A Preliminary Exploration of School-Based Mental Health Services for Teens: Insights into “Services as Usual” from a Depression Prevention Randomized Control Trial

Schools are an accessible and acceptable mental health service setting and have been identified as a front-line partner in identifying mental health concerns in youth. However, little is known about the services counselors regularly provide to students, particularly students with depression risk. This study used the Services as Usual (SAU) condition from a randomized controlled trial of a school-based depression prevention program to explore mental health services for middle and high school students with elevated depression symptoms, per validated self-report and diagnostic interview measures. Counselors with varying experience levels and training backgrounds from 17 schools submitted session logs describing meetings with students, the Therapy Procedures Checklist–Family Revised to capture techniques used most frequently with students, and the Evidence-Based Practice Attitude Scale to assess views towards adopting evidence-based programming. Counselors reported on other mental/behavioral health services students received through their school and students reported on service use outside of school-provided supports. Results suggest that over half of youth randomized to SAU did not meet with counselors during the 3-month intervention window. Meetings that occurred were often infrequent, impromptu, and brief. Despite the enrolled population, counselors rarely endorsed depression as a topic during meetings. Counselors, on average, reported positive attitudes toward evidence-based practices and endorsed utilizing techniques that ranged from problem-solving to insight-oriented approaches. This exploratory study suggests that students identified as having elevated depression symptoms may not consistently access mental health support through their school counselors. We discuss the relevance of the findings to evidence-based implementation of services in schools.