Children with Behavioral/Mental Health Disorders and School Mental Health Nurses in Australia Graeme Browne, RN, PhD, Andrew Cashin, RN, MHN, NP, PhD, and Iain Graham, RN, RMN, PhD Graeme Browne, RN, PhD, is Nurse Researcher; Andrew Cashin, RN, MHN, NP, PhD, is Professor of Nursing; Iain Graham, RN, RMN, PhD, is Professor of Healthcare Practices and Head of School, Health and Well-being Research Cluster, School of Health and Human Service, Southern Cross University, Lismore, New South Wales, Australia. Search terms: Behavior, case management, mental health, nurse, school, Australian school nursing Author contact: gbrowne@scu.edu.au, with a copy to the Editor: poster@uta.edu doi: 10.1111/j.1744-6171.2011.00306.x TOPIC: This review of the literature addresses Australian school mental health nursing is an emergent field of practice. PURPOSE: Children with behavioral/mental health disorders present challenges to schools, teachers, and their families. They can be disruptive in class, inappropriate with their peers, and perform poorly academically. Often this group of children do not respond to the school’s usual strategies to support appropriate behavior. When children with behavioral/mental health disorders do not receive specialized support based on their problems and needs, their problems can escalate over time and in ado- lescence their behavior may become more challenging, with increased aggression, substance use, contact with the criminal justice system, and school failure with or without dropout. CONCLUSION: Mental health nurses, working as case managers, could be effective in the support of children with behavioral/mental health disorders in schools. Mental health nurses, because of their professional education and clinical practice, work not only with the individual child but also with family members. They are well prepared to case manage in schools and support individual teachers and health and welfare services in their management of their clients with behavioral/mental health disorders. Introduction The issue of children at risk because of challenging behaviors and mental health problems is important both nationally and internationally. This group of children, without support, has poor outcomes both academically and socially (Bradley, Doolittle, & Bartolotta, 2008; Hayling, Cook, Gresham, State, & Kern, 2008; Larmar, 2008). In the short term, these prob- lems are associated with disruption in school, aggression with peers, difficulties in establishing relationships, and stress at home. In the long term, the problems are associated with lower completion rates of high school, poor employment out- comes, difficulties with socializing and relationships, an increased likelihood of involvement with criminal activities, increased substance abuse, and mental health problems (Brame, Nagin, & Tremblay, 2001; Larmar, 2008).All of which can represent not only reduced quality of life for the indi- vidual and their families, but also increased economic burden on the society. Schools attempt to support their students, but an educa- tion that focuses on and an orientation to the neurotypical means that, for children with challenging behaviors and mental health problems, their inappropriate behavior can be seen as a discipline problem (Forness, Kavale, MacMillan, Asarnow, & Duncan, 1996; Grossman, 2005). Unfortunately, because of the nature of the problems, children with behavioral/mental health disorders often do not respond to normal discipline and come to the attention of services later than any other group (Grossman, 2005). That is, they are the oldest of any special needs group to come to the attention of agencies that can help them. This is despite demonstration of troubling behaviors at a very early age (Hayling et al., 2008). This later identification makes helping the child and their family more difficult (Malmgren & Meisel, 2004). Researchers examining single factors have found that risks rarely occur alone and more often tend to cluster (Gutman, Sameroff, & Cole, 2003). Children often experience reoccurring stressors, or risks that occur in clusters that are multisystemic in nature. If left without intervention, the con- ditions worsen (Fraser, Richman, & Galinski, 1999; Gutman et al., 2003). In an analyses of multiple risk factors, it was found that a single environmental risk factor does not Journal of Child and Adolescent Psychiatric Nursing ISSN 1073-6077 17 Journal of Child and Adolescent Psychiatric Nursing 25 (2012) 17–24 © 2011 Wiley Periodicals, Inc.