Prevention and early intervention (tier 2)
School-based tier 2 supports are targeted prevention and early intervention services that aim to increase protective factors, address risk factors, and provide strategies and supports to help students people experiencing mild-to-moderate difficulties with their mental health.
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Why this is important
- 70% of mental health problems begin during childhood or adolescence. Early identification and intervention can improve mental health outcomes and reduce the need for more intensive services later on.
- 18% to 22% of children and youth in Ontario meet the criteria for a mental illness, but less than one-third of those children and youth have contact with a mental health provider.
- If children and youth do have contact with a mental health provider, school is the most common place where they access support.
- Every school board has funded positions at secondary schools for school mental health professionals. These individuals are trained and equipped to provide excellent tier 2 prevention and early intervention services. Making appropriate referrals for this level of support helps to ensure that students receive helpful services early, often preventing the need for more costly intensive services in community or hospital settings.
The school’s role in early identification
Between tier 1 and 2, early identification takes place. Often, the classroom teacher is the first to notice a concern; however, any staff member in the school or a parent/caregiver or the student themselves may identify the need for more support. All school staff need some level of mental health literacy and awareness, as any staff member could be the one a student chooses to connect with for support.
- While classroom educators are often the first to notice changes in emotions or behaviour that may signal a mental health concern, specialized knowledge focused on early identification and support of mental health problems can benefit staff who support students in a special capacity, such as child and youth workers, coaches, guidance teachers, special educators, gender and sexualities alliance leaders, and grad coaches.
- Along with learning to recognize signs of mental health concerns, school staff, as they grow in confidence, become aware that these signs may vary among students and that not all students show visible signs of distress when they are struggling. Noticing a change in behaviour or emotion happens best within the context of a caring staff–student relationship.
How to detect signs of possible mental health problems
In general, if school staff notice a change in how a student is expressing behaviour, emotions, or thoughts, they should also take note of how often, how intensely, and for how long the concerns have been present. It is also important to pay attention to how distressing it is for the student and how it’s affecting their day-to-day activities.
Frequency: Look for noticeable changes in behaviour or emotions that occur repeatedly or with increasing frequency. This could include sudden outbursts of anger, crying spells, or withdrawal from social activities.
Intensity: Observe the intensity of emotional reactions or behaviours exhibited by students. Look for signs of extreme sadness, anxiety, anger, or aggression that appear disproportionate to the situation
Duration: Pay attention to the duration of certain behaviours or emotional states, and note when a student displays prolonged periods of sadness, irritability, or withdrawal lasting more than a few weeks.
Here are a few important reminders for school administrators and staff when identifying signs of a possible mental health concern:
- Reflect on any beliefs and biases that may negatively influence your perception of a student’s emotions and behaviours and how mental health is perceived and addressed.
- Avoid assumptions and stereotypes, remembering that each student is unique and that mental health problems manifest differently for everyone. Base your observations on specifics rather than generalizations.
- Gather information from the school adults in the student’s life to develop a comprehensive understanding of changes you’re noticing. Documenting and consulting with other staff regarding these concerns will help to create a full picture before addressing the worries with the student and/or their parents/caregivers. It is possible the noticed changes are appropriate responses to a student’s experiences and not indicative of a mental health concern.
- Remain curious and open to school factors that may be affecting a student’s mental health. Be prepared to address these factors swiftly and effectively, if uncovered.
Common mental health concerns and support strategies
Challenges with anxiety, attention and mood are common mental health concerns in youth. These concerns may be long-term and diagnosed conditions. Or they may be acute reactions to a tragic event or other life situation. Learn more about common concerns and support strategies.
Dealing with emergency concerns
If your concern for a student is urgent (e.g., suicide risk or risk to others/imminent danger), act immediately to activate board protocols and never leave the student alone. See youth suicide prevention, intervention, and postvention for more information.
How to support students in the moment
Many students will feel worried, unsettled, irritable, or stressed at different points in their lives. Although there are no “good” or “bad” emotions, some emotions can make us feel more comfortable than others.
