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Exploring Self-Referral as a Low-Burden, Universally Administered Strategy to Connect Adolescents to Mental Health Supports Following Anonymous School-Based Screening

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Title: Exploring Self-Referral as a Low-Burden, Universally Administered Strategy to Connect Adolescents to Mental Health Supports Following Anonymous School-Based Screening
Language: English
Authors: Meghan A. Costello (ORCID 0000-0002-9520-4676), John Crocker, Jasmeen Kaur, Rosie Du, Elizabeth Oxendine, Lauren Greenspan, Rebecca Butler, Randi M. Schuster
Source: School Psychology. 2026 41(4):434-445.
Availability: American Psychological Association. Journals Department, 750 First Street NE, Washington, DC 20002. Tel: 800-374-2721; Tel: 202-336-5510; Fax: 202-336-5502; e-mail: order@apa.org; Web site: http://www.apa.org
Peer Reviewed: Y
Page Count: 12
Publication Date: 2026
Sponsoring Agency: Substance Abuse and Mental Health Services Administration (SAMHSA) (DHHS/PHS)
National Institute on Drug Abuse (NIDA) (DHHS/PHS)
Contract Number: INTF2400H78500224455
5K12DA04349007
Document Type: Journal Articles
Reports - Research
Education Level: Junior High Schools
Middle Schools
Secondary Education
High Schools
Descriptors: Mental Health, Referral, Middle School Students, High School Students, Depression (Psychology), Anxiety, Mental Disorders, Emotional Response, Attention Deficit Hyperactivity Disorder, Suicide, Psychological Patterns, Self Disclosure (Individuals), LGBTQ People, At Risk Persons, School Health Services, Screening Tests, Gender Differences, Racial Differences, Ethnicity, Substance Abuse
Geographic Terms: Massachusetts
DOI: 10.1037/spq0000719
ISSN: 2578-4218
2578-4226
Abstract: Integrating widespread, low-burden approaches to facilitate connection to school-based care may be helpful in expanding mental health reach in schools. The present study describes students' use of a single-item self-referral process following a school-wide anonymous screener of mental health and substance use. The Substance Use and Risk Factor Survey included a school-based referral request item in 47 Massachusetts public middle and high schools in fall 2023 (N = 16,236; 47% girls; 4% gender diverse; 41% racially or ethnically marginalized or minoritized). Students who self-referred, in comparison to those who did not self-refer, endorsed more symptoms of depression and anxiety (M[subscript self-referral] = 3.7 [SD = 3.8], M[subscript noReferral] = 3.0 [SD = 3.3], p = 0.0001), psychoticlike experiences (M[subscript self-referral] = 1.1 [SD = 1.6], M[subscript noReferral] = 0.9 [SD = 1.4], p = 0.0004), emotional reactivity (M[subscript self-referral] = 24.4 [SD = 23.7], M[subscript noReferral] = 20.8 [SD = 20.8], p = 0.001), and inattention and hyperactivity (M[subscript self-referral] = 0.8 [SD = 0.8], M[subscript noReferral] = 0.7 [SD = 0.7], p = 0.001). Students who self-referred were more likely to endorse a past-year suicide attempt (6.6% among self-referral group, 3.1% among the no-referral group; OR = 1.7, p = 0.02) and not talking to anyone (formal or informal mental health supports) about their mental health in the past year (31.4% self-referrals, 21.9% no referral; OR = 1.7, p < 0.001). Students who self-referred were also more likely to hold a minoritized gender identity (6.9% self-referrals, 3.9% no self-referrals; OR = 1.8, p = 0.012). School staff (N = 15) noted that the self-referral process was helpful (M = 3.87/5, SD = 1.27), and approximately half of the students requesting support (53.7%) were not already engaged in school-based mental health support. Self-referral requests following school-wide screeners may be a useful strategy to identify students experiencing mental health distress without supports in place.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1507971
Database: ERIC
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  Data: Exploring Self-Referral as a Low-Burden, Universally Administered Strategy to Connect Adolescents to Mental Health Supports Following Anonymous School-Based Screening
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  Data: American Psychological Association. Journals Department, 750 First Street NE, Washington, DC 20002. Tel: 800-374-2721; Tel: 202-336-5510; Fax: 202-336-5502; e-mail: order@apa.org; Web site: http://www.apa.org
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– Name: Abstract
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  Data: Integrating widespread, low-burden approaches to facilitate connection to school-based care may be helpful in expanding mental health reach in schools. The present study describes students&#39; use of a single-item self-referral process following a school-wide anonymous screener of mental health and substance use. The Substance Use and Risk Factor Survey included a school-based referral request item in 47 Massachusetts public middle and high schools in fall 2023 (N = 16,236; 47% girls; 4% gender diverse; 41% racially or ethnically marginalized or minoritized). Students who self-referred, in comparison to those who did not self-refer, endorsed more symptoms of depression and anxiety (M[subscript self-referral] = 3.7 [SD = 3.8], M[subscript noReferral] = 3.0 [SD = 3.3], p = 0.0001), psychoticlike experiences (M[subscript self-referral] = 1.1 [SD = 1.6], M[subscript noReferral] = 0.9 [SD = 1.4], p = 0.0004), emotional reactivity (M[subscript self-referral] = 24.4 [SD = 23.7], M[subscript noReferral] = 20.8 [SD = 20.8], p = 0.001), and inattention and hyperactivity (M[subscript self-referral] = 0.8 [SD = 0.8], M[subscript noReferral] = 0.7 [SD = 0.7], p = 0.001). Students who self-referred were more likely to endorse a past-year suicide attempt (6.6% among self-referral group, 3.1% among the no-referral group; OR = 1.7, p = 0.02) and not talking to anyone (formal or informal mental health supports) about their mental health in the past year (31.4% self-referrals, 21.9% no referral; OR = 1.7, p &lt; 0.001). Students who self-referred were also more likely to hold a minoritized gender identity (6.9% self-referrals, 3.9% no self-referrals; OR = 1.8, p = 0.012). School staff (N = 15) noted that the self-referral process was helpful (M = 3.87/5, SD = 1.27), and approximately half of the students requesting support (53.7%) were not already engaged in school-based mental health support. Self-referral requests following school-wide screeners may be a useful strategy to identify students experiencing mental health distress without supports in place.
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      – Type: doi
        Value: 10.1037/spq0000719
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 12
        StartPage: 434
    Subjects:
      – SubjectFull: Mental Health
        Type: general
      – SubjectFull: Referral
        Type: general
      – SubjectFull: Middle School Students
        Type: general
      – SubjectFull: High School Students
        Type: general
      – SubjectFull: Depression (Psychology)
        Type: general
      – SubjectFull: Anxiety
        Type: general
      – SubjectFull: Mental Disorders
        Type: general
      – SubjectFull: Emotional Response
        Type: general
      – SubjectFull: Attention Deficit Hyperactivity Disorder
        Type: general
      – SubjectFull: Suicide
        Type: general
      – SubjectFull: Psychological Patterns
        Type: general
      – SubjectFull: Self Disclosure (Individuals)
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      – SubjectFull: School Health Services
        Type: general
      – SubjectFull: Screening Tests
        Type: general
      – SubjectFull: Gender Differences
        Type: general
      – SubjectFull: Racial Differences
        Type: general
      – SubjectFull: Ethnicity
        Type: general
      – SubjectFull: Substance Abuse
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      – SubjectFull: Massachusetts
        Type: general
    Titles:
      – TitleFull: Exploring Self-Referral as a Low-Burden, Universally Administered Strategy to Connect Adolescents to Mental Health Supports Following Anonymous School-Based Screening
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              Y: 2026
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