(PS5-C55) Leveraging an Innovative Statewide Electronic Health Record System to Further Our Understanding of School-based Community Mental Health Services at the Practice Element Level

A lack of shared ontologies for problems and their treatments across organizations and service sectors has been identified as a large barrier to evidence-based practice (EBP) dissemination and implementation (D&I) efforts (National Academy of Sciences, Engineering, & Medicine, 2022). Hawaii’s Department of Education (DOE) School-Based Behavioral Health (SBBH) system recently implemented an electronic health record (EHR) system in which therapists select treatment targets for a session (TT) and a corresponding therapeutic practice element (PE), an ontological framework shared with the Hawaii Department of Health system and internationally recognized treatment distillation efforts (e.g., Chorpita et al., 2005). This new EHR system permits analyses that examine to what extent DOE SBBH staff are delivering PEs derived from the evidence base (PDEBs). The primary aim of this study is to further our field’s understanding of school-based community mental health services at the practice element level by examining PDEB utilization for the four major childhood TTs of Depressed Mood, Anxiety, Oppositional/Non-Compliance, Attention Problems.

Preliminary clinical data for all youth receiving SBBH services in Hawaii’s Department of Education system in January 2023 were analyzed. The 12,331 entries examined included all logged data statewide during the first month of the new EHR system and included one TT selected as the focus of intervention and one PE selected as the primary therapeutic strategy used. The Depressed Mood TT was selected 368 times (3.0%) and most commonly addressed with the Cognitive/Coping (n=74, 20.1%), Supportive Listening (n=40, 10.9%), and Mindfulness (n=30, 8.2%) PEs. The Anxiety TT was selected 917 times (7.4%) and most commonly addressed with the Cognitive/Coping (n=130, 14.2%), Mindfulness (n=99, 10.8%), and Relaxation (n=76, 8.3%) PEs. The Oppositional/Non-Compliance TT was selected 862 times (7.0%) and most commonly addressed with the Commands/Limit Setting (n=111, 12.9%), Natural & Logical Consequences (n=83, 9.6%), and Skill Building (n=44, 5.1%) PEs. The Attention Problems TT was selected 1096 times (8.9%) and most commonly addressed with the Attending (n=257, 23.4%), Line of Sight Supervision (n=88, 8.0%), and Other: Educational Support (n=72, 6.6%) PEs.

SBBH staff often selected cognitive practices for internalizing difficulties and commands and natural consequences for oppositional behaviors, which aligns with evidence-based practice recommendations. However, notable omissions were observed, including low endorsement of Exposure for Anxiety (n=33, 3.6%), Activity Selection for Depressed Mood (n=2, 0.5%), and Parent/Teacher Praise (n=7, 0.8%) for Oppositional/Non-Compliance. Therapists endorsed high rates of PEs less supported by the evidence base (e.g., Supportive Listening). Additionally, high rates of endorsement for some practices (e.g., Attending for Attention Problems) might suggest early misconceptions about TT and PE definitions in the new ontological framework. Findings will be updated after more months of statewide data collection, and implications for D&I efforts in school-based treatment settings will be discussed.