Abstract
Mental health problems in school-aged youth are a risk factor for poor outcomes in adulthood. Although these poor outcomes are well established, most youth with mental health problems continue to experience barriers to receiving appropriate services. Tier 2 interventions are sometimes provided to students who are at risk of developing a mental illness. The aim of this scoping review was to synthesize the peer-reviewed research regarding Tier 2 mental health interventions in primary and secondary school settings. A systematic search of published research was conducted in CINAHL, Education Research Complete, Embase, ERIC, Medline, PsycINFO and SocINDEX electronic databases. This scoping review followed a two-level screening process where articles were screened in duplicate by two blinded reviewers. A total of 288 articles were included in this scoping review. Tier 2 mental health interventions in schools have significantly increased since 1965, increasing to about 24 research publications per year. Interventions mainly targeted youth with behavioural problems (51.04%), social difficulties (21.88%), emotional problems (20.49%), and substance abuse (18.06%). Tier 2 interventions were administered by teachers (58.33%) and most often delivered in a group setting (42.01%). This scoping review demonstrated that Tier 2 mental health interventions in schools are gaining prominence in the literature and primarily target children with externalizing behavioural problems. The flexibility of Tier 2 interventions allows them to be implemented in a variety of settings and treat several symptoms making them ideal for broad-based mental health support in schools.
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The data that support the findings of this study are available from the corresponding author under reasonable request.
References
Abel, R. M., & Friedman, H. A. (2009). Israeli school and community response to war Trauma. School Psychology International, 30(3), 265–281. https://doi.org/10.1177/0143034309106493
Anderson, C. M., & Borgmeier, C. (2010). Tier II interventions within the framework of school-wide positive behavior support: Essential Features for design, implementation, and maintenance. Behavior Analysis in Practice, 3(1), 33–45. https://doi.org/10.1007/bf03391756
Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. https://doi.org/10.1080/1364557032000119616
Benner, G. J., Kutash, K., Nelson, J. R., & Fisher, M. B. (2013). Closing the achievement gap of youth with emotional and behavioral disorders through multi-tiered systems of support. Education and Treatment of Children, 36(3), 15–29. https://doi.org/10.1353/etc.2013.0018
Barnett, M. L., Gonzalez, A., Miranda, J., Chavira, D. A., & Lau, A. S. (2018). Mobilizing community health workers to address mental health disparities for underserved populations: A systematic review. Administration and Policy in Mental Health and Mental Health Services Research, 45(2), 195–211. https://doi.org/10.1007/s10488-017-0815-0
Betancourt, T. S., Meyers-Ohki, S. E., Charrow, A. P., & Tol, W. A. (2013). Interventions for children affected by war. Harvard Review of Psychiatry, 21(2), 70–91. https://doi.org/10.1097/hrp.0b013e318283bf8f
Braun, G., Kumm, S., Brown, C., Walte, S., Hughes, M. T., & Maggin, D. M. (2020). Living in Tier 2: Educators’ perceptions of MTSS in urban schools. International Journal of Inclusive Education, 24(10), 1114–1128. https://doi.org/10.1080/13603116.2018.1511758
Breithaupt, L., Eickman, L., Byrne, C. E., & Fischer, S. (2017). REbeL peer education: A model of a voluntary, after-school program for eating disorder prevention. Eating Behaviors, 25, 32–37. https://doi.org/10.1016/j.eatbeh.2016.08.003
Caldwell, D. M., Davies, S. R., Hetrick, S. E., Palmer, J. C., Caro, P., López-López, J. A., Gunnell, D., Kidger, J., Thomas, J., French, C., Stockings, E., Campbell, R., & Welton, N. J. (2019). School-based interventions to prevent anxiety and depression in children and young people: A systematic review and network meta-analysis. The Lancet Psychiatry, 6(12), 1011–1020. https://doi.org/10.1016/s2215-0366(19)30403-1
Caldwell, D. M., Davies, S. R., Thorn, J. C., Palmer, J. C., Caro, P., Hetrick, S. E., Gunnell, D., Anwer, S., López-López, J. A., French, C., Kidger, J., Dawson, S., Churchill, R., Thomas, J., Campbell, R., & Welton, N. J. (2021). School-based interventions to prevent anxiety, depression and conduct disorder in children and young people: A systematic review and network meta-analysis. Public Health Research, 9(8), 1–284. https://doi.org/10.3310/phr09080
Campbell, A., & Anderson, C. M. (2011). Check-in/check-out: A systematic evaluation and component analysis. Journal of Applied Behavior Analysis, 44(2), 315–326. https://doi.org/10.1901/jaba.2011.44-315
Chassin, L., Pitts, S. C., & Prost, J. (2002). Binge drinking trajectories from adolescence to emerging adulthood in a high-risk sample: Predictors and substance abuse outcomes. Journal of Consulting and Clinical Psychology, 70(1), 67–78. https://doi.org/10.1037/0022-006X.70.1.67
Cheney, D., Lynass, L., Flower, A., Waugh, M., Iwaszuk, W., Mielenz, C., & Hawken, L. (2009). The check, connect, and expect program: A targeted, tier 2 intervention in the schoolwide positive behavior support model. Preventing School Failure: Alternative Education for Children and Youth, 54(3), 152–158. https://doi.org/10.1080/10459880903492742
Clifford, M. E., Nguyen, A. J., & Bradshaw, C. P. (2020). Both/and: Tier 2 interventions with transdiagnostic utility in addressing emotional and behavioral disorders in youth. Journal of Applied School Psychology, 36(2), 173–197. https://doi.org/10.1080/15377903.2020.1714859
Covidence Systematic Review Software. In. (2017). [Computer Software]. Veritas Health Innovation.
