Students Seeking Mental Health Services at School‐Based Health Centers: Characteristics and Utilization Patterns

Abstract

BACKGROUND: School-based health centers (SBHC) can address unmet mental health needs. Little is known about how students seek care from different providers at SBHCs. We describe and compare how students' SBHC visits differ for students seen by mental health providers (MH group) relative to students seen only by primary care providers (PC group). METHODS:Using administrative data with ICD-9 codes from 9 SBHCs in Denver, Colorado serving youth 10-19 years old during the 2014-2015 school year, we analyzed predictors of SBHC clinic visits via negative binomial regression and ICD-9 codes for first visit to MH providers. RESULTS:Mental health users (N = 516) had an average of 14.2 ± 12.9 SBHC visits and PC users (N = 4026) had an average of 2.6 ± 2.4 SBHC visits annually. Students in the MH group, those with public insurance, and females had a higher incidence rate ratio for SBHC clinic visits than PC group students, those with private insurance, and males respectively. Depression was the most common primary diagnosis for the first MH visit. CONCLUSIONS:Students accessing MH services at SBHC return for follow up visits at higher rates than students only seeing PC providers. SBHCs represent a valuable opportunity to enhance integrated mental health services. Citation: Stempel H, Cox-Martin MG, O'Leary S, Stein R, Allison MA. Students seeking mental health services at school-based health centers: characteristics and utilization patterns.A dolescents experience a large burden of unmet mental health needs. 1-3 Roughly 1 in 5 youth have a diagnosable mental health condition that can cause lifetime impairment, yet 50-80% of youth with mental health conditions do not receive treatment for these diangoses. 2,4-7 Untreated mental health conditions can result in serious consequences, including troubled peer and family relationships, risky health behaviors, poor school performance, school dropout, and suicide.

School‐Based Mental Health Service Utilization Through the COVID‐19 Pandemic and Beyond

“…Increased adolescent mental health conditions and severity may demonstrate the longitudinal impact of the COVID-19 pandemic, involving exacerbated stress and life disruption related to familial death, contagious fear, isolation, and instability in daily life. 4,7,8,24 Ongoing surveillance should be implemented to monitor adolescent trends in mental health following the COVID-19 pandemic. This study provides practical implications for schools to consider adolescent mental health trends in resource allocation and interventions.…”

“…experiencing unstable peer and family relationships, school dropout, suicide, substance use disorder, unemployment, homelessness, and engaging in risky behaviors across the lifespan. [7][8][9] The COVID-19 pandemic exacerbated risk factors-including increased social isolation, contagious fear, household and personal stress and anxiety, and decreased stability in relationships and safety-leaving adolescents vulnerable to mental health conditions. 1,7,[10][11][12][13][14] In response to increasingly alarming mental health trends, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association declared the children's mental health crisis as a national emergency in October 2021.…”

“…21,22 Further research is needed to understand the longitudinal impact of SBHC in optimizing equitable access to mental health services among adolescents, particularly before the onset of COVID-19 and following return to in-person learning. 3,8 Existing studies have often relied on adolescent self-report to identify mental health conditions and subsequent need for services. Adolescents may have difficulty selfidentifying and reporting such conditions, limiting understanding of existing mental health treatment and associated access to care.…”

Individual and organizational factors as predictors of early evidence-based practice adoption in Michigan high schools: Baseline data from an implementation trial

“…Little is known about predictors of better or worse implementation climate or leadership in schools: some studies suggest that school demographics (such as racial composition, percentage of special education students, and school size) have a negligible effect on schools’ ability to support EBP implementation ( Lyon et al, 2022 ; Thayer et al, 2022 ), while others suggest potential differences in the inner context due to school location or size ( Moore et al, 2021 ; Suhrheinrich et al, 2021 ). In terms of linkages between strategic organizational factors and EBP implementation, studies have found mixed support in clinical settings ( Meza et al, 2021 ; Powell et al, 2021 ) as well as in schools.…”

Implementation of Telehealth Services in Rural Schools: A Qualitative Assessment

“…Partnerships between schools and local community providers have expanded, as demonstrated by the marked increase in school‐based health centers (SBHCs), often the sole providers of primary care, behavioral health, and dental services for children in a given community 2,6‐12 . There is evidence that SBHCs and school‐based mental health programs increase access to needed care, and improve health outcomes and academic performance 13‐19 …”