Do Service Provider Ratios Matter? An Examination of Student Mental Health Outcomes Following COVID-19 Disruptions

• In Event: The COVID-19 Pandemic: Social, Emotional, and Academic Outcomes Across Childhood and Adolescence

Abstract

The ratios of school mental health providers to students are a widely discussed topic due to the critical shortage of mental health staff and increase in student mental health needs. Professional organizations outline the recommended provider-student ratios to ensure adequate service provision. However, less than 1% of states met the recommended ratio for school psychologists and school counselors and no state met the recommended ratio for school social workers based on recent data (National Center on School Mental Health, 2020). Although school mental health services have been linked to academic success and positive mental health outcomes (Hoover & Mayworm, 2017; Walrath et al., 2004), less is known about this relationship following COVID-19, when youth experienced significant increases in mental health challenges (Bub et al., under review). To begin to address these gaps, we examined the ratio of school nurses, counselors, psychologists, and social workers post-COVID-19-onset to 1) identify differences in service provider ratios and 2) examine if a relationship exists between post-COVID-19 ratios and middle school youth mental health outcomes.
A researcher developed survey was completed by 36 middle school principals to gather information on the number of service providers and instructional modality prior to and following the onset of COVID-19. Data from students was gathered from the Georgia Department of Education’s voluntary Student Health Survey for the 2020/2021 school year (post-COVID-19). The dataset includes a sample of 14,941 middle school students. Of the schools included in the dataset, 64% of students were non-White while 49% identified as female. Mental health outcomes included student’s self-reported levels of stress, depression, anxiety, and concentration difficulties. Service provider-student ratios were calculated using school population size data from the National Center for Education Statistics.
Results suggest that most schools did not change in the number of service providers pre- and post-COVID-19 (87.5%); however, 4.8% of schools in the sample lost service providers and 7.7% of schools gained service providers. To investigate whether the ratio of service providers was related to mental health outcomes, we regressed post-COVID ratios on a range of mental health indicators (See Table 1). When controlling for the total number of providers pre-COVID-19, results indicated that post-COVID-19 ratios were associated with student’s mental health outcomes. Ten out of 16 regressions were significant. Surprisingly, the student-to-nurse ratio post-COVID-19 was significant for all mental health outcomes, such that the larger the ratio was, the fewer mental health concerns students had. All other statistically significant relationships were positive. The student-to-counselor ratio was associated with stress and anxiety, indicating that higher ratios were associated with more frequent feelings of stress and anxiety. As the ratio of school psychologists increased, stress and depression were more likely to increase. Finally, the social worker-to-student ratio was positively and significantly associated with anxiety and concentration difficulties. Additional analyses related to other mental health outcomes will be completed prior to the conference. These findings have important implications for practice which will be discussed.

Authors

• Shlon A Smith, University of Georgia
  Presenting Author

• Erica Smolinski, University of Georgia

• Sycarah Fisher, University of Georgia

• Kristen L Bub, University of Georgia