percent of schools without agreements. One

theme that emerged from open-ended comments in response to a question on their most

successful strategies for improving the mental health of students was the importance of

developing positive formal and informal relationships with community providers.

3.5 Summary

The findings on the administrative arrangements for the delivery of school mental health

services, as they relate to the formats described in the beginning of the chapter, suggest

that school districts were most likely to hire their own staff to provide mental health

Source: School Mental Health Services in the United States, 2002–2003. Substance Abuse and Mental Health Services

Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 12, Appendix C, School Tables 8, 8A, 8B, 8D, 8E

p

planning 30 12 18 23

Share MH Resources 37 23 15 9

Informal Communication 27 11 12 35
There was variation in the degree to which various strategies for coordinating mental

health services were used by schools. It was striking that about one third of schools

rarely or never used any of the strategies listed in the survey. Many schools reported

making referrals to community-based services, but passive referrals appear to be the

most common practice. On the other hand, close to half of schools reported that their

staff attend team meetings, suggesting that there was some level of commitment on

behalf of schools to collaborate with community providers.

It was not possible in this baseline study to determine the prevalence of “comprehensi

... integrated” models that would resemble a system of care, but there is evidence to

suggest that efforts are being made to enhance the service array via contractual and oth

formal arrangements, and that some collaboration is occurring among child-serving

systems.

School Mental Health Services in the United States, 2002–2003 3

School Mental Health Services in the United States, 2002–2003 3

O

understanding of the numbers and types of personnel providing

mental health services in schools. The questionnaire included the

following types of staff: school counselors, mental health counselors, school

psychologists, clinical/Ph.D.-level psychologists, social workers, substance

abuse counselors, school nurses, and other staff such as outreach workers and

behavioral aides. This study sought to identify the types and qualifications of

staff providing mental health services in schools, determine how much of the

staff provider’s day is devoted to mental health service provision, describe

staff distribution and qualifications, and identify the most common staff

combinations in schools.13

4.1 Characteristics of Staff Providing Mental Health Services

Almost all schools providing mental health services reported having at least one staff

member whose responsibilities included providing mental health services to students

(96 percent). Based on weighted estimates of schools’ responses, during the

2002–2003 school year, at most 358,000 staff, including both professional and

support staff, were providing some degree and type of mental health service to

students in their schools. (This is probably an overestimate due to the limitations of

the survey—see note in Exhibit 4.1). Exhibit 4.1 shows the number of each type of

staff in U.S. public schools and the average percent of time each type of staff spent

providing mental health services, relative to other duties. These estimates pertain

only to school or district-based staff, rather than outside staff providing mental

health services via contractual arrangements.

The most common types of staff providing mental health services in schools were

school counselors, followed by nurses, school psychologists, and social workers

(Exhibit 4.2). Three quarters of schools had at least one school counselor on staff,

over two thirds had a school psychologist and/or a school nurse, and 44 percent had

a school social worker. Other mental health staff members, such as mental health

and substance abuse counselors, clinical psychologists, and psychiatrists, were

available in less than 20 percent of schools.
34 School Mental Health Services in the United States, 2002–2003 

It is notable that such a large proportion of schools reported that nurses were providing

mental health services, and that over one third of their time was devoted to mental

health service provision. The data indicate that nurses were considered by the majority

of schools to be mental health providers. Nurses, as well as counselors, are likely to have

very high caseloads and may provide services that are more informal in nature than

traditional counseling. These findings also suggest that if nurses are, in fact, playing a

key mental health role in schools, more work should be done to better understand the

training and support needs of this type of staff. Psychiatrists were estimated to spend

only 40 percent of their time on mental health service provision, which seems somewhat

low, but the survey did not ask how the remainder of their time was spent. 

Source: School Mental Health Services in the United States, 2002–2003, Substance Abuse and Mental Health Services

Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 13, Appendix C, School Table 10B

Notes: 

*National estimates of the number of each type of staff were calculated by applying final sampling weights to the total number of each

staff type reported by schools in the sample. These national estimates may overestimate the number of staff since school respondents

from the same district may have double counted any staff working in more than one school in the district. The term “staff” should not

be construed as full-time employees of the school.

**One limitation of this survey is that the respondents, and thus the unit of analysis, represented schools, rather than staff. Thus, we

were not able to estimate the number of full-time equivalents (FTEs) in the U.S. using the survey data because a) the number of staff

may be double counted by schools within the same school district, b) we attempted to get schools to estimate the number of full-time

and part-time staff but many respondents gave invalid responses because they misunderstood the question (this type of information

can be more accurately estimated using a workforce survey of staff); and c) schools were asked to estimate the average percent of

time each type of staff spends providing mental health services rather than how much time each individual staff person spends.

Counselors 17,372 68

Substance Abuse Counselors 10,353 61

Counselors 7,832 48

Psychiatrists 1,927 40

School Nurses 63,661 32

Other School Staff (e.g.,

Outreach Workers, Behavioral

Aides)

41,025 58

Total 357,729
School Mental Health Services in the United States, 2002–2003 3

The proportion of time spent providing direct mental health services to students varie

by staff type. School counselors, substance abuse and mental health counselors, and

social workers were spending half to two thirds of their time providing mental health

services to students during the 2002–2003 school year, while school psychologists,

clinical psychologists, and psychiatrists were spending less than half of their time doin

so. Schools reported that nurses spent one third of their time14 and that other school s

such as behavioral aides spent 58 percent of their time providing mental health servic

Mental health counselors and substance abuse counselors, although they were less

commonly on staff in schools than other mental health providers, were reported to

spend over 60 percent of their time providing mental health services.

Number of Staff and Staff Combinations 

Most schools had between two and five staff providing mental health services, but the

distribution was very broad, from no staff (3 percent) to 10 or more staff (6 percent)

(Exhibit 4.3). The most commonly reported number of staff was 3 (20 percent of

schools). When schools had three staff, they were usually comprised of a school

counselor, a nurse, and a psychologist. When schools had only two staff, they were

usually a school counselor and a nurse; and when schools had four staff, staffing was

most likely to include a school counselor, a nurse, a psychologist, and a social worker

Although the majority of schools reported that they had more than one staff person of

various types providing mental health services, 8 percent of schools reported that only

Source: School Mental Health Services in the United States, 2002–2003, Substance Abuse and Mental Health Services

Administration, U.S. Department of Health and Human Services

School Questionnaire, Item 13, Appendix C, School Table 9
36 School Mental Health Services in the United States, 2002–2003 

one person in their school provided mental health services. Among the schools with only

one staff person, the sole mental health provider was most likely to be a school

counselor (50 percent), a school psychologist (20 percent), or a school social worker (18

percent) (Appendix C, School Table 9C). Only a small percentage of those schools

reported that nurses were their only staff person providing mental health services.15

The analysis of staffing configurations, regardless of number of staff, revealed no

predominant combination. However, the most common staffing combination among all

schools, reported in 13 percent of schools, was one or more school counselors,16 school

psychologists, and nurses. Another 11 percent of schools reported having one or more

school counselors, school psychologists, social workers, and nurses. All other

combinations accounted for 52 percent of schools, but each of these combinations

occurred in 4 percent or fewer schools, and no particular patterns emerged (Exhibit 4.4).

Staff Qualifications

The training qualifications of the staff who provide mental health services in schools

were a focus of this study. Respondents were asked to indicate the number of each type

of staff who held master’s degrees or higher in their field and who were licensed in their

field. The survey found that a high percentage of staff providing mental health services

held master’s degrees or higher (although not necessarily in a recognized mental health

specialty) and were licensed or certified in their fields (Exhibit 4.5).17 There is some

consistency between holding a master’s degree and being licensed: the majority of

psychologists, counselors, social workers, and mental health counselors held both

qualifications. Substance abuse counselors and school nurses were more likely to be

licensed (80 percent and 88 percent, respectively) than to hold master’s degrees (69

Source: School Mental Health Services in the United States, 2002–2003, Substance Abuse and Mental Health Services

Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 13, Appendix C, Schools Table 9E

Note: Numbers total 100 percent because of rounding up, though 1 percent of the data is missing.
School Mental Health Services in the United States, 2002–2003 3

Source: School Mental Health Services in the United States, 2002–2003. Substance Abuse and Mental Health Services

Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 13, Appendix C, School Table 9D

Note: Exhibit presents school-based or district-based staff combinations.

Staff Combination Percent of Schools

With Combination (%)

School Counselors + School Psychologists + Nurses 13

School Counselors + School Psychologists + Nurses + School

Social Workers 11

School Counselors + Nurses 9

School Psychologists + Nurses + School Social Workers 5

School Counselors + Psychologists 4

Exhibit 4.5 Percentage of Staff Providing Mental Health Services With Master’s Degree or Higher

and With Licensure in Their Field, 2002–2003

Source: School Mental Health Services in the United States, 2002–2003, Substance Abuse and Mental Health Services

Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 14, Appendix C, School Table 10, 10A
y g p

These findings suggest that, given the amount of time these staff spend providing mental

health services to students, more needs to be learned about their ongoing training,

support, and professional development needs.

38 School Mental Health Services in the United States, 2002–2003 
This chapter presents survey findings from the district survey related to

the sources and allocation of funding for school mental health

services. Potential funding sources were identified in the literature and

were categorized into Federal, State, and local funding streams, service

reimbursement sources (e.g., Medicaid, self-pay), and foundation grants.

Respondents were asked which funding sources their district used to provide

mental health services, how those resources were directed (e.g., to

intervention or prevention), and how funding was allocated to different costs

(e.g., administrative costs, staff salaries, contracts). The types of services

ultimately provided are often determined by categorical funding streams, so

respondents were asked to report on the extent to which their funding

sources facilitated or impeded the delivery of mental health services. Finally,

respondents were asked about any changes in funding and in the need for

mental health services in the 2 years prior to the survey (i.e., since the

beginning of the 2000–2001 school year).

5.1 Sources of Funding 

Nationally, the top Federal sources of funding for school mental health intervention

services were IDEA (the Individuals with Disabilities Education Act), reported by 63

percent of districts, State special education funds (55 percent), local funds (49

percent), and State general funds (41 percent). Interestingly, 38 percent of districts

reported Medicaid as a funding source for mental health services (Exhibit 5.1).

Twenty-eight percent of districts indicated that Medicaid was one of their top five

sources of funding (Appendix C, District Table 5). Title IV (the Safe and Drug-Free

Schools and Communities program) was most frequently reported by districts as a

prevention resource (57 percent of districts), followed by local funds (43 percent)

and State general funds (39 percent). 

School Mental Health Services in the United States, 2002–2003 3

Use 
some districts are collecting fees from parents who are uninsured or whose children’s

mental health services are not covered by insurance. The majority (58 percent) of

schools also reported that financial constraints of families were a barrier or a serious

barrier to the delivery of mental health services (see Exhibit 2.7). This finding suggests

that in spite of the array of funding sources available to districts to provide mental health

services, these options were inadequate for families without the ability to pay for these

services.

5.2 Funding Restrictions and Other Barriers to Providing Services

Some funding sources may restrict the types of services that can be provided, or how

services are delivered and coordinated. District respondents were asked to assess the

40 School Mental Health Services in the United States, 2002–2003 

Exhibit 5.1 Percentage of Districts Using Each Funding Source for Inventions and/or Prevention

Services, 2002–2003

Source: School Mental Health Services in the United States, 2002–2003, Substance Abuse and Mental Health Services

Administration, U.S. Department of Health and Human Services.

District Questionnaire, Item 7, Appendix C, District Table 5
Districts were more likely to consider other funding obstacles as impediments to deliv

and coordination of services: 70 percent of districts considered competing priorities fo

use of funds as a moderate or major impediment, and 61 percent considered insufficie

community mental health resources as such an impediment (Exhibit 5.2b). These ratin

are consistent with school reports of barriers to providing services. The restrictions/

obstacles least often cited by districts as impeding delivery and coordination of service

were funders’ restrictions on location of service provision, lack of administrative suppo

for third-party billing, resistance from nonmental health school staff or district staff, an

resistance from the community (Appendix C, District Table 8).

Open-ended comments pertaining to barriers to the delivery of mental health services

focused on insurance barriers. Several respondents wrote that the barriers to mental

health services were greatest for students who were uninsured or underinsured. Other

commented that the cost of billing Medicaid exceeds the reimbursement rate, and still

others expressed concern about the limitations of private insurance, especially for long

term treatment and inpatient care. 

School Mental Health Services in the United States, 2002–2003 4

Source: School Mental Health Services in the United States, 2002–2003, Substance Abuse and Mental Health Services

Administration, U.S. Department of Health and Human Services.

District Questionnaire, Item 11, Appendix C, District Table 8

*Note: Numbers do not total 100 percent because of missing data, ranging from 4 to 5 percent
5.3 Changes in Funding and Need for Mental Health Services 

Districts were asked what had happened to levels of funding and the need for mental

health services over the 2 years between 2000 and 2001 and the time of the survey in

2002–2003. Respondents were asked whether funding had increased, decreased, or

remained the same, and whether students’ needs for services increased, decreased, or

remained the same. Nearly 70 percent of districts nationally were facing increased need

for services at the same time that over 70 percent faced decreased or the same level of

funding (Exhibit 5.3). 

Districts in the Northeast, urban, suburban, and large school districts (16 or more

schools) were more likely than other districts to report increased need for mental health

services. During the same period, districts in the Northeast and urban areas were also

more likely than other districts to report increased funding. However, the proportion of

districts reporting increased funding (27 percent in the Northeast and 25 percent in

urban districts) was much lower than the percentage of these districts reporting

increased need (77 percent in the Northeast and 85 percent in urban districts).

(Appendix C, District Table 9A).19

Districts were asked similar questions about changes in the provision of mental health

services and resources over the same 2-year period: Had the number of mental health

staff, students served, referrals, availability of training, outreach to parents, and other

resources increased, decreased, or remained the same since the 2000–2001 school year?

42 School Mental Health Services in the United States, 2002–2003 

Source: School Mental Health Services in the United States, 2002–2003, Substance Abuse and Mental Health Services

Administration, U.S. Department of Health and Human Services.

District Questionnaire, Item 11, Appendix C, District Table 8

*Note: Numbers do not total 100 percent because of missing data, ranging from 5 to 9 percent
As with level of funding versus level of need, the overall pattern is one of increased us

of services and decreased or static availability of mental health resources (Exhibit 5.4)

Over half of districts reported an increase in the number of general education students

receiving mental health services. At the same time, the number of mental health staff

remained the same in half of the districts and decreased in 17 percent. The majority o

districts (60 percent) reported increased referrals to community-based providers, whil

during the same period, one third of districts reported decreased availability, and half

reported that the availability of community providers had remained the same.

Several issues related to lack of adequate funding for mental health services were

reported by district respondents in open-ended comments. Reductions in State and lo

funding to schools were projected by many respondents to result in losses in the area 

school mental health in the coming school year. Many districts also noted that other

mandates, such as the No Child Left Behind Act, have redirected mental health fundin

and counseling staff to academics and testing.

Respondents also commented on the inadequacy of available mental health resources

both on site and in the community, relative to increasing need. A common theme was

concern about the lack of treatment options in the community, particularly residential

and inpatient beds. Some districts indicated that presenting problems were being

identified earlier and were more serious than in previous years, thus contributing to

increasing mental health needs among both general and special education students. 

School Mental Health Services in the United States, 2002–2003 4

Source: School Mental Health Services in the United States, 2002–2003, Substance Abuse and Mental Health Services

Administration, U.S. Department of Health and Human Services.

District Questionnaire, Items 12, 13, Appendix C, District Table 9A

*Note: Numbers do not total 100 percent because of missing data, ranging from 4 to 12 percent
5.4 Budgeting and Resource Allocation 

The survey asked whether mental health services were budgeted separately from other

education expenditures, and whether mental health services for special education

students were budgeted separately from those for other students. Such information could

assist researchers in assessing the feasibility of conducting analyses of mental health

expenditures in schools. Almost half of the districts (48 percent) reported that they

budget mental health services separately from other education expenditures. Similarly,

about half of the districts (47 percent) budgeted mental health services for special

education students separately from mental health services for general education students

(Appendix C, District Table 4).20

School districts were asked to report the percentage of total expenditures for mental

health services that were allocated to various categories. On average, salaries accounted

for the greatest proportion (over half) of mental health expenditures, contracts with

outside organizations or providers accounted for one fourth, and technical assistance and

professional development/training accounted for 8 percent (Exhibit 5.5).

Districts were asked to describe the criteria they used to apportion their mental health

resources to schools in their district. The most common method used by districts was to

44 School Mental Health Services in the United States, 2002–2003 

Source: School Mental Health Services in the United States, 2002–2003, Substance Abuse and Mental Health Services

Administration, U.S. Department of Health and Human Services.

District Questionnaire, Item 14, Appendix C, District Table 10

*Note: Numbers do not total 100 percent because of missing data, ranging from 6 to 11 percent
direct funds to schools based on the mental health needs of students (47 percent).

Approximately one third of districts assigned funds on a per-pupil basis according to

student enrollment. A smaller proportion of districts (18 percent) distributed resource

equally to schools regardless of size (Appendix C, District Table 7). 

5.5 Access to and Use of Data

Access to current data on mental health services in public schools is valuable to

providers of care, as well as to school, district, and State administrators and

policymakers. Schools, for example, can use timely information to match resources to

student needs, develop training and professional development programs for staff,

evaluate programs, and justify budget requests. The survey asked schools whether the

collect or have access to data on service provision for their students, what types of dat

are available, and how the data are used. Half of schools (50 percent) either collected

data themselves or had access to data on mental health. The types of data collected an

the uses for the data appear in Exhibit 5.6.

Schools were asked how they used the available data for school and district purposes

such as mental health needs assessments and reporting. Schools used the data for a

variety of purposes including reporting to district or State offices (60 percent); plannin

and evaluation of school mental health services or resources (49 percent); developing

staff training and professional development programs (40 percent); and planning and

School Mental Health Services in the United States, 2002–2003 4

Source: School Mental Health Services in the United States, 2002–2003, Substance Abuse and Mental Health Services

Administration, U.S. Department of Health and Human Services.

District Questionnaire, Item 9, Appendix C, District Table 6
5.6 Summary

While survey results indicate that the primary sources of Federal funding for mental

health were IDEA, Title IV, Title I, and the Safer Schools/Healthy Students Initiative,

Medicaid was reported as a top-five funding source in over one third of districts. One

third of districts reported that lack of administrative capacity to bill third-party payers

impeded service delivery. At the same time, the survey revealed that insufficient

community mental health resources and insurance restrictions (e.g., on the types of

services that can be provided, length of service) impede service delivery in many

districts. Finally, many districts reported that service need is increasing at the same time

that funding for mental health is static or declining. 

46 School Mental Health Services in the United States, 2002–2003 

Source: School Mental Health Services in the United States, 2002–2003. Substance Abuse and Mental Health Services

Administration, U.S. Department of Health and Human Services.

School Questionnaire Items 34, 35, Appendix C, School Table 20

 Types of School-Based Mental Health Services Provided 69

 Demographic Characteristics of Students Who Receive Services 36

 Number of Units of Mental Health Services Delivered 32

 Referrals to Community Providers 52

 Referrals of Students for Medication 38

Uses for Data

 Reporting to District or State Offices 60

 Developing Training and Professional Development Programs for Various

School Staff 40

 Planning and Evaluation of School Mental Health Services and Resources 49

 Planning and Evaluation of Arrangements with Community-Based Mental

Health Providers 27

 Other Uses for the Data 14
This report has focused thus far on all public schools in the nation,

with attention to variation by school and student characteristics. To

make the results of this survey more tangible, this chapter examines

the data by school level. In order to understand how schools were organizing

and delivering school mental health services, school level—whether a school

is an elementary, middle, or high school—was perhaps the most salient

school characteristic. The staffing and services provided may vary according

to the stage of development of the children and youth served. This chapter,

where possible, describes the “typical” elementary, middle, and high school in

terms of the school’s characteristics, mental health problems, and how schools

delivered mental health services, and then explores differences and

similarities in the survey findings by level. It describes school mental health

for a typical elementary, middle, and high school (Exhibit 6.1) by using either

(1) the majority response (reported by over 50 percent of schools), or (2) the

most common response(s) to a question if there was not a majority response

(see Exhibits 6.2-6.7). For questions that asked schools to report a percent or

number, we used the median value rather than the average (mean) to

describe the “typical” school.

6.1 Mental Health Problems and Services at the Elementary School Level

According to the findings from this survey, the typical elementary school had 440

students (Exhibit 6.1). The mental health problem category most commonly reported

for both male and female elementary school students was social, interpersonal, or

family problems (Exhibits 6.1 and 6.2). The second and third most commonly

reported mental health problems differed for male and female elementary school

students. Among males, aggression or disruptive behavior, and behavior problems

associated with neurological disorders were the second and third most common

problems. For females, the second most commonly reported problem was anxiety,

and the third was adjustment issues.

