Youth with serious emotional disturbance experience the grimmest outcome with regard to long-term adaptation. They are most likely to drop out of school, become imprisoned, and be under-employed when compared to their peers in other special education categories (Coutinho & Denny, 1996). These children and adolescents are often involved with multiple treatment agencies (e.g. educational, juvenile justice, mental health, child welfare) that often result in poor coordination of services.

As a solution to meet the pressing needs of youth with serious emotional disturbance, a continuum of care has been proposed, in which services are administered from least restrictive to more restrictive (Stroul & Friedman, 1986).

The concept of full-service schools (Dryfoos, 1994) has emerged as a separate movement to meet the mental health and medical needs of students who are unable to receive such services elsewhere. These schools have proposed "one stop" services for youth in need. Although there has been confusion in the literature regarding defining features of full-service schools (Reeder, Maccow, Shaw, Swerdlik, Horton & Foster, 1997) it is generally agreed that a range of services (e.g. medical, mental health and educational) are offered at one location; the school settings (Dryfoos, 1994). Given the estimate that nearly 15% of school-aged children require mental health services (Tharinger, 1995) but do not receive them, the full-service concept has been implemented to fill this gap (Dryfoos, 1994; Paavola, Hannah & Nichol, 1989).