Both education and mental health professionals have been sounding the alarm in recent years about increasing child and adolescent mental health problems that impact student well-being, academic performance, and classroom behavior. The challenges associated with the pandemic exacerbated existing conditions such as anxiety, depression, and school avoidance, and in some cases contributed to the development of mental health issues in previously symptom-free children who were grappling with school disruption, social isolation, and the absence of familiar structures and routines.
School-based mental health services had become increasingly popular in the decades prior to the COVID-19 pandemic, but the explosion of distress levels coupled with the influx of pandemic-related funding opportunities led to an even greater presence of mental health services in school settings. As schools and society at large continue to adapt to a new normal, it may be a good time to step back and reassess the scope and effectiveness of school-based programs.
Understanding the Mental Health Crisis in Today’s Schools
Research from multiple fields of study including psychology and education have demonstrated that numerous factors affect academic achievement. It is necessary, of course, to consider the development of precise and thorough curricula, up-to-date teaching methods and technologies, the cultivation of teachers’ instructional and classroom management skills, and the availability of support and accommodation for students with identified learning disorders. But given the current youth mental health crisis school staff must also consider whether a student has paralyzing anxiety or depression, is struggling with the challenges of neurodiversity, is living with chronic family or community stress, or feels unwelcome or unsafe in the school environment. To meet these needs, schools have become increasingly proactive in providing the social-emotional support that can help students succeed.
In 2021 U.S. Surgeon General Vivek H. Murthy, M.D., M.B.A. issued an advisory about the youth mental health crisis. This advisory cited evidence that up to 1 in 5 children aged 3 to 17 in the US had a reported mental, emotional, developmental, or behavioral disorder, only half of whom had received adequate treatment. And, of those who did get help, approximately two thirds received services only at school.
The advisory also cited survey data that indicated that from 2009 to 2019 the proportion of high school students reporting persistent feelings of sadness or hopelessness had increased by 40% while those seriously considering suicide had increased by 36%. Perhaps most alarming was the finding that between 2007 and 2018 suicide rates among US youth aged 10-24 increased by 57%.
The causes of declining mental health amongst our young people are complex. In part, the increased reporting of mental health challenges may be due to greater awareness of mental health issues and a greater willingness of young people to openly discuss their concerns. Some child and adolescent experts point to the growing use of digital media and the ways that this has changed how adolescents interact with the world. Some researchers point to increasing academic pressure, limited access to mental health care, increased family stress, risky behaviors such as alcohol and drug use, and broader societal stressors such as the aftermath of the 2008 financial crisis and the COVID-19 pandemic, rising income inequality, racism, gun violence, and climate change. These factors put pressure on all American youth and disproportionately affect low income and minority students.
How Schools Integrate Mental Health Support for Students
According to data released in May 2022 by the National Center for Educational Statistics (NCES), 96% of schools in the United States reported that they provide at least one type of on-site mental health services to students. Most schools recognize the need for K-12 mental health programs, but the scope and types of services vary widely, in large part due to the lack of adequate financial and professional resources, but also due to varying state and local philosophies about educational priorities. And while there is considerable research that shows the effectiveness of specific school-based interventions, utilization rates and program effectiveness within districts remain unclear because of inadequate outcome measurement and/or a lack of fidelity in the application of various interventions.
School-based mental health services vary widely in format and focus, ranging from intensive interventions for those with the most serious symptoms to school-wide awareness and prevention programming that touches all students. They are all driven, however, by a shared understanding of the scope of the problem and a sense of urgency to offer much needed support.
NCES data revealed that the three most common types of mental health services provided are individual, one-on-one counseling (84%), case management and coordination of mental health support (69%), and referral to external mental health providers (66%). There are, however, numerous other options to consider for districts seeking to re-assess their existing services or to create a mental health support system.
4 Effective Mental Health Programs for K-12 Students
While school systems across the country all face a set of common issues, it is also true that each school district has unique needs and characteristics that mirror the community it serves. As such, it is best to avoid a one-size-fits-all approach, embracing instead the exploration of the various evidence-based models for school-based mental health services that exist.
Multi-Tiered System of Supports (MTSS)
One of the most common and highly effective approaches to school-based mental health programming is the Multi-Tiered System of Supports (MTSS). This is an approach that emerged directly within the educational community as a model for delivering instructional and/or behavioral interventions in varying intensities to address the academic needs of the student body, including those with identified disabilities.