School Mental Health Services in the United States, 2002–2003 4

School Levels 
In addition to its own staff, the typical elementary school had formal agreements with

community-based organizations such as county mental health agencies (Exhibit 6.4).

Elementary schools typically had two to four staff providing mental health services

(Exhibit 6.5); most often, they were school counselors and nurses when they had only

two staff. Schools with three or four staff typically had a psychologist and a social

worker in addition to a counselor and a nurse (Exhibit 6.6). School counselors in

elementary schools spent more of their time providing direct mental health services than

did the other types of staff, and school nurses spent the least amount of time (Exhibit

6.7). Since school counselors were part of the typical team of mental health staff at

schools and spent more of their time providing mental health services compared to other

types of staff, we can infer that at the typical elementary school, school counselors

provided most of the mental health services. However, we cannot infer the exact amount

of services provided. Although the survey also included mental health counselors and

other types of providers, few schools reported using them to deliver mental health

services.

6.2 Mental Health Problems and Services at the Middle School Level

The typical middle school had over 600 students (Exhibit 6.1). The mental health

problem category most commonly reported for both males and females was social,

interpersonal, or family problems (Exhibits 6.1 and 6.2). The second and third most

commonly reported mental health problems differed for male and female middle school

students. Among males, aggression or disruptive behavior, and behavior problems

associated with neurological disorders were the second and third most common

problems. For females, the second most commonly reported problem was anxiety, and

the third was adjustment issues. These findings are consistent with the most commonly

reported problems in elementary schools.

In the typical middle school, all students, not just special education students, were

eligible to receive mental health services. About one fifth of students in the typical

middle school had received one or more of the mental health services provided by their

school (Appendix C, School Table 3). These types of mental health services at the typical

middle school included basic services such as assessment for emotional or behavioral

problems, behavior management consultation, crisis intervention, and referral to

specialized programs and also included more intensive services such as counseling,

48 School Mental Health Services in the United States, 2002–2003 
(Exhibit 6.5). Most commonly, they were school counselors, psychologists, social

workers, and nurses (Exhibit 6.6). School social workers and school counselors spent

more of their time providing direct mental health services compared to the other type

staff, and school nurses spent the least amount of time (Exhibit 6.7). Although the

survey did not ascertain the amount of service provided by each type of staff, we can

infer from these data that school counselors provided most of the mental health servic

at the typical middle school. 

6.3 Mental Health Problems and Services at the High School Level

The typical high school generally enrolled 700 students (Exhibit 6.1). The mental hea

problem category most commonly reported for both male and female high school

students was social, interpersonal, or family problems (Exhibits 6.1 and 6.2). The

second and third most commonly reported mental health problems differed for male a

female high school students. Among males, aggression or disruptive behavior and

alcohol/drug problems were the second and third most common problems. For female

the second most commonly reported problem was depression/grief, and the third was

anxiety.

In the typical high school, all students, not just special education students, were eligib

to receive mental health services. However, less than one fifth of students in the typica

high school had received one or more of the mental health services provided by their

school (Appendix C, School Table 3). The types of mental health services at the typica

high school included basic services such as assessment for emotional or behavioral

problems, behavior management consultation, crisis intervention and referral to

specialized programs. Also included were more intensive services such as therapy and

case management (Exhibit 6.3). Substance abuse counseling was provided by the typic

high school, although medication management was not.

The typical high school had formal agreements with community-based organizations o

individuals (in addition to staff) to provide student mental health services (Exhibit 6.4

High schools that engaged community providers for mental health services usually ha

agreements with county mental health agencies, community health centers, and the

juvenile justice system.

School Mental Health Services in the United States, 2002–2003 4
50 School Mental Health Services in the United States, 2002–2003 
School Mental Health Services in the United States, 2002–2003 5
52 School Mental Health Services in the United States, 2002–2003 

Source: School Mental Health Services in the United States, 2002–2003, Substance Abuse and Mental Health Services

Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 27, Appendix C, School Tables 15, 15A

associated with

neurological

disorders (51%)

associated with

neurological

disorders (35%)

Alcohol/drug

problems (34%) 

Top mental health

problems for

females

Social/interpersonal

or family problems

(80%)

Social/interpersonal

or family problems

(83%)

Social/interpersonal

or family problems

74%)

Anxiety (42%) Anxiety (45%) Depression/grief

(47%)

Adjustment issues

(37%)

Adjustment issues

(37%) Anxiety (36%) 

Exhibit 6.3 Percentage of Schools Providing Various Mental Health Services by School Level,

2002–2003

Source: School Mental Health Services in the United States, 2002–2003, Substance Abuse and Mental Health Services

Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 29, Appendix C, School Table 17A

Mental Health Service Elementary

(%) Middle (%) HighSchool (%)

Assessment 90 87 86

Behavior Management Consultation 89 86 82

Crisis Intervention 87 86 82

Referral to Special Programs 85 83 81

Individual Counseling/Therapy 75 79 72

Case Management 74 70 68

Group Counseling/Therapy 70 67 61

Family Support Services 59 56 58

Substance Abuse Counseling 34 53 56

Medication/Medication Management 33 35 33
School Mental Health Services in the United States, 2002–2003 5
54 School Mental Health Services in the United States, 2002–2003 
pg() 

middle school. High schools reported two problems in the top three that were not cite

to this degree by middle or elementary schools: alcohol/drug problems for males and

depression/grief for females. 

Schools at all levels reported they provided a wide array of services, but the majority a

reported they had arrangements with community-based providers. This reliance on

collaborating agencies and providers is striking and could be attributable to factors su

as recognition among educators of the need to coordinate education with behavioral

health and health care to maximize educational achievement. Education and other chi

serving systems may also recognize the need to share resources and responsibility in

response to child mental health needs. 

The most common number of staff providing mental health services in elementary

schools was 2–4, but the ranges were much wider in middle schools and high schools

which makes it difficult to pinpoint the “typical” school in this regard. The most

common types of staff at all levels were school counselors, psychologists, and nurses,

followed by social workers. While counselors spent more of their time providing men

health services than other staff in elementary schools, they spent much less time in hig

schools on mental health services. In high school, social workers spent more time

providing mental health services than did other staff. 

School Mental Health Services in the United States, 2002–2003 5

T

U.S. public schools. Several key findings suggest that in 2002–2003,

public schools were being responsive to the mental health needs of

their students. The study found that one fifth of students received some type

of school-supported mental health services in the school year prior to the

study. One fifth of the districts in the U.S. reported increased numbers of

mental health providers on staff in schools over the year prior to the survey,

and another 50 percent indicated that staffing levels remained the same.

Almost half the schools were attempting to increase their capacity to provide

mental health services by making formal arrangements with communitybased providers. Close to 40 percent of districts increased parent outreach

services, which have been associated with enhanced identification,

assessment, and treatment of behavioral and emotional problems in children

and youth (Advocates for Youth, 1998). 

The findings from this survey, however, also point to an ongoing need for mental

health services, multiple challenges faced by schools in addressing those needs,

increasing funding pressures, and inadequate community-based resources. This

section discusses findings related to mental health problems, staffing, service array,

and funding. It concludes with a summary of study limitations and implications for

further research.

7.1 Mental Health Problems 

As expected, the most common mental health problems among school students were

social, interpersonal, and familial in nature. These issues were rated as the most

resource-intensive among the mental health issues that were identified and treated in

schools in the 2002–2003 school year. This school- and district-level study did not

generate the kind of epidemiological data that would permit estimation of prevalence

rates of mental health problems among children, but it does provide a picture of the

kinds of children’s problems seen by school personnel, and it sheds light on the

availability of services that are most suited to addressing reported problems. More

than half of all schools offered services that were commonly used to treat social,

interpersonal, and familial problems, but family support services and group

School Mental Health Services in the United States, 2002–2003 5
have difficulty both in providing medication management and in making referrals for

treatment with medication. Gender differences in mental health problems raise the

question as to whether, overall, boys are more likely to receive services and/or to receive

more intensive services because their problems are expressed as disruptive behaviors.

Elementary, middle, and high schools face somewhat different challenges in responding

to the mental health needs of their students. These differences have implications for

teacher training and professional development, parent education, and prevention and

intervention strategies for children. Many elementary schools were dealing with

aggressive and disruptive behavior, which can negatively affect the learning environment

for all children in a classroom. Almost two thirds of elementary schools used

curriculum-based programs to enhance social and emotional functioning and reduce

barriers to learning. Schools reported that using programs focusing on building skills

such as anger management and conflict resolution were particularly helpful in improving

the mental health of their students.

At the middle school level, the same problems predominated, but overall findings reveal

that depression, alcohol and drug problems, and delinquency were more frequently

reported as significant concerns. It appears that approximately three quarters of all

schools recognize the importance of prevention and use schoolwide strategies to reduce

the incidence of substance use and to promote drug-free environments but that

substance abuse counseling was less available.

In the high schools, alcohol and drug problems and depression were more often

reported as top mental health problems and made more demands on mental health

resources. The survey found that only 43 percent of schools could provide substance

abuse counseling, and that this service was difficult or very difficult to deliver. Effective

substance abuse counseling requires some specialized knowledge, which is absent from

many master’s-level mental health professional training programs. Substance abuse

counselors accounted for only 3 percent of all mental health staff in schools. This reality

is reflected in the finding that only half of the substance abuse counseling delivered to

students was provided by school- or district-based staff; the remaining half of substance

abuse services were delivered by community-based providers. 

58 School Mental Health Services in the United States, 2002–2003 
Several basic mental health services—assessment, behavior management, crisis

intervention, and counseling—were widely available in schools. The extent of the

reported service array might suggest that schools were providing the full continuum o

services required by students with mental health needs, but this finding should be

interpreted cautiously since the survey did not ask the respondents to report on the

intensity of these services, the specific qualifications of those providing the services, or

the extent of unmet need for services.

The survey findings also revealed that schools were providing a variety of prevention a

early intervention programs, primarily aimed at drug and alcohol abuse, mild mental

health problems, and enhancing student mental health. Peer counseling and parent

outreach were also available, but to a lesser extent, and although schoolwide screening

for mental health problems was reported by some schools, it was rarely available.

Respondents were not asked to rate the effectiveness of these programs or to commen

on the extent to which they were replacing traditional mental health treatment service

but given their prevalence, it would benefit the field to further study how, and to wha

extent, these prevention programs combine with treatment services and service provid

to promote a continuum of care within the school setting.

In spite of the extensive array of mental health services available in schools, financial

constraints of families was the most frequently reported barrier to receiving services;

furthermore, almost half of the schools cited inadequate internal and community men

health resources as barriers or serious barriers to services. This finding suggests that

while schools and their community partners were attempting to meet students’ mental

health needs, the systems put in place to respond to these needs were not deemed to b

adequate, and that accessing services under the current system was often dependent o

the financial resources of the family (rather than the school system). 

In the majority of schools, all students, as opposed to only special education students,

were eligible to receive mental health services. However, schools with high minority

enrollment were more likely to restrict mental health services to special education

students only. This finding suggests that disparities by race/ethnicity may exist regardi

access to mental health services in schools, but this is an area that should be pursued 

further study.

School Mental Health Services in the United States, 2002–2003 5
y g , y, , pgy

also found that the need for mental health services has been rising and that funding has

not kept pace with increased need. 

Nationally, schools most commonly had between two and five staff providing mental

health services. Although many different combinations were reported, the most common

were: (1) school counselor, school psychologist, and nurse; and (2) school counselor,

school psychologist, nurse, and social worker. Types of staff in schools varied somewhat

by school level. High schools were most likely to have a school counselor and a nurse,

and when there were four or more staff, they were most likely to have a psychologist and

a social worker in addition to a school counselor and a nurse. Middle schools were most

likely to have a combination of a counselor, psychologist, social worker, and nurse.

Elementary schools typically had a counselor and a nurse when there were two staff, and

a psychologist and social worker were the most likely additions when there were four

staff. 

Schools were much less likely to report that they had a clinical (Ph.D.) psychologist or a

mental health counselor, and psychiatrists were rarely reported to be on staff. The

paucity of clinical psychologists and mental health counselors in schools is of concern,

given that respondents also reported an increasing need for mental health services. The

limited availability of psychiatrists in schools no doubt contributes to the dearth of

medication management services. The survey did not ask about the mental health

functions specific to nursing, but it is possible that the rise of medication use among

children and youth with mental health problems (LeFever et al., 1999; Olfson et al.,

2002; and Zito et al., 1998) raises the question of the means by which psychotropic

medications are administered and monitored by schools. More research is needed into

the mental health functions specific to nursing in the school setting, the time nurses

spend on providing mental health services and coordinating medication management

with outside providers, and their training needs.

7.4 Service Delivery Arrangements 

Over half of the schools nationwide had agreements with community mental health

providers to provide services to their students. The survey found that most schools, even

if they did not have formal arrangements, referred out, and 40 percent of schools

reported that they participated in team meetings with community providers. These

60 School Mental Health Services in the United States, 2002–2003 
g py g,

suggesting that districts of this size may be developing the administrative capacity to b

Medicaid for mental health services. Alternatively, their collaborating providers may be

billing for services provided in the school. Answering these questions was beyond the

scope of this study. Small districts were much less likely to access Medicaid or other

third-party reimbursement, suggesting that they may not yet have the capacity to do s

and that as a result may not be able to provide the amount of counseling services that

larger districts can.

A majority of districts cited competing priorities (e.g., academic achievement versus

mental health services) for the use of funds as a major impediment to providing ment

health services in schools. Survey findings suggest that there were few Federal, State, o

local funding sources that are earmarked for mental health services to students who w

not in special education. Without dedicated funds, it is up to the school district to

determine how to allocate the funds available, and it appears that resources may go to

mandated educational interventions rather than to mental health in many cases. Lack 

(or inadequate) insurance and insufficient mental health resources also impeded acces

to mental health services for students. These constraints likely place increasing deman

on schools to address the mental health problems of students.

Finally, respondents reported that service use and need are increasing, while funding f

mental health remains static or is declining. Other findings, such as the lack of fundin

earmarked for mental health and the reported lack of community-based mental health

resources, together with rising need, indicate that schools face numerous challenges in

their attempts to maintain optimal student functioning.

7.6 Implications for Further Research

This survey is the first comprehensive, nationally representative survey of mental healt

services in U.S. public schools. Obtaining an unbiased sample of schools and districts

was a time-consuming, labor-intensive process. While the survey provides important

baseline information, it also leaves many questions unanswered and raises additional

questions. It provides measures of the mental health problems encountered in school

settings, but it does not address how many students present with each type of problem

and how these problems differ by demographic background characteristics of students

School Mental Health Services in the United States, 2002–2003 6
gg p

their schools. 

Research Needed on Specialty Staff Training and Qualifications

The individuals who provide mental health services in schools include specialists with

graduate degrees and licensure in their fields as well as nurses and paraprofessionals, but

this survey does not address whether these staff have specific qualifications to treat the

major presenting problems at each school level. Several open-ended comments also

pointed to the inadequacy of staff-to-student ratios. Future research should measure

specific staff and service assignments, the qualifications of staff to provide those services,

and the professional development needs and experiences of staff. 

Research Needed on Distribution of Funding Sources 

It would be important to learn more about the amount of funding allocated to different

types of prevention, assessment, and treatment services according to the number of

children served and their presenting problems. Such an analysis would shed light on

equity of funding and disparities between well-resourced and under-resourced schools.

The information would also guide policymakers in their decisions about funding

allocation for mental health services. The survey identified the top sources of funding for

mental health services and which sources were used for prevention versus intervention

services. However, additional information is needed about the specific services that

various funding streams support. Further, more research is needed to determine the

distribution of funding and other resources for mental health services by region,

urbanicity, minority enrollment, and other school characteristics.

Conclusion

This study, School Mental Health Services in the United States, 2002–2003, provides the first

source of information on the mental health services provided in the approximately

83,000 public elementary, middle, and high schools and their associated school districts

in the United States. The study’s findings confirm that mental health services currently

play an integral role in the school setting. The findings also suggest that needs for mental

health services are increasing, and that adequate funding and availability of community

resources are essential if schools are to meet the challenge of addressing these needs.

62 School Mental Health Services in the United States, 2002–2003 
gp

2

The estimated number of schools based on the survey data is about 83,500. The

difference between the survey estimate and the universe count from the Common

Core of Data results from the survey sample being drawn from the universe list

available at the time of the survey, which was 2 years earlier than the year of data

collection.

3

The National Assembly on School-Based Health Care (www.nasbhc.org) provides

several definitions of school-based health centers and delineates their common

features: located in schools; cooperative relationship with the school; a

comprehensive array of health and mental health services; a multidisciplinary team

of providers; written parental consent for health center enrollment; and clinical

linkages with a qualified medical provider.

4

With the exception of a question on the professional affiliation of a mental health

coordinator (which included nursing and other professions), survey questions on

mental health staffing in schools were limited to guidance counselors, psychologis

and social workers. 

5

The survey was endorsed by the American Counseling Association; National

Association of School Psychologists; National Association of Social Workers;

National Association of State Directors of Special Education; UCLA School Mental

Health Project; and the University of Maryland-Baltimore Center for Mental Healt

Assistance. The survey was reviewed and approved by the Education Information

Advisory Committee of the Council of Chief State School Officers.

6

The sample for the National Longitudinal Study of Adolescent Health, for example

was designed primarily to estimate characteristics of students as opposed to schoo

The estimates for schools, therefore, may not be as reliable as those from other

surveys that were designed primarily to measure school characteristics.

7

High minority enrollment was defined as 51 percent or more of the overall studen

population, and low minority enrollment was defined as 15 percent or less of the

student population.

8

Schools were asked whether or not they provided any of the listed services, in any

amount, which may explain the high percentage of positive responses.

9

Large districts are defined as those with 16 or more schools.

School Mental Health Services in the United States, 2002–2003 6
than on contracted staff. The research team felt that the reliability of the responses

would be diminished if respondents were asked to report specific characteristics of

collaborating community-based providers as well as internal staff.

14Respondents were not asked to identify the array of services provided by each staff

type; for nurses, services could include identification of mental health concerns or

medication distribution.

15The survey did not count the number of full-time equivalent positions; rather, it

counted the number of individuals providing mental health services in the school,

either on a part-time or full-time basis.

16Although on average, there was one or fewer of each type of staff per school,

schools of 500 to 1,000 or more students had more than one of certain types of staff

(see Appendix C, School Table 9A).

17Ph.D. psychologists were not included in the analysis of highest degree because by

definition, they hold a degree beyond a master’s. The survey asked whether staff

were licensed or certified; in some fields, certification can be obtained without a

bachelor’s degree; therefore, education level may more accurately reflect

qualifications.

18SCHIP may be underreported as a funding source. For billing purposes, children

receiving SCHIP would be indistinguishable from children receiving Medicaid in

States in which SCHIP was implemented as a Medicaid expansion program. In other

states, children with SCHIP are enrolled in health plans that are billed directly for

services and may not, therefore, be known to schools as SCHIP beneficiaries.

19It is important to note, however, that these findings are impressionistic and should

be interpreted with caution. To identify real trends, longitudinal data are needed.

20This finding seems to contradict an earlier finding; i.e., that 67 percent of districts

reported that mental health services for general and special education were

administered together. It may be the case that administrative functions are linked,

and districts draw from distinct budgets to serve students in general and special

education.

21The survey did not elicit information on the intensity or quantity of services

provided to students served, or from whom they received the service. Moreover, the

64 School Mental Health Services in the United States, 2002–2003 
School Mental Health Services in the United States, 2002–2003 6
66 School Mental Health Services in the United States, 2002–2003 
community-based care for adolescents. Retrieved October 5, 2001, from

www.advocatesforyouth.org/publications/iag/slhc_mdl.htm

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disorders. Fourth Edition, Revised (DSM-IV). APA: Washington, DC.

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Results from the school health policies and programs study 2000. Journal of School

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Centers for Disease Control and Prevention. (2000). School health policies and programs

study (SHPPS). Retrieved October 15, 2001, from www.cdc.gov/nccdphp/dash/shp

Centers for Disease Control and Prevention. (1999a). Youth risk behavior surveillance

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Centers for Disease Control and Prevention. (1999b). Mental health and social services

state, district and school questionnaires. (OMB Publication No: 0920-0445).

Costello, E.J., Angold, A., Burns, B., Erkanli, A., Stangl, D.K., & Tweed, D.L. (1996).

The Great Smoky Mountains study of youth: Functional impairment and serious

emotional disturbance. Archives of General Psychiatry, 53, 1137–43.

Costello, E.J., Angold, A., Burns, B., Stangl, D.K., Tweed, D.L., Erkanli, A., &

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methods, and the prevalence of DSM-III-R disorders. Archives of General Psychiatry

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LeFever, G., Dawson, K.V., & Morrow, A.L. (1999). The extent of drug therapy for

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National Assembly on School-Based Health Care (www.nasbhc.org).

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Guidelines, models, resources, and policy considerations. Department of Psychology,

University of California, Los Angeles.

