Coordinating Mental Health Supports Across Out-of-School and In-School Providers: A Scoping Review

Abstract

The coordination of school- and community-based mental health services is a promising strategy to respond to the rising mental health needs of youth. Out-of-school time (OST) programs are an under-utilized community-based resource that may be leveraged to help meet this need. We conducted a scoping review to (a) identify practices that facilitate the coordination of care between schools and OST programs and (b) examine whether such practices align with those used in existing models of expanded school mental health (ESMH). EBSCOhost, PsycINFO, PubMed, Google Scholar, ERIC Scopus, MedLine, ScienceDirect, and national organization websites were used to identify articles, including peer-reviewed (n = 2) and grey literature (n = 7) published from 2004 to 2024 that were written in English and described U.S.-based schools and programs. Coordination practices were coded inductively and categorized as a school/program, district/community, or state-level practice. Practices within the vision/mission alignment, coordinating daily operations, training, and resource/information sharing domains were identified at the highest frequency. Many of the strategies identified are included in existing models of ESMH. Thus, expanding coordination models to include OST may be a feasible direction for increasing the capacity of communities to meet the mental health needs of youth. Given the paucity of research in this area, further empirical research is needed.

1. Introduction

Youth mental health needs have dramatically increased in the past decade and are disproportionately worse for historically marginalized populations. For example, the number of high school students who report persistent sadness or hopelessness has increased from 30% to 40%, with a greater proportion of LGBTQ+ youth reporting such experiences relative to their peers (65% vs. 31%). Youth of color also report higher rates of attempted suicide relative to their white peers (Centers for Disease Control and Prevention, 2023). In response, school staff are tasked with providing mental, behavioral, and social-emotional support to students to promote positive development and learning. Yet, the enthusiasm for school mental health (SMH) services can exceed the capacity of school staff to respond. Increasing the coordination of school and community services has been identified as a strategy to increase capacity to respond to these needs. One community service that has a strong focus on promoting positive youth development in equitable ways is out-of-school (OST) programming, but limited research exists as to the practices that OST programs and schools must employ to effectively coordinate their strategies and goals for promoting positive youth mental health. Given the limited available research, we conducted a scoping review of empirical and grey literature (i.e., technical assistance centers and foundation guidance documents) to identify (a) the extent of research that exists addressing coordination between in-school and OST providers and (b) promising practices that facilitate this type of coordination.

1.1. Out-of-School Time Programs: Promoting Youth Mental and Behavioral Health

With nearly 8 million youth participating in OST programs, OST represents a significant, underused resource to increase the capacity of schools and communities to address mental health needs (America After 3PM, 2020). In this study, OST programs are defined as those that (a) occur during out-of-school hours during the school year or summer; (b) are school- or community-based; (c) are supervised by adult leaders; and (d) occur in group settings (adapted from Roth et al., 2010). This criterion excludes other extracurricular activities, such as sports or individual lessons, as well as one-on-one youth mentoring, because these activities require different considerations for coordination with other youth-serving systems and often have different aims. OST programs provide a unique opportunity in at least three ways. First, OST programs are unique contexts operating outside of traditional school hours that use an asset-based lens to promote psychological safety, supportive relationships, and opportunities to belong (Simpkins et al., 2017). This informal context, often embedded in the community, is a space where youth can advocate around issues of well-being, making it a unique, youth-focused setting for promoting mental health. Second, OST practitioners have expertise in building relationships to promote youth development (Akiva et al., 2023) and are well-positioned to learn about and respond to young people’s mental health needs. Third, OST programs that are embedded in the community, especially within historically marginalized communities (e.g., low income, rural, or urban centers), can empower youth who do not traditionally have access to additional mental health supports (Lerner et al., 2021; Zaff et al., 2015).

Despite these benefits, OST programs are often left out of efforts to coordinate mental health services for youth due to barriers that limit collaboration between agencies (Adams-Bass et al., 2022). These barriers include statutory (e.g., privacy laws), regulatory (e.g., regulations requiring professional licensure), financial (e.g., different funding streams), and disciplinary differences. Further, the youth development workforce is not always viewed as a unified, professional field (Borden et al., 2020). This can create a hierarchical relationship between school-based and OST professionals that discourages partnership. It also limits opportunities for career advancement and contributes to high turnover among OST practitioners.

