Psychology in the Schools, Vol. 36(5), 1999 © 1999 John Wiley & Sons, Inc. CCC 0033-3085/99/050379-11 SCHOOL-BASED MENTAL HEALTH SERVICES: THE BALTIMORE MODELS LOIS T. FLAHERTY AND MARK D. WEIST Center for School Mental Health Assistance. University of Maryland School of Medicine Through a variety of state and local funding and administrative arrangements. expanded school mental health (ESMH) programs have been developed in nearly half of the 176 Baltimore City schools over the past decade. These programs augment existing services provided by the school and help to ensure that a comprehensive range of services (assessment, prevention. case manage- ment. treatment) are available to youth in special and regular education. Baltimore's leadership in the emerging ESMH field led to the development of the Center for School Mental Health Assis- tance (CSMHA). one of two national centers that provide support and technical assistance to pro- mote comprehensive mental health programs for youth in schools. This paper shares experiences associated with the growth of ESMH programs in Baltimore and activities and initiatives of the CSMHA. © 1999 John Wiley & Sons. Inc. Baltimore has been recognized as a leader in the development of expanded school mental health (ESMH) programs. These programs, which involve comprehensive mental health services including assessment, therapy (individual, family, group), staff consultation, and prevention activities, aug- ment services provided by school-hired mental health professionals such as school psychologists (Flaherty, Weist, & Warner, 1996; Weist, 1997). In Baltimore City, ESMH programs came about as a result of a confluence of factors in the 1980s. The creative leadership of many individuals in the state and local health, mental health, and education systems was involved in responding to perceived unmet needs of children and adolescents for mental health care. These programs are part of a national movement given impetus by the realization that adoles- cents were not being served by the existing health care system and by concern about rising rates of teen pregnancy, sexually transmitted diseases, drug and alcohol use, homicide, and suicide. All of these problems have behavioral origins, so there was an obvious need to incorporate a counseling component if they were to be addressed successfully. In 1985, the Baltimore City Health Department (BCHD) opened seven school-based health centers in high schools in the city. The main focus of these centers was on basic health care, with limited mental-health services provided. Once the centers opened, the experience was similar to that nationwide, in that 22% of visits were' for psy- chosocial reasons, such as stress in families (e.g., substance abuse, neglect), violence exposure, or anxiety. The Medicaid revenues generated by these centers in excess of what was needed to main- tain them were used to hire mental health professionals. The hiring and training of the mental health professionals was by arrangement with the two medical schools in Baltimore, Johns Hopkins Uni- versity and the University of Maryland. Multiple City and State agencies collaborated to develop and support the placement of mental health services in these and other schools so that over a lO-year pe- riod, one-third ofthe 176 schools in Baltimore gained these services (Weist, 1997). Currently, in Bal- timore, almost one half of the city schools contain ESMH programs (Bruns, Glass-Siegel, Walrath, Anderson, & Weist, 1999). MULTIPLE MODELS Although the first mental health programs were adjuncts to school health centers, subsequent- ly other models were added in schools which did not have school based health centers (SBHCs). Within a year of the SBHC projects, a demonstration project involving coordinated mental health Supported by project # MCJ24SH02-01-0 from the Office of Adolescent Health, Maternal and Child Health Bureau (Ti- tle V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services. We express appreciation to Susan Hill for assistance in organizing information on the School Mental Health Program. Correspondence to: Lois Flaherty, M.D., 770 Lantern Lane, Blue Bell, PA 19422. 379