Robinson, G.K., Barrett, M., Tunkelrott, T., & Kim, J. (2000). School-based mental health

services under Medicaid managed care. (DHHS Publication No. SMA-00-3456).

Rockville, MD: Substance Abuse and Mental Health Services Administration, Center

for Mental Health Services.

Rones, M., & Hoagwood, K. (2000). School-based mental health services: A research

review. Clinical Child and Family Psychology Review, 3(4), 223–241.

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York: Wiley.

Slade, E. (2003). The relationship between school characteristics and the availability of

mental health and related health services in middle and high schools in the United

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68 School Mental Health Services in the United States, 2002–2003 
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School Mental Health Services in the United States, 2002–2003 6

Panel Members

Michael Curtis, Ph.D. 

Research and Training Center for Children’s

Mental Health 

Louis de la Parte Florida Mental Health

Institute 

University of South Florida 

Kevin Dwyer

Bethesda, MD 

Elizabeth Farmer

Assistant Professor

Duke University

Department of Psychiatry and Behavioral

Science

Durham, NC

Ted Feinberg

National Association of School Psychologists

Bethesda, MD

Lisa Hunter, Ph.D.

Center for the Advancement of Children’s

Mental Health

Columbia University NYSPI

Julia Graham Lear, Ph.D.

The Center for Health and Health Care in

Schools (RWJ) 

Washington, DC

Adelaida Montemayor

Lubbock, Texas 

Angela M. Oddone, MSW

Mental Wellness Program Coordinator

NEA Health Information Network

Alexandria, VA

Diane Oglesby 

National Association of State Directors of

Special Education 

Alexandria, Virginia 

David Osher, Ph.D.

Center for Effective Collaboration and

Practice

Washington, DC 

Robin Rosenthal 

Rosalynn Carter Institute for Human

Development

Georgia Southwestern State University

Americus, GA

John Schlitt

National Assembly on School-Based Health

Care

Washington, DC 

Mark Weist, Ph.D.

UMB Center for Mental Health Assistance

Baltimore, MD 

School Mental Health Services in the United States, 2002–2003 7

States, 20022003 

Expert Panel
Tom V. Hanley

U.S. Department of Education

Washington, DC 

Isadora Hare, MSW

Health Resources and Services Administration 

Maternal and Child Health Bureau 

Division of Child, Adolescent, and Family

Health

Rockville, MD 

Kelly Henderson

U.S. Department of Education

Washington, DC 

Kevin Hennessy, Ph.D.

Office of the Assistant Secretary for Planning

and Evaluation 

Department of Health and Human Services

Washington, DC 

Kimberly Hoagwood, Ph.D.

Associate Director of Child and Adolescent

Research

National Institute of Mental Health

Bethesda, MD 

Roseann R. Rafferty

U.S. Department of Education

Washington, DC 

LaVoyce Reid

Senior Staff Associate

Children, Families, and Schools

National Association of Social Workers

Washington, DC

Rockville, MD 

Michele Edwards, M.A., ACSW

Special Programs Development Branch Center

for Mental Health Services

Rockville, MD 

Malcolm Gordon, Ph.D.

Special Programs Development Branch

Center for Mental Health Services

Rockville, MD

Shelagh Smith, MPH, CHES

Office of Organization and Financing

CMHS/SAMHSA

Rockville, MD 

Judith L. Teich, MSW

Social Science Analyst

Office of Organization and Financing

CMHS/SAMHSA

Rockville, MD 

Abt Associates, Inc. Staff

Susan Foster

Gabriela Garcia

Dennese Neal

Gail K. Robinson

Mary Rollefson

72 School Mental Health Services in the United States, 2002–2003 
School Mental Health Services Services Services Services Services in the United States, States, States, States, States, 2002–2003 2002–2003 2002–2003 2002–2003 2002–2003 7

The survey included two open-ended questions:

School Questionnaire, Question 37:

“Please tell us what you think is the most successful approach or strategy that your school is

using to improve the mental health of students.”

District Questionnaire, Question 17:

“If you have any comments you would like to make about this survey or about funding

mental health services, please use the space below.”

The following is a summary of the responses to these questions; the responses were

organized into categories with common themes.

School Questionnaire 

Approximately 800 respondents provided 1,100 examples of approaches or strategies

described as being “most successful” in improving the mental health of students at

their schools. These approaches were classified into 22 categories.

Respondents most frequently named approaches that fell into five distinct categories.

In order of frequency, these are summarized as follows:

1. The availability of in-school mental health services through guidance

counselors, mental health counselors, social workers, and psychologists

employed by the school or school district. Many respondents noted that the

ability to refer students to these professionals was critical to student mental

health and that the provision of services within the school had several

advantages in that it avoided the transportation, insurance payment

problems, and perceived stigma that counseling outside of school presented.

Many also noted that onsite mental health resources were severely strained

and inadequate in their schools.

School Mental Health Services in the United States, 2002–2003 
services, particularly for students with more intensive needs. Especially valued

were partnerships with agencies that provided services in the school, which

enhanced communication and collaboration and diminished transportation

problems.

4. The ability to refer students experiencing mental health problems to

interdisciplinary “student assistance” or “student service” teams. These

teams were described as composed of school principals, assistant principals,

resource specialists, psychologists, community outreach workers, social workers,

teachers, and school counselors. The multidisciplinary teams meet regularly and

provide referrals, intervention, monitoring, and support through a collaborative

process. With the input of parents, they develop strategies to improve specific

behaviors, and they seek additional resources and community services.

5. Counseling and support provided in individual or small group therapy

sessions, as well as support groups designed to assist with specific issues such as

social skills, self-esteem, and depression surrounding issues such as divorce or

bereavement.

Less commonly cited strategies (reported by between 20 and 70 respondents) were:

1. Parent involvement and communication, and provision of family support

2. Developing a nurturing school environment with caring and involved staff who

know their students well, develop trusting relationships, and promote respect for

all members of the school community

3. Good communication and collaboration among teachers, staff, administration,

and mental health staff

4. Early identification of problems and a proactive approach when problems are first

identified or suspected

5. Peer support and mediation

6. Teacher and staff training on mental health issues

7. Creating a high level of comfort in seeking mental health services

74 School Mental Health Services in the United States, 2002–2003 
8. Early intervention programs

9. Alternative settings for students needing intensive mental health assistance

10. Provision of mental health services in homes

It is worth noting that 41 respondents (approximately 5 percent) wrote that their scho

did not have any successful strategies. Comments from these respondents frequently

cited funding issues leading to understaffing and compounded by limited community

resources. Several respondents noted that counseling staff are overburdened, with

responsibility for as many as 1,000 students each, and that other duties prevented the

from providing anything other than the most cursory attention to mental health needs

These respondents also noted they perceived increasing mental health needs in the

student population—in the number of students, the severity and complexity of proble

presented, and in the limitations of family resources. 

District Questionnaire

Analysis of Responses by Districts to Question 17: “If you have any comments you

would like to make about this survey or about funding mental health services, please 

the space below.”

Approximately 330 districts responded to the final question on the survey, a request fo

comments about the survey or the funding of mental health services. Information on

mental health services was classified into six general categories.

Representatives from 103 districts used the opportunity provided by the open-ended

question primarily to clarify previous survey question responses and to furnish

additional information about the mental health services in their school districts, such 

the number and type of mental health professionals employed, the types of

collaborations they were engaged in, and their sources of funding. Nine of these distri

reported that the survey was not applicable to them because their district did not

provide any mental health services to students.

Approximately 100 comments were received related to concerns about lack of fundin

for mental health services, many indicating a problem of crisis proportions. Decrease

School Mental Health Services in the United States, 2002–2003 7
more testing responsibilities. Respondents also noted that with the push towards

measurable accountability (defined as test scores), programs that have no obvious link to

academic standards are frequently the ones to be cut when budgets are overwhelmed.

The second most common concern voiced in the responses was the inadequacy of

available mental health services both on site and in the community. Fifty districts

voiced concerns about the lack of treatment options in the community, particularly

facilities for students who need to be out of their home environment. One district

commented that there are only 18 inpatient beds available to all adolescents in their

entire State. Thirty districts complained that mental health services within their schools

were also inadequate. School counselors spend increasing amounts of energy on student

scheduling and special education eligibility issues and have limited time for counseling

students.

The third most common response, noted by 41 districts, was that mental health needs

are increasing dramatically, with many students presenting more serious mental health

issues and presenting them at an earlier age than previously seen. Several districts

reported that they increasingly find that mental health issues are interfering with the

daily operations and instruction for students and that the need for mental health services

was seen as increasing for both general and special education students. One respondent

said that the number of children seen as significant suicidal risks has doubled in the past

year in their district, that hurtful sexual behavior among younger children is up

dramatically, and that the number of acting out/aggressive/depressive students is on the

rise. 

The concern about increasing mental health needs is paired with an awareness that

families of students are struggling and under significant multiple pressures (noted

by 13 districts). The downturn in the economy has affected parents’ ability to pay outof-pocket expenses and unemployment has increased the number of uninsured. Many

linguistic minority immigrant students are not able to access services in the community

because of insurance and language barriers. This fact was also noted by several districts,

with counseling and interventions provided by the school often the only service available

to the student. Even the purchase and administration of essential medications was noted

to be problematic because of income limitations. One district noted that the high

number of mentally ill or developmentally disabled parents makes it difficult to get the

76 School Mental Health Services in the United States, 2002–2003 
School Mental Health Services in the United States, 2002–2003 7

School Mental Health Services Services Services in the United States, States, States, 2002–2003 2002–2003 2002–2003 7

School Mental Health Services in the United States, 2002–2003 
Table 1

Overall Response Rates Among Schools: 2002–2003

WITHOUT COUNTING CRITICAL ITEMS

Elementary Middle High Combined 

Size Responses

(#)

Sampled

(#)

Responding

(%)

Responses

(#)

Sampled

(#)

Responding

(%)

Responses

(#)

Sampled

(#)

Responding

(%)

Responses

(#)

Sampled

(#)

Respo

(%

Missing 3 3 100.00 2 2 100.00 2 3 66.67 5 17 

Small

(1–250

students)

75 147 53.19 21 34 61.76 22 48 46.81 10 28 

Medium

(251–500

students)

211 396 53.83 40 70 57.14 32 58 55.17 7 16 

Large

(500+

students)

290 531 54.61 157 285 55.09 239 455 52.53 12 32 

Total 579 1077 54.26 220 391 56.27 295 564 52.40 34 93 

COUNTING CRITICAL ITEMS

Elementary Middle High Combined 

Size Responses

(#)

Sampled

(#)

Responding

(%)

Responses

(#)

Sampled

(#)

Responding

(%)

Responses

(#)

Sampled

(#)

Responding

(%)

Responses

(#)

Sampled

(#)

Respon

(%

Missing 3 3 100.00 2 2 100.00 2 3 66.67 5 17 3

Small

(1–250

students)

86 147 60.99 21 34 61.76 24 48 51.06 10 28 4

Medium

(251–500

students)

239 396 60.97 46 70 65.71 32 58 55.17 9 16 5

Large

(500+

students)

335 531 63.09 170 285 59.65 276 455 60.66 14 32 4

Total 663 1077 62.14 239 391 61.13 334 564 59.33 38 93 4

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.
Table 2

Characteristics of Schools (Among Respondents and Nonrespondents): 2002–2003

Without Critical Items Data

No Response Response All

Number Percent Number Percent Number Percent

Region

Northeast 136 16.33 222 17.43 358 16.99

South 289 34.69 448 35.16 737 34.98

Midwest 203 24.37 328 25.75 531 25.20

West 205 24.61 276 21.66 481 22.83

Total 833 100.00 1274 100.00 2107 100.00

Level

Elementary 404 48.50 663 52.04 1067 50.64

Middle 152 18.25 239 18.76 391 18.56

Secondary 229 27.49 334 26.22 563 26.72

Combination 48 5.76 38 2.98 86 4.08

Total 833 100.00 1274 100.00 2107 100.00

Urbanicity

Urban 291 34.93 467 36.66 758 35.98

Suburban 97 11.64 150 11.77 247 11.72

Rural 206 24.73 324 25.43 530 25.15

Total 833 100.00 1274 100.00 2107 100.00

Size

1–500 315 37.82 467 36.66 782 37.12

501–1,000 273 32.77 447 35.09 720 34.17

1,001+ 234 28.09 348 27.32 582 27.62

Missing 11 1.32 12 0.94 23 1.09

Total 833 100.00 1274 100.00 2107 100.00

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.
Table 2A

Percentage Distribution of Students by Demographic Characteristics: 2002–2003

RESPONDENTS: COUNTING CRITICAL ITEMS

Number Percentage

Minority Enrollment

Low: 0–19% 593 46.55%

Medium: 20–39% 216 16.95%

High: 40%+ 465 36.50%

Free Lunch Enrollment

Low: 0–19% 308 24.18%

Medium: 20–39% 780 61.22%

High: 40%+ 186 14.60%

RESPONDENTS: WITHOUT COUNTING CRITICAL ITEMS

Number Percentage

Minority Enrollment

Low: 0–19% 542 48.05%

Medium: 20–-39% 197 17.46%

High: 40%+ 389 34.49%

Free Lunch Enrollment

Low: 0–19% 281 24.91%

Medium: 20–39% 681 60.37%

High: 40%+ 166 14.72%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.
Table 3

Number of Schools Providing Mental Health Services, the Type of Students Eligible, and the Percentage of Students

Who Received Services Last Year, by Selected School Characteristics: 2002–2003

Schools That

Provide Services

All Students May

Receive Services

(%)

Only Special

Education Students

May Receive

Services (%)

Did Not Indicate

Which Students

May Receive

Services (%)

Average Percentage

of Students Who

Received Services

Last Year

TOTAL 81,901 87.4% 9.9% 2.5% 19.76%

Region

Northeast 13,625 95.6% 3.6% 0.7% 24.14%

South 23,360 87.4% 10.1% 2.3% 16.98%

Midwest 27,392 84.1% 13.5% 2.2% 20.20%

West 17,523 86.3% 8.9% 4.6% 19.52%

Level

Elementary 47,213 88.8% 9.2% 1.8% 20.59%

Middle 14,636 87.0% 9.2% 3.7% 21.66%

High 13,768 82.0% 14.1% 3.7% 17.94%

Combined 6,284 89.7% 8.0% 2.1% 13.31%

Urbanicity

Urban 19,933 86.1% 11.0% 2.7% 22.60%

Suburban 27,677 86.4% 10.8% 2.6% 20.23%

Rural 34,290 89.1% 8.5% 2.3% 17.87%

Size

1–500 44,269 88.2% 8.8% 2.9% 19.14%

501–1,000 28,237 85.8% 11.9% 2.2% 19.76%

1,001+ 9,395 88.7% 9.2% 1.9% 23.11%

Minority Enrollment

Unknown 371 57.3% 18.1% 24.5% 16.92%

Low: 0–15% 33,682 90.9% 7.5% 1.4% 18.39%

Medium: 16–50% 22,004 87.3% 9.6% 2.9% 19.60%

High: 51%+ 25,844 83.4% 13.2% 3.3% 21.94%

Free Lunch Enrollment

Unknown 1,208 86.8% 5.5% 7.5% 14.82%

Low: 0–25% 26,114 89.5% 8.2% 2.2% 17.99%

Medium: 26–50% 23,805 85.7% 10.7% 3.5% 18.44%

High: 51%+ 30,774 87.1% 10.9% 1.8% 22.58%

IEP Enrollment

Unknown 16,343 87.1% 11.1% 1.6% 17.24%

Low: 0–9% 22,472 87.7% 9.6% 2.6% 16.95%

Medium: 10–14% 22,845 87.1% 9.0% 3.7% 22.88%

High: 15%+ 20,242 87.7% 10.3% 1.8% 20.17%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 5
Table 3A

Number and Percentage of Schools Providing or Not Providing Mental Health Services, 2002–2003

Number of Schools Providing MH Services Not Providing MH Services

Number Number Percent Number Percent

TOTAL 77,754 76,793 98.7% 961 1.2%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 5
Table 4

Percentage of Schools With and Without a District Operated Clinic by Selected School Characteristics: 2002–2003

With District

Operated MH

Clinic

(%)

Without District

Operated MH

Clinic

(%)

Missing

(%)

TOTAL 17.0% 81.4% 1.5%

Region

Northeast 13.2% 85.5% 1.1%

South 12.0% 86.4% 1.5%

Midwest 22.7% 75.3% 1.9%

West 18.0% 80.8% 1.0%

Level

Elementary 17.7% 80.5% 1.7%

Middle 20.9% 78.0% 0.9%

High 16.3% 81.5% 2.0%

Combined 4.7% 95.2% 0.0%

Urbanicity

Urban 24.9% 72.8% 2.1%

Suburban 14.3% 84.4% 1.1%

Rural 14.7% 83.8% 1.4%

Size

1–500 15.5% 82.4% 1.9%

501–1,000 18.4% 80.8% 0.7%

1,001+ 20.2% 77.9% 1.7%

Minority Enrollment

Unknown 24.5% 75.4% 0.0%

Low: 0–15% 10.7% 87.5% 1.7%

Medium: 16–50% 19.4% 79.0% 1.4%

High: 51%+ 23.2% 75.4% 1.2%

Free Lunch Enrollment

Unknown 22.7% 77.2% 0.0%

Low: 0–25% 12.6% 86.0% 1.2%

Medium: 26–50% 14.2% 82.7% 2.9%

High: 51%+ 22.8% 76.5% 0.6%

IEP Enrollment

Unknown 14.2% 83.8% 1.9%

Low: 0–9% 18.2% 80.4% 1.3%

Medium: 10–14% 17.4% 80.2% 2.2%

High: 15%+ 17.7% 81.8% 0.4%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 6
Table 4A

Of Schools With a District-Operated Mental Health Clinic, Location of Clinic: 2002–2003

District Operated Clinic in

School

District Operated Clinic

Outside of School

District Operated Clinic in

and Outside of School Missing

Number Percent Number Percent Number Percent Number Percent

TOTAL 2,818 20.1% 9,727 69.4% 284 2.0% 1,171 8.3%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 7
Table 5

Percentage of Schools With Various Management Arrangements for Mental Health Services by Selected School Characteristics: 2002–2003

Who Manages Mental Health Services in Your School?

