BACKGROUND: Over a quarter of King County youth report depressive feelings, yet national data tells us that only about one-third of students in need receive treatment. Seattle’s School Based Health Centers (SBHCs) operate in 25 schools and are a partnership-based model between schools, community health, and mental health (MH) centers to increase healthcare access for ethnically, socio-economically, and clinically diverse students. This project’s main goals were to assess MH care utilization among Seattle SBHC clients during the 2015-16 academic year, determine the leading reasons for MH visits, and assess the prevalence of MH outcomes within demographic and academically vulnerable groups.
METHODS: SBHC electronic health record (EHR) exports from 2009 through 2015 were restructured and cleaned. MH case definitions from ICD-9 and ICD-10 diagnosis codes were developed based on scientific literature and guidance from academic partners. Student-level academic data was linked to SBHC client data. MH outcomes were assessed by demographic and academic risk variables using chi-square tests. Trends over time were determined using linear regression.
RESULTS: Relative to all enrolled students, a higher proportion of MH service clients are female, have two or more disciplinary actions, GPA of 2.0 or below, and have had 10 or more absences. The three leading MH diagnoses were anxiety, depression, and reaction disorder (13%, 11%, and 8% respectively of all clients). Clients with GPA above 2.0 were more likely to have an anxiety diagnosis compared to clients with 2.0 or below. English Language Learner (ELL)-eligible clients were less likely to have a depression diagnosis, compared to their non-ELL eligible peers. Between 2009 and 2015, male utilization of SBHC MH services increased from 25% to 35%. A large number of MH visits (44%) were found to have circumstantial diagnoses codes (V or Z codes).
CONCLUSIONS: These findings are timely given the Best Starts for Kids Levy which focuses on child and youth well-being and will expand SBHC service in King County. Outlining the leading MH diagnoses at Seattle’s SBHCs provides a valuable bird’s-eye view to practitioners, care-coordinators, and SBHC policy planners regarding students’ treatment needs. Future work will include disseminating findings to SBHC leadership, data quality improvement, and defining a SBHC Mental Health model of care, thus contributing to improving MH services for youth. Limitations include data limitations (no student socioeconomic or geographic information, limited academic risk data), limited case definition guidance for circumstantial diagnoses codes, and no information on treatment referrals outside of SBHCs.