School-based health centers (SBHCs) have gained popularity as an approach to provide adolescents with access to health and mental health services in a convenient, youth friendly environment. Although evidence exists regarding SBHC’s impact on access and health domains, clarification of the relationship between SBHC utilization and academic outcomes is needed. Yet, understanding the relationship between utilization of SBHCs and educational outcomes is fraught with many challenges. Although various studies attempt to singularly address these challenges, this study fully integrates these important prior insights into a single study. First, this study capitalizes upon a unique opportunity link three secondary data sources (administrative service utilization, education outcome data, and student survey data), which allows for analysis of the type of services used (medical services, general counseling, and behavioral health counseling) and dosage of each service used. Second, this study limits the impact school contextual differences by limiting the study population to one school, further enabling clarification of the general approach of the intervention. Third, this study employs propensity scoring methods to carefully control for differences between SBHC users and non-users. Specifically, this study aims to (1) clarify student level SBHC utilization patterns; (2) replicate prior research on school connection pathways (i.e. student perceptions of teacher support (school support) and student perceptions of their belonging to school (school connectedness), adding new analysis on specific types and dosages of SBHC use; and (3) replicate prior research linking SBHC utilization to academic outcomes, adding new analysis on specific types and dosages of SBHC use. Results indicate that students who use SBHC services have heterogeneous demographic characteristics and health and mental health needs compared to students who do not use SBHCs. This study did not find a relationship between SBHC service use and connection to school or education outcomes at the end of one school year. This study may serve as model for how we might approach future SBHC research.

For many maltreated youth between the ages of eight and fourteen, challenges associated with the family environment and entry into foster care placement compromises their ability to function and learn. Though prior research indicates that the educational attainment of foster youth is poor, negative performance is reported as though it is a unitary phenomenon among foster students, overlooking population heterogeneity. While collectively foster youth may have increased risk due to maltreatment and removal from home, correlates including educational risks prior to entry, child welfare case characteristics, and residential and school changes may be associated with differences in foster youth academic performance trajectories.

Performance levels on the California Standards Test in English language arts and math are followed longitudinally for four years for first-time entries to foster care from two California counties between school years 2003 and 2006. In addition to an all foster youth sample, foster youth are matched closely to students in the general population by Propensity Score Matching on key educational risks and performance level the year prior to foster care entry. Covariates include achievement gap variables such as ethnicity, disability, and English language learner status in addition to six child welfare case characteristics and five time sensitive residential and school change factors. Group-based analysis and multinomial logistic regression are used to determine the number and type of distinct academic performance trajectories and to examine whether group membership is associated with out of home placement, education risk factors, and child welfare case characteristics.

As variance within academic performance is indicated by six distinct English language arts and five math academic performance trajectories, findings support the current research approach to explore heterogeneity with educationally vulnerable populations. Analyses indicate that foster youth and comparison student academic performance trajectories in English and math are similar which suggests that educational vulnerability for foster youth is related to characteristics that exist prior to placement in out of home care. These findings are echoed in the foster youth sample, where pre-placement educational risks are more salient predictors of negative trajectories than experiences associated with foster care placement. For some foster youth, residential and school changes lead to decreased adjustment and academic performance. In particular, poor English academic trajectories are associated with same year normative school transitions and entrance into foster care. Overall, lower performing trajectory groups are defined by an increased number of education risks present at entry and residential and school changes in the first year of placement.

Group-based analysis can be an important statistical method for both child welfare and education personnel. Youth entering out of home placement or those identified as at-risk are not homogenous groups. Rather, there are meaningful subgroups within these populations that follow distinctive educational trajectories. By identifying clusters or groups of student trajectories, profiles of characteristics within and among groups can aid in uncovering educational strengths and challenges and lead to policies and practices which support improved academic trajectories for vulnerable youth.

Females are still vastly underrepresented in math and science careers. This may be partly due to continued gender disparities in math and science motivation (i.e., the cognitions and emotions that drive math and science related choices and behaviors). Yet the effect of school contexts on these disparities is still unclear. School effects research has mostly focused on schools' role in achievement outcomes, while research on student motivation, including gender differences in math motivation, has primarily studied the contribution of individual-level factors to motivation. There are numerous policy and practice implications that can emerge from the finding that schools impact motivation even after controlling for student and family characteristics. Determining what school features are related to gender disparities could inform classroom and school-wide reforms to improve girls' math and science motivation. Therefore, this study not only adds to the school effects and motivation literatures, but it could also shape education policy and practice by examining the school context of gender disparities in math motivation. To study school contributions to student motivational outcomes, data from the National High School Longitudinal Study of 2009 were analyzed. The survey tapped into students' and teachers' perceptions of their schools, significant school features (e.g., school sector and teaching quality) as well as students' 1) beliefs about their math ability, 2) interest in math 3) perceived usefulness of math, and 4) intentions to take math in the future. Multi-level modeling was used to assess school-level features that contribute to gender disparities in math motivation. Results suggest student perceptions of teachers are strongly associated with between-school differences in math motivation, as well as gender disparities in motivation. For schools in which females were strongly motivated for math compared to males, students reported highly positive relationships with their math teachers. The results from this study will help professionals involved in education recognize the role of math teaching climate and quality in enhancing the math motivation of underrepresented female students.

