CoChat
Sign Up
Cited by 66Mental Health Treatment and AccessChild and Adolescent Psychosocial and Emotional DevelopmentSchool Health and Nursing Education

Mental Health Service Use in Schools and Non-school-Based Outpatient Settings: Comparing Predictors of Service Use

Open access
Langer, David A., Wood, Jeffrey J., Wood, Patricia A., Garland, Ann F., Landsverk, John, Hough, Richard L.·2015·School Mental Health
DOI 10.1007/s12310-015-9146-zPMC PMC4591548
Open this paper in CoChat — free account

Abstract

Researchers have consistently documented a gap between the large number of US youth meeting criteria for a mental health disorder with significant associated impairment, and the comparatively few youth receiving services. School-based mental health care may address the need-services gap by offering services more equitably to youth in need, irrespective of family economic resources, availability of transportation, and other factors that can impede access to community clinics. However, diagnoses alone do not fully capture the severity of an individual's mental health status and need for services. Studying service use only in relation to diagnoses may restrict our understanding of the degree to which service use is reflective of service need, and inhibit our ability to compare school and non-school-based outpatient settings on their responsiveness to service need. The present study evaluated predictors of mental health service use in school- and community-based settings for youth who had had an active case in one of two public sectors of care, comparing empirically-derived dimensional measurements of youth mental health service need and impairment ratings against non-need variables (e.g., ethnicity, income). Three dimensions of youth mental health service need were identified. Mental health service need and non-need variables each played a significant predictive role. Parent-rated impairment was the strongest need-based predictor of service use across settings. The impact of non-need variables varied by service setting, with parental income having a particularly noticeable effect on school-based services. Across time, preceding service use and impairment each significantly predicted future service use.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1007/s12310-015-9146-z

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In the USA, the education sector is responsible for 50-80% of all mental healthcare.

    “In the USA, studies consistently indicate that the education sector is the most heavily accessed youth mental health service setting, responsible for 50–80% of all mental healthcare [4, 41–45].”

    From Leading the charge in the education sector: development and validation of the School Implementation Leadership Scale (SILS) (2022) · cites this paper as [42]

    The Results (Service Use Prediction; page unavailable) report school-based service use among 52.95% of this study’s youth, but that is the percentage of participants who used school services, not the share of all mental healthcare delivered by schools. Outpatient use was 57.78% in the same sample. The paper does not establish a 50–80% share or that schools are the most accessed setting across US youth. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • In the USA, the education sector is the most heavily accessed youth mental health service setting.

    “In the USA, studies consistently indicate that the education sector is the most heavily accessed youth mental health service setting, responsible for 50–80% of all mental healthcare [4, 41–45].”

    From Leading the charge in the education sector: development and validation of the School Implementation Leadership Scale (SILS) (2022) · cites this paper as [42]

    The School-Based and Community-Based Mental Health Services section describes schools as a primary resource for identifying and initiating treatment. It does not establish that schools are the most-accessed setting across US youth or account for 50–80% of all mental healthcare. In Results > Service Use Prediction, this study's selected sample reported slightly more outpatient use (57.78%) than school-based use (52.95%); the authors caution that the sample may not generalize to community samples. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

