The Role of Schools in Supporting Youth Behavioral Health Services Outcomes: Centering Youth and Caregiver Voices

Background: Youth behavioral health needs have continued to increase over the last decade, with recent urges from the Surgeon General to expand the role that schools play in attending to indicators of mental health need and meeting identified mental health needs through the provision of evidence-supported programming and supports. To provide responsive services and support, schools must understand the behavioral health outcomes youth and caregivers value most—and develop interventions and processes that support those outcomes. Youth and caregivers have identified priority behavioral health outcomes, but the roles that schools can plan in supporting the achievement of those outcomes has been unclear. The purpose of the current study is to explore caregiver and youth perspectives on the roles that schools and school personnel play in attaining the behavioral health outcomes that matter most to them.

Methods: This qualitative study involved primary data collection from caregivers and youth across six regions of the United States in two rounds of virtual focus groups, totaling 24 separate focus groups. Focus group recruitment processes and data collection protocols were developed in collaboration with caregivers with lived experience of parenting a child with behavioral health needs. Focus group participants identified the behavioral health service outcomes that mattered most to them and discussed the role that schools play in impacting those outcomes. Data collection took place in early 2023 with separate focus groups for caregivers (N = 42) and youth/young adults between the ages of 13 to 26 (N = 34). The average years of experience using behavioral health services among participants was 7.48 (SD = 5.60). After data collection, the research team transcribed all focus group data and conducted a thematic analysis using Braun and Clarke’s six steps using qualitative analytic software.

Findings: The primary themes regarding the roles schools and school administrations play in achieving behavioral health outcomes that matter to youth and caregivers included: 1) the importance of collaborative care; 2) Importance of affirming teacher/school response to behavioral health problems; 3) Limited school resources and capacity to support youth needs; and 4) Critical need for parent advocacy. Specifically, several caregivers noted that when school personnel working with youth behavioral health needs via special education services coordinate with additional services, such as their doctors and community-based therapists, care becomes “much less complex” and easier to navigate for families. Youth also noted the importance of schools in understanding, supporting, and having the capacity to work with them to build individual and social skills in additional to their academic outcomes.

Conclusions/Implications: The current study reveals important information about the roles schools play in supporting youth with behavioral health needs. Both youth and caregivers stressed the desire for schools to coordinate care with other services and to increase their capacity to support behavioral health needs among students. Additional collaborative research that engages youth and caregivers is needed to understand existing patterns of collaboration and care coordination between schools and community-based service providers, as well as barriers school personnel face in collaborating effectively with community-based providers.