Retention of public child welfare workers has been a recognized problem and a topic of interest among child welfare researchers for many years. However, findings in the literature are conflicting and the research is largely atheoretical. While many variables relevant to retention and turnover have been identified, the literature lacks explanation of how the variables are related.

The goals of this study were, thus, twofold. The first objective was to build a conceptual model using qualitative data generated from interviews of child welfare workers, theoretical works, as well empirical research which might explain retention and turnover specifically in the field of child welfare. The second objective was to test the conceptual model using logistic regression techniques on a large quantitative sample (N=1,121). This study employs mixed methods and draws its data from a larger ongoing study, utilizing a voluntary sample of child welfare workers who have participated in a Title IV-E MSW program in the state of California, have completed their work obligation period, and have either chosen to remain in public child welfare (stayers) or leave (leavers).

Results suggest that the conceptual model successfully identifies the complexity of the process that leads to retention and turnover behavior. Variables from three categories (individual, organizational, and response to job factors) are identified as predicting retention. Previous county employment, supervisor support, and client-related stress were all related to predicting retention. The implications of the study findings for social work education, agency practice, theory building and research are offered.

A persistent and seemingly intractable problem is the systemic failure to successfully scale evidence-informed social services to a level that achieves population-level improvements in well-being. There is a growing call for governments to enter the scaling environment as primary coordinators, trainers, and funders. Prior scholarship has identified four strategies governments may employ to enact these roles: convene and support high-level leadership teams, assess organizational readiness, provide technical assistance, and align funding. But it is unclear whether use of any or all of these government scaling strategies is sufficient to achieve desired outcomes. Moreover, prior scholarship largely focused on state and federal government roles, largely ignoring how these factors might operate in local government environments. Yet counties may hold the greatest scaling leverage because they often have well-established relationships with service providers through shared clients, contracts, and advocacy. The current study, thus, aimed to provide much needed insight into the relationship between these strategies and scaling outcomes in a local governmental context. Drawing data from a single county with a stated goal of scaling evidence-informed practices across human service organizations, it used public government records and crowd-sourced and computational data-extraction methods to create measures of these four alternative strategies. It assessed the relative effects of these strategies on scaling progress using time-to-event analysis. It found that county governments are well positioned to implement scaling strategies and that the proportion of social service providers adopting evidence-informed services can increase, as can the proportion of county funding directed to these organizations. It also found some empirical support for a link between three of the strategies and scaled evidence-informed services—convening a leadership team, assessing readiness, and aligning funding. Moreover, it identified a new and potentially desirable county strategy—establishing a shared local measure of evidence-informed service. This study design is highly replicable and as such provides a general model to apply to other local environments to identify common county levers that effectively promote the scaling of evidence-informed social services.

A growing body of evidence links demographic characteristics such as socio-economic status with exposure to stressful circumstances and physical and mental health outcomes (Adler, Boyce, Chesney, Cohen, Folkman, Kahn & Syme, 1994; Aldwin, 2007; Cohen, Doyle & Baum, 2006). This study applies a stress and coping framework to the relationship between stressful life experience and secondary and post-secondary schooling outcomes among students. This research investigates how parental level of education relates to exposure to stressful circumstances (life events, school stressors, and role strain) and whether these relationships influence four educational outcomes: high school math and reading achievement, college matriculation, and college degree attainment. This study is a secondary analysis of the National Education Longitudinal Study (NELS:88/2000), using a subsample of 7,989 high school students followed between 1988 and 2000. Results showed that students without college-educated parents are exposed to more stressful circumstances. This difference in exposure did not account for group differences in learning outcomes. Still, overall, exposure to certain stressors affects student high school achievement over the entire sample, and total life event stress exposure in high school relates to students' overall ability to finish a college degree. The unique contribution of this work is that it 1) employs a stress and coping conceptual framework applied to high school achievement and post-secondary opportunity; and 2) constitutes a rigorous study with robust statistical controls. This research informs interventions aimed at improved achievement and opportunity among high school students with high stressor exposure, in which low income and students of color are disproportionately represented (Organista, 2007).

It is estimated that approximately 8 to12% of all youth can be classified as severely emotionally disturbed (SED) (Costello, Egger, & Angold, 2005; Kessler et al., 2012). These youth exhibit a wide range of mental health disorders and symptoms (e.g., depression, anxiety, difficulty with emotion regulation or executive functioning) (Costello et al., 2005), and the extent to which to which their functioning is impaired by these symptoms and challenges varies widely (Williams, Scott, & Aarons, 2017). Only 25% of any of these children and adolescents ever access any outpatient mental health treatment (Costello et al., 2005; Costello, Messer, Bird, Cohen, & Reinherz, 1998) and even fewer obtain the intensive Home and Community-Based Services (HCBS) needed to keep youth with the most significant impairments safely in their home and communities (Owens et al., 2002; Spiker, 2017). Home and Community-Based Services (HCBS) often include in-home therapy, case management, or therapeutic behavioral support services (Kernan, Griswold, & Wagner, 2003; Marcenko, Keller, & Delaney, 2001). Without HCBS, youth with the most significant behavioral healthcare needs are at greater risk for chronic or long-term placement in a residential setting in either a psychiatric, correctional, or foster placement (Hansen, Litzelman, Marsh, & Milspaw, 2004; Knitzer & Olson, 1982; Narrow et al., 1998).

