It is estimated that 10-20% of children and adolescents experience some type of mental health concern, with the prevalence of these concerns increasing with the COVID-19 pandemic (World Health Organization, 2017). There are two larger categories of such concerns, externalizing concerns and internalizing concerns. Externalizing concerns (e.g., conduct problems, oppositional defiance) represent challenges that are directed outward to various environments and individuals, which can include disruptive behavior, noncompliance, and aggression. Internalizing concerns (e.g., depression, anxiety) are defined as inwardly directed problems that may include emotional distress, cognitive distortions, withdrawal, and physical symptoms (e.g., headaches). The severity of these concerns exists along a spectrum. Some youth experience challenges consistent with a diagnosable mental health disorder. Others experience what has been described as subsyndromal symptoms – those that are not severe enough to warrant a diagnosis but are nevertheless challenging and predictive of longer-term mental health concerns.
Though mental health problems can be detected at an early age, many youth who experience symptoms are inadequately supported, delayed in accessing services, or receive no treatment at all (Costello et al., 2014). This is particularly true of youth exhibiting internalizing concerns, given the difficulty associated with detecting inwardly expressed challenges (Arslan et al., 2021).
When left untreated, mental health disorders that manifest during childhood are associated with higher risk for placement in special education (Funk et al., 2010). Internalizing challenges can present a number of negative outcomes, including social rejection, academic failure, and suicide (Balázs et al., 2013). Recognition of these concerns has resulted in calls for both (a) universal screening to detect internalizing concerns and (b) targeted intervention to treat them (Community Preventive Services Task Force, 2019).
Children and families encounter many barriers to accessing clinical mental health professionals. As such, schools have become the primary provider of mental health services to at-risk children and youth, especially in the context of prevention and early intervention (Duong et al., 2021). Although many studies have examined the impact of school-based mental health supports on externalizing problems, less is known about how schools contribute to decreasing risk and promoting protective factors among children with internalizing problems (Kilgus et al., 2015). The research that is available is largely specific to interventions that would be appropriate for treating more intense internalizing concerns, such as through clinical mental health professionals or school-based Tier 3 services within multi-tiered systems of support (MTSS; Sanchez et al., 2018).
Recently, researchers have brought increasing attention to developing and testing Tier 2 interventions for students with subsyndromal internalizing concerns. Some of these interventions are founded in behavioral theory (e.g., Check In/Check Out), calling for the reinforcement of prosocial help-seeking behaviors (Hunter et al., 2014). Other interventions are founded in resiliency theory, calling for promoting contextual, social, and individual factors that help youth overcome challenges and risk exposure.
The purpose of this brief is to provide an overview of two Tier 2 interventions grounded in resiliency theory: the Resilience Education Program (REP; Kilgus & Eklund, 2017) and the Penn Resiliency Program (PRP; Gillham et al., 1990).