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Published Online: 14 June 2023

Disparities in the Implementation of School-Based Mental Health Supports Among K–12 Public Schools

Shamia Moore, M.P.H. [email protected], Zach Timpe, Ph.D., M.S., Catherine N. Rasberry, Ph.D., M.S., Marci Hertz, M.S., Jorge Verlenden, Ph.D., M.S., Patricia Spencer, Ph.D., M.A., Colleen Murray, Dr.P.H., M.P.H., Sarah Lee, Ph.D., M.P.H., Lisa C. Barrios, Dr.P.H., Sc.M., Tasneem Tripathi, Dr.P.H., M.P.H., Luke McConnell, M.S., Ronaldo Iachan, Ph.D., and Sanjana Pampati, M.P.H.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 75, Number 1
https://doi.org/10.1176/appi.ps.20220558
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Abstract

Objective:

The authors sought to explore the availability of mental health supports within public schools during the COVID-19 pandemic by using survey data from a nationally representative sample of U.S. K–12 public schools collected in October–November 2021.

Methods:

The prevalence of 11 school-based mental health supports was examined within the sample (N=437 schools). Chi-square tests and adjusted logistic regression models were used to identify associations between school-level characteristics and mental health supports. School characteristics included level (elementary, middle, or high school), locale (city, town, suburb, or rural area), poverty level, having a full-time school nurse, and having a school-based health center.

Results:

Universal mental health programs were more prevalent than more individualized and group-based supports (e.g., therapy groups); however, prevalence of certain mental health supports was low among schools (e.g., only 53% implemented schoolwide trauma-informed practices). Schools having middle to high levels of poverty or located in rural areas or towns and elementary schools and schools without a health infrastructure were less likely to implement mental health supports, even after analyses were adjusted for school-level characteristics. For example, compared with low-poverty schools, mid-poverty schools had lower odds of implementing prosocial skills training for students (adjusted OR [AOR]=0.49, 95% CI=0.27–0.88) and providing confidential mental health screening (AOR=0.42, 95% CI=0.22–0.79).

Conclusions:

Implementation levels of school-based mental health supports leave substantial room for improvement, and numerous disparities existed by school characteristics. Higher-poverty areas, schools in rural areas or towns, and elementary schools and schools without a health infrastructure may require assistance in ensuring equitable access to mental health supports.

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Supplementary Material

File (appi.ps.20220558.ds001.pdf)

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Volume 75 • Number 1 • January 01, 2024
Pages: 17 - 24
PubMed: 37312505

History

Received: 30 October 2022
Revision received: 17 March 2023
Accepted: 28 April 2023
Published online: 14 June 2023
Published in print: January 01, 2024