One Person or

Team for All

Students

One Person or

Team for

General

Students

One Person or

Team for

Special Ed

One Person or

Team for SPED

and Ged Ed

All Other

Combinations

No One

Manages MH

Services Other Missing

TOTAL 54.5% 0.6% 5.7% 6.1% 8.4% 10.9% 0.9% 12.4%

Region

Northeast 66.6% 0.7% 3.3% 7.2% 7.2% 4.7% 1.0% 8.9%

South 52.0% 0.9% 6.4% 4.9% 7.4% 13.7% 0.4% 13.8%

Midwest 49.2% 0.3% 7.5% 7.5% 9.4% 11.9% 1.3% 12.4%

West 56.6% 0.5% 3.9% 4.7% 9.1% 10.3% 1.0% 13.5%

Level

Elementary 57.2% 0.8% 4.5% 6.2% 7.1% 9.4% 0.8% 13.5%

Middle 54.0% 0.0% 5.3% 5.1% 10.8% 12.3% 1.7% 10.5%

High 44.7% 0.4% 11.7% 5.7% 10.7% 10.7% 0.9% 14.8%

Combined 56.6% 0.8% 2.9% 8.8% 8.2% 18.6% 0.0% 3.7%

Urbanicity

Urban 48.5% 0.4% 6.1% 7.6% 9.4% 10.6% 0.7% 16.4%

Suburban 58.1% 0.8% 5.8% 5.6% 8.1% 9.1% 0.6% 11.5%

Rural 55.1% 0.5% 5.5% 5.7% 8.1% 12.5% 1.4% 10.9%

Size

1-500 55.5% 0.8% 5.1% 4.8% 8.2% 12.8% 0.8% 11.6%

501-1,000 54.6% 0.1% 6.4% 8.4% 8.1% 8.3% 1.0% 12.6%

1,001+ 49.5% 0.7% 6.4% 5.6% 10.6% 9.4% 1.5% 15.9%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 8
Table 6

Percentage of Schools by the Unit That Has Responsibility for Various Functions

by Type of Student Served: 2002–2003

GENERAL EDUCATION STUDENTS

Function

School

%

District

%

Intermediate or

Collaborative

Unit

%

Combination

%

N/A

%

Miss

%

Allocating Funds for MH Services 4.57% 50.1% 5.50% 8.89% 17.7% 

Establishing Policies/Guidelines/Standards 4.79% 49.6% 6.04% 12.2% 14.8% 

Determining Number and Types of MH Staff Needed in School 5.71% 50.9% 4.78% 9.41% 16.3% 

Hiring MH Staff 7.16% 43.1% 6.97% 12.0% 18.1% 

Supervising MH Staff 14.0% 32.1% 7.48% 15.1% 18.1% 

Planning Training/In-House Development of MH Staff 4.41% 42.0% 8.30% 12.7% 19.8% 

Monitoring Contracts/Agreements with Outside Organizations 5.84% 48.0% 5.38% 8.13% 20.0% 

SPECIAL EDUCATION STUDENTS

Function

School

%

District

%

Intermediate or

Collaborative

Unit

%

Combination

%

N/A

%

Miss

%

Allocating Funds for MH Services 3.19% 56.1% 8.10% 10.0% 10.0% 

Establishing Policies/Guidelines/Standards 2.94% 54.9% 8.84% 11.5% 9.64% 

Determining # and Types of MH Staff Needed in School 4.15% 54.2% 7.92% 9.73% 11.8% 

Hiring MH Staff 5.54% 47.5% 9.65% 11.8% 12.9% 

Supervising MH Staff 10.6% 36.8% 9.74% 15.9% 13.7% 

Planning Training/In-House Development of MH Staff 3.79% 45.9% 10.3% 13.0% 14.4% 

Monitoring Contracts/Agreements with Outside Organizations 4.12% 51.1% 8.81% 8.97% 14.4% 

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Items 9 and 10
Table 7

Percentage of Schools by the Unit That Provides Mental Health Staff,

by Selected School Characteristics: 2002–2003

Mental Health Staff Are:

School Based (%) District Based (%)

Intermediate or

Collaborative Unit

Based (%)

Community Based

(%) Combination (%) Missing (%)

TOTAL 13.2% 22.2% 3.8% 16.2% 39.8% 4.6%

Region

Northeast 20.5% 13.9% 0.6% 12.7% 47.7% 4.3%

South 12.4% 26.8% 5.7% 15.0% 34.5% 5.2%

Midwest 11.1% 23.2% 4.2% 18.5% 39.7% 2.9%

West 11.6% 20.9% 2.9% 16.9% 40.8% 6.6%

Level

Elementary 13.3% 24.2% 2.4% 13.8% 42.3% 3.6%

Middle 14.2% 22.4% 2.9% 15.2% 41.4% 3.6%

High 14.1% 16.0% 3.5% 20.0% 37.6% 8.4%

Combined 7.6% 20.2% 16.2% 28.1% 22.0% 5.6%

Urbanicity

Urban 15.8% 24.5% 1.5% 12.7% 41.5% 3.6%

Suburban 14.3% 22.7% 1.5% 12.3% 46.1% 2.8%

Rural 10.7% 20.4% 6.9% 21.4% 33.8% 6.5%

Size

1-500 11.9% 24.9% 4.6% 18.3% 34.9% 5.2%

501-1,000 14.4% 19.7% 2.5% 14.9% 44.3% 3.9%

1,001+ 15.6% 16.9% 3.7% 10.4% 49.7% 3.5%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 11
Table 7A

Provision of Mental Health Staff — Common Combinations by Selected School Characteristics: 2002–2003

District-Based School-Based

School and

District-Based

Collaborative/

Community-Based

Only Missing

TOTAL 31.7% 18.9% 22.6% 24.3% 2.4%

Region

Northeast 23.0% 28.8% 27.0% 18.5% 2.5%

South 35.4% 17.0% 19.1% 25.3% 3.1%

Midwest 33.2% 15.8% 23.2% 25.7% 1.9%

West 31.0% 18.6% 22.7% 25.2% 2.3%

Level

Elementary 33.5% 19.0% 25.8% 19.8% 1.7%

Middle 33.2% 18.7% 22.3% 23.5% 2.1%

High 25.3% 21.0% 19.3% 28.7% 5.4%

Combined 28.3% 14.0% 5.8% 49.8% 1.9%

Urbanicity

Urban 35.6% 22.5% 22.7% 17.6% 1.4%

Suburban 31.5% 19.0% 31.2% 16.2% 1.9%

Rural 29.5% 16.7% 15.5% 34.7% 3.4%

Size

1–500 34.9% 16.4% 17.5% 28.2% 2.7%

501–1,000 28.4% 21.2% 27.6% 20.6% 1.9%

1,001+ 26.1% 23.8% 31.0% 16.6% 2.2%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 11.
Table 7B

Types of Mental Health Staff By School Level And Staffing Arrangement Type: 2002–2003

Number of

Schools

Any School

Counselors

Any Mental

Health

Counselors

Any School

Social

Workers

Any School

Psychologists

Any Clinical

or PHD

Psychologists

Any

Substance

Abuse

Counselors

Any Scho

Nurses

TOTAL 81,901 77.4% 16.0% 44.3% 68.2% 8.9% 11.5% 68.

Level Staff Arrangement Type

District Based 15,823 64.3% 15.7% 53.1% 76.2% 9.4% 5.2% 67.

School Based 8,992 69.1% 18.0% 44.1% 68.1% 8.3% 13.7% 73.

School and District Based 12,211 81.5% 17.7% 49.8% 80.6% 11.4% 7.5% 71.

Collaborative/Community Only 9,375 61.8% 7.9% 38.7% 66.9% 3.3% 4.5% 57.

Elementary

Arrangement Data Missing 812 82.8% 0.0% 24.5% 47.0% 0.0% 0.0% 63.

District Based 4,865 95.5% 21.5% 41.0% 72.0% 7.1% 18.0% 79.

School Based 2,737 91.3% 27.9% 43.9% 54.5% 10.7% 25.4% 80.

School and District Based 3,269 87.8% 26.7% 59.0% 83.7% 12.8% 18.5% 76.

Collaborative/Community Only 3,452 80.8% 17.6% 27.4% 71.9% 6.6% 24.9% 71.

Middle

Arrangement Data Missing 313 28.0% 0.0% 20.4% 28.0% 0.0% 0.0% 61.

District Based 3,495 96.2% 21.8% 44.9% 63.8% 17.7% 23.6% 70.

School Based 2,901 79.6% 23.5% 57.0% 70.0% 17.6% 24.4% 74.

School and District Based 2,667 98.0% 18.4% 56.8% 74.2% 15.0% 15.4% 71.

Collaborative/Community Only 3,953 91.5% 4.8% 29.1% 36.6% 4.3% 12.5% 64.

High

Arrangement Data Missing 752 68.0% 0.0% 47.3% 44.1% 0.0% 30.2% 45.

District Based 1,779 74.1% 10.3% 31.0% 41.2% 6.1% 6.6% 49.

School Based 881 100.0% 16.3% 34.4% 50.4% 0.0% 0.0% 97.

School and District Based 370 85.7% 32.7% 14.2% 87.3% 0.0% 0.0% 20.

Collaborative/Community Only 3,131 84.2% 6.6% 22.8% 40.4% 7.3% 5.7% 60.

Combined

Arrangement Data Missing 124 100.0% 0.0% 0.0% 100.0% 0.0% 0.0% 61.

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Items 11 and 13
Table 8

Percentage of Schools by Frequency of Strategies to Coordinate Activities and Services:

Interdisciplinary Meetings Among Mental Health Staff, by Selected School Characteristics: 2002–2003

Rarely or Never Quarterly Monthly Weekly Missing

TOTAL 32.3% 8.5% 20.1% 23.0% 15.8%

Region

Northeast 22.5% 7.3% 23.2% 35.1% 11.6%

South 29.8% 8.6% 21.6% 20.9% 18.8%

Midwest 41.0% 10.3% 17.4% 16.5% 14.5%

West 29.8% 6.4% 19.9% 26.5% 17.1%

Level

Elementary 29.2% 6.5% 22.2% 24.8% 17.0%

Middle 32.5% 7.8% 18.7% 27.9% 12.8%

High 33.8% 14.4% 17.3% 17.6% 16.7%

Combined 52.6% 12.0% 13.3% 9.9% 11.9%

Urbanicity

Urban 27.0% 3.6% 22.8% 27.1% 19.2%

Suburban 24.0% 10.9% 20.1% 29.1% 15.7%

Rural 42.2% 9.4% 18.5% 15.7% 14.0%

Size

1–500 36.1% 10.1% 18.3% 19.6% 15.7%

501–1,000 28.3% 6.7% 22.4% 27.4% 14.9%

1,001+ 26.7% 6.4% 21.4% 25.8% 19.4%

Minority Enrollment

Unknown 5.2% 35.1% 59.5%

Low: 0–15% 35.5% 8.3% 20.2% 22.0% 13.8%

Medium: 16–50% 31.1% 10.1% 19.0% 25.7% 13.9%

High: 51%+ 29.7% 7.0% 21.2% 22.3% 19.5%

Free Lunch Enrollment

Unknown 26.8% 4.3% 7.8% 60.8%

Low: 0–25% 24.1% 7.6% 25.2% 30.6% 12.3%

Medium: 26–50% 37.2% 11.0% 17.6% 19.3% 14.6%

High: 51%+ 35.8% 7.5% 18.5% 20.1% 18.0%

IEP Enrollment

Unknown 17.7% 6.0% 10.3% 9.1% 56.7%

Low: 0–9% 35.5% 6.9% 25.5% 24.8% 7.1%

Medium: 10–14% 31.8% 10.3% 23.7% 29.4% 4.5%

High: 15%+ 41.3% 10.3% 17.9% 25.0% 5.3%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 12
Table 8A

Percentage of Schools by Frequency of Strategies to Coordinate Activities and Services: Joint Planning Sessions Between

Mental Health Staff and Regular Classroom Teachers, by Selected School Characteristics: 2002–2003

Rarely or Never Quarterly Monthly Weekly Missing

Total 38.1% 10.8% 16.1% 18.8% 15.9%

Region

Northeast 28.8% 12.4% 16.9% 28.4% 13.3%

South 32.6% 12.4% 16.4% 19.5% 18.8%

Midwest 45.1% 9.1% 14.9% 16.4% 14.1%

West 41.7% 10.1% 16.9% 14.2% 16.9%

Level

Elementary 33.0% 11.1% 17.9% 21.1% 16.7%

Middle 36.1% 6.9% 18.5% 25.3% 12.9%

High 49.7% 13.4% 10.8% 8.5% 17.3%

Combined 56.1% 12.2% 8.4% 9.1% 14.0%

Urbanicity

Urban 32.3% 10.4% 16.7% 22.6% 17.7%

Suburban 31.5% 12.5% 18.6% 22.2% 15.0%

Rural 46.8% 9.7% 13.7% 13.9% 15.6%

Size

1–500 38.8% 12.2% 14.3% 17.8% 16.6%

501–1,000 36.9% 9.3% 19.2% 21.0% 13.3%

1,001+ 38.5% 8.7% 15.2% 16.9% 20.4%

Minority Enrollment

Unknown 26.3% 14.1% 59.5%

Low: 0–15% 38.4% 11.6% 15.2% 20.2% 14.4%

Medium: 16–50% 40.5% 8.4% 18.0% 17.1% 15.8%

High: 51%+ 35.8% 12.1% 15.9% 18.6% 17.4%

Free Lunch Enrollment

Unknown 21.5% 4.7% 12.8% 60.8%

Low: 0–25% 31.4% 11.0% 21.5% 22.8% 13.0%

Medium: 26–50% 45.5% 10.6% 13.4% 16.6% 13.7%

High: 51%+ 38.7% 11.3% 14.0% 17.4% 18.4%

IEP Enrollment

Unknown 21.0% 5.6% 6.9% 8.3% 57.9%

Low: 0–9% 41.1% 13.1% 19.7% 19.5% 6.4%

Medium: 10–14% 40.7% 9.1% 19.4% 25.4% 5.1%

High: 15%+ 45.7% 14.4% 15.8% 19.1% 4.8%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration. U.S. Department of Health and Human Services.

School Questionnaire, Item 12
Table 8B

Percentage of Schools by Frequency of Strategies to Coordinate Activities and Services: Joint Planning Sessions

Between Mental Health Staff and Special Education Teachers, by Selected School Characteristics: 2002–2003

Rarely or Never Quarterly Monthly Weekly Missing

TOTAL 30.5% 12.3% 18.1% 22.8% 16.1%

Region

Northeast 23.8% 12.0% 22.6% 28.7% 12.7%

South 25.5% 11.5% 19.4% 23.6% 19.7%

Midwest 38.7% 13.3% 14.9% 18.3% 14.6%

West 29.4% 11.8% 17.8% 24.3% 16.5%

Level

Elementary 27.8% 11.8% 18.6% 25.1% 16.5%

Middle 30.1% 9.9% 17.1% 28.4% 14.2%

High 32.7% 15.0% 17.3% 15.5% 19.2%

Combined 46.3% 15.1% 18.3% 8.6% 11.4%

Urbanicity

Urban 23.7% 11.8% 18.9% 27.3% 18.2%

Suburban 25.8% 12.2% 18.7% 28.2% 14.9%

Rural 38.2% 12.5% 17.2% 15.9% 15.9%

Size

1–500 32.6% 12.5% 17.4% 20.7% 16.5%

501–1,000 29.3% 11.8% 17.5% 26.8% 14.3%

1,001+ 23.8% 12.5% 22.9% 20.4% 20.1%

Minority Enrollment

Unknown 26.3% 14.1% 59.5%

Low: 0–15% 31.6% 12.3% 17.3% 23.2% 15.3%

Medium: 16–50% 33.7% 12.5% 15.6% 23.1% 14.9%

High: 51%+ 26.7% 12.2% 21.1% 22.1% 17.6%

Free Lunch Enrollment

Unknown 19.8% 3.1% 6.3% 9.7% 60.8%

Low: 0–25% 23.3% 10.1% 23.5% 29.4% 13.5%

Medium: 26–50% 38.5% 13.8% 13.2% 20.0% 14.4%

High: 51%+ 30.8% 13.2% 17.8% 19.9% 18.0%

IEP Enrollment

Unknown 17.0% 7.6% 7.7% 9.5% 57.9%

Low: 0–9% 32.9% 13.3% 22.0% 24.4% 7.2%

Medium: 10–14% 31.2% 12.5% 22.8% 28.0% 5.3%

High: 15%+ 37.9% 14.6% 16.8% 25.9% 4.6%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 12
Table 8C

Percentage of Schools by Frequency of Strategies to Coordinate Activities and Services: Professional Development on Mental

Health Topics for Regular School Staff, by Selected School Characteristic: 2002–2003

Rarely or Never Quarterly Monthly Weekly Missing

TOTAL 55.6% 22.3% 4.8% 1.0% 16.0%

Region

Northeast 49.9% 30.5% 6.3% 1.1% 11.9%

South 54.2% 19.6% 4.8% 1.3% 19.8%

Midwest 56.5% 23.8% 3.9% 8% 14.7%

West 60.7% 17.0% 4.9% 8% 16.4%

Level

Elementary 55.3% 21.8% 5.1% 1.2% 16.3%

Middle 52.3% 27.6% 5.4% 1.1% 13.3%

High 54.2% 22.1% 3.8% 7% 19.0%

Combined 68.6% 14.1% 2.9% 14.3%

Urbanicity

Urban 50.5% 24.3% 5.4% 1.1% 18.5%

Suburban 51.1% 25.2% 6.5% 1.6% 15.5%

Rural 62.3% 18.8% 3.0% 5% 15.1%

Size

1–500 57.6% 21.0% 3.7% 7% 16.7%

501–1,000 54.6% 23.5% 6.1% 1.7% 13.9%

1,001+ 49.7% 24.5% 5.7% 4% 19.4%

Minority Enrollment

Unknown 40.4% 59.5%

Low: 0–15% 58.9% 20.0% 5.3% 1.2% 14.3%

Medium: 16–50% 58.1% 22.6% 3.7% 1.2% 14.2%

High: 51%+ 49.5% 25.3% 5.0% 6% 19.3%

Free Lunch Enrollment

Unknown 31.2% 7.8% 60.8%

Low: 0–25% 55.0% 24.6% 5.7% 1.8% 12.6%

Medium - 26-50% 62.5% 19.3% 3.8% 3% 13.8%

High - 51%+ 51.8% 23.2% 4.9% 1.0% 18.9%

IEP Enrollment

Unknown 28.5% 11.2% 1.5% 58.7%

Low: 0–9% 59.2% 26.7% 5.1% 1.5% 7.3%

Medium: 1–14% 62.5% 25.7% 5.9% 9% 4.7%

High: 15%+ 65.8% 22.5% 5.9% 1.4% 4.1%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 12
Table 8D

Percentage of Schools by Frequency of Strategies to Coordinate Activities and Services: Sharing of Mental Health Resources

among School Staff, by Selected School Characteristic: 2002–2003

Rarely or Never Quarterly Monthly Weekly Missing

TOTAL 37.2% 22.9% 15.3% 8.9% 15.5%

Region

Northeast 29.0% 32.2% 16.1% 10.6% 11.9%

South 34.0% 23.9% 14.5% 9.0% 18.2%

Midwest 41.6% 19.6% 17.0% 7.2% 14.4%

West 41.1% 19.3% 12.9% 10.3% 16.2%

Level

Elementary 34.9% 21.6% 16.4% 10.6% 16.2%

Middle 39.6% 20.9% 18.2% 9.0% 12.1%

High 34.7% 27.9% 13.7% 5.3% 18.2%

Combined 54.9% 25.9% 3.6% 4.0% 11.4%

Urbanicity

Urban 34.8% 21.7% 16.1% 9.7% 17.5%

Suburban 28.9% 26.5% 17.8% 11.3% 15.2%

Rural 45.4% 20.6% 12.7% 6.5% 14.5%

Size

1–500 39.0% 23.7% 13.5% 8.2% 15.4%

501–1,000 36.0% 21.4% 18.3% 9.4% 14.6%

1,001+ 32.5% 23.7% 14.4% 10.9% 18.3%

Minority Enrollment

Unknown 5.2% 35.1% 59.5%

Low: 0–15% 39.8% 23.7% 13.9% 9.3% 13.1%

Medium: 16–50% 35.5% 24.6% 15.3% 9.6% 14.8%

High: 51%+ 35.8% 20.3% 17.2% 8.0% 18.5%

Free Lunch Enrollment

Unknown 24.9% 9.0% 1.9% 3.1% 60.8%

Low: 0–25% 34.1% 25.9% 16.4% 11.9% 11.4%

Medium: 26–50% 41.5% 20.9% 13.4% 9.6% 14.3%

High: 51%+ 37.0% 22.4% 16.3% 6.1% 18.0%

IEP Enrollment

Unknown 18.2% 15.8% 4.9% 3.3% 57.6%

Low: 0–9% 41.3% 25.1% 15.9% 11.1% 6.3%

Medium: 10–14% 42.5% 24.5% 17.9% 10.8% 4.1%

High: 15%+ 42.1% 24.3% 19.9% 8.9% 4.5%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 12
Table 8E

Percentage of Schools by Frequency of Strategies to Coordinate Activities and Services:

Informal Communication Among School Staff About Mental Health Issues/Services, by Selected School Characteristics:

2002–2003

Rarely or Never Quarterly Monthly Weekly Missing

TOTAL 26.9% 11.0% 12.3% 34.5% 15.1%

Region

Northeast 19.8% 12.3% 10.6% 45.1% 11.9%

South 25.4% 11.6% 11.4% 33.5% 17.9%

Midwest 31.4% 10.9% 14.7% 29.0% 13.7%

West 27.3% 9.4% 10.9% 36.1% 16.1%

Level

Elementary 24.3% 10.1% 10.5% 38.9% 15.9%

Middle 28.6% 8.5% 18.4% 31.5% 12.8%

High 28.9% 13.8% 11.8% 28.9% 16.3%

Combined 37.7% 17.6% 12.5% 20.6% 11.4%

Urbanicity

Urban 25.2% 7.1% 12.9% 37.5% 17.1%

Suburban 22.0% 12.5% 11.2% 39.6% 14.5%

Rural 31.8% 12.1% 12.8% 28.6% 14.4%

Size

1–500 28.3% 12.9% 10.6% 32.9% 15.1%

501–1,000 26.7% 8.4% 14.3% 36.4% 14.0%

1,001+ 21.0% 9.9% 14.2% 36.5% 18.2%

Minority Enrollment

Unknown 29.8% 35.1% 34.9%

Low: 0–15% 27.9% 12.3% 11.6% 34.9% 13.0%

Medium: 16–50% 24.9% 13.1% 11.5% 35.2% 15.0%

High: 51%+ 27.1% 7.8% 13.9% 33.3% 17.6%

Free Lunch Enrollment

Unknown 27.0% 19.5% 53.3%

Low: 0–25% 21.9% 9.8% 12.7% 43.8% 11.6%

Medium: 26–50% 30.5% 14.4% 9.5% 31.6% 13.7%

High: 51%+ 28.3% 9.8% 14.5% 29.5% 17.6%

IEP Enrollment

Unknown 14.1% 6.8% 5.5% 16.3% 57.0%

Low: 0–9% 30.8% 11.8% 11.3% 39.9% 6.0%

Medium: 10–14% 30.4% 11.9% 13.7% 40.1% 3.7%

High: 15%+ 29.0% 12.6% 17.1% 36.8% 4.2%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 12
Table 9