Validation is a skill that can be helpful when supporting students and others who are experiencing intense emotions (Ontario College of Teachers, 2018). It offers a way to acknowledge their point of view, thoughts, emotions, and experiences, without trying to solve, fix, or judge the situation. Like other skills, learning to validate others takes regular practice and reflection.
- Seek to understand by remaining curious, giving time for a student to express themselves, listening more, and speaking less. The goal is to help students feel genuinely heard and seen, not to minimize or change their feelings, provide opinions, fix the situation, rush to create a silver lining, or jump to explanations or problem-solving.
- During interactions, some students may readily share their feelings; others might benefit from open-ended questions, prompts, or visuals.
- Refrain from labelling feelings for students because when we name or identify feelings for others, we introduce our bias.
- Teach students how to use tools to identify their emotions/feelings when they are not feeling intense emotions or in crisis, as this creates better conditions for learning.
- Once you’ve actively listened for the range of feelings that a student may be experiencing and checked for understanding using a posture of curiosity and cultural humility, validate the emotion(s). Validation is best done when it comes out authentically (rather than from a script). Here are some examples of validating phrases:
- “Thank you for sharing that with me.”
- “I can see how you would feel ____.”
- “It makes sense that you’d feel ____.”
- “I can only imagine how ____ you’d feel.”
- “No wonder you’re feeling _____.”
- “That sounds really _______.”
- Students can often sense inauthenticity. Drawing on empathy and really trying to imagine what the situation may be like for a student can help you to provide validation sincerely. We will likely never fully understand someone else’s experiences, but we can still strive to empathize with them.
When a student shares how they are feeling in response to an experience of racism, marginalization, or oppression, it is important to use an anti-oppressive, anti-racist, and student-centred response. Along with naming the incident and following school/board guidelines to address this swiftly, the Listen, Believe & Act framework offers guidance on how to respond in the moment. There are three main tenets:
- Listening to understand is a key part of supporting student mental health and well-being in the moment. Active listening goes beyond absorbing what a student is saying; be mindful that your body language and non-verbal expression also convey listening.
- Believing what students share validates their lived experiences. Respond with compassion and be careful not to negate or diminish experiences or emotions with your responses. Use neutral language like “I hear you” and avoid vague reassurances like “It’s going to be okay.” Confirm your understanding of what a student has shared and express validation for their experiences and emotions.
- Acting with and for students is integral in reassuring students that their identities, mental health, and well-being are affirmed, valued, and supported.
These tenets help remind school administrators and staff how to engage in cultural humility through active listening and provide ways to affirm students’ identities by believing their lived experiences and supporting their agency when it comes to their own mental health.
You may be wondering how to provide emotional validation when a student has engaged in harm or is using avoidance to cope with feelings of anxiety. Emotional validation seeks to understand and then validate a student’s underlying feelings, but it does
not mean:
- validating hurtful or harmful behaviour
- validating avoidance as a coping strategy for anxious feelings, as this can lead to further avoidance
In these instances, you may need to validate the emotion and then set a limit or boundary. Below are two examples to help illustrate.
- “It sounds like you are really frustrated and upset that you didn’t make the basketball team. I’m so sorry this happened to you. However, it’s not ok to swear at the coach.”
- “Thank you for sharing with me that you are feeling anxious, overwhelmed, and sick to your stomach about completing the presentation. It’s okay to feel anxious…however, skipping English in the hope of avoiding the presentation is not a good idea because it will likely make the next one even more difficult. Would you be open to discussing with your teacher some alternate ways to complete the assignment (e.g., by creating a video, presenting to a small group)?”
How to talk with students and/or parents/caregivers about mental health
As a school administrator, you may either speak directly with students and their parents/caregivers when mental health concerns arise or provide support to staff members in addressing these concerns. As appropriate, depending on the age and maturity of the student, students should be part of the decision to engage their parents/caregivers as caring adults within their circle of care. Consult your mental health leadership team for age-of-consent guidelines that are followed at your board.
