School-based Mental Health Clinics Research Articles

Clinician and System-Level Facilitators for Successful School-Based Telehealth Implementation during COVID-19: Guiding Factors to Help Embrace Changes in Service Delivery

Abstract School-based mental health clinics are the ideal venue to provide mental health services for youth due to their accessibility and lack of stigma compared with other community treatment centers. There were challenges associated with the abrupt shift to remote education and clinic services caused by COVID-19, but some school-based mental health clinics excelled in their implementation of telehealth services. This study of New York schools found four main facilitators to implementing telehealth services among school-based mental health clinics: (1) strong collaborative relationships between the clinic and school setting, (2) active and responsive leadership, (3) provider experience in conducting telehealth, and (4) provider flexibility to accommodate the needs of children and families. Factors were identified at every level of the school-based mental health clinic and system that helped to facilitate exemplary telehealth service delivery and implementation.

7.1 QUANTUM LEAP: THE METAMORPHOSIS OF A SCHOOL-BASED MENTAL HEALTH CLINIC IN THE COVID-19 ERA

School-based mental health clinics (SBMHCs) are an excellent source of continuous child mental health (CMH) care for children with severe emotional dysregulation (SED). These clinics negate the multiple hurdles that families must navigate in accessing CMH care and afford direct input from the school’s educational and therapeutic staff. The University of Florida School Psychiatry Program (UFSPP) is a mobile SBMHC servicing children with SED in Florida. This presentation will examine the rapid changes made to sustain the UFSPP and school-based mental health services (SBMHSs) in Florida during the COVID-19 pandemic.

SCHOOL’S OUT: WHAT HAPPENED TO SCHOOL-BASED MENTAL HEALTH SERVICES (SBMHS) IN THE COVID-19 ERA?

Prior to the COVID-19 pandemic, over 90% of students in the United States attended “brick and mortar” public schools (PS). The reach of PS has facilitated school-based mental health services (SBMHS). In March 2020, schools closed abruptly and students transitioned to virtual learning. Numerous studies indicate a surge in child mental illness (CMI) during COVID-19 with an increase in the need for SBMHS. This Clinical Perspectives examines the impact of COVID-19 on the functioning of SBMHS in 4 states and nationally. After the panel introduction, the impact of COVID-19 on children’s mental health (CMH) and mechanisms to identify at-risk children will be briefly reviewed by Shirley Alleyne, MB, BS, and David Pruitt, MD. Next, each presenter will describe the impact of COVID-19 on SBMHS in their state, focusing on adaptations in the services offered and delivery methods, changes in SBMHS referral and attendance rates, and treatment outcomes. The presentations include: Dr. Alleyne, Quantum Leap: The Metamorphosis of a School-Based Mental Health Clinic in the COVID-19 Era; Brandon Johnson, MD, Supporting Our Most Vulnerable: The Pandemic's Impact on School-Based Day Treatment and LGBTQ Teens; Erika Ryst, MD, Flexible Adaptation of School Psychiatry Consultation to Meet the Needs of Schools During COVID-19; and Kristie Ladegard, MD, Sustaining the Mental Health of Our Youth: The Rapid Adaptation of School-Based Health Clinics During COVID-19. They will share recommendations to optimize SBMHS during periods of crisis. Participants will share their experiences with COVID-19 SBMHS. Sharon Hoover, PhD, will synthesize the presentations, reflecting on national changes in the delivery of SBMHS during COVID-19 and implications for future policy. The panel will then hold a Q&A session. SBMHS is essential to identifying and treating CMI during the COVID-19 pandemic. The use of telehealth and other innovative measures facilitated continuity of SBMHS with a decline in access to external CMH services. SBMHS referral and attendance rates varied across states with some common trends. COVID-19 has reinforced the critical importance of SBMHS to CMH. Concurrently, when a school is closed, its unique strength (being school-based) becomes its Achilles' heel. Policy considerations are necessary to maintain SBMHS during national crises, when its need is greatest.