Number and Percentage of Schools With Various Types of Mental Health Staff, by Type of Staff: 2002–2003

Schools

School

Counselors

Mental Health

Counselors

School

Social

Workers

School

Psychologists

Clinical/PHD

Psycholigists

Substance

Abuse

Counselors

School

Nurses Psy

Number of Schools With at Least 1 Staff 63,421 13,118 36,322 55,916 7,295 9,422 56,373 1,927 

Percentage of Schools With at Least 1 Staff 77.44% 16.02% 44.35% 68.27% 8.91% 11.50% 68.83% 2.35% 

Number of Schools With No Staff 17,465 66,028 42,672 22,120 63,470 61,787 13,972 69,650 

Percentage of Schools With No Staff 21.32% 80.62% 52.10% 27.01% 77.50% 75.44% 17.06% 85.04% 

Number of Schools Missing Data 1,014 2,755 2,908 3,866 11,136 10,691 11,556 10,324 

Percentage of Schools Missing Data 1.24% 3.36% 3.55% 4.72% 13.60% 13.05% 14.11% 12.61% 

Total Schools 81,901 81,901 81,901 81,901 81,901 81,901 81,901 81,901 

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 13
Table 9-1

Percentage of Schools With Mental Health Staff by Type of School Staff Elementary Schools: 2002–2003

Schools

School

Counselors

Mental Health

Counselors

School Social

Workers

School

Psychologists

Clinical / PHD

Counselors

Substance

Abuse

Counselors School Nurses Psychiatrists

Percentage of Schools With at Least One Staff 69.5% 14.9% 47.2% 73.5% 8.4% 7.2% 67.6% 2.5% 

Percentage of Schools With Just One Staff 58.3% 12.9% 43.4% 67.6% 7.9% 6.8% 63.3% 2.5% 

Percentage of Schools With No Staff 29.5% 82.4% 49.6% 22.2% 76.5% 78.8% 16.5% 83.1% 

Percentage of Schools Missing Data 0.9% 2.7% 3.2% 4.3% 15.1% 14.0% 15.9% 14.4% 

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 13
Table 9-2

Percentage of Schools With Mental Health Staff by Type of School Staff Middle Schools: 2002–2003

Schools

School

Counselors

Mental

Health

Counselors

School Social

Workers

School

Psychologists

Clinical/

PHD

Counselors

Substance

Abuse

Counselors

School

Nurses Psychiatrists

Other 

St

Percentage of Schools With At Least One Staff 88.1% 22.5% 42.0% 70.4% 8.8% 20.8% 76.8% 3.7% 24.0% 

Percentage of Schools With Just One Staff 37.4% 15.0% 36.9% 66.4% 8.4% 19.5% 69.4% 3.7% 13.9% 

Percentage of Schools With No Staff 10.8% 74.1% 56.1% 26.7% 78.7% 67.6% 12.3% 86.9% 65.6% 

Percentage of Schools Missing Data 1.1% 3.4% 1.9% 2.9% 12.5% 11.7% 10.9% 9.4% 10.4% 

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 13
Table 9-3

Percentage of Schools With Mental Health Staff by Type of School Staff High Schools: 2002–2003

Schools

School

Counselors

Mental

Health

Counselors

School Social

Workers

School

Psychologists

Clinical /

PHD

Counselors

Substance

Abuse

Counselors

School

Nurses Psychiatrists

Other S

Sta

Percentage of Schools With At Least One Staff 90.2% 15.5% 45.4% 58.3% 12.4% 19.4% 68.5% 1.4% 26.2% 

Percentage of Schools With Just One Staff 27.1% 11.0% 36.6% 48.3% 11.2% 17.3% 59.4% 1.4% 15.1% 

Percentage of Schools With No Staff 7.4% 78.8% 47.1% 33.7% 74.3% 66.8% 17.0% 84.7% 58.5% 

Percentage of Schools Missing Data 2.4% 5.7% 7.5% 8.0% 13.4% 13.8% 14.5% 13.9% 15.3% 

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 13
Table 9A

Average Number of Mental Health Staff per 500 Students, by Type of School Staff and Selected School Characteristics: 2002–2003

School

Counselors

Mental Health

Counselors

School Social

Workers

School

Psychologists

Clinical/PHD

Counselors

Substance

Abuse

Counselors School Nurses Psychiatrists

Other S

Sta

TOTAL 1.4595 0.2266 0.6533 1.0390 0.1285 0.1389 1.2120 0.0351 

Region

Northeast 1.3604 0.1894 0.7989 1.1887 0.1463 0.2599 1.5583 0.0322 

South 1.7711 0.2022 1.1572 1.4742 0.0650 0.1099 1.4400 0.0352 

Midwest 1.5032 0.2659 0.4070 0.7257 0.1177 0.1005 1.1316 0.0326 

West 1.0574 0.2260 0.2471 0.8145 0.2151 0.1422 0.7621 0.0411 

Level

Elementary 1.2416 0.2353 0.6996 1.2025 0.1584 0.1134 1.2463 0.0487 

Middle 1.4673 0.2935 0.4573 0.7372 0.0819 0.2374 1.0756 0.0345 

High 1.9790 0.1389 0.8837 0.8880 0.1060 0.1539 1.3148 0.0073 

Combined 1.9785 0.1928 0.2910 0.8397 0.0711 0.0694 1.0696 0.0000 

Urbanicity

Urban 1.0171 0.2105 0.6714 0.8229 0.1182 0.1123 0.8018 0.0191 

Suburban 1.2456 0.1780 0.6139 1.0262 0.0892 0.1345 0.9913 0.0249 

Rural 1.8887 0.2749 0.6742 1.1731 0.1642 0.1565 1.6084 0.0517 

Size

1–500 1.8364 0.2695 0.8767 1.4248 0.1559 0.1655 1.6787 0.0500 

501–1,000 0.9459 0.1947 0.4256 0.6658 0.1064 0.1021 0.7384 0.0184 

1,001+ 1.2348 0.1181 0.2967 0.3730 0.0628 0.1227 0.4295 0.0146 

Minority Enrollment

Unknown 1.1479 0.1398 0.4908 0.6510 0.0000 0.3283 0.9817 0.0000 

Low: 0–15% 1.7294 0.2059 0.6921 1.2324 0.1275 0.1590 1.5082 0.0288 

Medium: 16–50% 1.4074 0.2154 0.6242 0.9202 0.1240 0.1364 0.9340 0.0471 

High: 51%+ 1.1552 0.2650 0.6291 0.8912 0.1356 0.1107 1.0463 0.0336 
School

Counselors

Mental Health

Counselors

School Social

Workers

School

Psychologists

Clinical/PHD

Counselors

Substance

Abuse

Counselors School Nurses Psychiatrists

Other S

Sta

Free Lunch Enrollment

Unknown 2.2269 0.0755 0.9369 1.5144 0.2345 0.1410 1.3580 0.0000 

Low: 0–25% 1.3285 0.1846 0.7103 1.2108 0.1293 0.1649 1.1017 0.0400 

Medium: 26–50% 1.4316 0.2000 0.5632 0.9124 0.1056 0.1559 1.1214 0.0197 

High: 51%+ 1.5630 0.2898 0.6626 0.9743 0.1431 0.1021 1.3789 0.0440 

IEP Enrollment

Unknown 1.7798 0.2840 0.5659 1.1361 0.0747 0.1094 1.1927 0.0607 

Low: 0–9% 1.3548 0.1948 0.6137 1.0751 0.0918 0.1095 1.1233 0.0164 

Medium: 10–14% 1.2949 0.2347 0.5122 0.8795 0.1445 0.1452 1.0647 0.0150 

High: 15%+ 1.5051 0.2049 0.9343 1.1026 0.1712 0.1764 1.4894 0.0683 

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 13
Table 9B

Total Number of Mental Health Staff, by Type of Staff and Selected School Characteristics: 2002–2003

School

Counselors

Mental Health

Counselors

School Social

Workers

School

Psychologists

Clinical or

PHD

Psychologists

Substance

Abuse

Counselors School Nurses Psychiatrists

Other S

Sta

TOTAL 110,967 17,372 41,423 63,169 7,832 10,353 63,661 1,927 

Region

Northeast 21,794 2,824 9,721 13,578 1,866 3,225 14,271 480 

South 28,226 3,263 15,977 18,116 1,355 2,035 16,627 375 

Midwest 40,743 6,889 11,600 18,096 2,623 3,222 22,086 780 

West 20,204 4,396 4,126 13,378 1,988 1,871 10,676 292 

Level

Elementary 40,743 8,809 24,468 39,132 4,195 3,797 35,031 1,192 

Middle 23,764 4,651 7,161 11,075 1,415 3,255 12,585 539 

High 36,697 3,173 8,010 9,647 1,882 3,005 11,124 196 

Combined 9,762 740 1,784 3,315 340 296 4,921 0 

Urbanicity

Urban 27,210 5,363 12,729 16,002 2,045 2,545 14,318 384 

Suburban 41,806 5,251 14,933 25,339 2,871 3,983 23,902 650 

Rural 41,950 6,758 13,761 21,829 2,916 3,824 25,440 892 

Size

1–500 40,189 7,015 18,458 29,971 2,993 4,139 30,437 984 

501–1,000 36,474 7,372 15,500 23,752 3,518 3,489 23,813 649 

1,001+ 34,304 2,986 7,466 9,446 1,321 2,725 9,411 294 

Minority Enrollment

Unknown 538 76 214 201 0 91 300 0 

Low: 0–15% 43,854 5,277 14,912 24,550 2,453 3,905 27,858 677 

Medium: 16–50% 33,710 4,895 11,197 17,482 2,716 3,316 16,433 799 

High: 51%+ 32,864 7,125 15,100 20,936 2,663 3,042 19,070 451 
School

Counselors

Mental Health

Counselors

School Social

Workers

School

Psychologists

Clinical or

PHD

Psychologists

Substance

Abuse

Counselors School Nurses Psychiatrists

Other S

Sta

Free Lunch Enrollment

Unknown 1,908 178 715 904 38 91 755 0 

Low: 0–25% 41,263 5,076 13,876 23,332 3,002 3,897 21,343 852 

Medium: 26–50% 31,235 4,426 10,727 17,157 1,759 3,322 17,470 384 

High: 51%+ 36,562 7,693 16,106 21,776 3,033 3,043 24,092 691 

IEP Enrollment

Unknown 22,463 4,136 8,267 11,928 665 1,000 6,618 203 

Low: 0–9% 29,638 4,515 10,689 18,744 2,122 2,752 18,862 479 

Medium: 10–14% 31,834 4,960 11,214 18,055 2,790 3,301 21,109 433 

High: 15%+ 27,031 3,761 11,253 14,442 2,255 3,300 17,072 811 

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 13
Table 9C

Types of Mental Health Staff When Only One Staff Person by Selected School Characteristics: 2002–2003

# of Schools

with 1 Staff

Person

School

Counselors

Mental Health

Counselors

School Social

Workers

School

Psychologists

Clinical or

PHD

Psychologists

Substance

Abuse

Counselors School Nurses Psychiatrists

TOTAL 7,328 50.3% 2.6% 17.7% 19.7% 1.4% 1.7% 6.4% 0.0

Region

Northeast 322 0.0% 0.0% 35.5% 0.0% 0.0% 0.0% 64.4% 0.0

South 1,762 37.1% 6.3% 40.6% 10.4% 0.0% 0.0% 5.3% 0.0

Midwest 2,299 80.3% 3.4% 6.7% 0.0% 4.5% 0.0% 4.8% 0.0

West 2,945 40.2% 0.0% 10.5% 42.7% 0.0% 4.2% 2.1% 0.0

Level

Elementary 4,409 43.0% 1.8% 20.4% 28.6% 2.3% 0.0% 3.7% 0.0

Middle 729 44.0% 0.0% 16.0% 4.2% 0.0% 17.1% 18.4% 0.0

High 1,210 71.7% 0.0% 7.8% 12.5% 0.0% 0.0% 7.7% 0.0

Combined 980 61.4% 11.3% 18.8% 0.0% 0.0% 0.0% 8.2% 0.0

Urbanicity

Urban 1,230 32.6% 0.0% 47.2% 20.0% 0.0% 0.0% 0.0% 0.0

Suburban 2,038 26.5% 3.9% 15.2% 49.6% 0.0% 0.0% 4.5% 0.0

Rural 4,060 67.6% 2.7% 10.0% 4.5% 2.5% 3.0% 9.4% 0.0

Size

1–500 5,712 56.6% 3.3% 16.1% 13.0% 1.8% 2.1% 6.6% 0.0

501–1,000 1,331 33.7% 0.0% 15.0% 46.4% 0.0% 0.0% 4.7% 0.0

1,001+ 285 0.0% 0.0% 60.3% 28.9% 0.0% 0.0% 10.7% 0.0

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 13
Table 9D (Exhibit 3.3)

Selected Combinations of Types of Mental Health Staff by Selected School Characteristics: 2002–2003

Other Staffing includes Other Combinations, Single Staff Types, and Missing Staff Information

Number of

Schools

School

Counselors,

Psychologists,

and Nurses

School

Counselors,

Psychologists,

Nurses and

Social

Workers

School

Counselors

and Nurses

School

Psychologists,

Nurses and

Social

Workers

School

Counselors

and

Psychologists

School

Counselors,

Psychologists

and Social

Workers

No Mental

Health Staff Other Staffing

TOTAL 81,901 13.4% 11.2% 9.4% 4.8% 4.7% 4.2% 4.0% 47.8%

Region

Northeast 13,625 13.3% 11.2% 2.1% 9.8% 4.4% 2.5% 3.6% 52.7%

South 23,360 13.0% 12.1% 7.4% 8.8% 2.7% 9.4% 3.4% 42.8%

Midwest 27,392 12.3% 14.9% 18.6% 0.8% 3.7% 2.4% 3.2% 43.6%

West 17,523 15.6% 4.3% 3.2% 1.8% 9.3% 1.5% 6.6% 57.3%

Level

Elementary 47,213 15.5% 10.1% 6.3% 7.6% 4.3% 5.0% 4.0% 46.7%

Middle 14,636 14.2% 14.0% 9.7% 1.2% 4.9% 1.7% 3.3% 50.5%

High 13,768 6.2% 13.4% 14.3% 1.0% 3.3% 4.5% 4.6% 52.3%

Combined 6,284 11.2% 8.0% 21.2% 0.0% 10.5% 3.6% 4.8% 40.4%

Urbanicity

Urban 19,933 9.0% 14.0% 6.6% 7.1% 5.2% 3.4% 5.2% 49.2%

Suburban 27,677 17.2% 11.0% 7.0% 6.7% 4.7% 5.6% 3.4% 43.9%

Rural 34,290 12.9% 9.7% 13.0% 1.9% 4.5% 3.6% 3.9% 50.2%

Size

1–500 44,269 12.6% 8.9% 12.7% 4.7% 4.6% 4.2% 5.4% 46.5%

501–1,000 28,237 15.6% 11.8% 5.9% 6.5% 4.4% 4.1% 2.7% 48.6%

1,001+ 9,395 10.7% 20.2% 4.1% 0.0% 6.3% 4.9% 1.8% 51.7%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services,

School Questionnaire, Item 13
Table 9E—Weighted

Number and Percentage of Schools Reporting the Number of Staff

Providing Mental Health Services By Selected School Characteristics: 2002–2003

Number of Schools

0 Staff

Persons

1 Staff

Person

2 Staff

Persons

3 Staff

Persons

4 Staff

Persons

5 Staff

Persons

6 Staff

Persons

7 Staff

Persons

8 Staff

Persons

9 Staff

Persons

Number % % % % % % % % % % % 

TOTAL 81,901 100.0% 3.3% 7.9% 15.3% 19.7% 16.1% 10.8% 8.1% 5.8% 3.7% 2.4% 

Region

Northeast 13,625 16.6% 2.6% 1.6% 11.3% 17.4% 12.9% 14.6% 10.1% 7.4% 4.0% 3.3% 

South 23,360 28.5% 2.2% 7.3% 15.5% 23.8% 21.0% 7.9% 7.3% 4.0% 2.6% 2.5% 

Midwest 27,392 33.4% 2.7% 7.8% 16.6% 18.2% 13.3% 12.4% 9.9% 6.4% 4.3% 2.5% 

West 17,523 21.3% 6.2% 13.9% 16.0% 18.5% 16.3% 9.1% 4.7% 6.0% 3.9% 1.4% 

Level

Elementary 47,213 57.6% 3.6% 8.1% 16.7% 23.7% 19.4% 10.7% 6.0% 5.2% 1.8% 1.1% 

Middle 14,636 17.8% 2.5% 4.4% 10.0% 16.1% 14.9% 14.7% 15.4% 5.0% 5.5% 4.3% 

High 13,768 16.8% 2.3% 7.6% 7.8% 14.4% 7.7% 9.2% 9.7% 9.6% 8.5% 4.8% 

Combined 6,284 7.6% 4.8% 15.5% 32.7% 10.0% 12.4% 6.0% 3.2% 3.6% 3.0% 2.5% 

Urbanicity

Urban 19,933 24.3% 4.2% 5.6% 12.8% 17.6% 18.0% 12.1% 9.0% 5.2% 4.8% 3.0% 

Suburban 27,677 33.7% 2.7% 5.6% 12.5% 21.5% 14.0% 12.9% 7.8% 6.0% 4.3% 3.2% 

Rural 34,290 41.8% 3.2% 11.1% 18.9% 19.5% 16.6% 8.4% 7.9% 6.0% 2.6% 1.4% 

Size

1–500 44,269 54.0% 4.8% 11.4% 21.6% 22.0% 17.5% 7.6% 5.3% 4.0% 1.6% 0.9% 

501–1,000 28,237 34.4% 1.9% 4.0% 9.7% 21.2% 17.3% 15.4% 10.4% 7.6% 4.5% 2.9% 

1,001+ 9,395 11.4% 0.5% 3.3% 1.9% 4.6% 5.7% 11.7% 14.5% 8.9% 11.2% 8.0% 

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 14
Table 10

Percentage of Mental Health Staff with Masters Degrees in Their Field by Type of Staff and Selected School Characteristics: 2002–2003

School

Counselors

Mental Health

Counselors

School Social

Workers

School

Psychologists

Clinical/PHD

Counselors

Substance

Abuse

Counselors School Nurses Psychiatrists *

Other School

Staff

TOTAL 93.26% 83.73% 87.25% 97.56% 89.90% 68.97% 53.97% 93.79% 39.49%

Region

Northeast 97.77% 83.27% 99.34% 97.90% 93.39% 76.81% 58.81% 100.00% 42.05%

South 93.01% 74.56% 86.17% 98.06% 87.88% 82.02% 52.02% 100.00% 34.28%

Midwest 94.65% 92.12% 80.95% 97.40% 92.39% 71.85% 45.04% 86.70% 42.45%

West 86.68% 76.43% 79.15% 96.78% 84.70% 33.26% 68.54% 100.00% 39.26%

Level

Elementary 92.95% 84.91% 86.99% 98.74% 87.92% 73.53% 57.98% 100.00% 36.01%

Middle 95.00% 72.84% 85.83% 94.47% 85.06% 52.88% 48.99% 77.57% 43.41%

High 94.57% 91.59% 90.48% 95.75% 95.94% 77.56% 51.99% 100.00% 51.97%

Combined 88.16% 100.00% 85.22% 100.00% 100.00% 100.00% 41.15% 14.18%

Urbanicity

Urban 94.49% 78.52% 89.44% 98.04% 82.73% 73.47% 62.28% 87.67% 35.99%

Suburban 94.77% 82.49% 89.94% 98.97% 91.10% 76.27% 61.02% 100.00% 43.17%

Rural 91.60% 88.06% 82.00% 95.60% 94.27% 58.63% 42.75% 91.75% 38.36%

Size

1–500 92.87% 87.89% 88.39% 96.96% 93.54% 66.64% 51.03% 100.00% 39.97%

501–1,000 93.50% 77.62% 83.93% 98.17% 86.37% 62.58% 55.51% 88.47% 32.15%

1,001+ 94.20% 90.98% 92.01% 97.81% 90.85% 80.50% 60.49% 86.65% 55.69%

*Psychiatrists have an M.D.