Dalle Grave, R. (2003). School-based prevention programs for eating disorders: Achievements and opportunities. Disease Management and Health Outcomes, 11(9), 579–593. https://doi.org/10.2165/00115677-200311090-00006
Eagle, J. W., Dowd-Eagle, S. E., Snyder, A., & Holtzman, E. G. (2015). Implementing a multi-tiered system of support (MTSS): Collaboration between school psychologists and administrators to promote systems-level change. Journal of Educational and Psychological Consultation, 25(2–3), 160–177. https://doi.org/10.1080/10474412.2014.929960
Erskine, H. E., Baxter, A. J., Patton, G., Moffitt, T. E., Patel, V., Whiteford, H. A., & Scott, J. G. (2017). The global coverage of prevalence data for mental disorders in children and adolescents. Epidemiology and Psychiatric Sciences, 26(4), 395–402. https://doi.org/10.1017/s2045796015001158
Farmer, E. M. Z., Burns, B. J., Phillips, S. D., Angold, A., & Costello, E. J. (2003). Pathways into and through mental health services for children and adolescents. Psychiatric Services, 54(1), 60–66. https://doi.org/10.1176/appi.ps.54.1.60
Fazel, M., Hoagwood, K., Stephan, S., & Ford, T. (2014). Mental health interventions in schools in high-income countries. The Lancet Psychiatry, 1(5), 377–387. https://doi.org/10.1016/s2215-0366(14)70312-8
Feiss, R., Dolinger, S. B., Merritt, M., Reiche, E., Martin, K., Yanes, J. A., Thomas, C. M., & Pangelinan, M. (2019). A systematic review and meta-analysis of school-based stress, anxiety, and depression prevention programs for adolescents. Journal of Youth and Adolescence, 48(9), 1668–1685. https://doi.org/10.1007/s10964-019-01085-0
Flay, B. R. (2009). The promise of long-term effectiveness of school-based smoking prevention programs: A critical review of reviews. Tobacco Induced Diseases, 5(1), 7. https://doi.org/10.1186/1617-9625-5-7
Goodman, R. (1997). The strengths and difficulties questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38(5), 581–586. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x
Greenfield, R., Rinaldi, C., Proctor, C. P., & Cardarelli, A. (2010). Teachers’ perceptions of a response to intervention (RTI) reform effort in an urban elementary school: A consensual qualitative analysis. Journal of Disability Policy Studies, 21(1), 47–63. https://doi.org/10.1177/1044207310365499
Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: A systematic review. BMC Psychiatry, 10(1), 113. https://doi.org/10.1186/1471-244x-10-113
Hansen, B., Wills, H., & Kamps, D. (2014). Effects of aligning self-management interventions with functional behavioral assessment. Education and Treatment of Children, 37, 393–406. https://doi.org/10.1353/etc.2014.0027
Harlacher, J., Sakelaris, T., Kattelman, N. (2014). Multi-Tiered System of Support. In: Practitioner’s Guide to Curriculum-Based Evaluation in Reading. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9360-0_3.
Harowski, K., Turner, A. L., LeVine, E., Schank, J. A., & Leichter, J. (2006). From our community to yours: Rural best perspectives on psychology practice, training, and advocacy. Professional Psychology: Research and Practice, 37(2), 158–164. https://doi.org/10.1037/0735-7028.37.2.158
Hartley, D. (2004). Rural health disparities, population health, and rural culture. American Journal of Public Health, 94(10), 1675–1678. https://doi.org/10.2105/ajph.94.10.1675
Hawken, L. (2006). School psychologists as leaders in the implementation of a targeted intervention: The behavior education program. School Psychology Quarterly, 21, 91–111.