Several policy and research practices have been proposed to increase OST involvement in SMH services. These practices, informed by an ecological systems perspective, point to systemic barriers and facilitators of collaboration (Adams-Bass et al., 2022). Proposed practices include expanding professional development opportunities for OST professionals to implement specific mental health practices (Frazier et al., 2013); creating professional credentialing for the OST workforce to signal training, expertise and to build career pathways (Borden et al., 2020); and developing strategies for OST and in-school staff to co-plan and implement mental health services. Yet, the field has not prioritized, nor empirically tested, how these (and other) recommendations impact (a) coordination between schools and OST or (b) youth educational and mental health outcomes.

1.2. Expanded School Mental Health: A Model for Coordinated Care

Models of expanded school mental health (ESMH) are a useful guide for understanding how OST services can be coordinated with other community- and school-based mental health efforts (Weist, 1997). ESMH services involve coordinating mental and behavioral health support in and outside of school to increase the capacity of communities to address youth mental health needs. Often, ESMH services involve licensed community mental health professionals (e.g., counselors, social workers) providing individual therapeutic services to youth within the school building during the school day. These services might also involve case management and family supports such as providing referrals to psychiatric services or addressing basic needs (e.g., food and housing security).

To provide youth with the right level of support without taxing the capacity of SMH professionals, ESMH models rely on a multi-tiered system of support (MTSS) for delivering mental and behavioral health services. MTSS is a public health framework that relies on universal screening to determine students’ needs and ongoing data collection to monitor intervention progress (S. Hoover & Bostic, 2021). Tier 1 involves universal promotion activities for all students, such as social, emotional, behavioral, and relationship skill-building activities. At Tier 2, early intervention or prevention services are provided to students experiencing some distress or impairment, such as small group therapy or mentoring (S. Hoover & Bostic, 2021). Students with the highest demonstrated need or functional impairment are provided with services at Tier 3, which may include providing individual school- and/or community-based mental health services (e.g., individual therapy). To work well, schools and districts must establish multidisciplinary teams, collect and use data to inform decisions, and implement evidence-based practices (McIntosh & Goodman, 2016).

Within the MTSS framework, it is encouraged to coordinate school-based services with community mental health providers, but it can be difficult because of statutory, regulatory, organizational, and individual barriers. Statutory and regulatory barriers, like federal privacy laws (e.g., the Health Information Privacy and Protection Act), limit the type of information health and school staff can share with each other about a student. Organizationally, community mental health providers are often compensated for specific services provided (often billable to insurance companies involving direct mental health interventions). Individually, community- and school-based mental health staff must have opportunities to plan services, delineate each other’s roles and responsibilities, and evaluate the impact of these services.

One framework, called the Interconnected Systems Framework (ISF), provides strategies to address challenges associated with integrating school- and community-based mental health services (Barrett et al., 2013). The ISF leverages models of SMH as well as the strengths of the MTSS framework by expanding activities to include community mental health providers to address student mental and behavioral health concerns (Weist et al., 2022). Integrating these models addresses the capacity limitations of MTSS to provide services across tiers (i.e., Tier 1–3), provides support to students with externalizing and internalizing behaviors (e.g., anxiety, depression), and addresses the siloed nature of many SMH professionals’ work (Weist et al., 2022) by bringing together SMH clinicians (i.e., school and community providers) and the organizational systems associated with MTSS (Splett et al., 2017). Core practices of the ISF include teaming structures, data-based decision making, and evidence-based practice use (Barrett et al., 2013; Splett et al., 2017). Interdisciplinary teams allow for information and resource sharing as well as data-based decision making using information from a wider array of sources (e.g., academic and behavioral data, intervention and screening data, community data) (Splett et al., 2017). The implementation of evidence-based practices across tiers and across settings to meet a diverse range of student social, emotional, and behavioral needs is supported by effective collaboration and data-sharing (Weist et al., 2017).

The ISF expands the membership of SMH teams to include professionals from other youth-serving systems (e.g., child welfare) and families (e.g., caregivers, older students), yet OST professionals are not regularly integrated into these models of care. Nevertheless, the practices described in the ISF provide a useful framework for understanding how OST services can be systemically integrated within other mental health services delivered in schools. For effective coordination of services in the ISF, Splett et al. (2017) described collaboration practices as occurring across three domains: (a) state-level leadership (e.g., Departments of Education and Health), (b) district and community leaders (e.g., superintendents and directors of community mental health agencies), and (c) school and community members (e.g., school principal, families, students, teachers, mental health providers). School-level practices include training for school and community mental health providers on effective teaming practices, use of data, and evidence-based intervention strategies. District- and state-level practices include allocating financial resources and providing technical assistance to schools and community organizations (Splett et al., 2017). The structure of the ISF is based on the notion that teams are best suited to support students when there are members representing multiple disciplines and bring diverse strengths and perspectives. For example, state-level team members are often well-positioned to provide support to schools and districts through policy and funding; district team members can help to coordinate the allocation of funds and resources for individual school buildings; and building-level team members can conduct needs assessments to determine how best to allocate funds within the building. Given the structure of OST programs, they may be integrated at the school and community member level to support the direct delivery of services and supports to youth and families.