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 14
Table 10A

Percentage of Mental Health Staff Licensed in Their Field by Type of Staff

and Selected School Characteristics: 2002–2003

School

Counselors

Mental Health

Counselors

School Social

Workers

School

Psychologists

Clinical/PHD

Counselors

Substance

Abuse

Counselors School Nurses Psychiatrists

Other School

Staff

TOTAL 87.26% 83.23% 86.98% 91.62% 80.05% 79.55% 88.40% 78.06% 43.77%

Region

Northeast 95.73% 80.02% 93.74% 97.01% 86.72% 93.78% 93.89% 100.00% 40.70%

South 89.44% 90.24% 88.43% 89.35% 64.85% 82.31% 88.38% 50.55% 43.54%

Midwest 83.11% 92.07% 80.02% 93.00% 91.23% 74.32% 82.58% 77.13% 46.09%

West 86.11% 64.20% 84.50% 87.94% 69.39% 64.55% 93.92% 42.48%

Level

Elementary 89.50% 89.32% 89.64% 92.22% 76.44% 79.03% 92.84% 75.17% 39.92%

Middle 87.12% 68.21% 83.83% 92.27% 74.67% 74.83% 84.41% 79.16% 54.17%

High 85.47% 90.70% 83.14% 89.89% 94.42% 83.47% 86.44% 100.00% 45.27%

Combined 78.94% 61.69% 79.55% 87.48% 55.26% 100.00% 68.25% 45.68%

Urbanicity

Urban 91.84% 83.52% 88.44% 94.56% 78.30% 80.07% 88.59% 68.66% 37.89%

Suburban 89.15% 81.92% 88.04% 94.65% 83.05% 82.13% 92.98% 100.00% 40.98%

Rural 83.53% 83.94% 84.59% 85.92% 78.14% 76.89% 84.47% 63.75% 50.26%

Size

1–500 86.98% 84.77% 87.54% 88.23% 73.04% 81.43% 84.66% 62.83% 43.18%

501–1,000 87.37% 80.48% 86.39% 94.75% 83.33% 77.42% 90.85% 100.00% 41.98%

1,001+ 87.92% 87.16% 86.69% 92.90% 88.38% 79.94% 94.83% 83.84% 49.54%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 14
Table 10B

Average Percentage of Time Spent Providing MH Services to Students,

by Type of Staff and Selected School Characteristics: 2002–2003

School

Counselors

Mental Health

Counselors

School Social

Workers

School

Psychologists

Clinical or

PHD

Psychologists

Substance

Abuse

Counselors School Nurses Psychiatrists

Other School

Staff

TOTAL 52.02% 68.42% 56.59% 48.28% 47.84% 61.05% 31.90% 39.87% 57.27%

Region

Northeast 51.80% 80.83% 68.32% 55.70% 64.09% 73.47% 30.29% 35.53% 63.45%

South 51.16% 54.76% 55.69% 41.19% 33.81% 50.39% 36.67% 43.31% 47.95%

Midwest 48.05% 76.48% 46.39% 58.35% 42.66% 62.01% 35.27% 44.94% 64.39%

West 61.12% 58.94% 57.00% 38.39% 47.54% 51.19% 22.11% 22.76% 53.54%

Level

Elementary 59.54% 66.90% 53.00% 48.78% 42.21% 66.71% 31.37% 42.25% 61.26%

Middle 51.71% 63.98% 60.32% 47.23% 41.83% 57.69% 30.51% 21.28% 53.01%

High 32.51% 76.10% 67.82% 54.89% 69.06% 60.25% 37.57% 61.78% 45.98%

Combined 38.54% 70.92% 54.43% 29.92% 20.00% 30.00% 24.91% 70.01%

Urbanicity

Urban 64.64% 81.09% 58.71% 48.92% 48.25% 73.37% 32.53% 68.14% 60.34%

Suburban 47.65% 60.29% 56.55% 46.82% 44.11% 60.50% 26.72% 19.48% 60.35%

Rural 48.54% 65.87% 54.65% 49.72% 52.49% 52.35% 36.94% 48.52% 52.89%

Size

1–500 55.92% 60.67% 54.27% 51.49% 41.31% 52.15% 30.98% 41.86% 55.33%

501–1,000 50.61% 72.21% 56.65% 44.89% 49.88% 67.51% 34.97% 23.35% 59.32%

1,001+ 41.22% 81.28% 63.70% 48.04% 59.27% 67.05% 26.55% 63.70% 58.76%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 14
Table 11

Percentage of Schools With and Without Agreements with Community Organizations To Provide Mental Health Services,

and Percentage of All Schools with Agreements with Various Community–Based Organizations, by Selected School Characteristics: 2002–2003

With

Agreement

with CBO

Without

Agreement

with CBO Missing

School Based

Health

Center

Community

Health

Center

County MH

Agency

Local

Hospital

Child

Welfare

Agency

Juvenile

Justice

System

Faith Based

Organization

Com

Se

Orga

TOTAL 55.4% 43.6% .9% 16.7% 19.2% 29.2% 5.8% 11.4% 17.1% 4.3% 

Region

Northeast 62.3% 36.1% 1.4% 18.9% 16.2% 31.0% 8.9% 9.9% 15.2% 3.9% 

South 41.3% 57.7% .9% 12.2% 13.9% 22.3% 4.4% 8.2% 12.9% 2.4% 

Midwest 59.1% 39.9% .8% 19.5% 24.7% 32.6% 7.3% 16.3% 22.7% 6.8% 

West 63.0% 36.2% .7% 16.8% 19.9% 31.8% 2.8% 9.2% 15.3% 3.1% 

Level

Elementary 56.5% 42.8% .6% 16.0% 17.3% 27.8% 5.3% 10.4% 13.8% 3.7% 

Middle 58.1% 41.0% .7% 22.6% 27.2% 36.3% 9.0% 15.4% 25.7% 9.2% 

High 55.2% 42.1% 2.6% 13.8% 21.9% 30.1% 5.1% 12.4% 19.4% 2.0% 

Combined 41.3% 58.6% *0.0% 14.9% 9.1% 21.9% 3.8% 7.3% 16.4% 1.7% 

Urbanicity

Urban 58.7% 39.8% 1.3% 21.7% 22.2% 29.9% 8.8% 11.0% 15.7% 6.1% 

Suburban 55.7% 43.6% .6% 15.3% 16.9% 28.1% 5.7% 8.9% 15.6% 4.2% 

Rural 53.2% 45.7% .9% 15.0% 19.4% 29.8% 4.1% 13.7% 19.1% 3.3% 

Size

1–500 50.9% 48.6% .4% 15.5% 18.4% 26.9% 4.9% 10.4% 15.9% 3.8% 

501–1,000 58.8% 40.0% 1.0% 18.2% 19.3% 30.3% 6.3% 11.8% 17.0% 4.9% 

1,001+ 66.4% 30.8% 2.7% 18.2% 22.8% 37.1% 8.6% 15.2% 22.8% 4.3% 

Notes: *Estimated percent is less than 0.05 and therefore rounds to zero. Denominator for all columns is all schools.

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Items 15–25
Table 12

Number and Percentage of Schools That Have Agreements With Various Community–Based Organizations,

by Community–Based Organization and by Location of Services: 2002–2003

Location of Services

Community-Based Organizations

Number of

Schools With

Agreements

Percentage of

Schools With

Agreements In School

In

Community

In Both

School and

Community Missing

School-Based Health Center 13,750 16.8% 67.4% 58.2% 30.2% 4.6%

Community Health Center or Clinic 15,774 19.3% 41.8% 77.2% 24.8% 5.9%

County MH Agency 23,982 29.3% 64.9% 68.6% 34.9% 1.5%

Local Hospital 4,773 5.8% 26.5% 79.6% 7.8% 1.7%

Child Welfare Agency 9,394 11.5% 65.1% 79.4% 46.2% 1.7%

Juvenile Justice System/Court 14,034 17.1% 63.2% 78.8% 42.1% 0.0%

Faith Based Organization 3,539 4.3% 61.9% 53.3% 18.4% 3.2%

Community Service Organization 12,618 15.4% 64.2% 58.3% 22.4% 0.0%

Other Organization 3,530 4.3% 83.9% 38.3% 24.5% 2.3%

Individual Providers 15,095 18.4% 86.1% 40.2% 27.0% 0.6%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Items 15–25
Table 13

Number and Percentage of Schools That Have Agreements With Various Community–Based Organizations, and

the Percentage That Use Various Payment Sources, by Community Organization: 2002–2003

Payment Sources

Community-Based Organizations

Number of

Schools with

Agreements

Percentage of

Schools with

Agreements School/District County/Agency

Third

Party

Grant

Funds

Combination of

Payment

Sources 

School-Based Health Center 13,750 16.8% 25.2% 6.5% 13.3% 8.5% 43.9% 

Community Health Center or Clinic 15,774 19.3% 16.0% 11.3% 20.2% 4.7% 46.3% 

County MH Agency 23,982 29.3% 17.6% 12.1% 19.1% 6.0% 44.4% 

Local Hospital 4,773 5.8% 5.9% 15.5% 28.2% 5.7% 38.9% 

Child Welfare Agency 9,394 11.5% 7.8% 37.0% 7.7% 0.3% 44.4% 

Juvenile Justice System/Court 14,034 17.1% 9.5% 44.9% 3.8% 8.4% 30.9% 

Faith-Based Organization 3,539 4.3% 0.0% 50.8% 16.4% 9.5% 14.4% 

Community Service Organization 12,618 15.4% 4.2% 35.6% 11.8% 13.6% 31.8% 

Other Organization 3,530 4.3% 23.1% 18.2% 4.4% 11.7% 40.3% 

Individual Providers 15,095 18.4% 57.8% 2.5% 7.4% 3.0% 28.3% 

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Items 15–25
Table 14

Number and Percentage of All Schools that Use Various Practices for Routine Referrals and Coordination with

Community-Based Organizations and Providers: 2002–2003

Practices

Number of

Schools

Percentage of

Schools

Passive Referrals Only 15,565 19.0%

Active Referrals Only 2,579 3.1%

Follow-up With Family Only 262 0.3%

Follow-up With Provider Only 355 0.4%

Attend Team Meetings Only 948 1.2%

Combination of Practices 50,031 61.1%

Practices Data Missing 12,161 14.8%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 26
Table 14A

Number and Percentage of All Schools That Use Various Practices for Routine Referrals and Coordination With

Community-Based Organizations and Providers: 2002–2003

Practices

Number of

Schools

Percentage of

Schools

Passive Referrals 60,229 73.5%

Active Referrals 43,142 52.7%

Follow-up With Family 37,042 45.2%

Follow-up With Provider 35,481 43.3%

Attend Team Meetings 33,048 40.4%

Combination of Practices 50,031 61.1%

All Practices Data Missing 12,161 14.8%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 26
Table 15

Percentage of Schools Reporting That Various Mental Health Problems Are Among the Top Three Problems for Males,

by Selected School Characteristics: 2002–2003

Adjustment

Issues

Social,

Interpersonal

or Family

Problems

Anxiety,

Stress,

School

Phobia

Depression,

Grief

Reactions

Aggressive

/Disruptive

Behavior,

Bullying

Behavior

Problems

Associated

With

Neurological

Disorders

Delinquency

and

Gang–Relate

d Problems

Suicidal

or

Homicidal

Thoughts

or

Behavior

Alcohol

/Drug

Problems

Eating

Disorders

Concerns

About

Gender or

Sexuality

E

o

TOTAL 23.7% 72.7% 18.0% 12.8% 63.1% 42.0% 5.3% .8% 7.6% *0.0% .5% 

Region

Northeast 26.5% 79.2% 22.5% 12.3% 64.7% 39.6% 3.2% .8% 8.3% *0.0% *0.0% 

South 20.8% 69.6% 18.2% 12.9% 58.5% 42.3% 4.4% .3% 9.1% *0.0% *0.0% 

Midwest 26.4% 71.8% 16.1% 11.0% 65.5% 44.3% 7.1% 1.1% 7.2% .2% 1.3% 

West 21.0% 73.3% 17.3% 15.9% 64.4% 39.8% 5.5% 1.2% 5.6% *0.0% .5% 

Level

Elementary 23.6% 72.0% 17.3% 8.3% 64.1% 50.9% 2.1% 2% .4% 1% .1% 

Middle 26.8% 76.7% 22.1% 12.2% 68.8% 34.5% 11.0% 1.1% 3.5% *0.0% 2.5% 

High 23.0% 65.9% 16.7% 23.1% 54.4% 20.1% 10.1% 2.2% 33.8% *0.0% .1% 

Combined 18.6% 83.7% 16.8% 25.3% 62.0% 39.9% 5.8% 1.6% 13.7% *0.0% *0.0% 

Urbanicity

Urban 19.6% 63.4% 18.7% 9.5% 65.4% 40.4% 9.8% .6% 4.6% *0.0% .9% 

Suburban 27.3% 75.5% 20.3% 13.1% 60.3% 44.5% 2.9% .7% 6.4% *0.0% .3% 

Rural 23.2% 75.9% 15.8% 14.5% 64.1% 40.9% 4.6% 1.1% 10.3% .1% .5% 

Size

1–500 23.2% 73.3% 17.9% 12.4% 61.4% 45.2% 3.8% .7% 6.8% *0.0% .5% 

501–1,000 25.3% 73.9% 18.2% 11.3% 67.6% 42.1% 5.5% .2% 5.0% .2% .6% 

1,001+ 21.3% 66.9% 18.1% 19.4% 57.8% 26.4% 11.9% 3.6% 19.3% *0.0% .2% 
Adjustment

Issues

Social,

Interpersonal

or Family

Problems

Anxiety,

Stress,

School

Phobia

Depression,

Grief

Reactions

Aggressive

/Disruptive

Behavior,

Bullying

Behavior

Problems

Associated

With

Neurological

Disorders

Delinquency

and

Gang–Relate

d Problems

Suicidal

or

Homicidal

Thoughts

or

Behavior

Alcohol

/Drug

Problems

Eating

Disorders

Concerns

About

Gender or

Sexuality

E

o

Minority

Enrollment

Unknown 5.2% 35.1% 35.1% 14.1% 26.3% *0.0% 5.2% *0.0% *0.0% ∗

0.0% *0.0% 

Low: 0–15% 24.9% 75.3% 21.8% 15.0% 59.5% 41.4% 2.3% .7% 9.5% *0.0% .5% 

Medium: 16–50% 24.9% 73.9% 18.2% 11.6% 62.5% 47.8% 4.5% 1.2% 7.7% .2% .1% 

High: 51%+ 21.4% 68.9% 12.6% 10.9% 68.9% 38.4% 9.9% .8% 5.1% *0.0% .9% 

Free Lunch

Enrollment

Unknown 6.3% 27.1% 13.7% 21.5% 31.6% 24.1% 7.0% *0.0% 1.7% *0.0% *0.0% 

Low: 0–25% 26.9% 76.0% 24.9% 15.5% 56.7% 41.2% 3.0% 1.6% 9.4% 1% 

Medium: 26–50% 27.0% 76.2% 15.2% 13.4% 65.4% 42.5% 2.8% 2% 8.7% 7% 

High: 51%+ 19.0% 69.0% 14.5% 9.8% 68.0% 43.0% 9.2% 7% 5.3% 1% 8% 

IEP Enrollment

Unknown 15.0% 40.7% 10.4% 6.8% 30.4% 19.9% 9% 1.2% 3.6% 

Low: 0–9% 27.2% 80.9% 19.1% 14.1% 69.2% 48.5% 5.4% 8% 7.5% 1% 

Medium: 10–14% 27.0% 81.2% 21.7% 15.8% 71.8% 44.9% 6.0% 1.0% 7.7% 2% 1.0% 

High: 15%+ 23.0% 80.0% 18.6% 12.8% 73.0% 49.3% 7.9% 4% 10.8% 9% 

∗

 Estimate was less than 0.05% and therefore rounded to zero.

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 27

 
Table 15A

Percentage of Schools Reporting That Various Mental Health Problems Are Among the Top Three Problems for Females,

by Selected School Characteristics: 2002–2003

Adjustment

Issues

Social,

Interpersonal

or Family

Problems

Anxiety,

Stress,

School

Phobia

Depression,

Grief

Reactions

Aggressive

/Disruptive

Behavior,

Bullying

Behavior

Problems

Associated

With

Neurological

Disorders

Delinquency

and

Gang–Relate

d Problems

Suicidal

or

Homicidal

Thoughts

or

Behavior

Alcohol /

Drug

Problems

Eating

Disorders

Concerns

About

Gender or

Sexuality

Experienc

of Physica

or Sexual

Abuse

TOTAL 35.7% 79.9% 40.5% 29.1% 27.3% 20.1% 1.8% 2.3% 4.5% 3.7% 1.2% 6.2% 

Region

Northeast 38.3% 85.2% 47.2% 30.2% 27.6% 14.3% 1.5% 8% 6.8% 4.3% 2.6% 4.0% 

South 30.5% 76.4% 40.2% 31.1% 22.1% 21.6% 1.4% 3.0% 4.8% 4.4% .9% 5.5% 

Midwest 37.9% 80.5% 37.5% 24.9% 30.7% 25.0% 3.1% 1.5% 3.9% 3.6% 1.2% 8.0% 

West 37.3% 79.3% 40.4% 32.3% 28.8% 15.1% .6% 3.7% 3.1% 2.3% .6% 6.0% 

Level

Elementary 37.4% 79.5% 41.9% 21.1% 30.4% 25.7% .8% 1.2% .6% .8% .6% 7.3% 

Middle 36.5% 82.9% 44.7% 31.3% 29.9% 15.2% 3.5% 3.1% 2.7% 4.1% 2.8% 5.4% 

High 27.0% 74.4% 35.5% 47.4% 18.0% 6.0% 4.5% 5.5% 19.3% 6.8% 2.4% 3.6% 

Combined 40.4% 87.6% 31.1% 44.7% 18.8% 21.0% *0.0% 1.6% 5.1% 16.9% *0.0% 5.2% 

Urbanicity

Urban 29.8% 71.8% 37.8% 25.1% 34.3% 17.8% 2.9% 2.9% 2.8% 1.0% .5% 8.7% 

Suburban 41.6% 81.7% 46.6% 30.1% 22.9% 21.3% 1.3% 2.5% 3.8% 2.5% .5% 1.8% 

Rural 34.4% 83.1% 37.2% 30.7% 26.9% 20.6% 1.6% 1.7% 6.0% 6.1% 2.2% 8.3% 

Size

1–500 37.6% 79.9% 37.9% 26.4% 27.7% 23.0% 1.9% 1.7% 4.5% 4.0% 1.6% 6.6% 

501–1,000 35.6% 80.7% 43.7% 28.4% 29.4% 19.3% 1.2% 2.1% 2.5% 2.9% 1.0% 6.5% 

1,001+ 27.3% 77.1% 43.4% 44.2% 19.5% 9.2% 3.3% 5.4% 10.3% 4.4% .2% 3.0% 

Minority

Enrollment

Unknown *0.0% 35.1% 35.1% 40.4% 5.2% *0.0% 5.2% *0.0% *0.0% *0.0% *0.0% *0.0% 

Low: 0–15% 37.5% 82.7% 45.8% 34.3% 19.4% 18.9% 9% 2.1% 6.0% 5.6% 1.5% 5.8% 
Adjustment

Issues

Social,

Interpersonal

or Family

Problems

Anxiety,

Stress,

School

Phobia

Depression,

Grief

Reactions

Aggressive

/Disruptive

Behavior,

Bullying

Behavior

Problems

Associated

With

Neurological

Disorders

Delinquency

and

Gang–Relate

d Problems

Suicidal

or

Homicidal

Thoughts

or

Behavior

Alcohol /

Drug

Problems

Eating

Disorders

Concerns

About

Gender or

Sexuality

Experienc

of Physica

or Sexual

Abuse

Medium: 16–50% 38.4% 81.5% 40.2% 27.9% 26.6% 23.1% 1.7% 2.4% 4.2% 3.0% .8% 7.2% 

High: 51%+ 31.7% 75.5% 34.0% 23.3% 38.5% 19.5% 3.1% 2.5% 2.8% 1.8% 1.2% 6.0% 

Free Lunch

Enrollment

Unknown 13.7% 27.1% 21.0% 30.8% 20.6% 12.0% 1.6% *0.0% 6.2% 1.7% 6.2% *0.0% 

Low: 0–25% 39.6% 83.8% 53.2% 34.1% 17.4% 16.6% 3% 2.9% 4.8% 4.1% 6% 2.8% 

Medium: 26–50% 38.8% 83.4% 39.5% 30.6% 26.4% 19.6% 1.0% 2.1% 4.9% 4.1% 8% 6.6% 

High: 51%+ 30.9% 75.9% 31.3% 23.7% 36.8% 23.9% 3.7% 1.9% 3.8% 3.0% 1.9% 9.0% 

IEP Enrollment

Unknown 20.9% 41.2% 21.7% 14.0% 12.0% 11.0% 8% 2.2% 1.9% 4.3% 2.2% 

Low: 0–9% 44.9% 88.7% 44.3% 30.5% 30.3% 22.0% 1.7% 3.6% 4.1% 2.5% 2% 6.7% 

Medium: 10–14% 38.0% 90.8% 49.4% 34.9% 29.8% 19.4% 2.2% 1.1% 5.3% 3.7% 3.6% 7.3% 

High: 15%+ 35.0% 89.0% 41.5% 33.3% 33.7% 26.2% 2.4% 2.2% 6.1% 4.4% 7% 7.7% 

∗

 Estimate was less than 0.05% and therefore rounded to zero.

