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Purpose: One in 7 children ages 2-8 have a behavioral, mental or developmental diagnosis. The prevalence of mental health disorders increases in adolescence to over 20%. Only 36% of youth who have a mental health disorder in their lifetime receive treatment. School-based services can address barriers to care. The purpose of this study was to determine the frequency and indication of referrals for students to 19 hospital-employed clinical social workers placed within a school district during one academic year (2017- 2018) and how the indication varies with level of schooling.

Methods: Students were referred to social workers by self, classmates or school personnel. The student’s school name, age, indication for assessment and place of referral were collected. The entries were analyzed if a school was listed with the entry. District demographics were collected from publicly accessible sources. Descriptive analysis was performed.

Results: For the 2017-2018 school year, enrollment for K-12 students was over 20,000. Race of the students were primarily Caucasian (74%). All schools had less than 10% receiving free/reduced lunches. Indications for triage totaled 1643, 43% from high school (HS), 26% from middle school (MS), 30% from elementary school (ES). Behavioral problems were most frequent (23%), followed by anxiety (22%). Average age for behavioral problems was 10.6(SD 3.5); with 16% HS, 27% MS, and 69% ES. Average age for anxiety was 13.3(SD 3.3); with 41% HS, 27% MS, and 32% ES. Suicide ideation/attempt had a frequency of 10% with an average age of 14.5(SD 3.0); with 62% HS, 13% MS, and 26% ES. Depression had a frequency of 5% with an average age of 14.0(SD 2.656) and 46% HS, 33% MS, and 21% ES. ADHD had a frequency of 3% with 28% HS, 17% MS, and 55% ES.

Conclusions: Internalizing disorders were the most frequent indications. The indications varied by level of schooling. School mental health professionals like social workers are able to provide triage and community mental health referrals to some. An innovative approach is needed within the schools. Currently, we are conducting a multimodal (survey, focus group, interviews) needs assessment within the school district to inform an innovative approach.


Behavioral Medicine | Pediatrics


Presented at the Society for Developmental & Behavioral Pediatrics Annual Meeting, Anaheim, CA, September 2018.

Social Work Triage in a School District for the School Year 2017-2018