ABSTRACT Research supports the use of multi‐tiered systems of support (MTSS) for meeting student academic, behavioral, and socioemotional needs. MTSS is viewed as an ideal model to deliver school‐based mental health (SBMH) services to students. However, limited research has examined what this framework for service delivery looks like in practice. Utilizing a national participant sample and a mixed‐methods convergent (quan + QUAL) design, the purpose of this study is to examine participant use of MTSS for SBMH and to examine practitioners' perspectives on the implementation of Tier 2 and 3 services. Respondents in our current sample indicated a level of uncertainty regarding the identification of students for SBMH services and the delivery of Tier 2 and Tier 3 services, particularly as this relates to special education. Additionally, respondents indicated “insufficient” supports for the provision of Tier 3 services. Limitations, implications for practice, and future directions are discussed.

Although care coordination (CC; i.e., the organization of care activities between professionals to facilitate appropriate service delivery; McDonald et al., 2007) has yet to be studied extensively within schools, preliminary research suggests coordinating school mental health supports can be beneficial (Francis et al., 2021) and that interprofessional and interagency collaboration is warranted to meet student needs (McClain et al., 2022). We examined the perceptions of school mental health providers (SMHPs) regarding importance, quality, and engagement with within-district transition CC practices within a multitiered system of support framework. Participants were 163 SMHPs who endorsed being involved in designing, providing, or implementing mental health services in a U.S. school district. The three scales used to measure engagement with CC practices were based on the Care Coordination Measures Atlas (McDonald et al., 2014) and were found to have promising preliminary psychometrics. Descriptive statistics indicated SMHPs endorsed CC as very important but perceived school and district personnel to view it as less important, reported their own quality of CC was slightly above that of their school and district, and regularly engaged in broad CC practices. Moreover, bivariate correlations indicated SMHP's personal views of CC importance were not associated with the quality of school and district CC, yet engagement in broad CC activities was associated with transition facilitation practices, and attitudes about CC were associated with engagement in broad CC activities. Implications of findings are discussed.

The use of self-report measures evaluating social, emotional, and behavioral risk can be an important element of universal screening with older children and adolescents. Research has demonstrated discrepancies between teacher ratings and student self-report ratings of social, emotional, and behavioral risk, which commonly result in incongruent risk classifications. The present study explored classification incongruence and informant discrepancies on the teacher- and student self-report versions of the Social, Academic, and Emotional Behavior Risk Screener. Screening data from over 600 high school students and their homeroom teachers were examined. Results showed classification congruence was highest for the Social Behavior subscale and lowest for the Emotional Behavior subscale of the Social, Academic, and Emotional Behavior Risk Screener, with teachers endorsing lower levels of risk compared to students. Analysis of potential sociodemographic predictors of informant discrepancies indicated that grade, sex, free and reduced-price lunch eligibility, 504 plan status, and special education status were significant predictors of classification incongruence on at least one Social, Academic, and Emotional Behavior Risk Screener subscale. Implications for practice and limitations are discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

While there is evidence suggesting school-based transitions impact student mental health and academics (Lester et al., 2013), it is unknown how these transitions specifically impact the domains of social, academic, and emotional behavior, as measured via the Social, Academic, and Emotional Behavior Risk Screener (SAEBRS). The purpose of this study was to explore the relationship between school-based transitions and teacher ratings of student SAEBRS scores in a midsize, suburban school district. Using paired t-tests and McNemar's test we examined changes in SAEBRS scores and benchmark risk levels across grade level changes and school-based transitions. SAEBRS scores decreased significantly from 8th to 9th grade (school-based transition) in the total, academic, and emotional subscales, although risk level did not increase significantly during this transition. In contrast, SAEBRS scores increased significantly in each subscale as students transitioned from 7th to 8th grade (no school-based transition). Implications for research and school psychology are discussed. IMPACT STATEMENT Findings from this study confirm students transitioning to high school experience academic and emotional behavior risk, as observed by teachers. In contrast, students transitioning from the middle grade in their school to the top grade (e.g., 7th to 8th grade) experienced improvement in social, academic, and emotional behavior. Therefore, school psychologists can focus school-based mental health efforts on equipping students with the socioemotional skills and academic enablers to cope prior to the transition to high school.

