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J Adolesc Health. 2003 Jun;32(6 Suppl):70-8.

Funding a full continuum of mental health promotion and intervention programs in the schools.

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Center for School Mental Health Assistance, Department of Psychiatry, University of Maryland School of Medicine, 680 West Lexington Street, 10th Floor, Baltimore, MD 21201, USA.



To assess the availability of public and private financing sources to support comprehensive school mental health programs. The paper focuses on "expanded school mental health" (ESMH) programs, which provide a full array of mental health promotion and intervention services to youth in general and special education through school-community partnerships.


A range of strategies to fund ESMH services are reviewed, including fee-for-service funding, as well as grants, contracts, and other mechanisms from federal, state, local, and private sources.


An objective national study of the characteristics and financing of ESMH programs has yet to be conducted. Existing evidence suggests that funding for these programs is patchy and tenuous. Many programs are being funded through fee-for-service programs, which generally only support the provision of more intensive services (e.g., assessment, therapy) and are associated with significant bureaucracy and other concerns (e.g., the need to diagnose students). As programs move to enhance funding for preventive and mental health-promoting activities and services, there is an increasing need for grants, contracts, and other sources of support.


Progress in the national movement toward ESMH will be promoted through an interconnected agenda of quality improvement, evaluation of program effectiveness, and the advancement of advocacy. These developments will facilitate policy improvements and increased funding for the full continuum of mental health promotion and intervention in the schools.

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