Scanlan Center for School Mental Health
two students sitting with teacher
Practice Briefs

The purpose of the Practice Briefs on School Mental Health project is to provide free-access research-based summaries on important topics that are relevant to practicing educators and school mental health professionals. Our practice briefs are written by national experts in the field, reflect best practices in education and school mental health, and undergo a peer-review process before publication.

Isaac T. Petersen, Ph.D, Assistant Professor, Department of Psychological and Brain Sciences, University of Iowa
Description
Externalizing behavior problems encompass a wide range of acting out behavior difficulties with the (external) environment, including behaviors such as aggression, bullying, conduct problems, callousness, inattention, hyperactivity, oppositionality, rule breaking, defiance, substance use, and disruptive behavior. Externalizing problems are prevalent in school-aged children and are costly and burdensome to individuals, families, schools, and society. Externalizing problems are disruptive to classrooms and make it challenging for educators to focus on teaching and for the child and classroom to learn. Moreover, early externalizing problems can predict later, more severe problems like violence if left untreated, so accurate assessment of externalizing problems is crucial to ensure children and adolescents receive the services they need. The goal of this practice brief is to help clinicians and school psychologists conduct accurate assessments of externalizing behavior in school-aged children to support effective intervention and prevention. Identification/Assessment Strategies Conduct a Multi-Stage Approach to Assessment Effective assessment of externalizing behaviors uses a multi-stage approach including screening, using multiple assessment methods, interpreting results, designing the treatment plan, and evaluating treatment progress (Volpe & Chafouleas, 2011; Youngstrom & Van Meter, 2016). Consider the Goals of the Assessment When selecting assessment tools to use, it is important to consider the goals of the assessment process. Various goals of assessment include (a) screening, (b) diagnosis, (c) monitoring progress, (d) and characterizing the full range of strengths and difficulties. Different assessments should be selected depending on the goal(s). Another consideration is whether to assess behavior problems at a more general, broad-band level (e.g., externalizing problems), or in more specific, narrow-band ways—e.g., callous-unemotional behaviors, inattention/impulsivity/hyperactivity, oppositionality, aggression, conduct problems, or substance use. Assessments that focus on broad-band problems tend to provide limited depth in any specific concern (Collett et al., 2003). If time allows, it can be helpful to include both the assessment of general, broad-band problems as well as more focused assessment of narrow-band problem dimensions in the areas of greatest potential concern (Achenbach et al., 2016). Screening devices tend to be brief, broad-band, and aim to identify children who are at risk of showing clinically significant problems in their current or future behavior. Schools often implement school-wide screening. Because screening devices aim to identify children who are at risk, screening devices focus on differentiating the top half of the distribution (i.e., the 50th percentile of misbehavior and above) as briefly (i.e., with as few items) as possible. Another purpose of assessment may be to monitor a child’s progress, such as their response to treatment. Instruments designed to monitor progress tend to be brief, so they can be completed regularly (e.g., daily or weekly). A consideration for such measures is whether it is sensitive to change to detect improvement in a child’s behavior over a short timeframe. A fourth purpose of assessment may be to characterize the full range of a child’s strengths and difficulties. Here, the goal is to determine where in the distribution (e.g., what percentile) the child is relative to their peers on dimension(s) of interest (e.g., aggression). Such instruments are longer because they aim to differentiate children across the full distribution (i.e., 1st to 99th percentile), which requires items that differ in severity and requires more items. Other Considerations When Selecting Assessment Tools Other important considerations when selecting assessments include psychometrics: reliability and validity. That is, scores from a given measure should be precise and accurate for the intended construct (i.e., externalizing problems), population, and purpose. The psychometric properties of measures are reviewed by Sattler (2022) and the Buros Mental Measurements Yearbook. It is important to consider whether the measure’s content and items are developmentally appropriate for the child’s age and developmental level (Wakschlag & Danis, 2004). In addition, it is important to consider whether the measures’ scores and norms are appropriate for special populations, including those with intellectual disabilities, those in the child welfare system (Keil & Price, 2006), and those who may not be proficient in English (Paalman et al., 2013). If the instruments used do not have established validity or norms with respect to the particular population of interest (e.g., 13-year-olds), it is important to note potential interpretive concerns in any reports. Use Multiple Methods and Perspectives at Multiple Time Points It is best to conduct the assessment with at least two assessment methods and at least two perspectives, at multiple points in time (Lochman et al., 2001). Assessment methods include questionnaires, interviews, observations, behavior tracking, and school records (e.g., Walker et al., 1991). It is preferable for the perspectives represented to span the home and school contexts. Perspectives could include, for instance, parents, teachers, other caregivers, the child, siblings, and peers. Easily observable misbehavior may be best reported by informants, whereas more hidden or covert misbehavior may require self-report. To ensure validity, the assessments should be administered and interpreted by licensed professionals who are trained to use them. Questionnaires Questionnaires can be a quick, easy way to collect information from multiple informants. However, questionnaires have limitations, including (a) they require respondents to be able to read proficiently in the language, (b) they involve informant bias, (c) they often have subjective response formats (e.g., “sometimes”, “often”) that lead to bias and imprecision, and (d) they do not provide systematic opportunities for respondents to ask clarifying questions or for examiners to ask follow-up questions, making it more likely that a respondent will misinterpret a question. One of the most widely used assessments of externalizing problems is the Achenbach System of Empirically Based Assessment (ASEBA). The ASEBA includes assessment of broad-band problems as well as more narrow-band problems, and it includes varying items for different informants and ages to maintain developmental and contextual relevance. For instance, parents provide reports on the Child Behavior Checklist, which has different versions based on the child’s age. Teachers provide reports on the Teacher’s Report Form, which also has different versions based on the child’s age. The ASEBA also includes an optional Multicultural Supplement with multicultural norms. Moreover, the ASEBA includes a brief form, the Brief Problem Monitor that is more sensitive to change for the purposes of monitoring progress. The Peer-report Measure of Internalizing and Externalizing Behavior uses peer nomination to identify externalizing problems. Another widely used questionnaire of externalizing problems is the Strengths and Difficulties Questionnaire*. It assesses functional impairment, has different forms for various ages and informants, and has translated versions in many languages. A questionnaire that is well-suited to study the full range of strengths and weaknesses is the Extended Strengths and Weaknesses of Normal Behavior*. In addition to broad-band questionnaires, there are also questionnaires designed to assess more narrow-band problems, including for callous-unemotional behaviors (Inventory of Callous-Unemotional Traits*), inattention/impulsivity/hyperactivity (Conners 4), oppositionality (Disruptive Behavior Disorder Rating Scale*), aggression (Children’s Aggression Scale), conduct problems (Conduct Disorder Rating Scale), or substance use (Problem-Oriented Screening Instrument for Teenagers*). The Conners 4 is also available in Spanish and French. Interviews Interviews are another common form of assessment. Interviews do not require respondents to be able to read, and they allow examiners to ask follow-up questions. However, interviews take more time to conduct than questionnaires and can be subject to confirmatory bias on the part of the interviewer. For instance, interviewers tend to assess only the behavior problems