1.3. Current Study

There is growing support for engaging schools and OST programs to promote positive mental health and social–emotional outcomes for youth. Past research on OST programs suggests that it is a setting wherein youth, especially historically marginalized youth, receive significant social–emotional support (Lerner et al., 2021; Zaff et al., 2015). Furthermore, because OST programs are often located in under-resourced communities, there are significant opportunities to redress inequities observed in accessing and benefiting from mental health and social–emotional services. OST programs also have the potential to complement the delivery of clinical services in schools and communities through promotion and prevention strategies focused on positive youth development. Past research on ESMH suggests that a multisystemic approach involving policy, organizational, and individual strategies may be most likely to increase access to equitable mental and behavioral supports through coordination between schools, family, youth representatives, and other youth-serving settings. Yet, existing models, like the ISF, do not include OST professionals as stakeholders in teaming recommendations. The unique strengths of OST programs hold promise for introducing a unique perspective to the coordination of services, particularly given their often-strong connections to youth and families, and for expanding the capacity of schools to meet the needs of communities.

Given this promise, the current study (a) provides an overview of practices that have been used to facilitate coordinated mental health care for youth across schools and OST programs and (b) examines how current practice recommendations for coordinating care between schools and OST programs align with or add to existing models of ESMH. Scoping reviews, unlike meta-analyses or systematic reviews, are intended to provide readers with a scan of the literature and are indicated for use when an area of scholarship is emergent (Munn et al., 2018). Consistent with past research on ISF services (Splett et al., 2017), we organized the results according to practices identified to support coordination among (a) state-level agencies, (b) district and community leaders, and (c) school and community partners. The results provide a clearer picture of the existing literature on strategies (and gaps) in the practices that exist for coordinating SMH services with OST providers. In doing so, the results provide opportunities to explore novel strategies to support greater integration of mental health services provided between schools and OST programs.

2. Methods

2.1. Literature Search

Following the PRISMA guidelines for scoping reviews, we conducted a systematic search of literature, including qualitative and quantitative research, organizational reports, and organizational resources, from May to June 2024 that described approaches for coordinating mental health and social–emotional learning programming across schools and OST programs. Specifically, we used EBSCOhost, PsycINFO, PubMed, Google Scholar, ERIC Scopus, MedLine, and ScienceDirect databases and searched for peer-reviewed articles that contained the following keywords: “school mental health” OR “school-based mental health” AND “out-of-school program” OR “out-of-school time” OR “after-school”. In addition, national organizations involved in supporting SMH services and OST programs were included in the literature search (National Afterschool Association, Afterschool Alliance, Wallace Foundation, Child Trends, National Institute on Out-of-School Time, Global Family Research Project, America’s Promise, Search Institute, RAND Corporation, American Institutes for Research, Afterschool Matters, National Alliance on Mental Illness, ProQuest, University of Chicago Consortium on School Research, National Center for Education Statistics, AERA White Paper Repository, Communities in Schools, and MENTOR). Although not peer reviewed, these organizations publish resources for OST and school staff (i.e., grey literature) that may be helpful for identifying strategies for collaboration that are used in the field but have not been studied empirically.

2.2. Inclusion and Exclusion Criteria

Two graduate research assistants reviewed and applied inclusion criteria to study titles and abstracts. The graduate students received training and consultation from a librarian with expertise in conducting scoping reviews as well as in education and social science research. To be included in the review, articles must have been written in English and published from 2004 to 2024. Studies published only after 2004 were included in this review because a federal law called the Individuals with Disabilities Education Act was reauthorized in 2004 and allowed schools to engage in more prevention and community-engaged services to support students with disabilities (including those with mental or behavioral health challenges). Thus, this review only includes studies that are consistent with this federal legislation. We screened titles and abstracts for any indication that the article would discuss coordination between schools and OST. Again, OST programs include those that (a) occur during out-of-school hours during the school year or summer; (b) are school- or community-based; (c) are supervised by adult leaders; and (d) occur in group settings. These articles were included for subsequent review.

2.3. Article Coding

After screening the article titles and abstracts, the two graduate research assistants reviewed the full-text articles. Articles were excluded if they (a) only described schools or OST and not both settings, (b) included both settings but did not include coordination practices, (c) included coordination, but not of mental health services or interventions, (d) did not meet the previously mentioned criteria (e.g., occurred outside the United States), or (e) were unable to be retrieved.

