Expanding the vision: the strengths-based, community-oriented child and adolescent psychiatrist working in schools

Because the majority of children with mental health needs are most likely to receive treatment in a school setting, there is a long history of linking child and adolescent psychiatrists to schools. Psychiatrists traditionally have been involved in assessing, diagnosing, and treating the severely mentally ill or consulting with school-based providers. With no end in sight to the dearth of child and adolescent psychiatrists, not to mention child and adolescent behavioral health providers in other disciplines, this role has been broadened in recent years by several programs in which the child and adolescent psychiatrist provides flexible, population-based, systemic, and context-specific approaches to working in schools. In this article, the authors first review some of the traditional roles for child and adolescent psychiatrists working in school mental health settings. Then 2 national programs are highlighted, which successfully integrate psychiatrist trainees into comprehensive school mental health programs. The theoretical approach to a specific community-oriented, strengths-based model for school mental health support used in New Mexico by the University of New Mexico (UNM) Psychiatry Department's Center for Rural and Community Behavioral Health school telepsychiatry program, which supports rural and frontier school mental health programs and school-based health centers, is discussed in detail. The UNM model involves a strength-and resiliency-based collaboration between the child and adolescent psychiatrist, students, families, educators, and those who support them. The psychiatrist co-creates a "community of concern" and support for students, including not only customary participants such as parents, educators, and health care providers but also peers, families of choice, lay professionals, community gatekeepers, and others identified by the student as critical to his or her well-being. The advantages for child and adolescent psychiatry trainees being exposed to a wider variety of potential roles working with schools are also discussed.