Shanna (eight) has always been a sensitive child. She feels nervous about many things, and these feelings have only increased during the pandemic. It is becoming increasingly difficult for her caregiver to get her to school in the mornings.
Yasmin (11) has struggled with her adjustment to Canada and gets frustrated that school is so difficult when she was a strong student in her home country. Her worries about her family that are still back at home can feel overwhelming, and often distract her from her classes.
Jesse (14) is finding it really difficult to navigate their queer identity in different spaces, including different levels of acceptance at the home of each of their parents. They are feeling increasingly isolated and have thoughts of harming themselves.
What do these seemingly diverse students have in common? They have different strengths and different challenges, but are all struggling with the everyday expectations placed on them, including at school. Further, they could all benefit from opportunities to improve their mental health. For many students, mental health can be promoted through creating welcoming environments and teaching skills such as self-regulation, communication, and healthy relationships. For others, additional opportunities to learn coping strategies might be required. Still others may need more specialized services. As a major piece of children’s ecosystems, schools must be intentional in how they support positive mental health. We need to look beyond academic rankings for schools and recognize that successful schools support mental health, both for compassionate reasons and because strong mental health underlies future success.
Canada is often identified as a great place to live on international lists and rankings. However, our performance on children’s mental health is not a source of national pride. Even prior to the pandemic, the last UN report card ranked us 31st out of 38 rich countries on children’s mental health and happiness. We also have one of the highest rates of adolescent suicide. We would not accept such a ranking for our math scores; to score this low in mental health is cause for a significant call to action.
The COVID-19 pandemic has affected every aspect of our lives and routines. Not surprisingly, children and youth are paying the price with decreased well-being. Data collected by SickKids looking at impacts during the second wave found that more than half of 750 kids aged 8–12 reported significant symptoms of depression; 70 percent of adolescents reported significant depression. Furthermore, the pandemic has exposed and amplified the inequities that were there all along. Equity-seeking groups have been harder hit by pandemic impacts, and this includes worse mental health for youth who belong to marginalized groups. The jury is still out on long-term impacts of disruptions related to the pandemic, but there is no question many of the negative impacts will linger.
Before we talk about the central role schools can play in promoting student well-being, I want to clarify what is meant by mental health. All too often, mental health is considered synonymous with mental illness, as if it only exists when there is a problem. Of course, we all have mental health the same way we all have physical health. Thinking about mental health in a deficit-based manner is analogous to saying we only have physical health when we are sick. The Public Health Agency of Canada defines positive mental health as, “the capacity of each and all of us to feel, think, act in ways that enhance our ability to enjoy life and deal with the challenges we face.” Within that definition, we can see there is significant overlap with the role of schools. We need to expand our ideas around what makes a school successful and recognize that one indicator of a successful school or school system is that proper mental-health supports are in place and education is seen as truly being about the development of the whole person.
There are many pragmatic reasons to think about an expanded notion of school mental health. Many skills that underlie positive mental health can be taught, often within a social-emotional learning framework. Promoting facets of mental health, such as self-regulation and optimism, improve learning outcomes. Most children and youth attend school, thus minimizing access barriers. Educators see children daily and are familiar with a wide range of what might be considered normal and healthy in a particular age group; as such, they are well positioned to notice changes.
A tiered mental-health approach
Obviously, teachers are not social workers, nor should they be expected to take on that role. The answer lies in a tiered school mental-health approach, with role clarity at each tier. This tiered approach is often conceptualized as a triangle, and although different names are given to the tiers in different models, the notion of three tiers that represent universal, selected, and targeted intervention is widely understood in any comprehensive public health approach.
TIER 1 is where universal prevention or promotion happens. It can include everyday practices that create welcoming spaces for all students. At Tier 1, educators can introduce social-emotional learning concepts in short activities and reinforce them during teachable moments. There are also excellent programs that are effective in promoting well-being and align well with curricular expectations.
