Sustaining school-based mental health services: a case study of the implementation of the San Diego Unified School District's Mental Health Resource Center

Problem: A major gap in adolescent mental health services exists in the United States. Nearly 80% of children and adolescents who are defined as needing mental health services are not receiving mental health care. School-based services have demonstrated promise as a strategy to address this gap. The purpose of this dissertation is to determine how a large urban school system implemented and sustained an innovative service of care model in response to financial, human resource, and community constraints and opportunities. Methods: A case study of the San Diego Unified School District’s (SDUSD) Mental Health Resource Center (MHRC) was completed using Pettigrew and Whipp's Content, Context, and Process Model of Strategic Change (PWM) as the theoretical framework that guided the research. Three primary sources of evidence were collected covering a fifteen-year period of implementation (1999–2014): 1) documents; 2) archival records; and, 3) interviews. The interviews were conducted with local and state stakeholders (n=20) and with students who received MHRC services and their parents (n= 15). A chronological reconstruction was completed and all data underwent a content analysis to organize and identify emergent themes based on the PWM framework. Results: Eight factors were identified as critical to the implementation and sustainability of the MHRC: establishing the legitimacy of school as environment for the delivery of mental health services; aligning education and mental health policies; implementing cross systems collaboration; utilizing data to improve performance and prioritize services; strengthening parent and student involvement; commitment to lead; institutionalization of mental health training; and, investment in staff. Further analysis assessed potential system improvements and opportunities for new collaborations and produced sustainability recommendations for SDUSD and MHRC administration, staff, and stakeholders. Conclusion: The MHRC provides a unique systems model that can inform best practices and policy decisions regarding the implementation and sustainability of school-based mental health services. Lessons learned from the sustainability of the MHRC support schools as a legitimate environment for the delivery of mental health services and the integration of mental health services in schools as a feasible strategy to improve student academic and mental health outcomes