TY - JOUR
T1 - Patterns of Student Treatment Attendance and Dropout in an Urban School-Based Mental Health Program
AU - Kronsberg, Hal
AU - Bettencourt, Amie
N1 - Funding Information:
For years prior to the large-scale expansion of BCPS’s ESMH program, JHBMC had been independently contracting with a handful of BCPS schools to provide in-house therapists and a rotating psychiatrist. A citywide reorganization in 2015 dramatically expanded the number of schools with part or full-time ESMH providers, with JHBMC providing care initially in 29 different schools during its first 2 years. ESMH masters-level therapists were funded by a mix of grant funding from BCPS and individual schools and insurance-reimbursed fee-for-service care. Therapists not only provide individual therapy sessions for students, but also work collaboratively with school staff, participating in team meetings, providing informal consultations, and leading professional development sessions. JHBMC ESMH therapists had degrees in social work, mental health counseling, or school counseling but may not necessarily have had experience specific to school-based treatment.
Publisher Copyright:
© 2020, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Baltimore City Public Schools’ school-based mental health program sought to reduce barriers to treatment for students by providing on-site mental health care. This study examines differences in treatment attendance, dropout, and pharmacologic referral among students enrolled in the Johns Hopkins affiliated program. Enrolled student records for SY2015–2016 and SY2016–2017 (N = 655) were analyzed. Latent class analyses (LCAs) identified classes of youth who varied in demographic and clinical characteristics, and differences in treatment outcomes by class were examined. LCAs identified three classes: one with higher probability of being male, Black, in elementary/middle school, and with externalizing symptoms (33%), one with higher probability of being female, Black, in high school, and with internalizing symptoms or adjustment problems (34%), and one with higher probability of being male, ethnically diverse, in elementary/middle school, and with equal probability of having or not having externalizing symptoms (33%). Classes differed significantly in their likelihood of receiving a psychiatrist visit during treatment (χ2 = 10.7, p =.01), with younger classes more likely to receive psychiatric visits than the older class. No class had fewer than 50% of students attending more than 20 sessions. However, classes differed in achieving high treatment attendance (χ2 = 9.6, p =.01), with both younger classes more likely to exceed 20 visits than the older class of students. The older class of students was more likely to refuse treatment once it was initiated (χ2 = 7.1, p =.03). Overall, the ESMH delivery-of-care model studied showed great promise in retaining vulnerable students in treatment, though older students are more likely to stop treatment and questions remain about the clinical benefit of so many students remaining in treatment for such a prolonged period of time.
AB - Baltimore City Public Schools’ school-based mental health program sought to reduce barriers to treatment for students by providing on-site mental health care. This study examines differences in treatment attendance, dropout, and pharmacologic referral among students enrolled in the Johns Hopkins affiliated program. Enrolled student records for SY2015–2016 and SY2016–2017 (N = 655) were analyzed. Latent class analyses (LCAs) identified classes of youth who varied in demographic and clinical characteristics, and differences in treatment outcomes by class were examined. LCAs identified three classes: one with higher probability of being male, Black, in elementary/middle school, and with externalizing symptoms (33%), one with higher probability of being female, Black, in high school, and with internalizing symptoms or adjustment problems (34%), and one with higher probability of being male, ethnically diverse, in elementary/middle school, and with equal probability of having or not having externalizing symptoms (33%). Classes differed significantly in their likelihood of receiving a psychiatrist visit during treatment (χ2 = 10.7, p =.01), with younger classes more likely to receive psychiatric visits than the older class. No class had fewer than 50% of students attending more than 20 sessions. However, classes differed in achieving high treatment attendance (χ2 = 9.6, p =.01), with both younger classes more likely to exceed 20 visits than the older class of students. The older class of students was more likely to refuse treatment once it was initiated (χ2 = 7.1, p =.03). Overall, the ESMH delivery-of-care model studied showed great promise in retaining vulnerable students in treatment, though older students are more likely to stop treatment and questions remain about the clinical benefit of so many students remaining in treatment for such a prolonged period of time.
KW - Access to school mental health services
KW - Children’s mental health
KW - Latent class analysis
KW - Mental health service use
KW - Psychiatric services
UR - http://www.scopus.com/inward/record.url?scp=85083205632&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85083205632&partnerID=8YFLogxK
U2 - 10.1007/s12310-020-09370-1
DO - 10.1007/s12310-020-09370-1
M3 - Article
AN - SCOPUS:85083205632
SN - 1866-2625
VL - 12
SP - 610
EP - 625
JO - School Mental Health
JF - School Mental Health
IS - 3
ER -