(PS3-86) Development and Initial Service Outcomes of a Brief Affirming, Trauma-informed “treatment as Usual” Counseling Model in Schools

Abstract Text: Children and adolescents in urban communities experience trauma and chronic stressors at a disproportionate rate, but long-standing barriers have made accessing mental health care difficult. Schools are a key provider of mental health care for youth, reducing many barriers to care. However, we have limited insight in the outcomes from these services and the treatment models used. The current study explores the development and initial services outcomes of affirming, trauma-informed counseling services in an urban school district as part of a larger, multi-tiered effort to integrate mental health care in schools. It also provides insight into key features of “treatment as usual” (TAU) in community contexts. The current study utilized document review and key informant interviews with providers to describe the affirming practices and use of evidence-based treatment components. It also presents initial practice-based service use and outcome data from the 2023-2024 school year for 254 students aged 5 to 18 that received mental health counseling services across 32 schools within the district. Specifically, we examine pre and post differences in clients’ trauma symptoms, internalizing and externalizing symptoms, prosocial behavior, and functioning. Repeated measure t-tests were used to analyze students’ clinical outcomes. As part of the multi-tiered mental health model, school administrators, supervisors, and clinicians were trained in several empirically supported treatments for childhood trauma, emotion regulation strategies, and core DBT skills. These trainings informed the development of the school district’s TAU mental health care model. Clinical supervisors also integrated practices from social work and school counseling into the model. Clinicians determined which students were eligible for counseling services through a referral pathway, in which students were screened with the Strengths and Difficulties Questionnaire (SDQ) and the Child Trauma Screener (CTS). Qualifying students received counseling services by 18 clinicians employed by the school district. Preliminary analysis of the clinician and supervisor-reported practices reveal that practices aligned with a strengths-based, positive psychology lens and included CBT core components (e.g., emotion regulation, assertiveness training, social problem solving, cognitive restructuring). Results from the self-report CTS (N = 145) demonstrated significant improvements in reactions to trauma after services. Results from the teacher-report SDQ (N = 119) demonstrated significant improvements in total difficulties, and in the emotional problems, prosocial, and internalizing subscales after receiving counseling services. Further analysis will explore demographics (e.g., age, race/ethnicity) and service utilization (e.g., type of service, session attendance) as moderators in outcomes. The exploration in the development of the district’s mental health services model and our examination of these practices provides insight into what TAU consists of. Service outcomes findings have implications that the evidence-informed district counseling model is effective in improving trauma symptoms and social and emotional difficulties among students.