Patient Centered Enhancements in School Behavioral Health: A Randomized Trial

Change in Emotional/Behavioral Functioning of Students Receiving Services

时间窗: Baseline (intake) and at 3 months and 6 months post-intake

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.

Change in Discipline Rates

时间窗: Annually per academic year

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?".

Change in Perceptions of School Climate

时间窗: Once annually, spring of each intervention year (2020, 2021, 2022, 2023)

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

Change in Access to Services

时间窗: Duration of study enrollment from intake to study exit (average 6 months)

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

Change in Client Satisfaction With Services

时间窗: At 3 months and 6 months post-intake

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.

Change in Social Functioning of Students Receiving Services

时间窗: Baseline (intake) and at 3 months and 6 months post-intake

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.

Change in Therapeutic Alliance

时间窗: Baseline (intake), and 3 months and 6 months post-intake

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.

Change in Academic Attendance Rates

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

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.