Youth Mental Health Crisis Response: A Mixed Methods Study to Map Resources and Identify Facilitators and Barriers to Service Access

Background and Purpose: Youth mental health crises in the United States increased dramatically during the COVID-19 pandemic. School social workers and behavioral health staff are uniquely positioned to address the growing mental health needs of youth by connecting them with community-based mental health services; however, they are often under-resourced to provide these services. There is a critical need to understand how school social workers and other school behavioral health staff engage in referrals to community-based mental health services, particularly among minoritized youth who encounter significant barriers to service access. This study used multiple methods to examine the research questions: 1) what is the existence, distribution and types of youth mental health services available in the Boston metro-area, and 2) what are the facilitators and barriers to youth mental health service access?

Methods: The study takes place in the city of Boston and in collaboration with Boston Public Schools (BPS), the city’s primary school district that serves approximately 46,000 students. Behavioral health services in BPS are provided primarily by the Department of Social Work and Department of Behavioral Health. Community resource mapping, an asset-focused approach that engages community stakeholders in identifying existing resources, was used to identify the existence, distribution and types of youth mental health services available in the Boston metro-area. The steps included (1) defining the parameters of service mapping, (2) identifying services, (3) mapping those services, and (4) using the mapping findings to facilitate change. Additionally, semi-structured interviews were conducted with school and community-based providers to better understand how youth in Boston are referred to and access mental health services, and the facilitators and barriers to service accessibility. The interviews were transcribed verbatim, uploaded to NVivo qualitative software and analyzed using reflexive thematic analysis.

Results: While 23 community mental health programs were identified in the Boston-metro area, there were gaps in terms of service availability by neighborhood, language accessibility, and type of crisis services provided. In particular, we identified low-income communities with a high proportion of youth of color had fewer in-person mental health services. Additionally, while the services identified serve children and youth in multiple modalities, very few websites specified the type of crisis services provided and over half of the services do not clearly state whether they provided services in other languages besides English. Thematic analysis of the qualitative interviews identified attitudinal and structural barriers to service utilization, including family stigma related to mental health diagnosis and services, resource accessibility, COVID-19 impacts, and the need for additional training and support for youth, families and school staff.

Conclusions and Implications: Results demonstrate a need for additional support, training and resources for families, school social work and community-based providers, cross-discipline school and community collaboration, and the need for culturally and racially responsive community mental health education and promotion. Results were used to develop accessible and user-friendly youth mental health crisis support resources for use by school and community providers, including a web-based behavioral health resource guide and a 1-page mental health crisis information pamphlet for school staff.