(PS5-36) Timing, Dosage, and Types of Youth Mental Health Evidence-Based Practices for Anxiety in Public School Mental Health Settings

Abstract Text: Anxiety problems are among the most common childhood mental health problems, and school is a potential frontline setting for treating anxiety (Ghandour et al., 2016; Kern et al., 2017). However, there is a paucity of research on evidence-based practices (EBP) and community care approaches to treating anxiety in school-based settings. Using the recently implemented electronic health record (EHR) system (Lōkahi) by the Hawaiʻi Department of Education, all school-based therapists now report standardized treatment targets (TTs) and practice elements (PEs) for every treatment session. As all TTs and PEs are based on the PracticeWise Evidence Based Services Database, we can make comparisons between therapist treatment approaches to the evidence-base (Chorpita et al., 2011). Towards the goal of furthering our understanding of anxiety treatment in school mental health settings to identify potential areas of improvement, we had four main aims: (1) identify the average amount of time it takes for therapists to first start treating anxiety, (2) examine the proportion of sessions focused on anxiety problems within a treatment episode, (3) report on the average amount of time it takes for a youth to receive an EBP, after sessions begin focusing on anxiety problems, and (4) identify the typical dosages for Exposure, Cognitive/Coping, and Psychoeducation with Child.
Of the 163,239 therapist treatment sessions from Hawai’i public schools in the 2023-2024 academic year, 14,527 sessions had at least one anxiety-related TT (e.g., Anxiety, Avoidance, Phobia/Fears). These anxiety treatment sessions were nested within 2,362 students (Mage= 14.4, SD = 3.1), who were primarily male (1,261; 53.4%) and Native Hawaiian (726; 30.7%). Regarding our first aim, for those youth receiving one or more treatment sessions focused on an anxiety-related TT, therapists first endorsed addressing this target at 7.6 (SD = 13.9) sessions or 56.5 (SD = 72.8) days into a treatment episode. Second, anxiety-focused treatment sessions comprised 32.1% (SD = 32.0%) of anxious youths’ entire treatment episode. Third, after therapists begin targeting anxiety for treatment, Cognitive/Coping is typically introduced at 6.8 (SD = 15.8) sessions or 41.2 (SD = 65.5) days later, Exposure at 8.9 (SD = 11.2) sessions or 65.0 (SD = 74.5) days later, and Psychoeducation with Youth at 10.2 (SD = 20.9) sessions or 61.6 (SD = 81.5) days later. Fourth, for youth treated with at least one EBP, Exposure occurred for 4.0 (SD = 8.5) sessions, Cognitive/Coping occurred for 3.8 (SD = 5.8) sessions, and Psychoeducation with Child occurred for 1.8 (SD = 1.9) sessions.
These results suggest that targeting anxiety may not occur at the very beginning of treatment and that anxiety-focused treatment sessions comprise a relative minority of focus within a school year. Once identified as a treatment priority, youth tend to receive a practice derived from the evidence-base, such as Exposure, Cognitive/Coping, and Psychoeducation with a Child several months later. Encouragingly, when therapists endorse EBPs, the dosages seem to be in line with EBP protocols (Kendall & Hedtke, 2006). Training on screening, EBP implementation, and other implications and future directions will be discussed.