that fit their hypotheses of the child’s difficulties (Sharp et al., 2013). To prevent confirmatory bias, it is important to use structured or semi-structured interview approaches and to supplement the approach with assessments that span a wider array of potential difficulties than the clinician’s hypotheses might suggest. Some interviews assess broad-band problems, whereas others focus on more narrow-band problems. General interviews include the Schedule for Affective Disorder and Schizophrenia for School-Age Children*, Child and Adolescent Psychiatric Assessment (CAPA)*, and Development and Well-Being Assessment* (DAWBA). CAPA has a child interview and a parent interview. The DAWBA has translations in many languages. Interviews that are focused on externalizing behavior include the Disruptive Behavior Disorders Parent Interview*, Kiddie Disruptive Behavior Disorders Schedule, and Clinical Parent Interview for Externalizing Disorders in Children and Adolescents. An interview focused on callous-unemotional behavior is the Clinical Assessment of Prosocial Emotions*. Observation Observational assessment is a valuable assessment process for externalizing behaviors. Observations are less influenced by informant bias. However, observations can be time consuming to conduct. Moreover, during a brief observation period, it may be unclear how representative a child’s behavior is of their behavior in other situations or contexts, especially if the child acts differently because they are being observed (i.e., reactivity). In addition, if the target behavior is infrequent or covert, it can be more difficult to observe. A widely used approach to observational assessment is functional behavior assessment (FBA). FBA involves observing patterned sequences of antecedents and consequences of the target problem behavior to generate and test potential hypotheses regarding the function(s) of the behavior, which can be useful in intervention (Broussard & Northup, 1995; Gresham, 2015). The same behavior can occur for different reasons, and it is important to know why the child engaged in the problem behavior, because each function might be targeted differently in intervention. Common hypotheses regarding the functions of problem behavior include approach- (e.g., access to attention or access to tangibles, such as toys or preferred activities) and avoidance-related functions (e.g., escape from undesirable situations). When conducting observational assessments, it is helpful to observe the child in different situations (e.g., lunch time, recess, math work), times of day (e.g., morning, afternoon, evening), and contexts (e.g., home, school). Rating specific behaviors close to when they are exhibited is helpful for monitoring progress (Daniels et al., 2021). Schools may also have FBA processes and tools developed by their district, intermediate service agencies, or state departments of education that they are required to use as part of processes like multi-tiered systems of support (MTSS) and special education identification. In addition to FBA, several observational assessments have been developed for externalizing behavior, including the ADHD School Observation Code, ADHD Behavior Coding System, Disruptive Behavior Diagnostic Observation Schedule, Direct Observation Form, Adjustment Scales for Children and Adolescents, Overt Aggression Scale, Revised Edition of the School Observation Coding System, and Classroom Observation Code. There are also playground-based observational systems (Leff & Lakin, 2005). Behavior Tracking  Behavior tracking is a form of observational assessment that aims to assess children prospectively in a less time-consuming way. For instance, it may involve the parent or teacher making a tally for each instance of various behaviors, including compliance, noncompliance, and aggression. Behavior tracking is sensitive to change and is therefore particularly useful for progress monitoring. For instance, behavior tracking may allow practitioners to evaluate whether the frequency of the target problem behaviors change on a day-to-day or week-to-week basis. Handling Informant Discrepancies Informants (e.g., parent, teacher) often disagree about the extent to which a given child shows behavior problems. Informant discrepancies likely occur for many reasons, including (a) the child may behave differently in different contexts and/or with different people, (b) informants may have differing knowledge and perspectives of what is developmentally typical versus atypical; for instance, teachers may generally have a wider range of comparisons than parents and may thus be uniquely positioned to rate the child, (c) there may be cultural differences in what is considered developmentally appropriate behavior, (d) informants have biases to respond in particular ways, and (e) measurement error. To handle informant discrepancies when there is not a clear primary informant who is best positioned to rate the child most accurately, one can count a symptom as present if it is endorsed by any of the informants (Hinshaw & Nigg, 1999). What to Assess It is important to assess many facets of the problem behavior, including its frequency, intensity/severity, onset, and duration; that is, how long it has been occurring, how frequently it occurs, and how intense or severe the behavior is when it occurs. It is also important to consider potential function(s) of the misbehavior (Reitman et al., 1998). Functional impairment should also be considered. For instance, it is important to consider whether the behavior impedes the child’s ability to perform well in school, to hold a job, or to develop meaningful relationships with peers, teachers, and family members. In addition, it is important to consider cultural and contextual factors, including the family and social context (Knapp et al., 2012). It is also important to consider co-occurring issues and conditions. Many cognitive, academic, emotional, behavioral, and medical difficulties commonly co-occur with externalizing problems and are important to assess. Commonly co-occurring issues include internalizing problems (e.g. mood and anxiety-related problems; Achenbach et al., 2016; Cunningham et al., 2013), intellectual disabilities, learning disorders, academic difficulties, neurodevelopmental conditions such as autism, and problems related to sleep, feeding (e.g., picky eating), and voiding (e.g., enuresis, encopresis; McKinney & Morse, 2012) . Data Privacy and Sharing Federal laws protect the privacy of protected health information (HIPAA) and of educational records (FERPA). It can be helpful for clinicians, schools, and families to work together to address a child’s needs. To achieve this, it is important to obtain informed consent and two-way releases of information to ensure that the clinician can share information with the school, and that the school can share information with the clinician. For instance, a parent and teacher might rate the child’s behavior for a clinician conducting an assessment. The clinician then might share their assessment results and a suggested treatment plan with the family and might work with the teacher and family to help them enact the treatment plan. The school may then share the child’s treatment progress with the family and clinician. Putting It Altogether With the assessment information collected, the clinician can develop a case formulation that considers predisposing factors, precipitating factors, perpetuating factors, and protective factors for the given child’s misbehavior. Such a case formulation is helpful when developing a treatment plan. Intervention often aims to address a child’s perpetuating/maintaining factors (e.g., low frustration tolerance; ineffectual caregiver responses) and minimize how frequently the triggering situations occur, while building on the child’s strengths and considering predisposing factors (e.g., family history, temperament). To maximize the usefulness of assessment results for schools, it is important to write a concise and clear report and be timely and attentive to requests for data sharing. In sum, externalizing behavior problems in school-aged children are prevalent, burdensome, and important to assess and address. Key Implications for Practice Conduct a multi-stage approach that includes screening, multi-method assessment, interpreting results, designing the treatment plan, and evaluating treatment progress. Select measures based on their psychometrics, their intended depth and breadth, and the goals of the assessment: screening, diagnosis, monitoring progress, or patterns of strengths and weaknesses. Consider cultural and contextual factors and co-occurring issues. Incorporate multiple perspectives (e.g., parents and teachers) and methods, including observational assessment, across multiple time points. Consider frequency, intensity, duration, functions, and impairment of problem behaviors. Develop a case formulation based on predisposing, precipitating, perpetuating, and protective factors for the child’s problem behaviors. Ensure information sharing forms are completed and reports are shared with families and schools, so that schools can use the information in their planning and delivery of services. Related Resources Supporting Child and Student Social, Emotional, Behavioral, and Mental Needs - U.S. Department of Education Brochures and Facts Sheets - National Institute of Mental Health Attention-Deficit/Hyperactivity Disorder in Children and Teens: What You Need to Know - National Institute of Mental Health Disruptive Mood Dysregulation Disorder: The Basics - National Institute of Mental Health Resources Centers - American Academy of Child & Adolescent Psychiatry Child, Youth and Family (CYF) Database - Centre for Effective Services as part of the Prevention and Early Intervention Research Initiative Mental Measurements Yearbook - Buros Center for Testing Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) Institute on Violence and Destructive Behavior (IVDB) Systematic Screening - Comprehensive Integrated Three-Tier Model of Prevention Conduct Disorder - Mental Health America Externalizing Academic Educational - youth.gov * indicates an assessment instrument that is freely and publicly available https://doi.org/10.17077/rep.006639
