(PS3-58) Examining the Utilization of Behavioral Parent Training in School-Based Mental Health Interventions

Abstract Text: Schools are critical access points for treatment for youth with externalizing challenges (Bohnenkamp, 2024), and implementing behavioral parent training (BPT)—the gold standard for externalizing behaviors—in schools could reach families who face barriers to outpatient care. Although research on school-based BPT is limited, existing studies suggest it is acceptable and effective (Fefer et al., 2022). However, engaging caregivers in school-based treatment remains challenging (Corteselli et al., 2020), leaving the feasibility of widespread implementation uncertain.

The Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH; Chorpita & Weisz, 2009) is a flexible, transdiagnostic model well-suited for schools. Based on students’ presenting concerns, clinicians can select the primary focus, including the Conduct Protocol, a comprehensive BPT intervention. This study evaluates MATCH implementation in two school districts, focusing on (a) the prevalence of externalizing concerns and (b) how frequently the Conduct Protocol was used to address these challenges.

Participants included 103 students (45% male, 52% female, < 2% other/unknown; 46% White, 15% Black, 14% unknown, 25% prefer to self-describe), and 37 caregivers across 36 clinicians. Student age ranged from 6–19 years (M=14, SD=3.52). Clinicians collected three primary “Top Problems (TPs )” at intake. The Top Problems Assessment is a psychometrically-sound, idiographic approach that supports clinicians in selecting a treatment protocol that aligns with youth and caregivers’ areas of greatest concern (Weisz et al., 2011). Coders categorized these into Child Behavior Checklist (CBCL) and Youth Self Report (YSR) narrowband and broadband scales (Achenbach & Rescorla, 2001) using established protocols (Yeh & Weisz, 2001). Analyses focused on Attention Problems, Rule-Breaking Behavior, and Aggressive Behavior—scales targeted by the MATCH Conduct Protocol.

Of student-reported TPs, 61% were Internalizing, 19% were Externalizing, 20% were Other. More specifically, 9.3% of TPs were Attention Problems, 0% Rule-Breaking, 17% Aggressive Behavior. Of caregiver-reported TPs, 46% were Internalizing, 42% were Externalizing. For narrowband scales, 4.2% of TPs were Attention Problems, 7.3% were Rule-Breaking, and 30% Aggressive Behavior. Only 2 ( < 1%) received the Conduct Protocol, while 97% received anxiety and depression protocols.

Despite the prevalence of rule-breaking, attention problems, and aggressive behavior TPs (26% of students, 42% of caregivers), fewer than 1% of students received the Conduct Protocol, highlighting a gap in school-based treatment of externalizing behaviors. Underutilization may reflect caregiver engagement challenges, clinician preferences, and external factors limiting caregiver involvement. Addressing these implementation challenges is essential to realize the potential for expanded treatment access through school-based treatment.