Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Melissa M. Pearrow

Second Advisor

Lindsay Fallon

Third Advisor

Brian Daniels


Concerningly, 1 in 5 children meet criteria for a behavioral health disorder; and yet only a small portion of children with behavioral health needs actually receive services. Longitudinal research indicate a predictive relationship between early-onset behavioral health problems and later quality-of-life interfering outcomes; the effects are exacerbated for individuals with complex trauma and minimal social supports. Best practice currently recommends behavioral health services that are comprehensive, multitiered, and school-based.

The design of this study was a secondary data analysis, with data from Boston elementary schools in the first year of comprehensive behavioral health supports. This study examined student internalizing and externalizing behavior through a bioecological approach, in consideration of individual, classroom, and school effects. Hierarchical linear models were run on 5099 observations (of internalizing and externalizing behavior) from 2,789 students, nested in 117 classrooms, in 11 elementary schools. Results suggest that student internalizing and externalizing behavior, though explained primarily by student-level factors, are also influenced by effects at the classroom and school levels. These findings support the paradigm shift toward comprehensive school-based behavioral health frameworks and the utilization of hierarchical linear modeling when analyzing nested data. Implications for school practice and future research, as well as limitations of this study, were discussed.


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