Here are some general guidelines to keep in mind when talking with students and parents/caregivers about mental health concerns:
Ideally, trust has been fostered over time through positive and supportive interactions with the student, parents/caregivers, and family. In a conversation about mental health concerns, take the time to establish rapport, showing empathy and creating a supportive and non-judgmental space for the student and parents/caregivers.
- The beginning of the conversation is the right time to explain the limits of confidentiality.
- Then, share explicitly what the school staff has observed. Invite the student and/or parents/caregivers to also share what they are observing about themselves or their child/loved one.
Using strength-based language during the conversation is essential because it shifts the focus from deficits and problems to strengths and abilities, which promotes a supportive and empowering conversation. This approach recognizes that mental health concerns do not define a person and that there are multiple dimensions to every student’s identity, including unique strengths and qualities that can be used to support their mental health and well-being.
Using strength-based language reduces stigma associated with mental health concerns and mental illness by shifting the narrative from labelling and judgment. This is crucial for creating space for open dialogue and supporting further help-seeking. Strength-based language can also foster a sense of hope and optimism and increase a student’s confidence in their ability to navigate the challenges.
Here are some examples of strength-based phrases:
- I appreciate your courage in seeking support and expressing your feelings.
- You possess many talents and strengths that can contribute to your well-being.
- Let’s focus on building on your existing strengths to support your mental health and well-being.
- I believe in your potential to navigate through these challenges.
- You possess a positive attitude and enthusiasm, which are valuable assets in addressing challenges in life.
- It’s evident that you have a strong support system, which is crucial for your mental health and well-being.
Gathering the student’s perspective of their strengths and needs is crucial. Remember that each student has unique ways of feeling supported. Provide space for their understanding and ways of knowing and being. Acknowledge, respect, and value their unique perspectives and experiences from their cultural teachings, lived experiences, and ways of life that shape how an individual understands and interacts with the world.
It is important to acknowledge that some students may be experiencing mental health concerns because of systemic oppression such as racism or discrimination within the school/school system. Work alongside students and their parents/caregivers to swiftly address issues identified as contributing factors. When you expand your thinking and work toward finding broader solutions that address the systemic and oppressive causes of mental health problems in students, you are demonstrating your active commitment to anti-oppressive practice and equity.
Offer a mutually convenient time and place to have the conversation, try to limit the possibility for interruptions and disruptions, and allow sufficient time. Sometimes a break in the conversation is okay, as this is emotional work. Schedule a time to come back together.
How to respond when a parent/caregiver approaches the school about a mental health concern
A parent/caregiver may reach out to the school with concerns about their child’s mental health. Staff members may not have noted any concerns, or they may be able to round out the concerns noted with observations about the student’s behaviour or emotions in the school context.
In the same way that you would validate the student’s concerns, it is helpful to listen carefully and attentively to the worries of parents or caregivers, knowing that they may feel quite anxious about their child’s well-being. A caring, compassionate connection can make all the difference to a family who is facing the challenges and worry of a child or young person’s emerging or escalating mental health problems.
Note that at times, the worry and fear that a parent/caregiver feels may come across as anger or intolerance. Though they may not be at their best, parents/caregivers of children who struggle with their mental health may be walking a difficult path, so it is best to lend calm and grace to the interaction.
When parents/caregivers are considered the main expert and navigator in their child’s mental health care, they are empowered to lead the coordinated treatment planning, with caring support from all partners. In contrast, when students come back to school from hospital or community treatment without this sort of discharge planning and support, continuity of care suffers. Whenever possible, try to set the stage so that parents/caregivers engage with the school and share information to facilitate seamless care across settings. School administrators may want to regularly review and role-play situations with the staff to help team members prepare for unscheduled conversations about mental health concerns and to receive the information in a good way. The WE CARE resource provides guidance to school staff on how to listen, respond, and connect with parents/caregivers when a concern is shared.
Prevention and early intervention services available in Ontario schools
While educators and student support staff provide ongoing support to students in the classroom to assist with learning and wellness, psychotherapeutic prevention and early intervention services are offered within the school setting by regulated mental health professionals, like social workers, psychologists, and psychotherapists.