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 27
Table 16

Percentage of Schools Reporting That Various Mental Health Problems Are the Ones That Use Most of Their Mental Health Resources, by Selected Schoo

Adjustment

issues

Social,

InterPersonal or

Family

Problems

Anxiety,

Stress,

School

Phobia

Depression,

Grief

Reactions

Aggressive

/Disruptive

Behavior,

Bullying

Behavior

Problems

Associated

With

Neurological

Disorders

Delinquency

and GangRelated

Problems

Suicidal

or

Homicidal

Thoughts

or

Behavior

Alcohol

/Drug

Problems

Eating

Disorders

Concerns

About

Gender or

Sexuality

Experie

of Phys

or Sex

Abus

TOTAL 3.7% 44.6% 1.2% 2.0% 18.4% 12.2% .2% .2% .7% .4% *0.0% 

Region

Northeast 3.7% 47.0% .4% 3.2% 20.5% 7.7% *0.0% .1% 1.0% *0.0% *0.0% *0

South 3.9% 48.6% *0.0% 1.6% 14.4% 10.8% .5% *0.0% .8% .8% *0.0% *0

Midwest 2.8% 40.7% 2.9% 1.0% 20.2% 16.7% .2% .2% .5% .6% *0.0% 

West 4.6% 43.4% 1.0% 3.2% 19.1% 10.5% *0.0% .5% .4% *0.0% *0.0% *0

Level

Elementary 2.3% 42.1% .4% .6% 20.8% 15.4% *0.0% *0.0% *0.0% *0.0% *0.0% 

Middle 5.1% 49.5% 2.0% 3.1% 18.2% 7.7% 1.0% .4% .6% .4% *0.0% *0

High 6.3% 44.5% 1.6% 5.8% 13.7% 5.9% .3% .9% 3.5% *0.0% *0.0% 

Combined 5.0% 52.0% 4.6% 1.6% 10.8% 11.9% *0.0% *0.0% *0.0% 4.8% *0.0% *0

Urbanicity

Urban 3.9% 33.2% .8% 1.4% 28.4% 11.0% .3% .1% 1.2% .3% *0.0% *0

Suburban 4.2% 48.2% .8% 2.8% 14.9% 13.0% .1% .4% .5% *0.0% *0.0% 

Rural 3.1% 48.3% 1.9% 1.7% 15.3% 12.2% .2% .1% .5% .8% *0.0% 

Size

1–500 3.5% 45.8% 1.5% 1.5% 18.1% 12.8% .1% *0.0% .3% .4% *0.0% *0

501–1,000 3.0% 42.2% 1.1% 2.0% 19.5% 13.3% .2% .2% .6% .6% *0.0% 

1,001+ 6.5% 45.7% 5% 4.4% 16.2% 6.0% .4% 1.3% 2.6% *0.0% *0.0% 

Minority

Enrollment

Unknown *0.0% 35.1% *0.0% *0.0% 5.2% *0.0% *0.0% *0.0% *0.0% *0.0% *0.0% *0
Adjustment

issues

Social,

InterPersonal or

Family

Problems

Anxiety,

Stress,

School

Phobia

Depression,

Grief

Reactions

Aggressive

/Disruptive

Behavior,

Bullying

Behavior

Problems

Associated

With

Neurological

Disorders

Delinquency

and GangRelated

Problems

Suicidal

or

Homicidal

Thoughts

or

Behavior

Alcohol

/Drug

Problems

Eating

Disorders

Concerns

About

Gender or

Sexuality

Experie

of Phys

or Sex

Abus

Low: 0-15% 4.4% 53.9% 1.3% 2.3% 13.8% 9.7% .2% *0.0% .6% .8% *0.0% *0

Medium: 16–50% 4.4% 45.8% 1.0% 2.4% 14.1% 15.0% .1% .3% .6% *0.0% *0.0% 

High: 51%+ 2.1% 31.5% 1.3% 1.4% 28.2% 13.3% .3% .3% .8% .2% *0.0% *0

Free Lunch

Enrollment

Unknown 12.7% 4.7% 22.3% 7.3% 

Low: 0–25% 5.8% 52.5% 1.3% 3.3% 11.1% 10.3% 4% 4% 1.0% 

Medium: 26–50% 4.3% 48.6% 1.2% 1.7% 15.8% 11.7% 2% 5% 4% 

High: 51%+ 1.5% 35.9% 1.1% 1.2% 26.4% 14.4% 2% 6% 8% 

IEP Enrollment

Unknown 2.8% 21.3% 6% 1.5% 8.5% 7.0% 5% 3% 5% 

Low: 0–9% 4.2% 53.2% 1.3% 1.7% 19.6% 12.9% 1% 1% 4% 

Medium: 10–14% 4.3% 49.7% 1.7% 2.7% 20.1% 13.6% 4% 3% 1.0% 4% 

High: 15%+ 3.1% 47.9% 1.1% 2.0% 22.9% 14.0% 3% 9% 8% 

∗

 Estimate was less than 0.05% and therefore rounded to zero.

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 28
Table 17

Percentage of Schools Providing and Not Providing Various Mental Health Services, by Service Provider: 2002–2003

Provision of Mental Health Services

Assessment for

Emotional or

Behavioral

Problems/

Disorders

Behavior

Management

Consultation

Case

Management

Referral to

Specialized

Programs/

Services

Crisis

Intervention

Individual

Counseling/

Therapy

Group

Counseling/

Therapy

Substanc

Abuse

Counselin

Services Provided 86.9% 86.8% 71.2% 83.5% 86.6% 76.0% 68.2% 43

Services Not Provided 11.4% 11.5% 25.8% 14.0% 10.6% 12.2% 19.7% 44

Missing 1.8% 1.7% 2.9% 2.4% 2.8% 11.9% 12.1% 12

Who Provides Service

School/District-Based Staff 81.3% 83.4% 77.1% 76.0% 80.8% 86.7% 86.1% 64

Community-Based Staff 25.5% 23.9% 29.0% 0.0% 34.7% 43.9% 36.2% 56

Both School and Community Staff 18.2% 18.8% 17.7% 0.0% 27.8% 32.8% 25.0% 23

Missing 11.5% 11.5% 11.6% 24.0% 12.3% 2.2% 2.7% 2

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 29
Table 17A

Percentage of Schools Providing Various Mental Health Services, by Selected School Characteristics: 2002–2003

Assessment for

Emotional or

Behavioral

Problems

/Disorders

Behavior

Management

Consultation

Case

Management

Referral to

Specialized

Programs

/Services

Crisis

Intervention

Individual

Counseling

/Therapy

Group

Counseling

/Therapy

Substance Abus

Counseling

TOTAL 86% 86% 71% 83% 86% 75% 68% 43% 

Region

Northeast 91% 90% 75% 86% 90% 77% 76% 48% 

South 80% 81% 70% 83% 85% 70% 62% 37% 

Midwest 89% 87% 67% 79% 85% 80% 70% 45% 

West 88% 90% 74% 87% 87% 74% 66% 42% 

Level

Elementary 90% 89% 74% 85% 87% 75% 70% 34% 

Middle 87% 86% 67% 83% 86% 79% 70% 56% 

High 82% 81% 68% 82% 86% 72% 61% 56% 

Combined 70% 78% 58% 69% 83% 79% 57% 51% 

Urbanicity

Urban 89% 90% 78% 89% 88% 74% 70% 42% 

Suburban 90% 91% 73% 87% 92% 75% 74% 42% 

Rural 82% 81% 65% 77% 81% 76% 61% 44% 

Size

1–500 83% 84% 67% 80% 83% 74% 64% 38% 

501–1,000 90% 88% 75% 86% 88% 77% 73% 45% 

1,001+ 91% 90% 77% 89% 95% 77% 70% 58% 

Minority Enrollment

Unknown 77% 72% 77% 65% 77% 59% 45% 24% 

Low: 0–15% 82% 83% 66% 81% 84% 74% 66% 42% 

Medium: 16–50% 89% 88% 75% 83% 84% 78% 68% 43% 

High: 51%+ 90% 89% 73% 86% 90% 75% 71% 44% 
Assessment for

Emotional or

Behavioral

Problems

/Disorders

Behavior

Management

Consultation

Case

Management

Referral to

Specialized

Programs

/Services

Crisis

Intervention

Individual

Counseling

/Therapy

Group

Counseling

/Therapy

Substance Abus

Counseling

Free Lunch Enrollment

Unknown 71% 75% 57% 78% 72% 42% 29% 11% 

Low: 0–25% 88% 87% 73% 83% 87% 77% 72% 46% 

Medium: 26–50% 84% 87% 70% 83% 85% 73% 63% 40% 

High: 51%+ 87% 85% 70% 83% 87% 77% 70% 43% 

IEP Enrollment

Unknown 83% 84% 68% 80% 82% 39% 34% 24% 

Low: 0–9% 81% 83% 67% 82% 85% 81% 73% 41% 

Medium: 10–14% 91% 92% 77% 83% 89% 84% 78% 53% 

High: 15%+ 89% 86% 69% 86% 87% 89% 76% 48% 

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 29
Table 17B

Number and Percentage of Schools by Percent of Students Who

Received Mental Health Services in the Previous School Year: 2002–2003

Percentage of Students

Who Received Mental

Health Services

Number of

Schools

Percentage of

Schools

0–10% 26,840 32.8%

11–25% 19,963 24.4%

26–50% 11,316 13.8%

51–75% 2,543 3.1%

76–100% 1,843 2.2%

Missing 19,397 23.7%

Total 81,901 100%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.
Table 18

Percentage of Schools Reporting Various Degrees of Difficulty in Providing Various Mental Health Services,

among Schools that Provide Each Type of Mental Health Service: 2002–2003

Ranked Degree of Difficulty

Mental Health Services

Number of

Schools Providing

Service Not Difficult

Somewhat

Difficult Difficult

Very

Difficult Not 

Assessment for Emotional or Behavioral Problems /Disorders 71,142 32.7% 28.6% 20.6% 6.4% 

Behavior Management Consultation 71,125 32.5% 31.8% 18.8% 5.3% 

Case Management 58,342 28.4% 28.5% 21.9% 6.6% 

Referral to Specialized Programs/Services 68,391 22.4% 26.2% 23.8% 13.5% 

Crisis Intervention 70,913 32.5% 30.8% 18.9% 6.0% 

Individual Counseling/Therapy 62,209 37.2% 33.0% 19.9% 7.6% 

Group Counseling/Therapy 55,833 34.7% 32.0% 21.8% 8.8% 

Substance Abuse Counseling 35,455 23.9% 27.8% 23.8% 14.5% 

Medication/Medication Management 27,587 21.7% 23.0% 22.7% 16.2% 

Family Support Services 47,245 24.0% 26.6% 30.7% 12.7% 

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 31
Table 19

Percentage of Schools Reporting Extent to Which Various Factors Are Barriers to Providing Mental Health Services: 2002–2003

Extent of Barrier

Factors Not a Barrier

Somewhat

of a Barrier Barrier

Serious

Barrier Missing

School MH Resources 16.4% 21.6% 22.0% 27.0% 12.9%

Competing Priorities Taking Precedence Over MH Services 15.8% 24.6% 26.6% 19.6% 13.5%

Protecting Student Confidentiality 59.5% 19.8% 5.8% 2.0% 12.9%

Gaining Parental Cooperation and Consent 15.5% 38.1% 23.8% 9.9% 12.8%

Financial Constraints of Families 12.4% 17.1% 27.4% 30.5% 12.5%

Stigma Associated With Receiving MH Services 15.4% 35.5% 25.7% 10.5% 13.0%

Language and Cultural Barriers of Students or Families 38.2% 29.1% 13.6% 6.4% 12.6%

Inadequate Community MH Resources 16.9% 26.2% 22.7% 21.7% 12.6%

Inadequate Cooperation Between School and Community 24.6% 33.8% 18.9% 9.3% 13.4%

Transportation Difficulties Traveling to Providers 15.0% 26.6% 27.3% 17.7% 13.5%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 32
Table 20

The Types of Data and Uses for Data That Are Collected by Those Schools With Access to Data, by Selected School Characteristics: 2002–2003

Of Schools With Access to Data:

Percentage of

Schools With

Access To Data

Types of MH

Problems

Presented by

Students

Types of

School-Based

MH Services

Provided

Demographic

Characteristics

of Students

Who Receive

Services

Number of

Units of MH

Services

Delivered

Referrals to

Community

Providers

Referrals of

Students

for

Medication

Reporting

to District

or State

Offices

Developing,

Training and

Professional

Development

Programs For

Various School

Staff

Planning and

Evaluation of

School-Based

MH Services

and

Resources

TOTAL 49.8% 66.8% 68.9% 36.2% 32.4% 51.5% 37.9% 60.0% 39.6% 48.5% 

Region

Northeast 60.4% 65.6% 75.9% 29.1% 44.4% 64.2% 37.2% 62.9% 43.1% 53.2% 

South 45.0% 68.2% 70.0% 42.6% 24.4% 43.3% 43.1% 57.7% 39.8% 48.8% 

Midwest 50.6% 68.4% 64.3% 40.8% 29.4% 49.9% 39.0% 58.6% 46.5% 46.4% 

West 46.8% 63.7% 67.9% 27.4% 35.7% 52.2% 30.2% 62.8% 24.2% 46.9% 

Level

Elementary 52.2% 64.0% 71.5% 35.2% 33.1% 46.6% 41.2% 60.5% 40.5% 48.0% 

Middle 53.7% 72.8% 65.2% 40.1% 32.2% 58.1% 32.2% 59.8% 42.7% 52.7% 

High 45.6% 69.5% 63.5% 36.0% 36.6% 57.2% 33.8% 60.1% 40.9% 49.2% 

Combined 31.8% 70.0% 67.3% 33.5% 10.6% 68.0% 33.3% 54.7% 12.6% 36.0% 

Urbanicity

Urban 52.4% 66.9% 66.8% 37.1% 33.7% 54.9% 39.4% 58.3% 36.3% 44.5% 

Suburban 54.2% 60.5% 69.9% 36.2% 42.0% 44.5% 35.6% 65.4% 41.1% 53.3% 

Rural 44.8% 73.0% 69.3% 35.7% 22.2% 56.1% 39.2% 56.1% 40.4% 46.4% 

Size

1-500 46.9% 67.6% 70.7% 37.8% 31.2% 51.2% 41.1% 57.7% 39.8% 44.9% 

501-1,000 54.0% 66.9% 65.7% 34.5% 32.1% 51.8% 38.0% 61.9% 40.1% 53.2% 

1,001+ 50.5% 63.3% 71.2% 34.8% 38.6% 52.2% 23.8% 64.4% 37.1% 48.9% 

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Items 34 and 35
Table 21

Percentage of Schools That Provide Various Prevention and Early Intervention Programs, by Selected School Characteristics: 2002–2003

School-Wide

Screening for

Behavioral or

Emotional

Problems

CurriculumBased

Programs To

Enhance

Social And

Emotional

Functioning

and Reduce

Barriers to

Learning

School-Wide

Strategies To

Promote

Safe, DrugFree Schools

School-Wide

Programs To

Prevent

Alcohol,

Tobacco, or

Drug Use

Prevention

and PreReferral

Interventions

for Mild

Problems

Outreach to

Parents

Regarding

Student

Mental

Health

Peer

Counseling

/Mediation,

Support

Groups

Other

Programs Missing

TOTAL 15.0% 59.2% 77.8% 72.2% 62.8% 33.8% 47.1% 2.5% 12.9%

Region

Northeast 18.5% 66.0% 80.3% 71.2% 69.3% 44.4% 57.4% 4.0% 10.2%

South 13.4% 53.7% 72.4% 69.2% 57.6% 26.8% 42.2% 1.5% 15.7%

Midwest 13.6% 61.4% 84.5% 76.9% 65.4% 36.2% 48.0% 2.2% 10.1%

West 16.6% 57.9% 72.5% 69.6% 60.8% 30.9% 44.4% 3.0% 15.9%

Level

Elementary 14.8% 64.2% 77.3% 69.3% 66.7% 38.2% 46.1% 1.8% 14.0%

Middle 14.8% 58.3% 84.2% 77.9% 65.6% 30.1% 55.7% 5.6% 9.0%

High 14.7% 48.2% 76.6% 75.4% 56.2% 28.7% 49.0% 1.9% 12.2%

Combined 17.9% 47.9% 68.8% 73.7% 42.1% 19.9% 31.2% 1.5% 15.7%

Urbanicity

Urban 16.4% 54.4% 71.1% 62.2% 61.5% 33.3% 51.4% 3.3% 16.1%

Suburban 12.1% 65.0% 79.9% 75.4% 67.9% 42.1% 54.6% 3.0% 13.0%

Rural 16.5% 57.3% 80.0% 75.4% 59.5% 27.2% 38.6% 1.6% 11.1%

Size

1–500 14.2% 59.0% 77.7% 73.0% 59.3% 30.1% 42.0% 1.8% 12.8%

501–1,000 16.6% 62.6% 80.1% 72.5% 68.0% 38.9% 51.2% 3.5% 12.6%

1,001+ 13.9% 50.1% 71.3% 67.4% 64.1% 35.4% 59.3% 2.8% 14.8%

Minority Enrollment

Unknown * 35.1% 19.4% 14.1% 35.1% * 35.1% * 59.5%
School-Wide

Screening for

Behavioral or

Emotional

Problems

CurriculumBased

Programs To

Enhance

Social And

Emotional

Functioning

and Reduce

Barriers to

Learning

School-Wide

Strategies To

Promote

Safe, DrugFree Schools

School-Wide

Programs To

Prevent

Alcohol,

Tobacco, or

Drug Use

Prevention

and PreReferral

Interventions

for Mild

Problems

Outreach to

Parents

Regarding

Student

Mental

Health

Peer

Counseling

/Mediation,

Support

Groups

Other

Programs Missing

Low: 0–15% 14.9% 59.3% 78.9% 77.5% 63.5% 31.2% 44.0% 2.3% 10.4%

Medium: 16–50% 14.1% 62.7% 80.5% 72.7% 67.2% 35.5% 50.6% 0.6% 12.0%

High: 51%+ 16.1% 56.5% 74.9% 65.7% 58.7% 36.1% 48.5% 4.4% 16.4%

Free Lunch Enrollment

Unknown 9.0% 32.2% 34.5% 32.2% 29.2% 10.5% 22.2% 1.7% 52.8%

Low: 0–25% 14.2% 60.8% 79.4% 77.8% 67.4% 35.4% 52.0% 2.3% 10.2%

Medium: 26–50% 14.5% 58.5% 78.3% 71.7% 60.8% 30.6% 44.1% 2.3% 11.7%

High: 51%+ 16.3% 59.5% 77.7% 69.4% 61.9% 35.8% 46.4% 2.7% 14.7%

IEP Enrollment

Unknown 7.4% 26.3% 40.7% 36.6% 25.7% 12.9% 23.7% 1.2% 55.9%

Low: 0–9% 17.4% 65.2% 83.7% 79.8% 69.4% 38.5% 47.5% 1.8% 3.3%

Medium: 10–14% 15.6% 68.0% 87.6% 85.5% 72.4% 38.1% 59.2% 4.4% 1.6%

High: 15%+ 17.9% 69.3% 90.0% 77.5% 74.8% 40.4% 52.0% 2.1% 1.7%

 * Estimate is less than 0.05% and therefore rounds to zero.

