National Trends in School-based Health Centers With and Without Mental Health Providers


Satu Larson, Susan Chapman, Joanne Spetz and Claire Brindis

August 1, 2017

Children and adolescents exposed to chronic trauma have a greater risk for mental health disorders and school failure. Children and adolescents of minority racial/ethnic groups and those living in poverty are at greater risk of exposure to trauma and are less likely to have access to mental health services. School-based health centers (SBHCs) may be one strategy to decrease health disparities.


Chronic childhood trauma is a major social and public health problem in the United States. Approximately 80% of US children and adolescents have experienced childhood trauma in the form of victimization. Exposure to childhood trauma is associated with academic problems, emotional and behavioral difficulties, sexually risky behavior and substance use, all of which can be closely tied with mental health issues.

Current estimates indicate that 1 in 5 children and adolescents have a diagnosable mental health disorder that can cause severe lifetime impairment. Yet, up to 70% of children and adolescents with mental health disorders do not receive mental health services, with minorities and lower socioeconomic youths disproportionately not receiving treatment. Mental health disorders negatively impact social and academic functioning with related decreased opportunities for educational, employment and social mobility advancement. Untreated mental health disorders can lead to severe disability and even death from suicide.


A search of the PsycINFO and PubMed databases was conducted. Empirical studies and literature reviews conducted in the past 10 years of US child and adolescent populations and of US SBHCs between 2003 and 2013 were included. The search terms used to review the 4 major topics of this paper are childhood trauma’s effects, mental health care disparities, and health equity and academic achievement as they pertain to SBHC mental health services.


Schools are an important point of contact for prevention, identification and treatment of mental health issues and disorders. Schools have increasingly become the focus for health interventions and services because of their availability and accessibility to students. There is some evidence that SBHCs have demonstrated the ability to increase access to and utilization of quality cost-effective health and mental health services for children and adolescents, especially in underserved populations. Expanding this model of care has the potential to increase health equity in underserved-risk youths.