(PS5-41) Who is most vulnerable? Investigating youth-level factors related to the occurrence of emergent life events

Abstract Text: Emergent life events (ELEs) are sudden unexpected stressors in a patient’s life, such as school suspension, eviction from home, and death in the family. Within the context of youth community mental health settings, ELEs have been associated with reduced evidence-based practice delivery and patient treatment progress (Guan et al., 2017a). While there has been significant progress in informing providers on how to best respond to ELEs, there has been limited research exploring which variables may help identify youth who are more vulnerable to experiencing ELEs. Research within community mental health has explored demographic risk factors (e.g., ethnic minority, low socioeconomic status) that predict poor mental health treatment outcomes, such as premature dropout (de Haan et al., 2018). Additionally, there is emerging literature suggesting that these demographic risk factors may also be related to higher incidence of ELEs during treatment. For example, Guan et al. (2017b) found that youth who report ELEs during treatment tended to have lower family incomes than those who did not. Thus, our study aimed to begin exploring the relationship between youth characteristics and the occurrence of ELEs during treatment.

Per the Hawai‘i State Department of Education (DOE) 2023 Data Book, Hawai‘i DOE serves 168,634 students enrolled in its Public Schools who are ethnically diverse (e.g., 23.2% Native Hawaiian, 22.1% Filipino, 20.0% White). Additionally, 80,681 (48.0%) students are identified as economically disadvantaged, 16,920 (10.0%) are English learners, and 18,036 (11.0%) are enrolled in Special Education. Hawai‘i DOE utilizes an electronic health record (EHR) system across all Hawai‘i public schools in which school-based mental health providers (SMHPs) indicate types of clinical encounters, including the occurrence of crisis sessions. By using crisis sessions as a marker for occurrence of ELEs, this EHR system permits analyses that study the extent to which crisis sessions are occurring in a school setting and which students are experiencing crises most frequently.

From August 2023 to May 2024, crisis sessions (n = 2,718) accounted for 1.8% of total sessions provided by SMHPs. SMHPs indicated that crisis sessions ranged from 1 to 96 times per youth, with a mode of 1 crisis session. Descriptive comparisons between crisis sessions and regular sessions will also be presented. Exploratory Pearson chi-square analyses will be conducted to investigate whether the occurrence of ELEs (i.e., crisis sessions) varies by youth characteristics such as race, grade, gender, economic disadvantage status, homelessness, as well as service type utilization (e.g., SPED, 504). Additional analyses will explore the relationship between session characteristics (e.g., treatment target) and the occurrence of ELEs. Overall, this poster aims to explore how socio-cultural factors are related to the experience of ELEs in youth. Results will aid SMHPs in identifying youth who may be more vulnerable to experiencing ELEs and inform decisions on providing preventative programs for these youth. Clinically, this work may also inform case conceptualization and treatment planning for youth who are already experiencing social and economic disparities.