Over the past five years, my team has partnered with the London District Catholic School Board to implement and evaluate a program called MindUP. In our research with students with 580 students in 42 kindergarten classrooms, we found that students in MindUP classrooms experienced significant benefits. Problematic behaviours were reduced (Crooks, Bax et al., 2020). Their prosocial behaviours and executive functioning showed gains, suggesting that new and mental-health promoting skills were being developed. This project shows how mental health promotion can lead to much wider benefits than simply less depressed children. Improvements in executive functioning could be expected to translate to improved academic performance – a contention we were in the process of investigating when COVID hit and ended our research!
Furthermore, educators reported decreased burnout and an increased sense of personal efficacy (Kim et al., 2021). They talked about creating calmer classrooms that in turn led to a greater sense of personal well-being. By implementing a program that was aligned with curriculum and board priorities, this initiative reduced educator stress rather than leading to work intensification.
“I’ve become a lot more mindful as a teacher. You always recognize those kids who have difficulty, but there’s a whole different perspective now… as to how we look at children and how we deal with them.” – MindUP educator
TIER 2 is where students who may be considered vulnerable can be offered additional support. The source of this vulnerability may not be the individual child at all; effective programming at this level for identified equity-seeking groups might help buffer against experiences of discrimination or past trauma. Tier 2 work is often implemented by mental-health professionals, but educators still have an important role in identifying students who would benefit and supporting their involvement. We have developed or evaluated several programs through our intervention research over the past 15 years.
For example, our Uniting Our Nations mentoring program for Indigenous students promotes healthy relationship skills and coping, within a cultural framework. In the elementary school version, students meet weekly in groups with an adult mentor. The secondary school version uses student mentors and mentees who are also guided by an adult mentor. Our longitudinal evaluation found that students who were involved for two years had increased positive mental health, were more culturally connected, and achieved better credit accumulation than their peers (Crooks et al., 2017). This is an important study because it counters the prevailing notion that focusing on social and emotional well-being and cultural connectedness somehow competes with academic achievement. In this study, the opposite was true. By focusing on social and emotional well-being with an identity-affirming approach, students were able to shine with their academics.
Mentors are showing other kids that you can succeed and still be First Nations. That’s the key; it’s showing kids they don’t have to lose who they are in order to be successful. We are not asking you to assimilate or give up everything to succeed. We know that you can keep connected to your culture and succeed. – Indigenous educator
Supporting Transition Resilience of Newcomer Groups (STRONG) is a small-group resiliency-enhancing intervention for newcomer students who are struggling with some aspect of their adjustment. STRONG brings together groups of six to ten students with a clinician (and often a co-facilitator, who may be an educator) to teach youth resilience skills such as relaxation, coping, problem-solving skills, and goal setting. In addition to the individual skill development, youth benefit from the relationships they develop with other participants, and a decreased sense of being alone. Preliminary evidence suggests that STRONG increases coping strategies, connectedness, and resilience (Crooks, Kubyshin, et al., 2020).
HRP for 2SLGBTQA+ Youth is a group-based intervention for secondary school students who identify as gender, romantic, and sexual minority youth (and their allies). It was designed to be facilitated by educators in schools in the context of gender sexuality alliances (GSAs). The program includes key relationship skills and coping strategies appropriate for all youth, but has an expanded focus on being identity affirming and addressing stressors that are more specific to 2SLGBTQIA+ youth. Our focus groups with youth and educators suggest that students enjoy the program and benefit from the skills they learn, as well as the connections they make to others (Lapointe & Crooks, 2018).
Clearly, having effective programs for equity-seeking groups does not reduce the need to fight racism, colonialism, and homophobia on a larger societal level, but these strengths-based programs can help students develop important skills and strategies while also developing a sense of community.
TIER 3 refers to the domain where students’ mental health needs are of sufficient severity and complexity to require specialized services. Within a comprehensive school mental health model, the vision is for schools to hand over the care of students to qualified mental health professionals in the community at this point, while staying involved as part of the circle of supports for the student. In reality, there is a significant shortage of mental health resources in the community and schools are often left trying to support students with Tier 3 needs. Some boards are even exploring taking on this work more intentionally, in the face of the shortage of referral options.