The two graduate research assistants divided the final set of articles and charted the data (Arksey & O’Malley, 2005) by extracting the article citation, coordination practices identified, a brief description of the practice, whether the article was primarily theoretical, empirical, or both, the target audience (schools, OST, State Education Agencies, State Leaders), and the target setting (schools, OST, both) (

Table 1. Summary of data charting.

Citation	Article Type	Target Audience(s)	Target Setting(s)
Afterschool Alliance (2020)	Theoretical	Schools, OST programs, School Leaders	Schools, OST programs
Dwyer (2022)	Empirical	Schools, OST programs, School Leaders, State Education Agencies	Schools, OST programs
Freeman (2011)	Theoretical	Schools, OST programs, State Education Agencies	Schools
Freeman et al. (2014)	Theoretical	Schools, OST programs, State Education Agencies	Schools, OST programs
Great Lakes Comprehensive Center (2016)	Theoretical	Schools, OST programs	Schools, OST programs
S. A. Hoover (2024)	Theoretical	Schools, State Education Agencies	Schools
Iachini and Anderson-Butcher (2014)	Theoretical with empirical evidence cited	Schools, OST programs	Schools, OST programs
Johnston et al. (2017)	Empirical	Schools, OST programs, State Education Agencies	Schools, OST programs
Jones et al. (2022)	Theoretical with empirical evidence cited	Schools, OST programs	Schools, OST programs

). Following the full-text review, the two graduate research assistants divided the final set of articles and coded inductively for coordination practices. The resulting set of practices was then organized into higher-order categories by the principal investigator. One graduate research assistant reviewed and modified the higher-order categories. The second graduate researcher reviewed and double-coded the full set of practices using the higher-order categories, with 95.7% agreement between the two graduate research assistants. Disagreements were resolved through consensus between the two graduate researchers. Throughout the entirety of the review process, the graduate students received weekly supervision and consultation from the principal investigator.

3. Results

The original search of articles conducted between May and June 2024 yielded 310 potentially relevant citations. After duplicates were removed (n = 18), the remaining 292 citations were screened for relevance and eligibility based on their titles and abstracts. Based on this screening, 251 articles were determined to be irrelevant for the current study, and 41 articles were procured for full-text review. Three articles could not be procured and were thus excluded from the current study. After reviewing the full-text articles, nine remained and were included in the analysis (

Table 2. Number of practices identified within each domain by article.

Citation	Communication	Coordinate Daily Operations	Data Collection, Use, and Sharing	Family and Community Engagement	Financial Resources	Institutional Support	Leadership	Professional Relationships	Resource and Information Sharing	Role Clarity	Training	Vision and Mission Alignment
(Afterschool Alliance, 2020)	1	5	1	2	1		1		3	1	1	1
(Dwyer, 2022)	1	2				7	1	1	3		1	2
(Freeman, 2011)		2	1	1	2	1		1	1	2	1	1
(Freeman et al., 2014)		1			1		1			1	1	2
(Great Lakes Comprehensive Center, 2016)				2							1	1
(S. A. Hoover, 2024)	1		2		1	3					1
(Iachini & Anderson-Butcher, 2014)	2	4	1	1					4			3
(Johnston et al., 2017)		1					1	2	1	1		1
(Jones et al., 2022)		1	1									2

). See Figure 1 for a flow of articles selected through identification and final inclusion. Initial inductive coding yielded 93 non-mutually exclusive practices that were identified across articles. These 93 practices were first sorted into 12 higher-order categories and then into a state-, district-/community-, or school-/program-level practice, reflective of the ISF model described by Splett et al. (2017) (

Table 3. Summary of the coordination practices identified.