As students present to school with mental health needs, the role of schools has evolved to include the provision of school-based mental health services delivered across a continuum or multitiered system of supports. Within this framework of services, students can receive intensive mental health services at the Tier 3 level. School-based mental health systems must consider best practices in related fields to ensure schools are well equipped to handle intensive student mental health needs. This exploratory study used a national sample and employed a convergent QUAN+ qual design to explore professional perceptions that were associated with school mental health providers’ likelihood of having a proactive plan of care for students in need of mental health supports who are transitioning schools. Quantitative results suggested having sufficient Tier 3 services and sufficient resources (e.g., personnel and time) were associated with school mental health providers using a proactive plan of care. Qualitative results supported this finding and further highlighted potential barriers to school mental health providers’ buy in. Additional considerations for facilitating the use of a proactive plan of care in schools and implications for practice are provided. Limitations and future directions are discussed.

Mental health services are increasingly being delivered within schools via a multi-tiered system of supports. Although care coordination, or the deliberate organization of activities and personnel required to facilitate care, is viewed as an imperative for meeting student needs in school, there is a paucity of research on practices for coordinating mental health care for students receiving intensive, Tier 3 services. With a national participant sample from the United States and a convergent mixed methods design, the purpose of the present study was to explore the nature of care coordination practices implemented by school mental health providers for students with intensive mental health needs. Through both survey (N = 163) and interview (N = 13) responses, school mental health providers indicated mental health care coordination practices are not systematized and follow informal, provider-initiated procedures. However, providers endorsed engaging in more than one type of care coordination practice at a time and highlighted the importance of communication practices for coordinating mental health care. We detail the prevalence and associations among reported engagement with (a) broad care coordination, (b) communication, (c) transition facilitation, and (d) information sharing practices, and describe subthemes for the qualitative theme: School transition planning for students with mental health needs is currently patchwork and requires effective collaboration. We discuss limitations, implications for practice, and future directions.

Research has consistently demonstrated the benefits of school mental health (SMH) services on the well-being of students. Administrators play an important role in the implementation and sustainability of SMH services within a school. However, school principals’ perspectives regarding their role in SMH implementation are underrepresented in research examining the implementation of SMH services. The present study utilized a semi-structured interview format to examine principals’ perceptions of their role regarding the implementation of SMH services in one Midwestern state. Four themes developed: (1) principals perceive SMH services to be beneficial due to increasing mental health needs; (2) principal involvement in SMH implementation varies; (3) critical staff promote SMH; and (4) systemic complexities exist related to SMH implementation and sustainability. Implications for practice, future research, and limitations are discussed.

Limited research has examined the impact of Bounce Back (BB), a trauma-focused intervention for elementary-age students, on student academic engagement and daily classroom behavior. This study utilized both ongoing direct and indirect measures of student functioning to evaluate student progress and inform the implementation of BB. Participants were six U.S. students (four male and two female). We employed an AB single-subject design across cases with follow-up, and we collected data via the Direct Behavior Rating–Single Item Scale (DBR-SIS). We also employed a quasi-experimental pretest–posttest design using the Strengths and Difficulties Questionnaire (SDQ), Social, Academic, and Emotional Behavior Risk Screener (SAEBRS), and mySAEBRS across raters before/after intervention implementation. We found either direct or indirect assessment could be used to monitor intervention effectiveness for youth who presented with some internalizing and externalizing problems, whereas indirect measures (i.e., rating scales) showed the primary effect for youth with solely internalizing problems, and direct assessment (i.e., DBR-SIS) showed the primary effect for youth with predominantly externalizing behaviors. Selecting progress-monitoring tools based on presenting concerns is important to adequately monitor the effectiveness of school-based mental health interventions. Implications for practice are discussed.

