Editor’s Note: This is the final article 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.
Suicide is now the second leading cause of death for those age 10 to 14. The consequences of rising rates of anxiety and depression among our kids are very real and very serious.
Youth mental health has been declining for the past decade, but reached crisis levels during the COVID-19 pandemic. U.S. Surgeon General Vivek Murthy recently called worsening youth mental health as the “crisis of our time,” with 40 percent of American high schoolers saying they feel persistent feelings of sadness or hopelessness.
Social media – among ambient global uncertainty and school shootings – is a primary cause of declining mental wellbeing, serving as a platform for social isolation, bullying, and body image issues (especially for teenage girls). LGBTQ+ youth and students of color facing discrimination by peers and society also experience mental health challenges at a higher rate.
Schools are at the frontlines to address this crisis, with 80 percent of families relying on in-school services for their child’s mental healthcare. Districts are therefore uniquely positioned to safely, equitably, and successfully deliver support. For students who are in the midst of a mental health crisis, these services are critical to setting them on a trajectory for recovery. In some extreme circumstances, they can be the difference between life and death.
A Multi-Tiered Systems of Support (MTSS) model for in-school student mental health services is a clinically-supported strategy that provides every student support based on their appropriate need for care. Three tiers make up the overall MTSS mental health pyramid of support, each representing an increasing level of treatment and services.
As discussed in our previous articles, Tier 1 focuses on prevention and building capacity within districts to recognize early signs of mental illness, getting ahead of burgeoning mental challenges. Tier 2 supports students in need of a moderate intensity of care - those who are not in immediate harm but are nevertheless exhibiting mental health symptoms.
Tier 3 programs offer the highest level of support for students who need a highly structured clinical environment while they are participating in a traditional school schedule. Overall, the MTSS model for school-based mental health programs plays an essential role in a balanced, holistic, and long-term approach to improving student wellbeing, with Tier 3 programming offering the highest level of intervention for students who are most at-risk.
Adherence to the MTSS model for in-school mental health is essential to curbing the crisis plaguing students nationwide. Districts across the country must include these programs in their planning for the coming school year and for years to come, ensuring all students get the help they urgently need.
Tier 3 in practice
Tier 3 services provide intensive, clinical therapeutic treatment to students identified with the most severe mental health symptoms.
Due to a lack of resources, school districts can outsource these services so care for the student is facilitated within a self-contained environment. In-school Tier 3 services, on the other hand, are provided in a “wrap-around” model embedded within a student’s typical school schedule. The school-based strategy is effective because it affords students a high-level of support while maintaining a sense of normalcy by receiving services within their school day.
A multi-disciplinary team that includes a school nurse, special education teachers and licensed mental health professionals is the best mix to provide Tier 3 care to students. Services at a minimum include daily processing and psycho-education groups, weekly individual and family therapy sessions, parent support groups, and ongoing collaboration with teachers, administrators, and special services individuals.
Tier 3 services are effective because they offer a symphony of evidence-based approaches that work simultaneously during each week of a student’s time in the program. They create a powerful, interlinked foundation of support that works to stabilize a student’s mental health symptoms.
Greater Egg Harbor Regional High School District in New Jersey serves as a model Tier 3 program. Implemented during the 2016-2017 school year, the district began offering these intensive clinical services to reduce the amount of students referred to out-of-district placements and better appropriate staff time.
The district's Tier 3 programming includes daily group counseling and weekly individual or family counseling sessions. School-based clinicians maintain weekly communication with parents, collaborate with outside mental health providers for certain more severe student needs, and host bi-weekly meetings with district staff to review the academic and behavioral progress of each student in the program. As a result, the district has seen a decrease in disciplinary infractions, with an increase in student attendance and academic performance.
The success of Greater Egg Harbor Regional’s Tier 3 programming is its comprehensive approach to in-school mental health care. Through a variety of integrated services within the school environment, students have a strong network of support while maintaining their normal lives. Combined with equally strong Tier 1 and Tier 2 programs as well as a district-wide referral process to identify students who could benefit from a Tier 3 level of care, all Greater Egg Harbor Regional students have access to high-quality mental health services.
Why Tier 3?
Tier 3 allows students to remain in the safety, comfort, and familiarity of their in-school community while receiving treatment. For schools without MTSS mental health programming, these services would take place in an office or hospital setting, removing a student from the educational environment.
An off-campus approach, while well-intentioned, might do more harm than good, adding a layer of unfamiliarity and stress in an already challenging situation for the student. On-campus Tier 3 support helps students stay within the least restrictive and most normalized environment, while still providing the highest level of care.
This model for intensive mental health support is also more cost efficient than expensive off-campus placements. Money saved from coordinating out-of-district placements can be invested to provide more students access to Tier 3 services, or to help build out a school’s mental health support ecosystem with robust Tier 1 and Tier 2 programming.
Funding for MTSS
We have begun to see the most dire consequences of the youth mental health crisis. Tier 3 in-school clinical services are vitally important to getting the most at-risk students the care they desperately need.
For school leaders looking for funding to implement Tier 3 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.
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/.
