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Background: Collaborative care (CC) is a well-established approach for the delivery of accessible behavioral health services in integrated health care settings. Substantial evidence supports its effectiveness in improving the quality and outcomes of adult services, and growing research indicates utility with child and adolescent populations. Methods: To date, studies examining CC models for youth have focused exclusively on primary-care settings. Nevertheless, as the most common integrated service delivery setting for youth, the education sector is an equally important context for improving access to behavioral health services for children and adolescents. Results: We provide a narrative review of the literature on CC, describes the relevance of CC to schools, and details its alignment with contemporary movements in education and school-based behavioral health. Conclusions: Potential adaptations of the CC model for use in schools are detailed to improve: (1) behavioral health service accessibility, (2) the capacity of schools to provide behavioral health services, and (3) school service effectiveness through use of evidence-based practices. Although little research has explored the applicability of CC in the education sector, the model holds potential promise to improve the quality and efficiency of school-based behavioral health services.

Background: To compare the mental health status of children of immigrant (COI) and non-immigrant (NI) parents and to determine whether differences in mental health status between COI and NI vary across 4 racial/ethnic groups. Methods: We conducted universal mental health screening of 2374 sixth graders in an urban public school district. To screen, we administered well-validated adolescent depression and disruptive behavior problem questionnaires. We evaluated associations between child mental health, parent immigration status, and race/ethnicity using binomial regression. Results: Among Asian American/Pacific Islanders and Latinos, COI had significantly higher depression and disruptive behavior scores compared to NI. For Blacks/African Americans, children of NI parents had significantly higher disruptive behavior scores compared to COI. For European Americans, scores of COI and NI did not differ and were relatively low. Conclusion: Our study suggests that how the emotional health of COI is faring relative to children of NI depends on the child's race/ethnicity.

Background: School-based screening for health conditions can help extend the reach of health services to underserved populations. Screening for mental health conditions is growing in acceptability, but evidence of cost-effectiveness is lacking. This study assessed costs and effectiveness associated with the Developmental Pathways Screening Program, in which students undergo universal classroom emotional health screening and those who have positive screens are provided with on-site clinical evaluation and referral. Methods: Costs are enumerated for screening and clinical evaluation in terms of labor and overhead and summarized as cost per enrolled student, per positive screen, and per referral. Cost-effectiveness is summarized as cost per student successfully linked to services. School demographics are used to generate a predictive formula for estimating the proportion of students likely to screen positive in a particular school, which can be used to estimate program cost. Results: Screening costs ranged from $8.88 to $13.64 per enrolled student, depending on the prevalence of positive screens in a school. Of students referred for services, 72% were linked to supportive services within 6 weeks. Cost-effectiveness was estimated to be $416.90 per successful linkage when 5% screened positive and $106.09 when 20% screened positive. A formula to estimate the proportion of students screening positive proved accurate to within 5%. Conclusion: Information concerning costs and effectiveness of school-based emotional health screening programs can guide school districts in making decisions concerning resource allocation. (Contains 1 figure and 5 tables.)

Background: Depression is prevalent among children and adolescents and often goes untreated with adverse effects on academic success and healthy development. Depression screening can facilitate early identification and timely referral to prevention and treatment programs. Conducting school-based emotional health screening, however, raises the controversial issue of how to obtain informed parental permission. Methods: During implementation of a depression screening program in an urban school district in the Pacific Northwest, the district's parental permission protocol changed from passive (information provided to parents via a school mailer with parents having the option to actively decline their child's participation) to active (information provided to parents via a school mailer requiring the written permission of the parents for their child's participation). This change provided an opportunity to examine differences in participation under these 2 conditions. Results: A total of 1533 students were enrolled in this program across both years. Compared to conditions of passive permission, participation was dramatically reduced when children were required to have written parental permission, dropping from 85% to 66% of eligible children. Furthermore, under conditions of active parental permission, participation decreased differentially among student subgroups with increased risk for depression. Conclusions: Successful implementation of school-based emotional health screening programs requires careful consideration of how to inform and obtain permission from parents. (Contains 2 tables and 1 figure.)