Editor’s Note: This is the third of a four-part series on the student mental health crisis and Multi-Tiered Systems of Support (MTSS) for in-school mental health resources. An overview of the MTSS model can be found here.
What can schools do to help the influx of students suffering from mental health challenges? Provide them clinical support and treatment — now.
The youth mental health crisis has worsened in the past decade, especially as a result of the COVID-19 pandemic. Forty-four percent of American high schoolers say they feel persistent feelings of sadness or hopelessness. That number rises to three in five for teenage girls.
High social media usage (with accompanying body dysmorphia, bullying, isolation, and social anxiety) and the seemingly never-ending stream of school shootings are just a few factors contributing to kids’ declining wellbeing. Over 80 percent of parents believe schools should play a role in supporting student mental health. Because students spend the majority of their time on campus, districts are uniquely positioned to safely, equitably, and effectively deliver support.
As discussed in our previous article, prevention and building capacity within districts to recognize early signs of mental illness is key to getting ahead of the crisis. But implementing long-term mental health services in schools to support the influx of students struggling with various trauma responses cannot be overlooked. Both are vital pieces of the school-based mental health care puzzle.
The Multi-Tiered Systems of Support (MTSS) model for in-school student mental health services outlines the necessary components for these programs. Like a pyramid of support, three tiers ladder up to the overall MTSS mental health model, each representing an increasing level of treatment and services. Programs that fall under Tier 2 support students in need of a moderate intensity of care. These students might not be in immediate crisis, but they are exhibiting mental health symptoms that prevent them from reaching their fullest potential.
It is incumbent that school districts prioritize evidence-based Tier 2 counseling services in planning their MTSS system of care for the upcoming school year, ensuring that students who have been identified with a mental health challenge (i.e. during Tier 1 screenings) receive the help they need.
Why Tier 2?
Tier 2 serves a central role in the MTSS ecosystem for trauma-informed in-school mental health care. It’s helpful to think of this tier as both preventative and re-entry programming.
The tier provides therapeutic care to students experiencing mental health challenges, intervening before symptoms reach crisis-level to decrease the likelihood of them further climbing the MTSS ladder of support. This care is introduced in a safe, comfortable school environment – rather than a hospital, office, or costly outpatient care. Tier 2 quickly provides clinically-supported services to students right on campus and in a setting that is supportive rather than intimidating.
It’s also important to have care available to students as they step down from higher-levels of care (i.e. Tier 3). Tier 2 serves as a re-entry point, maintaining support for students as their mental health symptoms improve. The holistic flexibility of the MTSS tiers of support is essential, allowing students to move in and out of tiers based on their changing need for care.
Tier 2 in practice
Tier 2 services are intended for students showing mild to moderate mental health symptoms. Given the surge of students experiencing mental health challenges, on-campus programs provide this group of students with convenient access to services, giving them the help they need to prevent conditions for worsening or de-escalate from higher levels of support when the time is right.
The foundational elements of a Tier 2 program are flexibly delivered Brief Treatment interventions and a well-designed process for conducting, responding to, and following up on Comprehensive Assessments. Together, they work in tandem to provide an individually-focused therapeutic treatment plan for each student in need of support.
Students receiving Brief Treatment are considered low-risk, without suicidal or homicidal ideation, self-injury behaviors, substance use, or impulse control issues. Treatment typically consists of short-term individual and/or group counseling for students (and possibly with their caregivers) that addresses the root of a student’s mental health challenge. These sessions are led by a school-based licensed therapist or social worker and often among fellow students experiencing similar symptoms where they can explore the causes of their mental health challenges and build new social-emotional skills.
The Comprehensive Assessment is an essential tool in determining a student's appropriateness and entry into Tier 2 programming. After receiving a referral from a school district’s Student Support Team (SST), a school-based mental health professional conducts an assessment with the student and their family. The assessment serves as a comprehensive interview with additional evidenced-based tools to help the mental health clinician determine if the student is in any way at risk, while helping them tailor specific interventions to address the student's support needs.
Fair Lawn Public Schools in New Jersey serves as a model Tier 2 program. As student need for in-school mental health services has grown, the district implemented Tier 2 programming to complement its existing Tier 3 services. This year, Fair Lawn expanded both its Tier 2 and Tier 3 programming to every secondary school in the district, increasing the level of mental health clinicians and support available to students.
The district’s Tier 2 programming includes a combination of individual, small group, and family counseling for students showing moderate mental health symptoms. There is also a monthly parent support group for families in the caseload. In 2023 to date, there have been 1,083 instances of Tier 2 services provided to students, and with this year’s Tier 2 expansion, there is new capacity to support an additional 50 students. These services have led to a positive trend in improved student wellbeing, most notably in middle school student conduct and behavior.
The success of Fair Lawn’s Tier 2 programming can be attributed to its wide availability and combination with Tier 3 services, creating a holistic network of support. Whether a student is identified with a mental health challenge or is decreasing their intensity of care from Tier 3 as symptoms improve, every secondary student in the district has access to high-quality, therapeutic mental health services.
Funding for MTSS
Tier 2 services are foundational to a successful in-school mental health strategy because they offer our kids exactly what they need: clinical, therapeutic support and treatment.
For school leaders looking for funding to implement Tier 2 of the MTSS model for in-school mental health programs, Effective School Solutions recently published a guide highlighting a variety of funding strategies – state, federal, and other sources – schools can tap.
Look out for our final article to learn more on Tier 3 of the MTSS model for mental health.
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/.