Many families cite expense and lack of sufficient health coverage as barriers to service use (Owens et al., 2002; Spiker, 2017). The only type of health coverage that routinely covers HCBS is Medicaid (Howell, 2004), leaving these services mostly inaccessible to families whose incomes are above the Medicaid means-test limits. In order to access public health insurance to fund the intensive mental health care needed for their child, many parents relinquish custody to the state—either through the child welfare or juvenile justice system (U.S. Government Accountability Office, 2003).

States use a variety of policy interventions to reduce income barriers to HCBS for these youth, including Medicaid waivers, the TEFRA provision, and State Plan Amendments (Friesen, Giliberti, Katz-Leavy, Osher, & Pullmann, 2003; Ireys, Pires, & Lee, 2006). However, little is known about these strategies or state motivations for choosing one policy over another. Limited evaluation also exists regarding their relative effectiveness at meeting the needs of these youth and their families. Having knowledge of the variety of policy tools available to states and how states utilize these tools, as well as the factors that increase the likelihood that a state will opt to use a particular tool, will allow future research to control for such variables, and better discern the effects of the policy on state level mental health system outcomes.

This two-part mixed methods study aims to discern state policies that are more and less effective at reducing access barriers to home and community-based mental health care for non-Medicaid eligible youth with SED. The first, qualitative portion of the study aims to 1) identify policy mechanisms utilized by states to deliver HCBS to youth with SED and their families, particularly for youth whose family income disqualifies them for Medicaid and 2) understand what motivates State Mental Health Authorities and Medicaid Agencies to utilize current policy tools and structures for HCBS delivery for both Medicaid and non-Medicaid eligible youth with SED. The second, quantitative analysis seeks to 1) assess the relationship between a state’s use of a Medicaid waiver and the odds that a youth with SED will have public health coverage, 2) assess the relationship between public health coverage and unmet mental health care needs and cost barriers to care for youth with SED, and 3) assess the direct relationship between a youth’s residence in a state with a Medicaid waiver, and the odds that the youth will have unmet mental health care needs and cost barriers to care.

Part I of this study gathered qualitative data through semi-structured interviews with officials from 32 state mental health systems about policy tactics for funding and delivering HCBS to Medicaid and non-Medicaid eligible youth with SED in their state. Interviews also gathered information about each state administration’s motivation and history that shaped the use of current HCBS policies for this population. Part II of the study utilized data created from information and observations in Part I in conjunction with data from the National Survey for Children with Special Health Care Needs from 2009/2010. Multi-level, random-intercept logistic regression models assessed the relationship between Medicaid waivers and unmet mental health care needs and cost barriers to treatment for youth with SED.

Results indicate that states use many strategies for funding and organizing care for the non-Medicaid eligible population of youth with SED, but that strategies generally involve the allocation of state general revenue funds or the use of a policy that expands the financial eligibility limits of Medicaid for children. Reasons for the use of each approach are most related to the size and flexibility of Medicaid budgets, political prioritization of children and families, and political ideology related to the role of the state in providing for the welfare of children and families. The quantitative analysis found that policies expanding financial eligibility for Medicaid were related to reductions in cost-related barriers to treatment, even controlling for the mediating effect of these policies in changing the insurance status of children. However, the use of these policies and a child's coverage under public health insurance was not significantly predictive of reduced odds of having unmet mental health care needs. By controlling for the severity of a child's mental health care needs, and the interaction between their level of need and type of health insurance coverage, this analysis also highlighted the role of clinical severity in unmet treatment needs and barriers to care and the ways in which public insurance moderated this relationship.

This study concludes that, though states have many means of funding care for non-Medicaid eligible youth with complex behavioral healthcare needs and have various reasons specific to state environments for choosing a particular approach, states with policies that allow children to more easily access Medicaid appear to have fewer families experiencing cost barriers to mental health services. However, these state policies do not address other, unknown barriers to obtaining mental health services for families in their states. Expansion of Medicaid eligibility for children can help to reduce unmet need due to financial obstacles but does not solve all problems related to service accessibility. Additional barriers to treatment access must be identified at the individual, organizational and policy levels for children with all levels of clinical need. Policies and practices aimed at reducing these must be identified and implemented in the manner most suitable and applicable to the unique political, fiscal, and structural concerns of each state and community. Then, these practices and policies must be rigorously evaluated for effectiveness in achieving equitable access to high quality and effective mental health treatment for all children with behavioral health concerns.