The citation lists haven’t been fetched yet

References 86 · Cited by 66

Research works printed but not linked: 53

  1. Angold A Costello EJ Farmer EMZ Burns BJ Erkanli A Impaired but undiagnosed. Journal of the American Academy of Child and Adolescent Psychiatry 1999 38 2 129 137 9951211
  2. Angold A Messer SC Stangl D Farmer EM Costello EJ Burns BJ Perceived parental burden and service use for child and adolescent psychiatric disorders. American Journal of Public Health 1998 88 1 75 80 9584037 PMC1508410
  3. APA Diagnostic and Statistical Manual of Mental Disorders 1987 American Psychiatric Association Washington, DC 3rd edition (DSM-III)
  4. APA Diagnostic and Statistical Manual of Mental Disorders 1994 American Psychiatric Association Washington, DC 4th edition (DSM-IV)
  5. Bentler PM Comparative fit indexes in structural models. Psychological Bulletin 1990 107 2 238 246 2320703
  6. Bird HR Andrews H Schwab-Stone M Goodman S Dulcan M Richters J Global measures of impairment for epidemiologic and clinical use with children and adolescents. International Journal of Methods in Psychiatric Research 1996 6 4 295 307
  7. Bird HR Shaffer D Fisher P Gould MS Staghezza B Chen JY The Columbia Impairment Scale (CIS): Pilot findings on a measure of global impairment for children and adolescents. International Journal of Methods in Psychiatric Research 1993 3 3 167 176
  8. Brewin CR Wing JK Mangen SP Brugha TS MacCarthy B Principles and practice of measuring needs in the long-term mentally ill: the MRC needs for care assessment. Psychological Medicine 1987 17 4 971 981 3124155
  9. Bryk AS Raudenbush SW Hierarchical linear models in social and behavioral research: Applications and data analysis methods (First ed., Advanced qualitative techniques in the social sciences 1992 265 Sage Publications Newbury Park, CA
  10. Cattell RB The scree test for the number of factors. Multivariate Behavioral Research 1966 1 245 276 26828106
  11. Cicchetti D Rogosch FA A developmental psychopathology perspective on adolescence. Journal of Consulting and Clinical Psychology 2002 70 1 6 20 11860057
  12. Clark LA Watson D Reynolds S Diagnosis and Classification of Psychopathology: Challenges to the Current System and Future Directions. Annual Review of Psychology 1995 46 121 153 7872729
  13. Cohen P Hesselbart CS Demographic factors in the use of children's mental health services. American Journal of Public Health 1993 83 49 52 8417606 PMC1694500
  14. Costello EJ Egger H Angold A 10-year research update review: the epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden. Journal of the American Academy of Child and Adolescent Psychiatry 2005 44 10 972 986 16175102
  15. Costello EJ Janiszewski S Who gets treated? Factors associated with referral in children with psychiatric disorders. Acta Psychiatrica Scandinavica 1990 81 6 523 529 2378243
  16. Farmer EMZ Stangl DK Burns BJ Costello EJ Angold A Use, Persistence, and Intensity: Patterns of Care for Children's Mental Health Across One Year. Community Mental Health Journal 1999 35 1 31 46 10094508
  17. Flisher AJ Kramer RA Grosser RC Alegria M Bird HR Bourdon K Correlates of unmet need for mental health services by children and adolescents. Psychological Medicine 1997 27 1145 1154 9300518
  18. Garland AF Hough RL McCabe KM Yeh M Wood PA Aarons GA Prevalence of psychiatric disorders in youths across five sectors of care. Journal of the American Academy of Child and Adolescent Psychiatry 2001b 40 4 409 418 11314566
  19. Garland AF Lau AS Yeh M McCabe KM Hough RL Landsverk JA Racial and Ethnic Differences in Utilization of Mental Health Services Among High-Risk Youths. American Journal of Psychiatry 2005 162 7 1336 1343 15994717
  20. Glied S Hoven CW Garrett AB Moore RE Leaf P Bird HR Measuring Child Mental Health Status for Services Research. Journal of Child and Family Studies 1997 6 2 177 190
