Mental Health Service Utilization Patterns in a School Mental Health Program for High Poverty Communities

Background: Children living in poverty experience high rates of mental health difficulties including high rates of externalizing and internalizing disorders. However, up to 80% of low-income children in need of mental health services do not receive needed services. Given the barriers and lack of available mental health services, the school setting has been the de facto place of services in high-poverty communities. However, the effectiveness of school mental health (SMH) programs for low-income youth and found substantial evidence that school mental health programs had become less effective over time. Prior studies have not considered more complex research designs and analyses to further understand how students and families engage in such programs and how their engagement in services affects outcomes. Analyzing service utilization profiles may be crucial for expanding this inquiry. It can provide an as-treated approach to enhance our understanding of treatment effects and identify potential mechanisms of change. Methods: This study utilizes data from a randomized controlled trial of a school mental health program designed to enhance engagement for children in kindergarten through fourth grade with disruptive behavior disorders and their families. The program, Links to Learning (L2L), was implemented in seven elementary schools by four mental health agencies in high-poverty areas from 2006 to 2010. The original study (Atkins et al., 2015) found that students in the L2L program had better academic engagement and social skills than those who received treatment as usual (TAU). The current study identified unique service utilization profiles over a three-year period by examining seven indicators from Medicaid billing fee-for-service records, aiming to understand how participants engaged in mental health services. Findings: The latent profile analysis showed four distinct service utilization patterns, which intersect with the two randomization conditions to form five unique groups: Group 1- TAU with minimal engagement in mental health services, Group 2 – L2L but no engagement in mental health services, but teachers provide classroom-based supports, Group 3 - TAU with engagement in therapeutic services, Group 4 – L2L engaged in comprehensive and coordinated services that include collaboration between parents, teachers, and service providers and teachers implemented classroom-based supports, and Group 5 – L2L families with intensive case management to address their basic needs and teachers implemented classroom-based supports. This exploratory study used, as-treated analyses which revealed significant indicators of treatment effects, including student and parent outcomes, when comparing across the five service utilization groups. Specifically, analyses revealed significant improvements in student outcomes (social skills, problem behaviors, and academic behaviors) and parent self-efficacy among families who utilized the full range of L2L services. Implications: Findings demonstrated that engaging parents in mental health services serves as a crucial mechanism for change in the effectiveness of L2L. Real-world data, such as Medicaid billing records, emphasized the actual service use of treatment, which can enhance the replicability of school-based service models. The analysis of service utilization patterns can help address barriers to policy reforms aimed at improving mental health care quality for youth, particularly in urban, high-poverty communities.

Author dc:creator

• Grace Cua (14790493)

• children
• mental health
• service utilization

Statement dc:rights

• In Copyright

DOI dc:identifier

https://doi.org/10.25417/uic.32991824.v1

OAI identifier oai:identifier

oai:figshare.com:article/32991824