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Minority racial/ethnic pediatric populations and those living in poverty are at greater risk of exposure to trauma, development of mental health disorders and school failure, yet are less likely to have access to mental health services (MHS). School-based health centers (SBHCs) staffed with mental health providers may be one strategy for decreasing health care disparities.

Approximately 80% of children and adolescents in the United States have experienced childhood trauma in the form of victimization. Types of victimization include peer– sibling, physical abuse or assault, sexual victimization or assault, exposure to community violence, bullying, maltreatment and witnessing family violence. The most common locations for victimization occurrences are in schools (54%) and in the home (44%). Exposure to victimization and chronic childhood trauma is associated with increased risk for behavioral and mental health disorders. Approximately one in five children and adolescents has a diagnosable mental health disorder that can cause severe lifetime impairment, yet estimates indicate that 70% do not receive mental health services, with youth of lower socioeconomic status and/or minority race and ethnicity even less likely to receive care.

Schools are an important point of contact for prevention, identification and treatment of behavioral health problems because of the accessibility of students. The SBHC is a model of pediatric primary care delivery that offers comprehensive services provided by a multidisciplinary team on school grounds. SBHCs have been shown to increase access to and utilization of high-quality cost-effective health care services for children and adolescents, especially in underserved populations. Even though the SBHC is a successful model of care, fewer than 2% of U.S. schools have one. Among those schools that do have a SBHC, one third of SBHCs do not have a mental health provider as part of their staff.

There is a great need for pediatric mental health services. Exposure to victimization and childhood trauma is pervasive and a major predictor of mental health disorders and poor academic achievement. The provision of mental health screenings, preventive care, treatment, and peer and parent groups at schools has the potential to decrease the impact of adverse childhood experiences. SBHCs are in a position to ameliorate the impacts of exposure to chronic childhood trauma, because a large proportion provide primary preventive health and mental health care. The promotion of the SBHC model of care is a structural intervention with the potential to increase access and utilization of mental health care if services are provided on a suffi- cient basis and if a coordinated physical and behavioral health care plan can be developed for the individual student. This combination of services also has the potential to improve academic achievement, especially among hard-to-reach adolescents, low-income rural and urban pediatric populations, and racial and ethnic minority populations. However, further evidence is needed to assess whether the mental health services currently available in SBHCs are adequate in number and if staff are properly trained to mitigate childhood exposure to trauma. Having services available is a first step that should be followed up with more rigorous evaluation research.