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Research ArticleArticles
Open Access

Effects of School-Based Mental Health Services on Youth Outcomes

View ORCID ProfileEzra Golberstein, View ORCID ProfileIrina Zainullina, View ORCID ProfileAaron Sojourner and Mark A. Sander
Journal of Human Resources, April 2024, 59 (S) S256-S281; DOI: https://doi.org/10.3368/jhr.1222-12703R2
Ezra Golberstein
Ezra Golberstein is an Associate Professor of Health Policy and Management at the University of Minnesota School of Public Health .
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  • ORCID record for Ezra Golberstein
  • For correspondence: egolber{at}umn.edu
Irina Zainullina
Irina Zainullina is a doctoral student in Applied Economics at the University of Minnesota.
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Aaron Sojourner
Aaron Sojourner is a Senior Researcher at the W.E. Upjohn Institute for Employment Research.
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Mark A. Sander
Mark A. Sander is Director of School Mental Health at Hennepin County.
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Article Figures & Data

Figures

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  • Trend in SBMH Implementation across Hennepin County Schools Notes: Data on SBMH collected by the authors.
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    Figure 1

    Trend in SBMH Implementation across Hennepin County Schools

    Notes: Data on SBMH collected by the authors.

  • Event Study Model of Average Daily Attendance Notes: Data are from administrative data on all students. Results are from an event study model with individual-level covariates (age, race/ethnicity, sex, free/reduced-price lunch status), and grade level by year fixed effects. Significance of test of pre-intervention trends: p = 0.823.
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    Figure 2

    Event Study Model of Average Daily Attendance

    Notes: Data are from administrative data on all students. Results are from an event study model with individual-level covariates (age, race/ethnicity, sex, free/reduced-price lunch status), and grade level by year fixed effects. Significance of test of pre-intervention trends: p = 0.823.

  • Estimated Relative ATT Effect and 95 Percent Confidence Interval of SBMH on Attendance Rate, by Subgroup Notes: Daily attendance rate ranges from zero to one. AIAN is American Indian or Alaska Native. API is Asian or Pacific Islander. FRPL is free/reduced-price lunch, and FRPL eligibility is a proxy for low family income. MH is mental health, and the risk model is based on predictions made from a model trained in a separate, nationally representative sample. CPS represents a child protective services investigation, and OHP is out-of-home (foster care) placement; these two things proxy for child welfare system involvement.
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    Figure 3

    Estimated Relative ATT Effect and 95 Percent Confidence Interval of SBMH on Attendance Rate, by Subgroup

    Notes: Daily attendance rate ranges from zero to one. AIAN is American Indian or Alaska Native. API is Asian or Pacific Islander. FRPL is free/reduced-price lunch, and FRPL eligibility is a proxy for low family income. MH is mental health, and the risk model is based on predictions made from a model trained in a separate, nationally representative sample. CPS represents a child protective services investigation, and OHP is out-of-home (foster care) placement; these two things proxy for child welfare system involvement.

  • Dynamic Effects on Standardized Test z-Scores (Pooled Academic Subjects) Notes: Test score data are available for all students who took tests in years they were eligible to do so. Results are from an event study model with individual-level covariates (age, race/ethnicity, sex, free/reduced-price lunch status), and grade level by year fixed effects. Significance of test of pre-intervention trends: p = 0.865.
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    Figure 4

    Dynamic Effects on Standardized Test z-Scores (Pooled Academic Subjects)

    Notes: Test score data are available for all students who took tests in years they were eligible to do so. Results are from an event study model with individual-level covariates (age, race/ethnicity, sex, free/reduced-price lunch status), and grade level by year fixed effects. Significance of test of pre-intervention trends: p = 0.865.

  • Estimated Relative ATT Effect and 95 Percent Confidence Interval of SBMH on Standardized Test z-Score, by Subgroup Notes: AIAN is American Indian or Alaska Native. API is Asian or Pacific Islander. FRPL is free/reduced-price lunch, and FRPL eligibility is a proxy for low family income. MH is mental health, and the risk model is based on predictions made from a model trained in a separate, nationally representative sample. CPS represents a child protective services investigation, and OHP is out-of-home (foster care) placement; these two things proxy for child welfare system involvement.
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    Figure 5

    Estimated Relative ATT Effect and 95 Percent Confidence Interval of SBMH on Standardized Test z-Score, by Subgroup

    Notes: AIAN is American Indian or Alaska Native. API is Asian or Pacific Islander. FRPL is free/reduced-price lunch, and FRPL eligibility is a proxy for low family income. MH is mental health, and the risk model is based on predictions made from a model trained in a separate, nationally representative sample. CPS represents a child protective services investigation, and OHP is out-of-home (foster care) placement; these two things proxy for child welfare system involvement.