Student reading at desk
Naomi H. Rodgers, Ph.D., CCC-SLP, Assistant Professor in the Communication Sciences and Disorders Department, University of Iowa
Description
Roughly 8% of children between the ages of 3 and 17 years have documented speech and/or language disorders (Black et al., 2015). Speech disorders impact how people produce sounds including articulation, phonology, fluency, and voice. Language disorders impact how people understand and formulate vocabulary, grammar, and pragmatics in both oral and written modalities. https://youtu.be/j6AoP_300Ts Students with receptive communication challenges may have difficulty understanding what others say to them, while students with expressive challenges may be unsuccessful in communicating in ways that are understandable by others. While communication disorders are sometimes caused by underlying impairments like hearing loss, intellectual disability, or other genetic issues, they often arise without any identifiable underlying or co-occurring issues. Given how central communication is to one’s personhood, cultural identity, and social belonging, students with communication differences and disorders often experience a range of social-emotional effects due to repeated difficulties with understanding and/or being understood. Research shows that children with a variety of communication disorders experience greater social-emotional issues compared to typically developing peers. For example, children with speech sound disorders are often teased (McLeod et al., 2013), and those who stutter often harbor negative attitudes about communication (Guttormsen et al., 2015). Children with developmental language disorder have smaller peer groups (Chen et al., 2020), and those who are deaf/hard of hearing report lower levels of social competence (Stevenson et al., 2015). Across the board, children with communication disorders tend to experience higher levels of anxiety than typically developing peers (Bernard et al., 2022; Lewis et al., 2016; Samson et al., 2020; Theunissen et al., 2012). This poses serious threats to personal well-being, social engagement, and educational/vocational fulfillment.  Prevention and Identification Strategies There are individual differences in how children with communication disorders cope with communicative adversity. Some may internalize or externalize their frustrations with interpersonal situations (Petersen et al., 2013). Internalizing behaviors may look like reduced participation in class activities, minimal talking, distress during public speaking, difficulty concentrating on communication tasks, and withdrawal during social activities. Students may externalize their frustration through off-task behaviors, refusal to participate, and aggression. Additionally, students with communication disorders are more likely to be victimized by peers (Hughes, 2014). Bullying prevention strategies for students with disabilities involve fostering peer relationships, helping students develop empathy, creating a buddy system for children with communication challenges, involving students in adaptive communication strategies in the classroom, facilitating team-based learning activities, implementing social-emotional learning activities, and rewarding positive, helpful, inclusive behaviors. If teasing or bullying are observed, teachers and other school personnel should address it immediately (see strategy 5 below). Students with communication challenges may qualify for school-based special education services by a speech-language pathologist (SLP) if (a) the student is diagnosed with a communication disorder, (b) the communication disorder adversely affects their educational performance, and (c) specialized services are necessary to help the child make progress (IDEA, 2004). Regarding (b) “educational performance,” school SLPs take into consideration students’ oral participation, social-emotional adjustment/behavior, and reactions of self/peers/teachers/parents to the students’ communication patterns (Farquharson & Boldini, 2018). School personnel can talk to the school SLP if a child’s communication challenges appear to be interfering with their classroom and social engagement. Intervention Strategies Supporting the mental health of students with communication disorders requires a collaborative, ecological approach (Hoff & Unger, 2021). Although research efforts in this area are desperately needed, the following six strategies are offered as a preliminary approach to supporting social-emotional well-being in students with communication challenges. These strategies can be implemented by all school personnel, not just SLPs. #1 Educate peers about communication differences. Facilitate a classroom discussion about communication differences present in the classroom—what they are, what they are not, and how listeners can be helpful communication partners. The topic of the presentation should be created collaboratively, at least with the student(s) with communication differences, but the school SLP and the parent(s) can also be involved. The content should be factual and discuss communication differences in a judgement-free, strengths-based way. For example, for a student who stutters, it could be helpful to provide facts and dispel myths about stuttering: stuttering sounds like speech repetitions and blocks, that people stutter because that’s how their brains are wired for talking not because they’re nervous people, and that the most helpful thing listeners can do is wait patiently for the person who stutters to finish their own words. In this example, it would be important not to describe stuttering as “worse” than fluent speech. The goal of this type of presentation is to create an environment where students with communication differences feel safe and valued as communicators, and that environment is created when teachers and peers see the student’s communication style as valid—not inferior to mainstream communication patterns (e.g., Weidner et al., 2018). In addition to collaborating on content, it is important to involve the target student in the presentation in a way that they are comfortable. One student may want to present on the topic themselves or co-present along with the teacher or SLP, while another student may want to be out of the room when the teacher talks about it. The student’s wishes and comfort level should always be honored, and they should not be required to do anything they are not comfortable with. #2 Share messages of empowerment and representation. When a student hears messages from adults like “That’s not how we talk,” “Say that again using your good sounds,” or “Your talking has been worse today,” this sends the message that the way a student talks is not the “right” way. These messages are often shared with good intentions; adults recognize that communicating in a certain mainstream way can afford people access to certain opportunities. However, students may internalize guilt and shame about how they talk (Gerlach-Houck et al., 2023). An impactful way to show students that they have allies at school is to use accepting and empowering language when talking about their communication. If someone is unable to understand what the student says, the listener may say something like: “You have such important things to say and I want to make sure I understand” and then help the student problem-solve how to express themselves in a way that they are understood. Get down on the child’s level and prompt them to try repeating themselves, using different words that communicate the same idea, or augmenting their verbal message with gestures or writing. Because communication differences are usually noticed via audio/visual modalities, teachers can include stories in their classroom that involve characters who have communication differences and watch videos of people who speak different dialects. More visible communication differences like using a