Doctor of Philosophy (PhD)
There is a high prevalence of diagnosable, yet often untreated, mental health disorders among youth. School-based mental health (SBMH) services have evolved to address these needs and represent an area of growing clinical and research interest. For children with the most severe emotional and behavioral disorders receiving the most intensive level of intervention, the rate of program implementation has outpaced contributions to the literature on effectiveness. To extend the literature on treatment outcomes, this study explored the patterns and predictors of behavioral health change over time among children enrolled in such an understudied program. A novel methodological approach was employed through synthesizing data from multi-informant (caregiver and teacher) standardized behavior rating scales with mental health service utilization data. The majority of enrolled youth were African-American and male, disproportionate to the composition of the local urban school district. Not surprisingly, disruptive behavior disorders accounted for the majority of intake diagnoses, with ADHD more prevalent among younger children and mood disorders more prevalent among older children. Outcome results were mixed, with predominantly neutral to positive changes of small to moderate effect size. There were statistically significant reductions in both ASEBA Child Behavior Checklist (CBCL) problem scores and quantity and intensity of mental health service utilization. Although both informants reported high levels of problems at the 85th – 90th percentile across problem areas at Intake, caregivers reported both greater severity of impairment and more changes over time than did teachers per the Teacher Report Forms (TRFs). No gender effects emerged, though there was variation in some domains between young and old children. The extent of missing data was substantial, presenting many methodological and analytic obstacles. Limitations of this, and most SBMH outcome research studies are discussed, and recommendations for future investigations are presented.
Grundy, Karen M. "Patterns and Predictors of Behavioral Change Among Children Enrolled in an Intensive School-Based Mental Health Program." PhD diss., Bryn Mawr College, 2016.