Editor’s Note: This is the first of a four-part series on the student mental health crisis and Multi-Tiered Systems of Support (MTSS) for in-school mental health resources.

Our children are facing a mental health epidemic. From 2009 to 2021, the share of American high school students who say they feel “persistent feelings of sadness or hopelessness” rose from 26 percent to 44 percent.

This is the highest level of teenage sadness ever recorded.

The COVID-19 pandemic — and the accompanying social isolation, family loss and illness, economic hardship, and reduced access to healthcare — exacerbated the mental health crisis. But, youth mental health has been on a steady decline for over the past decade.

Consider the pre-pandemic trauma our kids were already facing: growing global political unrest, gun violence, impacts of climate change, unstable economic conditions, and mental isolation and body dysmorphia stemming from high social media usage. Pre- and post-pandemic anxieties combined, our students are facing levels of mental stress like never before.

Schools are positioned to play a vital role in tackling this problem. If done correctly, our schools can be a place where high-quality student mental health care can be equitably and effectively delivered. After all, schools are where young people spend the majority of their time. According to new polling by Effective School Solutions (ESS), 80 percent of parents believe that schools should play a role in providing mental health support to students.

Data shows that districts are increasingly eager to support students, but there are significant barriers that have stymied progress. The survey also found that educators say early identification of students with mental health challenges (52%), properly trained staff (50%), and funding (47%) remain top concerns.

This year, we must enter into a new era of effective in-school mental health services. Our children and their futures depend on it. A Multi-Tiered Systems of Support (MTSS) is the pathway to success.

What is MTSS?

The MTSS model might sound familiar. It’s a common conceptual framework in education, designed to ensure students receive increasingly intensive support based on their level of need. It has also become a best practice for clinically-informed, holistic delivery of mental health services.

This approach to mental health support emphasizes consistency and individualization, embedding clinical services and resources into the foundations of a child’s educational experience. This is in contrast to “random acts of therapy,” or sporadic and inconsistent mental health support, which leaves room for at-risk students to slip through the cracks and ignores proactive support as a way to prevent mental illnesses from emerging in the first place. In addition, districts who have strong MTSS practices in place often prevent students from climbing the tiers of support.

There are three tiers to the MTSS model of mental health support, all of which work together in tandem and are intended to be woven together to create a successful school-based mental health continuum of care.

Tier 1: Preventative Care

Tier 1 is categorized as mental health wellness services that are embedded into classroom instructional materials, including a district’s chosen Social Emotional Learning (SEL) curriculum. This tier is focused on prevention for the entire student body and establishes a school-wide culture for mental health services.

Examples of Tier 1 activities are:

● Universal mental health screenings to identify students who might need increased support beyond Tier 1.

● School-wide programs and presentations (such as regular distribution of mental health newsletters) that inform administrators and students on mental health-related topics.

● Professional development activities for teachers that build their capacity to recognize signs and symptoms of mental health disorders, approach students from a trauma-informed perspective, and create a supportive classroom culture.

● Workshops for school-based counselors.

Tier 2: At-Risk Students

Tier 2 focuses on the needs of students who self-identify or are identified as having mild to moderate mental health symptoms via the school’s universal screening process or the observations of parents or educators.

Examples of Tier 2 activities include:

● Short-term individual and/or family therapy sessions to address stressors contributing to mental health symptoms.

● The development of student safety, wellness, and/or behavior plans that are tracked by school-based clinical personnel.

● Regular student check-ins, such as peer-to-peer support groups or meetings.

Tier 3: In-Crisis Students

Tier 3 services are the most intensive and reserved for students with severe mental health challenges or have not succeeded at previous levels of intervention. Tier 3 programs are typically provided daily, including a variety of components to preserve student safety, address trauma, build self-regulation, and other skills to manage the symptoms of serious mental health disorders.

Tier 3 program components include:

● Crisis assessment, intervention, and referral as needed.

● Frequent consultations between clinical and educational staff members, as well as with external service providers such as prescribing psychiatrists.

● Ongoing monitoring of student progress with treatment plan adjustments as needed.

Funding for MTSS

From short-term COVID-19 relief to a number of long-term state and federal sources, there is a variety of funding districts can tap to implement mental health services.

But over 55 percent of administrators express that they do not have enough information about or are not aware of funding resources for mental health programs. ESS provides online resources with funding strategies and best practices to help districts implement mental health programs.

About the authors

Duncan Young is the CEO and Jerry Barone is the Chief Clinical Officer of Effective School Solutions, the country’s largest provider of school-based mental health care. To learn more about Effective School Solutions, please visit: https://www.effectiveschoolsolutions.com/.