communication device, signing, or wearing hearing aids/cochlear implants can also be represented in print materials. #3 Increase classroom accessibility. Teachers and school staff can collaborate with students with communication disorders to personalize their access to educational and social activities. This can happen officially through the student’s individualized educational plan (IEP), a 504 plan, or informal discussions with the student (and SLP, if feasible). Teachers should think creatively and proactively about how to make the classroom a welcoming place that invites students to take communication risks on their own terms. For example, students who have difficulty reading aloud perhaps because of dyslexia, articulation challenges, stuttering, or voice issues that make it difficult to project loudly may work out an alternative plan to practice reading aloud in a setting with less social pressure. For classroom presentations, it could be helpful to increase or remove a time limit for students who need more time to communicate, and to consider how grading criteria for “clarity” or “fluency” disproportionally affect students with communication differences. #4 Embed opportunities to develop resilience. To support students’ emotional resilience, help them build emotional awareness and regulation. Provide opportunities for students to develop an emotional vocabulary through structured activities, role play, book reading, and capitalizing on teachable moments as they arise. Extend their emotional vocabulary so they are better able to identify nuanced feelings and put words to those emotions. For example, happiness can be relief, excitement, or pride, and sadness can be frustration, disappointment, or guilt. Creating a visual feelings wheel or map can be an accessible way for students to point to how they feel when verbally expressing it may be difficult. When students “name it to tame it” (Siegel, 2010), it grounds them in the present moment when they feel emotionally overwhelmed, and this emotional vocabulary expansion can be especially important for students with vocabulary challenges. Students can also explore how different emotions feel in their body. Keep in mind that students with language or pragmatic challenges may have difficulty understanding idioms and metaphors. For example, “when I’m excited, I get ants in my pants” may be taken literally, so it would be more helpful to model “when I’m excited, I feel buzzing in my body, and I have a big smile on my face.” Once a foundation of emotional awareness has been established, students can develop their emotional regulation. This may be particularly difficult (and thus important) for students with communication disorders as some findings reveal lower levels of self-regulation in this population (Binns et al., 2019). Mindfulness activities like body scans and mindful walking can promote cognitive performance, resilience, and stress relief (Zenner et al., 2014). Calming strategies like deep breathing, 5-5-5 (naming five things they see, hear, and feel), leaving the room for a few minutes to reduce sensory overload, or reciting an affirmation (e.g., “I have important ideas to share,” “my voice matters”) may be useful. Using tangible materials for experiential self-regulating activities may be particularly helpful for students with language difficulties. For example, students can make a glitter bottle representing their swirling thoughts/feelings as they watch them settle on their own, or they can draw a picture of ocean waves carrying away their difficult thoughts/feelings (Black, 2022; Fang & Ding, 2020). In the realm of social resilience, students with communication challenges can be supported in recognizing cues when their communication partners are not understanding them and problem-solve ways to self-advocate and get their message across. Students with limited verbal output or low intelligibility may benefit from an alternative or augmentative communication system in the classroom and other social settings. There are low-tech options (e.g., picture boards) and high-tech options (e.g., iPad apps) that the school SLP can help with. #5 Address teasing and bullying. Communication disorders are protected disabilities. When bullying is directed at a child because of how they communicate, it is considered “disability harassment” which the school must address under Section 504 of the Rehabilitation Act of 1973 and Title II of the Americans with Disability Act of 1990. Support students with communication differences/disorders by assuring them it is okay to talk with you about bullying and thank them for telling you about bullying when it arises. Listen to them to learn what happened, show you want to help, and assure the student that bullying is not their fault. Help them to develop problem-solving strategies through role play, give advice through age-appropriate discussions, and guide them to seek social support from trusted peers and other adults (Hughes, 2014). Address bullying behavior by ensuring the student who bullies knows what the problem behavior is, showing them that bullying is taken seriously, taking steps to understand why the child bullies, using consequences to build empathy, and involving the student who bullies in making amends with the student they bullied. #6 Support students’ parents. Parents of students with communication disorders want to be listened to, taken seriously, and not blamed for their child’s difficulties (Hobson et al., 2022). When teachers meet with these parents, it is important for them to be supportive and work with the parents to understand the student’s issues and collaborate to make a plan together. Listen to parents and validate their concerns, even if the child’s behavior is different at home than it is at school. Key Implications for Practice Students with communication disorders have challenges with speech and/or language, which can impact their oral and written engagement in learning and social environments. Students with communication challenges are disproportionately affected by round-robin style speaking and oral reading activities, time limits for presentations, and grading rubrics for “clarity” or “fluency.” Students with language disorders may better engage in multi-modal learning activities. Use concrete language, limit the use of idioms/metaphors, and supplement with visuals. Create an accepting, accommodating environment where all students feel empowered to communicate. Educate peers about communication differences and how to be a helpful communication partner. Help students problem solve communication breakdowns and ways to self-advocate for their communication needs.   Related Resources Bullying and Youth with Disabilities and Special Health Needs - StopBullying.gov Support the Kids Involved - StopBullying.gov School-Based Language Pathologists: Who We Are and What We Do - American Speech-Language-Hearing Association Cultural Competence Check-Ins - American Speech-Language-Hearing Association https://doi.org/10.17077/rep.006640
Teacher and student walking together
A. Stephen Lenz, Ph.D., LPC-S, Professor, Texas A&M University-San Antonio
Description
School climate is a broad concept representing the academic and non-academic factors that distinguish the felt experience of interactions with a school campus. While a single representative definition of school climate has eluded practitioners, several systematic reviews have identified four composite domains that can support assessment, planning, intervention, and evaluation activities (Lenz et al., 2021; Rocha et al., 2019; Wang & Degol, 2016).   https://youtu.be/vlax0C_YkvA   Academic climate is characterized by features that promote student achievement and a culture of learning through developmentally responsive instruction, sufficient allocation of teaching resources, and an affirming culture of learning. At its core, a positive academic climate is grounded in strong leadership, high expectations of learning, support for students and teachers, timely assessment and monitoring practices, personalized learning plans, and the use of technology to promote engagement, collaboration, and success. School community is defined by the quality of interpersonal relationships grounded in a strong relationship between students, teachers, staff, parents, and community members that promotes inclusion, mutual respect, trust, safety, and connectedness. A positive school community is characterized by fair and equitable engagement of school stakeholders to share input, innovations, and resources during evaluation, decision-making, and planning processes that inform activities such as positive behavior programs, student well-being initiatives, professional development, and public relations. School safety is represented by the degree of physical and emotional security experienced by students, teachers, and staff that is conducive to a sense of protection and well-being that allows for optimal learning experiences. School safety is cultivated through physical and digital learning environments that minimize exposure to safety hazards, but