Hawken, L. S., Sandra Macleod, K., & Rawlings, L. (2007). Effects of the behavior education program (BEP) on office discipline referrals of elementary school students. Journal of Positive Behavior Interventions, 9(2), 94–101. https://doi.org/10.1177/10983007070090020601
Hawken, L. S., Adolphson, S. L., MacLeod, K. S., & Schumann, J. (2009). Secondary-tier interventions and supports. In Sailor, W., Dunlop, G., Sugai, G., & Horner, R. (Eds.), Handbook of positive behavior support (pp. 395–420). Springer Publishing Company. https://doi.org/10.1007/978-0-387-09632-2_17.
Hickie, I. B., Scott, E. M., Hermens, D. F., Naismith, S. L., Guastella, A. J., Kaur, M., Sidis, A., Whitwell, B., Glozier, N., Davenport, T., Pantelis, C., Wood, S. J., & McGorry, P. D. (2013). Applying clinical staging to young people who present for mental health care. Early Intervention in Psychiatry, 7(1), 31–43. https://doi.org/10.1111/j.1751-7893.2012.00366.x
Hoagwood, K., & Johnson, J. (2003). School psychology: A public health framework. Journal of School Psychology, 41(1), 3–21. https://doi.org/10.1016/s0022-4405(02)00141-3
Iizuka, C. A., Barrett, P., Gillies, R., Cook, C., & Marinovic, W. (2015). Preliminary evaluation of the FRIENDS for life program on students’ and teachers’ emotional states for a school in a low socio-economic status area. Australian Journal of Teacher Education. https://doi.org/10.14221/ajte.2014v40n3.1
Johnson, C., Burke, C., Brinkman, S., & Wade, T. (2016). Effectiveness of a school-based mindfulness program for transdiagnostic prevention in young adolescents. Behaviour Research and Therapy, 81, 1–11. https://doi.org/10.1016/j.brat.2016.03.002
Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21(3), 169–184. https://doi.org/10.1002/mpr.1359
King, T., & Fazel, M. (2021). Examining the mental health outcomes of school-based peer-led interventions on young people: A scoping review of range and a systematic review of effectiveness. PLoS ONE, 16(4), e0249553. https://doi.org/10.1371/journal.pone.0249553
Kirkham, J. J., Dwan, K. M., Altman, D. G., Gamble, C., Dodd, S., Smyth, R., & Williamson, P. R. (2010). The impact of outcome reporting bias in randomised controlled trials on a cohort of systematic reviews. BMJ (Clinical Research Ed.), 340, c365. https://doi.org/10.1136/bmj.c365
Levac, D., Colquhoun, H., & O’Brien, K. K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5(1), 69. https://doi.org/10.1186/1748-5908-5-69
Levitt, J. M., Saka, N., Hunter Romanelli, L., & Hoagwood, K. (2007). Early identification of mental health problems in schools: The status of instrumentation. Journal of School Psychology, 45(2), 163–191. https://doi.org/10.1016/j.jsp.2006.11.005
Lewis, T. J., McIntosh, K., Simonsen, B., Mitchell, B. S., & Hatton, H. L. (2017). Schoolwide systems of positive behavior support: Implications for students at risk and with emotional/behavioral disorders. AERA Open, 3(2), 233285841771142. https://doi.org/10.1177/2332858417711428
Lochman, J. E., Curry, J. F., Dane, H., & Ellis, M. (2001). The anger coping program: An empirically-supported treatment for aggressive children. Residential Treatment for Children & Youth, 18(3), 63–73. https://doi.org/10.1300/j007v18n03_06
Maggin, D. M., Zurheide, J., Pickett, K. C., & Baillie, S. J. (2015). A systematic evidence review of the check-in/check-out program for reducing student challenging behaviors. Journal of Positive Behavior Interventions, 17(4), 197–208. https://doi.org/10.1177/1098300715573630
Martinsen, K. D., Rasmussen, L., Wentzel-Larsen, T., Holen, S., Sund, A. M., Løvaas, M., Patras, J., Kendall, P. C., Waaktaar, T., & Neumer, S. P. (2019). Prevention of anxiety and depression in school children: Effectiveness of the transdiagnostic EMOTION program. Journal of Consulting and Clinical Psychology, 87(2), 212–219. https://doi.org/10.1037/ccp0000360
McDaniel, S. C., Bruhn, A. L., & Mitchell, B. S. (2017). A responsive tier 2 process for a middle school student with behavior problems. Preventing School Failure: Alternative Education for Children and Youth, 61(4), 280–288. https://doi.org/10.1080/1045988x.2016.1275503