  21. Grice JW Computing and evaluating factor scores. Psychological Methods 2001 6 4 430 450 11778682
  22. Hartman CA Hox J Auerbach J Erol N Fonseca AC Mellenbergh GJ Syndrome Dimensions of the Child Behavior Checklist and the Teacher Report Form: A Critical Empirical Evaluation. Journal of Child Psychology and Psychiatry 1999 40 07 1095 1116 10576539
  23. Hartman CA Hox J Mellenbergh GJ Boyle MH Offord DR Racine Y DSM-IV Internal Construct Validity: When a Taxonomy Meets Data. Journal of Child Psychology and Psychiatry 2001 42 6 817 836 11583254
  24. Hawley KM Weisz JR Youth versus parent working alliance in usual clinical care: Distinctive associations with retention, satisfaction, and treatment outcome. Journal of Clinical Child and Adolescent Psychology 2005 34 1 117 128 15677286
  25. Hazen AL Hough RL Landsverk JA Wood PA Use of Mental Health Services by Youths in Public Sectors of Care. Mental Health Services Research 2004 6 4 213 226 15588032
  26. Henry GT Practical Sampling 1990 Sage Publications Inc
  27. Institute of Medicine Unequal treatment: Confronting racial and ethnic disparities in health care 2002 National Academies Press. Washington, DC 25032386
  28. Ivanova M Achenbach TM Rescorla L Dumenci L Almqvist F Bilenberg N The Generalizability of the Youth Self-Report Syndrome Structure in 23 Societies. Journal of Consulting and Clinical Psychology 2007 75 5 729 738 17907855
  29. Jensen PS Bloedau L Davis H Children at risk: II. Risk factors and clinic utilization. Journal of the American Academy of Child and Adolescent Psychiatry 1990 29 5 804 812 2228937
  30. Jensen PS Rubio-Stipec M Canino G Bird HR Dulcan MK Schwab-Stone ME Parent and child contributions to diagnosis of mental disorder: Are both informants always necessary? Journal of the American Academy of Child & Adolescent Psychiatry 1999 38 12 1569 1579 10596258
  31. John LH Offord DR Boyle MH Racine YA Factors predicting use of mental health and social services by children 6-16 years old: findings from the Ontario Child Health Study. American Journal of Orthopsychiatry 1995 65 1 76 86 7733219
  32. Kataoka SH Zhang L Wells KB Unmet Need for Mental Health Care Among US Children: Variation by Ethnicity and Insurance Status. American Journal of Psychiatry 2002 159 9 1548 1555 12202276
  33. Koot HM Verhulst FC Prediction of children's referral to mental health and special education services from earlier adjustment. Journal of Child Psychology and Psychiatry 1992 33 4 717 729 1601945
  34. Kraemer HC Measelle JR Ablow JC Essex MJ Boyce WT Kupfer DJ A New Approach to Integrating Data From Multiple Informants in Psychiatric Assessment and Research: Mixing and Matching Contexts and Perspectives. American Journal of Psychiatry 2003 160 1566 1577 12944328
  35. Leaf PJ Alegria M Cohen P Goodman SH Horwitz SM Hoven CW Mental health service use in the community and schools: results from the four-community MECA study. Journal of the American Academy of Child and Adolescent Psychiatry 1996 35 7 889 897 8768348
  36. Mattison RE Carlson GA Cantwell DP Asarnow JR Teacher and parent ratings of children with depressive disorders. Journal of Emotional and Behavioral Disorders 2007 15 3 184 192
  37. McGuire TG Alegria M Cook BL Wells KB Zaslavsky AM Implementing the Institute of Medicine definition of disparities: An application to mental health care. Health Services Research 2006 41 5 1979 2005 16987312 PMC1955294
  38. Merikangas KR He JP Burstein M Swanson SA Avenevoli S Cui L Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry 2010 49 10 980 989 20855043 PMC2946114
  39. Merikangas KR He JP Burstein M Swendsen J Avenevoli S Case B Service utilization for lifetime mental disorders in U.S. adolescents: results of the National Comorbidity Survey-Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry 2011 50 1 32 45 21156268 PMC4408275
  40. Muthén LK Muthén BO MPlus user's guide 2007 Muthén & Muthén. Los Angeles, CA 5th edition