also include policies for security and emergency readiness, procedures to address compliance with rules, and an integrated approach to prevention and intervention for social-emotional well-being threats such as bullying, conflict, and mental health challenges. Institutional environment is evidenced by the organizational, structural, and physical features through which school activities are conducted. These include variables ranging from the hours of operation, campus layout, quality of upkeep and maintenance, and class size to the degree of transparency and communication regarding the availability and allocation of technology, resources, supports, and materials. Taken together, the composite domains of school climate are expressed in synergistically complex ways that are both uniquely subjective and objectively observable experiences; they operate not only within student-student dyads, but within a matrix of interactions between students, teachers, staff, parents, and community members; they are influenced both actively and as a part of natural developmental processes; they are both input and output and often function as both process and outcome in their contribution to overall school climate. Despite these complexities, investments in school climate are certainly worthwhile as researchers continue to find promising associations with academic achievement (Daily et al., 2019), graduation rates (Buckman et al., 2021), college-going and persistence (Knight & Duncan, 2020), reductions in physical, emotional, and cyberbullying behaviors (Acosta et al., 2019), positive student and teacher mental health (Dreer, 2022; Wang et al., 2020), teacher job satisfaction and retention (Casely-Hayford et al., 2022; Otrębski, 2022), and civic engagement (Torney-Purta, 2002). Prevention and Identification Strategies Supporting a positive school climate requires intentional collaboration among multiple stakeholders and decision-makers to foster a proactive preventative agenda that targets the academic and non-academic development and well-being of the school community. Key among the related activities is the use of a well-designed assessment strategy to develop a data-driven plan to implement age-appropriate prevention programs. The American Institutes for Research (2023) cited school climate assessment as the principal activity to support a positive school climate through the identification of similarities and differences in perceptions between groups of stakeholders. When selecting an assessment for your campus, consider that the reliability and validity of all scores do not generalize to all stakeholders equally. Thus, it is imperative to consider not only the constructs, costs, length, and logistics of a school climate measure but also the degree that normative data reflects your campus. Furthermore, an equity-minded approach to school climate need identification will need to account for the representativeness of the sample with the corpus of students, teachers, and staff, as well as, a multi-method analysis that articulates both broad and disaggregated data trends. Some measures available for consideration include: Panorama Student Survey (Grades 6-12; Students, no cost); School Climate Assessment Instrument (Grades K-12; Students, Teachers, Staff, Parents/ Guardians, no cost); U.S. Department of Education School Climate Surveys (Grades 5-12; Students, Teachers, Staff; no cost); Comprehensive School Climate Inventory (Grades 3-12; Students, Staff, Parents/Guardians, Community Members, fee-based). Once campus characteristics are identified, it is possible to develop data-responsive prevention campaigns. School-based prevention programs vary in nature from universal to targeted, persistent to short-term, digital to face-to-face, and resource intensive to logistically modest. Once campus characteristics are identified, it is possible to develop data-responsive prevention campaigns. School-based prevention programs vary in nature from universal to targeted, persistent to short-term, digital to face-to-face, and resource intensive to logistically modest. Taken together, the campaigns selected for implementation also bear varying degrees and paces of impact. For example, some preventative programs may be short-term and efficacious; by contrast, others may feature multi-year campaigns with small but systemic cumulative effects. Therefore, it is prudent to develop a campus prevention programming agenda that not only responds to school climate data but can also be monitored for global and differentiated responses among stakeholders. While many areas of academic and non-academic development are worthwhile foci for prevention efforts, common topics include: Alcohol and drug use prevention programming that provides normative education, teaches social resistance skills, provide normative education, and reinforces competence;  Anti-bullying programs that develop the knowledge and skills to recognize, respond, and report wide-ranging forms of bullying such as verbal, physical, social, and cyberbullying;  Civic engagement and social responsibility efforts aimed to promote volunteerism, participation in public elections, and advocacy;  Cybersecurity awareness raising related to issues such as the use of good netiquette, identity protection, interacting with others online, and sharing sensitive information;  Personal wellness and mental health promotion initiatives that include healthy living, nutrition, personal resilience, mental health literacy, and social-emotional coping skills;  Positive relationships and social skills that teach active listening, effective communication, character education, non-violent conflict resolution, and self-advocacy;  Safety and security of self and others in school and non-school-based spaces.  Intervention Strategies School-based interventions have a prominent position within the cadre of approaches to improve, support, and maintain a positive school climate. While many of the topics and methods of intervention delivery are similar to those of prevention efforts, there are key differences in the purpose and intended outcomes. Among these key differences is a focus on (a) directing efforts to children who have developed a problem rather than those who are at risk, (b) deliberate rather than incidental risk reduction, and (c) targeted rather than universal implementation. There is substantial evidence that well-designed intervention programs can affect the domains of school climate with some prominent options available in urban and rural campuses described below. However, the selection of which intervention may be best suited for your campus would rest on thoughtful deliberation of available data, feedback, and available resources. #1 School-Wide Positive Behavioral Interventions and Supports (PBIS) The implementation of PBIS has increased in recent decades as campus stakeholders attempt to support academic and non-academic success through teaching, modeling, and rewarding positive behaviors as an alternative to practices such as admonishment, inconsistent punishment, and exclusionary practices. Rather than rely on a standardized curriculum, PBIS is grounded in a foundational framework of measurable goals and outcomes, databased decision-making, identification and implementation of evidence-based practices, and a systems-level application (Center on PBIS, 2023). These composite interventions are supported across 3 tiers (Universal, Targeted, Intensive and Individualized) as indicated by student needs and school capacity (Harlacher et al., 2018). Despite the unique expression of PBIS across campuses, there is promising evidence for the fidelity of implementation and desired associations with academic achievement, prosocial behavior, discipline referrals, and suspensions (Noltemeyer et al., 2019). #2 Mental Health Support Services School-based mental health support services (MHSS) increase student access to individual or team-based care delivered by licensed and non-licensed providers for commonly occurring clinical issues. MHSS approaches are based on the assumption that mental health and academic achievement have reciprocal influences on one another and consider evidence-based and manualized interventions as a pathway to promote to support development and well-being across the lifespan (Raffaele Mendez, 2017). Students participate in individual and small group services using any combination of in-person and telehealth mediums. Programs such as Think First (Larson, 2005), Brief Coping Cat (Kendall et al., 2013), Stop and Think (Caselman, 2005), the Adolescent Coping with Depression Course (Clark et al., 1990), and Cognitive Behavioral Intervention for Trauma in Schools (Jaycox et al., 2018) are available for treating aggression, anxiety, attention-deficit/hyperactivity disorder, depression, and posttraumatic stress, respectively. While considerable evidence exists for the application of such programs, the observed effects tend to be largest for targeted interventions and moderated by a combination of program type, length of intervention, and age group (Feiss et