School nurses (SNs) practicing in DC public and public charter schools were surveyed to assess their perceived role and self-reported preparation to provide behavioral health prevention, early identification, and treatment services in schools. A total of 154 SNs completed a questionnaire about their role in the delivery of behavioral health services and supports. SNs reported they are primarily involved in the identification and referral of students to other school behavioral health professionals. Respondents also reported a lack of training in behavioral health and a desire for more information on related programs and services. This study offers recommendations for educating future SNs and highlights how the DC School Health Services Program utilized study findings to build capacity for SNs employed in practice. This study can help tailor educational opportunities for SNs to maximize their role in school behavioral healthcare process flows and ultimately improve outcomes for students and families.

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.