School Policy and Adolescent Mental Health over the COVID-19 Pandemic

Clinical Psychology; Developmental Psychology; Education Policy; Data Science

We will partner with Albemarle County Public Schools to examine how remote schooling relates to income-based disparities in mental health treatment among adolescents throughout the COVID-19 pandemic.

Research Interests
  • Stress and Socioeconomic Status
  • Economic disparities
  • Wellbeing
  • Adolescent mental health
  • Adolescent stress

Aims

This project will build on a recently created clinically integrated network (CIN) to (1) operationalize indicators of adolescent mental health treatment and (2) use data science to (a) examine patterns and prevalence of adolescents’ mental health treatment throughout the COVID-19 pandemic and (b) differences by Medicaid eligibility in Albemarle County. Furthermore, we will use a new school indicator in the CIN to (3) examine how the period during which adolescents participated in remote schooling relates to income-based disparities in mental health treatment among ACPS secondary schools. Altogether, the project will lay the foundation to apply for a larger grant to integrate school and medical record data to examine student mental health and other indicators of psychological well-being across the COVID-19 pandemic.

Hypotheses

We hypothesize that mental health treatment will significantly increase among adolescents in Albemarle County throughout the COVID-19 pandemic and that this increase will be significantly higher for adolescents who receive Medicaid.  Furthermore, among ACPS students, we hypothesize that the overall increase in the mental health treatment and the disproportionate increase among adolescents receiving Medicaid will be temporally related to the period and duration of remote schooling. 

School Policy During COVID-19

Since the onset of the pandemic in Spring 2020, adolescents have been largely isolated from social interactions with peers and adults outside of their immediate family.  A year after public schools in Virginia transitioned to remote instruction, parents, teachers, and students are concerned about the compounded impact of these restrictions on adolescents’ mental health (Gallup, 2020).  Closing schools not only isolated students from their friends and extra curricular activities, it also removed 55 million children and teenagers from the social and emotional support provided by school teachers and staff (Levin, 2020).  Adolescents from low-income families may be particularly impacted; they are more likely to have experienced trauma, suffer from depression or anxiety, and may have fewer resources and supports to manage the challenges of remote schooling. 

New Partnership with Albemarle County Public Schools

Since Fall 2020, we have been working with Albemarle County Public Schools (ACPS) to better understand how remote schooling has impacted students’ well-being and mental health.  While some private schools in the county have been able to offer hybrid or in-person instruction, ACPS secondary schools have been remote since March 2020.  Throughout the pandemic, the school system has been monitoring the policies and schedule of remote schooling and the principal of the district’s laboratory secondary school, Chad Ratliff, has been tracking parent, teacher, and student concerns in their school.  Through an extensive series of interviews and surveys, they learned that 83% of parents, 73% of students, and 100% of teachers in their school report being concerned about students' social and emotional well-being and mental health.  Students reported that they are worrying more during this time, feel isolated from teachers and peers, and feel an increased sense of burnout from school. Recently, the ACPS school board approved a proposal to use a brief survey to ask adolescents about how they have been feeling and doing during the pandemic.  While the surveys may provide a rough snapshot of adolescent perceptions of their well-being and mental health, the information is collected once and lacks the depth and specificity to assess impacts on mental health.  Thus, we proposed leveraging the newly established Clinically Integrated Network to examine indicators of mental health treatment among adolescence before and throughout the pandemic.

Clinically Integrated Network (CIN)

In 2018, the University of Virginia Children’s Hospital and the Children’s Hospital of the King’s Daughters announced the formation of the nation’s first all-pediatric clinically integrated network.  The network (called Fortify Children’s Health) established a digital and personnel infrastructure to improve the coordination of clinical care and enable the pursuit of meaningful clinical metrics. 

The IT platform for the network captures a wide range of meaningful health and economic data, including multiple indicators of mental health treatment, like mental health diagnoses, psychotropic medications, and recommendations for psychotherapy and mood or behavior concerns during visits to clinics, social work, or primary care.  A primary aim of the proposed study will be to operationalize indicators of mental health treatment in the CIN, which will enable us to assess adolescents’ mental health treatment before and during the COVID-19 pandemic, and to explore how these metrics compare and relate to information available from ACPS. 

