Date on Paper


Document Type

Doctoral Paper

Degree Name




Committee Chair

Galloway, Lynette

Committee Member

Nash, Whitney

Author's Keywords

mental health care; children; adolescents; school nurses


Nearly one in six American children between the ages of six and 17 have a treatable mental disorder (American Academy of Family Physicians [AAFP], 2020). Still, less than half do not receive help from a mental health professional (Whitney & Peterson, 2019). School nurses have an opportunity to bridge the gap by improving youth access to mental health care. Purpose: The purpose of this quality improvement project was to implement and evaluate a mental health referral pathway for school nurses. The specific aims were to improve school nurses' preparedness to recognize and address mental health concerns and to increase the proportion of school nurses that made mental health referrals in a large metropolitan public school district. Intervention: School nurses received weekly informative presentations regarding resource mapping, identification of common mental health "red flags," utilization of a mental health triage tool, and documentation of student referrals to mental health resources over five weeks. Methods: Outcome measures included preparedness to identify and address mental health concerns, the proportion of school nurses that made mental health referrals and feedback from participating nurses. Self-Rated Preparedness Surveys and retrospective chart audits were conducted pre-intervention and post-intervention. Background data and feedback were collected via questionnaires. Results: The results revealed an increase in the participating school nurses’ self-rated preparedness to recognize when a student’s appearance indicates psychological distress. The results demonstrated an increase in the proportion of participating school nurses that made mental health referrals, although this increase was not statistically significant. The results of this study support further evaluation of barriers to school nurses making mental health referrals, development of additional programs to help address barriers, and further evaluation of similar programs in other settings.

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