1 - (SYM 110) Furthering Our Understanding of Treatment Targets, Practice Elements and Youth Characteristics for Emergent Life Events in School-based Community Mental Health Settings

Research within community mental health service settings have found that emergent life events (ELEs), which are sudden unexpected stressors in a client’s life, are associated with reduced evidence-based treatment (EBT) delivery and client progress. Scholars have suggested that EBT skills can be integrated into sessions with ELEs as “teaching moments” (e.g., use cognitive restructuring to address an unexpected bad grade). Both EBT experts and providers acknowledge coping, problem solving, and relaxation as three EBT skills that could be used to address majority of ELEs in community mental health. Given existing barriers accessing mental health services, school-based providers are often front-line mental health therapists. However, little is known about what ELEs occur in school settings or how providers respond. Our study had two aims: (a) examine characteristics of unscheduled sessions: commonly endorsed treatment target (TT) and practice elements (PEs) and (b) compare reported PEs against practices recommended for ELEs.

Hawai’i’s Department of Education (DOE) recently implemented an electronic health record (EHR) system for all Hawai’i public schools in which therapists select TTs for a session and a corresponding PE. This new EHR system permits analyses that study the extent to which school therapists are delivering PEs derived from the evidence base. Unscheduled “walk in” sessions (n = 23,189) will be examined for analyzing ELEs among youth formally and not formally identified for IDEA/504 education support services (n = 5,210) in Hawai’i’s DOE system from January 2023 to January 2024.

Analyses reveal that unscheduled sessions lasted an average of 33.6 minutes (SD = 32.2) and 64.8% (n = 15029) were held for students not formally identified for education support services. The most frequently endorsed TT and PE were “Other Targets” (endorsed for 16.5% of sessions; n = 3826) and “Other Practices” (21.4%; n = 4962) where staff write in entries. The other top four TTs most frequently reported by school therapists were: (a) Positive Peer Interaction (11.4%; n = 2641); (b) Self-Management (7.8%; n = 1806); (c) Social Skills (7.4% n = 1725); and (d) Anxiety (6.5%; n = 1518). The top four PEs endorsed were: (a) Supportive Listening (6.6%; n = 1526); (b) Rapport Building (6.5%; n = 1508); (c) Skill Building (5.5%; n = 1272); and (d) Therapist Praise/Rewards (5.0%; n = 1154). Our findings partially align with EBT expert recommendations for responding to ELEs. Further analyses will explore potential predictors of ELE occurrence and moderator effects.