Level of Intervention	Theme	Example Practices	Percent of Articles
Schools and OST Programs	Communication	Regular meetings between IST and OST staff; discuss feasibility of implementing common strategies in- and out-of-school; formal and informal discussions about strategy effectiveness	44.4%
	Coordinate daily operations	Adjust schedules for coordinated meetings; coordinate referral processes; interdisciplinary teaming; coordinated policies (e.g., behavioral); coordinated content and skills (e.g., extended learning, SEL)	77.8%
	Data collection, use, and sharing	Share social, emotional, and academic outcome data; create data infrastructure to inform and monitor intervention implementation; continuous quality improvement of strategies and interventions; needs assessments; report on program outcomes to state leaders	55.6%
	Family and community engagement	Seek family input in after-school hours; employ staff from the same communities as students and families; coordinated distribution of resources to families (e.g., meals); provide information to families about programming; leverage OST–family partnerships to promote school-family engagement; engage families in programming	44.4%
	Leadership	School leaders coordinate and convene meetings to discuss IST-OST coordination; problem-solving led by school and community leaders; coordination of service delivery by leaders	44.4%
	Professional relationships	Staff follow through on commitments and agreements to build trust; schools provide ongoing consultation and education to IST and OST staff; build community through joint IST and OST staff retreats; OST staff hold positions on IST teams	33.3%
	Resource and information sharing	Schools and OST programs contribute to resources to support youth and families; shared facilities; shared access to technology and connectivity for learning in- and out-of-school; share information, best practices, tools, and models to support programming; leverage college-level interns and apprentice teachers to provide summer program services; offer additional pay to school staff to offer summer program services; school-based staff (e.g., teachers, SMHPs) work and provide services in afterschool;	66.7%
	Role clarity	Collaboratively define the roles, responsibilities, and resource contribution of each setting in promoting positive youth development; complementary service provision; contract defining roles; MOU/MOA to define scope of work; landscape scan of available OST programs	44.4%
	Vision and mission alignment	Joint IST-OST planning, needs assessment, and implementation of school goals; establish shared values across IST and OST; review mission statements; joint development of measurable outcomes and goals; create and develop a shared vision, mission, goals, and objectives; develop plan to share outcomes with shareholders; communicate program outcomes to influence state and local governments; joint SEL planning and approaches; connect SMH and OST to classroom learning; create shared understanding of students’ needs and strengths	88.9%
District and Community	Financial resources	Coordinated seeking of federal funding; consult with state leaders on sources of funding; discuss sustainability options with state leadership; outline funding streams for OST and IST	44.4%
	Training	Joint IST and OST professional development; training on varied youth needs across development; schools survey MH topics from staff, develop yearly plan for PD, including OST staff; schools provide materials and support to OST to implement SEL	66.7%
State	Institutional support	State education agencies should: collect and report on data regarding access and participation of summer offerings; equitably distribute funds; align grant funding and reporting periods to meet needs of summer programs; permit carryover of grant funds; review regulatory requirements (e.g., personnel and facility licensing) that act as barriers and consider policy changes; consistent messaging to promote summer programming and partnerships; support joint training; work with schools to identify legislative opportunities and advance desired local and state policies; leverage Medicaid to reimburse for school-based services. District policies to help with transportation for OST. Work with state education agencies to establish funding streams. State education agency provides centralized training that is consistent with state policies, develops compendium of effective programs, and provides school-level technical assistance.	33.3%

). Each of these categories is subsequently discussed.

3.1. Building-Level Team Practices (Schools and OST Programs)

Practices at the building level (i.e., schools and OST programs) are intended to be carried out by the school and OST program staff working within these spaces. Most practices included in the articles reviewed were intended to be carried out by professionals at this level. The practice domains at this level are subsequently reviewed.

3.1.1. Vision and Mission Alignment

Vision and mission alignment practices refer to those that involve coordination between schools and OST programs in terms of their goals and objectives. Almost all articles (88.9%) discussed at least one practice within this domain. Example practices included engaging in a coordinated needs assessment and goal development process, identifying shared values, reviewing and revising mission statements, developing a shared understanding of students’ needs and strengths, and coordinating goals to support student learning outcomes. To effectively coordinate care for youth and families, the articles reviewed indicate that schools and programs must develop a shared understanding of their goals and plans for achieving such goals.

3.1.2. Coordinate Daily Operations

Coordinated daily operations refers to practices supporting collaboration and coordination between schools and OST programs on a daily basis. Most articles (77.8%) included at least one practice within this domain. With a shared mission and vision developed, schools and programs can turn towards the day-to-day logistics required for coordinated care. Example practices include adjusting schedules to allow for the formation and meeting of interdisciplinary teams, coordinating referral processes, and coordinating the delivery of content to youth, such as social–emotional learning curriculum. These practices are implemented and carried out by individuals working within and across schools and OST programs, although team, meeting, and referral streams may include other individuals from the community (e.g., mental health professionals and youth and family representatives).

3.1.3. Resource and Information Sharing

Resource and information sharing refers to practices carried out by school and program staff that involve pooling and sharing tangible resources, knowledge, and manpower. Several articles (66.7%) included practices within this domain. Example practices related to more tangible resources include sharing facilities, technology, access to connectivity, and necessities (e.g., food). Knowledge sharing included the sharing of best practices, tools, and models to support programming. Practices related to sharing manpower included SMH professionals allocating some of their time and capacity to providing services in OST and providing teachers extra pay for working in OST during the summer months. These practices expand the capacity of SMH systems to meet students’ needs outside of school hours.

