Organizing school mental health services for prevention

Why prevention?

Schools are busy places. One school psychologist serves hundreds of children. There is a Farside cartoon one of my professors is fond of: It’s a building on fire, floating down a river, about to fall off a waterfall, with a sign that says “Crisis Clinic”.

Ask a group of people who work in a high needs school if they feel like this cartoon reflects their day to day life and watch the hands go up.

Clinical skills, prevention services

Feeling like you’re operating in crisis mode is not sustainable for the long term. What if schools could respond to student crises and prevent problems from occurring in the first place?

School psychologists take a public health approach to providing school services — we respond to the immediate needs of students, but we also strategize about how to prevent challenges from occurring from the beginning. As schools serve all children regardless of need or health insurance, they are excellent places to take a public health approach to children’s mental health.

A public health approach

The public health approach has been around for decades, but has only recently made inroads into school practice. In schools, this approach is called multi-tiered systems of support (MTSS) — sometimes also referred to as the three-tiered model or the response-to-intervention model. Imagine a triangle. The base of the triangle is the largest area — this represents the universal level that aims to meet the needs of all students. The next part in the triangle is smaller and provides services for about 15% of students who need supports in addition to tier 1 to be successful. Finally, the tip of the triangle is the smallest part and represents tier 3 where about 5% of students receive intensive individualized services. Buy focusing on the universal base of the triangle and intervening early with milder problems as they develop, this model helps prevent challenges before the occur rather than waiting to provide help until problems are severe at tier 3.

At the universal level, all students receive services. This can look like evidence-based systems for positively managing challenging behavior in class, strong reading curriculums, and social-emotional learning instruction to help all children recognize and understand their emotions. Tier 2 services involve a brief problem solving assessment to identify the students’ needs. Interventions at this level are typically time limited or delivered in group format to be resource efficient — for example additional small group instruction might be provided to a struggling reader, group counseling to students with social skills challenges, or brief in class behavioral interventions for students who are off task. In tier 3, assessments are more comprehensive and services are more intensive — such as individualized instruction, counseling, and case management. At this level, services often involve multiple providers both inside and outside of the school, warrant greater family involvement, and may involve services through special education.

At each level, there is an emphasis on providing evidence-based interventions and collecting data so that the team serving the students can make decisions on whether or not the services provided are working.

A public health approach like MTSS helps schools meet the needs of all students. Incorporating population health thinking is critical in schools as most schools do not have enough resources to provide intensive services to a large number of students. Addressing challenges before they start or become severe is the right thing to do for children and helps school providers keep from continually running in crisis mode. Prevention, from both an ethical and logistical standpoint, is the key.

Want to know more? The National Association of School Psychologists has a resource sheet on using MTSS to support all students. Curious about who school psychologists are and what they do? You can find more information about school psychologists here.

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