Think in tiers and focus on the positive
Thinking in tiers is common in education and is useful in school mental health. It can help to build understanding of the continuum of supports available, clarify the roles of various staff in supporting student mental health, and support the design and monitoring of services at the school and system level.
Educators and school staff are well-positioned to contribute to positive mental health for every student and to assist with early identification and ongoing daily support for those who struggle.
Honing school staff’s skills related to upstream mental health promotion and prevention in schools allows for meaningfully contributions while working within professional boundaries. The Aligned and Integrated Model (AIM), which outlines a multi-tiered system of support for Ontario schools, emphasizes that most of the work of schools is, or should be, focused on tier 1 (mental health promotion) and tier 2 (prevention) services.
The Aligned and Integrated Model or AIM is a triangle with three equal sides that shows the three levels of student mental health support in Ontario. The bottom of the triangle is the Foundation and includes school and classroom leadership. It’s divided into the following five sections:
Welcome – school and classroom physical environments
Include – student engagement and belonging
Understand – Mental health literacy and knowing your students
Promote – Curriculum, teaching and learning
Partner – Home, school, community partnerships
The second level is Notice and represents early identification. It’s divided into the following three segments:
Prevent – Provide early intervention services
Support – Offer ongoing classroom support
Bolster – Build skills and resiliency
The third level is the top of the triangle. It is Bridge and represents mobilizing board and community supports. It includes one segment:
Intervene – Assessment and treatment services The words equity, engagement and evidence appear around the graphic.
This model helps to organize mental health promotion efforts offered in a universal way for all students (Tier 1), services for students who may be at risk and needing a “higher dose” of targeted skill development (Tier 2) and supports for students who have a diagnosable mental health problem who need treatment and ongoing care (Tier 3).
The first level – tier 1 – is good for all – Tier 1 is the foundational everyday work school staff do to welcome and include students, to understand them and build knowledge of mental health, to promote mentally healthy habits and to partner with parents, students and other staff to create a supportive environment. Most of the mental health work in schools is at this level.
The second level – tier 2 – is necessary for some – Tier 2 focuses on prevention and early intervention. In every class and school, there will be some students who may need additional support in the classroom. Educators and school staff can help by reinforcing skills and working to remove barriers to learning. School mental health professionals and others with specialized skills provide intervention services, like structured psychotherapy, at this level.
The third level – tier 3 – is essential for few. Tier 3 services support students requiring more intensive assessment and intervention services. Although it will always be necessary for schools to provide some level of tier 3 service (because students cannot or will not access outside supports, and to manage crisis events as they arise), the role of school staff is to help students to access appropriate community or health services and to provide needed ongoing care while students are at school.
Overall, schools are uniquely positioned for mental health promotion, early identification, prevention, and early intervention services. All school staff work in partnership with community and health partners, as part of the system of care.
While educators and school staff have a supportive role to play in crisis management and can provide accommodations and classroom strategies for students struggling with a mental illness, these folks do not have responsibility for intensive mental health services.
Hoover, S., Lever, N., Sachdev, N., Bravo, N., Schlitt, J., Acosta Price, O., Sheriff, L. & Cashman, J. (2019). Advancing Comprehensive School Mental Health: Guidance From the Field. Baltimore, MD: National Center for School Mental Health. University of Maryland School of Medicine. https://www.schoolmentalhealth.org/Resources/Foundations-of-School-Mental-Health/Advancing-Comprehensive-School-Mental-Health-Systems/
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
Stroul ,B. A., Blau, G. M., & Larson, J. (2021). The evolution of the system of care approach. The Institute for Innovation and Implementation, University of Maryland School of Social Work.
Clarke, A., Sorgenfrei, M., Mulcahy, J., Davie, P., Friedrich, C. & McBride, T. (2021). Adolescent mental health: A systematic review on the effectiveness of school-based interventions. Early Intervention Foundation. https://www.eif.org.uk/report/adolescent-mental-health-a-systematic-review-on-the-effectiveness-of-school-based-interventions
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