Stakeholder perspectives on the advantages and challenges of expanded school mental health services for publically-insured youth.

Abstract

Although partnerships between community-based mental health (MH) organizations and school systems to deliver MH services on school grounds (i.e., expanded school mental health, ESMH services) are growing, qualitative research is needed about stakeholders' perspectives on ESMH services. This study collected qualitative data from caregivers, MH providers, and MH administrators recruited from three MH organizations to understand their perspectives regarding potential advantages and challenges associated with ESMH services. The three MH organizations were located in three regions of Georgia and the majority of youth served by the organizations were enrolled in Medicaid. We conducted four focus groups with 33 caregivers and 13 semistructured interviews with MH administrators and providers, and we implemented a thematic content analysis. Caregivers, providers, and MH administrators described how ESMH services could improve MH services by (a) facilitating appointment attendance through the reduction of logistical barriers to care (including geographic barriers, missed class time, and missed work time) and (b) enhancing communication between providers and teachers. However, some participants also described logistical issues with ESMH services including school space constraints and challenges scheduling appointments. In addition, some caregivers expressed concerns about peer stigma if MH services are delivered at school (vs. the clinic). Providers and MH administrators discussed problems with low caregiver engagement and challenges collaborating with school personnel that stem from lack of understanding of MH problems and treatment. Although ESMH services can improve MH treatment among low-income youth, MH providers and MH administrators may consider collaborating with school personnel to proactively develop strategies to address challenges to its success. Impact StatementPartnerships between mental health (MH) organizations and school systems to deliver MH services at schools are growing. Qualitative data from caregivers, MH providers, and MH administrators at three MH organizations identified key advantages of these partnerships: reduction of logistical barriers (e.g., distance to provider) and enhanced communication between providers and teachers. Challenges were also identified (i.e., space constraints, scheduling, collaboration with school personnel, peer stigma, and low caregiver engagement) that can be proactively addressed to maximize partnership success.

Mental Health Clinic Administrators’ Perspectives on the Impact of Clinic-School Partnerships on Youth Mental Health Services Continuity and Quality

“…Even though clinic administrators perceived numerous benefits of school partnerships to deliver services on school grounds, they also reported several challenges concerning family engagement. These findings are consistent with and build on our prior qualitative research that included the perspectives of administrators and providers at MH agencies (Cummings et al, 2021 ). The current results indicate that between 70 and 90% of respondents reported that challenges related to consent, communication with parents, and parent no-shows at child appointments occurred sometimes, often, or always (versus never or rarely).…”

“…Prior research has documented high no-show rates at child and family MH clinics (Benway et al, 2003 ), and findings from our earlier qualitative work revealed that the reduction in appointment no-shows was one of most important advantages of in-school service delivery from the perspective of administrators and providers at MH facilities (Cummings et al, 2021 ). In our survey, the estimated no-show rate in school-based settings (7.1%) was less than one-third of the estimated no-show rate for appointments in clinical settings (23.9%).…”

“…This survey was conducted as part of larger project that sought to understand barriers and facilitators of care for Medicaid-enrolled children who seek MH treatment in safety-net settings and to identify strategies to improve service utilization (Blake et al, 2019 ; Cummings et al, 2017b ; Cummings et al, 2019 ; Cummings et al, 2021 ). We conducted this study in Georgia because it is a large, ethnically diverse state (31.2% of children less than 18 years of age are non-Hispanic Black, 9.4% are Hispanic, and 3.9% are non-Hispanic Asian) (U.S. Census Bureau, 2019 ), and it has a high percentage of youth (19.5%) living in poverty (U.S. Census Bureau, 2020a , 2020b ).…”

“…In addition to the Donabedian framework, the development of survey items was informed by our earlier qualitative work (Cummings et al, 2021 ), which included semi-structured interviews with administrators and providers at MH clinics and caregiver focus groups recruited from these settings. We explored barriers and facilitators of the provision and receipt of MH treatment among youth who seek care from safety net providers in Georgia.…”

“…Findings from this study revealed that the provision of services on school grounds has the potential to improve appointment attendance by reducing a number of logistical barriers to care. Findings also revealed that the delivery of services on school grounds has the potential to improve communication between MH clinicians and teachers, and between teachers and caregivers concerning the child’s MH service utilization (Cummings et al, 2021 )—both of which constitute changes in the process of care delivery as defined by Donabedian. If continuity of care and communication are improved when services are delivered at school, this has the potential to lead to overall gains in the quality of MH service delivery.…”