  41. Offord DR Boyle MH Szatmari P Rae-Grant NI Links PS Cadman DT Ontario Child Health Study. II. Six-month prevalence of disorder and rates of service utilization. Archives of General Psychiatry 1987 44 9 832 836 3498458
  42. Owens PL Hoagwood K Horwitz SM Leaf PJ Poduska JM Kellam SG Barriers to children’s mental health services. Journal of the American Academy of Child and Adolescent Psychiatry 2002 41 6 731 738 12049448
  43. Ortega AN Chavez L Inkelas M Canino G Persistence of mental health service use among Latino children: A clinical and community study. Administration and Policy in Mental Health and Mental Health Services Research 2007 34 353 362 17295060
  44. Schwab-Stone ME Shaffer D Dulcan MK Jensen PS Fisher P Bird HR Criterion validity of the NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3). Journal of the American Academy of Child and Adolescent Psychiatry 1996 35 7 878 888 8768347
  45. Shaffer D Fisher P Lucas CP Dulcan MK Schwab-Stone ME NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry 2000 39 1 28 38 10638065
  46. Slade EP Effects of School-Based Mental Health Programs on Mental Health Service use by Adolescents at School and in the Community. Mental Health Services Research 2002 4 3 151 166 12385568
  47. Stanger C Lewis M Agreement among parents, teachers, and children on internalizing and externalizing behavior problems. Journal of Clinical Child Psychology 1993 22 1 107 115
  48. Stiffman AR Cunningham R Gibbs JT The epidemiology of child and adolescent mental health disorders. Child and Adolescent Mental Health: Challenges for Social Work Education and Practice 1990 9 32 NASW Press Berkeley Berkeley, CA
  49. Stiffman AR Horwitz SM Hoagwood K Compton W Cottler L Bean DL The Service Assessment for Children and Adolescents (SACA): Adult and child reports. Journal of the American Academy of Child and Adolescent Psychiatry 2000 39 8 1032 1039 10939232
  50. Weist MD Goldstein J Evans SW Lever NA Axelrod J Schreters R Funding a full continuum of mental health promotion and intervention programs in the school. Journal of Adolescent Health 2003 32 Suppl6 70 78 12782445
  51. Williamson DA Womble LG Smeets MAM Netemeyer RG Thaw JM Kutlesic V Latent structure of eating disorder symptoms: A factor analytic and taxometric investigation. American Journal of Psychiatry 2002 159 3 412 418 11870005
  52. Wu P Hoven CW Cohen P Liu X Moore RE Tiet Q Factors associated with use of mental health services for depression by children and adolescents. Psychiatric Services 2001 52 2 189 195 11157117
  53. Zahner GE Daskalakis C Factors associated with mental health, general health, and school-based service use for child psychopathology. American Journal of Public Health 1997 87 9 1440 1448 9314794 PMC1380967

Authors
Langer, D. A., Wood, J. J., Wood, P. A., Garland, A. F., Landsverk, J., & Hough, R. L.
Affiliations
  • Boston University (US)
  • University of California, Los Angeles (US)
  • Rady Children's Hospital-San Diego (US)
  • University of San Diego (US)
Corresponding author
Langer, David A.
ORCID
Venue
School Mental Health
Publisher
Springer Science and Business Media LLC
Published
2015-03-04
Volume
7
Issue
3
Pages
161-173
ISSN
  • 1866-2625 (ISSN-L)
  • 1866-2633
DOI
10.1007/s12310-015-9146-z
PMC
PMC4591548
OpenAlex
W2050273719
Cited by
66
References
86
Citations by year
2026: 1 · 2025: 4 · 2024: 4 · 2023: 3 · 2022: 9 · 2021: 8 · 2020: 12 · 2019: 10 · 2018: 6 · 2017: 6 · 2016: 1 · 2015: 1
FWCI
7.66
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • School Mental Health (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (U01MH055282, F31MH079631)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
Keywords
school-based mental health services, psychiatric disability, predictors of service use, parental income, service gaps

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review