6.54 Parents’ Satisfaction With a School-Based Mental Health Clinic Versus Traditional Outpatient Clinics

6.54 Parents’ Satisfaction With a School-Based Mental Health Clinic Versus Traditional Outpatient Clinics

A Mixed Methods Study of the Stages of Implementation for an Evidence-Based Trauma Intervention in Schools

A mixed methods study was conducted to examine the implementation process of 26 urban school-based mental health clinics that took part in a training and implementation support program for an evidence-based school trauma intervention. Implementation process was observed using the Stages of Implementation Completion (SIC) measure. Qualitative interviews were conducted with clinic leaders in order to gain insight into clinic processes related to the SIC. Results showed that almost all of the clinics engaged in some activities related to pre-implementation (engagement, feasibility, and readiness), but only 31% of the sites formally started delivering the program to youth. Completing more pre-implementation activities, particularly those related to readiness, predicted program start-up. Qualitative analysis comparing those that implemented the program to those that did not revealed critical differences in decision-making processes, leadership strategies, and the presence of local champions for the program. This study documented the patterns of clinic behavior that occurs as part of large-scale training efforts, suggests some unique challenges that occur in schools, and highlights the importance of engaging in particular implementation activities (i.e., readiness planning, stakeholder consensus and planning meetings) as part of program start-up. Findings indicate that pre-implementation and readiness-related consultation should be employed as part of broad-scale implementation and training efforts.

Youth Substance Abuse and Co-occurring Disordersedited by Yifrah Kaminer, M.D., M.B.A. Washington, D.C., American Psychiatric Association Publishing, 2016, 386 pp., $65.00 (paperback).

Youth Substance Abuse and Co-occurring Disordersedited by Yifrah Kaminer, M.D., M.B.A. Washington, D.C., American Psychiatric Association Publishing, 2016, 386 pp., $65.00 (paperback).

Innovations in Practice: The relationship betweensleep disturbances, depression, and interpersonal functioning in treatment for adolescent depression.

Sleep disturbance is frequently comorbid with depression and sleep complaints are the most common residual symptoms after treatment among adolescents with depression. The present analyses investigated the effect of sleep disturbance in depressed adolescents treated with Interpersonal Psychotherapy for Adolescents (IPT-A) versus Treatment as Usual (TAU) in school-based mental health clinics. 63 adolescents participated in a randomized clinical trial of IPT-A versus TAU for adolescent depression. Participants were diagnosed with a DSM-IV depressive disorder and assessed for symptoms of depression, interpersonal functioning and sleep disturbance. Measures were assessed at baseline, session 4 and 8 of treatment, and session 12 for post-acute treatment follow-up. Hierarchical linear modeling (HLM) was used to model change in depression, interpersonal functioning and sleep disturbance. Ongoing sleep disturbance was significantly associated with worse depression scores as rated by clinician (γ = 1.04, SE = 0.22, p < .001) and self-report (γ = 1.63, SE = 0.29, p < .001), as well as worse interpersonal functioning across the course of treatment (γ = 0.09, SE = 0.02, p < .001). Treatment condition did not predict change in sleep disturbance (γ = -0.13, SE = 0.14, p = ns). For all patients in the study, sleep disturbance was a predictor of depression and interpersonal functioning for depressed adolescents. Sleep disturbance predicted more depression and interpersonal stress across treatments and led to a slower improvement in depression and interpersonal functioning. This data suggests that sleep disturbance should be a target for future treatment development research among depressed adolescents.

Bridge over troubled waters

Meeting the mental health needs of black children will take more than just increasing access to mental health services and early identification. It also will require a critical evaluation of the practices and models being used to diagnose and treat mental health concerns. Frameworks have been established that use a positive, strengths-based, culturally appropriate approach in working with black children and adolescents. These models recognize that while black youth go through the same developmental processes as nonblack youth (e.g., puberty, identity, and maturation), culture and context play a unique role in their lives. School-based mental health clinics, wellness centers, and using peers as first responders are all proven solutions to help improve the mental health of not only black students but all students.

