Intervention and pathways to care (tier 3)
Some students require more intensive or urgent mental health services, referred to as tier 3 support. Schools are part of a community-wide system of care for mental health and often serve as a critical link between students with mental health concerns and community mental health supports and services.
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Why this is important
- In Ontario, schools are the most common place children and youth receive mental health support. And while ideally positioned for mental health promotion, and prevention and early intervention services, schools are not well suited to provide intensive therapeutic intervention.
- System coordination helps to ensure that as many young people as possible receive the help they need, at the earliest possible time.
Coordination between schools and community services
Right Time, Right Care: Strengthening Ontario’s Mental Health and Addictions System of Care for Children and Young People outlines an aspirational vision for the system of care for child and youth mental health in Ontario:
- Schools enact the multi-tiered system of support with primary emphasis on mental health promotion, and prevention and early intervention services.
- Community mental health organizations enact their multi-tiered system of support with primary emphasis on tier 3 and 4 intensive assessment and treatment services.
- Other community, culture/faith, hospital, and hub partners provide specific services according to their expertise.
All partners work together to support young people and their families who may be in crisis and require urgent care (and in response to postvention, tragic events, incidents of violence, and other events with community impacts).
The graphic includes an upright triangle and an inverted triangle. Each triangle is divided into three sections.
The upright triangle on the left is labelled school-based mental health and includes:
- A large bottom section in green labeled first tier mental health promotion
- A slightly smaller blue section in the middle labelled second tier targeted prevention and brief services
- A small purple section at the point labelled tier three specialized consultation and assessment, family caregiver support, and therapy services
The inverted triangle is labelled community-based mental health services and is to the right of the upright triangle.
- Its point is a blue section and aligns with the middle blue area of the first triangle, which is labelled second tier. There are arrows between the sections of both triangles to depict how someone can move between the services available at tier two in school or the community.
- The section above the point is purple and larger. It aligns with the small tier 3 purple section on the first triangle. Again, arrows between the sections depict movement or collaboration between school and community services.
- Lastly, a large orange section is labelled fourth tier Intensive services: community-based and in-home treatment or in-patient/live-in treatment.
Tier 3 interventions at school
It will always be necessary for regulated school mental health professionals to provide some level of intensive services (e.g., when students cannot access outside supports or choose not to, when services are unavailable because of geography or demand). At the same time, it is the role of school mental health professionals to help students access appropriate community or health services and to provide needed ongoing care while students are at school.
School mental health professionals are well trained in providing assessment and treatment services for children and youth requiring more intensive supports. They also have strong crisis-management and support skills.
- Psychologists with clinical training can provide thorough assessments of learning and mental health needs and can provide diagnoses when warranted and helpful.
- Social workers, psychologists, and psychotherapists are also trained in a range of psychotherapeutic techniques that can assist with significant and severe mental health concerns.
- It is important to think carefully about the role of schools in the system of care and reserve these costly and time-intensive services only for students who can’t access support elsewhere.
- In most cases, a referral through community or hospital care is appropriate when students are showing signs of significant mental illness. The role of the school mental health professional is to provide ongoing support at school according to the treatment plan offered by the primary mental health provider.
Tier 3 services in the community
Mental health organizations strive to provide services across the continuum of care:
- service coordination
- brief services (often in walk-in clinics)
- counselling and therapy
- family support
- specialized consultation and assessment
- crisis-support services
- intensive treatment services
The lead agency for each region is responsible for ensuring that these core services are provided in the area, across the various agencies and school boards involved. Several communities also have youth wellness hubs, which provide low-barrier access to youth-friendly evidence-informed services across the continuum of care. Some regions have a central intake process to assist with referrals from the school board to community service providers.
More recently, the Ministry of Health has invested in One Stop Talk, which is a provincial service through which young people can access immediate, brief therapeutic support and may be referred for ongoing care following the first point of contact. This can be considered the “front door” to accessing community mental health services. School staff continue to support students through and from services, reinforcing skills and strategies that community supports have established with them.
How to support students receiving community-based mental health interventions
Sometimes, a student may be receiving care in the community or in a hospital-based setting and the parent/caregiver is seeking support with transitions, safety planning, or reinforcement of strategies known to be helpful to the student. Working as a team can make a significant difference for a child who is struggling with their mental health and is in treatment outside of school.
School staff can:
- act as advocates and help students and parents/caregivers navigate the community mental health supports and system, if needed
- ensure adherence to privacy and confidentiality
- be understanding and compassionate of the student’s needs while at school or with needed time away from school
- work collaboratively with the student, parent/caregiver, and community support to support accommodations and recommendations needed at school; follow protocols for the development of an individualized support plan
- check in to see how things are going and what you can do to help
- develop a communication plan to ensure that important updates are shared with the right people at the right time
- look at your work together as an equal partnership; listen to the student’s needs, goals, and desires, and work to achieve them together
- address negative or harmful comments about student mental health promptly; educate yourself and students on using person-first language and avoiding labelling and stigmatizing language
Some students may require community-based mental health interventions, and some will not – or cannot – access services for a number of reasons, including wait-lists and lack of culturally responsive or linguistically appropriate supports. In these complex and often challenging cases, school administrators and staff, along with parents/caregivers, coordinate to wrap around supports as best as they can to help the student to be well.
How to support a student’s mental-health-related absence and return to school
There are several scenarios that may result in a student’s absence as a result of mental health problems, like being in hospital or treatment or at home accessing support but unable to attend school. Maintaining a relationship with the student while they are absent is critical for parent/caregiver and student engagement, transition planning, and collaboration with community partners. Often, transitions back to school require careful attention and supportive planning.
- Lead your school team and the student’s circle of support to collaboratively plan for the student’s successful return.
- Be mindful that there may be some processes – related to such things as sharing of information, age of consent, sudden discharges, or changes of plans – that may make it difficult to create a timely and comprehensive return-to-school plan. This is a time to remember that these things are often outside the control of the student and/or their parents/caregiver and to be patient, compassionate, flexible, and accommodating when things don’t go as planned or there is no plan at all.
- When transition meetings are possible, it is important that you attend and work closely with students, parents/caregivers, and community-based mental health service providers to ensure that supportive intervention strategies are understood and implemented feasibly within the school setting. This may require providing some extra support to educators and support staff in implementing, maintaining, and reviewing accommodations and support strategies for students.
- Be sure to also plan for regular conversations/meetings for updates to and from school, home, and community (if involved).
Know the pathways to tier 3 services
Students and their parents/caregivers should have easy access to services in locations that are accessible, comfortable, and meet their unique needs. When it’s in the best interest of the student to access mental health supports and services from community agencies, effective coordination and collaboration between school and community become paramount.
Repeatedly, students and their parents/caregivers have expressed frustration with the child and youth mental health system, citing confusion among service providers regarding roles and the need to recount their story multiple times.
To address these issues and adequately address the mental health needs of Ontario students, schools play a central role in supporting an interconnected system of care that focuses on children and young people.
Smooth transitions between service providers and tiers of service are vital, particularly for those with complex needs or requiring intensive individual and family support.
The Circle of Support and System Pathways resources are designed to guide school administrators through the available resources, personnel, and pathways within the school, the board, and the community, for when a student requires additional support.
Children’s Mental Health Ontario (n.d.). Ontario’s Child and Youth Mental Health Agencies.
Offord Centre for Child Studies at McMaster University. (2019). Ontario Child Health Study,
School and Community System of Care Collaborative. (2022). Right time, right care: Strengthening Ontario’s mental health and addictions system of care for children and young people.