(PS5-37) Treatment Approaches for Youth Aggression in Public School Mental Health Settings: Converging and Diverging Strategies with Evidence-Based Practice Recommendations

Abstract Text: Children with Aggression problems have been found to be at risk for school dropout, delinquency, violent behavior and substance abuse (Tremblay, 2000). Previous studies have found that childhood aggression can serve as a risk factor for the development of depression and anxiety disorders as adults (Burke, Rowe & Boylan, 2014) and across the lifespan (Feindler & Engel, 2011). Accordingly, recommendations from our field stress the importance of early intervention (Powell, Boxmeyer, Stromeyer, Mushtaq & Lochman, 2011). School-based therapists are often the front line for recognizing and addressing these problems, however, there is a paucity of research for systematically understanding modal treatment approaches in school mental health settings. Furthering our understanding of school-based treatment approaches for Aggression is important for early intervention and overall dissemination and implementation efforts.
Within the state of Hawaii, the Department of Education has implemented an electronic health record system that allows school-based therapists to document therapeutic treatment targets and practice elements (PEs) used in every session. This project will compare the pattern of PE usage in all sessions targeting Aggression against evidence-based practice (EBP) recommendations found in the PracticeWise Evidence-Based Services Database (PWEBS, 2025).
Of the 163,239 treatment sessions recorded during the 2023-2024 academic year for all Hawaii public schools, 7,424 sessions indicated Aggression as the primary treatment target, distributed across 1,482 students (Mage = 12.01) who were mostly Native Hawaiian (34.6%; 513) and overwhelmingly male (81.2%; 1,203). According to a PWEBS (2025), the top five PEs recommended by the evidence-base for the umbrella term of ‘Disruptive Behavior’ are Praise, Problem Solving, Tangible Rewards, Psychoeducation for Caregiver and Modeling (occurring in 56%, 51%, 51%, 41%, and 40%, respectively across all EBP protocols). The top five PEs used during actual school mental health treatment sessions focused on Aggression were Care Coordination (n = 732, 10.11%), Natural & Logical Consequences (n = 667, 9.21%), Problem Solving (n = 495, 6.84%), Crisis Management (n = 424, 5.85%), and Behavioral Contracting (n = 324, 4.47%). Comparing and contrasting these two PE profiles suggests a partial overlap between EBP recommendations and modal school mental health approaches.
Acknowledging the nested nature of this data, forthcoming additional analyses will examine the possibility of youth and therapist effects on treatment approaches. For example, to what extent do therapist characteristics and youth background information like race, grade, gender, economic disadvantage status, homelessness, as well as service type utilization (e.g., SPED, 504) affect treatment approaches for the problem of Aggression? These findings and implications related to larger EBP dissemination and implementation efforts, and school-mental health early intervention will be discussed.