al., 2019; Sanchez et al., 2018). #3 Conflict Resolution and Peer-Mediation Programs Teaching students to resolve disagreements provides a supportive platform to increase felt safety and reduce incidents of violence while concurrently fostering the communication, problem-solving, and interpersonal effectiveness skills that will be adaptive across the lifespan. Conflict resolution skills are taught to individual students by teachers, administrators, and school counselors who focus on applications such as early intervention, real-time remedies, and follow-up training. Common elements include the use of constructive communication, steps in negotiation, and debriefing activities. Staff and students can also serve as a mediator between 2 or more students when students require additional support to resolve a disagreement. While standalone programs and curricula Teaching Students to Be Peacemakers (Johnson & Johnson, 2005) and Overcoming Obstacles are available for access, school personnel often develop and implement interventions based on units within a universal social-emotional learning curriculum or to meet established standards. Evidence has indicated program effects ranging from small to moderate based on various implementation characteristics (McElwain et al., 2017; Turk, 2018). #4 Peer Mentoring and Support Programs Peer mentoring programs offer a dynamic and relational way to support student success by matching an older student with a younger one who shares a similar developmental pathway. These interventions have the potential to stimulate mutual growth and learning for mentors and mentees by capitalizing on the youth's inherent interest in peer relationships and innate tendency to look up to slightly older peers (Garringer & MacRae, 2008). Effective peer mentoring programs need to consider several elements such as (a) goals and intended impact, (b) participant recruitment, screening, and selection, (c) mentor training, (d) strategies for matching, (e) parent education and orientation, (f) mentor and mentee supports and monitoring, and (g) approaches to resolving the relationship. Several models such as Big Brothers Big Sisters of America, the Cross-Age Mentoring Program (CAMP) Cross-Campus Model (Karcher 2012), and Just for Kids! (Smith, 2011) are available for reference, as well as, toolkits provided by groups such as the National Success Mentors Initiative and National Mentoring and Resource Center. Well-designed peer mentoring and support programs have been associated with promising evidence for academic, psychosocial, and health outcomes, particularly when delivered off-campus and with adult supervision and support (Burton et al., 2022; Raposa et al., 2019). #5 Restorative Practices Restorative practices provide an alternative to zero-tolerance disciplinary policies and punitive discipline through the facilitated repair and strengthening of relationships among individual students when harm has occurred. These aims can be reached through several strategies including (a) informal proactive discussions that allow for respectful, empathic, accountability-oriented, and collaborative conversations; (b) reactive strategies that address individual and classroom-wide incidents of harm; and (c) formal discussions that focused on support and accountability to increase empathy, acceptance, and belonging. Specific restorative practice interventions include restorative conferences, restorative conversations, conversation circles, classroom conferences, and classroom lessons (Winslade et al., 2014). Numerous program models and training guides are available through groups such as the International Institute for Restorative Practice and Restorative Practices Partnership which can be referenced by school administrators, teachers, and staff. Preliminary evidence reviews of restorative practices have indicated trends between intervention with decreased disciplinary referrals and improved student-teacher relationships (Zakszeski & Rutherford, 2021). However, given the correlational nature of evidence to date, school personnel must consider the unique intersection of campus characteristics, training and support resources, implementation capacity, and emerging research findings when developing their approach to cultivating school safety and security. Key Implications for Practice Fostering a positive school climate is a complex task requiring an intentional approach that includes stakeholders across the ecology of student academic and non-academic development. Scoping reviews of best practices and evidence-based approaches offer numerous considerations including: The importance of articulating, adopting, and communicating a shared vision of a positive school climate and related campus priorities, goals, and activities;  Establishing and nurturing a culture of quality improvement that emphasizes transparency, developmental supports, multiple sources of feedback and data and avoids interpersonal pitfalls such as toxic positivity, stereotyping, and scapegoating;  Implementation across the campus’ multi-tiered system of supports using evidence-based approaches to prevention and intervention that are delivered with consistent vernacular and a sense of shared ownership;  Intentional and consistent inclusion of internal stakeholders such as students, teachers, and school/district staff, as well as, external stakeholders who are outside of the day-to-day operations, but whose interests can support success; and  District support for school climate-promoting initiatives through the allocation of funding, resources, personnel, and training to promote implementation fidelity, monitoring, and accountability practices.  Related Resources Every Student Succeeds Act (ESSA)  This guiding legislation empowered school districts to establish accountability standards and related interventions and supports to promote student success. The ESSA requires annual reporting of school climate and safety data and creates opportunities to create learning environments that support the academic and non-academic success of all students.  National School Climate Standards  The National School Climate Standards represent a set of criteria intended to support school climate assessment, intervention, and accountability. Rather than provide specific guidance, the Standards provide a framework for identifying, planning, and implementing local practices that are based on campus characteristics, priorities, and resources.  National Center on Safe and Supportive Learning Environments  The National Center on Safe Supportive Learning Environments is funded by the U.S. Department of Education, Office of Elementary and Secondary School's Office of Safe and Supportive Schools. The Center offers information and technical assistance focused on improving school climate and conditions for learning for all students.  School Climate Survey Compendium  This compendium includes links to several surveys that can be administered to pre-K through postsecondary campus stakeholders to identify and monitor school climate. All of the listed surveys have score reliability and validity data available for inspection; however, the constructs representing the internal structure of the measures may vary.  School Climate Literature Compendium  This compendium includes access to peer-reviewed publications that address issues, trends, policies, best practices, and research related to planning, implementation, and monitoring of school climate. The hosting site provides links to organizations and resources that support youth, parents, educators, and community involvement in positive school climate promotion.  https://doi.org/10.17077/rep.006641 
Teacher working with 2 students
Sharon Hoover, Ph.D., Co-Director, National Center for School Mental Health
Description
