Patient Centered Enhancements in School Behavioral Health

School-level variable representing average number of days absent for all students in grades 6-8. The average is calculated by dividing the number of days absent by the total number of days in the school year (180). Note: attendance data are drastically skewed due to the impact of COVID-19. Many schools around the country, including those in one participating district, offered remote-only instruction (no in-person learning) during the 2020-2021 school year; thus the concept of absence from school was distorted. Therefore data presented here during 2019-2020 and 2020-2021 may not be meaningfully interpreted.

Time frame: Annual following each school year (2019-2020, 2020-2021, 2021-2022, and 2022-2023)

Population: Complete attendance records for all students enrolled in grades 6-8 at each of the 20 participating schools

Average number of clinical sessions per student during study enrollment, divided by type (in-person and via tele-health)

Time frame: Duration of study enrollment from intake to study exit (average 6 months)

Population: Number of students who participated in therapy (attended sessions with provider)

Client Satisfaction Questionnaire-8 (CSQ-8): 8-item measure for youth 11 and older and adults to assess individual's satisfaction with counseling services. Responses are given using a Likert scales ranging from 1 (indicating poor quality or dissatisfaction with service) to 4 (excellent or highly satisfied with service). Responses were summed for a possible score ranging from 8 to 32; with high scores indicating greater levels of satisfaction for respondents. Analysis included students who completed at least 80% of the items on the scale.

Time frame: At 3 months and 6 months post-intake

Population: There was some variance in number of students completing measures across the different measures

Computed models for student referrals to in-school suspension (ISS). The primary estimate can be interpreted as the log count difference between the treatment and control, and the zero inflated parameter can be interpreted as the log odds of not belonging to the inflated zero latent class. The primary analysis answers the question Did random assignment to the Partnership condition change the number of observed behaviors? and the zero inflated parameter asks Did random assignment to the Partnership condition change the odds of having any observed behaviors?.

Time frame: Annually per academic year

Population: This number includes all students who were enrolled at each of the 20 participating schools, not only those who were engaged in clinical practice. Students did not actively consent into this analysis of administrative school record data. Only a small fraction of the schoolwide population enrolled in the study to provide self-reported data on behaviors and clinical outcomes; whereas this analysis was of whole-school data.

Brief Problem Checklist: 12-item questionnaire measuring externalizing and internalizing problems found in children age 7-13 years old. Responses are given using a 3-point Likert scale ranging from 0 (not true) to 2 (very true), with responses summed for a possible score ranging from 0 to 24. High scores indicate a worse outcome for respondents. Analysis included students who completed at least 80% of the items on the scale.

Time frame: Baseline (intake) and at 3 months and 6 months post-intake

Population: Students and parents who responded to at least 80% of items on the measure at each timepoint were included for analysis.

School Climate Survey (SCS): a free, online climate survey from the US Department of Education (ED). The SCS is a 73-item questionnaire for students and an 83-item questionnaire for school instructional and non-instructional staff on a 4 point scale ranging from 1 Strongly Agree to 4 Strongly Disagree. School-level data were analyzed using ED School Climate Surveys (EDSCLS) platform which produces a benchmarked scale score. The benchmarked scale scores were created using item parameters based on a Rasch model. The EDSCLS produced scores which may fall into one of three categories: * Least Favorable (scores below 300) * Favorable (scores 300-400) * Most Favorable (scores above 400-500) Additional information on the benchmark scale score calculation is available at safesupportivelearning.ed.gov/edscls/benchmarks

Time frame: Once annually, spring of each intervention year (2020, 2021, 2022, 2023)

Population: Participants in this outcome measure are schools, because this is a school-level variable. A total of 10 schools participated in each condition. In Spring 2020 and Spring 2021, only one school district participated due to the impact of the novel coronavirus pandemic and related transition to remote learning. In some cases, no teachers or staff responded to the invitation to participate (as indicated in participation numbers below).

Child and Adolescent Social and Adaptive Functioning Scale (CASAFS): 24-item measure on school performance, peer relations, family relations, and home duties/self-care. The items range from 0 Never to 3 Always. For some items, Does not apply to me is an optional response. Scores were summed for a possible range of 0 to 72, and respondents with at least 80% of items answered were included in analysis. Several items on the instrument required reverse coding prior to analysis. For this scale, lower scores indicate worse outcomes.

Time frame: Baseline (intake) and at 3 months and 6 months post-intake

Population: There was some variance in number of students completing measures across the different measures.

Therapeutic Alliance Scale for Children-revised (TASC) is a twelve item scale measuring the therapeutic alliance across treatment. The scale is a 12-item, 4-point Likert scale, with responses ranging from 0 not like me to 3 very much like me. Five items on the scale required reverse coding prior to analysis. The total score is the sum of all items, ranging from 0 to 48, where higher scores mean stronger therapeutic alliance (better outcomes). Survey data were collected at 3- and 6-months post intake.

Time frame: Baseline (intake), and 3 months and 6 months post-intake

Population: There was some variance in number of students completing measures across the different measures.

Parent Participation Engagement Measure is a 5-item measure of parent participation in therapy sessions, with responses on a 5-point Likert scale ranging from 1 not at all to 5 very much; and where 0 indicates not applicable. Scores on this scale can range from 0 to 25 with higher scores indicating higher rates of parent engagement.

Time frame: At 3 months and 6 months post-intake

Population: There was some variance in number of students completing measures across the different measures.

The Guide Curriculum Assessment (GCA): Mental Health Knowledge scale includes 14 true-false questions related to mental health. These items were scored based on the number of correct answers (0 to 14), where higher scores means more correct answers.

Time frame: Baseline (intake), and 3 months and 6 months post-intake

Population: There was some variance in number of students completing measures across the different measures.

The Guide Curriculum Assessment (GCA): Perceived Stigma scale includes 12 items with responses on a 7-point Likert scale from 1 strongly agree to 4 not sure to 7 strongly disagree. Two items require reverse coding. Lower scores on this scale mean more stigma and higher scores are optimal, indicating less mental health stigma. Scores on this scale range from 12 (most stigma) to 84 (least stigma).

Time frame: Baseline (intake), 3 months post intake, and 6 months post intake

Population: There was some variance in number of students completing measures across the different measures