R ESEARCH A RTICLE Help-Seeking in the School Context: Understanding Chinese American Adolescents’ Underutilization of School Health Services YOLANDA ANYON, PhD, MSW a KELLY WHITAKER, MPA b JOHN P. SHIELDS, PhD, MSW c HEATHER FRANKS, MA d ABSTRACT BACKGROUND: This article examines whether school contextual factors, such as referral practices and peer dynamics, contribute to Chinese American students’ underrepresentation in school health programs. METHODS: Data from the 2007 Youth Risk Behavior Survey (N = 1,744) as well as interviews and focus groups (N = 51) with Chinese American users and nonusers of high school health programs were analyzed to identify aspects of the help-seeking process unique to Chinese American students. RESULTS: Chinese American students primarily defined the need for school health services as having personal problems, engaging in early sexual activity, or using drugs. For the most part, they did not recognize their own health or psychosocial concerns as falling in these categories. Teacher referrals and peer dynamics were also salient factors in students’ decisions to seek help from school health programs. Relationships with providers in strengths-based prevention programs improved their utilization of individual therapy and reproductive health services. CONCLUSIONS: To increase Chinese American students’ access of needed services, the organizational systems and social contexts of school health programs (in addition to the practices of individual clinicians) must be responsive to the needs and preferences of these ethnic minority youth. Keywords: child and adolescent health; school-based clinics; school health services. Citation: Anyon Y, Whitaker K, Shields JP, Franks H. Help-seeking in the school context: understanding Chinese American adolescents’ underutilization of school health services. J Sch Health. 2013; 83: 562-572. Received on August 28, 2011 Accepted on July 24, 2012 I n June 2008, a headline in the San Francisco Bay area education section of Asian Week newspaper announced: ‘‘API students top suicide list: Chinese students attempted suicide multiple times.’’ 1 The article contrasted the high number of reported suicide attempts among Chinese American high school students in San Francisco with their relatively low use of mental health services. These local concerns parallel those voiced by a growing number of scholars a Assistant Professor, (yanyon@du.edu), University of Denver, School of Social Work, 2148 South High Street, Denver, CO 80208. b Research Associate, (kellyw@etr.org), ETR Associates, 251 Rhode Island St, Suite 204, San Francisco, CA 94103. c Senior Research Associate, (johns@etr.org), ETR Associates, 251 Rhode Island St, Suite 204, San Francisco, CA 94103. d Research Associate, (heatherf@etr.org), ETR Associates, 4 Carbonero Way, Scotts Valley, CA 95066. Address correspondence to: Yolanda Anyon, Assistant Professor, (yanyon@du.edu), University of Denver, School of Social Work, 2148 South High Street, Denver, CO 80208. The authors would like to thank Stacey Blankenbaker, Wellness Initiative Manager, for her support, encouragement, and feedback throughout the process of data collection and analysis. In addition, the authors wish to acknowledge participating Wellness Coordinators (Jen Kenny-Baum, Christine Lee, and Jen Krasner) and Community Health Outreach Workers (Ian Enriquez, Vanessa Fontana, and Max Anders) for their support with youth recruitment and logistics for the focus groups and interviews that are the subject of this manuscript. The views expressed in the manuscript do not necessarily reflect the opinions of the Wellness Initiative or its employees. and professional associations who argue that far too many Asian American adolescents do not have access to, or use, the psychosocial services they need. 2,3 The phenomenon of health service underutilization among Chinese American youth is not unique to San Francisco, and there is a pressing need across the country to understand how to serve these adolescents better, particularly given the tremendous growth in the Chinese American population in recent years. 3 562 • Journal of School Health • August 2013, Vol. 83, No. 8 •  2013, American School Health Association