School mental health has recently seen an unprecedented surge in interest and investment. This growth is fueled by a youth mental health crisis, exacerbated by the global pandemic, paired with evidence for schools as a critical venue for preventing and treating mental health problems (Hoover & Bostic, 2021a). As Co-Director of the federally-funded National Center for School Mental Health for over a decade, and as a clinical psychologist working in schools for a decade before that, I have had the privilege of witnessing and supporting expansion of school mental health in the United States. In all of my years in this field, I have never observed the (long overdue) level of interest and investment we are now seeing, and it is essential that we act with intention and focus.   [embed]https://youtu.be/AkrJa-t5jGA[/embed] 5 Opportunities to Leverage this School Mental Health Moment Below, I outline five opportunities fundamental to leveraging this unparalleled moment in school mental health to achieve the ultimate goal of promoting mental health and well-being for all youth. Each opportunity aligns with the central theme of “moving upstream,” investing in a public health approach to promote well-being of all students, identify mental health concerns early, and strategically offer early intervention and treatment where youth are – in schools. Opportunity 1: Nurturing Environments that Foster Prosocial Behaviors and Connectedness We have incontrovertible evidence that the vast majority of challenges impacting our youth could be prevented or diminished by creating nurturing environments starting early and continuing into middle and high school and beyond. In his book, “The Nurture Effect: How the Science of Human Behavior Can Improve Our Lives and Our World,” Dr. Anthony Biglan, a Senior Scientist at the Oregon Research Institute, distills decades of scientific research from the fields of psychology and prevention science into tangible, actionable steps that policymakers, families, and institutions like schools can take to reduce youth problems and to produce caring and productive young people (Biglan, 2015). In a nutshell, the research from years of rigorous randomized trials tells us that all successful interventions make environments more nurturing in at least three of four ways: Promoting and reinforcing prosocial behavior Minimizing socially and biologically toxic conditions, like poor nutrition and housing insecurity Monitoring and setting limits on influences and opportunities to engage in problem behavior Promoting the mindful, flexible, and pragmatic pursuit of prosocial values These interventions can and should be implemented with both families and schools. In the earliest years of children’s development, effective interventions include things like Incredible Years, Nurse-Family Partnerships, and the Triple P Parenting Program. In elementary years and beyond, interventions like Family Check Up are helpful to support parents in handling common problems, using reinforcement to promote positive behavior, monitoring their child’s behavior and setting limits, and improving family communication and problem solving. Schoolwide systems to minimize coercive and punitive interactions and to teach, promote, and richly reinforce prosocial behaviors have demonstrated long-term positive impacts on adolescent risk behavior and engagement in college and career. When implemented with fidelity, the promise of programs like Good Behavior Game, Positive Action, and Positive Behavioral Interventions and Supports to promote prosocial outcomes in our adolescents and young adults is tremendous. Further, we must invest in school environments and strategies that increase a sense of student connectedness (Centers for Disease Control, 2022). In their most recent report on youth mental health, the Centers for Disease Control called on the nation’s schools to act with urgency and compassion to promote connectedness and belonging among students (CDC, 2023). Doing so, they argued, has the potential to dramatically improve youth well-being and to tackle the concerning increases in child and adolescent depression, anxiety, and suicide. The good news is that we have years of evidence for the positive impact of effective programming to promote student connectedness and belonging, including interventions that target positive school climate and positive youth development. There are seemingly simple daily strategies that educators can employ to create a warm environment that fosters connection. For example, welcoming students by name and with a friendly greeting when they board the school bus and enter the school and classroom is a no-cost but powerful tool. Ensuring that each student has at least one positive adult ally in the school and one extracurricular activity in which they are actively engaged also enhances student connectedness. More comprehensive school climate programming, including assessment and continuous quality improvement of school climate domains (belonging and connection, safety and wellness, environment), is also critical. Several districts across the nation have utilized the school climate assessment platform and accompanying toolkit for school leaders funded by the U.S. Department of Education via the National Center for Safe and Supportive Learning Environments (National Center for Safe Supportive Learning Environments, 2023). To fully address the current youth crisis and to prevent future mental health challenges, it is essential to foster nurturing environments where youth feel connected and engage in positive, health-promoting behaviors. Schools can also increase connectedness and belonging among students by employing positive youth development programming and strategies that identify and leverage youth assets and protective factors (U.S Government Youth, n.d.). Opportunity 2: Mental Health Literacy and Life Skills In addition to fostering positive and nurturing school environments that enhance student and staff well-being, we are increasingly seeing efforts to embed life skills and mental health literacy into the curriculum (Hopeful Futures, 2023). Several states and districts have adopted standards of social emotional learning (SEL), sometimes referred to as “skills for life,” and aligned them with curricular requirements. Despite the ongoing debate about the role of SEL in schools, educators and families universally agree that schools must foster life skills that promote academic success, employability, and citizenship. In partnership with families, schools are an essential venue for teaching and reinforcing skills like problem-solving, empathy, communication skills, and emotion regulation, all critical to daily and life success. Whether states and communities choose to call them “social emotional competencies,” “skills for life,” or even “employability skills,” there is a long and robust research base documenting the evidence of these skills as predictors of better school performance, well-being, and college and career readiness (Greenberg, 2023). Recently, several states have also passed legislation that requires the integration of mental health literacy into K-12 education (Mission Square Research Institute, 2021). Typically, mental health literacy involves teaching students how to obtain and sustain positive mental health, understand and identify mental health challenges, decrease stigma about mental illness, and seek help for mental health concerns. Dr. Stan Kutcher and colleagues from Canada developed, studied, and widely disseminated mental health literacy programming throughout schools in Canada and several other countries. Implementation studies of their mental health literacy intervention demonstrated increased educator and student knowledge about mental illness and health and greater help-seeking behaviors among students (see www.mentalhealthliteracy.org). This intervention has since been adapted for and studied in the United States by the Mental Health Collaborative with versions for educators, students, families, and coaches. I anticipate Mental Health Essentials and other mental health literacy programs like Born this Way and Teen Mental Health First Aid will be increasingly adopted by state and district leaders as an upstream approach to managing the youth mental health crisis. Other states will develop “homegrown” life skills curricula, as we saw mandated by Utah’s legislature, in which the state department of education partnered with a local mental health institute to embed mental health literacy during the school day and to engage parents in its implementation (State of Utah, 2022). Both life skills and mental health literacy offer an opportunity to build more resilient and emotionally healthy generation of students, better equipped to navigate life stressors and mental health challenges. Opportunity 3: Well-Being Check Ins Almost two decades ago we saw a burgeoning interest in school mental health screening when states were increasingly funded to deliver suicide prevention activities in schools. This trend was not without challenges or controversy, and many states and districts opted not to implement comprehensive screening programs, often due to concerns about privacy or liability if concerns were identified without the capacity to address them in the school. While these concerns remain, COVID and a greater recognition of the vital role of schools in early identification of mental health challenges have contributed to a renewed interest in school mental health screening (Hoover et al., 2020). As interest and implementation of mental health screening in schools grows, we have observed some best practices to safeguard against some of the challenges encountered with previous efforts. For example, to address concerns about privacy and parent/student rights, many school communities have intentionally engaged families and students during the planning stages of screening. Students and families provide input on consent and assent processes, instrument selection, privacy considerations, and family notification procedures to ensure that efforts are feasible, culturally sound, and well-received by the community (Hoover & Bostic, 2021b). Our National Center for School Mental Health developed a School Mental Health Quality Guide on Screening, laying out the nuts and bolts of best practices in school mental health screening (National Center for School