More than 14 million children in the United States are identified as children with special healthcare needs (CSHCN). Rates of hospitalization for CSHCN with chronic conditions as well as re-admissions have been increasing in recent years. For hospitalized children transitioning back to their school of record, a host of issues may arise such as socioemotional concerns, peer rejection, and being behind in academics. Hospital-based school programs (HBSPs) play an important role in the transition back to a child’s school of record. Utilizing a database of inpatient CSHCN at a midwestern children’s hospital’s HBSP, private and public-school educators associated with the previously hospitalized CSHCN were asked to complete an online survey to gather their perspectives related to the child’s transition back to the school of record upon hospital discharge. Overall, educators’ perspectives of the HBSP were positive while perceptions related to communication provided by the HBSP were mixed. Educators surveyed reported a lack of training related to working with CSHCN. Finally, accommodations and services offered to students upon return to school focused mostly on academic performance and attendance. Study limitations and implications for practice in schools are discussed.

We examined differences in knowledge, attitudes, and practices related to student trauma and trauma-informed practices among various educators and certified staff members in a United States, Midwestern school district. We examined three research questions: 1.) Are there significant differences in knowledge, attitudes, and practices among teachers with differing years' experience? 2.) Are there significant differences in knowledge, attitudes, and practices among primary and secondary educators and staff? 3.) Are there significant differences in knowledge, attitudes, and practices among educators and staff who have participated in professional development (PD) regarding student trauma, and those who have not? We utilized a revised version of the Knowledge, Attitudes, and Practices (KAP) survey (Law, 2019) focused on student trauma. The KAP survey was sent via email to all certified staff members in the school district. No significant differences were found among knowledge and attitudes; however, primary school educators implemented significantly more trauma-informed practices compared to secondary educators. Additionally, educators with PD implemented significantly more trauma-informed practices compared to those without PD. Findings revealed our staff members had similar levels of knowledge and attitudes, though practices differed depending on years' experience, PD, and grades taught. Implications for future research relating to student trauma and the research-to- practice gap are discussed.

Universal screening for social, emotional, and behavioral risk is an important method for identifying students in need of additional or targeted support (Eklund and Dowdy in School Mental Health 6:40–49, 2014). Research is needed to explore how potential bias may be implicated in universal screening. We investigated student demographics as predictors of being placed at risk via a teacher-report measure: the Social, Academic, and Emotional Behavior Risk Screener as reported by Kilgus et al. (in: Theodore J. Christ et al. (eds) Social, academic, and emotional behavior risk screener (SAEBRS), 2014). Results indicated student demographics, including sex, special education status, free/reduced price lunch status, and identification as a student of color, were statistically significant predictors across multiple SAEBRS risk placements. The predictive power of student demographics was meaningful when evaluated independently (i.e., when each characteristic was considered separately with each risk placement) as well as when evaluated relatively or dependently (i.e., when all characteristics were taken together as a set to predict each risk placement). We discuss findings in the context of implications for implementation of universal behavioral screening amidst potential bias and serving students with identified levels of social, emotional, and behavioral risk.

Schools have become primary providers of mental health services for children and adolescents (Kern et al. in School Mental Health 9:205–217, 2017). Within schools, school principals play a significant role in the implementation of school-based mental health (SBMH; Langley et al. in School Mental Health 2:105–113, 2010). This multimethod study aimed to investigate school principals’ perceptions of SBMH, specifically in how they view SBMH and what barriers and facilitators they identify to successful implementation. School principals from 244 public schools in the United States completed a survey, and 19 principals also participated in semi-structured interviews. Data from a quantitative measure based on Normalization Process Theory (NPT; Finch et al. in BMC Med Res Methodol 18(1):1–13, 2018) indicated that while principals strongly believe SBMH will become a normal part of their work in the future, their responses to whether they are familiar with SBMH and see it as a normal part of the current work were less robust. Results from a framework analysis of the qualitative results identified barriers and facilitators to the implementation of SBMH within and outside of schools, thus aligning with implementation science frameworks such as the Exploration, Preparation, Implementation, and Sustainment (EPIS; Moullin et al. in Implement Sci 14:1–1, 10.1186/s13012-018-0842-6, 2019) framework. The findings may inform SBMH policy in light of the increasing number of children and adolescents with mental health needs (Hoover and Bostic in Psychiatr Serv 72(1):37–48, 2021).