The three tiers of a comprehensive school mental health approach are not isolated, and students may need different levels of support at different times. Also, referring to this integrated and comprehensive approach as school mental health does not let those beyond the school setting off the hook – we all have a role to play in promoting well-being for children and youth.
Steps to school mental health
So, what do we need to advance the vision of comprehensive school mental health in every school in Canada? We need to move beyond piecemeal initiatives and create a comprehensive and coordinated strategy. Organizations such as the pan-Canadian Joint Consortium for School Health (www.jcsh-cces.ca) can facilitate the sharing of effective practices across jurisdictions. This work cannot be achieved on the backs of individual educator and administrator champions. We need all the implicated government ministries to commit to this work and provide the appropriate resources.
What would a co-ordinated, comprehensive approach include?
- Preservice education programs to ensure that educators are launched into the profession with a toolkit to recognize and respond to mental health challenges. Currently, few universities offer dedicated classes in mental health. Furthermore, many early career educators leave the profession due to challenges related to the mental health and behaviour of the students. Very few educators leave because they can’t figure out the math curriculum!
- Commitment to implementation science principles that move us beyond a train-and-hope approach to new initiatives. Educators and school-based clinicians require high-quality training, but training alone is not sufficient. Implementation science identifies the importance of coaching, communities of practice, and consultation (as examples) for a new initiative to be implemented with high quality and lead to sustained impact.
- Community-based services that are accessible and can offer service in a timely manner. Often at the point of crisis there is a window of readiness for students and their families to engage with professionals, yet they might be facing waitlists of 6–18 months to receive services. The extent to which services are attuned or linguistically accessible to the wide diversity of Canadian families is another issue altogether. As we build strength in school mental health, policymakers will need to avoid the temptation to reduce other parts of the system (i.e. use funding for community-based mental health to bolster school mental health).
- Effective programs (especially in Tiers 2 and 3) that have been developed and tested in a Canadian context to provide educators and administrators with evidence-informed options. Our School Mental Health Ontario Innovation and Scale Up Lab (www.csmh.uwo.ca/smho-lab/index.html) works at this intersection of evidence-based and implementation-sensitive to identify and test approaches that meet the needs of educators.
- Attention to educator and administrator well-being. Promoting educator well-being is important for preventing burnout, but beyond the impact on educators there is also a clear impact for students. Stress is contagious, and research has shown that educator stress can be reflected in neurobiological markers of stress among their students. It is difficult for educators to model and promote well-being and social and emotional competencies if they are struggling in these areas themselves.
Finally, we need to remember that schools are embedded in and reflect larger societal values and dynamics. As Canada continues to navigate reconciliation and attend to systemic racism, we need to think critically about how school mental health initiatives can be aligned with these movements and not reinforce negative systemic influences.
First published in Education Canada, March 2022
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For two-page summaries of the research mentioned in this article, see “Research Snapshots” at: www.csmh.uwo.ca/research
Crooks, C. V, Bax, K., et al. (2020). Impact of MindUP among young children: Improvements in behavioral problems, adaptive skills, and executive functioning. Mindfulness, 11(10), 2433–2444. doi.org/10.1007/s12671-020-01460-0.
Crooks, C. V., Exner-Cortens, D., et al. (2017). Two years of relationship-focused mentoring for First Nations, Métis, and Inuit adolescents: Promoting positive mental health. The Journal of Primary Prevention, 38. doi.org/10.1007/s10935-016-0457-0.
Crooks, C. V., Kubishyn, N., et al. (2020). The STRONG Resiliency program for newcomer youth: A mixed-methods exploration of youth experiences and impacts. International Journal of School Social Work, 5(2). doi.org/10.4148/2161-4148.1059.
Kim, S., Crooks, C. V., Bax, K., & Shokoohi, M. (2021). Impact of trauma-informed training and mindfulness-based social–emotional learning program on teacher attitudes and burnout: A mixed-methods study. School Mental Health, 13(1), 55-68.
Lapointe, A., & Crooks, C. (2018). GSA members’ experiences with a structured program to promote well-being. Journal of LGBT Youth, 15(4), 300–318. doi.org/10.1080/19361653.2018.1479672.