  • Event Study Model of the Probability of Any Out-of-School Suspension Notes: Data are from administrative data on all students. Results are from an event study model with individual-level covariates (age, race/ethnicity, sex, free/reduced-price lunch status), and grade level by year fixed effects. Significance of test of pre-intervention trends: p = 0.306.
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    Figure 6

    Event Study Model of the Probability of Any Out-of-School Suspension

    Notes: Data are from administrative data on all students. Results are from an event study model with individual-level covariates (age, race/ethnicity, sex, free/reduced-price lunch status), and grade level by year fixed effects. Significance of test of pre-intervention trends: p = 0.306.

  • Event Study Model of Any Suicide Attempts in Past 12 Months Notes: Data are from Minnesota Student Surveys. Results are from an event study model with individual-level covariates (age, race/ethnicity, sex), and grade level by year fixed effects. Significance of test of pre-intervention trends: p = 0.173.
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    Figure 7

    Event Study Model of Any Suicide Attempts in Past 12 Months

    Notes: Data are from Minnesota Student Surveys. Results are from an event study model with individual-level covariates (age, race/ethnicity, sex), and grade level by year fixed effects. Significance of test of pre-intervention trends: p = 0.173.

Tables

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    Table 1

    Estimated Effects of School SBMH on School and Juvenile Justice Administrative Data Outcomes

    Average Daily AttendanceStandardized Test z-Score (Subjects Pooled)Any Out-of-School SuspensionAny Juvenile Justice Case Initiated
    ATT−0.00120.0004−0.0124−0.0085−0.0041−0.00440.0002−0.0010
    SE(0.0018)(0.0019)(0.0164)(0.0177)(0.0026)(0.0026)(0.0006)(0.0004)
    p-value0.5110.8340.4510.6310.1110.0870.8070.020
    Sharpened q-value0.4240.5690.4240.4610.2050.1830.5690.068
    Matched sampleXXXX
    Sample mean0.9420.945−0.0260.0110.03830.04100.00470.0041
    N2,528,6241,873,6271,754,5741,438,697997,579796,191853,319685,120
    • Notes: Attendance data are from administrative data available on all students. Test score data are available for all students who took tests in years they were eligible to do so. All results are from models with individual-level covariates (age, race/ethnicity, sex, free/reduced-price lunch status), and include grade level by year fixed effects.

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    Table 2

    Estimated ATT Effects of SBMH on Mental Health Services Administrative Data Outcomes

    Outpatient MH Services or Psychotropic Drug UsePsychotherapy ServicesAny MH MedicationAny Inpatient or ED Use for Mental Health DiagnosisAny New Mental Health Diagnosis
    ATT0.01370.01290.01590.01670.00240.00260.00260.00260.00900.0058
    SE(0.0049)(0.0050)(0.0040)(0.0043)(0.0037)(0.0039)(0.0020)(0.0021)(0.0036)(0.0037)
    p-value0.0050.009<0.001<0.0010.5140.5110.1840.2320.0120.117
    Sharpened q-value0.0390.0500.0070.0070.4240.4240.2670.3030.0540.205
    Matched sampleXXXXX
    Sample mean0.18070.18320.12230.12280.11080.11430.03340.02610.08110.0798
    N401,387301,443401,387301,443401,387301,443258,284194,700346,351260,030
    • Notes: All mental health services use data are from administrative data available on Medicaid-enrolled students. All results are from models with individual-level covariates (age, race/ethnicity, sex, free/reduced-price lunch status) and include grade level by year fixed effects.

    • View popup
    Table 3

    Survey Data Outcomes from MSS: Estimated ATT Effects

    Any Substance Use in Past 30 DaysSuicidal Ideation in Past 12 MonthsAny Suicide Attempts in Past 12 Months
    ATT−0.00010.0035−0.0021−0.0041−0.0038−0.0053
    SE(0.0076)(0.0091)(0.0037)(0.0047)(0.0019)(0.0025)
    p-value0.9950.6970.5640.3900.0500.034
    Sharpened q-value0.5960.4970.2050.2050.0730.089
    Matched sampleXXX
    Sample mean0.2300.2180.1380.1350.0250.036
    N147,151104,303156,323110,507156,511110,672
    • Notes: Data are from Minnesota Student Survey data available every three years for some grades and schools. All results are from models with individual-level covariates (grade, race/ethnicity, sex) and include grade level by year fixed effects.

Additional Files

  • Figures
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  • Free alternate access to The Journal of Human Resources supplementary materials is available at https://uwpress.wisc.edu/journals/journals/jhr-supplementary.html

    • 1222-12703R2_supp.pdf
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Journal of Human Resources: 59 (S)
Journal of Human Resources
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1 Apr 2024
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Effects of School-Based Mental Health Services on Youth Outcomes
Ezra Golberstein, Irina Zainullina, Aaron Sojourner, Mark A. Sander
Journal of Human Resources Apr 2024, 59 (S) S256-S281; DOI: 10.3368/jhr.1222-12703R2

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Effects of School-Based Mental Health Services on Youth Outcomes
Ezra Golberstein, Irina Zainullina, Aaron Sojourner, Mark A. Sander
Journal of Human Resources Apr 2024, 59 (S) S256-S281; DOI: 10.3368/jhr.1222-12703R2
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    • Abstract
    • I. Introduction
    • II. The School-Based Mental Health Model
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