Despite the widespread use of school-based universal screening systems for social, emotional, and behavioral risk, limited research has examined discrepancies in ratings provided by teachers and their secondary students. Using the Social, Academic, and Emotional Behavior Risk Screener (SAEBRS; teacher report) and mySAEBRS (student report) scores from a middle school sample, we examined the magnitudes and prevalence of informant discrepancies as well as associated student and teacher factors. Analyses revealed discrepancies consistently in the direction of teachers reporting lower levels of risk than students and were starkest for the Emotional Behavior Risk subscale. Across subscales, multiple student and teacher factors significantly predicted variance in discrepancies. We discuss these findings in the context of implications for selecting screening informants at the secondary level and opportunities to advance practical guidance in this area.Impact StatementMiddle school students and their teachers provide discrepant ratings within universal screenings of students' social, emotional, and behavioral risk. In this sample, students self-reported higher levels of risk than their teachers reported for them. This was especially true for risk in the Emotional Behavior domain and for students and teachers with certain demographic characteristics.

When teachers care for children with trauma histories, they are at risk of developing compassion fatigue (CF), or a reduced empathic capacity (Hupe and Stevenson in J Child Custody Res Issues Pract 16(4):364-386, 2019. https://doi. org/10.1080/15379418.2019.1663334). They may also develop secondary traumatic stress (STS), a secondary condition resulting from a person learning about details of a traumatic event experienced by someone in their care (Essary et al. in Kappa Delta Pi Record 56(3):116-121, 2020). While CF and STS have been studied widely in healthcare and mental health professionals (Baird and Kracen in Couns Psychol Q 19(2):181-188, 2006; Caringi et al. in Adv Sch Ment Health Promot 8(4):244-256, 2015. https://doi.org/10.1080/1754730X.2015.1080123; Cieslak et al. in Psychol Serv 11(1):75-86, 2014), STS and CF have been understudied in the teaching profession (Caringi et al., 2015; Christian-Brandt et al. in Child Abuse Neglect 110(3):104437, 2020; Hupe & Stevenson, 2019). As such, we sought to complete a systematic review of the literature to answer two questions: (1) To what extent are CF and STS being studied in teachers?; and (2) How have CF and STS been studied in teachers? Qualitative data analysis led to the emergence of four themes across all included studies: (1) conceptualization of CF and STS; (2) teachers are at risk of developing CF and STS; (3) varying approaches can mitigate the risk of CF and STS in teachers; and (4) there is limited research on CF and STS in teachers. Limitations and directions for future research and practice are described.

During the early years of formal education, young students develop a number of formative academic, motor, behavioral, and socioemotional skills that lay the foundation for future learning. Since student mental health in the early grades predicts academic achievement in later grades, mental health interventions are essential at the primary school level. Not only are teachers expected to provide academic instruction, they are now involved in providing students with mental health services, despite a lack of training to do so. The current study sought to gather the perspectives of 38 primary-level educators to gain understanding about mental health knowledge, current approaches to mitigating mental health challenges, and barriers that prevent them from successfully addressing student mental health issues. Using thematic analysis, three themes developed: (1) Educators indicate supporting primary students' mental health is within their role; (2) Systems-level constraints prevent effective mental health supports; and (3) Staff desire increased mental health resources. Implications for educators and practice are discussed.

The National Child Traumatic Stress Network has applied a trauma-informed (TI) lens to a multi-tiered systems of support framework, referred to as TI-MTSS. The NCTSN presents 10 Core Area guidelines to guide school personnel toward the implementation of TI-MTSS. The purpose of this paper is to connect the training and expertise of school psychologists to a rationale that school psychologists are ideally positioned to lead the efforts of TI-MTSS in schools. Framed in the 10 Core Area guidelines provided by the National Child Ttraumatic Stress Network, we operationalize the school psychologist's role and skills within each of the 10 Core Area domains.