Date of Award

2025

Document Type

Open Access Thesis

Department

Psychology

First Advisor

Samuel McQuillin

Abstract

The youth mental health crisis continues to face persistent barriers of stigma, workforce shortages, and fragmented service delivery systems. Schools play a pivotal role in addressing these challenges, as youth are six times more likely to access mental health services in schools than in community settings. Frameworks such as the Comprehensive School Mental Health Systems (CSMHS) and the Interconnected Systems Framework (ISF) have improved access and quality of school-based mental health services through integration and partnership efforts. However, stigma remains a persistent barrier for seeking help and perpetuating untreated mental health difficulties. Research has found that mental health literacy (MHL) interventions can improve the understanding of mental health, reduce stigma, and encourage help-seeking. It is necessary to further research school-based MHL interventions to identify what factors may facilitate improved MHL outcomes. Therapeutic alliance is one of the most influential factors facilitating positive therapeutic outcomes regardless of therapeutic approach. The present study examined how therapeutic alliance between students and their school-based therapist may influence the treatment effort heterogeneity of a MHL intervention, within a larger CSMHS randomized controlled trial. The study included 751 students in sixth through eighth grade across 22 schools. We hypothesized that the therapeutic alliance would increase treatment effectiveness between a weak and modest alliance, but not beyond a modest and strong alliance. Treatment effect heterogeneity was evaluated using Bayesian Additive Regression Trees (BART), by estimating how the therapist-child therapeutic alliance influences the causal estimate of the MHL intervention. Therapeutic alliance at 3-months predicted individual conditional average treatment effect for perceived mental health stigma at 3-months, indicating students with a stronger therapeutic alliance, on average, had lower scores of perceived mental health stigma than their peers who reported weak therapeutic alliances with their school-based therapists. This study provides one of the first examinations of how therapeutic alliance may influence the effectiveness of a MHL intervention within the short term, through reducing stigma to foster positive attitudes towards help-seeking and receiving services.

Rights

© 2025, Alena Quinn

Download

Included in

Psychology Commons

Share

COinS