Keywords

  1. Adolescents
  2. COVID-19
  3. Child psychiatry
  4. Health disparities
  5. Health equity
  6. Schools

Authors

Affiliations

Shamia Moore, M.P.H. [email protected]
Oak Ridge Associated Universities, Atlanta (Moore, Spencer); Health, Economics, Environment, and Development Division, ICF, Atlanta (Timpe, Murray, Tripathi, McConnell, Iachan); Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta (Rasberry, Hertz, Verlenden, Barrios, Pampati); Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta (Lee).
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Zach Timpe, Ph.D., M.S.
Oak Ridge Associated Universities, Atlanta (Moore, Spencer); Health, Economics, Environment, and Development Division, ICF, Atlanta (Timpe, Murray, Tripathi, McConnell, Iachan); Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta (Rasberry, Hertz, Verlenden, Barrios, Pampati); Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta (Lee).
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Catherine N. Rasberry, Ph.D., M.S.
Oak Ridge Associated Universities, Atlanta (Moore, Spencer); Health, Economics, Environment, and Development Division, ICF, Atlanta (Timpe, Murray, Tripathi, McConnell, Iachan); Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta (Rasberry, Hertz, Verlenden, Barrios, Pampati); Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta (Lee).
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Marci Hertz, M.S.
Oak Ridge Associated Universities, Atlanta (Moore, Spencer); Health, Economics, Environment, and Development Division, ICF, Atlanta (Timpe, Murray, Tripathi, McConnell, Iachan); Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta (Rasberry, Hertz, Verlenden, Barrios, Pampati); Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta (Lee).
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Jorge Verlenden, Ph.D., M.S.
Oak Ridge Associated Universities, Atlanta (Moore, Spencer); Health, Economics, Environment, and Development Division, ICF, Atlanta (Timpe, Murray, Tripathi, McConnell, Iachan); Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta (Rasberry, Hertz, Verlenden, Barrios, Pampati); Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta (Lee).
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Patricia Spencer, Ph.D., M.A.
Oak Ridge Associated Universities, Atlanta (Moore, Spencer); Health, Economics, Environment, and Development Division, ICF, Atlanta (Timpe, Murray, Tripathi, McConnell, Iachan); Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta (Rasberry, Hertz, Verlenden, Barrios, Pampati); Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta (Lee).
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Colleen Murray, Dr.P.H., M.P.H.
Oak Ridge Associated Universities, Atlanta (Moore, Spencer); Health, Economics, Environment, and Development Division, ICF, Atlanta (Timpe, Murray, Tripathi, McConnell, Iachan); Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta (Rasberry, Hertz, Verlenden, Barrios, Pampati); Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta (Lee).
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Sarah Lee, Ph.D., M.P.H.
Oak Ridge Associated Universities, Atlanta (Moore, Spencer); Health, Economics, Environment, and Development Division, ICF, Atlanta (Timpe, Murray, Tripathi, McConnell, Iachan); Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta (Rasberry, Hertz, Verlenden, Barrios, Pampati); Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta (Lee).
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Lisa C. Barrios, Dr.P.H., Sc.M.
Oak Ridge Associated Universities, Atlanta (Moore, Spencer); Health, Economics, Environment, and Development Division, ICF, Atlanta (Timpe, Murray, Tripathi, McConnell, Iachan); Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta (Rasberry, Hertz, Verlenden, Barrios, Pampati); Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta (Lee).
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Tasneem Tripathi, Dr.P.H., M.P.H.
Oak Ridge Associated Universities, Atlanta (Moore, Spencer); Health, Economics, Environment, and Development Division, ICF, Atlanta (Timpe, Murray, Tripathi, McConnell, Iachan); Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta (Rasberry, Hertz, Verlenden, Barrios, Pampati); Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta (Lee).
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Luke McConnell, M.S.
Oak Ridge Associated Universities, Atlanta (Moore, Spencer); Health, Economics, Environment, and Development Division, ICF, Atlanta (Timpe, Murray, Tripathi, McConnell, Iachan); Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta (Rasberry, Hertz, Verlenden, Barrios, Pampati); Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta (Lee).
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Ronaldo Iachan, Ph.D.
Oak Ridge Associated Universities, Atlanta (Moore, Spencer); Health, Economics, Environment, and Development Division, ICF, Atlanta (Timpe, Murray, Tripathi, McConnell, Iachan); Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta (Rasberry, Hertz, Verlenden, Barrios, Pampati); Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta (Lee).
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Sanjana Pampati, M.P.H.
Oak Ridge Associated Universities, Atlanta (Moore, Spencer); Health, Economics, Environment, and Development Division, ICF, Atlanta (Timpe, Murray, Tripathi, McConnell, Iachan); Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta (Rasberry, Hertz, Verlenden, Barrios, Pampati); Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta (Lee).
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Notes

Send correspondence to Ms. Moore ([email protected]).
Findings from this study were presented at the 2022 American Public Health Association annual meeting, Boston, November 9, 2022.

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

Funding for this study was provided through contract delivery order 75D30121F10577 from the CDC’s Division of Adolescent and School Health to ICF. This project was supported in part by an appointment to the Research Participation Program at the CDC, administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and the CDC. The authors acknowledge the contributions of the school staff participants, as well as Sarah Conklin, Ph.D., James Demery, Ph.D., Cherrelle Dorleans, M.P.H., Brandee Hicks, M.P.H., Adrian King, M.P.H., Erica McCoy, M.P.A., Leah Powell, M.P.H., Lynnea Roberts, India Rose, Ph.D., April Carswell, Ph.D., Syreeta Skelton-Wilson, Ph.D., Carmen Ashley, M.P.H., Lorin Boyce, M.A., Nancy Brener, Ph.D., Michelle Carman-McClanahan, M.P.H., Xiaoyi Deng, Ph.D., Neha Kanade Cramer, M.P.H., Dana Keener Mast, Ph.D., Catherine Lesesne, Ph.D., Seraphine Pitt Barnes, Ph.D., Leah Robin, Ph.D., Lucas Godoy Garraza, M.A., Nicole Gonzalez, M.S., Christine Walrath, Ph.D., and all others at the National School COVID-19 Prevention Study team.The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the CDC.

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