The Alhambra Unified School District (AUSD) has an enrollment of 18,541, with students' families being predominately low-income immigrants. Approximately 53 percent are Asian, 40 percent Latino, 1 percent African-American, and 9 percent Caucasian and others. AUSD students speak 27 different languages and over half are non-citizens, with one-fourth having arrived in the United States less than three years ago. Nearly 70 percent of students reside in low-income homes and between 70 and 81 percent of students receive free and reduced-price lunches. One hundred percent are eligible for Title I funding.

Gateway to Success In 2008 U.S. Department of Education Safe Schools/Healthy Students grant—$7 million over four years—provides the funding for this program, which links district students with counselors or other health and wellness resources to help them with the challenges that interfere with their academic, personal, or social adjustment. Mental health and wellness programs are brought directly to school sites and services are available to all students, whether they have health insurance or not. Sixteen hundred students now receive school-based mental health and other supportive services through the Gateway program (much of it through community-based providers, without any cost to AUSD), which starts at the pre-school level and extends through the twelfth grade.

Mental Health Need

It is estimated that approximately one in five youth experience mental health issues. By adolescence, approximately 40% of youth meet diagnostic criteria for a mental health disorder Unmet mental health needs may impact the transition to adolescence and adulthood, resulting in low academic achievement and, eventually, low job performance, lower levels of physical fitness, and increased psychological suffering and left untreated, these issues often worsen and significantly impact adulthood. This extreme need for mental health services by youth has significant public health implications. While the need for mental health intervention is high, service access and utilization is extremely limited.

Our schools have the ability to serve all children and provide an ideal environment to identify and address mental health needs through school Based Mental Health (SBMH). A Comprehensive mental health service models increase availability of mental health services for our youth. Services, available in the schools, provide positive impact on the student population and are likely to engage in problem behaviors that interfere with learning. Accessibility to school based mental health services contribute to the reduction of stigma by students and increases the likelihood that they will seek mental health help.

Gateway Overview

The goal of Gateway To Success is to increase access to quality mental health care by development of an innovative approach in order to link the school system with the local mental health system resulting in increased service capacity and access. Gateway has been developed to align with a three tier public health framework aimed at improving prevention, diagnosis, and treatment services. The continuum of efforts addresses; 1) universal prevention strategies aimed at reducing risk factors and enhancing protective factors, reducing difficulties before they occur; 2) early intervention emphasizing early identification of and intervention for youth at risk; and 3) intensive strategies involving treatment to reduce the impact of existing problems. This framework is a district wide and employs a multi-layered approach incorporating comprehensive prevention and intervention services to reduce campus violence, student behavioral and substance-related problems, and to increase the reach of school base mental health.

School Based Management System

The key to this framework is a multidisciplinary management team consisting of leadership from the school district, community partners, and higher education. The Mental Health Integration Team (MHIT) is dependent on Referral Form in order to review each student's referral at the MHIT meeting and link students to the appropriate service provider. The referral form is completed by school staff, includes a checklist of problems: (a) difficulties with mood/affect, (b) behavior problem, (c) difficulties with peers, (d) physical/somatic complaints, (e) absenteeism, (f) alcohol, tobacco and other drug involvement, (g) exposure to trauma, (h) justice system involvement, (i)onset of serious psychiatric illness, (j) disciplinary action, (k) family-related difficulties (l) in stressed families, (m) at risk for school failure, and (n) academic difficulties. The referral form also includes demographic information including gender, ethnicity, age, primary language spoken at home, grade, parent's marital status, and insurance eligibility. Information, derived from the referral form, is integrated in the computer based surveillance system.

During a MHIT meeting a representatives from each partnering agency along with school staff and administration participates and reviews the Gateway referrals. The MHIT provides site based management, supervises school-wide student support issues and crises, coordinates universal and early interventions, and collaborates with school site staff. The MHIT monitors students identified as at risk, facilitates their referral to and engagement in services, and supports families through the referral process. Representatives from partnering agencies, participating on the MHIT, deliver a range of evidenced-based, developmentally appropriate approaches. This ensures quality of treatment, increasing the range, quantity and availability of services. Culturally responsive mental health providers who speak predominant languages are included on the School Site Team.

Referrals to mental health services are initiated by school staff; including teachers, law enforcement, administrators, parents, and students. District staff participates in training focused on the identification of mental health concerns in students, associated issues, and referral procedures which include; the completion of a universal referral form and a problem checklist. The referral process allows for identification of students who have a range of psychological symptoms or are at risk for psychological distress. Completed referral forms are submitted to the MHIT and the team assigns and tracks each referral to mental health service providers either employed or contracted by the school district.

Training

School personnel and partnering agencies participate in cross-training (training multiple disciplines together) on topics including identifications of mental health risk factors , available services, referral protocol, school culture, collaboration strategies, confidentiality and family privacy, and culturally sensitive intervention. To increase capacity, school and partnering agency staff participate in crisis response training.

Gateway To Success

The Gateway Program encourages teamwork and collaboration between school personnel and partnering agencies with the goal of increasing capacity and service access. Collaboration is interwoven at every program level of this comprehensive School Base Mental Health system. Leadership is provided through the MHIT which incorporates representation from a continuum of stakeholder with the goal of improved care and coordination. This comprehensive approach is built upon a number of strategies that have demonstrated positive outcome. The SBMH system has allowed for increased capacity for care through a network of partnerships between the district, higher education, and community agencies, resulting in thousands of students being linked to treatment through the Gateway To Success Program.

SBMH approaches have been implemented across the country as a means of supporting academic, behavioral, and social emotional needs of all students. These programs emerged to address barriers to mental health services and increasing access. SBMH systems reveal the potential to address unmet mental health need in youth.