3.1.4. Data Collection, Use, and Sharing

Approximately half of the articles (55.6%) included a practice related to data collection, use, and/or sharing. Example practices within this domain include schools and OST programs creating an infrastructure for data sharing (e.g., social, emotional, and academic outcomes) and collection for intervention-monitoring, relying on data to inform continuous quality improvement of programming, and reporting on outcomes to state leaders. These practices facilitate a shared understanding of what students and communities need as well as what is and is not working. It also allows programs and schools to identify areas of strength to leverage to support youth mental health.

3.1.5. Communication

Communication practices refer to methods for schools and OST programs to communicate regarding coordinated care and were discussed in 44.4% of articles. These practices are related to daily operations in that they are facilitative of coordination when they are successfully implemented on a frequent basis but are distinct in that they relate more to processes as opposed to logistics. Namely, once a meeting schedule is established (i.e., a daily operation practice), school and program staff must, for example, engage in effective communication practices during that time. Regular formal and informal discussions between school and program staff about strategy implementation, effectiveness, and feasibility were recommended.

3.1.6. Family and Community Engagement

Family and community engagement practices involve school and program staff communicating and developing relationships with families and communities. These practices are referenced in 44.4% of articles. Examples include seeking input from families during OST hours, employing staff from the same communities as students and families, providing resources to families (e.g., meals), and engaging families in programming. Families may feel more comfortable in OST settings as opposed to school settings, and thus, OST can facilitate engagement between schools and families.

3.1.7. Leadership

Leadership practices are those that involve coordination between leaders in schools and OST programs and were discussed in 44.4% of articles. Example practices include coordinating and convening meetings between school and OST staff (i.e., facilitating coordinated daily operations), supporting problem-solving, and coordinating service delivery to youth. Leaders across settings can play a key role in supporting practices at the level of school and program staff.

3.1.8. Professional Relationships

To effectively coordinate and deliver care, positive relationships between school and OST program staff are cited as important across one-third of articles. Example professional relationship practices include building community through joint retreats, ensuring commitment and follow-through on agreements between staff, schools providing consultation and education to school and OST staff, and including staff across settings on interdisciplinary teams.

3.1.9. Role Clarity

Practices within the role clarity domain relate to methods of establishing clear roles for staff across schools and OST programs and are discussed in 44.4% of articles. Specific examples include collaboratively defining roles, responsibilities, and the resource contribution of each setting, complementary service provision, and establishing a memorandum of understanding or other contract to define such roles and responsibilities.

3.2. District and Community Team Practices

Practices at the level of school districts and communities are intended to be carried out by individuals working at the district level. Additionally, practices for engaging with communities as a collective are included. These are distinct from the individual-level engagement between staff and families included at the school/program level.

3.2.1. Training

Training practices were included at the district level because funding is often allocated from this level down to schools. Training is discussed in the majority (66.7%) of the articles. Specific examples include joint professional development for school and OST staff and schools providing materials and support to OST programs for the implementation of social–emotional learning. Other recommendations include providing foundational knowledge about youth development during trainings and relying on school and program staff surveys to inform the development of professional development.

3.2.2. Financial Resources

Like training, funding for schools is often coordinated by their associated district. Practices related to the coordination of financial resources were included in 44.4% of articles. Specifically, it is recommended that schools and programs jointly seek federal funding and consult with their state leaders about sustainable funding sources. These efforts may be best coordinated by school districts. It is also recommended that funding streams for schools and programs are clearly outlined.

3.3. State-Level Team Practices

State-level practices refer to those intended to be carried out by state education agencies.

Institutional Support

Although only discussed in one-third of articles, several practices were proposed for state education agencies to provide institutional support for school and OST program coordination. These agencies often have more power than schools to allocate funds and promote policy change. Specific practices include modifying funding and reporting timelines to meet the needs of summer programs, reviewing and modifying regulatory requirements that are acting as barriers to coordination, and providing additional support for joint school and program training and provision of services (e.g., technical assistance).

4. Discussion

Coordinating mental health services between schools and OST programs holds promise for addressing the unmet mental health needs of youth. In the United States, over 40% of youth report feelings of sadness or hopelessness, and dramatic increases in youth mental health needs (e.g., suicide attempts and mental health hospitalizations) have been reported (Centers for Disease Control and Prevention, 2023). At the same time, the availability of licensed mental health providers remains low and is often worse for youth living in low-income and historically marginalized communities due to systemic and structural barriers (Centers for Disease Control and Prevention, 2023). In comparison to school and community mental health services, OST programs tend to offer more programming focused on the prevention and promotion of youth mental health (Lerner et al., 2021; Zaff et al., 2015). Thus, OST programs offer services that are naturally complementary to the services provided by licensed mental health providers, which tend to emphasize identification and treatment of diagnosable mental health conditions. Our results provide insights into promising practices for facilitating this type of coordination and areas for future research.

