Author ORCID Identifier

Defense Date


Document Type


Degree Name

Doctor of Philosophy


Social Work

First Advisor

Youngmi Kim

Second Advisor

Traci Wike

Third Advisor

Kyeongmo Kim

Fourth Advisor

Kevin Sutherland


The rising mental health needs of adolescents has recently been declared a “national emergency” and an epidemic. With the many barriers to accessing mental health services, schools have taken the lead in being a primary source of mental health services for their students due to their ability to remove barriers to access. Using a three-paper format, this dissertation examines predictors of school-based mental health service utilization, the link between school-based services and continued use of mental health services, and the work of school-based mental health service providers. This dissertation assesses individual and school-level factors that impact service utilization and provision.

Paper one and two use nationally representative secondary data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine school-based mental health service use among adolescents and its impact on future service use and mental health using guidance from Andersen’s Behavioral Model of Health Care Utilization. In paper one, I examined individual- and school- level factors that impacted school-based mental health service utilization. Findings show that identifying as female, having government assistance, having increased depressive symptoms, anxiety symptoms, and risk-taking behaviors all significantly increased the odds of school-based mental health service utilization, while identifying as Non-Hispanic Black (compared to White) decreased the odds of service use. Additionally, students who attended schools with services on-site had increased odds of service use, while those attending schools with a majority of White students had decreased odds of using school-based services. In Paper two, I examined the longitudinal, reciprocal relationships between school-based and other mental health services and depressive symptoms in adolescence with subsequent service use and depressive symptoms across four time points. This study found that school-based and other mental health service utilization was significantly related to subsequent mental health service use across each time point. Increased levels of depressive symptoms were associated with increased odds of subsequent mental health service use. Additionally, increased depressive symptoms were significantly associated with subsequent increased symptoms. Finally, any mental health service utilization was associated with increased subsequent depressive symptoms.

Paper three explored perceptions of school-based mental health service use and adolescent mental health among Virginia school social workers. The themes highlighted in this study were mental health stigma, lack of knowledge of school social workers, and lack of time and capacity as primary barriers for their students using school-based mental health services. Additionally, participants shared increased mental health needs among their students following their return to school after school closures due to the COVID-19 pandemic.

Findings from these three papers encourage continued efforts to examine and remove barriers to adolescents seeking mental health services from their schools while also emphasizing the importance of advocating for and promoting school-based mental health professionals in continued policy efforts to support student mental health and well-being.


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Available for download on Sunday, May 07, 2028

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