Service Utilization of a School-Sponsored Online Counseling Clinic

Background. Established by a school of social work in 2021, Talk It Out Counselling Clinic (TIOC) provides free mental health counseling to adult clients who experience multiple barriers to health and equity, and members who belong to Black and other racialized communities. TIOC operates from a community-partnership model, where all referrals are made by our community partners who face challenges in connecting their client to timely mental health services. These partners include homeless shelters, newcomer and settlement services, youth and neighborhood centers, and community health centers. Under supervision and trained to deliver services from anti-racist and trauma-informed lens, all counseling sessions at TIOC are rendered by MSW practicum students via a PHIPA-compliant platform or over the phone. This study aims to describe service utilization at TIOC and examine factors associated with initial service engagement and service completion.

Methods. A chart review was conducted with all clients (N=116, mean age 37.0 years [SD = 15.3], 59.5% female) referred between March 2021 and June 2022. Those who were still receiving services at the time of the study were excluded in the analysis. Descriptive analyses were used to document client’s demographic information, reasons for referrals, levels of depression and anxiety, as well as their service utilization. We assessed if the client attended a “warm hand-off” session (Mitchell et al., 2022; Pace et al., 2018) where the referral provider introduced the TIOC student to the client (Mitchell et al., 2022; Pace et al., 2018), if the client had an intake session, and their reasons for termination. Logistic regression were used to identify factors associated with client service utilization.

Results. The analysis shows that 41.6% of clients were Black, followed by White (23.8%), Latino (13.3%), and Asian (12.4%). Anxiety (64.7%), stress (61.2%), and depression (52.6%) were the top reasons for referral, and 71.8% of clients had a GAD-2 score >= 3, and 65.8% had a PHQ-2 score >= 3. Many clients (73.0%) rated their mental health as poor or fair and 53.8% rated their physical health as poor or fair. Close to two-thirds (62.9 %) of clients received a warm hand-off session, 81.9% had an intake, 55.2% successfully completed services. Bivariate analysis showed that gender, age, and warm hand-off were related to client’s service utilization and engagement (all p values < .01). Logistic regression further indicated that those who had a warm hand-off were much more likely to proceed with an intake (OR=12.23, 95%CI, 3.66-40.89, p <.001); while those who identified as female (OR=5.08; 95%CI, 1.83-14.09, p=.002) and younger age (OR=0.95, 95%CI, 0.92-0.98, p=.003).

Conclusions. This service utilization results provide helpful insight to understand clients who utilized a low-barrier counseling service such as TIOC, their mental health needs, and factors related to their service engagement and utilization. Given that clients can easily fall through the cracks between services, our data show that warm hand-off appears to be helpful in engaging clients with counseling services. Moreover, we need to further understand why non-female and older clients tend to discontinue the services and improve our services accordingly.