Social and Environmental Determinants of Access: Predictors of Participation in School-Based Mental Health Prevention Programs

Background:  An increasingly popular approach to preventing and reducing psychosocial problems among underserved youth of color is to offer mental health prevention and early intervention services in educational settings. School-based mental health (SBMH) programs clearly reduce practical barriers to adolescent help-seeking such as cost and inconvenience.  Yet limited research has considered whether SBMH services minimize cultural or contextual barriers to access (Cauce et al., 2002). The purpose of this study is to examine individual and contextual predictors of students’ participation in SBMH prevention and early intervention programs.

Methods:  The current study uses data from 15 high schools in a large urban district offering free health education, therapy, and case management services through coordinated SBMH prevention programs. In the spring of 2009, the California Healthy Kids Survey of risk behaviors and protective factors was administered to all students at these sites (Hanson & Kim, 2007). The survey yielded a 71% response rate, resulting in a sample of 8,466 students that was 58% Asian, 15% Latino, 9% Black, 6% White, 3% Pacific Islander, and 11% Multiracial. The extent to which individual and contextual variables predicted access of SBMH services was examined using multilevel logistic regression models that accounted for the clustering of students by school. Student-level independent variables were self-reported race, internal and external protective factors, and risk behaviors. School-level independent variables were the racial and ethnic composition of the school, the proportion of students receiving free lunch, and rates of student suspensions or expulsions. The dependent variable was a dichotomous measure of SBMH program participation (1 = use of SBMH services at least once in the past year). Control variables were gender, family structure, and grade level.

Results: Black (OR=2.9, p<.001) and Latino (OR=1.6, p<.005) youth were significantly more likely than Asian students to access services. Students who reported more risk behaviors (OR=1.5 p<.001), external protective factors (OR=1.4, p<.01), or internal protective factors (OR=1.3, p<.05) had higher odds of accessing SBMH prevention services.  There was significant variation in service use across schools.  The only school-level factor associated with students’ access was the increased concentration of Black and Latino students in the student body (OR=1.4 p<.05). 

Conclusions: Findings suggest that schools exert contextual influences on students’ use of mental health prevention programs offered in educational settings.  Racial group differences in access might also reflect cultural influences on adolescents’ service use trajectories in schools. SBMH services appear to be a promising bridge over the behavioral health service-system gap observed for Black and Latino youth, but improving access for Asian youth is a critical next step.