Building a school-based mental health practice that works.

School classroom with school desks and blackboard in South Korea high school.

Many years ago, when I entered into private practice, I knew I had skills and expertise to work with children. Over the years, I found opportunities to develop my knowledge further to be even more efficient in the work I love doing.

I quickly realized that my target population could not get to my office. It is in the suburbs of a state with limited public transportation. I also learned that mental health services for children were sorely lacking. From a clinical perspective, I know that sometimes the best work is done in a client’s natural environment. The social worker in me is firmly rooted in community-based services. The businesswoman had to figure out how to meet a burgeoning and ongoing need.
What I did:
I approached one school about seeing one child who was already receiving services from me. The principal was open to this arrangement. The teachers were less than enthusiastic because they perceived it would disrupt the learning environment, which I understood. However, I worked hard to develop a positive rapport with the teachers and assured them my therapy interventions would ultimately increase this child’s ability to attend to the learning environment. Viola. My client’s behaviors improved, I became a familiar face at the school, and before I know it, the administrator was talking to me about seeing other children.
How I did it:
It became incumbent upon me to figure out a system for working in schools. I didn’t want it to be hit or miss and I wanted to make sure that the services I offered were quantifiably impactful in a positive way.

I had previously managed wellness centers in high schools, so I used that knowledge and experience to create an infrastructure that would work. It’s too easy for therapists to walk in a school and see a child. That’s not how I wanted to function. It made better sense to create a model that was like private practice, only different. It would be different because the school primarily serves as my office. It’s the same because we bill third parties for all clinical services. Nothing else is billable which came with constraints. I wanted to be able to attend school meetings, consult with school personnel and be seen as the in-house mental health expert. The schools in my state don’t have excess money, receiving reimbursement from them was not an option.

I met with the director of special services in one of the primary school districts. She loved my pitch to provide school-based mental health services and contracted with me to serve four schools. The next year, she asked me to increase my ability to take on more buildings and soon, I had to bring on another therapist to help with the growing need. We were getting inundated with referrals. That was in 2008. At this point, my practice contracts with over 80 schools throughout Delaware and is known for school-based mental health. We are also the mental health consultants for other early childhood programs and have expanded to provide training to daycare providers. I currently employ a staff of 38 and we continue to grow to meet the needs of our target audience.

I figured out how to build a program that was built on a limited private practice model. We attend school meetings, conduct consultation with personnel and participate in school activities. We have learned how to integrate ourselves into schools as an outside provider who is very much involved in the school community. I insist that my therapists provide the highest quality of service possible. We measure quality using assessment tools to conduct pre and post-therapy assessments.
The results:
I practice in schools because kids need us. Parents need us to be accessible to them, and schools need us to help improve the learning environment by improving behavior and emotional regulation. We ‘show up’ for children whose behavior often improves because we’re consistent, warm, and accepting. We also set firm boundaries and implement consequences. Schools love us because we get results. We talk to the staff. We support them in feeling good about the hard work they put into helping children learn. We partner with parents to help them discover their parenting strengths. We’re also normalizing therapy because we’re visible. We talk about mental health issues and lessen the gaps in services.


  1. ROBIN MCPHERSON on January 16, 2019 at 5:10 pm

    Again, thank you SO much for sharing this empowered and uplifting story. This is exactly what I would like to do. This article definitely have the wheels turning in my head!

    • Lisa Savage on January 16, 2019 at 5:35 pm

      yes! Be encouraged and create your dream practice.

  2. Robin McPherson on January 16, 2019 at 9:22 pm

    Hi there I’ve been reviewing your website and the Starting Your School Based MH Practice course does that go more into detail about the process with examples as well? As mentioned before the article was detailed and I’m wanting to verify more of the course content. Please advise.

    • Lisa Savage on January 17, 2019 at 3:15 pm

      Yes, it does!