School Nurses' Perspectives on the Implementation of a Behavioral Health Referral Process

Increasing youth behavioral health needs in the United States have underscored the essential role school nurses can play in mitigating them. In response, the District of Columbia Department of Health developed the Behavioral Health Referral Process (BHRP) as a standardized guide, integrating school nurses into multidisciplinary teams and improving students' access to behavioral health services. To assess the BHRP's strengths and opportunities while understanding factors that could impact its implementation, key informant interviews were conducted using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework with seven school nurses and school nurse managers working in DC schools. Participants anticipated challenges related to the BHRP, from managing competing priorities to overcoming stigmas. Still, nurses reported the BHRP will enable a more coordinated referral process that promotes student linkage to care. The findings can inform efforts to assess and optimize school behavioral health referral processes as part of larger, comprehensive care systems.