Minnesota Title V MCH Needs Assessment Fact Sheets

Children with Special Health Needs

Behavioral Health Services in Schools

Summer 2004

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Size of the Problem

Data on a representative sample of children and adolescents in the 1990s show that at any time 1 in 6 will have a psychiatric disorder ± and at least 1 in 3 will have 1 or more psychiatric disorders by age 16 years.[1] In Minnesota, there could be as many as 160,000 children with a psychiatric disorder in school.

17,051 students in Minnesota are diagnosed as having an emotional or behavioral disorder and being in need of special education services.

The Office of Special Education Programs (OSEP) has estimated that 3-5% of children and youth with disabilities have a coexisting mental health disorder. Children who have physical problems, intellectual disabilities, low birth weight, family history of mental and addictive disorders, multi-generational poverty, caregiver separation, abuse, and neglect are at greater risk for experiencing mental health disorders than those without such conditions.[2]

Analysis of the Minnesota Student Survey of 6 th, 9 th and 12 th Grade Students 2001 in terms of the presence of a chronic health condition suggests that students with special health needs are at increased risk for depression, social isolation and suicide attempts than those without special needs.


Nationally, 16% of all children receive any mental health services.

  • Minorities have less access to mental health services and are less likely to receive needed care.[3]
  • Analysis of the 1994-95 National Health Interview Survey Disability Supplement found that 40% of children with disabilities with poor psychosocial adjustment received treatment.[4] Of those receiving care, 70-80 % receive that care in a school setting.[5]

In Minnesota, children with special health care needs receiving special education services are more likely to need mental health care than children with special health care needs not in special education. (See chart below)

Need for Mental Health Care by Whether Child 3 or Older was Receiving Special Education Services. (Weighted numbers and percents)


Receiving special education services


During the past 12 months, was there any time when the child needed mental health care or counseling?

























Fifty-eight percent of the children referred to MCSHN Development and Behavior Clinics for evaluation are from school districts of less than 1,500 students indicating the challenges smaller districts have in accessing such services on behalf of children and youth.

Numerous studies have shown that untreated mental health problems can develop into more serious psychosocial impairments as the child matures, placing them at risk for school failure, dropping out, and being placed in more restrictive settings (e.g., juvenile detention facilities and care and treatment centers).[6]

Untreated mental health problems impact the child, family, schools and communities emotionally and financially and have serious implications for both short term and long-term quality of life.


In the report entitled Mental Health: A Report of the Surgeon General (National Institute of Mental Health, 1999), the Surgeon General suggests that schools become "portals of service" for children and families. The report encouraged schools to develop a range of multiple resources including school-based services, mental health and social services to address the needs of children and youth experiencing mental health or addictive disorders.

  • School-based mental health services can include prevention-focused activities to create a healthy school environment, selective interventions with groups of students whose circumstances place them at higher risk for emotional or behavioral health problems, as well as diagnosis and treatment of individual students with specific health needs.[7] It has been demonstrated that school-based programs were more likely to serve minority and poor children than community-based clinics.[8]

Mental health literature has revealed effective and promising school-based practices in six areas:

  • Enhancing teacher capacity for addressing problems and for fostering social, emotional, intellectual, and behavioral development, for example, through pre-referral intervention, tutoring, and; reduction in class size;
  • Enhancing school capacity to handle the variety of transition concerns (e.g., early childhood education, before- and after-school programs, vocational and career education, and programs to facilitate transition to middle school, high school, and between regular and special education);
  • Prevention, responding to and minimizing impact of crises, e.g., school-wide and classroom programs to reduce school violence, create safe schools, and foster resiliency;
  • Enhancing home and family involvement, e.g., parenting and adult education;
  • Building community linkages and collaborations, e.g., community outreach, mentoring, volunteer program, and school-community partnerships;
  • Providing special assistance to students and families, (e.g., school-based, school-owned, and school-linked services).[9]

The Mental Health Leadership Committee and the Infant Mental Health Committee developed under the auspices of the Minnesota Department of Education Division of Special Education and comprised of state agency representatives, parents, mental health professionals, and local education and school health representatives recommended the development of a process for interagency teaming and coordination enabling access to school and community mental health services as needed for children and youth with disabilities, age birth to 21.

The Minnesota Children with Special Health Needs Program (MCSHN) provides multidisciplinary development and behavior evaluations for approximately 180 children per year in Greater Minnesota. Most of the children are referred by their local school districts. Preliminary analysis of an evaluation of the Development and Behavior Clinics results in parents reporting improved school performance for nearly 80% of the children seen in clinic, improved behavior at school for 75% of the children and improved behavior at home for 73% of the children.


The state and the vast majority of local public health agencies have established mental health and well being as a public health priority.

The Minnesota System of Interagency Coordination provides leadership in interagency efforts at the state and local levels. It has established mental health needs of students with special education disabilities as a priority.

Some Minnesota communities are using Family Services Collaborative dollars to fund school services such as social workers, family facilitators and early childhood mental health therapists.

± one or more of separation anxiety disorder, generalized anxiety disorder, simple phobia, panic disorder, agoraphobia, major depression, dysthymia, depression nos, bipolar disorder, ADHD, conduct disorder, ODD, anorexia nervosa, bulimia, mania, trichotillomania, enuresis, encopresis, substance use disorders, PTSD, psychosis, or obsessive compulsive disorder.
1. Costello, E, Mustillo, S., Erkanli, A., Keeler, G., Angold, A., "Prevalence and Development of Psychiatric Disorders in Childhood and Adolescence." Archives of General Psychiatry Vol 60;837-844. August 2003.
2. Minnesota Department of Education. "Minnesota's Self-Improvement Plan". February 2002.
3. ibid
4. Witt, W., Kasper, J., Riley, A. "Mental Health Services Use among School-Aged Children with Disabilities: The Role of Sociodemographics, Functional Limitations, Family Burdens and Care Coordination". HSR: Health Services Research 38:6, Part 1. December 2003.
5. www.healthinschools.org. [Attn: Non-MDH Link] "Children's Mental Health Needs, Disparities and School Based Services: A Fact Sheet"; website accessed on 6-2-04.
6. Minnesota Department of Education. "Minnesota's Self-Improvement Plan". February 2002.
7. www.healthinschools.org. [Attn: Non-MDH Link] "School-Based Mental Health Services: A Select Bibliography"; website accessed on 6-2-04.
8. v Nastasi BK, Pluymert,D, Varjas, K, Moore, RB. Exemplary Mental Health Programs: School Psychologists as Mental Health Service Providers. 3 rd edition. 2002; National Association of School Psychologists. p.xiv.
9. ibid.