Rates of Mental Health Service Utilization by Children and Adolescents in Schools and Other Common Service Settings: A S
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ORIGINAL ARTICLE
Rates of Mental Health Service Utilization by Children and Adolescents in Schools and Other Common Service Settings: A Systematic Review and Meta‑Analysis Mylien T. Duong1 · Eric J. Bruns2 · Kristine Lee2 · Shanon Cox2 · Jessica Coifman2 · Ashley Mayworm3 · Aaron R. Lyon2 Accepted: 7 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract A meta-analysis was conducted to examine the relative rates of youth mental health service utilization across settings among the general population and among those with elevated mental health symptoms or clinical diagnoses. Rates of school-based mental health were compared to outpatient, primary care, child welfare, juvenile justice, and inpatient. Nine studies presented rates of mental health service use for general-population youth in the U.S., and 14 studies presented rates for youth with elevated symptoms or clinical diagnoses. Random effects meta-analysis was used to calculate mean proportions of youth receiving care in each sector. Of general population youth, 7.28% received school mental health services. Rates for other sectors are as follows: 7.26% in outpatient settings, 1.76% in primary care, 1.80% in inpatient, 1.35% in child welfare, and 0.90% juvenile justice. For youth with elevated mental health symptoms or diagnoses, 22.10% of youth were served by school-based mental health services, 20.56% outpatient settings, 9.93% primary care, 9.05% inpatient, 7.90% child welfare, and 4.50% juvenile justice. Schools and outpatient settings are the most common loci of mental health care for both the general population and samples of youth with elevated symptoms or clinical diagnoses, although substantial amounts of care are also provided in a range of other settings. Results hold potential for informing resource allocation, legislation and policy, intervention development, and research. Given that mental health services are delivered across many settings, findings also point to the need for interconnection across child-serving sectors, particularly schools and outpatient clinics. Keywords Mental health services · Services utilization · Children and youth · Meta-analysis Rates of diagnosable mental health disorders that impair functioning in children and adolescents (hereafter referred to as “youth”) are at historical highs and rising (Houtrow et al. 2014; et al. 2015). Yet, only a minority of youth who would benefit from mental health intervention actually access treatment (Costello et al. 2014; Costello 2009). As such, there is a clear need for national, state, and local strategies that guide how to finance, manage, and support provision of accessible, effective mental health services (Hoagwood et al. 2018). Young people access mental health treatment from many sources beyond specialty mental health, including schools, * Mylien T. Duong [email protected] 1
Education, Research, and Impact, Committee for Children, Seattle, USA
2
University of Washington School of Medicine, Seattle, USA
3
Loyola University Chi
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