For many decades the mental health treatment community has used a “levels of care” model that offers treatment in a tiered manner that matches the intensity of treatment to the severity of a patient’s symptoms. The goal of this model is to offer the right level of care at the right time in the least restrictive environment, and it lines up perfectly with the concepts espoused by the MTSS model that was designed to address students’ academic and behavioral needs. As such, mental health MTSS programs have become increasingly popular, and in fact they are the foundation upon which all ESS services are based.
Tier 1 interventions are sometimes called “universal” services since they are directed toward all students. They include programs to increase mental health awareness, to build social-emotional skills (e.g., SEL programming), and to screen for potential problems before they manifest as mental health symptoms. Tier 2 services are focused on students with early onset or moderate levels of distress to mitigate risk and prevent the development of more serious and debilitating symptoms. Tier 3 services offer the most intensive level of support for the small group of high-risk students with more serious concerns who without intervention might be headed for higher levels of mental health care (e.g., partial hospital services) and/or for an out-of-district placement. Tiered models of support that match students’ needs can offer a cost-efficient way to apportion resources and support the mental health of a school community.
Cognitive Behavioral Intervention for Trauma in Schools (CBITS)
CBITS is an evidence-based treatment model that includes both group and individual sessions to help students struggling with posttraumatic stress disorder (PTSD), depression, and other emotional/behavioral problems. It was designed specifically to address the needs of students with trauma histories, including exposure to community or family violence, abuse, neglect, or catastrophic loss. Several strategies are used to reduce symptoms and improve functioning, including psychoeducation, relaxation and mindfulness techniques, cognitive restructuring, exposure therapy, and the development of social problem-solving skills. Outreach is also provided for parents and other support systems in order to strengthen the safety net around struggling students as they move toward recovery.
Social-Emotional Learning (SEL) Programs
SEL curricula have grown in popularity over the years to build students’ self-regulation, problem-solving, coping, communication, and social skills. The specifics of these curricula can vary widely, but they all focus on improving self-awareness and distress tolerance by providing information and teaching a range of self-care skills.
Some SEL programs provide specific information about the etiology and treatment of mental health disorders to reduce stigma and maximize the possibility that students will seek help when needed. SEL programs typically draw from several cognitive-behavioral interventions to build capacity BEFORE mental health symptoms appear. These interventions include positive self-talk, the labeling of emotions, the identification of environmental triggers, grounding and re-set strategies, relaxation and mindfulness practices, and effective communication and conflict resolution skills. The development of such capacities can help reduce or avert altogether future mental health symptoms when students are faced with life’s inevitable stressors.
Trauma-Informed Care and PBIS Approaches
Some districts address student mental health by adopting school-wide programs that focus on changing school culture. These involve training staff at all levels to adopt a certain stance toward students and to respond to students’ behavior in a consistent way, while offering students clear guidelines about what is expected of them. Two of these approaches are the trauma-informed method and the SWPBIS (School-Wide Positive Behavioral Interventions and Supports) program, and they are often used in combination with the other strategies described above.
Schools that adopt a trauma-informed approach are choosing to view disruptive and other problematic behaviors as children’s learned survival strategies rather than willful attempts to be “bad” or difficult. When encountering a student who frequently exhibits defiant, angry, or aggressive behavior the impulse to label the child as “oppositional” or simply “a problem kid” can be strong. It is rare, however, that children and adolescents choose to be difficult. More commonly a history of trauma underlies problematic behavior, an experience that is all too common among today’s students. According to data reported by The National Center for PTSD about 15% to 43% of girls and 14% to 43% of boys go through at least one trauma, and of those, 3% to 15% of girls and 1% to 6% of boys go on to develop PTSD.
Within this model aggressive and off-putting behavior is viewed as a learned, adaptive, survival mechanism that serves a useful purpose in dangerous and unpredictable environments. It cannot easily be “turned off” even in seemingly “safe” places. Staff in schools that have adopted a trauma informed approach are trained to communicate with students in a very specific way – they allow students to have physical space and speak in a low, calm, and neutral voice, preferably audible only to the student in question; they assume that the student is hurting, and inquire from a “what happened, how can I help you” perspective rather than from a blaming “what did you do now?” perspective; and they validate students’ feelings and experiences before offering alternative perspectives and behavioral choices. An example of one such program is the CLEAR program implemented in Junea, Alaska.