Mental Health, 2020). I am also heartened by the movement away from annual screenings rooted in traditional medical models of psychopathology toward more frequent “well-being check-ins” that assess constructs like subjective well-being, belonging, and connectedness. Furlong and Dowdy, colleagues at UCSB, have led the Covitality project to support schools in measuring these factors as opposed to simply assessing for anxiety, depression, or trauma alone. In doing so, they have demonstrated that when we inquire about how connected students feel to their home, school, and community and about their general well-being, we are more able to predict who is doing well and who could benefit from intervention. Schools are also increasingly assessing for social determinants of health that influence mental health, shifting the focus of intervention to systems that contribute to poor mental health, like housing and food stability, and away from “fixing” individuals responding to poor conditions. We have also seen a movement toward more frequent check-ins that allow teachers and other school staff to quickly assess the emotional status of their students and connect them to coping skills or staff support when needed. Programs like CloseGap, a rapid, technology-supported app that students can report on daily as they begin school, offers teachers and school mental health staff a “pulse check” of the daily well-being of students. This type of relatively low-burden check-in prevents students who may be suffering from falling through the cracks and allows teachers to route students to support. Opportunity 4: Filling in Tier 2 School mental health has long been described as best implemented as a multi-tiered system of supports, or MTSS (Hoover et al., 2019). Usually, this involves three tiers, from Tier 1 (Universal) supports that promote mental health of all students in the school system to Tier 3 (Indicated) services for students with identified mental health challenges that interfere with daily functioning. While most schools offer something at each tier, I am increasingly hearing concerns about a “missing tier 2” within the MTSS. That is, schools often have at least some programming that reflects universal approaches to mental health such as school climate efforts, positive behavior interventions and supports, mental health literacy, or social emotional learning. Similarly, schools typically offer some level of Tier 3 services to struggling students, sometimes as part of special education supports or via partnerships with school-based community behavioral health providers. However, there is considerably less consistency in the delivery of Tier 2 supports for students with mild mental health concerns or for those who may be at greater risk for experiencing mental health challenges. Despite their demonstrated effectiveness in schools, Tier 2 interventions are often limited due to lack of staffing or funding to support training and implementation. Whereas Tier 1 supports are typically delivered by educators and other school staff and Tier 3 services are regularly funded and delivered by specialty providers like psychologists, social workers, and counselors, it is often unclear who is best equipped to deliver Tier 2 services and how those services can be funded. From a public health perspective, a “missing Tier 2” is a major limitation in fully supporting the mental health needs of all youth in a school and community. It is well established that a longer duration of untreated mental illness is associated with poorer outcomes and that early identification and intervention can positively adjust the trajectory of psychosocial, academic, and life outcomes for youth. Fortunately, intervention developers and funders are gaining momentum filling in Tier 2 by offering feasible approaches for Tier 2 implementation. Tier 2 services may include brief individual interventions, like Screening, Brief Intervention, and Referral to Treatment (SBIRT), an early intervention for substance use concerns, or Brief Intervention for School Clinicians, a 4-session intervention based on cognitive behavioral and motivational enhancement techniques. Group modalities are also sometimes used to deliver Tier 2 interventions, including programs like Supporting Transition Resilience of Newcomer Groups,  a school-based intervention to facilitate the transition of refugee and immigrant students to a new school and community. Some schools also utilize Tier 2 interventions like Check In Check Out (Maggin et al., 2015) or Check and Connect as a way to monitor and support students through checking in throughout the school day with a designated adult and employing coping skills if challenges like mild anxiety or low mood are identified. To fully realize the potential of effective Tier 2 interventions, we must leverage a broader workforce, including health educators and peers, and require reimbursement for these upstream interventions via education funding, Medicaid, and other insurers. Opportunity 5: School Staff Well-Being The pandemic shed new light on educator stress and burnout and their impact on quality of teaching performance, retention, and student academic and well-being outcomes (Mission Square Research Institute, 2021). The constant shifting demands, added burden, and perceptions of lack of transparency by administrators left educators feeling even more overworked and undervalued than before COVID. Given research that stressed teachers are more likely to leave the profession, researchers, policymakers, and education leaders have increasingly focused on promoting educator well-being and reducing their stress. Efforts have targeted both individual and organizational factors that contribute to educator well-being. Live and asynchronous online training opportunities have been adopted by states and school districts to enhance teachers’ personal well-being. For example, Wisconsin’s educators utilize the Compassion Resilience Toolkit  to understand, recognize, and prevent/reverse compassion fatigue. The Georgetown Well-being in School Environments (WISE) Center also developed an online course, TeacherWISE, for educators and school staff to engage in personal well-being planning and support. Beyond relying on educators to simply care better for themselves, districts and schools must be accountable for creating conditions that foster educator well-being. Our National Center for School Mental Health partnered with the SAMHSA-funded Central East Mental Health Technology Transfer Center to develop a free online system, the Organizational Well-Being Inventory for Schools for districts and schools to assess the organizational factors that contribute to educator well-being and to engage in continuous quality improvement in eight domains: Work Climate and Environment; Input, Flexibility, and Autonomy; Professional Development and Recognition; Organizational and Supervisory Support; Self-Care; Diversity, Equity, Inclusion, and Access; Purpose and Meaningfulness; and, Professional Quality of Life. Be attending to organizational factors that contribute to educator well-being, districts and schools can better support school staff so that they are best able to fully engage in their professional responsibilities and flourish as human beings. Conclusion As a nation, we are primed to fully recognize schools as critical to promoting mental health and well-being for all youth and identifying and intervening early when mental health challenges arise. The need is clear and urgent, there are many best practice frameworks and programs to support implementation, and educators and families universally recognize that schools must be part of the solution to our youth mental health crisis. To realize the potential of the school mental health opportunities discussed above, there must be an intentional shift in policy and funding, supported by federal, state, and local partners. The Hopeful Futures Campaign, a national coalition of health, education, family, and youth leaders, have united around state policy levers that can advance comprehensive school mental health (see www.hopefulfutures.us for the National School Mental Health Report Card and the National School Mental Health Legislative Guide). They have assessed each state’s progress on drivers of school mental health like mental health professional-to-student ratios, well-being check-ins, healthy school climate, and skills for life, and offered legislative examples and guidance to state policymakers. Table 1 outlines policies aligned with the five opportunities laid out above. All of us should approach this moment in human history with a combined sense of urgency and hope. For school mental health, we are equipped to position schools as a true partner to families and communities in their quest to foster youth that are well and flourishing. Let us together strategically capitalize on the interest and investment in school mental health by advocating for policy and funding shifts that align with opportunities in the field. https://doi.org/10.17077/rep.006642
Four high school students sitting at desks