Epidemiology of Mental and Behavioral Health Among Youth in California Alternative Schools

Background and Purpose: Youth pushed out of traditional schools through suspension and expulsion attend alternative schools, generally by “forced choice” (Lehr & Lange, 2003). Unsurprisingly, studies have suggested that students attending alternative schools have higher rates of risk behaviors, like substance abuse, suicide attempts, and risky sex, and higher prevalence of physical, emotional, and sexual abuse history (Fulkerson, Harrison, Beebe, 1997). Over the past few years, the number of students attending alternative schools have increased significantly (Lehr, Tan, & Ysseldyke, 2009); however, little research has been done about alternative schools and who attend these schools. This study uses a population-based statewide youth survey to examine school safety, violence, and risk behaviors in alternative schools.

Methods: Data come from the 2015-17 California Healthy Kids Survey (CHKS), a statewide survey of elementary, middle, and high school students’ perceptions of school climate, resilience, and risk behaviors (Austin, Bates, & Duerr, 2013). The CHKS is administered to a representative districtwide, grade-level sample of students in the fifth, seventh, ninth, and 11th grades (Austin et al., 2013). Prior studies have suggested that approximately 85% of school districts in California participate with most district surveyed every other year. T-tests and chi-square tests were used to assess the difference between alternative schools and traditional schools on school climate, substance use, mental health, and violence as self-reported by youth.  

Results: Across the academic years, 2015-16 and 2016-17, over 1,030,000 students in California were surveyed and approximately 30,000 of these students attended alternative schools, including continuation schools (n = 24,254), community day schools (n = 1,177), county community schools (n = 3,749), juvenile court schools (n = 1,228), opportunity schools (n = 284), and Regional Occupational Centers and Programs (n = 97). The sample comprised 51% male and 49% female youth; 51% Hispanic/Latinx, 21% White, 10% mixed race, 10% Asian American, 4% Black, and 2% other (Native American, Alaskan Native, Native Hawaiian) youth. Youth in alternative schools were far more likely to be male (63%) than female (37%); and significantly more likely to be African American and Hispanic/Latinx than White compared to those in traditional schools. In the past year, youth in alternative schools reported having been afraid of being beaten up, close to twice the rate of youth in traditional schools (p<.001). Youth in alternative schools reported significantly higher likelihood of reporting lifetime prevalence of being high or drunk (p<.001) or having smoked marijuana (p<.001) on school property. In the past year, close to one in five youth in alternative schools carried a gun to school and 27% were threatened or injured with a weapon.

Conclusions and Implications: This is one of the first studies to provide an epidemiological understanding of school climate in alternative schools. Consistent with previous studies, youth in alternative schools exhibited higher levels of risk compared to youth in traditional schools. The findings of this study highlight the experiences of youth attending alternative schools across California and illuminate potential targets for intervention in alternative schools beyond standard academic progress.