McGorry, P. D., & Mei, C. (2018). Early intervention in youth mental health: Progress and future directions. Evidence Based Mental Health, 21(4), 182–184. https://doi.org/10.1136/ebmental-2018-300060
Mersky, J. P., Topitzes, J., & Reynolds, A. J. (2013). Impacts of adverse childhood experiences on health, mental health, and substance use in early adulthood: A cohort study of an urban, minority sample in the U.S. Child Abuse & Neglect, 37(11), 917–925. https://doi.org/10.1016/j.chiabu.2013.07.011
Mitchell, B. S., Stormont, M., & Gage, N. A. (2011). Tier Two interventions implemented within the context of a tiered prevention framework. Behavioral Disorders, 36(4), 241–261. https://doi.org/10.1177/019874291103600404
Morales, D. A., Barksdale, C. L., & Beckel-Mitchener, A. C. (2020). A call to action to address rural mental health disparities. Journal of Clinical and Translational Science, 4(5), 463–467. https://doi.org/10.1017/cts.2020.42
Mazzer, K. R., & Rickwood, D. J. (2015). Teachers’ role breadth and perceived efficacy in supporting student mental health. Advances in School Mental Health Promotion, 8(1), 29–41. https://doi.org/10.1080/1754730x.2014.978119
National Research Council (US) and Institute of Medicine (US) Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions; O'Connell ME, Boat T, Warner KE, editors. Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Washington (DC): National Academies Press (US); 2009. Available from: https://www.ncbi.nlm.nih.gov/books/NBK32775/ doi: https://doi.org/10.17226/12480.
Newton, N. C., Teesson, M., Mather, M., Champion, K. E., Barrett, E. L., Stapinski, L., Carragher, N., Kelly, E., Conrod, P. J., & Slade, T. (2018). Universal cannabis outcomes from the Climate and Preventure (CAP) study: A cluster randomised controlled trial. Substance Abuse Treatment, Prevention, and Policy. https://doi.org/10.1186/s13011-018-0171-4
Peters, M., Marnie, C., Tricco, A. C., Pollock, D., Munn, Z., Alexander, L., McInerney, P., Godfrey, C. M., & Khalil, H. (2020). Updated methodological guidance for the conduct of scoping reviews. JBI Evidence Synthesis, 18(10), 2119–2126. https://doi.org/10.11124/JBIES-20-00167
Reinke, W. M., Herman, K. C., & Stormont, M. (2013). Classroom-level positive behavior supports in schools implementing SW-PBIS. Journal of Positive Behavior Interventions, 15(1), 39–50. https://doi.org/10.1177/1098300712459079
Reiss, F., Meyrose, A. K., Otto, C., Lampert, T., Klasen, F., & Ravens-Sieberer, U. (2019). Socioeconomic status, stressful life situations and mental health problems in children and adolescents: Results of the German BELLA cohort-study. PLoS ONE, 14(3), e0213700. https://doi.org/10.1371/journal.pone.0213700
Rodriguez, B. J., Loman, S. L., & Borgmeier, C. (2016). Tier 2 interventions in positive behavior support: A survey of school implementation. Preventing School Failure: Alternative Education for Children and Youth, 60(2), 94–105. https://doi.org/10.1080/1045988x.2015.1025354
Schumaker, J. B., Hovell, M. F., & Sherman, J. A. (1977). An analysis of daily report cards and parent-managed privileges in the improvement of adolescents’ classroom performance. Journal of Applied Behavior Analysis, 10(3), 449–464. https://doi.org/10.1901/jaba.1977.10-449
Schmitz, S. L., Clopton, K. L., Skaar, N. R., Dredge, S., & Vanhorn, D. (2022). Increasing school-based mental health services with a “grow your own” school psychology program. Contemporary School Psychology. https://doi.org/10.1007/s40688-020-00348-z
Silverman, W. K., Ortiz, C. D., Viswesvaran, C., Burns, B. J., Kolko, D. J., Putnam, F. W., & Amaya-Jackson, L. (2008). Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events. Journal of Clinical Child & Adolescent Psychology, 37(1), 156–183. https://doi.org/10.1080/15374410701818293
Skinner, J. N., Veerkamp, M. B., Kamps, D. M., & Andra, P. R. (2009). Teacher and peer participation in functional analysis and intervention for a first grade student with attention deficit hyperactivity disorder. Education and Treatment of Children, 32(2), 243–266.
