What is the research about?
Youth with mental health needs often do not receive treatment and African-American/Black (AAB) youth are at greatest risk of having unmet mental health needs. Failing to address children’s mental health needs increases risk for several short- and long-term deleterious outcomes, including exclusionary discipline, drug dependency, and suicidality.
School-based mental health services (SBMH) are a critical pathway for accessing services for AAB youth who are twice as likely to access mental health services in schools as outpatient or specialty clinics. Unfortunately, AAB children’s access to SBMH is dependent on school personnel working on teams to decide who needs to be referred for services. Their team-based decision making often involves consideration of factors other than student need. School personnel on intervention teams disproportionately attribute AAB youth’s behavior problems as disciplinary issues rather than mental health needs, reducing the likelihood AAB students receive SBMH services.
Consistent with the empirical literature, patient families and stakeholders recommend mental health screening of all students in a school (universal screening) to better identify all AAB children with mental health needs and enhancements to address unconscious racial biases and poor mental health literacy of school personnel making intervention referral decisions. This study will compare the effectiveness of two strategies to address this need and respond to patient/stakeholder calls to action.
- SBMH enhanced with universal screening where all students in schools with SBMH delivery systems are screened and teams of school personnel use the screening data to make intervention referral decisions
- Equity-enhanced universal screening in SBMH where, again, all students in schools with SBMH delivery systems are screened, and the decision-making processes of school teams making intervention referrals are enhanced with three components: (a) unconscious racial bias training, (b) mental health literacy training for school team members, and (c) a refinement to school teams’ data-based decision-making process in which they also review screening, mental referral/receipt, and discipline data disaggregated by race/ethnicity to identify and problem-solve system-level inequities.
The research team wants to learn whether and how equity-enhanced screening in SBMH increases the number of AAB children who are referred for and receive SBMH services and decreases their experience of exclusionary discipline (suspension) compared to SBMH enhanced with screening alone during two years of exposure. The team also wants to see how contextual factors about the quality of implementation, team composition, school composition, and perceived impact of the interventions influence and explain results of the study to better inform dissemination and implementation in other schools.
Who can this research help?
School and mental health systems, administrators, advocates, and policy makers may be able to use these findings to enact, fund, and implement strategies that increase the likelihood AAB children with mental health needs are referred for mental health services and decreasingly suspended and removed from the instructional environment.
What is the research team doing?
The team is working with two large and diverse school districts in Florida and South Carolina with well-established SBMH delivery systems to enroll elementary school students in 40 elementary schools (20 in each site). The team plans to enroll 18,904 students in grades K to 5 in the study, and analyses will only include those youth who are AAB with a mental health need identified by screening and not previously receiving SBMH services, approximately 3,022 students.
The team will randomly assign schools to one of the two study conditions to either receive screening to enhance their SBMH delivery system or equity-enhanced screening for their SBMH delivery system. Members of each school’s intervention decision-making team will be trained to use screening data to make referral decisions and those in the equity-enhanced condition will also receive training, coaching, and technical assistance in the three enhancements, including the unconscious racial bias training, mental health literacy training, and disaggregated data review.
For primary study outcomes, the research team will track students’ referral to and receipt of SBMH services and receipt of suspensions during two school years to examine outcomes for AAB youth. The team will also assess unconscious racial biases and mental health literacy in team members’ knowledge and attitudes, as well as behaviorally in their decision making during team meetings to examine how the effects on primary outcomes for AAB students were achieved.
Families representing patients and stakeholders from school, community, and mental health systems are helping the research team carry out the study as members of the patient and stakeholder advisory board. The team is also guided by a community advisory board operating the last five years for a study on similar issues of race-related health disparities and lending their expertise to inform dissemination, communication, and implementation of the research.