First, the scoping review revealed common strategies across the research studies (n = 2) and resources compiled through a grey literature search (n = 7). Many of the strategies identified in the scoping review aligned well with best practices in existing coordinated care models, specifically with the ISF. The strategies identified include those involving individual staff members (e.g., training for school and OST staff) while also considering organizational and systemic factors that facilitate coordination (e.g., models of funding, identifying shared mission and visions). This finding is useful because it suggests that schools using the strategies associated with the ISF may be able to readily apply these practices to coordinate with OST programs. Notably, studies were found as early as 2011 and as late as 2024. This suggests that the topic of coordinating OST services with school-based services remains a relatively understudied area but has been discussed by researchers and program developers for at least a decade. Important differences were also noted that build upon the ISF and are subsequently discussed. These additions may be necessary to integrate OST into the ISF, given the capacity of OST programs to provide direct services to youth and thus the potential to integrate such programming at both the school and district/community levels of the ISF.

Second, some practices may be particularly important for coordination, given that they were identified across nearly all the studies included in this review. Practices falling within the domains of (a) vision and mission alignment, (b) coordination of daily operations, (c) training, and (d) resource and information sharing, for example, were identified in 88.9%, 77.8%, 66.7%, and 66.7% of the studies, respectively. These practices are interrelated. Specifically, it is important that schools and OST programs implement practices within the vision and mission alignment domain early in their partnership (e.g., conduct a joint needs assessment and goal development process). With this shared understanding established, schools and programs will be better positioned to implement practices within the coordinate daily operations (e.g., adjusting schedules to allow for regular meetings, coordinated referral processes), training (e.g., engage in joint training supportive of their shared mission and vision), and resource and information sharing (e.g., tools, models, facilities) domains. Moreover, coordinated daily operations may be facilitated by joint training and support resource and information sharing. It is important to note that many of the practices identified build upon each other and are thus best implemented together. Although those cited at a higher frequency may be more frequently utilized due to acceptability, feasibility, and effectiveness, those included more often in the literature are also shaped by several factors, including the researchers themselves, funding, and sociopolitical context.

The practices for coordination identified in this scoping review align with those identified within the ESMH literature, but important differences were also noted. As communities consider novel strategies to support youth mental health, this alignment between practices is a useful finding. The ISF, for example, provides teams with specific state-, district-, and school-level practices to facilitate collaboration. As described in the ISF, we also identified practices related to the coordination of funding, technical assistance, and policies by state- and district-level team members, as well as the coordination of needs assessments, referral processes, intervention delivery, and progress monitoring by school-level team members. Given this overlap, it may be possible to integrate OST programming into existing frameworks of ESMH that do not currently reference OST providers in their interdisciplinary teaming structure (

Table 4. Comparing the ISF model with practices identified in the scoping review.

Feature	ISF	Scoping Review
Interdisciplinary collaboration and team functioning	✓	✓
Data-based decision making	✓	✓
Evidence-based practices	✓	✗
Communication	✓	✓
Coordinate daily operations	✗	✓
Data collection, use, and sharing	✓	✓
Family and community engagement	✓	✓
Leadership	✓	✓
Professional relationships	✓	✓
Resource and information sharing	✓	✓
Role clarity	✓	✓
Vision and mission alignment	✗	✓
Financial resources	✓	✓
Institutional support	✓	✓
Training	✓	✓

). Our scoping review also builds on and adds to the ISF by placing greater emphasis on creating shared missions and visions, coordinating daily operations, and sharing information and resources between schools and community programming, including OST. These practices may be particularly important for engaging OST in ESMH because OST professionals provide direct services to youth, like the responsibilities included at the building level in the ISF. Additionally, OST programs may engage in a more supportive role, like the responsibilities included at the ISF district/community level, that do not always include direct service delivery. These practices may be needed for integrating OST programs into the ISF, given the greater variability in programming and staff training within OST programs.