SWPBIS programs, often included under an MTSS umbrella, have been implemented in over 16,000 schools in the United States. They are designed to promote positive student behaviors and school safety, thus fostering a welcoming school environment for students, families, and staff. There are many components that schools can choose to build a SWPBIS, but some common ones include:
- fostering a positive classroom environment by engaging students in deciding on classroom rules and routines and then maintaining consistency in adhering to them;
- developing and communicating clearly (and often) behavioral expectations;
- adopting proactive rather than reactive approaches to managing classroom behavior;
- building a student-centered support network that might include a trauma informed approach and student buddy systems;
- using effective communication strategies, verbal and nonverbal, when addressing a student’s problem behavior.
Essential Considerations for School Mental Health Programs
Despite the many complexities and resource challenges, most school staff are fully aware that attending to students’ mental health needs is not optional. And while additional research is needed, there is certainly enough evidence now to support the effectiveness of many types of interventions.
Collaboration, Budget Considerations and Resources
While it might seem that there is never enough funding and professional resources to implement an ideal school-based mental health program, there are options to explore. One option is to develop partnerships with community-based providers and agencies, each of which might offer part of a comprehensive safety net. These include local ER’s, mental health and substance abuse treatment centers, local universities, health departments, the court system, law enforcement, homeless services, etc. Either in collaboration with such partners or on its own a school can seek funding from a variety of granting sources, including foundations that support school mental health, government funding (e.g., ESSER funding), private partnerships, and/or donations.
Staff Training and Professional Development
As with all school-wide initiatives staff buy-in and training are critical. Both mental health counselors and educators should be involved in designing school-based mental health services so that priorities and roles are clear. Once a model has been selected, training and professional development should be ongoing and comprehensive, offering updated information about mental healthcare in general as well as about the school’s own outcome data. A mental health oversight committee that includes teachers, mental health professionals, school nurses, administrators, coaches, other relevant staff and perhaps parents and students can help keep the program on track. Equally important is attention to the health and well-being of school staff who themselves are vulnerable to stress and burnout given the responsibilities that they shoulder.
Measuring Program Success and Outcomes
ESS has learned over the years that data collection and ongoing assessment of outcomes are necessary to ensure program success. Regular assessments provide valuable data about what is working and where improvements can be made. ESS clients track data on attendance, grades, disciplinary actions, and adherence to school-wide behavioral standards. This information, combined with the standardized clinical outcome measurements and treatment plan progress tracked by ESS, offers important feedback about program success.
Case Management or Coordinating Mental Health Services
One of the best ways to offer mental health resources in schools is to collaborate with community mental health organizations that are experienced in providing expert care and support. These organizations can offer a range of services including case management, diagnostic assessment, psychotherapy, substance use evaluations and intervention, emergency evaluations and intervention, and 24-hour crisis phone and/or text lines.
Transform Your School’s Mental Health Support System
This article offers a few ideas for school districts that are interested in establishing or enhancing their school-based mental health services. There is no one-size-fits-all model and districts are invited to contact ESS to request a meeting with one of our clinical experts to design a customized program to fit their needs.
FAQs About Examples of Mental Health Programs in Schools
What can schools do to help mental health?
Schools can implement an SEL curriculum, design a tiered MTSS system, offer individual and group therapy, implement a SWPBIS, cultivate a trauma-informed approach, and provide ongoing training and professional development for school staff.
What are examples of mental health policies?
Some mental health policies include the Americans with Disabilities Act, the Rehabilitation Act, the Mental Health Parity and Addiction Equity Act, and the Community Mental Health Centers Act.
What are the 5 C’s of mental health?
The 5 C’s of mental health are Connection, Compassion, Coping, Community, and Care. They provide a comprehensive framework for fostering mental well-being.
How many US schools have mental health programs?
According to data released in May 2022 by the National Center for Educational Statistics (NCES), 96% of schools in the United States reported that they provide at least one type of on-site mental health services to students.
However, only 55% of public schools offer diagnostic mental health assessments, and even fewer provide treatment. 42% of K-12 schools offer counseling and psychotherapy.
Resources:
surgeon-general-youth-mental-health-advisory.pdf
Promoting Mental Health in Schools – Psychiatry Advisor
Mental Health | SchoolSafety.gov
CEBC » Program › Cognitive Behavioral Intervention For Trauma In Schools
Social-Emotional Learning and Student Mental Health – Changing Perspectives
Strategies and Resources to Support Trauma-Informed Schools
How Common is PTSD in Children and Teens? – PTSD: National Center for PTSD
Collaborative Learning for Educational Achievement and Resilience (CLEAR)
School-based Mental Health | Ohio Department of Education and Workforce
12 Eye-Opening Statistics on Mental Health in Schools — Schools That Lead