Ethnic and gender disparities in needed adolescent mental health care.

Psychological problems are overlooked and undertreated in adolescents, especially in low-income and ethnically-diverse youth. School-based health centers are one way to increase health care utilization, and may be particularly important for accessing hard-to-reach populations. The present study examines adolescents' psychological health and their experiences with receiving needed mental health care. Participants included 1,695 African-American (31%), Hispanic (38%), and White (31%) high-school students in southeast Texas. All students were from the same high school and all had access to a school-based mental health clinic. Twenty six percent of the sample had symptoms indicative of major depression, and 18% had scores consistent with subthreshold depression. Across all ethnicities, the prevalence of depressive symptoms was highest among females. Depressed White students were more likely than depressed minority youth to report having received a prior diagnosis of depression and to have been treated for depression. Thus, ethnic disparities in obtaining needed mental health care may persist even in settings where access to equivalent care is readily available.

Commentary: Expanding the Research Agenda on Interventions for Child and Adolescent Anxiety Disorders

The articles in this series describe complementary programs of research and innovative approaches to extend evidence-based interventions for youth with anxiety in several important directions: to extend the target age range [Pincus, D. B., Santucci, L. C., Ehrenreich, J. T., & Eyberg, S. M. (2008-this issue). Treating separation anxiety disorder in young children: Exploring the additive impact of exposure on PCIT treatment outcome. Cognitive and Behavioral Practice, 15]; to extend interventions to more broadly defined target populations, including youth with co-occurring psychiatric symptoms [Weersing, V. R., Gonzalez, A., Campo, J. V., & Lucas, A. N. (2008-this issue). Brief CBT for pediatric anxiety and depression: Piloting an integrated treatment approach. Cognitive and Behavioral Practice, 15] and somatic symptoms [Reigada, L. C., Fisher, P. H., Cutler, C., & Masia Warner, C. (2008-this issue). An innovative treatment approach for children with anxiety disorders and medically unexplained somatic complaints. Cognitive and Behavioral Practice, 15]; to extend access in specific community-practice settings [Ginsburg, G. S., Becker, K., Kingery, J., & Nichols, T. (2008-this issue). Transporting CBT for childhood anxiety disorders into inner city school-based mental health clinics. Cognitive and Behavioral Practice, 15; Reigada, L. C., Fisher, P. H., Cutler, C., & Masia Warner, C. (2008-this issue). An innovative treatment approach for children with anxiety disorders and medically unexplained somatic complaints. Cognitive and Behavioral Practice, 15; Weersing, V. R., Gonzalez, A., Campo, J. V., & Lucas, A. N. (2008-this issue). Brief CBT for pediatric anxiety and depression: Piloting an integrated treatment approach. Cognitive and Behavioral Practice, 15]; and to extend access to these evidence-based approaches, in general [Khanna, M. S., & Kendall, P. C. (2008-this issue). Computer assisted CBT for child anxiety: The Coping Cat CD. Cognitive and Behavioral Practice, 15]. This commentary addresses how, collectively, these programs of research illustrate promising approaches to intervention adaptation and testing. The discussion also explores potential directions that might facilitate future research, including potential directions for broadening the interventions research agenda to help ensure that high-quality, evidence-based interventions are ultimately available to children and adolescents with anxiety.

Transporting CBT for Childhood Anxiety Disorders into Inner-City School-Based Mental Health Clinics

The systematic expansion of evidence-based cognitive behavioral (CBT) protocols into the schools provides an opportunity for training front-line service providers in the early identification of anxious children and in the delivery of evidence-based treatments to children who might otherwise go without such treatment [Weist, M. D., & Evans, S. W. (2005). Expanded school mental health: Challenges and opportunities in an emerging field. Journal of Youth and Adolescence, 3, 3­6]. In this article, we discuss the progress of our ongoing study aimed at transporting manualized CBT for anxious youth into inner-city school-based clinics. In this context, we outline the rationale for the study and specific adaptations and obstacles encountered to date.