Sloboda, Z., Stephens, R. C., Stephens, P. C., Grey, S. F., Teasdale, B., Hawthorne, R. D., Williams, J., & Marquette, J. F. (2009). The adolescent substance abuse prevention study: A randomized field trial of a universal substance abuse prevention program. Drug and Alcohol Dependence, 102(1–3), 1–10. https://doi.org/10.1016/j.drugalcdep.2009.01.015
Smalley, K. B., Yancey, C. T., Warren, J. C., Naufel, K., Ryan, R., & Pugh, J. L. (2010). Rural mental health and psychological treatment: A review for practitioners. Journal of Clinical Psychology, 66(5), 479–489. https://doi.org/10.1002/jclp.20688
Snyder, M. (2015). Changing the tide. NASN School Nurse, 30(2), 130–132. https://doi.org/10.1177/1942602x14553307
Stormshak, E. A., & Dishion, T. J. (2009). A school-based, family-centered intervention to prevent substance use: The family check-up. The American Journal of Drug and Alcohol Abuse, 35(4), 227–232. https://doi.org/10.1080/00952990903005908
Sugai, G., & Horner, R. H. (2009). Responsiveness-to-intervention and school-wide positive behavior supports: Integration of multi-tiered system approaches. Exceptionality, 17(4), 223–237. https://doi.org/10.1080/09362830903235375
Torstveit, M. K., Aagedal-Mortensen, K., & Stea, T. H. (2015). More than half of high school students report disordered eating: A cross sectional study among norwegian boys and girls. PLoS ONE, 10(3), e0122681. https://doi.org/10.1371/journal.pone.0122681
Tricco, A. C., Lillie, E., Zarin, W., O’Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., Hempel, S., Akl, E. A., Chang, C., McGowan, J., Stewart, L., Hartling, L., Aldcroft, A., Wilson, M. G., Garritty, C., … Straus, S. E. (2018). PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Annals of Internal Medicine, 169(7), 467–473. https://doi.org/10.7326/M18-0850
Walker, H. M., Severson, H. H., Todis, B. J., Block-Pedego, A. E., Williams, G. J., Haring, N. G., & Barckley, M. (1990). Systematic screening for behavior disorders (SSBD): Further validation, replication, and normative data. Remedial and Special Education, 11, 32–46.
Werner-Seidler, A., Perry, Y., Calear, A. L., Newby, J. M., & Christensen, H. (2017). School-based depression and anxiety prevention programs for young people: A systematic review and meta-analysis. Clinical Psychology Review, 51, 30–47. https://doi.org/10.1016/j.cpr.2016.10.005
Wilson, S. J., & Lipsey, M. W. (2007). School-based interventions for aggressive and disruptive behavior. American Journal of Preventive Medicine, 33(2), S130–S143. https://doi.org/10.1016/j.amepre.2007.04.011
Woicik, P. A., Stewart, S. H., Pihl, R. O., & Conrod, P. J. (2009). The substance use risk profile scale: A scale measuring traits linked to reinforcement-specific substance use profiles. Addictive Behaviors, 34(12), 1042–1055. https://doi.org/10.1016/j.addbeh.2009.07.001
Wolfe, K., Pyle, D., Charlton, C. T., Sabey, C. V., Lund, E. M., & Ross, S. W. (2016). A systematic review of the empirical support for check-in check-out. Journal of Positive Behavior Interventions, 18(2), 74–88. https://doi.org/10.1177/1098300715595957
Acknowledgements
The authors would like to thank both Tom Lange for his help with creating the search strategy and Nicole Dunnewold, a librarian at the University of Calgary Health Sciences Library that confirmed the search strategy.
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Funding was provided by the Alberta Innovates Translational Health Chair in Child and Youth Mental Health.
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P. T., D. D. and P. A. contributed to the overall study concept and design. T. L. and P. T. ran the search strategy in relevant databases. Article screening was completed by P. T., S. W., S. F. and O. A. Data extraction was performed by P. T., S. W. and S. F. The first draft of the manuscript was written by P. T. All authors read, commented on and approved the final manuscript.
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Townes, P., Weiss, S., Devoe, D. et al. Tier 2 Mental Health Interventions in Primary and Secondary Schools: A Scoping Review. School Mental Health 15, 36–48 (2023). https://doi.org/10.1007/s12310-022-09554-x
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DOI: https://doi.org/10.1007/s12310-022-09554-x