Knowing the protocols and procedures for accessing mental health supports within your school board is essential to efficiently connect students with mild-to-moderate mental health problems to brief, school-based early interventions.
The Circle of Support and System Pathways Flowchart resources are designed as a guide for staff when they are concerned about a student and wondering if additional mental health support might be required. The text boxes in the worksheet may be populated to include local or specific board information.
Modifications and accommodations to support student mental health
Educators are very familiar with modifying and accommodating in the classroom based on the unique strengths and needs of students. The same approach can be taken when modifications or accommodations are required for mental health problems.
Accommodations can start right away when the educator or other school staff notice that a student may be experiencing a mental health concern – they don’t need to have a diagnosis or be receiving treatment to benefit from more focused support in the classroom. See common student mental health concerns for guidance. As with teaching and learning, what works for one student may not work for another. Mental health needs can also change over time. Be sure to review supports to ensure they’re still effectively supporting the student.
- Know the school mental health professionals who support your school and the services they offer.
- Work with educators to identify students who may benefit from more specialized prevention and early intervention services and students who could benefit from classroom accommodations and modifications as a first step.
- Keep in mind that the services of school mental health professionals are a limited resource and should be maintained for students needing psychotherapy. Those in need of regular connection and support can be served well by student support staff and others in key support roles.
- Build knowledge of common mental health concerns and classroom support strategies.
- Consider ways to build on the student’s strengths and natural coping strategies and supports (e.g., inquire about ways of coping and, if necessary, offer additional skills and strategies; model and support students with steps for problem-solving, decision-making, and conflict resolution).
- Ask the school mental health professional assigned to your school or who is working with the individual student for guidance related to specific support strategies.
- Actively promote mental health and well-being in the school and classroom every day, for all students.
- Consider introducing class activities that help students understand what supports are available in the community. My Circle of Support Pocketbook and No Problem Too Big or Too Small are two options.
- Maintain communication with the student and parent/caregiver to understand evolving needs.
Student mental health concerns and attendance
Some students may miss school because of mental health concerns. This is sometimes called school avoidance. When anxiety is the cause of an absence, best practice is to encourage attendance, even for short periods, every day. Avoiding school only makes it harder to return. Students may also avoid school because a situation at the school is affecting their well-being, such as bullying or experiences of racism. It’s important to pinpoint the reason for avoidance in order to support the student effectively. PPM 169: Student Mental Health outlines requirements for boards to follow regarding mental health absences. If a student is unable to attend school because of a mental health concern, their absence must be excused under s. 21(2)(b) (“by reason of sickness or other unavoidable cause”) of the Education Act. Emphasizing the importance of self-care and prioritizing mental health can allow for more open conversations among students, parents/caregivers, and teachers.
Working with community partners at tier 2
At times, partners like community mental health organizations, youth wellness hubs, public health or cultural/faith groups approach schools and school districts with offers to provide tier 2 prevention and early intervention services.
While additional support may be welcome, alignment with the board mental health and addictions strategy, and relevant partnership protocols, is an important step. This includes consideration of agreements with board employee groups, as well as clarity about which services will be provided within the school setting and who carries responsibility for supervision, record-keeping, communication, etc.
Before entering into arrangements for the provision of prevention and early intervention services with an external partner, like public health or a cultural/faith organization, review PPM 149 and your board’s procedure regarding external partnerships and partnership agreements to ensure that protocols are followed.
Resources to support tier 2 prevention and early intervention
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.
Government of Canada. (2006). The human face of mental health and mental illness in Canada. Minister of Public Works and Government Services Canada.
Ontario College of Teachers (2018). Supporting Students’ Mental Health – Professional Advisory.
Offord Centre for Child Studies at McMaster University. (2019). Ontario Child Health Study.
Family Care Centre. (n.d.). School refusal: Supporting kids who avoid school [Webpage]. Children’s Mental Health Ontario.