(PS9-25) Furthering Our Understanding of Community Care Practices for Anxiety-related Treatment Targets in School Mental Health Settings

There is a discrepancy between practices derived from the evidence-base (PDEB) and treatments delivered in public healthcare settings. Additionally, little is known about community care practices for anxiety-related treatment targets (TTs) in school settings, in which school-based providers are often front-line mental health therapists. Therefore, this study investigates how anxiety is addressed by school-based providers by: (1) describing characteristics of treatment sessions focused on youth anxiety problems and (2) comparing practice elements (PEs) chosen for anxiety-focused treatment sessions against the treatment outcome literature (e.g., the extent to which school-based providers use PDEBs recommended for youth anxiety problems). Further analyses include moderation by elementary, middle, and high school settings.

The recent implementation of Hawai'i’s Department of Education (DOE) School-Based Behavioral Health (SBBH) electronic health record system for services delivered in all Hawai'i public schools offers an opportunity to explore how DOE SBBH staff are selecting TTs and PEs for each session. Notably, their system shares an ontological framework with the Hawai'i Department of Health and globally recognized treatment distillation efforts (Chorpita et al., 2005). Specifically, sessions addressing anxiety-related TTs (i.e., Anxiety, Avoidance, Phobia/Fears, Shyness) will be examined for PEs among youth receiving SBBH services in Hawai’i’s DOE system from January 2023 to January 2024.

Of 133,701 school mental health treatment sessions, 13,418 sessions (10.0%) included at least one anxiety-related TT as the primary focus of intervention and one PE selected as the primary therapeutic strategy used. The most to least commonly reported anxiety-related TTs were Anxiety (9,850; 75.2% of anxiety-related TTs), Avoidance (3,068; 23.4%), Phobias/Fears (184; 1.4%), and Shyness (0, 0.0%). The most commonly addressed PEs selected to address anxiety-related TTs were Cognitive/Coping (1,789, 13.7% of sessions primarily addressing anxiety), Problem-Solving (866, 6.6%), and Mindfulness (814, 6.2%). The most frequently utilized PDEBs were Cognitive/Coping, Problem-Solving, and Relaxation (725, 5.5%). Practices with minimal evidence support (PMES; cf. Higa-McMillan et al., 2015) for youth anxiety included Mindfulness, Communication Skills (756, 5.8%), and Relationship-Rapport Building (616, 4.7%). Less frequently delivered PDEBs in school settings included psychoeducation to the child (231, 1.8%), maintenance/relapse prevention (167, 1.3%), Modeling (132, 1.0%).

Furthermore, as compared to middle schoolers, high school youth received more PDEBs than PMESs for youth anxiety problems, F(1, 8333) = 35.403, p < .001, ΔR² = .003. However, PDEBs and PMESs were selected at a similar proportion in elementary schools and middle schools, F(1, 6336) = 1.857, p = .135, ΔR² = .00. These and other forthcoming findings can help further our field’s understanding of community mental health therapists’ approaches in large school settings. Future directions, including recommendations for decreasing the science-service gap for the treatment of anxiety in school-based treatment settings, will be reviewed.