The IT platform tracks Medicaid eligibility, enabling us to examine income-based disparities.  It captures the zip code of residence, enabling us to identify Albemarle County residents.  Recently, the platform also began tracking the school that pediatric patients attend, enabling us to identify adolescents in Albemarle County that attend ACPS. 

Data Science

Data Science can help us explore the complex and longitudinal nature of adolescent mental health treatment during the COVID-19 pandemic.  We will receive around three years of data from the CIN from two time periods: pre-COVID-19 (two calendar years prior to remote schooling instituted due to the COVID-19 pandemic) and COVID-19 (the period of remote schooling).  The data science team will include a professor from Data Science who will lead a team of four data science graduate students to examine the mental health treatment data and a doctoral student in research methods to explore time-related associations.

Project Activities

Upon receiving funding, we will meet with our colleagues at ACPS and in the School of Medicine.  With ACPS, we will map the timing and duration of remote instruction and collect any additional de-identified information available about student well-being and mental health during the pandemic.  With the School of Medicine, we will meet to identify indicators of mental health treatment in the CIN.  Once the indicators are identified, we will employ one existing administrative associate to be trained to use the CIN.  This person will locate, pull, and de-identify data about mental health treatment, Medicaid eligibility, school attendance, and relevant non-identifying demographic characteristics from records for adolescents who are residents of Albemarle County.  We will gather and clean data for the pre-COVID-19 and COVID-19 periods described above.

Once the data from ACPS and the CIN is collected, the data science team will use a range of analytic approaches to visualize and explore the indicators of mental health treatment, examine and display differences across the pre- and during COVID-19 time periods, and assess compound and lagged effects of remote schooling on mental health treatment throughout the pandemic.

We will use information collected from ACPS about student well-being and mental health to help interpret findings about mental health treatment.

We will use the results of this study to write grant proposal to NIH to conduct a larger study that will propose integrating school and medical record data to examine income-based disparities in mental health and other indicators of psychological well-being across the COVID-19 pandemic. 

Educators and parents in ACPS will be invited to participate in focus groups, during which we will share and discuss the interpretation and implications of study findings. We will analyze these data and create a report, the results of which will be included in the NIH proposal.

Resources

Several resources for this project are largely already in place and would be bolstered by the support provided by the 3Cavaliers award.  The partnership between Dr. Hofkens, ACPS, and the faculty who manage the Fortify Children’s Health CIN School of Medicine (Dr. James Nataro) is well-developed.  ACPS is committed with the study and we have outlined a plan for procuring district data.  This grant would provide the opportunity and funds to create the interdisciplinary team to move this project forward in earnest.  While the CIN presents abundant opportunities for cross-disciplinary approaches to studying development, mental health, and education policy across the School of Education and Human Development (EHD), the School of Medicine (SOM), and the School of Data Science (SDS), it has yet to be used for that purpose.  With funding from a 3Cavaliers award, we could do cement the team and do the groundwork needed to assess the potential to integrate medical and school record data do large scale research of adolescent well-being and mental health. Practically, this requires support for a person to be trained to use the CIN for this purpose and support to compensate personnel from ACPS to help us structure, validate, and interpret how study findings relate to pandemic-related remote schooling policies and resources. More substantively, the funding would support a new collaboration between EHD, SOM, and SDS, and using advanced analytics to understand indicators of mental health in intensive longitudinal data.

Budget Narrative

The total cost of this project is $60,000, $30,863 (51.4%) of which is for supporting student engagement.

Personnel: As described above, we will employ one doctoral student and a capstone team of four masters’ students during the 2021-2022 academic year [GRA 50% = $20,863 ($9,000wages; $10,328 tuition; $1,535 health insurance); Data Science Capstone Team =$10,000).  We will also support 25% of the time of an existing research associate for the first 12 months of the project [25% = $21,285 ($15,413 wages; $5,872 fringe)]. 

Other Direct Costs: We will provide $7,852 to ACPS staff to support us in creating the calendar of remote instruction and to facilitate focus groups with teachers and parents.   




Desired outcomes

As a result of this project, we will have operationalized mental health treatment in the CIN and we will have examined the quantity and quality of mental health treatment data.  We will assess the robustness of the school indicator and other information available to determine school attendance. Finally, we will have a snapshot of how mental health treatment relates to the timing and duration of remote schooling.  All of this information is critical to inform an NIH grant application for a more comprehensive study of well-being by integrating mental health with school and medical record data.