An examination and comparison of adolescent utilization of crisis intervention, clinical consultation and individual counseling services at high school level school-based health centers

Mental health clinicians at two inner city school-based health centers in the San Francisco East Bay Area observed that of the high number of clinical consultation cases only a small number developed into formal individual counseling cases. In most circumstances this was due to difficulty in obtaining parental consent to treatment. Because minors are not able to consent to treatment, with the exception of particular circumstances, therapists are not permitted to treat a minor in individual therapy. Consequently, students who are not able to obtain parental consent engage with therapists by way of extended clinical consultation, beyond the normative one to two information-gathering meetings. This study explored utilization similarities and/or differences among students participating in clinical consultation, and individual counseling services. It was expected that participants in the two groups participating in 8 or more visits would discuss similar topics per visit and share similar attendance patterns, indicating comparable therapeutic utility between the two mental health services.;Demographic data, type of visit, frequency of visits and the "topics covered" per visit were derived from Visit Encounter Forms that are completed by therapists following each visit with a student. Overall, the data contradicted expectations of similarities between individual counseling and clinical consultation. Univariate of analyses revealed that individual counseling participants were significantly more likely to have more visits greater than eight and were more likely to cover a wider span of the coded topics during their visits than clinical consultation participants. Individual counseling participant were also more likely to remain in treatment for a year or more than their cohorts in clinical consultation. Conclusions drawn from the data indicate that individual counseling participants are using the treatment in a more intensive and prolonged capacity than those in clinical consultation. Findings also indicate a reluctance, and perhaps uncertainty, for clinical consultation participants to discuss topics during their visits and to remain in treatment.