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

School Questionnaire, Item 36

School Mental Health Services Services Services Services in the United States, States, States, States, 2002–2003 2002–2003 2002–2003 2002–2003 
Table 1

Percentage of School Districts by Students Eligible To Receive Mental Health Services,

and Administrative Arrangement of Mental Health Services, by Selected District Characteristics: 2002–2003

Students Eligible To Receive Mental Health Services Administrative Arrangements for Mental Health Services

Number of

Districts All Students

Only Special

Education

Students Missing

General and

Special

Education

Administered

Together

General and

Special

Education

Administered

Separately

Administered

Both Together

and Separately

Not

Administered

at District

Level M

TOTAL 14,752 82.8% 14.4% 2.6% 67.0% 26.0% 1.8% 4.1% 

Region

Northeast 3,110 92.7% 6.6% 0.6% 75.6% 21.7% 0.7% 1.0% 

South 5,441 82.7% 16.9% 0.3% 67.0% 25.1% 1.8% 4.4% 

Midwest 3,330 82.8% 16.9% 0.2% 65.1% 28.6% 2.0% 3.4% 

West 2,872 72.2% 15.4% 12.2% 60.1% 29.4% 2.5% 7.4% 

Urbanicity

Urban 2,003 83.0% 10.2% 6.7% 55.3% 36.0% 1.4% 7.0% 

Suburban 4,773 83.0% 13.7% 3.1% 64.2% 30.3% 2.4% 2.0% 

Rural 7,976 82.6% 15.9% 1.4% 71.6% 20.9% 1.5% 4.6% 

District Size

1–5 Schools 10,651 81.3% 15.3% 3.3% 69.7% 23.5% 1.1% 4.7% 

6–15 Schools 3,100 86.3% 12.7% 0.8% 62.6% 30.4% 3.0% 2.2% 

16+ Schools 1,001 88.3% 10.5% 1.0% 52.4% 38.8% 4.7% 2.9% 

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

District Questionnaire, Items 1, 3
Table 1A

Number and Percentage of Districts Providing and Not Providing Mental Health Services: 2002–2003

Total Number

of Districts

Number of

Districts

Providing

Mental

Health

Services

Percentage of

Districts

Providing

Mental

Health

Services

Number of

Districts Not

Providing

Mental

Health

Services

Percentage of

Districts Not

Providing

Mental

Health

Services

15,226 14,752 96.9% 474 3.1%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

District Questionnaire, Item 1
Table 2

Percentage of Districts by Location of Administrative Responsibility for Mental Health Services,

by Selected District Characteristics: 2002–2003

Location of Administrative Responsibility Most Common Combinations o

Number of

Districts

At the School

District

At an

Intermediate

unit,

collaborative

or cooperative

Each School

Administers its

own MH

Services

No Unit Has

Administrative

Responsibility Other

District and

School

District and

Coop

District

and S

TOTAL 14,752 72.5% 14.1% 21.9% 5.2% 6.1% 8.4% 4.9% 

Region

Northeast 3,110 84.5% 9.5% 27.3% 0.1% 1.7% 13.3% 4.0% 

South 5,441 68.7% 28.0% 20.0% 3.0% 2.8% 5.9% 9.2% 

Midwest 3,330 72.3% 5.8% 23.1% 7.4% 8.8% 9.2% 1.7% 

West 2,872 66.9% 2.3% 18.3% 12.3% 13.7% 6.7% 1.2% 

Urbanicity

Urban 2,003 80.0% 9.2% 19.4% 8.3% 9.6% 14.3% 7.9% 

Suburban 4,773 72.9% 16.1% 24.3% 3.5% 5.0% 9.5% 4.2% 

Rural 7,976 70.3% 14.1% 21.1% 5.4% 5.8% 6.2% 4.5% 

District Size

1–5 Schools 10,651 68.1% 14.9% 20.8% 6.5% 6.6% 6.1% 5.3% 

6–15 Schools 3,100 82.2% 13.4% 24.4% 1.4% 4.4% 13.1% 4.1% 

16+ Schools 1,001 89.1% 7.9% 25.8% 2.5% 5.2% 18.0% 3.4% 

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

District Questionnaire, Item 2
Table 3

Percentage of School Districts Using Various Staffing Arrangements for Mental Health Services,

by Selected District Characteristics: 2002–2003

Mental Health Staffing Arrangements Most Common C

Number of

Districts

Mental

Health Staff

Are SchoolBased

Mental

Health Staff

Are DistrictBased

Mental

Health Staff

Are

Provided

Through

Contracts

with Outside

Providers

Schools/

Clusters of

Schools

Determine

MH Staffing

District

Operates

MH Unit or

Clinic

Serving

Multiple

Schools Other

School and

District

School and

Outside

District an

Outside

TOTAL 14,752 39.9% 41.3% 48.8% 10.1% 2.3% 6.5% 7.2% 7.0% 5.5

Region

Northeast 3,110 48.1% 53.3% 43.2% 10.1% 3.4% 4.4% 9.9% 6.4% 7.6

South 5,441 40.5% 44.1% 42.3% 13.3% 0.2% 4.7% 9.8% 9.3% 4.2

Midwest 3,330 38.5% 34.1% 53.5% 10.9% 2.8% 7.3% 3.8% 4.6% 6.7

West 2,872 31.2% 31.5% 61.6% 3.2% 4.8% 11.3% 3.3% 6.2% 4.5

Urbanicity

Urban 2,003 50.4% 26.0% 61.2% 3.7% 3.0% 11.9% 7.0% 17.0% 3.6

Suburban 4,773 49.1% 46.4% 44.1% 8.4% 2.1% 4.0% 11.0% 9.1% 4.6

Rural 7,976 31.7% 42.1% 48.4% 12.8% 2.3% 6.7% 5.0% 3.2% 6.6

District Size

1–5 Schools 10,651 35.2% 36.0% 48.0% 10.2% 2.0% 7.9% 6.4% 6.3% 4.0

6–15 Schools 3,100 50.3% 52.5% 48.0% 9.9% 1.2% 2.4% 9.2% 9.8% 9.7

16+ Schools 1,001 57.6% 64.1% 58.8% 10.1% 9.3% 4.7% 9.8% 6.6% 9.6

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

District Questionnaire, Item 4
Table 3A (Mutually Exclusive Version)

Percentage of School Districts Using Various Staffing Arrangements for Mental Health Services,

by Selected District Characteristics: 2002–2003

Number of

Districts

Mental

Health Staff

Are SchoolBased

Mental

Health Staff

Are DistrictBased

Mental

Health Staff

Are

Provided

Through

Contracts

With

Outside

Providers

Schools/

Clusters of

Schools

Determine

MH Staffing

District

Operates

MH Unit or

Clinic

Serving

Multiple

Schools Other

Combined

Practices Missing

TOTAL 14,752 14.6% 17.0% 22.8% 3.5% 0.5% 4.4% 36.2% 0.6%

Region

Northeast 3,110 18.7% 19.7% 12.1% 3.3% 1.2% 3.0% 41.7% 0.0%

South 5,441 15.6% 20.3% 18.1% 4.0% 0.0% 2.5% 38.5% 0.6%

Midwest 3,330 14.5% 12.4% 28.5% 5.0% 0.0% 5.7% 32.3% 1.2%

West 2,872 8.3% 13.2% 36.9% 1.1% 1.5% 7.9% 30.3% 0.4%

Urbanicity

Urban 2,003 14.5% 5.4% 27.4% 1.5% 0.2% 6.8% 43.8% 0.0%

Suburban 4,773 18.4% 18.0% 16.8% 3.2% 0.0% 2.4% 41.0% 0.0%

Rural 7,976 12.4% 19.4% 25.3% 4.2% 0.9% 5.0% 31.4% 1.1%

District Size

1–-5 Schools 10,651 14.5% 16.9% 27.1% 4.0% 0.7% 5.5% 30.2% 0.7%

6–15 Schools 3,100 16.0% 18.8% 12.9% 2.1% 0.1% 1.2% 48.2% 0.3%

16+ Schools 1,001 10.8% 12.9% 8.9% 2.2% 0.0% 1.8% 63.0% 0.1%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

District Questionnaire, Item 4
Table 4

Percentage of School Districts Using Various Arrangements for Budgeting Mental Health Services,

by Selected District Characteristics: 2002–2003

Are Mental Health Services Budgeted Separately from Other

Education Expenditures?

Are Mental Health Services for Special Education Stude

Budgeted Separately From Those for Other Students

Number of

Districts

Yes,

Separately No, Combined

Both Yes and

No Missing

Yes,

Separately No, Combined

Both Yes and

No Mis

TOTAL 14,752 47.9% 49.7% 0.7% 1.4% 47.1% 44.3% 1.3% 

Region

Northeast 3,110 45.7% 53.0% 0.9% 0.3% 48.3% 47.1% 2.1% 

South 5,441 43.7% 54.8% 0.7% 0.7% 42.6% 48.6% 1.0% 

Midwest 3,330 57.9% 39.7% 0.7% 1.5% 53.0% 37.9% 1.4% 

West 2,872 47.0% 48.0% 0.7% 4.1% 47.6% 40.4% 0.9% 

Urbanicity

Urban 2,003 60.0% 38.3% 1.1% 0.4% 73.5% 23.5% 1.0% 

Suburban 4,773 46.7% 52.4% 0.4% 0.3% 46.3% 44.8% 2.0% 

Rural 7,976 45.6% 50.9% 0.8% 2.4% 41.0% 49.1% 1.0% 

District Size

1–5 Schools 10,651 47.5% 50.3% 0.5% 1.5% 46.5% 45.4% 0.8% 

6–15 Schools 3,100 49.2% 48.7% 0.8% 1.1% 47.5% 43.1% 1.8% 

16+ Schools 1,001 48.5% 46.6% 3.0% 1.7% 52.4% 36.3% 4.7% 

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

District Questionnaire, Items 5,6
Table 4A

Percentage of School Districts that Combine or Separate Mental Health

and Education Budgets, 2002–2003

Are Mental Health Services for Special Education Students Budgeted Separately

From Those for Other Students?

Are Mental Health Services Budgeted Separately

from Other Education Expenditures? Yes, Separately No, Combined Both Yes and No Missing

Yes, Separately 32.1% 39.0% 0.3% 0.0%

No, Combined 38.4% 67.0% 0.3% 0.4%

Both Yes and No 64.9% 30.9% 30.6% 0.0%

Missing 60.5% 16.5% 0.8% 17.6%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

District Questionnaire, Items 5, 6
Table 5

Percentage of School Districts Using and Not Using Various Funding Sources for Mental Health Services,

Percentage With Each Source Among Its Top Five, and Percentage Using Each Source by Type of Use: 2002–2003

Percent of Districts Using and Not Using Each

Funding Source for MH Services Top Five Sources How are Mental H

Funding Source Percentage Using

Percentage Not

Using Missing

Top Five Funding

Sources

Prevention Services

Only

Intervent

O

Federal Sources

Individuals with Disabilities Education Act 66.5% 29.6% 4.0% 61.6% 4.0% 

Title 1 26.3% 68.6% 5.1% 22.3% 6.9% 

Community Mental Health Services Block Grant 11.4% 79.4% 9.3% 6.9% 1.5% 

Title IV - Safe and Drug Free Schools and Communities 60.5% 35.4% 4.0% 52.9% 26.5% 

Safe Schools– Healthy Students Initiative 26.0% 66.5% 7.5% 16.2% 10.2% 

State Sources

State Special Education Funds 58.3% 32.1% 9.6% 51.5% 3.4% 

State General Funds 47.4% 43.8% 8.7% 40.2% 6.7% 

Tobacco Tax or Settlement 12.7% 79.8% 7.5% 5.9% 6.8% 

Lottery Funds 3.5% 87.6% 8.8% 0.9% 0.2% 

Local Funds 54.4% 34.3% 11.3% 47.1% 4.9% 

Service Reimbursement

Medicaid 39.7% 51.0% 9.3% 28.4% 2.0% 

Third Party Payments 11.3% 81.5% 7.2% 5.0% 0.6% 

SCHIP 1.7% 89.1% 9.1% 0.8% 0.0% 

Self-Pay 10.0% 81.4% 8.7% 7.6% 0.3% 

Private Foundation Grants (e.g., RWJF) 4.9% 89.2% 5.9% 2.5% 0.3% 

Other Sources of Funding 10.2% 79.6% 10.2% 10.1% 1.9% 

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. District Questionnaire, Items 7–8
Table 5A

Percentage of School Districts for Which the Source Is Among Their Top Five Sources for Funding Mental Health Services,

by Selected District Characteristics: 2002–2003 of Districts Number IDEA Title 1

MH Community 

Services Block Grant

Title 4

Safe Schools/Healthy

Svc Students Init 

Funding

Education State Special 

Funds

nd Fu State General 

/ Tobacco Tax 

Settlement

Lottery Funds

(Taxes) Local Funds 

Medicaid

Reimbursement

3rd Party Payments

TOTAL 14,752 61.5% 22.3% 6.9% 52.8% 16.1% 51.5% 40.1% 5.8% 0.8% 47.1% 28.4% 4.9% 

Region

Northeast 3,110 77.0% 17.0% 3.7% 58.2% 24.8% 54.6% 33.9% 0.8% 1.2% 71.6% 31.7% 3.7% 

South 5,441 54.0% 26.1% 5.6% 53.2% 5.5% 52.7% 43.8% 2.7% 0.8% 50.0% 31.6% 4.8% 

Midwest 3,330 61.3% 22.1% 7.2% 47.9% 21.3% 54.8% 42.0% 2.9% 0.3% 39.4% 26.3% 7.1% 

West 2,872 59.4% 21.0% 12.1% 52.2% 21.0% 41.9% 37.6% 20.6% 1.1% 23.9% 21.2% 4.0% 

Urbanicity

Urban 2,003 64.8% 35.1% 5.1% 47.5% 19.7% 57.8% 38.8% 9.0% 0.7% 38.5% 28.3% 4.5% 

Suburban 4,773 64.8% 16.7% 6.0% 54.9% 14.4% 55.7% 38.1% 6.4% 1.7% 54.6% 32.4% 3.8% 

Rural 7,976 58.7% 22.4% 7.8% 53.0% 16.3% 47.3% 41.7% 4.7% 0.3% 44.7% 26.0% 5.7% 

District Size

1–5 Schools 10,651 56.9% 24.5% 5.1% 52.4% 15.6% 50.4% 38.9% 6.1% 0.2% 47.1% 25.4% 3.1% 

6–15 Schools 3,100 73.0% 13.5% 10.0% 53.3% 15.4% 52.6% 43.0% 4.3% 2.4% 49.5% 36.1% 10.1% 

16+ Schools 1,001 75.8% 25.7% 15.1% 56.5% 23.7% 59.2% 43.9% 8.2% 2.8% 39.3% 36.2% 8.0% 

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

District Questionnaire, Item 8
Table 6

Average Percentage of Mental Health Expenditures Allocated to Various Categories,

by Selected District Characteristics: 2002–2003

Number of

Districts

Administrative

Overhead

Salaries for

Mental Health

Staff

Contracts With

Community

Organizations or

Providers to

Provide Mental

Health Services

Technical

Assistance,

Professional

Development and

Training All Other

TOTAL 14,752 4.4% 57.1% 26.1% 8.2% 2.2%

Region

Northeast 3,110 5.2% 64.8% 22.2% 5.8% 1.4%

South 5,441 3.8% 63.1% 21.5% 6.9% 3.3%

Midwest 3,330 5.0% 43.0% 37.6% 7.8% 2.3%

West 2,872 3.7% 52.2% 26.6% 14.4% 1.0%

Urbanicity

Urban 2,003 3.1% 53.8% 27.7% 12.8% 1.7%

Suburban 4,773 5.4% 63.3% 24.4% 4.6% 0.6%

Rural 7,976 4.0% 54.0% 26.8% 9.2% 3.4%

District Size

1–5 Schools 10,651 4.2% 54.8% 27.4% 9.2% 2.5%

6–15 Schools 3,100 4.4% 62.9% 23.8% 5.5% 1.0%

16+ Schools 1,001 5.6% 63.4% 19.7% 6.6% 3.1%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

District Questionnaire, Item 9
Table 7

Percentage of School Districts Using Various Methods To Direct Mental Health Resources to Schools,

by Selected District Characteristics: 2002–2003

Number of

Districts

On a Per Pupil

Basis (Based on

Student

Enrollment)

Targeted to

Schools Based on

Mental Health

Needs of

Students

Resources are

Equally

Distributed

(Regardless of

School Size) Other Missing

TOTAL 14,752 33.8% 46.6% 18.1% 14.3% 4.5%

Region

Northeast 3,110 42.1% 46.3% 13.9% 13.2% 0.9%

South 5,441 28.8% 45.6% 23.7% 12.1% 6.4%

Midwest 3,330 35.4% 40.0% 21.0% 22.0% 1.7%

West 2,872 32.5% 56.7% 8.7% 10.6% 8.0%

Urbanicity

Urban 2,003 33.6% 46.0% 17.4% 19.7% 0.5%

Suburban 4,773 36.1% 48.1% 15.9% 14.5% 3.6%

Rural 7,976 32.5% 45.9% 19.6% 12.8% 6.0%

District Size

1–5 Schools 10,651 32.4% 44.7% 16.6% 13.0% 5.5%

6–15 Schools 3,100 36.2% 49.4% 22.0% 16.8% 1.6%

16+ Schools 1,001 41.2% 58.6% 22.6% 20.0% 2.3%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

District Questionnaire, Item 10
Table 8

Percentage of School Districts Reporting the Degree to Which Various Funding Restrictions and Obstacles are Impediments to

Delivery and Coordination of Mental Health Services, 2002–2003

Restriction/Obstacle Not At All Minor Extent

Moderate

Extent Major Extent 

Funding Source Obstacles

Restrictions on Location of Service Provision 36.9% 25.6% 23.4% 9.9% 

Restrictions on Types of Mental Health Services Provided 19.4% 27.1% 30.6% 18.5% 

Restrictions on Types of Staff Who Can Provide Services 20.9% 29.8% 29.5% 15.7% 

Limitations on Providers Considered Eligible To Provide Service 22.9% 30.2% 27.4% 14.9% 

Limitations on the Number of Sessions or Duration of Mental Health Services 21.8% 23.5% 29.9% 20.7% 

Other Funding Obstacles

Complexities of Using Multiple Funding Sources To Fund Mental Health Positions or Programs 20.6% 27.7% 26.3% 20.3% 

Lack of Administrative Support For 3rd Party Billing for 3rd Party Reimbursement 42.1% 20.8% 14.5% 14.0% 

Insufficient Community Mental Health Resources 14.0% 21.2% 24.5% 36.7% 

Competing Priorities for Use of Funds (e.g.. Focus on Improving Academic Achievement) 9.9% 15.7% 28.0% 41.9% 

Restrictions with Insurance and HMOs 29.7% 19.3% 21.4% 21.6% 

Other Obstacles

Barriers Involving Parents or Guardians 9.4% 39.6% 37.7% 10.3% 

Resistance from Non-Mental Health School or District Staff 39.0% 40.4% 13.6% 3.9% 

Resistance from the Community 49.5% 37.8% 8.5% 0.9% 

Other Obstacles 82.4% 0.3% 2.2% 8.2% 

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

District Questionnaire, Item 10
Table 9

Percentage of School Districts Reporting Changes in Funding Versus Changes in Need

for Mental Health Services Since the 2001-2002 School Year: 2002–2003

TOTAL

Funding

Decreased

Funding

Remained the

Same

Funding

Increased Missing

TOTAL 100.0% 33.2% 40.0% 14.4% 12.2%

Q13: Change in Need of General Education Students for MH Services

Need Decreased 2.0% 51.8% 43.4% 4.6% 0.0%

Need Remained the Same 24.6% 21.8% 61.1% 5.1% 11.8%

Need Increased 69.2% 38.6% 34.8% 18.9% 7.6%

Missing 4.0% 0.0% 0.0% 0.0%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

District Questionnaire, Items 12,13
Table 9A

Percentage of School Districts Reporting Changes in Level of Funding and Level of Need for Mental Health Services

Among General Education Students Since the 2000–2001 School Year, by Selected District Characteristics: 2002–2003

Number of

Districts

Funding

Decreased

Funding

Remained the

Same

Funding

Increased Missing / NA Need Decreased

Need Remained

the Same Need Increased 

TOTAL 14,752 33.2% 40.0% 14.4% 12.2% 2.0% 24.6% 69.2% 

Region

Northeast 3,110 28.9% 36.2% 26.8% 7.9% 0.1% 21.1% 77.3% 

South 5,441 34.9% 42.2% 9.3% 13.5% 1.0% 27.0% 67.5% 

Midwest 3,330 22.8% 50.0% 12.7% 14.3% 3.6% 29.7% 62.5% 

West 2,872 46.4% 28.5% 12.7% 12.1% 4.2% 17.8% 71.5% 

Urbanicity

Urban 2,003 29.1% 38.6% 24.5% 7.6% 0.3% 16.3% 76.3% 

Suburban 4,773 36.7% 41.4% 13.4% 8.4% 0.8% 24.2% 74.1% 

Rural 7,976 32.1% 39.6% 12.5% 15.6% 3.2% 26.9% 64.5% 

District Size

1–5 Schools 10,651 33.0% 39.8% 14.0% 13.0% 2.4% 26.9% 65.8% 

6–15 Schools 3,100 31.4% 42.7% 15.1% 10.5% 1.0% 20.5% 75.8% 

16+ Schools 1,001 39.8% 34.8% 16.7% 8.5% 1.1% 12.3% 84.8% 

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

District Questionnaire, Items 12,13
Table 10

Percentage of School Districts Reporting Changes in Mental Health Resources of Various Types

Since the 2000–2001 School Year: 2002–2003

Mental Health Resource Decreased Stayed the Same Increased Missing/NA

Number of Mental Health Staff 16.9% 51.2% 21.0% 10.9%

Number of General Education Students Served 9.6% 27.7% 56.4% 6.4%

Range of Mental Health Services Offered 13.2% 55.8% 24.8% 6.2%

Professional Development and Training 10.4% 56.0% 25.2% 8.3%

Referrals to Outside Providers 3.0% 31.0% 59.5% 6.5%

Availability of Outside Providers To Deliver Services to

Students

30.6% 50.8% 12.5% 6.2%

Outreach to Parents 7.1% 49.8% 36.5% 6.7%

Other Mental Health Resource 0.9% 0.1% 1.5% 97.5%

Source: School Mental Health Services in the United States, 2002–2003,

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

District Questionnaire, Item 14