A Case Study of the Implementation of the San Diego Unified School District's Mental Health Resource Center

Background: It is estimated that one half of all mental health disorders experienced throughout the lifetime begin by age 14. Yet, nearly 80% of children and adolescents, between the ages of 6 to 17 who were defined as needing mental health services, are not receiving mental health care. School based health services are as a strategy to address this gap. Effective implementation strategies for school health initiatives is largely unknown, including dissemination, replication, and sustainability of existing models. San Diego Unified School District’s Mental Health Resource Center (MHRC) was established in 2001 as a decentralized, community oriented, “clinic without walls.” The purpose of this study was to determine how the MHRC adapted, evolved, and sustained itself as a service-of-care model in response to financial, human resource, and community factors.

Methods: This implementation study used a case-study methodology that included document and archival review and analysis; a series of qualitative interviews with state and local stakeholders; and a series of retrospective interviews with students who received MHRC services and their parents. Researchers used a Systems of Change framework to describe the cycle of Adoption to Sustainability.

Results: Stakeholders identified the following factors as critical to the ongoing implementation and sustainability of the MHRC: Organizational leadership, Organizational flexibility and Managed growth; Parent/Family communication and engagement; Staff expertise, coaching and training; Evaluation and Outcomes focus; Teacher and School Staff training and communication; and Community Accountability.

Implications: Results will be structured to inform best practices and influence policy decisions regarding the implementation and sustainability of school based mental health services to improve student academic and mental health outcomes.