Despite the many benefits of OST programming for youth, there is the potential for disparities to emerge if coordination practices are not implemented thoughtfully. There is evidence that efforts to provide OST programming, specifically to low-income students and students of color, including the 21st Century Community Learning Center (CCLC) Program, have been ineffective in supporting this target population (Klumpner & Woolley, 2021). Federal funding programs often require school and district resources to apply for grants and to meet ongoing funding requirements, which many under-resourced schools do not have. Also, there is evidence that low-income schools are more likely to have fee-based OST programming; this may be a result of higher-resourced schools having the means to provide programming without charging families (Klumpner & Woolley, 2021). If low-income schools do allocate limited district funding and resources to OST, they may also be diverting it away from SMH and thereby limiting the internal capacity of schools to provide services. Because schools that tend to rely on OST programming are more often serving under-resourced communities (Hammer & White, 2012), this has the potential to further disparities in the SMH resources available to students and families. Therefore, ensuring that OST programming is well-integrated with school-based services and funding streams may allow districts and communities to better coordinate their resources to ensure that building up OST programs does not detract from the services and support that students are provided in school.

Limitations

This scoping review is subject to a few limitations. First, the small number of empirical studies (n = 2) and reliance on unpublished, grey literature limit the generalizability of the findings and underscore the need for additional research into the area of OST and SMH coordination. It is worth noting that much of the research carried out on OST is conducted in reports and grey literature, so this finding may not be surprising. This work may also have greater external reliability, given its development in the field. Second, there is a considerable amount of variability in the methodologies represented across the published and unpublished sources. Empirical, peer-reviewed studies on the coordination of OST and SMH initiatives are few, and grey literature (e.g., policy briefs, practitioner reports, etc.) is not subject to the same scientific standards. While the coordination strategies mentioned across the review’s sources may be rooted in theory or informed by practical knowledge, empirical research is needed to determine the efficacy of strategies. Additionally, the terms used in our search strategy may have excluded some articles with relevant practices. Our focus on school mental health systems (i.e., “school mental health” and “school-based mental health”) specifically may have excluded literature that discussed student mental health outcomes outside such systems. Furthermore, we did not include “community program” in our OST-related search string. Even though this language may be used for OST in some contexts, some community programs are beyond the scope of OST as defined in this study. Regarding our use of grey literature, we relied on literature from national and regional organizations known to the authors, all with experience and expertise in OST and/or SMH. There may be organizations unknown to the authors that were excluded. Last, the inclusion criteria used in this scoping review may impact the applicability of findings to other contexts. Temporal and geographical restrictions were placed given the unique cultural and political context of schools within the United States, and as a result, the identified coordination strategies may not translate fully to other settings. The criteria may also have excluded sources delineating coordination practices in other countries.

5. Conclusions for Practitioners and Researchers

The results of this study provide promising strategies for practitioners (school and OST staff) to consider implementing to expand their capacity to address and promote youth mental health. Importantly, the common themes identified as strategies are regularly used by schools implementing ESMH programming (e.g., developing shared mission and vision, creating clear roles and responsibilities). This means that integrating OST programming into other mental health services may be viewed as an extension of work already being done rather than redirecting efforts in a new direction. OST providers may provide additional capacity to coordinate services and can also engage in direct intervention and prevention. Like schools, providing services in settings in which youth are already embedded reduces structural barriers. In particular, OST programs have a history of promoting positive development for historically marginalized youth populations, holding promise for redressing mental health disparities. Furthermore, many of the strategies identified were drawn from organizations that routinely provide direct technical assistance and support to schools and OST programs (i.e., grey literature sources) rather than peer-reviewed sources. Although the absence of rigorous empirical evidence of these strategies is an important limitation, these strategies may be more acceptable and feasible to implement, given that many were field-generated (rather than researcher-developed).

At the same time, the practices identified have not been rigorously evaluated. Thus, there are unique opportunities for researchers to partner with schools and OST programs to develop and test promising practices for coordination. Initial empirical evidence of the effectiveness of the ISF provides support for a model of ESMH that includes coordination between school-based and community programming to increase the delivery of services, improve team functioning, and contribute to more equitable disciplinary outcomes (Weist et al., 2022). Ideally, district-/community-level ISF teams include professionals from multiple youth-serving systems, such as child welfare, juvenile justice, and primary care (Splett et al., 2017). Future research should examine the feasibility, acceptability, and effectiveness of an interdisciplinary team with broader membership, including individuals working within OST settings as well as those suggested in the ISF, and with services and programming extending to after-school hours and spaces. Mixed methods designs may be particularly useful for understanding the barriers and facilitators to implementing the coordination practices identified through our scoping review. These descriptive studies may provide useful and actionable information about how programs may tailor strategies to meet the specific needs for coordinating in this context. Moreover, longitudinal studies that examine the sustainability of such programming as well as the long-term impacts on student mental health outcomes are needed.