School-based mental health clinics.

TOPIC: The research, planning, implementation, and evaluation of school-based mental health clinics located throughout a large metropolitan city, which were established in a joint project by four local mental health centers. PURPOSE: To explain the evolution of the idea of providing school-based mental health to a large, inner-city population, including the delineation of team roles and responsibilities. SOURCES: Nursing, medical, social work, and educational literature. Notes detailing the formation of InteCare, the school-based mental health clinic system. CONCLUSIONS: Providing mental health services in inner-city schools improves access and removes barriers to treatment for this population. Working collegially with school personnel and families significantly improves the academic function of the children, the functioning of the families, and the relationships between parents and schools.

An evidence based alcohol screening, brief intervention and referral to treatment (SBIRT) curriculum for emergency department (ED) providers improves skills and utilization.

OBJECTIVE: Emergency Departments (EDs) offer an opportunity to improve the care of patients with at-risk and dependent drinking by teaching staff to screen, perform brief intervention and refer to treatment (SBIRT). We describe here the implementation at 14 Academic EDs of a structured SBIRT curriculum to determine if this learning experience improves provider beliefs and practices. METHODS: ED faculty, residents, nurses, physician extenders, social workers, and Emergency Medical Technicians (EMTs) were surveyed prior to participating in either a two hour interactive workshops with case simulations, or a web-based program (www.ed.bmc.org/sbirt). A pre-post repeated measures design assessed changes in provider beliefs and practices at three and 12 months post-exposure. RESULTS: Among 402 ED providers, 74% reported < 10 hours of prior professional alcohol-related education and 78% had < 2 hours exposure in the previous year. At 3-month follow-up, scores for self-reported confidence in ability, responsibility to intervene, and actual utilization of SBIRT skills all improved significantly over baseline. Gains decreased somewhat at 12 months, but remained above baseline. Length of time in practice was positively associated with SBIRT utilization, controlling for gender, race and type of profession. Persistent barriers included time limitations and lack of referral resources. CONCLUSIONS: ED providers respond favorably to SBIRT. Changes in utilization were substantial at three months post-exposure to a standardized curriculum, but less apparent after 12 months. Booster sessions, trained assistants and infrastructure supports may be needed to sustain changes over the longer term.