My previous MTSS blog detailed the fundamentals of MTSS and the importance of an early warning system. The next step is incorporating mental health intervention to increase access and opportunity as well as bridge gaps.
According to the National Association of School Psychologists (NASP), “Comprehensive mental health services are most effective when provided through a multitiered system of supports (MTSS).” This suggests that schools should be prepared to provide integrated supports addressing the full continuum of student needs. By leveraging their MTSS, a school team can more effectively collaborate with service providers to ensure that those services are contextually appropriate and aligned with the curriculum and available supports.
A Growing Need
Data from the National Alliance on Mental Illness (NAMI) shows that approximately 50% of all lifetime mental illness begins by age 14, and the U.S. Department of Health and Human Services (DHHS) indicates that approximately one in five children and adolescents experience a mental health problem during their school years. Despite this, only half of those aged 6–17 receive treatment for a mental health condition. This data forces us to ask ourselves why we don’t have more options for integrated mental health services since children spend such a large portion of their day in school.
As I mentioned in my previous post on this important topic, positive behavioral supports (PBS) and school mental health traditionally operated separately. The result has been less than optimal, with disorganized delivery of mental health services, lack of depth in Tier II and Tier III, and low community agency involvement in Tier I for PBS. Said another way, schools have been doing the best job they can in teaching fundamentals of social-emotional behavior—in many cases without outside support—and the few interventions that were available either didn’t address the root causes, were siloed, or weren’t directly meeting students’ needs.
These gaps in availability, access, and fidelity require schools and districts to adapt and search for new ways to support students’ social and emotional learning (SEL) and mental health. A recent poll by the American Psychological Association (APA) indicates that almost a third of therapists are seeing more patients. On top of this, a lack of therapists is resulting in longer wait times, fewer choices, and a growing divide in access—and this is especially true in traditionally underserved communities.
Leveraging Alternative Service Delivery Models
Researchers and educators have broadly concluded that there is a significant need for an alternative avenue to provide tiered interventions for mental health and SEL alongside traditional models. While NASP advocates that school psychologists and social workers are ideally suited to provide these services in schools, availability and funding are often tied to special education and other compliance-related activities. I’ll never forget my first interview after grad school when I expressed a desire to have some therapy groups and was politely told, “That’s not what psychs do here.”
While the desire to provide more integrated mental health services still exists today, the reality is that most districts don’t have funding streams to sustainably employ more social workers or psychologists to provide direct mental health services. In some areas, especially rural, schools may be the only local source of mental health support. To bridge this gap and facilitate better partnerships with outside organizations, NASP suggests schools use their professional staff in a collaborative capacity.
Based on NASP’s aforementioned recommendation and similar sentiment from the APA, school psychologists, social workers, and other qualified staff should begin to develop new skills that incorporate emerging models of care. One alternative model specifically noted is telehealth. By embracing the telehealth model to provide teletherapy in coordination with the district’s MTSS, educators can offer more opportunity and access to mental health services for all students.
Utilizing teletherapy allows us to break down the barrier of access for students who may not have reliable transportation or may have to work after school to provide for themselves and their families. Additionally, when we intentionally remove obstacles, we create more opportunities for our students and open the door to those who may have felt stigmatized or those who have never considered mental health intervention services.
What Can Schools Do Right Now?
With the preponderance of ESSER, Title I, Title IV, IDEA, and other funding sources, federal and state governments have given schools and districts an opportunity (some would call it a mandate) to fill gaps that have long been present—as well as those that are emerging in the wake of the pandemic. Teletherapy is one of many alternatives to traditional models and an appropriate way to provide services in support of mental health and SEL.
Schools and districts with a desire to equitably provide opportunity and access to tiered mental health supports should not only investigate teletherapy but should strongly consider it as part of their integrated systems to increase the efficacy of their MTSS. Not only will integrating alternative models result in more depth at the Tier II and Tier III intervention levels, but by including district mental health professionals in the collaboration, coordination, and follow-up, we can develop an optimal, organized delivery of school mental health and positive behavioral supports.
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